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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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Vol. 222. Núm. 2.
Páginas 73-81 (febrero 2022)
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Vol. 222. Núm. 2.
Páginas 73-81 (febrero 2022)
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
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234
T. Casanova Querola,
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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Estadísticas
Tablas (3)
Tabla 1. Características basales de los pacientes
Tabla 2. Características de las variables de proceso
Tabla 3. Características de los desenlaces evaluados
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Material adicional (1)
Resumen
Antecedentes y objetivo

Evaluar el impacto de la aplicación de una guía clínica multidisciplinar en el proceso de atención a pacientes con fractura de cadera.

Material y métodos

Estudio prospectivo pre y postintervención en una Unidad de Ortogeriatría de un hospital de segundo nivel tras implementar una guía clínica multidisciplinar de atención a la fractura de cadera. Se analizan las características basales de los pacientes y las variaciones observadas en las variables de proceso y de desenlace en los 2períodos estudiados (junio del 2015-mayo del 2016 y junio del 2016-mayo del 2017).

Resultados

Las características basales de la población fueron similares en el período preintervención (n = 455) y en el período postintervención (n = 456). La edad media de los pacientes fue 84,8 ± 6,8 años y un 70,8% eran mujeres. La aplicación de la guía clínica multidisciplinar produjo una reducción de la estancia media (16,9 días vs. 15,6 días, p = 0,014) y mejoró la prescripción del tratamiento de la osteoporosis (51,6% vs. 88%, p < 0,001), y redujo los episodios de delirio (44% vs. 31,2%, p < 0,001), broncoespasmo (18,3% vs. 12%, p = 0,019), insuficiencia cardíaca (20% vs. 11,5%, p < 0,001) y enfermedad pulmonar obstructiva crónica agudizada (7,9% vs. 3,8%, p = 0,017). Observamos un incremento de las úlceras por presión al alta (2,9% vs. 9%, p = 0,001). No hubo diferencias en la proporción de pacientes operados en menos de 48 h (56% vs. 61,2%, p = 0,64), en reingresos hospitalarios (6,9% vs. 5,9%, p = 0,51) ni en mortalidad (5,0% vs. 7,2%, p = 0,17).

Conclusiones

La implantación de una guía clínica multidisciplinar mejoró aspectos del proceso de atención a los pacientes con fractura de cadera.

Palabras clave:
Fractura de cadera
Medicina Interna
Atención continuada
Ortogeriatría
Abstract
Background and objectives

This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures.

Materials and methods

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. We analyzed patients’ baseline characteristics and the variations observed in care provided and in outcome variables in the 2periods studied (June 2015-May 2016 and June 2016-May 2017).

Results

The baseline characteristics of the population were similar in the pre-intervention period (n=455) compared to the post-intervention period (n=456). Patients’ mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs 15.6 days, p=.014); improved osteoporosis treatment prescribing (51.6% vs 88%, p<.001); and reduced episodes of delirium (44% vs 31.2%, p<.001), bronchospasm (18.3% vs 12%, p=.019), heart failure (20% vs 11.5%, p<.001), and COPD exacerbation (7.9% vs 3.8%, p=.017). We observed an increase in pressure ulcers at discharge (2.9 vs 9%, p<.001). There were no differences in the percentage of operations in less than 48hours (56% vs 61.2% p=.64), hospital readmissions (6.9% vs 5.9%, p=.51), or mortality (5.0% vs 7.2%, p=.17).

Conclusions

The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture.

Keywords:
Hip fracture
Internal Medicine
Continued care
Orthogeriatrics

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