In Colombia's contributory regime, LA is associated with lower 30-day mortality rate and higher hospital costs as compared to OA. No differences are found in ICU admissions or LOS.
PURPOSE Breast cancer care requires a multimodal approach and a multidisciplinary team who must work together to obtain good clinical results. The fragmentation of care can affect the breast cancer care; however, it has not been measured in a low-resource setting. The aim of this study was to identify fragmentation of care, the geographic variation of this and its association with 4-year overall survival (OS), and costs of care for patients with breast cancer enrolled in Colombia's contributory health care system. MATERIALS AND METHODS A retrospective cohort study was conducted using administrative databases. Women with breast cancer who were treated from January 1, 2013, to December 31, 2015, were included. Fragmentation of care was the exposure, which was measured by the number of different health care provider institutions (HCPIs) that treated a patient during the first year after diagnosis. Crude mortality rates were estimated, survival functions were calculated using the nonparametric Kaplan-Meier approach, and adjusted hazard ratios (HRs) were estimated using multivariate Cox regression model to identify the association of fragmentation with 4-year OS. The association between fragmentation and costs of care was assessed using a multivariate linear regression model. RESULTS A total of 10,999 patients with breast cancer were identified, and 1,332 deaths were observed. The 4-year crude mortality rate was 31.97 (95% CI, 30.25 to 33.69) per 1,000 person-years for the whole cohort, and the highest rate was in the cohort defined for the fourth quartile of the fragmentation measurement (eight or more HCPIs), 40.94 (95% CI, 36.49 to 45.39). The adjusted HR for 4-year OS was 1.04 (95% CI, 1.01 to 1.07) for each HCPI additional. The cost of care is increased for each additional HCPIs (cost ratio, 1.25; 95% CI, 1.23 to 1.26). CONCLUSION Fragmentation of care decreases overall 4-year OS and increases the costs of care in women with breast cancer for Colombia.
La infección del sitio quirúrgico (ISQ) es una de las principales causas de infecciones asociadas a la atención en salud (IAAS), con un impacto significativo en la mortalidad y morbilidad del paciente quirúrgico, así como en los costos asociados a la atención en salud. El adecuado uso de la profilaxis quirúrgica antimicrobiana es un aspecto fundamental en la reducción del riesgo de ISQ, dado que su utilización inapropiada o indiscriminada puede representar un riesgo para los pacientes y contribuir al desarrollo de resistencia a los antimicrobianos, por lo que resulta de importancia generar directrices que permitan orientar el uso adecuado de antimicrobianos en la profilaxis del paciente quirúrgico, con el objetivo de obtener mejores desenlaces clínicos y propender por un uso racional de antibióticos. La presente guía contiene recomendaciones para profilaxis antibiótica de pacientes sometidos a procedimiento quirúrgico, basadas en la evidencia, realizadas mediante el proceso de adaptación de guías de práctica clínica para el contexto colombiano.
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