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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La atenci&#243;n de la fractura de cadera ha evolucionado en los &#250;ltimos 30 a&#241;os hacia el desarrollo de modelos asistenciales de corresponsabilidad total entre equipos m&#233;dicos y quir&#250;rgicos&#44; demostrando una reducci&#243;n significativa de las complicaciones intrahospitalarias&#44; la mortalidad y una mejora en los par&#225;metros de gesti&#243;n asistencial<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La fractura de cadera por fragilidad conlleva un riesgo de complicaciones m&#233;dicas durante el ingreso y un deterioro en la capacidad funcional previa<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; La asistencia m&#233;dica debe abordarse de manera multidisciplinar&#44; incluyendo Traumatolog&#237;a&#44; Medicina Interna&#44; Anestesia&#44; Rehabilitaci&#243;n y Trabajo Social<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a>&#46; El objetivo no es otro que mejorar la recuperaci&#243;n funcional&#44; reducir la morbimortalidad intrahospitalaria y promover el retorno del paciente a su domicilio en una situaci&#243;n funcional lo m&#225;s parecida a su estado basal previo<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En una Unidad de Ortogeriatr&#237;a&#44; el traumat&#243;logo toma las decisiones referentes al tratamiento y el seguimiento de la fractura y el internista realiza un control diario del manejo cl&#237;nico desde urgencias&#44; lo cual facilita la recuperaci&#243;n funcional&#44; la planificaci&#243;n individualizada de la continuidad de cuidados&#44; y organiza la derivaci&#243;n al nivel asistencial m&#225;s adecuado<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">8-10</span></a>&#46; El establecimiento de gu&#237;as cl&#237;nicas facilita este cometido&#44; asegurando que el paciente recibe los cuidados est&#225;ndar adecuados en el tiempo apropiado<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las gu&#237;as cl&#237;nicas han demostrado utilidad en la optimizaci&#243;n de la cirug&#237;a&#44; la movilizaci&#243;n precoz&#44; el manejo cl&#237;nico y la planificaci&#243;n del alta<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a>&#46; El modelo de atenci&#243;n multidisciplinar que ofrece una unidad ortogeri&#225;trica no debe ser r&#237;gido ni uniforme<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a>&#46; Lo ideal es que la gu&#237;a se adapte a la realidad de cada hospital<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> y a los recursos disponibles en cada centro<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es evaluar el impacto de la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar del paciente con fractura de cadera&#46; Su aplicaci&#243;n incluye la atenci&#243;n continuada durante las 24 h durante todo el ingreso por el equipo de Medicina Interna&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Presentamos un estudio descriptivo pre y postexposici&#243;n en que se analiz&#243; una cohorte prospectiva de pacientes durante los 12<span class="elsevierStyleHsp" style=""></span>meses posteriores al inicio de aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar&#44; de junio del 2016 a mayo del 2017&#46; Dicha cohorte se compar&#243; con otra cohorte previa de la misma Unidad de Ortogeriatr&#237;a&#44; per&#237;odo de junio del 2015 a mayo del 2016&#46; La recogida de datos de esta cohorte previa tambi&#233;n fue prospectiva&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">&#193;mbito del estudio</span><p id="par0035" class="elsevierStylePara elsevierViewall">La Unidad de Ortogeriatr&#237;a del Consorci Sanitari Integral est&#225; ubicada en el Hospital del Baix Llobregat-Mois&#233;s Broggi&#44; en Sant Joan Desp&#237; &#40;Barcelona&#41;&#46; Es un hospital de segundo nivel que pertenece a la Xarxa d&#8217;Hospitals d&#8217;Utilitzaci&#243; P&#250;blica &#40;XHUP&#41; de Catalu&#241;a&#46; Acoge alumnos en formaci&#243;n especializada de pregrado y de posgrado&#46; Dispone de 300 camas de hospitalizaci&#243;n&#44; Unidad de Hemodi&#225;lisis y 20 camas de Medicina Intensiva&#46; El &#225;rea de influencia son 426&#46;000 habitantes de la zona norte de L&#8217;Hospitalet de Llobregat y Baix Llobregat&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La Unidad de Ortogeriatr&#237;a inici&#243; su actividad en septiembre del 2012&#46; Desde el inicio se estableci&#243; el pase de visita diario de Traumatolog&#237;a y Medicina Interna&#44; con corresponsabilidad compartida&#46; La toma de decisiones y la planificaci&#243;n asistencial se desarrollan en una reuni&#243;n diaria a la que asisten traumat&#243;logo&#44; internista&#44; enfermera cl&#237;nica&#44; trabajador social&#44; anestesista y rehabilitador&#46; En junio del 2016 se inici&#243; la implantaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar de la Unidad de Ortogeriatr&#237;a&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Gu&#237;a cl&#237;nica multidisciplinar</span><p id="par0045" class="elsevierStylePara elsevierViewall">La elaboraci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar aporta 3<span class="elsevierStyleHsp" style=""></span>cambios en la actividad asistencial de la unidad&#46; En primer lugar&#44; supone la protocolizaci&#243;n de los tratamientos y procesos asistenciales desde la llegada del paciente a Urgencias y durante el ingreso&#44; y facilita la unificaci&#243;n de criterios en la pr&#225;ctica asistencial&#46; En segundo lugar&#44; se organiza la atenci&#243;n continuada de estos pacientes durante el ingreso&#44; de manera que el equipo de guardia de Medicina Interna asume la asistencia continuada de los pacientes&#46; Esto incluye laborables&#44; fines de semana y festivos&#44; las 24<span class="elsevierStyleHsp" style=""></span>h del d&#237;a&#46; En tercer lugar&#44; se organiza el seguimiento hasta los 18 meses del alta hospitalaria por parte de Medicina Interna y Geriatr&#237;a&#44; unificando criterios de manejo de la prevenci&#243;n secundaria de fracturas y garantizando la coordinaci&#243;n con la Asistencia Primaria al alta de la consulta&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se puede consultar esta gu&#237;a cl&#237;nica multidisciplinar en el material suplementario &#40;<a class="elsevierStyleCrossRef" href="#sec0070">anexo</a>&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Pacientes</span><p id="par0055" class="elsevierStylePara elsevierViewall">Presentamos el an&#225;lisis descriptivo de los pacientes que ingresaron con fractura de cadera en la Unidad de Ortogeriatr&#237;a del Hospital Mois&#233;s Broggi&#44; en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos de estudio&#46; Los criterios de inclusi&#243;n fueron todos los pacientes con fractura de cadera por fragilidad&#44; diafisaria o distal y periprot&#233;sicas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Variables del estudio</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se recogieron variables de estructura&#44; de proceso y de desenlace del proceso de hospitalizaci&#243;n en la Unidad de Ortogeriatr&#237;a de todos los pacientes ingresados en la Unidad de Ortogeriatr&#237;a de 2015 a 2017&#46; Todas fueron incluidas de manera prospectiva desde el ingreso y se completaron a partir de los informes de alta de los pacientes ingresados en la Unidad de Ortogeriatr&#237;a&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A continuaci&#243;n&#44; se dise&#241;&#243; el estudio descriptivo pre y postintervenci&#243;n comparando 12 meses antes y despu&#233;s de la aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar&#58; per&#237;odo pre-Gu&#237;a &#40;junio del 2015-mayo del 2016&#41; y per&#237;odo post-Gu&#237;a &#40;junio del 2016-mayo del 2017&#41;&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Caracter&#237;sticas basales de los pacientes&#58; edad&#44; sexo&#44; estado civil&#44; nivel de estudios&#44; n&#250;cleo de convivencia&#44; lugar de residencia y existencia de barreras arquitect&#243;nicas en el domicilio&#46; Tipo de fractura&#44; tipo de implante&#44; n&#250;mero de fracturas al ingreso&#44; presencia de fracturas previas al ingreso&#44; par&#225;metros funcionales prefractura utilizando el &#237;ndice de Barthel &#40;IB&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a>&#44; comorbilidad previa mediante el &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a>&#44; riesgo anest&#233;sico seg&#250;n la clasificaci&#243;n ASA<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a>&#44; valoraci&#243;n nutricional &#40;prote&#237;na&#44; alb&#250;mina&#44; test MNA<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> al ingreso&#41;&#44; par&#225;metros de laboratorio y tratamiento anticoagulante previo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Variables de proceso&#58; estancia media&#44; estancia &#62; 15 d&#237;as&#44; programa de rehabilitaci&#243;n al alta&#44; par&#225;metros funcionales al alta utilizando el IB&#44; intervenciones en &#8804; 48 h&#44; causas de demora quir&#250;rgica&#44; transfusiones en el ingreso&#44; pauta de tratamiento de osteoporosis previo y al alta&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Variables de desenlace&#44; como complicaciones m&#233;dicas durante el ingreso&#58; delirium &#40;instrumento de cribado el Confussion Assessment method &#91;CAM&#93;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a>&#41;&#44; insuficiencia card&#237;aca&#44; enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; agudizada&#44; broncospasmo&#44; insuficiencia renal aguda o cr&#243;nica agudizada&#44; retenci&#243;n aguda de orina&#44; e infecci&#243;n nosocomial&#44; infecci&#243;n de herida quir&#250;rgica&#44; &#250;lceras por presi&#243;n &#40;UPP&#41; al ingreso y alta&#44; reingresos &#60; 30 d&#237;as&#44; destino al alta de los pacientes y mortalidad al ingreso&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0085" class="elsevierStylePara elsevierViewall">Las variables continuas se describen como la media &#177; desviaci&#243;n est&#225;ndar&#46; Las variables categ&#243;ricas se presentan como n&#250;mero de sujetos y porcentaje&#46; Para realizar el an&#225;lisis univariado en las variables categ&#243;ricas se ha utilizado la prueba de la chi al cuadrado&#46; Para evaluar si existieron diferencias significativas en las variables continuas se utiliz&#243; la prueba de la t Student y la U de Mann-Whitney en caso de ausencia de normalidad&#44; que se verific&#243; mediante el test de Kolmogorov-Smirnov&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Para realizar los an&#225;lisis estad&#237;sticos se utiliz&#243; el paquete estad&#237;stico SPSS 19 &#40;IBM Corporation&#44; Armonk&#44; NY&#41;&#46; El nivel de significaci&#243;n se fij&#243; en p &#60; 0&#44;05&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen los pacientes agrupados del per&#237;odo previo a la aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar &#40;junio del 2015 a mayo del 2016&#41; con 455 pacientes y los del per&#237;odo posterior &#40;junio del 2015 a mayo del 2016&#41; con 456 pacientes&#46; Se recogen las caracter&#237;sticas basales de los 2<span class="elsevierStyleHsp" style=""></span>grupos analizados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Los 2<span class="elsevierStyleHsp" style=""></span>grupos de pacientes fueron comparables en edad y sexo&#46; En el primer per&#237;odo el porcentaje de pacientes con barreras arquitect&#243;nicas en el domicilio fue significativamente superior &#40;48&#44;9&#37; vs&#46; 41&#44;5&#37;&#59; p &#61; 0&#44;021&#41;&#46; En el per&#237;odo post-Gu&#237;a hay m&#225;s pacientes que ingresaron en la unidad procedentes de otros servicios del hospital &#40;0 vs&#46; 2&#44;9&#37;&#44; p &#61; 0&#44;004&#41;&#46; No se evidenciaron diferencias en la tipolog&#237;a de fractura ni en el tipo de implante&#46; El an&#225;lisis de la comorbilidad no mostr&#243; diferencias entre ambos grupos y tampoco las hay al analizarla por enfermedades espec&#237;ficas&#46; El an&#225;lisis de par&#225;metros funcionales prefractura entre ambos grupos sigui&#243; una distribuci&#243;n tambi&#233;n similar&#46; En el grupo post-Gu&#237;a se apreci&#243; un porcentaje mayor de pacientes con m&#225;s de una fractura al ingreso &#40;0&#44;9&#37; vs&#46; 5&#37;&#59; p &#60; 0&#44;001&#41;&#46; Tambi&#233;n en el per&#237;odo post-Gu&#237;a se produjo un aumento significativo del tratamiento de la osteoporosis al alta&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se recogen las variables de proceso de ambos grupos&#46; En el per&#237;odo post-Gu&#237;a hubo un descenso significativo de la estancia media y de las estancias &#62;15 d&#237;as&#46; En el segundo per&#237;odo tambi&#233;n se derivaron m&#225;s pacientes a unidades de recuperaci&#243;n funcional&#46; No hubo diferencias significativas en el porcentaje pacientes intervenidos en &#8804; 48<span class="elsevierStyleHsp" style=""></span>h en ambos per&#237;odos&#46; Se analizan las causas de demora quir&#250;rgica&#46; En el segundo per&#237;odo hubo un descenso significativo de las complicaciones m&#233;dicas como causa de demora de la intervenci&#243;n quir&#250;rgica&#46; En este segundo per&#237;odo tambi&#233;n se detect&#243; un aumento significativo de demora por ingresar en fin de semana o festivo y por aumento del consumo de anticoagulantes&#46; Los problemas de disponibilidad de quir&#243;fanos afectaron de manera similar a la demora quir&#250;rgica en ambos per&#237;odos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se exponen las variables de desenlace en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46; En el per&#237;odo post-Gu&#237;a hubo un descenso significativo de las complicaciones m&#233;dicas durante el ingreso&#46; Se produjeron menos episodios de delirium&#44; insuficiencia card&#237;aca&#44; agudizaciones de EPOC y broncospasmo&#46; Hubo mayor porcentaje de UPP al ingreso y al alta en el per&#237;odo post-Gu&#237;a&#46; Tambi&#233;n se aprecia en este per&#237;odo post-Gu&#237;a un descenso en el porcentaje de reingresos a &#60; 30 d&#237;as&#44; tanto en el mismo servicio como en otros servicios&#44; si bien las diferencias no alcanzan significaci&#243;n estad&#237;stica&#46; En el per&#237;odo post-Gu&#237;a se detecta un aumento de los fallecidos&#44; por ello analizamos la relaci&#243;n entre la demora quir&#250;rgica los fallecimientos durante el ingreso&#46; Se observa que&#44; en el segundo per&#237;odo&#44; las causas administrativas&#44; es decir&#44; la falta de quir&#243;fano disponible y el ingreso en fin de semana o festivo se asocian con el aumento de la mortalidad&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Hemos analizado el impacto de la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar en el paciente con fractura de cadera por fragilidad y hemos hallado diferencias tanto en las variables de proceso como de desenlace&#46; La implantaci&#243;n de gu&#237;as cl&#237;nicas permite dar uniformidad y mejorar la pr&#225;ctica cl&#237;nica de los profesionales<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a>&#46; En el a&#241;o 2017 se cre&#243; en Espa&#241;a el Registro Nacional de Fracturas de Cadera &#40;RNFC&#41;&#46; El an&#225;lisis de los resultados de este grupo de trabajo nos permite valorar y comparar nuestra actividad y hallar nuestros puntos d&#233;biles que hay que mejorar<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Los pacientes ingresados en nuestra unidad son de edad muy avanzada&#44; en su mayor&#237;a mujeres&#44; residentes en su domicilio y con un grado de dependencia funcional leve prefractura&#44; como se describe en otras publicaciones<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a>&#46; Los tipos de fractura y los tipos de implante realizados en nuestro hospital no difieren de las series publicadas<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a>&#46; En el per&#237;odo post-Gu&#237;a aumentan los ingresos procedentes de otros servicios del hospital&#46; Esta diferencia puede ser fruto de que la aplicaci&#243;n de la gu&#237;a mejora el trabajo en equipo y aumenta las sinergias entre profesionales<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">25&#44;26</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Las complicaciones m&#233;dicas registradas son congruentes con la literatura&#44; siendo el delirium la m&#225;s frecuente<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">27-29</span></a>&#46; En el per&#237;odo post-Gu&#237;a se contabilizaron menor n&#250;mero de complicaciones m&#233;dicas&#46; Se redujeron el delirium&#44; la insuficiencia card&#237;aca&#44; el broncoespasmo y la EPOC agudizada&#46; En nuestros datos se recoge una incidencia inferior de enfermedad tromboemb&#243;lica y de alteraciones hidroelectrol&#237;citas a las recogidas en la literatura<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a>&#46; En el per&#237;odo pre-Gu&#237;a&#44; el porcentaje de UPP al alta es inferior a los datos recogidos en el RNFC &#40;6&#44;7&#37;&#41;&#44; mientras que al alta se sit&#250;a por encima de la media del Registro<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&#46; Valoramos que puede existir un sesgo por optimizaci&#243;n del registro a partir de la aplicaci&#243;n de la gu&#237;a&#46; Al alta&#44; el 50&#37; de los pacientes presentan dependencia severa o total&#44; lo cual es similar a los datos publicados en centros comparables<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Un estudio reciente de &#225;mbito nacional sobre el manejo de la fractura de cadera en el anciano pone de manifiesto una importante reducci&#243;n en el n&#250;mero de complicaciones m&#233;dicas e incluso de la mortalidad intrahospitalaria&#44; mediante la creaci&#243;n de protocolos de tratamiento&#59; si bien no logra mejor&#237;as organizativas<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a>&#46; El 68&#37; de los pacientes recibieron tratamiento de la osteoporosis al alta&#44; estos datos son muy superiores a la media del RNFC&#44; con una variabilidad entre hospitales del 0 al 93&#44;9&#37;&#46; La implementaci&#243;n de gu&#237;as cl&#237;nicas que mejoren el tratamiento de la osteoporosis reduce la mortalidad y el riesgo de fractura a 2<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a>&#46; Es importante destacar el aumento de prescripci&#243;n de zoledronato&#44; al crear el circuito de administraci&#243;n en el Hospital de D&#237;a&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Evidenciamos tambi&#233;n una reducci&#243;n significativa de la estancia media y de las estancias &#62; 15 d&#237;as en el per&#237;odo post-Gu&#237;a<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a>&#46; Aun as&#237;&#44; seguimos teniendo una estancia media superior a la media nacional&#44; que es de 10&#44;09 &#177; 6&#44;7 d&#237;as&#44; seg&#250;n datos del RNFC<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&#46; En el segundo per&#237;odo hubo un mayor porcentaje de derivaciones a la Unidad de Recuperaci&#243;n Funcional y un descenso de derivaciones al hospital de larga estancia&#46; La regi&#243;n sanitaria donde estamos ubicados dispone de una dotaci&#243;n de camas de recuperaci&#243;n funcional estable y adecuada a la poblaci&#243;n de referencia&#44; y pensamos que por ello la derivaci&#243;n a dichas unidades es superior a la media de nuestro pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&#46; Atribuimos el aumento de derivaciones en el segundo per&#237;odo a una mejor coordinaci&#243;n de los recursos con la aplicaci&#243;n de la gu&#237;a&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">El porcentaje de reingresos &#60; 30 d&#237;as en el segundo per&#237;odo ha descendido&#44; tanto en la misma Unidad de Ortogeriatr&#237;a como en otros servicios del hospital&#46; El porcentaje de reingresos relacionados con la fractura es inferior a los reingresos recogidos en el RNFC &#40;2&#44;7&#37; vs&#46; 1&#44;8&#37;&#41; y globalmente bajo si se compara con estudios previos&#46; En el per&#237;odo post-Gu&#237;a se detect&#243; una reducci&#243;n significativa de las complicaciones m&#233;dicas y de la estancia media&#44; mientras que el porcentaje de pacientes intervenidos en &#8804; 48<span class="elsevierStyleHsp" style=""></span>h es discretamente inferior&#46; En el per&#237;odo post-Gu&#237;a se registr&#243; un aumento significativo de los ingresos en festivo y fin de semana&#44; lo que pensamos que puede influir en el aumento de la demora quir&#250;rgica en dicho per&#237;odo&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Vemos tambi&#233;n que la falta de quir&#243;fanos disponibles se mantiene de manera constante en ambos per&#237;odos&#46; Las revisiones publicadas nos dicen que la reducci&#243;n de infecciones&#44; insuficiencia card&#237;aca&#44; delirium e insuficiencia renal durante el ingreso reduce la mortalidad intrahospitalaria y a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">28&#44;33&#44;34</span></a>&#46; Por eso nos llama la llama la atenci&#243;n el aumento de fallecidos en dicho per&#237;odo&#46; Es necesario analizar la relaci&#243;n entre los fallecimientos y la demora quir&#250;rgica en nuestra serie&#46; Al analizar las causas de dicha demora quir&#250;rgica&#44; las causas administrativas fueron significativamente superiores en este grupo&#46; En cambio&#44; la demora por causas m&#233;dicas no hall&#243; diferencias entre los pacientes fallecidos en ambos per&#237;odos&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Estos resultados ponen de manifiesto la necesidad de disponer de quir&#243;fanos y dotaci&#243;n de personal suficiente para poder operar a los pacientes en d&#237;as festivos y los fines de semana<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">35-38</span></a>&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitaciones del estudio</span><p id="par0155" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene limitaciones importantes&#46; Se ha realizado en un &#250;nico hospital con su propia idiosincrasia y las conclusiones pueden no ser extrapolables a otros centros&#46; En este estudio &#250;nicamente hemos analizado el impacto de la aplicaci&#243;n de la gu&#237;a durante el ingreso hospitalario y no hemos analizado la mortalidad a largo plazo&#46; Al tratarse de un estudio descriptivo&#44; no podemos establecer relaciones de causalidad directa en los resultados obtenidos&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar se asocia a una tasa menor de complicaciones m&#233;dicas&#44; a una reducci&#243;n de la estancia media y de las estancias prolongadas&#44; y a un aumento en la prescripci&#243;n del tratamiento de la osteoporosis&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no haber recibido ninguna fuente de financiaci&#243;n para la elaboraci&#243;n del estudio&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2020-12-29"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar el impacto de la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar en el proceso de atenci&#243;n a pacientes con fractura de cadera&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo pre y postintervenci&#243;n en una Unidad de Ortogeriatr&#237;a de un hospital de segundo nivel tras implementar una gu&#237;a cl&#237;nica multidisciplinar de atenci&#243;n a la fractura de cadera&#46; Se analizan las caracter&#237;sticas basales de los pacientes y las variaciones observadas en las variables de proceso y de desenlace en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos estudiados &#40;junio del 2015-mayo del 2016 y junio del 2016-mayo del 2017&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas basales de la poblaci&#243;n fueron similares en el per&#237;odo preintervenci&#243;n &#40;n &#61; 455&#41; y en el per&#237;odo postintervenci&#243;n &#40;n &#61; 456&#41;&#46; La edad media de los pacientes fue 84&#44;8 &#177; 6&#44;8 a&#241;os y un 70&#44;8&#37; eran mujeres&#46; La aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar produjo una reducci&#243;n de la estancia media &#40;16&#44;9 d&#237;as vs&#46; 15&#44;6 d&#237;as&#44; p &#61; 0&#44;014&#41; y mejor&#243; la prescripci&#243;n del tratamiento de la osteoporosis &#40;51&#44;6&#37; vs&#46; 88&#37;&#44; p &#60; 0&#44;001&#41;&#44; y redujo los episodios de delirio &#40;44&#37; vs&#46; 31&#44;2&#37;&#44; p &#60; 0&#44;001&#41;&#44; broncoespasmo &#40;18&#44;3&#37; vs&#46; 12&#37;&#44; p &#61; 0&#44;019&#41;&#44; insuficiencia card&#237;aca &#40;20&#37; vs&#46; 11&#44;5&#37;&#44; p &#60; 0&#44;001&#41; y enfermedad pulmonar obstructiva cr&#243;nica agudizada &#40;7&#44;9&#37; vs&#46; 3&#44;8&#37;&#44; p &#61; 0&#44;017&#41;&#46; Observamos un incremento de las &#250;lceras por presi&#243;n al alta &#40;2&#44;9&#37; vs&#46; 9&#37;&#44; p &#61; 0&#44;001&#41;&#46; No hubo diferencias en la proporci&#243;n de pacientes operados en menos de 48 h &#40;56&#37; vs&#46; 61&#44;2&#37;&#44; p &#61; 0&#44;64&#41;&#44; en reingresos hospitalarios &#40;6&#44;9&#37; vs&#46; 5&#44;9&#37;&#44; p &#61; 0&#44;51&#41; ni en mortalidad &#40;5&#44;0&#37; vs&#46; 7&#44;2&#37;&#44; p &#61; 0&#44;17&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La implantaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar mejor&#243; aspectos del proceso de atenci&#243;n a los pacientes con fractura de cadera&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care&#46; We analyzed patients&#8217; baseline characteristics and the variations observed in care provided and in outcome variables in the 2<span class="elsevierStyleHsp" style=""></span>periods studied &#40;June 2015-May 2016 and June 2016-May 2017&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The baseline characteristics of the population were similar in the pre-intervention period &#40;n&#61;455&#41; compared to the post-intervention period &#40;n&#61;456&#41;&#46; Patients&#8217; mean age was 84&#46;8 &#177; 6&#46;8 years and 70&#46;8&#37; were women&#46; The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay &#40;16&#46;9 days vs 15&#46;6 days&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;014&#41;&#59; improved osteoporosis treatment prescribing &#40;51&#46;6&#37; vs 88&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#59; and reduced episodes of delirium &#40;44&#37; vs 31&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#44; bronchospasm &#40;18&#46;3&#37; vs 12&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;019&#41;&#44; heart failure &#40;20&#37; vs 11&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#44; and COPD exacerbation &#40;7&#46;9&#37; vs 3&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;017&#41;&#46; We observed an increase in pressure ulcers at discharge &#40;2&#46;9 vs 9&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#46; There were no differences in the percentage of operations in less than 48<span class="elsevierStyleHsp" style=""></span>hours &#40;56&#37; vs 61&#46;2&#37; <span class="elsevierStyleItalic">p</span>&#61;&#46;64&#41;&#44; hospital readmissions &#40;6&#46;9&#37; vs 5&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;51&#41;&#44; or mortality &#40;5&#46;0&#37; vs 7&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;17&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture&#46;</p></span>"
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                  \t\t\t\t">402 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;5&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Sexo &#40;mujeres&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Estado civil &#40;viudos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">274 &#40;63&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">N&#250;cleo convivencia &#40;solos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Lugar residencia</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Domicilio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">344 &#40;75&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Traslado al hospital</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Nivel de estudios &#40;analfabetos&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">80 &#40;17&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Barreras arquitect&#243;nicas &#40;s&#237;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">186 &#40;40&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Tipo de fractura</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Subcapital</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">155 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">158 &#40;34&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pertrocant&#233;rea</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">241 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">238 &#40;52&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Tipo de implante</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemiartroplastia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120 &#40;26&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">137 &#40;28&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clavo intramedular</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">250 &#40;56&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Conservador</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;5&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidad previa</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Charlson medio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;21 &#177; 2&#44;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;25 &#177; 1&#44;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes complicada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad pulmonar obstructiva cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;14&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54 &#40;11&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia card&#237;aca</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;16&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Demencia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;25&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">125 &#40;27&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia renal cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#40;23&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">115 &#40;25&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad cerebrovascular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;21&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia s&#243;lida</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;9&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia diseminada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hepatopat&#237;a grave</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Par&#225;metros nutricionales &#40;Puntuaci&#243;n MNA&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60; 17&#58; malnutrici&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;5&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">17-23&#58; riesgo de malnutrici&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92 &#40;26&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">119 &#40;26&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805; 24&#58; normalidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">247 &#40;70&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">300 &#40;68&#37;&#41;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Par&#225;metros funcionales prefractura &#40;IB categorizado&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dependencia leve</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">256 &#40;70&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">316 &#40;70&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805; Dependencia severa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49 &#40;13&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;11&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Fracturas previas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">28 &#40;6&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62; 1 fractura al ingreso</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Riesgo ASA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Medio categorizado III-IV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">185 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Par&#225;metros de laboratorio</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Calcio &#40;mmol&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Calcidiol &#40;ng&#47;mL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prote&#237;nas totales &#40;g&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#44;5 &#177; 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alb&#250;mina &#40;g&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;8 &#177; 3&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hb &#40;g&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FGE &#40;mL&#47;min&#47;1&#44;73 m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#44;5 &#177; 20&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">62&#44;7 &#177; 18&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Tratamiento antiagregante-anticoagulante</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">273 &#40;56&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">230 &#40;46&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">AAS</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">118 &#40;24&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">141 &#40;28&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Acenocumarol-warfarina</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;9&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nuevos anticoagulantes</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;2&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;4&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clopidogrel</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;5&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo pre-Gu&#237;a &#40;n &#61; 455&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo post-Gu&#237;a &#40;n &#61; 456&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">16&#44;9 &#177; 13&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#44;2 &#177; 8&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;014&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Estancias &#62; 15 d&#237;as</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">125 &#40;27&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Rehabilitaci&#243;n carga alta</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">344 &#40;77&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">373 &#40;84&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Par&#225;metros funcionales alta &#40;IB categorizado&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dependencia leve</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;13&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;13&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dependencia moderada</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;23&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 &#40;24&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805; Dependencia severa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207 &#40;57&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">236 &#40;54&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Demora quir&#250;rgica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Intervenciones &#8804; 48 h</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">206 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">181 &#40;61&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Demora presente-causa</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Complicaciones m&#233;dicas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Terapia anticoagulante</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;29&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fin de semana&#47;festivo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;23&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Falta de quir&#243;fano</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125 &#40;47&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">112 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;37&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">103 &#40;22&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">184 &#40;40&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;0&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;8&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Denosumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teriparatida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Solo calcio-vitamina D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sin tratamiento al alta</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">223 &#40;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">55 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo post-Gu&#237;a &#40;n &#61; 456&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Delirium</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">199 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">137 &#40;30&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Retenci&#243;n aguda orina</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46 &#40;10&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia card&#237;aca</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93 &#40;20&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Broncospasmo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;17&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">56 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">EPOC agudizado</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia renal aguda</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infecci&#243;n nosocomial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;58&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Infecci&#243;n herida quir&#250;rgica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#218;lceras por presi&#243;n-UPP</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">UPP al ingreso</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;5&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">UPP al alta</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Destino al alta</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Domicilio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Residencia geri&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hospital larga estancia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;10&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">URF</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">206 &#40;45&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">227 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fallecidos-fallecimiento</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;5&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 &#40;9&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Traslado a otros servicios</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Reingresos &#60; 30 d&#237;as</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unidad de Ortogeriatr&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros servicios&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;01&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;29&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Fallecimiento durante la hospitalizaci&#243;n y demora quir&#250;rgica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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ORIGINAL
Resultados en salud tras la implantación de una guía multidisciplinar para la atención a la fractura de cadera
Health outcomes after the implementation of multidisciplinary clinical guidelines for the care of hip fractures
T. Casanova Querola,
Autor para correspondencia
Teresa.CasanovaQuerol@sanitatintegral.org

Autor para correspondencia.
, J.M. Santiago Bautistab, M. Lafuente Salinasc, E. Güell Farréa, J. Girós Torresc, M. Martín-Baranerad, R. Miralles Bassedae
a Servicio de Medicina Interna, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España
b Servicio de Geriatría, Hospital Sociosanitari de L’Hospitalet, L’Hospitalet de Llobregat, Barcelona, España
c Servicio de Traumatología, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España
d Servicio de Epidemiología Clínica, Consorci Sanitari Integral, Universitat Autònoma de Barcelona, Barcelona, España
e Servicio de Geriatría, Hospital Germans Trias i Pujol, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La atenci&#243;n de la fractura de cadera ha evolucionado en los &#250;ltimos 30 a&#241;os hacia el desarrollo de modelos asistenciales de corresponsabilidad total entre equipos m&#233;dicos y quir&#250;rgicos&#44; demostrando una reducci&#243;n significativa de las complicaciones intrahospitalarias&#44; la mortalidad y una mejora en los par&#225;metros de gesti&#243;n asistencial<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La fractura de cadera por fragilidad conlleva un riesgo de complicaciones m&#233;dicas durante el ingreso y un deterioro en la capacidad funcional previa<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; La asistencia m&#233;dica debe abordarse de manera multidisciplinar&#44; incluyendo Traumatolog&#237;a&#44; Medicina Interna&#44; Anestesia&#44; Rehabilitaci&#243;n y Trabajo Social<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a>&#46; El objetivo no es otro que mejorar la recuperaci&#243;n funcional&#44; reducir la morbimortalidad intrahospitalaria y promover el retorno del paciente a su domicilio en una situaci&#243;n funcional lo m&#225;s parecida a su estado basal previo<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En una Unidad de Ortogeriatr&#237;a&#44; el traumat&#243;logo toma las decisiones referentes al tratamiento y el seguimiento de la fractura y el internista realiza un control diario del manejo cl&#237;nico desde urgencias&#44; lo cual facilita la recuperaci&#243;n funcional&#44; la planificaci&#243;n individualizada de la continuidad de cuidados&#44; y organiza la derivaci&#243;n al nivel asistencial m&#225;s adecuado<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">8-10</span></a>&#46; El establecimiento de gu&#237;as cl&#237;nicas facilita este cometido&#44; asegurando que el paciente recibe los cuidados est&#225;ndar adecuados en el tiempo apropiado<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las gu&#237;as cl&#237;nicas han demostrado utilidad en la optimizaci&#243;n de la cirug&#237;a&#44; la movilizaci&#243;n precoz&#44; el manejo cl&#237;nico y la planificaci&#243;n del alta<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a>&#46; El modelo de atenci&#243;n multidisciplinar que ofrece una unidad ortogeri&#225;trica no debe ser r&#237;gido ni uniforme<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a>&#46; Lo ideal es que la gu&#237;a se adapte a la realidad de cada hospital<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> y a los recursos disponibles en cada centro<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es evaluar el impacto de la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar del paciente con fractura de cadera&#46; Su aplicaci&#243;n incluye la atenci&#243;n continuada durante las 24 h durante todo el ingreso por el equipo de Medicina Interna&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0030" class="elsevierStylePara elsevierViewall">Presentamos un estudio descriptivo pre y postexposici&#243;n en que se analiz&#243; una cohorte prospectiva de pacientes durante los 12<span class="elsevierStyleHsp" style=""></span>meses posteriores al inicio de aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar&#44; de junio del 2016 a mayo del 2017&#46; Dicha cohorte se compar&#243; con otra cohorte previa de la misma Unidad de Ortogeriatr&#237;a&#44; per&#237;odo de junio del 2015 a mayo del 2016&#46; La recogida de datos de esta cohorte previa tambi&#233;n fue prospectiva&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">&#193;mbito del estudio</span><p id="par0035" class="elsevierStylePara elsevierViewall">La Unidad de Ortogeriatr&#237;a del Consorci Sanitari Integral est&#225; ubicada en el Hospital del Baix Llobregat-Mois&#233;s Broggi&#44; en Sant Joan Desp&#237; &#40;Barcelona&#41;&#46; Es un hospital de segundo nivel que pertenece a la Xarxa d&#8217;Hospitals d&#8217;Utilitzaci&#243; P&#250;blica &#40;XHUP&#41; de Catalu&#241;a&#46; Acoge alumnos en formaci&#243;n especializada de pregrado y de posgrado&#46; Dispone de 300 camas de hospitalizaci&#243;n&#44; Unidad de Hemodi&#225;lisis y 20 camas de Medicina Intensiva&#46; El &#225;rea de influencia son 426&#46;000 habitantes de la zona norte de L&#8217;Hospitalet de Llobregat y Baix Llobregat&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La Unidad de Ortogeriatr&#237;a inici&#243; su actividad en septiembre del 2012&#46; Desde el inicio se estableci&#243; el pase de visita diario de Traumatolog&#237;a y Medicina Interna&#44; con corresponsabilidad compartida&#46; La toma de decisiones y la planificaci&#243;n asistencial se desarrollan en una reuni&#243;n diaria a la que asisten traumat&#243;logo&#44; internista&#44; enfermera cl&#237;nica&#44; trabajador social&#44; anestesista y rehabilitador&#46; En junio del 2016 se inici&#243; la implantaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar de la Unidad de Ortogeriatr&#237;a&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Gu&#237;a cl&#237;nica multidisciplinar</span><p id="par0045" class="elsevierStylePara elsevierViewall">La elaboraci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar aporta 3<span class="elsevierStyleHsp" style=""></span>cambios en la actividad asistencial de la unidad&#46; En primer lugar&#44; supone la protocolizaci&#243;n de los tratamientos y procesos asistenciales desde la llegada del paciente a Urgencias y durante el ingreso&#44; y facilita la unificaci&#243;n de criterios en la pr&#225;ctica asistencial&#46; En segundo lugar&#44; se organiza la atenci&#243;n continuada de estos pacientes durante el ingreso&#44; de manera que el equipo de guardia de Medicina Interna asume la asistencia continuada de los pacientes&#46; Esto incluye laborables&#44; fines de semana y festivos&#44; las 24<span class="elsevierStyleHsp" style=""></span>h del d&#237;a&#46; En tercer lugar&#44; se organiza el seguimiento hasta los 18 meses del alta hospitalaria por parte de Medicina Interna y Geriatr&#237;a&#44; unificando criterios de manejo de la prevenci&#243;n secundaria de fracturas y garantizando la coordinaci&#243;n con la Asistencia Primaria al alta de la consulta&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se puede consultar esta gu&#237;a cl&#237;nica multidisciplinar en el material suplementario &#40;<a class="elsevierStyleCrossRef" href="#sec0070">anexo</a>&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Pacientes</span><p id="par0055" class="elsevierStylePara elsevierViewall">Presentamos el an&#225;lisis descriptivo de los pacientes que ingresaron con fractura de cadera en la Unidad de Ortogeriatr&#237;a del Hospital Mois&#233;s Broggi&#44; en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos de estudio&#46; Los criterios de inclusi&#243;n fueron todos los pacientes con fractura de cadera por fragilidad&#44; diafisaria o distal y periprot&#233;sicas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Variables del estudio</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se recogieron variables de estructura&#44; de proceso y de desenlace del proceso de hospitalizaci&#243;n en la Unidad de Ortogeriatr&#237;a de todos los pacientes ingresados en la Unidad de Ortogeriatr&#237;a de 2015 a 2017&#46; Todas fueron incluidas de manera prospectiva desde el ingreso y se completaron a partir de los informes de alta de los pacientes ingresados en la Unidad de Ortogeriatr&#237;a&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A continuaci&#243;n&#44; se dise&#241;&#243; el estudio descriptivo pre y postintervenci&#243;n comparando 12 meses antes y despu&#233;s de la aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar&#58; per&#237;odo pre-Gu&#237;a &#40;junio del 2015-mayo del 2016&#41; y per&#237;odo post-Gu&#237;a &#40;junio del 2016-mayo del 2017&#41;&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Caracter&#237;sticas basales de los pacientes&#58; edad&#44; sexo&#44; estado civil&#44; nivel de estudios&#44; n&#250;cleo de convivencia&#44; lugar de residencia y existencia de barreras arquitect&#243;nicas en el domicilio&#46; Tipo de fractura&#44; tipo de implante&#44; n&#250;mero de fracturas al ingreso&#44; presencia de fracturas previas al ingreso&#44; par&#225;metros funcionales prefractura utilizando el &#237;ndice de Barthel &#40;IB&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a>&#44; comorbilidad previa mediante el &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a>&#44; riesgo anest&#233;sico seg&#250;n la clasificaci&#243;n ASA<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a>&#44; valoraci&#243;n nutricional &#40;prote&#237;na&#44; alb&#250;mina&#44; test MNA<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> al ingreso&#41;&#44; par&#225;metros de laboratorio y tratamiento anticoagulante previo&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Variables de proceso&#58; estancia media&#44; estancia &#62; 15 d&#237;as&#44; programa de rehabilitaci&#243;n al alta&#44; par&#225;metros funcionales al alta utilizando el IB&#44; intervenciones en &#8804; 48 h&#44; causas de demora quir&#250;rgica&#44; transfusiones en el ingreso&#44; pauta de tratamiento de osteoporosis previo y al alta&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Variables de desenlace&#44; como complicaciones m&#233;dicas durante el ingreso&#58; delirium &#40;instrumento de cribado el Confussion Assessment method &#91;CAM&#93;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a>&#41;&#44; insuficiencia card&#237;aca&#44; enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; agudizada&#44; broncospasmo&#44; insuficiencia renal aguda o cr&#243;nica agudizada&#44; retenci&#243;n aguda de orina&#44; e infecci&#243;n nosocomial&#44; infecci&#243;n de herida quir&#250;rgica&#44; &#250;lceras por presi&#243;n &#40;UPP&#41; al ingreso y alta&#44; reingresos &#60; 30 d&#237;as&#44; destino al alta de los pacientes y mortalidad al ingreso&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis estad&#237;stico</span><p id="par0085" class="elsevierStylePara elsevierViewall">Las variables continuas se describen como la media &#177; desviaci&#243;n est&#225;ndar&#46; Las variables categ&#243;ricas se presentan como n&#250;mero de sujetos y porcentaje&#46; Para realizar el an&#225;lisis univariado en las variables categ&#243;ricas se ha utilizado la prueba de la chi al cuadrado&#46; Para evaluar si existieron diferencias significativas en las variables continuas se utiliz&#243; la prueba de la t Student y la U de Mann-Whitney en caso de ausencia de normalidad&#44; que se verific&#243; mediante el test de Kolmogorov-Smirnov&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Para realizar los an&#225;lisis estad&#237;sticos se utiliz&#243; el paquete estad&#237;stico SPSS 19 &#40;IBM Corporation&#44; Armonk&#44; NY&#41;&#46; El nivel de significaci&#243;n se fij&#243; en p &#60; 0&#44;05&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0095" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen los pacientes agrupados del per&#237;odo previo a la aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar &#40;junio del 2015 a mayo del 2016&#41; con 455 pacientes y los del per&#237;odo posterior &#40;junio del 2015 a mayo del 2016&#41; con 456 pacientes&#46; Se recogen las caracter&#237;sticas basales de los 2<span class="elsevierStyleHsp" style=""></span>grupos analizados&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Los 2<span class="elsevierStyleHsp" style=""></span>grupos de pacientes fueron comparables en edad y sexo&#46; En el primer per&#237;odo el porcentaje de pacientes con barreras arquitect&#243;nicas en el domicilio fue significativamente superior &#40;48&#44;9&#37; vs&#46; 41&#44;5&#37;&#59; p &#61; 0&#44;021&#41;&#46; En el per&#237;odo post-Gu&#237;a hay m&#225;s pacientes que ingresaron en la unidad procedentes de otros servicios del hospital &#40;0 vs&#46; 2&#44;9&#37;&#44; p &#61; 0&#44;004&#41;&#46; No se evidenciaron diferencias en la tipolog&#237;a de fractura ni en el tipo de implante&#46; El an&#225;lisis de la comorbilidad no mostr&#243; diferencias entre ambos grupos y tampoco las hay al analizarla por enfermedades espec&#237;ficas&#46; El an&#225;lisis de par&#225;metros funcionales prefractura entre ambos grupos sigui&#243; una distribuci&#243;n tambi&#233;n similar&#46; En el grupo post-Gu&#237;a se apreci&#243; un porcentaje mayor de pacientes con m&#225;s de una fractura al ingreso &#40;0&#44;9&#37; vs&#46; 5&#37;&#59; p &#60; 0&#44;001&#41;&#46; Tambi&#233;n en el per&#237;odo post-Gu&#237;a se produjo un aumento significativo del tratamiento de la osteoporosis al alta&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se recogen las variables de proceso de ambos grupos&#46; En el per&#237;odo post-Gu&#237;a hubo un descenso significativo de la estancia media y de las estancias &#62;15 d&#237;as&#46; En el segundo per&#237;odo tambi&#233;n se derivaron m&#225;s pacientes a unidades de recuperaci&#243;n funcional&#46; No hubo diferencias significativas en el porcentaje pacientes intervenidos en &#8804; 48<span class="elsevierStyleHsp" style=""></span>h en ambos per&#237;odos&#46; Se analizan las causas de demora quir&#250;rgica&#46; En el segundo per&#237;odo hubo un descenso significativo de las complicaciones m&#233;dicas como causa de demora de la intervenci&#243;n quir&#250;rgica&#46; En este segundo per&#237;odo tambi&#233;n se detect&#243; un aumento significativo de demora por ingresar en fin de semana o festivo y por aumento del consumo de anticoagulantes&#46; Los problemas de disponibilidad de quir&#243;fanos afectaron de manera similar a la demora quir&#250;rgica en ambos per&#237;odos&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se exponen las variables de desenlace en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos&#46; En el per&#237;odo post-Gu&#237;a hubo un descenso significativo de las complicaciones m&#233;dicas durante el ingreso&#46; Se produjeron menos episodios de delirium&#44; insuficiencia card&#237;aca&#44; agudizaciones de EPOC y broncospasmo&#46; Hubo mayor porcentaje de UPP al ingreso y al alta en el per&#237;odo post-Gu&#237;a&#46; Tambi&#233;n se aprecia en este per&#237;odo post-Gu&#237;a un descenso en el porcentaje de reingresos a &#60; 30 d&#237;as&#44; tanto en el mismo servicio como en otros servicios&#44; si bien las diferencias no alcanzan significaci&#243;n estad&#237;stica&#46; En el per&#237;odo post-Gu&#237;a se detecta un aumento de los fallecidos&#44; por ello analizamos la relaci&#243;n entre la demora quir&#250;rgica los fallecimientos durante el ingreso&#46; Se observa que&#44; en el segundo per&#237;odo&#44; las causas administrativas&#44; es decir&#44; la falta de quir&#243;fano disponible y el ingreso en fin de semana o festivo se asocian con el aumento de la mortalidad&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Hemos analizado el impacto de la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar en el paciente con fractura de cadera por fragilidad y hemos hallado diferencias tanto en las variables de proceso como de desenlace&#46; La implantaci&#243;n de gu&#237;as cl&#237;nicas permite dar uniformidad y mejorar la pr&#225;ctica cl&#237;nica de los profesionales<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a>&#46; En el a&#241;o 2017 se cre&#243; en Espa&#241;a el Registro Nacional de Fracturas de Cadera &#40;RNFC&#41;&#46; El an&#225;lisis de los resultados de este grupo de trabajo nos permite valorar y comparar nuestra actividad y hallar nuestros puntos d&#233;biles que hay que mejorar<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Los pacientes ingresados en nuestra unidad son de edad muy avanzada&#44; en su mayor&#237;a mujeres&#44; residentes en su domicilio y con un grado de dependencia funcional leve prefractura&#44; como se describe en otras publicaciones<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a>&#46; Los tipos de fractura y los tipos de implante realizados en nuestro hospital no difieren de las series publicadas<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a>&#46; En el per&#237;odo post-Gu&#237;a aumentan los ingresos procedentes de otros servicios del hospital&#46; Esta diferencia puede ser fruto de que la aplicaci&#243;n de la gu&#237;a mejora el trabajo en equipo y aumenta las sinergias entre profesionales<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">25&#44;26</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Las complicaciones m&#233;dicas registradas son congruentes con la literatura&#44; siendo el delirium la m&#225;s frecuente<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">27-29</span></a>&#46; En el per&#237;odo post-Gu&#237;a se contabilizaron menor n&#250;mero de complicaciones m&#233;dicas&#46; Se redujeron el delirium&#44; la insuficiencia card&#237;aca&#44; el broncoespasmo y la EPOC agudizada&#46; En nuestros datos se recoge una incidencia inferior de enfermedad tromboemb&#243;lica y de alteraciones hidroelectrol&#237;citas a las recogidas en la literatura<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a>&#46; En el per&#237;odo pre-Gu&#237;a&#44; el porcentaje de UPP al alta es inferior a los datos recogidos en el RNFC &#40;6&#44;7&#37;&#41;&#44; mientras que al alta se sit&#250;a por encima de la media del Registro<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&#46; Valoramos que puede existir un sesgo por optimizaci&#243;n del registro a partir de la aplicaci&#243;n de la gu&#237;a&#46; Al alta&#44; el 50&#37; de los pacientes presentan dependencia severa o total&#44; lo cual es similar a los datos publicados en centros comparables<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Un estudio reciente de &#225;mbito nacional sobre el manejo de la fractura de cadera en el anciano pone de manifiesto una importante reducci&#243;n en el n&#250;mero de complicaciones m&#233;dicas e incluso de la mortalidad intrahospitalaria&#44; mediante la creaci&#243;n de protocolos de tratamiento&#59; si bien no logra mejor&#237;as organizativas<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a>&#46; El 68&#37; de los pacientes recibieron tratamiento de la osteoporosis al alta&#44; estos datos son muy superiores a la media del RNFC&#44; con una variabilidad entre hospitales del 0 al 93&#44;9&#37;&#46; La implementaci&#243;n de gu&#237;as cl&#237;nicas que mejoren el tratamiento de la osteoporosis reduce la mortalidad y el riesgo de fractura a 2<span class="elsevierStyleHsp" style=""></span>a&#241;os<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a>&#46; Es importante destacar el aumento de prescripci&#243;n de zoledronato&#44; al crear el circuito de administraci&#243;n en el Hospital de D&#237;a&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Evidenciamos tambi&#233;n una reducci&#243;n significativa de la estancia media y de las estancias &#62; 15 d&#237;as en el per&#237;odo post-Gu&#237;a<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a>&#46; Aun as&#237;&#44; seguimos teniendo una estancia media superior a la media nacional&#44; que es de 10&#44;09 &#177; 6&#44;7 d&#237;as&#44; seg&#250;n datos del RNFC<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&#46; En el segundo per&#237;odo hubo un mayor porcentaje de derivaciones a la Unidad de Recuperaci&#243;n Funcional y un descenso de derivaciones al hospital de larga estancia&#46; La regi&#243;n sanitaria donde estamos ubicados dispone de una dotaci&#243;n de camas de recuperaci&#243;n funcional estable y adecuada a la poblaci&#243;n de referencia&#44; y pensamos que por ello la derivaci&#243;n a dichas unidades es superior a la media de nuestro pa&#237;s<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a>&#46; Atribuimos el aumento de derivaciones en el segundo per&#237;odo a una mejor coordinaci&#243;n de los recursos con la aplicaci&#243;n de la gu&#237;a&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">El porcentaje de reingresos &#60; 30 d&#237;as en el segundo per&#237;odo ha descendido&#44; tanto en la misma Unidad de Ortogeriatr&#237;a como en otros servicios del hospital&#46; El porcentaje de reingresos relacionados con la fractura es inferior a los reingresos recogidos en el RNFC &#40;2&#44;7&#37; vs&#46; 1&#44;8&#37;&#41; y globalmente bajo si se compara con estudios previos&#46; En el per&#237;odo post-Gu&#237;a se detect&#243; una reducci&#243;n significativa de las complicaciones m&#233;dicas y de la estancia media&#44; mientras que el porcentaje de pacientes intervenidos en &#8804; 48<span class="elsevierStyleHsp" style=""></span>h es discretamente inferior&#46; En el per&#237;odo post-Gu&#237;a se registr&#243; un aumento significativo de los ingresos en festivo y fin de semana&#44; lo que pensamos que puede influir en el aumento de la demora quir&#250;rgica en dicho per&#237;odo&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Vemos tambi&#233;n que la falta de quir&#243;fanos disponibles se mantiene de manera constante en ambos per&#237;odos&#46; Las revisiones publicadas nos dicen que la reducci&#243;n de infecciones&#44; insuficiencia card&#237;aca&#44; delirium e insuficiencia renal durante el ingreso reduce la mortalidad intrahospitalaria y a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">28&#44;33&#44;34</span></a>&#46; Por eso nos llama la llama la atenci&#243;n el aumento de fallecidos en dicho per&#237;odo&#46; Es necesario analizar la relaci&#243;n entre los fallecimientos y la demora quir&#250;rgica en nuestra serie&#46; Al analizar las causas de dicha demora quir&#250;rgica&#44; las causas administrativas fueron significativamente superiores en este grupo&#46; En cambio&#44; la demora por causas m&#233;dicas no hall&#243; diferencias entre los pacientes fallecidos en ambos per&#237;odos&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Estos resultados ponen de manifiesto la necesidad de disponer de quir&#243;fanos y dotaci&#243;n de personal suficiente para poder operar a los pacientes en d&#237;as festivos y los fines de semana<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">35-38</span></a>&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitaciones del estudio</span><p id="par0155" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene limitaciones importantes&#46; Se ha realizado en un &#250;nico hospital con su propia idiosincrasia y las conclusiones pueden no ser extrapolables a otros centros&#46; En este estudio &#250;nicamente hemos analizado el impacto de la aplicaci&#243;n de la gu&#237;a durante el ingreso hospitalario y no hemos analizado la mortalidad a largo plazo&#46; Al tratarse de un estudio descriptivo&#44; no podemos establecer relaciones de causalidad directa en los resultados obtenidos&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar se asocia a una tasa menor de complicaciones m&#233;dicas&#44; a una reducci&#243;n de la estancia media y de las estancias prolongadas&#44; y a un aumento en la prescripci&#243;n del tratamiento de la osteoporosis&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no haber recibido ninguna fuente de financiaci&#243;n para la elaboraci&#243;n del estudio&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar el impacto de la aplicaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar en el proceso de atenci&#243;n a pacientes con fractura de cadera&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo pre y postintervenci&#243;n en una Unidad de Ortogeriatr&#237;a de un hospital de segundo nivel tras implementar una gu&#237;a cl&#237;nica multidisciplinar de atenci&#243;n a la fractura de cadera&#46; Se analizan las caracter&#237;sticas basales de los pacientes y las variaciones observadas en las variables de proceso y de desenlace en los 2<span class="elsevierStyleHsp" style=""></span>per&#237;odos estudiados &#40;junio del 2015-mayo del 2016 y junio del 2016-mayo del 2017&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas basales de la poblaci&#243;n fueron similares en el per&#237;odo preintervenci&#243;n &#40;n &#61; 455&#41; y en el per&#237;odo postintervenci&#243;n &#40;n &#61; 456&#41;&#46; La edad media de los pacientes fue 84&#44;8 &#177; 6&#44;8 a&#241;os y un 70&#44;8&#37; eran mujeres&#46; La aplicaci&#243;n de la gu&#237;a cl&#237;nica multidisciplinar produjo una reducci&#243;n de la estancia media &#40;16&#44;9 d&#237;as vs&#46; 15&#44;6 d&#237;as&#44; p &#61; 0&#44;014&#41; y mejor&#243; la prescripci&#243;n del tratamiento de la osteoporosis &#40;51&#44;6&#37; vs&#46; 88&#37;&#44; p &#60; 0&#44;001&#41;&#44; y redujo los episodios de delirio &#40;44&#37; vs&#46; 31&#44;2&#37;&#44; p &#60; 0&#44;001&#41;&#44; broncoespasmo &#40;18&#44;3&#37; vs&#46; 12&#37;&#44; p &#61; 0&#44;019&#41;&#44; insuficiencia card&#237;aca &#40;20&#37; vs&#46; 11&#44;5&#37;&#44; p &#60; 0&#44;001&#41; y enfermedad pulmonar obstructiva cr&#243;nica agudizada &#40;7&#44;9&#37; vs&#46; 3&#44;8&#37;&#44; p &#61; 0&#44;017&#41;&#46; Observamos un incremento de las &#250;lceras por presi&#243;n al alta &#40;2&#44;9&#37; vs&#46; 9&#37;&#44; p &#61; 0&#44;001&#41;&#46; No hubo diferencias en la proporci&#243;n de pacientes operados en menos de 48 h &#40;56&#37; vs&#46; 61&#44;2&#37;&#44; p &#61; 0&#44;64&#41;&#44; en reingresos hospitalarios &#40;6&#44;9&#37; vs&#46; 5&#44;9&#37;&#44; p &#61; 0&#44;51&#41; ni en mortalidad &#40;5&#44;0&#37; vs&#46; 7&#44;2&#37;&#44; p &#61; 0&#44;17&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La implantaci&#243;n de una gu&#237;a cl&#237;nica multidisciplinar mejor&#243; aspectos del proceso de atenci&#243;n a los pacientes con fractura de cadera&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care&#46; We analyzed patients&#8217; baseline characteristics and the variations observed in care provided and in outcome variables in the 2<span class="elsevierStyleHsp" style=""></span>periods studied &#40;June 2015-May 2016 and June 2016-May 2017&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The baseline characteristics of the population were similar in the pre-intervention period &#40;n&#61;455&#41; compared to the post-intervention period &#40;n&#61;456&#41;&#46; Patients&#8217; mean age was 84&#46;8 &#177; 6&#46;8 years and 70&#46;8&#37; were women&#46; The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay &#40;16&#46;9 days vs 15&#46;6 days&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;014&#41;&#59; improved osteoporosis treatment prescribing &#40;51&#46;6&#37; vs 88&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#59; and reduced episodes of delirium &#40;44&#37; vs 31&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#44; bronchospasm &#40;18&#46;3&#37; vs 12&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;019&#41;&#44; heart failure &#40;20&#37; vs 11&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#44; and COPD exacerbation &#40;7&#46;9&#37; vs 3&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;017&#41;&#46; We observed an increase in pressure ulcers at discharge &#40;2&#46;9 vs 9&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#46; There were no differences in the percentage of operations in less than 48<span class="elsevierStyleHsp" style=""></span>hours &#40;56&#37; vs 61&#46;2&#37; <span class="elsevierStyleItalic">p</span>&#61;&#46;64&#41;&#44; hospital readmissions &#40;6&#46;9&#37; vs 5&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;51&#41;&#44; or mortality &#40;5&#46;0&#37; vs 7&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span>&#61;&#46;17&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture&#46;</p></span>"
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                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">158 &#40;34&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">241 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">238 &#40;52&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Periprot&#233;sica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;5&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tipo de implante</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemiartroplastia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">120 &#40;26&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">137 &#40;28&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Clavo intramedular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">250 &#40;56&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">244 &#40;54&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Conservador</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;4&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;5&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidad previa</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Charlson medio</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;21 &#177; 2&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;25 &#177; 1&#44;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes complicada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad pulmonar obstructiva cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;14&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54 &#40;11&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia card&#237;aca</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76 &#40;16&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Demencia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114 &#40;25&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125 &#40;27&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia renal cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">106 &#40;23&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115 &#40;25&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad cerebrovascular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;21&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia s&#243;lida</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;9&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia diseminada</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hepatopat&#237;a grave</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;1&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Par&#225;metros nutricionales &#40;Puntuaci&#243;n MNA&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60; 17&#58; malnutrici&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">17-23&#58; riesgo de malnutrici&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805; 24&#58; normalidad</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Par&#225;metros funcionales prefractura &#40;IB categorizado&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dependencia leve</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dependencia moderada</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805; Dependencia severa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Fracturas previas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">A&#241;o previo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;6&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">General</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62; 1 fractura al ingreso</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Riesgo ASA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Medio categorizado III-IV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">185 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">182 &#40;40&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Par&#225;metros de laboratorio</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Calcio &#40;mmol&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;2 &#177; 0&#44;21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Calcidiol &#40;ng&#47;mL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#44;5 &#177; 8&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prote&#237;nas totales &#40;g&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#44;5 &#177; 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55&#44;9 &#177; 6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alb&#250;mina &#40;g&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;8 &#177; 3&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;8 &#177; 3&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hb &#40;g&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;1 &#177; 1&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">373 &#40;84&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 &#40;24&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8805; Dependencia severa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207 &#40;57&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">236 &#40;54&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Demora quir&#250;rgica</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Intervenciones &#8804; 48 h</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">206 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">181 &#40;61&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Complicaciones m&#233;dicas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Terapia anticoagulante</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84 &#40;29&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fin de semana&#47;festivo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;23&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Falta de quir&#243;fano</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125 &#40;47&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">112 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;30&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;37&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tratamiento osteoporosis al alta</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Con tratamiento</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">232 &#40;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">401 &#40;88&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Bifosfonatos orales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">103 &#40;22&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">184 &#40;40&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Zoledronato ev&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38 &#40;8&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Denosumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;15&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teriparatida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;4&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;6&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Solo calcio-vitamina D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sin tratamiento al alta</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">223 &#40;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo pre-Gu&#237;a &#40;n &#61; 455&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo post-Gu&#237;a &#40;n &#61; 456&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Complicaciones m&#233;dicas</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Delirium</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">137 &#40;30&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Retenci&#243;n aguda orina</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia card&#237;aca</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81 &#40;17&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;019&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">EPOC agudizado</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Insuficiencia renal aguda</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infecci&#243;n nosocomial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Infecci&#243;n herida quir&#250;rgica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">&#218;lceras por presi&#243;n-UPP</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">&#60; 0&#44;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Destino al alta</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Domicilio</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Residencia geri&#225;trica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hospital larga estancia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;10&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">URF</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">227 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fallecidos-fallecimiento</span>&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00142565
Idioma original: Español
DOI:10.1016/j.rce.2021.04.002
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