Factors associated with the appropriate use of preoperatory hospital stays: historical cohort study.
BACKGROUND
To ensure the highest efficiency, health services should be provided with the least possible complexity. The aim of this study is to quantify the degree of appropriateness in preoperatory hospital stays and to analyse those factors associated with a greater inappropriate use.


METHODS
Historical cohort study. The histories of 440 hospitalised patients who underwent at least one surgical procedure were analysed. Data collection was carried out by doctors not involved in the services studied, following the Appropriateness Evaluation Protocol. A bivariate and multivariate analysis of the factors associated with the appropriateness of preoperatory stays was carried out.


RESULTS
The mean number of days of preoperatory stay was 5.5 (SD 5.11), of which a mean number of 2.5 days were considered to be inappropriate (SD 4.11). The overall rate of inappropriateness was 45.2% (CI 95% 43.3-47.1). The multivariate analysis showed a positive association of the inappropriateness of the preoperatory stay with weekend days, programmed admission, hospital stays longer than 7 days, medical records incorrectly or incompletely documented and the age groups of 45-65 and the >65 with respect to the <45 age group. Sex and an incorrect or incomplete nursing register did not show such an association.


CONCLUSIONS
The inappropriate use of hospital stay during preoperatory care affects almost half the period and there are some risk determinants that could act as indicators at admission. In addition, the efficiency of care provision was found to vary greatly from the point of view of its appropriateness.
Tamames
Sonia
S
Quality Unit, University Clinical Hospital, Valladolid, Spain. soniatamames@gmail.com
Perez Rubio
Alberto
A
Castrodeza Sanz
Javier
J
Canton Alvarez
Maria Belen
MB
Luquero
Francisco J
FJ
Santos Sanz
Sara
S
Lopez Encinar
Placido
P
de la Torre Pardo
Maria Paz
MP
Gil Gonzalez
Juan Manuel
JM
D000368:Aged; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D017050:Episode of Care; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013997:Time Factors; D014600:Utilization Review