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• The increased demand for hip arthroplasty means a growing number of postsurgical complications. • Surgical site infection is the second most frequent complication after prosthetic loosening. • Hospital-based infection surveillance is an important component for of surgical site infection control. • Timing of surgery (elective or urgent/unplanned) influences the infection risk in orthopedic surgery. • Operative times, blood transfusion or patient preparation before surgery, are key for infection prevention. The increased demand for hip arthroplasty means a growing number of postsurgical complications. This study aims to assess the risk of surgical site infection (SSI) in a teaching hospital; develop regional, national and international external comparisons; and evaluate SSI-related risk factors, particularly according to the timing of surgery (urgent/unplanned or elective). Prospective cohort study from January 2008 to December 2018. Patients were followed up to 90 days after surgery. Primary endpoint was SSI incidence according to the Centers for Disease Control and Prevention criteria. Multivariate analysis was conducted to find independently associated SSI risk factors. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR). Analyses were also performed among urgent/unplanned and elective patients to identify whether SSI risk factors differed between groups. The study population (n = 1,808) has an overall SSI rate of 3.0% (95% confidence interval [CI]: 2.4-3.9). Timing of surgery caused an effect modification, so surgery duration> 75th percentile (OR: 3.8; 95% CI: 1.5-9.8) and inadequate preparation (OR: 3.3; 95% CI: 1.1-10.0) were independent risk factors in the urgent/unplanned group; National Healthcare Safety Network risk index≥ 2 (OR: 6.3; 95% CI: 0.1-19.2) and transfusion (OR: 3.6; 95% CI: 1.1-11.9) in the elective group. Hospital infection surveillance systems allow identifying risk factors susceptible to change. Characterization of factors that caused an effect modification is key to identify areas of quality improvement, including reducing operating times, preventing perioperative blood transfusion, or improving patient preparation before surgery. [ABSTRACT FROM AUTHOR]

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Highlights • Hospital surveillance systems provide indicators that are critical to reduce nosocomial infection. • Low surgical site infection (SSI) rates serve as a good measure by which healthcare quality can be assessed. • Our SSI risk proved to be lower than those for the Madrid Region and for Spain. • The standardized infection ratio was 1.14 with respect to rates in the United States. • A declining trend was found in our SSI risk in the 9 years of follow-up. • Independent risk factors included hair removal and National Healthcare Safety Network risk index ≥ 2. Background Surgical site infection (SSI) is one of the complications posed by knee replacement surgery. Hospital-based infection surveillance systems may provide indicators of improvement and allow the characterization of risk factors critical to reduce infection. The aims of this study were to compare the incidence of SSI in our center with rates in the Madrid Region, Spain, and the United States, and to evaluate any possible SSI-related risk factor in knee replacement surgery. Methods All patients who underwent knee replacement surgery at a tertiary hospital in 2008–2016 were included. SSI was defined according to Centers for Disease Control and Prevention criteria. Infection rate was calculated. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR) with multivariate analysis. Results The study population (n = 1969) had a global SSI risk of 1.0%. We found a declining trend in the follow-up period, from an SSI risk of 1.8% in 2009 to 0.4% in 2016. Independent risk factors included hair removal (OR: 3.09, 95% confidence interval [CI]: 1.27–7.50) and National Healthcare Safety Network risk index ≥ 2 (OR: 9.37, 95% CI: 2.90–30.26). Conclusion This study identified risk factors that showed the necessity to strictly comply with wound decontamination and patient preparation protocols, reduce surgery duration, and identify patients who require comprehensive monitoring. [ABSTRACT FROM AUTHOR]

The aim of this study is to report the epidemiological characteristics of a food poisoning outbreak due to scombroid fish in a hospital. A case-control study (1:4) was conducted. Patients either symptomatic of food poisoning (cases) or asymptomatic (controls) eating at the hospital cafeteria were included. To identify the source of the outbreak, sanitary control factors were assessed. Microbiological studies and the mast cell tryptase test were performed. All cases and controls received a questionnaire enquiring about symptoms and foods consumed. The odds ratios (OR) for all risk factors and their 95% confidence intervals (CI) were assessed. In total, 20 individuals (90% female) were included in the study: four cases and 16 controls. The overall mean age was 43 years (SD: 10.2). The most frequent symptom observed was facial and neck erythaema (100%). Microbiological cultures were negative, the mast cell tryptase test was normal and breakdown of the cold chain did not occur. The most likely source of the outbreak was fried anchovies (OR: 34.7; 95% CI: 1.50–809.6; p = 0.02). Methods suitable to the rapid assessment of the outbreak allowed us to establish prompt preventive measures and identify the likely aetiology. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to estimate the frequency of hospitalizations due to herpes zoster (HZ) and to describe their clinical characteristics by sex and age group.Methods: Descriptive population-based cross-sectional study of hospital admissions due to HZ from 2003 to 2013 among residents in the Autonomous Community of Madrid. Sex, age, comorbidities, length of stay and outcomes were collected and described. Crude and age-adjusted cumulative incidence rates, and stratified by sex and age, were estimated. Robust Poisson regression analysis was used to calculate the incidence rate ratios by age group.Results: 2039 hospitalizations were identified (51.0% in women). Complicated HZ caused 48.7% of them (50.9% in women). The hospitalization rate was 2.98/100,000 person-years and 7.19/1000 cases of HZ in primary care. Both rates were significantly higher in men, except in the extreme age groups. An immunosuppression-associated comorbidity was identified in 32.8% of the cases and was less common in patients ≥75 years of age. The median length of stay was 6 days, and in-hospital mortality was 1.4%.Conclusions: Hospitalization rates due to HZ were higher in men and increased with age. In two out of every three cases, a comorbidity that potentially caused immunosuppression could not be identified. These cases could benefit from vaccination. [ABSTRACT FROM AUTHOR]

Summary Objectives This study aimed to estimate herpes zoster (HZ) related hospitalization rates in the Autonomous Community of Madrid (Spain), considering both total and complicated cases, and to analyze their temporal trends by sex and age. Methods Population based cross-sectional study of all hospital admissions with an HZ diagnosis in any position from 2003 to 2013. Annual crude, age-adjusted and age-specific hospitalization rates were calculated by sex and year. Joinpoint Regression models were used to analyze time trends. Results The incidence of hospitalizations with HZ increased significantly during the study period from 10.81 to 16.97 per 100,000 person-year, with an average annual rise of 2.80%. The rate of hospitalization of complicated HZ increased from 4.67 to 8.99 per 100,000 person-year. No ‘breakthrough points’ of the time trends were detected. The proportion of complicated HZ was similar in both sexes, and increased from 43.2% to 53.0%. By age and sex significant increases affecting women from age 85 and men from age 75 and in the group of 45–64 years were observed. Conclusions Hospitalizations related to HZ are increasing, with a significant rise of complicated cases. Long term and more detailed studies are required to monitor HZ. [ABSTRACT FROM AUTHOR]

• To our knowledge, this is the first cost-utility analysis comparing HD-QIV to aTIV. • Switching from aTIV to HD-QIV would prevent 36,476 cases of influenza annually. • Up to 9,193 hospitalisation episodes and 357 deaths would be avoided annually. • HD-QIV would be a cost-effective or even cost-saving strategy for ≥ 65 yo in Spain. • HD-QIV could save €28 million annually due to prevented cardiorespiratory events. The normal ageing process is accompanied by immunosenescence and a progressive weakening of the immune system. High-dose inactivated influenza quadrivalent vaccine (HD-QIV) has shown greater immunogenicity, relative efficacy, and effectiveness than the standard-dose inactivated quadrivalent vaccine (SD-QIV). The aim of the study was to assess the cost-utility of an HD-QIV strategy compared with an adjuvanted trivalent inactivated vaccine (aTIV) strategy in the population above 65 years of age in Spain. We evaluated the public health and economic benefits of alternatives by using a decision-tree model, which included influenza cases, visits to the general practitioner (GP), visits to the emergency department (ED), hospitalisations, and mortality related to influenza. We performed deterministic and probabilistic sensitivity analyses to account for both epidemiological and economical sources of uncertainty. Our results show that switching from aTIV strategy to HD-QIV would prevent 36,476 cases of influenza, 5,143 visits to GP, 1,054 visits to the ED, 9,193 episodes of hospitalisation due to influenza or pneumonia, and 357 deaths due to influenza – increasing 3,514 life-years and 3,167 quality–adjusted life–years (QALYs). Healthcare costs increase by €78,874,301, leading to an incremental cost-effectiveness ratio (ICER) of €24,353/QALY. The sensitivity analysis indicates that the results are rather robust. Our analysis shows that HD-QIV in people over 65 years of age is an influenza-prevention strategy that is at least cost-effective, if not dominant, in Spain. It reduces cases of influenza, GP visits, hospitalisations, deaths, and associated healthcare costs. [ABSTRACT FROM AUTHOR]

• Lower respiratory infections remain the most lethal communicable disease worldwide. • Viral and bacterial coinfections are common complications of seasonal influenza and are associated with around 25% of all influenza-related deaths, particularly in the elderly population. • In Spain, community-acquired pneumonia and influenza continue to be an important cause of hospitalization and mortality in patients aged 60 years or older. • There is an urgent need to further develop prevention strategies in elderly people such as joint vaccination with both influenza and pneumococcal vaccines. Lower respiratory infections remain the most lethal communicable disease worldwide. Viral and bacterial coinfections (VBC) are common complications in patients with seasonal influenza and are associated with around 25% of all influenza-related deaths. The burden of pneumonia in patients with VBC in Spain is poorly characterized. To address this question, we aimed to provide population data over a period of six consecutive influenza seasons, from 2009–10 to 2014–15. We used the discharge report from the Minimum Basic Data Set (MBDS), published annually by the Spanish Ministry of Health, to retrospectively analyse hospital discharge data in individuals aged ≥60 years with a diagnosis of pneumonia and influenza, based on the International Classification of Diseases (ICD-9-CM codes 480–486 and 487–488, respectively), from 1 October 2009 to 30 September 2015. In total, 1933 patients ≥60 years old were hospitalized for pneumonia and influenza, of whom 55.2% were male. The median age was 74 years (interquartile range [IRQ] 15); half of the patients were ≥75 years old. Influenza was the main diagnosis in 64.4% of the patients, and all–cause pneumonia in 15.8%, half of whom were assigned a diagnostic code for pneumococcal pneumonia. The mean annual hospitalization rate was 2.99 per 100,000 population (95% CI 2.9–3.1) throughout the study period, while the highest rate, 5.6 per 100,000 population (95% CI 5.2–6.0), was observed in the 2013–14 season. The mean annual mortality rate was 0.5 deaths per 100,000 population (95% CI 0.4–0.6) and in-hospital case fatality rate was 16.1% (95% CI 14.5–17.8). In Spain, community-acquired pneumonia and influenza continue to be an important cause of hospitalization and mortality in patients over 60 years of age. There is an urgent need to further develop prevention strategies such as joint vaccination for both pathologies. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Bariatric surgery is associated with a significant improvement in glucose control and even diabetes remission. There are no studies investigating national trends in the use of bariatric surgery in people with type 2 diabetes. We examine trends in the use of bariatric surgery in patients with and without type 2 diabetes between 2001 and 2010 in Spain. Methods: We identified patients who underwent bariatric surgery using national hospital discharge data. Discharges were grouped by diabetes status. Incidence of discharges due to bariatric surgery were calculated and stratified by diabetes status, procedure and year. We calculated length of stay (LOS) and in-hospital mortality (IHM). Results: From 2001 to 2010 13,038 bariatric surgery procedures were performed. Over the study period 23.6% (n =3080) of all patients undergoing bariatric procedure had DM as a co-diagnosis. This prevalence increased from 17.3% in 2001 to 25.5% in 2010. LOS and IHM were similar among patients with and without type 2 diabetes. Conclusion: The proportion of subjects with type 2 diabetes among bariatric surgery patient has increased over time, in part due to an increase in the use of laparoscopic techniques. [Copyright &y& Elsevier]

Abstract: We examined trends and characteristics of deliveries in women with gestational diabetes in Spain from 2001 to 2008. There were 101,643 deliveries with gestational diabetes among 2,782,369 delivery discharges (3.6%) with no increase over time. Rate of caesarean section increased (19–24.2%) and length of stay decreased. [Copyright &y& Elsevier]

Abstract: All hospital discharges and deaths related to invasive meningococcal disease, meningococcal meningitis and meningococcemia in the general population from 1997 to 2008 in Spain were obtained. Among the 11,611 meningococcal infection related discharges 53% were meningococcal meningitis and 55% were meningococcemia. The annual hospitalization rate was 2.33, 1.23 and 1.29 cases per 100,000 for invasive meningococcal disease, meningococcal meningitis and meningococcemia, respectively. 846 deaths for invasive meningococcal disease, 235 for meningococcal meningitis and 605 for meningococcemia were reported. Although an important decrease in meningococcal infections related morbidity and mortality has occurred in the last twelve years in Spain, they still continue being major causes of hospitalization and death, especially in the children up to 2 years of age. Future preventive measures, such as vaccination with vaccines covering new conjugated serogroups (B and ACYW135), could further improve population health. [Copyright &y& Elsevier]

Abstract: All hospital discharges and deaths related to CAP and pneumococcal-pneumonia from adults over 50 from 2003 to 2007 in Spain were obtained. Among the 447,670 Pneumonia-all causes discharges 17% were pneumococcal pneumonia. The annual hospitalisation rate was 6.27 and 1.09 cases per 1000, respectively. 75,932 deaths for Pneumonia-all causes and 9062 for pneumococcal-pneumonia were reported. CAP and pneumococcal pneumonia are major causes of morbidity and mortality in Spain, especially in the elderly. Despite current preventive measures, no significant changes in hospitalisation, mortality and case-fatality rates were found over the study period. Future preventive measures, like vaccination, could overcome these limitations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We examined time trends in the use of health care services between diabetic and nondiabetic adults in Spain and their associations with sociodemographics variables. Research Design and Methods: Using data from two national health surveys, we estimated use of health care services, including hospital days per person-year, in the diabetic and nondiabetic populations in 1993 (n=20,880) and 2006 (n=29,478) in Spain. As the dependent variable, we took the answer to the questions, “Has used emergency medical services in the preceding year?” and/or “Have you been admitted to hospital in the preceding year?” Independent variables were age group, gender, educational level, and coexistence of chronic conditions. Results: Use of emergency medical services has been significantly incremented between 1993 and 2006—from 19.6% to 36.6% for the diabetic population and from 13.8% to 29.0% for the nondiabetics. In the diabetic population, with respect to hospital admission, 13.2% of diabetics said that they had been hospitalized in 1993 compared with 18.0% in 2006 (P<.05). The results of multivariate analysis, after controlling for confounders, indicated that diabetics used significantly more health care resources in 2006 than in 1993 [odds ratio (OR)=1.34, 95% confidential interval (CI)=1.01–1.79 for admission in hospital and OR=2.03 95% CI=1.58–2.62]. Also, the length of hospital stay for diabetics increased significantly in 2006 with respect to 1993 (1.38 relative hospital days). Conclusions: Spanish diabetic individuals used health care services (emergency room, admission to hospital) more often than nondiabetics. Furthermore, the length of hospital stay increased among the diabetics surveyed in 2006 compared with that in 1993. [Copyright &y& Elsevier]

Objectives: Traditionally, influenza is not considered to be a serious disease in healthy children. However, for vulnerable populations, such as young children and those with chronic medical conditions, influenza can lead to serious complications and even death. This study aimed to assess vaccination coverage among Spanish children under 16 years of age in 2006, and to describe the factors associated with vaccination. Study design: Cross-sectional survey. Methods: In total, 8851 records of children included in the Spanish National Health Survey for 2006 were analysed. The reply ('yes' or 'no') to the question: 'Did you have a flu shot in the latest campaign?' was used as a dependent variable. Influenza vaccine coverage was calculated as the percentage of individuals aged 6 months to 16 years whose parents reported that they had been vaccinated against influenza in the most recent campaign. The influence of sociodemographic variables on vaccination and the presence of associated chronic diseases (asthma and/or diabetes) were also analysed. Results: Vaccination coverage among Spanish children in 2006 was 6.82%: 19.43% in children with associated conditions (asthma and/or diabetes), and 5.81% in healthy children. The only factor significantly associated with influenza vaccination in children with associated conditions was household income; children with a lower household monthly income were more likely to have been vaccinated against influenza than children with a higher household monthly income (odds ratio 1.96). In children for whom vaccination is not indicated, the probability of being vaccinated against influenza was greater in those whose parents were not university graduates. Conclusion: Influenza vaccination coverage in Spanish children is low. Socio-economic inequalities continue to be a factor at the time of vaccination. [ABSTRACT FROM AUTHOR]

Abstract: We examine trends in cigarette smoking in adults with and without diabetes in Spain. Among diabetic men, prevalence of smoking was lower in 2009 (20.7%) than in 1987 (34.6%); however among diabetic women, the prevalence significantly increased. Prevalence of smoking in diabetic adults was lower than for those without diabetes. [Copyright &y& Elsevier]

Abstract: Using data from the Minimum Basic Dataset (MBDS) we described the hospitalizations in Spanish patients with diabetes. In 2007, acute diabetes-related complications accounted for 3.9% of admissions and chronic complications accounted for 30.3%. Mean cost per patient was €4339. We conclude that diabetes had a high impact on hospitalizations including costs. [Copyright &y& Elsevier]