Villalonga Antonio, Sabaté Sergi, Campos Juan Manuel, Fornaguera Joan, Hernández Carmen, Sistac José María
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari de Girona Dr. Josep Trueta, Avgda. França s/n, Girona, Spain.
Med Clin (Barc). 2006 May 24;126 Suppl 2:27-31. doi: 10.1157/13088798.
The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003.
We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training.
A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals.
The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.
ANESCAT研究的这一环节旨在描述2003年西班牙加泰罗尼亚各类医疗保健机构的麻醉实践情况。
我们根据以下因素分析调查数据：a）机构的资金来源：由加泰罗尼亚公共卫生管理局（ICS）资助的公立医院、公共使用的补贴医院网络（XHUP）或私立医院；b）规模：无床位的机构、床位少于250张的医院、床位在251至500张之间的医院以及床位超过500张的医院；c）培训认证状态：机构是否提供住院医师培训。
共有131家机构参与（11家属于ICS，47家来自XHUP，73家为私立医院）。26家诊所无床位，78家机构床位少于250张，21家床位在251至500张之间，6家床位超过500张。17家医院培训住院医师。XHUP医院实施了所有麻醉手术的44.3%，私立医院为36.7%，ICS机构为18.5%。5%的手术在无床位的诊所进行，42.9%在床位少于250张的机构进行，35%在床位在251至500张的医院进行，17.1%在床位超过500张的医院进行。教学医院的麻醉医师实施了所有手术的35.5%。私立医院、床位少于250张的机构以及不培训住院医师的医院中患者的平均年龄较低。ICS医院、床位超过500张的机构以及教学医院中患者的身体状况较差。值得注意的是，在XHUP和ICS医院、床位超过250张的机构以及教学医院中，25%的麻醉手术是在急诊情况下进行的。门诊手术麻醉在私立医院占总数的40%，在ICS和XHUP医院占实践的31%。ICS医院、床位超过500张的机构以及有住院医师培训项目的机构中，麻醉持续时间和麻醉后恢复时间较长。ICS医院、床位超过500张的机构以及教学医院中，术后入住重症监护病房的人数和实施的特殊镇痛技术数量较多。
麻醉和外科实践的复杂性以及患者病情的严重程度随着医院规模和公共资金状况的增加而增加。
