Sergio Carmona G

SE puede reducir el índice de cesárea? Experiencia del Hospital Clínico de la Universidad de Chile

SUMMARY The experience at the Maternity Ward of Hospital Clinico de la Universidad de Chile in reducing avoidable cesarean sections is presented. The purpose of this study is to analyze the effects of an audit cycle in the cesarean section rate, using the proposal of Robson et al. A specifically designed program is used. Using the cesarean section rate of january to march trimester as a baseline, we designed an intervention protocol for april to september period which involves: daily resident report, second opinion for cesarean section, detailed pelvis diagnosis in the medical file, monthly “avoidable” cesarean section audit cycle and abnormal lie protocol standardization. The overall cesarean section rate was reduced from 44.9% to 37.1%, in nulliparous from 39.0% to 29.5% and in multiparous from 48.1% to 42.2%, all these differences were statistically significant.

ANÁLISIS CLÍNICO Y ECONÓMICO DE LA HISTERECTOMÍA ABDOMINAL VERSUS LA HISTERECTOMÍA VAGINAL EN EL HOSPITAL CLÍNICO DE LA UNIVERSIDAD DE CHILE: REVISIÓN DE 2.338 CASOS

RESUMENAntecedentes: La histerectomia es una intervencion quirurgica frecuente y de alto costo. Despues dela operacion cesarea, es el segundo procedimiento quirurgico mas frecuente en ginecologia. Objetivos:Evaluar la relacion costo/efectividad de la histerectomia vaginal versus la histerectomia abdominal. Metodo:Estudio retrospectivo observacional, en 2.338 pacientes sometidas a histerectomia por patologia benignaen el Servicio de Ginecologia del Hospital Clinico de la Universidad de Chile, en el periodo comprendidoentre enero de 1997 a diciembre de 2005. Se analizaron variables clinicas y de costo entre las dos viasde abordaje. Resultados: La edad de las pacientes fluctuo entre 27 y 86 anos. De las 2.338 histerectomias,la via vaginal correspondio al 36,9% y la abdominal en el 63,1%; con una tasa de complicaciones de 29,8/100 mujeres operadas vaginalmente y de 42,8/100 mujeres operadas abdominalmente. Conclusion: Esteestudio sugiere que el abordaje vaginal se asocio a tiempos operatorios mas cortos, menor numero decomplicaciones y a costos mas bajos que la via abdominal.PALABRAS CLAVE: Histerectomia vaginal, histerectomia abdominal, costo-efectividadhisterectomiasSUMMARYBackground: After cesarean delivery, hysterectomy it is the second most frequently performed majorsurgical procedure. Objective: To study de relation cost/effectivity between vaginal and abdominalhysterectomy. Method: Retrospective and observational study in 2338 hysterectomy, performed betweenJanuary 1997 and December 2005. Clinical and cost variables were analysed between both surgical routes.Results: The study included 2338 patients aged 27 to 86 years in whom hysterectomy was performed forbenign gynaecologic disorders. Of 2338 hysterectomies, 36.9% were performed vaginally and an abdominalapproach was required in 63.1%. The overall complication rate was 29.8 per 100 women for vaginalhysterectomy and 42.8 per 100 women for abdominal hysterectomy. Conclusion: This study suggests thatvaginal route presents some advantages in comparison to abdominal hysterectomy that include lessexpensive, fewer complications, shorter operating times and shorter stays.KEYWORDS: Vaginal hysterectomy, abdominal hysterectomy, cost-effectiveness hysterectomy

Indicadores de gestión de servicios de salud públicos y asignación de recursos desde el Ministerio de Salud de Chile

Background: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. Aim: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. Material and methods: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadisticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificacion y Cooperacion (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. Results: The first two main components were selected, with an accumulated percentage of explained variability of 63.05%. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and ery poor populations and public health insurance beneficiaries, to take care of in each Health Service. Conclusions: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined (Rev Med Chile 2004; 132: 1532-42). (Key Words: Health care facilities, manpower and services; Health services; Public health)

FACTORES PREDICTORES DE CESÁREA

RESUMENObjetivo: Identificar factores predictores de cesarea, en pacientes que ingresan para atencion de parto.Material y Metodos: 2883 pacientes con embarazo de termino, feto unico, presentacion cefalica, queingresaron para atencion de parto, desde enero de 2001 a diciembre de 2002, en el Servicio de Obstetriciadel Hospital Clinico de la Universidad de Chile, las que fueron sometidas a un analisis multifactorial defactores de riesgo para cesarea (regresion logistica). En el modelo final los factores de riesgo incluidosfueron los siguientes: multiparidad, inicio espontaneo del trabajo de parto, induccion del trabajo de parto,cicatriz de cesarea y peso del recien nacido ≥ 4000 gramos. Resultados: El riesgo de cesarea paramultiparidad fue 0,467 (IC95%, 0,264-0,826), inicio espontaneo del trabajo de parto 1,36 (IC95%, 2,02-9,17), induccion del trabajo de parto 2,950 (IC95%, 2,1-4,1), cicatriz de cesarea 22 (IC95%, 16,812-28,806)y peso del recien nacido ≥ 4000 g 2,746 (IC95%, 2,076-3,631). Conclusion: En pacientes con embarazode termino, la multiparidad disminuye el riesgo de cesarea. Macrosomia fetal, induccion del trabajo de partoy cicatriz de cesarea aumentan significativamente dicho riesgo. Estos factores debieran ser empleados paradetectar a gestantes con alto riesgo de cesarea y concentrar en estas, una mayor vigilancia durante elcontrol prenatal.PALABRAS CLAVES: Cesarea, analisis multifactorialSUMMARYObjective: To identify cesarean section’s predictive factors, in pregnant patients consulting for labor.Material and Methods: 2883 term (≥37 weeks) pregnant patients, single fetus, cephalic, consulting forlabor, between January 2001 and December 2002, in the Maternity Ward of the University of Chile. Thepatients were analyzed by logistic regression for cesarean section risk factors (Multi-factorial analysis).Finally, the risk factors included in the regression model were: multiparity, spontaneous beginning of labor,labor induction, previous cesarean section and birth weight ≥ 4000 g. Results: Odds Ratio (OR) forcesarean section in multiparous was 0.467 (95%CI, 0.264-0.826), spontaneous beginning of labor 1.36(95%CI, 2.02-9.17), labor induction 2.95 (95%CI, 2.1-4.1), previous cesarean section 22 (95%CI, 16.812-28.806) and live birth weight ≥ 4000 g 2.746 (95%CI, 2.076-3.631). Conclusions: In pregnant termpatients, multiparity reduces cesarean section risk. Macrosomia, labor induction and previous cesareansection significantly increase cesarean section risk. These predictive factors should be used to identifypregnant patients with high risk for cesarean section, to focus on them our attention, during prenatal care.KEY WORDS: Cesarean, multi-factorial analysis

IMPACTO ECONÓMICO DE LA PREMATUREZ Y LAS MALFORMACIONES CONGÉNITAS SOBRE EL COSTO DE LA ATENCIÓN NEONATAL

RESUMENObjetivos: Calcular los costos de la atencion neonatal de recien nacidos prematuros y en portadores demalformaciones congenitas mayores compatibles con la vida. Pacientes y Metodo: Estudio retrospectivoefectuado en el Departamento de Ginecologia y Obstetricia del Hospital Clinico de la Universidad de Chile,en 82 recien nacidos menores de 34 semanas de gestacion y en 14 con malformaciones congenitasmayores, de mas de 37 semanas de gestacion, compatibles con la vida, atendidos entre enero y diciembrede 2004. Resultados evaluados son los costos de la atencion neonatal subdivididos en componentes.Resultados: El costo promedio de la atencion neonatal en recien nacidos menores de 34 semanas fue iguala

CREACIÓN DE ÍNDICES DE GESTIÓN DE MATERNIDADES MEDIANTE EL ANÁLISIS DE COMPONENTES PRINCIPALES

2.519.508, en menores de 32 semanas igual a

Estudio del polimorfismo de receptores FcgammaIIa en pacientes chilenos con lupus eritematoso sistémico

3.766.999, en menores de 1500 gramos igual a

INDICADORES DE CALIDAD DE ASISTENCIA EN OBSTETRICIA

12.017.650 y en portadores de malformaciones congenitas mayores compatibles con la vida de

NORMAS DE PROFILAXIS ANTIBIÓTICA EN PROCEDIMIENTOS OBSTÉTRICOS

30.967.180. El dia cama representa el componente mas significativo dentro cada paquete con mas del60% del costo promedio. Conclusiones: El costo de la atencion neonatal de prematuros menores de 34semanas o portadores de malformaciones congenitas mayores compatibles con la vida es mayor alcontemplado en los paquetes de prestaciones a todo evento, representando el dia cama su componentemas significativo.PALABRAS CLAVES: Atencion neonatal, costo de salud, prematurez, malformacionescongenitas mayoresSUMMARYObjective: To calculate the cost involved in the neonatal care of premature or live born babies carriersof mayor congenital abnormalities compatible with life. Patients and method: Retrospective study whoanalyzed 82 premature live born of less than 34 weeks and 14 live born carriers of mayor congenitalabnormalities compatible with life, from January to December 2004, at the Maternity Ward from theUniversity of Chile Clinical Hospital. The outcome measures were the neonatal care average cost packagesubdivided by components. The cost was expressed in chilean currency. Results: Neonatal care averagecost was

SCREENING GENETICO ANTENATAL PARA LA DETECCION DE ANEUPLOIDIAS

2.519.508 in live born of less than 34 weeks,