Search

Background Measures of multimorbidity are often applied to source data, populations or outcomes outside the scope of their original developmental work. As the development of a multimorbidity measure is influenced by the population and outcome used, these influences should be taken into account when selecting a multimorbidity index. The aim of this study was to compare the strength of the association of health-related quality of life (HRQOL) with three multimorbidity indices: the Cumulative Illness Rating Scale (CIRS), the Charlson index (Charlson) and the Functional Comorbidity Index (FCI). The first two indices were not developed in light of HRQOL. Methods We used data on chronic diseases and on the SF-36 questionnaire assessing HRQOL of 238 adult primary care patients who participated in a previous study. We extracted all the diagnoses for every patient from chart review to score the CIRS, the FCI and the Charlson. Data for potential confounders (age, sex, self-perceived economic status and self-perceived social support) were also collected. We calculated the Pearson correlation coefficients (r) of the SF-36 scores with the three measures of multimorbidity, as well as the coefficient of determination, R2, while controlling for confounders. Results The r values for the CIRS (range: -0.55 to -0.18) were always higher than those for the FCI (-0.47 to -0.10) and Charlson (-0.31 to -0.04) indices. The CIRS explained the highest percent of variation in all scores of the SF-36, except for the Mental Component Summary Score where the variation was not significant. Variations explained by the FCI were significant in all scores of SF-36 measuring physical health and in two scales evaluating mental health. Variations explained by the Charlson were significant in only three scores measuring physical health. Conclusion The CIRS is a better choice as a measure of multimorbidity than the FCI and the Charlson when HRQOL is the outcome of interest. However, the FCI may provide a good option to evaluate the physical aspect of HRQOL for the ease in its administration and scoring. The Charlson index may not be recommended as a measure of multimorbidity in studies related to either physical or mental aspects of HRQOL.

Background Uncertainty regarding comorbid illness, and ability to tolerate aggressive therapy has led to minimal enrollment of elderly cancer patients into clinical trials and often substandard treatment. Increasingly, comorbid illness scales have proven useful in identifying subgroups of elderly patients who are more likely to tolerate and benefit from aggressive therapy. Unfortunately, the use of such scales has yet to be widely integrated into either clinical practice or clinical trials research. Methods This article reviews evidence for the validity of the Charlson Comorbidity Index (CCI) in oncology and provides a Microsoft Excel (MS Excel) Macro for the rapid and accurate calculation of CCI score. The interaction of comorbidity and malignant disease and the validation of the Charlson Index in oncology are discussed. Results The CCI score is based on one year mortality data from internal medicine patients admitted to an inpatient setting and is the most widely used comorbidity index in oncology. An MS Excel Macro file was constructed for calculating the CCI score using Microsoft Visual Basic. The Macro is provided for download and dissemination. The CCI has been widely used and validated throughout the oncology literature and has demonstrated utility for most major cancers. The MS Excel CCI Macro provides a rapid method for calculating CCI score with or without age adjustments. The calculator removes difficulty in score calculation as a limitation for integration of the CCI into clinical research. The simple nature of the MS Excel CCI Macro and the CCI itself makes it ideal for integration into emerging electronic medical records systems. Conclusions The increasing elderly population and concurrent increase in oncologic disease has made understanding the interaction between age and comorbid illness on life expectancy increasingly important. The MS Excel CCI Macro provides a means of increasing the use of the CCI scale in clinical research with the ultimate goal of improving determination of optimal treatments for elderly cancer patients.

Background and Purpose— The Charlson Index is commonly used in outcome studies to adjust for patient comorbid conditions, but has not been specifically validated for use in studies of ischemic stroke. The purpose of the present study was to determine whether outcomes of ischemic stroke patients varied on the basis of the Charlson Index. Methods— The Department of Veterans Affairs (VA) Stroke Study prospectively identified stroke patients admitted to 9 VA hospitals between April 1995 and March 1997. The Charlson Index was scored on the basis of discharge International Classification of Diseases, 9th Revision, Clinical Modification coding and dichotomized (low comorbidity 0 or 1 versus high ≥2) for analysis. Validity was assessed on the basis of modified Rankin score at hospital discharge (good outcome 0 or 1 versus poor ≥2 or dead) and 1-year mortality, adjusting for initial stroke severity. Results— Of the 960 enrolled ischemic stroke patients, 23% had a Charlson Index of 0, 34% 1, 22% 2, 12% 3, and 8% ≥4. Forty-eight percent of those with a low Charlson Index had a good outcome at discharge versus 37% of those with a high Charlson Index ( P P P =0.038) and 72% greater odds of death at 1 year ( P =0.001). Every 1-point increase in Charlson Index was independently associated with a 15% increase in the odds of a poor outcome at discharge ( P P Conclusions— These data support the validity of the Charlson Index as a measure of comorbidity for use in ischemic stroke outcome studies.

Objective: To describe the incidence and epidemiological characteristics of hip fracture (HF) in patients aged 65 years or over in the various autonomous regions (AR) of Spain from the year 2000 to 2002 and to determine which factors affect in-hospital mortality. Methods: Retrospective, observational study including all patients aged N65 years with acute hip fracture in the 19 AR of Spain from 2000 to 2002. Data were obtained from the National Record of the Minimum Basic Data Set of the Ministry of Health. We analyzed the following: incidence rates (crude and age- and gender-adjusted rates) and incidence of hospital admission by season, length of hospital stay and in-hospital mortality. We used regression analysis to identify the factors that influenced in-hospital mortality. Results: There were 107,718 cases of HF in patients aged N65 years; of these, 74% were women, with a mean age of 79 years (SD 14). The crude incidence rate for HF was 511 cases per 100,000 N65-year-old patients per year (265 cases per 100,000 men and 688 per 100,000 women and year). Incidence adjusted for age and gender was 503 cases per 100,000 inhabitants per year. Catalonia had the highest age-adjusted incidence and Galicia the lowest (623 and 317 cases per 100,000 inhabitants per year, respectively). Incidence rates increased from spring (24.1%) to winter (25.8%). The mean length of hospital stay was 15 days (SD 13). Seasonal influence and length of stay varied greatly between autonomous regions. While the overall in-hospital mortality rate was 5.3%, the rate for males was double that of females (8.9% and 4.8%, respectively), and in-hospital mortality increased with comorbidity (each point on the Charlson index increased mortality by 34.5%) was higher in winter (11% more risk compared to warmer seasons) and in cold climate regions (15% more risk compared to regions with a warm climate, i.e.: Catalonia, Valencia, Murcia, Andalusia, Balearic Islands and Canary Islands). Conclusions: Hip fracture mainly affects elderly women and presents great variability in incidence, seasonality, length of hospital stay and mortality between the different autonomous regions in Spain. Elderly male patients with severe comorbid conditions, who are admitted in winter and in cold climate regions are more at risk of in-hospital mortality.

E-mail: antonella.cherubini@ass1.sanita.fvg.it Background: From the literature we know that less than 50% of patients with coronary artery disease (CAD) reaches the target LDL cholesterol 75 yo 42% vs 46%, p=0,002), had more cardiovascular (CV) risk factors, comorbidities (Charlson index >5) and statins prescription (70% vs 61%), but less frequent stroke or TIA. In the group with LDL available, CARDIOVASCULAR PREVENTION and REHABILITATION

Background The problem of overprescribing and failure to provide appropriate medicines in elderly people has been associated with hospitalisation. Purpose To analyse Inappropriate Prescribing (IP) and Prescribing Omissions (PO) in elderly patients in an attempt to find a link with said patients’ hospitalisation. Materials and methods Retrospective observational study from June to August 2013 with patients admitted to the Internal Medicine Unit in a tertiary hospital. We included patients ≥65 with at least four medicines in their home treatment. We used the STOPP/START criteria to detect IP/PO and compared them to the hospital’s diagnosis. We analysed IP/PO resolved after the hospitalisation process (treatment prescribed at discharge). Exclusion criteria: patients transferred to other units and patients who died. Data collected: sex, age, high comorbidity (Charlson Index ≥2), home treatment, diagnosis, hospitalisation duration, STOPP/START criteria. Results 93 patients were included: 52% male, 48% female; Average age was 79 (range = 66–92), 100% high comorbidity; average of 9 medicines (range = 3–17) prescribed per patient; average of 7 days’ (range = 1–27) hospitalisation. We identified 34 IP and 72 PO in 62% of patients (1.8 criteria/ patient). 71% of criteria related to the diagnosis and 21% of criteria unrelated to the diagnosis were solved after the hospitalisation process. Table 1 lists the IP or OP related to the diagnosis, found in 21 patients (26%). Conclusions Most under- or overprescribing related to the reason for admission was detected and solved, but the rest is often unnoticed and continues unresolved in the treatment prescribed at discharge. STOPP/START criteria should be incorporated into primary care practice to improve prescription accuracy in older people and prevent morbidities. No conflict of interest.

OBJECTIVES To analyze the clinical characteristics, grade of physical and cognitive dependence and social coverage of patients of 64 years who are admitted to and Internal Medicine Service. DESIGN AND METHODS A total of 105 patients (63 females, 42 males) older than 64 years admitted over 2 months in a General Internal Medicine Unit of a tertiary University Hospital were studied. RESULTS Fifty nine patients (56%) were 80 years or older. Pulmonary, cardiac and gastrointestinal problems were the main reasons for admission. A total of 80% of patients had comorbid conditions with a Charlson index of 2.7 +/- 1.4. Mean Barthel index before admission was 71+/-35. More than one third of the patients had cognitive impairment (MMSE

Results.– Despite high number of diseases (mean Charlson index 1.7; mean number of drugs 6.5), most participants were active and had good psychological well-being (PWB>0.80). Of participants, 73% reported a hobby related to regular physical activity and 46% other social hobbies. However, numerous abnormalities were found in assessments and tests. Altogether 64% of participants’ were sent to further interventions: 35% were sent to further diagnostic tests, 15% to blood pressure follow-ups, 13% to further cognitive tests, 9% were admitted to specialists, 7% to physiotherapists, 5% to oral check-ups and 9% received physicians’ medical certificates for economical or social advantages. Conclusions.– Systematic health check-ups among 75and 80year-olds reveal that although older people feel well, they have potential for preventive interventions. Systematic, multidimensional preventive health check-ups among 75and 80-year-olds led to multiple interventions.

Objectives To study the development of impairment, disability, radiological damage, comorbidity and mortality over 20 years in a cohort followed prospectively from diagnosis. Methods 183 RA patients diagnosed between 1985 and 1989 were prospectively monitored according to a standardised protocol over 20 years. Treatments followed clinical practice. There were 115 (63%) women, mean (SD) age was 51 (12) years and symptom duration before inclusion was 11 (7) months. Impairment was measured by signals of functional impairment (SOFI), a 3-parts performance based index measuring hand, arm and leg function, disability by health assessment questionnaire (HAQ), joint damage by Larsen score of radiographs of hands and feet, comorbidity by Charlson Comorbidity Index (17 diagnoses each weighted by mortality risk). Comorbidity was ascertained by scrutinizing medical records which are linked to national census registers to ascertain vital status. Due to mortality, both per protocol and last observation carried forward (LOCF) techniques were used. LOCF was used from baseline for comorbity, and from 10 years for the other variables. Data are given as means and 95% CI. Results Impairment had a linear progression over the whole study period while disability progressed year 2-10 and then stabilised. Disease activity decreased year 1 and 2 and remained stable thereafter. Radiological damage progressed more rapidly year 1-5 and then gradually showed diminished progression rate. LOCF analyses did not change these analyses to any significant degree. Comorbidity increased the first 10 years but then stabilised in the per protocol analysis, but showed a steady increase over 20 years when using LOCF technique. Conclusions Impairment measured by SOFI is much more progressive in RA over 20 years in this cohort diagnosed in the late 1980ies, compared to disability measured by HAQ where progression levelled off after 10 years. Radiographic damage increased most rapidly during the first 5 years. Disease activity was high in the beginning but stabilised after 2 years. Comorbidity measured by Charlson index showed a linear progression over time when using LOCF but not when using per protocol analyses. None of the other variables seemed sensitive to mortality as LOCF did not markedly change the results. Disclosure of Interest None Declared

PSY31 TRANSFUSIONS IN PATIENTS WHO UNDERWENT OPEN SPINE FUSION VERSUS MINIMALLY INVASIVE SPINE FUSION BASED ON A PREMIER PERSPECTIVE® DATABASE SAMPLE Mohandas A DePuy Synthes Spine, Raynham, MA, USA OBJECTIVES: Transfusions are linked to adverse outcomes such as mortality, post-operative morbidity and increased costs. Patients who have undergone open spine surgery can experience high volume of blood loss and require transfusions due to the extensive muscle dissection associated with the procedure. Recently, there has been a focus on minimally invasive spine surgery techniques (MIS) that can minimize the exposure of tissue during spine surgery, which has resulted in the reduction of blood loss and related transfusions. METHODS: This retrospective study utilized the Premier Perspective® database to compare costs of transfusion between patients who underwent 1-2 level MIS posterior lumbar interbody fusion (n=727) and open spine fusion (n=727) matched based on age and gender. A regression model was used to assess the impact of factors that affected the likelihood of transfusion. RESULTS: Patients who underwent MIS surgery had significantly fewer transfusions of perioperative autologous blood (1.8% vs. 6.2%), packed cells (5% vs. 10%) and platelets (0% vs. 0.6%) when compared to open fusion (p

Background The use of multiple medications and/or the administration of more medications that are clinically indicated, representing unnecessary drug use (polypharmacy) increases the risk of non-adherence, adverse drug reaction and drug interaction. These problems are specially common and relevant in older hospitalised patients. Purpose Analyse the prevalence of polypharmacy at hospital admission and at hospital discharge in a group of older patients, and how the hospital stay modifies this prevalence. Materials and methods Patients enrolled in our retrospective study were hospitalised at the Internal Medicine Department during October 2010. Only Patients ³ 75 years old were enrolled. Polypharmacy was defined as the concomitant use of five or more medications and high-level polypharmacy was defined as concomitant use of ten or more medications. The following data were recorded for each patient: sociodemographic details, functional status, Charlson co-morbidity index (predicts the ten-year mortality for a patient who may have a range of co-morbid conditions), diagnoses at discharge, and treatments at hospital admission and discharge. Results Of the 109 patients enrolled, 61 were women. The average age was 82,69±5,15 years. At admission, 29,4% of patients were independents. The average of Charlson index was 4,62±2,3. On average, the patients studied were taking 9,01±4,01 drugs at the time of hospital admission and 9,84±3,83 drugs at discharge. Hospitalisation led to a significant increase in the number medications (p=0,001). Polypharmacy on admission and at discharge was observed in 87,2% and 91,8% of patients, respectively; and 42,2% were taking ten or more different drugs at admission and 53,2% at discharge, existing statistically significant difference between high-level polypharmacy at admission and discharge (p=0,036). Conclusions Our study confirmed a relatively high prevalence of polypharmacy in older hospitalised patients at the Internal Medicine Department. Hospitalisation led to a significant increase in the number of medications and in the prevalence of the high-level polypharmacy. The high prevalence of polypharmacy in elderly patients shows the need to reevaluate the pharmacotherapy during hospital stay.

Background To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain. Methods We selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends. Results 32, 280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01). The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire period The crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008. After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively). Conclusions The crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.

To date, clinico-physiologic indices have not been compared with quantitative CT imaging indices in determining the risk of chronic obstructive pulmonary disease (COPD) exacerbation. We therefore compared clinico-physiologic and CT imaging indices as risk factors for COPD exacerbation in patients with COPD. We retrospectively analyzed 260 COPD patients from pulmonary clinics at 11 hospitals in Korea from June 2005 to November 2009 and followed-up for at least one year. At the time of enrollment, none of these patients had COPD exacerbations for at least 2 months. All underwent clinico-physiologic and radiological evaluation for risk factors of COPD exacerbation. After 1 yr, 106 of the 260 patients had at least one exacerbation of COPD. Multiple logistic regression analysis showed that old age, high Charlson Index, and low FEV(1) were significant in a clinico-physiologic model, with C-statistics of 0.69, and that increased age and emphysema index were significant in a radiologic model, with C-statistics of 0.64. The difference between the two models was statistically significant (P = 0.04 by bootstrap analysis). Combinations of clinico-physiologic risk factors may be better than those of imaging risk factors in predicting COPD exacerbation.

Comorbidities are coexisting diseases that are distinct from the primary illness for which a patient seeks health care services 1. Comorbidity may affect detection, prognosis, therapy, and outcome of the primary disease. We recently published a paper evaluating the role of comorbidities in the survival of patients with myelodysplastic syndromes, in which Charlson index was utilized as the measure of comorbidities 2. Charlson et al. developed a weighted index measure of comorbidities based on medical records review and identified a total of 19 conditions that influence mortality 3. Both the number and the seriousness of comorbid conditions were taken into account. Each of the 19 conditions was assigned a weight (0 - 6) according to its potential for influencing mortality. A patient's comorbidity index would be the sum of all weighted comorbidities. A higher score on the Charlson index indicates a greater burden of comorbid conditions. Later, Deyo et al. adapted the Charlson index for use with the ICD-9-CM diagnostic and procedure codes available in administrative datasets 4. Researchers at the National Cancer Institute subsequently developed a SAS macro to calculate Charlson index for linked SEER*Medicare data (http://healthservices.cancer.gov/seermedicare/program/comorbidity.html). We adopted this method to calculate Charlson index for the more than 2,000 patients included in our study.

The aim of this study was to describe the characteristics of HAIE and to establish a comparison between health care and community-acquired episodes. HAIE was defined as either IE manifesting >48 hours after admission to the hospital or IE acquired in association with a significant invasive procedure performed during a stay and/or manipulation in a hospital setting within 6 months before diagnosis. Results: HAIE accounted for 16% of 793 cases. Compared with community-acquired infection, patients with HAIE tended to be older (60.1 vs. 53.6; P= 0.0001) and had more co-morbidities (Charlson index, 3.3 vs. 1.8; P= 0.0001) and staphylococcal infections (58.3% vs. 24.8%). Intra-hospital mortality (44.9 vs. 24.2%) was higher in the HAIE group. Vascular manipulation constituted the main cause of bacteremia responsible for HAIE (63%). Septic shock (OR, 10.13; 95% CI, 3.18 32.12; P= 0.0001) and severe heart failure (OR, 2.79; 95% CI, 1.09 7.13; P= 0.03) were independent predictors of intrahospital mortality in the HAIE cohort. Conclusions: The present study demonstrates that HAIE attacks a fragile population and it is principally caused by microorganisms strongly related to vascular manipulations. Extremely careful management of vascular accesses is needed in order to minimize the risk of secondary bacteraemias.

e20500 Background: Despite recent therapeutic advances, PNA remains a significant source of morbidity and mortality among CLL pts. We determined population-level estimates for the incidence and outcome of PNA hospitalizations. We further investigated secular trends in care by comparing cohorts before (1994) and after (2004) the widespread use of multiagent chemoimmunotherapy. Methods: Using data from the U.S. Nationwide Inpatient Sample and ICD-9CM diagnosis codes, we identified all non-governmental hospitalizations of CLL pts for a primary dx of PNA in calendar years 1994 and 2004. Admissions were described by pt demographics (age, gender, race) and comorbidity (Charlson index, presence of chronic lung disease). Ten-year prevalence estimates for CLL were obtained from NCI SEER data and used as denominators in incidence calculations. Outcomes studied included need for intubation, in-hospital mortality, and length of stay (LOS). All analyses were sample weighted. Estimates and 95% confidence limits are reported. Results: PNA was the primary dx for 7316 (13.1%) and 7651 (11.2%) CLL pt admissions in 1994 and 2004, respectively. Incidence of PNA admission was similar in 1994 (140/per 1000 pts, 95%CI 130–151) and 2004 (129/per 1000 pts, 95%CI 119–138). CLL pts admitted in 2004 were older (75.7 v. 74.2 years, p No significant financial relationships to disclose.

Methods: The Medicare 5% national sample database was employed to identify and continuously follow TJA patients between 1997-2006. ICD9 and CPT4 procedure codes were used to identify primary TJA patients. Patients less than 65 years old and HMO enrollees were excluded. Deep infections were identified with the 996.66 ICD9 code. Kaplan-Meier survivorship curves were compiled with PJI and revision as endpoints, and adjusted for comorbidities using the Charlson index. Cox and logistic regression were used to evaluate patient and hospital characteristics.

20679 Background: Aging is a process different from person to person, which is influenced by several factors. Comprehensive Geriatric Assessment (CGA) should lead to a more scientific approach to the elderly cancer patient, aimed to the identification and sometimes treatment of oncological and medical problems. Methods: We have ideated GONG model for CGA with the purpose of selecting patients eligible for oncological treatment or supportive care only, and then used it to evaluate 351 patients from April 2004 to 0ctober 2007. Results: Their mean age was 76.4 years old (22.81% were older than 80), male/female ratio was 1.2. Distinguish three categories of patients: frail; border-line (frail patients with a good functional status but Charlson Index > 8, or a bad functional status with a low Charlson score); and not frail. Our evaluation included also nutritional, psychological and cognitive assessment. 39 patients were classified as frail (11.11%), 77 as border-line (21.94%), 235 as not frail (66.9%). In the...

METHODS: A retrospective study of adrenalectomy patients was performed using 5 years of National Inpatient Sample file (19992003). We included patients with ICD-9 procedure codes for partial, unilateral and bilateral adrenalectomy. Outcome variables included in-hospital mortality, length of stay (LOS), and transfusion requirement. Major independent variables were teaching status of the hospital and caseload. Other independent variables included age, gender, and disease severity as measured by Charlson index.

Objectives Adjustment for morbidity is important to ensure fair comparison of outcomes between patient groups and health care providers. The Quality and Outcomes Framework (QOF) in UK primary care offers potential for developing a standardized morbidity score for low-risk populations. Study Design and Setting Retrospective cohort study of 653,780 patients aged 60 years or older registered with 375 practices in 2008 in a large primary care database (The Health Improvement Network). Half the practices were randomly selected to derive a morbidity score predicting 1-year mortality; the others assessed predictive performance. Results Nine chronic conditions were robust copredictors (hazard ratio=≥1.2) of mortality independent of age and sex, producing high predictive discrimination ( c -statistic=0.82). An individual's QOF score explained more between practice variation in mortality than the Charlson index (46% vs. 32%). At practice level, mean QOF score was strongly correlated with practice standardized mortality ratios ( r =0.64), explaining more variation in practice death rates than the Charlson index. Conclusion A simple nine-item score derived from routine primary care recording provides a morbidity index highly predictive of mortality and between practice variation in older UK primary care populations. This has utility in research and health care outcome monitoring and can be easily implemented in other primary and ambulatory care settings.

Aim: To investigate the influence of a screening program on the short-term outcome of patients undergoing surgery for colorectal cancer. Methods: Between April 2010 and December 2012 patients diagnosed with colorectal cancer via the screening program (n = 80) were compared with patients diagnosed elsewhere (n = 106). Only patients of ≥ 50 and ≤ 69 years of age diagnosed outside the program were selected as controls. The clinical variables included age, sex, American Society of Anesthesiologists (ASA) status, Charlson index, preoperative hemoglobin and serum albumin levels, surgical approach, tumor location and stage, perioperative transfusion and postoperative morbidity. A multivariate analysis was used to identify variables independently associated with outcome. Results: There were no significant differences with regard to age, sex and ASA status. Preoperative hemoglobin (14.1 ± 1.6 g/ dl vs 12.3 ± 2.3 g/dl; p < 0.001) and serum albumin (4.45 ± 0.26 g/dl vs 4.0 ± 0.6 g/dl; p < 0.001) levels were significantly higher in the screening group. The overall morbidity was significantly lower in the screening group (38.8% vs 63.2; p < 0.001) and mainly related to a higher rate of Clavien-Dindo grade II complications in controls. There were no differences with regard to wound infection, postoperative ileus, anastomotic leakage or reoperations. The median length of hospital stay was shorter in the screening group (6 vs 9 days; p = 0.003). Multivariate analysis showed that diagnosis outside the screening program, type of surgical procedure, open surgery and Charlson index were independent risk factors for postoperative complications. Conclusions: The diagnosis of colorectal cancer via the screening program is associated with a lower rate of postoperative minor complications and a shorter hospital stay.

Resumen Introducción: El tratamiento conservador es una opción de tratamiento en la enfermedad renal crónica. Esta elección es decisión del paciente y/o familia. Objetivo: Analizar el proceso de elección de tratamiento conservador, identificar el perfil de paciente que lo elige, su supervivencia y quien comunica la elección. Material y Método: Estudio observacional, retrospectivo. Se incluyeron pacientes que eligieron tratamiento conservador entre 2010-2017. Los datos se obtuvieron de los registros de enfermería en historia clínica. Se recogieron variables demográficas, supervivencia, Índice de Comorbilidad de Charlson, índice de Barthel y valores de los pacientes utilizando la herramienta Tarjetas de valores. Resultados: Se estudiaron 95 pacientes: 41,05% hombres, edad media 82,36±9 años, 27,37% institucionalizados. La familia comunicó la elección en el 62,11% de los casos. La media del filtrado glomerular al inicio de la información fue 11,53±2,73 ml/min, mediana del Charlson 8 (13-3), Barthel 55 (100-0) puntos. En el proceso de evidenciar valores, la tarjeta más elegida fue “personal sanitario responsable del tratamiento”. La supervivencia media fue 496,19 días±553,8. Viven menos los hombres y los institucionalizados, sin diferencia significativa. El riesgo de muerte es mayor, al aumentar el Charlson y disminuir el filtrado glomerular (p=0,01). La familia comunicó la elección de seguir tratamiento conservador en el 62,11% de los casos. Conclusiones: El paciente que opta por tratamiento conservador es, una persona anciana, dependiente, con comorbilidades, supervivencia media en torno a 18 meses y en más de la mitad de los casos es la familia quien comunica la decisión de optar por ese tratamiento.

Introduction: Patient safety includes monitoring, analysis, and proposed actions for the prevention of reportable events with unwanted effects (REUE). Objective: To estimate the incidence, preventability, severity, and contributing factors of REUEs in patients admitted to the surgery service. Materials and methods: Prospective cohort study in patients with at least 12hours of hospitalization in the surgical services of a university hospital in Bogotá, Colombia. Random sampling was used and the sample size was 200 subjects. Sociodemographic and baseline clinical variables were evaluated. We estimated the presence of REUE detection events, their preventability and severity. The analysis of the contributing factors was done using the London protocol. Results: A total of 106 women (52.47%) and 96 men (47.53%) were included; the median age was 51.93 years (range 18-93); 60% had at least 1 comorbidity measured by the Charlson index and 25.74% had 3 or more. Of the participants, 28.21% presented at least 1 detection event, the incidence of REUEs was 11.8%, and 75% of them were classified as preventable while 75% were serious events. The main contributing factors were: patient-related 58.33%, related to scheduled tasks and clinical context 50.00%, and work team-related factors 37.50%. Conclusion: The incidence, preventability, and severity of REUE are similar to those reported in the literature. The analysis of the contributing factors shows areas that are susceptible to intervention and can be considered as opportunities for improvement. Resumen Introducción: La seguridad del paciente incluye la vigilancia, análisis y la propuesta de acciones para la prevención de eventos reportables con efectos no deseados (EREND). Objetivo: Estimar la incidencia, preventibilidad, severidad y factores contribuyentes de los EREND en pacientes hospitalizados en el servicio de cirugía. Materiales y métodos: Estudio de cohorte prospectiva en pacientes con al menos 12 horas de hospitalización en los servicios quirúrgicos de un hospital universitario en Bogotá, Colombia. Muestreo aleatorio. Tamaño muestral: 200 sujetos. Se evaluaron las variables sociodemográficas y clínicas basales. Se estimó la presencia de eventos de detección, de EREND, si eran prevenibles y su severidad. El análisis de los factores contribuyentes se hizo mediante el protocolo de Londres. Resultados: Se incluyeron 106 mujeres (52.47%) y 96 hombres (47.53%); la edad mediana fue 51.93 años (rango 18-93). El 60% tuvo al menos una comorbilidad medida por el índice de Charlson y el 25.74% tuvo 3 o más. El 28.21% de los participantes presentaron al menos un evento de detección, la incidencia de EREND fue 11.8% y el 75% de estos fueron calificados como prevenibles y 75% fueron eventos serios. Los principales factores contribuyentes fueron: del paciente 58.33%, relacionados con tareas programadas y contexto clínico 50.00% y factores del equipo de trabajo 37.50%. Conclusiones: La incidencia, evitabilidad y severidad de los EREND del estudio se encuentran dentro de las reportadas en la literatura, el análisis los factores contribuyentes presenta elementos que son susceptibles de intervención y pueden ser considerados como oportunidades de mejora.

Background Risk adjustment and mortality prediction in studies of critical care are usually performed using acuity of illness scores, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), which emphasize physiological derangement. Common risk adjustment systems used in administrative datasets, like the Charlson index, are entirely based on the presence of co-morbid illnesses. The purpose of this study was to compare the discriminative ability of the Charlson index to the APACHE II in predicting hospital mortality in adult multisystem ICU patients. Methods This was a population-based cohort design. The study sample consisted of adult (>17 years of age) residents of the Calgary Health Region admitted to a multisystem ICU between April 2002 and March 2004. Clinical data were collected prospectively and linked to hospital outcome data. Multiple regression analyses were used to compare the performance of APACHE II and the Charlson index. Results The Charlson index was a poor predictor of mortality (C = 0.626). There was minimal difference between a baseline model containing age, sex and acute physiology score (C = 0.74) and models containing either chronic health points (C = 0.76) or Charlson index variations (C = 0.75, 0.76, 0.77). No important improvement in prediction occurred when the Charlson index was added to the full APACHE II model (C = 0.808 to C = 0.813). Conclusion The Charlson index does not perform as well as the APACHE II in predicting hospital mortality in ICU patients. However, when acuity of illness scores are unavailable or are not recorded in a standard way, the Charlson index might be considered as an alternative method of risk adjustment and therefore facilitate comparisons between intensive care units.