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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar los costes mediante la medici&#243;n directa&#44; caso a caso&#44; de la infecci&#243;n del sitio quir&#250;rgico en la apendicectom&#237;a y la colectom&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dise&#241;o&#58; estudio de casos y controles con base poblacional&#59; los casos fueron todos los pacientes diagnosticados de infecci&#243;n de sitio quir&#250;rgico tras apendicectom&#237;a o colectom&#237;a en SCIAS-Hospital de Barcelona&#44; y los controles una muestra seleccionada aleatoriamente entre los pacientes no infectados que reun&#237;an caracter&#237;sticas comunes para el apareamiento&#46; Per&#237;odo de estudio&#58; del 1 de enero de 1998 al 31 de diciembre de 1999&#46;</p> <span class="elsevierStyleSectionTitle">Tipos de apareamiento</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">a</span>&#41; individual de pacientes agrupados seg&#250;n el diagn&#243;stico principal&#44; el procedimiento quir&#250;rgico principal&#44; la edad y el sexo&#44; y <span class="elsevierStyleItalic">b</span>&#41; individual de pacientes agrupados seg&#250;n el diagn&#243;stico principal&#44; la edad y el sexo&#44; pero utilizando adem&#225;s para la selecci&#243;n de los controles el diagn&#243;stico secundario&#46;</p> <span class="elsevierStyleSectionTitle">Fuentes de informaci&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">sistema inform&#225;tico de registros e historias cl&#237;nicas en soporte electr&#243;nico&#44; incluyendo los costes registrados en tiempo real&#46;</p> <span class="elsevierStyleSectionTitle">Contabilidad anal&#237;tica</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">programa ADS plus&#174;&#44; que calcul&#243; costes reales &#40;paciente por paciente&#41; a partir de datos como el consumo de farmacia&#44; el material sanitario&#44; las pruebas adicionales de diagn&#243;stico y las estancias generadas&#46; Los costes estructurales se imputaron en la matriz de costes a partir del c&#225;lculo contable y su impacto en los costes directos&#46; Se consider&#243; coste atribuible a la infecci&#243;n al coste incremental o adicional resultante de la diferencia entre casos y controles&#46;</p> <span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">los c&#225;lculos estad&#237;sticos se realizaron mediante el paquete estad&#237;stico SPSS&#44; versi&#243;n 9&#46;0&#46; Se utilizaron pruebas no param&#233;tricas teniendo en cuenta el tama&#241;o de la muestra&#46; Se aplic&#243; el test de Wilcoxon para variables continuas con el fin de comparar la edad&#44; la duraci&#243;n de las intervenciones quir&#250;rgicas&#44; la estancia hospitalaria y los costes&#46; Los resultados se expresaron como media aritm&#233;tica&#46; Se consider&#243; un nivel de significaci&#243;n estad&#237;stica un valor de p &#60; 0&#44;01&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el primer apareamiento se incluyeron 23 casos y 23 controles para los pacientes operados de apendicectom&#237;a&#44; y 20 casos y 20 controles de colectom&#237;a&#46; En el apenapareamiento 2 la muestra fue de 17 pares de casos y controles en apendicectom&#237;a&#44; y 14 pares de casos y controles en colectom&#237;a&#46; La infecci&#243;n comport&#243; un aumento de la estancia media entre 7&#44;7 d&#237;as &#40;apareamiento 1&#41; y 7&#44;3 d&#237;as &#40;apareamiento 2&#41; en apendicectom&#237;a infectada&#44; y entre 17&#44;6 d&#237;as &#40;apareamiento 1&#41; y 15&#44;4 d&#237;as &#40;apareamiento 2&#41; en colectom&#237;a&#46; Los pacientes con infecci&#243;n de apendicectom&#237;a presentaron un coste medio tres veces superior a los no infectados tanto en el apareamiento 1 &#40;2&#46;998&#44;60 frente a 941&#44;89 e&#44; respectivamente&#59; p &#60; 0&#44;0001&#41; como en el apareamiento 2 &#40;2&#46;751&#44;70 frente a 870&#44;81 e&#44; respectivamente&#59; p &#60; 0&#44;0001&#41;&#46; Similar hallazgo se observ&#243; en la colectom&#237;a&#44; tanto en el apareamiento 1 &#40;10&#46;705&#44;34 frente a 2&#46;600&#44;55 e&#44; respectivamente&#59; p &#60; 0&#44;0001&#41; como en el apareamiento 2 &#40;9&#46;081&#44;12 frente a 2&#46;621&#44;39 e&#44; respectivamente&#59; p &#60; 0&#44;0001&#41;&#46; El coste medio atribuible a la infecci&#243;n de sitio quir&#250;rgico oscil&#243; entre 2&#46;056&#44;71 e &#40;apareamiento 1&#41; y 1&#46;880&#44;89 e &#40;apareamiento 2&#41; en el caso de la apendicectom&#237;a&#44; y 8&#46;140&#44;79 e &#40;apareamiento 1&#41; y 6&#46;405&#44;65 e &#40;apareamiento 2&#41; en la colectom&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En las condiciones del estudio&#44; la infecci&#243;n del sitio quir&#250;rgico determina la prolongaci&#243;n de la estancia hospitalaria de m&#225;s de una semana en la apendicectom&#237;a y de m&#225;s de dos en la colectom&#237;a&#44; con un incremento superior al 300&#37; en el coste directo total&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To determine the costs&#44; with the help of direct case to case measurement&#44; of the surgical site infection in apendicectomy and colectomy&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Design&#58; cases and controls study&#44; population-based&#44; in which the cases were all the patients diagnosed of surgical site infection after apendicectomy or colectomy in SCIASHospital de Barcelona&#44; and the controls were a random sample of noninfected patients that presented common characteristics for matching purposes&#46;</p> <span class="elsevierStyleSectionTitle">Study period</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">from January 1&#44; 1998&#44; to December 31&#44; 1999&#46;</p> <span class="elsevierStyleSectionTitle">Types of matching</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">a</span>&#41; individual&#44; patients grouped according to main diagnosis&#44; main surgical procedure&#44; age and gender&#44; and <span class="elsevierStyleItalic">b</span>&#41; patients grouped according to main diagnosis&#44; main surgical procedure&#44; age and gender using in addition&#44; as controls criteria&#44; the number of secondary diagnoses&#46;</p> <span class="elsevierStyleSectionTitle">Data sources</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">computer system with all the registries and clinical histories in electronic support&#44; including the costs registered in real time&#46;</p> <span class="elsevierStyleSectionTitle">Analytical Accounting</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ADS plus&#174; program that calculated the real costs &#40;patient to patient&#41; extracted from real data&#44; such as drugs consumption&#44; medical supplies&#44; additional diagnosis tests and generated stays&#46; The structural costs were imputed in the matrix of costs from the countable calculation and its impact on the direct costs&#46; The cost attributable to the infection was calculated as the additional cost resultant from the difference between cases and controls&#46;</p> <span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">the statistical calculations were made by means of the statistical package SPSS&#44; version 9&#46;0&#46; Nonparametric tests were used considering the sample size&#46; The test of Wilcoxon for continuous variables&#44; with the purpose of comparing age&#44; operations length&#44; hospital stay and costs&#44; was applied&#46; The results were expressed as arithmetic mean&#46; A level of statistical meaning of p &#60; 0&#46;01 was considered&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The first matching included 23 cases and 23 controls for patients operated on apendicectomy and 20 cases and 20 controls for those operated on colectomy&#46; In matching 2&#44; the sample consisted on 17 pairs of cases and controls on apendicectomy and 14 pairs of cases and controls on colectomy&#46; The infection increased the average length of stay between 7&#46;7 days &#40;matching 1&#41; and 7&#46;3 days &#40;matching 2&#41; in cases of infected apendicectomy and between 17&#46;6 days &#40;matching 1&#41; and 15&#46;4 days &#40;matching 2&#41; in cases of infected colectomy&#46; The patients with apendicectomy infection presented an average cost three times higher than the ones not infected&#44; both in matching 1 &#40;2&#44;998&#46;60 versus 941&#46;89 e&#44; respectively&#59; p &#60; 0&#46;0001&#41; and in matching 2 &#40;2&#44;751&#46;70 versus 870&#46;81 e&#44; respectively&#59; p &#60; 0&#46;0001&#41;&#46; Similar findings were observed in colectomy both in matching 1 &#40;10&#44;705&#46;34 versus 2&#44;600&#46;55 e&#44; respectively&#59; p &#60; 0&#46;0001&#41; and in matching 2 &#40;9&#44;081&#46;12 versus 2&#44;621&#46;39 e&#44; respectively&#59; p &#60; 0&#46;0001&#41;&#46; The average cost of surgical site infection oscillated between 2&#44;056&#46;71 e &#40;matching 1&#41; and 1&#44;880&#46;89 e &#40;matching 2&#41; in apendicectomy and between 8&#44;140&#46;79 e &#40;matching 1&#41; and 6&#44;405&#46;65 e &#40;matching 2&#41; in colectomy&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Under the study conditions&#44; the infection of surgical site determines the prolongation of the hospital stay in more than one week in apendicectomy and in more than two in colectomy&#44; with an increase higher than 300&#37; in the total direct cost&#46;</p>"
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Vol. 17. Núm. 3.
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Vol. 17. Núm. 3.
Páginas 218-225 (mayo - junio 2003)
Open Access
Incremento de costes atribuible a la infección quirúrgica de la apendicectomía y colectomía
Increase in costs attributable to surgical infection after appendicectomy and colectomy
Visitas
5075
J. Ríosa, C. Murilloa,
Autor para correspondencia
carles.murillo@cexs.upf.es

Correspondencia: C. Murillo. Centre de Recerca en Economia i Salut (CRES). Departament de Ciències Experimentales i de la Salut. Universitat Pompeu Fabra. (UPF). Ramón Trías Fargas, 25-27. 08025 Barcelona. España
, G. Carrascob, C. Humetb
a Centre de Recerca en Economia i Salut (CRES). Universitat Pompeu Fabra (UPF)
b SCIAS-Hospital de Barcelona. España
Este artículo ha recibido

Under a Creative Commons license
Información del artículo
Resumen
Objetivo

Determinar los costes mediante la medición directa, caso a caso, de la infección del sitio quirúrgico en la apendicectomía y la colectomía.

Métodos

Diseño: estudio de casos y controles con base poblacional; los casos fueron todos los pacientes diagnosticados de infección de sitio quirúrgico tras apendicectomía o colectomía en SCIAS-Hospital de Barcelona, y los controles una muestra seleccionada aleatoriamente entre los pacientes no infectados que reunían características comunes para el apareamiento. Período de estudio: del 1 de enero de 1998 al 31 de diciembre de 1999.

Tipos de apareamiento

a) individual de pacientes agrupados según el diagnóstico principal, el procedimiento quirúrgico principal, la edad y el sexo, y b) individual de pacientes agrupados según el diagnóstico principal, la edad y el sexo, pero utilizando además para la selección de los controles el diagnóstico secundario.

Fuentes de información

sistema informático de registros e historias clínicas en soporte electrónico, incluyendo los costes registrados en tiempo real.

Contabilidad analítica

programa ADS plus®, que calculó costes reales (paciente por paciente) a partir de datos como el consumo de farmacia, el material sanitario, las pruebas adicionales de diagnóstico y las estancias generadas. Los costes estructurales se imputaron en la matriz de costes a partir del cálculo contable y su impacto en los costes directos. Se consideró coste atribuible a la infección al coste incremental o adicional resultante de la diferencia entre casos y controles.

Análisis estadístico

los cálculos estadísticos se realizaron mediante el paquete estadístico SPSS, versión 9.0. Se utilizaron pruebas no paramétricas teniendo en cuenta el tamaño de la muestra. Se aplicó el test de Wilcoxon para variables continuas con el fin de comparar la edad, la duración de las intervenciones quirúrgicas, la estancia hospitalaria y los costes. Los resultados se expresaron como media aritmética. Se consideró un nivel de significación estadística un valor de p < 0,01.

Resultados

En el primer apareamiento se incluyeron 23 casos y 23 controles para los pacientes operados de apendicectomía, y 20 casos y 20 controles de colectomía. En el apenapareamiento 2 la muestra fue de 17 pares de casos y controles en apendicectomía, y 14 pares de casos y controles en colectomía. La infección comportó un aumento de la estancia media entre 7,7 días (apareamiento 1) y 7,3 días (apareamiento 2) en apendicectomía infectada, y entre 17,6 días (apareamiento 1) y 15,4 días (apareamiento 2) en colectomía. Los pacientes con infección de apendicectomía presentaron un coste medio tres veces superior a los no infectados tanto en el apareamiento 1 (2.998,60 frente a 941,89 e, respectivamente; p < 0,0001) como en el apareamiento 2 (2.751,70 frente a 870,81 e, respectivamente; p < 0,0001). Similar hallazgo se observó en la colectomía, tanto en el apareamiento 1 (10.705,34 frente a 2.600,55 e, respectivamente; p < 0,0001) como en el apareamiento 2 (9.081,12 frente a 2.621,39 e, respectivamente; p < 0,0001). El coste medio atribuible a la infección de sitio quirúrgico osciló entre 2.056,71 e (apareamiento 1) y 1.880,89 e (apareamiento 2) en el caso de la apendicectomía, y 8.140,79 e (apareamiento 1) y 6.405,65 e (apareamiento 2) en la colectomía.

Conclusiones

En las condiciones del estudio, la infección del sitio quirúrgico determina la prolongación de la estancia hospitalaria de más de una semana en la apendicectomía y de más de dos en la colectomía, con un incremento superior al 300% en el coste directo total.

Palabras clave:
Infección
Sitio quirúrgico
Diseño de casos y controles
Costes de la infección
Abstract
Objective

To determine the costs, with the help of direct case to case measurement, of the surgical site infection in apendicectomy and colectomy.

Methods

Design: cases and controls study, population-based, in which the cases were all the patients diagnosed of surgical site infection after apendicectomy or colectomy in SCIASHospital de Barcelona, and the controls were a random sample of noninfected patients that presented common characteristics for matching purposes.

Study period

from January 1, 1998, to December 31, 1999.

Types of matching

a) individual, patients grouped according to main diagnosis, main surgical procedure, age and gender, and b) patients grouped according to main diagnosis, main surgical procedure, age and gender using in addition, as controls criteria, the number of secondary diagnoses.

Data sources

computer system with all the registries and clinical histories in electronic support, including the costs registered in real time.

Analytical Accounting

ADS plus® program that calculated the real costs (patient to patient) extracted from real data, such as drugs consumption, medical supplies, additional diagnosis tests and generated stays. The structural costs were imputed in the matrix of costs from the countable calculation and its impact on the direct costs. The cost attributable to the infection was calculated as the additional cost resultant from the difference between cases and controls.

Statistical analysis

the statistical calculations were made by means of the statistical package SPSS, version 9.0. Nonparametric tests were used considering the sample size. The test of Wilcoxon for continuous variables, with the purpose of comparing age, operations length, hospital stay and costs, was applied. The results were expressed as arithmetic mean. A level of statistical meaning of p < 0.01 was considered.

Results

The first matching included 23 cases and 23 controls for patients operated on apendicectomy and 20 cases and 20 controls for those operated on colectomy. In matching 2, the sample consisted on 17 pairs of cases and controls on apendicectomy and 14 pairs of cases and controls on colectomy. The infection increased the average length of stay between 7.7 days (matching 1) and 7.3 days (matching 2) in cases of infected apendicectomy and between 17.6 days (matching 1) and 15.4 days (matching 2) in cases of infected colectomy. The patients with apendicectomy infection presented an average cost three times higher than the ones not infected, both in matching 1 (2,998.60 versus 941.89 e, respectively; p < 0.0001) and in matching 2 (2,751.70 versus 870.81 e, respectively; p < 0.0001). Similar findings were observed in colectomy both in matching 1 (10,705.34 versus 2,600.55 e, respectively; p < 0.0001) and in matching 2 (9,081.12 versus 2,621.39 e, respectively; p < 0.0001). The average cost of surgical site infection oscillated between 2,056.71 e (matching 1) and 1,880.89 e (matching 2) in apendicectomy and between 8,140.79 e (matching 1) and 6,405.65 e (matching 2) in colectomy.

Conclusions

Under the study conditions, the infection of surgical site determines the prolongation of the hospital stay in more than one week in apendicectomy and in more than two in colectomy, with an increase higher than 300% in the total direct cost.

Key words:
Infection
Surgical site
Case-control design
Costs
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