Montero Ruiz E, Monte Secades R, Padilla López D R, Palomo Antequera C, Gómez Fernández R C, Marco Martínez J, Vázquez Campo M, Garrachón Vallo F, Porto Pérez A B
Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España.
Servicio de Medicina Interna, Hospital Lucus Augusti, Lugo, España.
Rev Clin Esp (Barc). 2020 Apr;220(3):167-173. doi: 10.1016/j.rce.2019.08.007. Epub 2019 Nov 15.
Hospitalized surgical patients are increasing in medical complexity, thereby increasing the need for support by internal medicine departments. This support is provided through interconsultations, which present problems that have resulted in the development of shared care (SC). Our objective was to compare the healthcare results achieved by the SC and interconsultation models in Orthopaedic Surgery and Trauma.
We conducted an observational, prospective, multicentre study of patients hospitalized for emergency Orthopaedic Surgery and Trauma recorded in the REINA-SEMI registry, treated by internal medicine departments through interconsultation or SC. We recorded the demographic characteristics, comorbidity, medical complications, hospital stay and mortality.
The study included 697 patients, 415 with SC and 282 with interconsultations. The SC patients were older (78.9 vs. 74.3; P<.001) underwent more operations (89.9 vs. 78.7%; P<.001), had fewer medical complications (50.4 vs. 62.8%; P<.001) and had shorter hospital stays (10 vs. 18 days; P<.001), with no differences in comorbidity or mortality. The following independent factors were associated with stays longer than 15 days: heart failure (OR 3.4; 95% CI 1.8-6.1; P<.001), the male sex (OR 1.9; 95% CI 1.2-3.1; P=.004), electrolyte disorder (OR 2.4; 95% CI 1.3-4.4; P=.003), respiratory infection (OR 1.9; 95% CI 1.04-3.7; P=.035), surgical delay (OR 1.1; 95% CI 1.08-1.2; P<.001) and treatment using the interconsultation on demand model (OR 3.5; 95% CI 2.3-5.4; P<.001).
SC offers better healthcare results than interconsultations for patients hospitalized for emergency Orthopaedic Surgery and Trauma.
住院手术患者的医疗复杂性不断增加，因此对内科支持的需求也在增加。这种支持通过相互会诊提供，但相互会诊带来了一些问题，促使了共享护理（SC）模式的发展。我们的目的是比较骨科手术和创伤领域中共享护理模式与相互会诊模式的医疗效果。
我们对REINA-SEMI登记册中记录的因急诊骨科手术和创伤住院的患者进行了一项观察性、前瞻性、多中心研究，这些患者由内科通过相互会诊或共享护理模式进行治疗。我们记录了人口统计学特征、合并症、医疗并发症、住院时间和死亡率。
该研究纳入了697例患者，其中415例采用共享护理模式，282例采用相互会诊模式。采用共享护理模式的患者年龄更大（78.9岁对74.3岁；P<0.001），接受手术的比例更高（89.9%对78.7%；P<0.001），医疗并发症更少（50.4%对62.8%；P<0.001），住院时间更短（10天对18天；P<0.001），在合并症或死亡率方面无差异。以下独立因素与住院时间超过15天相关：心力衰竭（比值比3.4；95%置信区间1.8 - 6.1；P<0.001）、男性（比值比1.9；95%置信区间1.2 - 3.1；P = 0.004）、电解质紊乱（比值比2.4；95%置信区间1.3 - 4.4；P = 0.003）、呼吸道感染（比值比1.9；95%置信区间1.04 - 3.7；P = 0.035）、手术延迟（比值比1.1；95%置信区间1.08 - 1.2；P<0.001）以及采用按需相互会诊模式进行治疗（比值比3.5；95%置信区间2.3 - 5.4；P<0.001）。
对于因急诊骨科手术和创伤住院的患者，共享护理模式比相互会诊模式能提供更好的医疗效果。
