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Although complete tumor resection is accepted as the best means to reduce recurrence, reoperations after lumpectomy are a common problem in breast cancer. The aim of this study was to assess the reoperation rates after primary breast conserving surgery in invasive breast cancer cases diagnosed in Catalonia, Spain, between 2005 and 2011 and to identify variations based on patient and tumour characteristics. Women with invasive incident breast cancer identified from the Patient’s Hospital Discharge Database [174.0–174.9 codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as the primary diagnosis] and receiving primary breast conserving surgery were included in the study and were followed up to 3 and 12 months by collecting information about repeat breast cancer surgery. Reoperation rates after primary breast conserving surgery decreased from 13.0 % in 2005 to 11.7 % in 2011 at 3 months and from 14.2 % in 2005 to 12.9 % in 2011 at 12 months’ follow-up. While breast conservation reoperations saw a slight, non-significant increase in the same period (from 5.7 to 7.3 % at 3 months, and from 6.0 to 7.5 % at 12 months), there was a significant decrease in radical reoperation (from 7.3 to 4.4 % at 3 months and from 8.2 to 5.4 % at 12 months). Overall, additional breast surgeries decreased among younger women. Despite the rise of breast conserving surgery, reoperation rates following initial lumpectomy in Catalonia decreased by 10 % at 3 and 12 months’ follow-up, remaining low and almost unchanged. Ultimately, there was also a significant decrease in mastectomies.

Miguel Cainzos-Achirica was funded by a research grant frorn the Spanish Society of Cardiology.

Objectives: Convalescence care strives to achieve functional recovery of individuals, reducing likelihood of institutionalisation or re-hospitalisation. This work assesses the efficacy of convalescence units in Catalonia, and identifies prognostic factors related to functional improvement. Design and setting: Retrospective analysis of information system data for 11,945 stays in convalescence units with admission and discharge within 2009. Measurements: Main outcome is functional improvement, defined as the reduction of the number of dependent activities of daily life (ADL) between admission and discharge. Other outcomes were functional and cognitive status, Resource Utilization Groups III (RUG III) resource use categories, coverage and intensity of therapies, diagnosis, comorbidities and medical procedures. Logistic regression analyses were performed to identify factors related to functional improvement. Results: Functional improvement was reached in 5618 individuals (47.0%). It was more likely in patients admitted from acute care hospitals (49.5%) than for other procedences (41.6%). Less than two thirds of the sample (63.5%) were able to return to their usual residence. Median length of stay was 35 days, and 93% of patients were discharged at three months. Identified negative factors that decreased the likelihood of functional improvement: cognition and alertness outcomes, complexity, RUG III categories, functional status and therapies received. Positive factors were: less than 9 dependent ADL, and intensity of training in walking skills and dressing/grooming. Conclusion: Based on the identified prognostic factors for functional improvement, convalescence unit users may be classified by rehabilitative expectatives according to their diagnosis and degree of functional and cognitive impairment at admission. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Resumen Introduccion Describir la complejidad clinica de los pacientes al ingreso en unidades de larga estancia sociosanitaria en Cataluna entre los anos 2003 y 2009. Material y metodos Analisis transversal de 47.855 ingresos registrados en el sistema de informacion Conjunt Minim Basic de Dades dels Recursos Sociosanitaris. Las variables analizadas fueron agrupaciones diagnosticas, las comorbilidades y los procedimientos medicos, estado funcional y cognitivo, categorias de uso de recursos del Resource Utilization Groups III (RUG-III), la cobertura y la intensidad de la terapias rehabilitadoras. Se realizo un analisis descriptivo de la informacion. Resultados Las agrupaciones diagnosticas mas frecuentes en el periodo de estudio fueron demencia y enfermedad cerebrovascular aguda, que mostraron un descenso continuado (descenso del 8,8 y el 2,3%). El mayor aumento correspondio a ingresos por descanso familiar y fractura (7,7% y 1,9%). El estado funcional y cognitivo promedio se mantuvo estable, aunque aumento el porcentaje de individuos con dependencia en todas las actividades de la vida diaria. Las categorias RUG-III mas frecuentes fueron rehabilitacion, funciones fisicas reducidas, complejidad clinica y cuidados especiales. Durante el periodo estudiado, la categoria «rehabilitacion» se incremento marcadamente (20,3%), mientras las otras categorias disminuyeron. Las terapias rehabilitadoras incrementaron su cobertura durante el periodo (20,8%), especialmente la fisioterapia (25,4%) y la terapia ocupacional (17,4%). Conclusiones La complejidad clinica de la poblacion atendida en unidades de larga estancia aumento en el periodo 2003-2009. El uso de recursos y terapias indican un creciente esfuerzo rehabilitador, como posible respuesta a cambios en la complejidad clinica atendida, los estandares de practica clinica o las practicas establecidas en el registro y notificacion de la informacion.

Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF.This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure.In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF.

To verify the usefulness of the minimum data set (MDS) for acute-care hospitals and emergency resources for the study of road traffic injuries and to describe the use of health resources in Catalonia (Spain).The study population consisted of patients treated in any kind of emergency service and patients admitted for acute hospitalization in Catalonia in 2013. A descriptive analysis was performed by age, gender, time and clinical variables.A total of 48,150 patients were treated in hospital emergency departments, 6,210 were attended in primary care, and 4,912 were admitted to hospital. There was a higher proportion of men (56.2%), mainly aged between 20 and 40 years. Men accounted for 54.9% of patients with minor injuries and 75.1% of those with severe injuries. Contusions are the most common injury (30.2%), followed by sprains (28.7%). Fractures mostly affected persons older than 64 years, internal injuries particularly affected men older than 64 years, and wounds mainly affected persons younger than 18 years and older than 64 years. In the adult population, the severity of the injuries increased with age, leading to longer length of stay and greater complexity. Hospital mortality was 0.2%. Fractures, internal injuries and wounds were more frequent in the group of very serious injuries, and sprains and contusions in the group of minor injuries.MDS records (acute hospitals and emergency resources) provide information that is complementary to other sources of information on traffic accidents, increasing the completeness of the data.

Background Breast cancer (BC) is the most frequent cancer in women, accounting for 28% of all tumors among women in Catalonia (Spain). Mastectomy has been replaced over time by breast-conserving surgery (BCS) although not as rapidly as might be expected. The aim of this study was to assess the evolution of surgical procedures in incident BC cases in Catalonia between 2005 and 2011, and to analyze variations based on patient and hospital characteristics. Methods We processed data from the Catalonian Health Service’s Acute Hospital Discharge database (HDD) using ASEDAT software (Analysis, Selection and Extraction of Tumor Data) to identify all invasive BC incident cases according to the codes 174.0-174.9 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that were attended for the one-year periods in 2005, 2008 and 2011. Patients were classified according to surgical procedures (BCS vs mastectomy, and immediate vs delayed reconstruction), and results were compared among periods according to age, stage, comorbidity and hospital level. Results BC surgical procedures were performed in more than 80% of patients. Surgical cases showed a significant increasing trend in the proportion of women aged 50–69 years, more advanced disease stages, higher comorbidity and they were attended in hospitals of less complexity level throughout the study period. Similar pattern was found for patients treated with BCS, which increased significantly from 67.9% in 2005 to 74.0% in 2011. Simple lymph node removal increased significantly (from 48.8% to 71.4% and from 63.6% to 67.8% for 2005 and 2011 in conservative and radical surgery, respectively). A slightly increase in the proportion of mastectomized young women (from 28% in 2005 to 34% in 2011) was detected, due to multiple factors. About 22% of women underwent post-mastectomy breast reconstruction, this being mostly immediate. Conclusions The use of HDD linked to the ASEDAT allowed us to evaluate BC surgical treatment in Catalonia. A consolidating increasing trend of BCS was observed in women aged 50–69 years, which corresponds with the pattern in most European countries. Among the mastectomized patients, immediate breast reconstructions have risen significantly over the period 2005–2011. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-587) contains supplementary material, which is available to authorized users.

Introduccion La epidemiologia de la insuficiencia cardiaca desde el punto de vista de la morbimortalidad se conoce poco, a pesar del impacto economico que representa por el tratamiento farmacologico cronico y por la frecuente hospitalizacion de los pacientes con esta patologia. Objetivos Analizar las tendencias de la mortalidad por insuficiencia cardiaca en Cataluna durante el periodo 1975-1994, y de la morbilidad por esta misma causa durante el periodo 1989-1994. Pacientes y metodos Se han calculado las tasas especificas por edad (entre 45 y 65, y para mayores de 65 anos) y sexo para la mortalidad y la morbilidad. Ademas, se han calculado las tasas estandarizadas de mortalidad aplicando un ajuste directo y utilizando la poblacion europea como la poblacion de referencia. Resultados La tendencia de la mortalidad por insuficiencia cardiaca en la poblacion entre 45 y 65 anos es estable durante todo el periodo y superior en varones que en mujeres. La tendencia en el grupo de edad por encima de los 65 anos refleja un incremento sustancial a partir del ano 1983, sobre todo en las mujeres. Respecto a la morbilidad (medida esta como las tasas de las altas hospitalarias), se observa un aumento moderado para el grupo de edad entre 45 y 65 anos, mas pronunciado en varones que en mujeres, mientras que para el grupo de edad superior a 65 anos se observa un incremento muy importante, siendo las tasas casi coincidentes para varones y mujeres. Conclusiones La tendencia de la mortalidad por insuficiencia cardiaca es estable en el grupo entre 45 y 65 anos, mientras que es ascendente en los mayores de 65 anos, sobre todo en las mujeres. La tendencia de la morbilidad es claramente ascendente para varones y para mujeres de ambos grupos de edad, aunque superior en los mayores de 65 anos.

This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009.Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission.Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%).The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices.

To evaluate differences in the number of cases of perinatal mortality in Catalonia (Spain) recorded in 2 health information systems, as well as trends in this phenomenon.Data were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics) and the minimum data set (MDS) for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteria for reporting.The mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered.The differences between the two sources were related to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal mortality statistics.

ResumenObjetivoEvaluar la diferencia en muertes perinatales (MP) ocurridas en Cataluña y su evolución según 2 fuentes de información sanitaria.MétodosLos datos proceden de la estadística de mortalidad (Departament de Salut e Institut d’Estadística de Catalunya) y del Conjunto Mínimo Básico de Datos de Altas Hospitalarias (CMBDAH) del Servei Català de la Salut del período 2000-2003. Se describen las frecuencias totales de MP según si cumplen o no criterio legal de declaración.ResultadosLa estadística de mortalidad registró un 27,2% menos de MP, un 44,77% menos de muertes fetales y un 13,5% más de muertes neonatales precoces que el CMBDAH. Estos porcentajes son menores considerando sólo los casos con criterios legales de declaración.ConclusiónLas diferencias de casos entre ambas fuentes están relacionadas con características del recién nacido: bajo peso al nacer, prematuridad y lugar en que se produjo. Los datos hospitalarios podrían mejorar la estadística de mortalidad perinatal.AbstractObjectiveTo evaluate differences in the number of cases of perinatal mortality in Catalonia (Spain) recorded in 2 health information systems, as well as trends in this phenomenon.MethodsData were obtained from the mortality statistics (Health Department and the Catalan Institute of Statistics) and the minimum data set (MDS) for hospital discharges of the Catalan Health Service from 2000-2003. The frequencies are given for the cases reported and for cases following the legal criteria for reporting.ResultsThe mortality statistics registered 27.2% fewer perinatal deaths, 44.77% fewer fetal deaths and 13.5% more early neonatal deaths than the MDS. These percentages were lower when only the cases following the legal criteria for reporting were considered.ConclusionThe differences between the two sources were related to low birth weight, prematurity, and the place of occurrence. Use of hospital data might improve the quality of perinatal mortality statistics.

Fibrilación Atrial; Insuficiencia Cardíaca; Estudio longitudinal Fibril·lació atrial; Insuficiència cardíaca; Estudi longitudinal Atrial Fibrillation; Heart Failure; Longitudinal study BACKGROUND Heart failure (HF) is frequent and its prevalence is increasing. We aimed to evaluate the epidemiologic features of HF patients, the 1-year follow-up outcomes and the independent predictors of those outcomes at a population level. METHODS AND RESULTS Population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on December 31st, 2012. Patients were divided in 3 groups: patients without a previous HF hospitalization, patients with a remote (>1 year) HF hospitalization and patients with a recent (