Factores asociados al tiempo de estancia intrahospitalaria post trasplante renal en pacientes del Hospital Miguel Hidalgo

Abstract

Introducción: La enfermedad renal crónica es una pandemia que afecta al 10% de la población adulta. La relación costo beneficio de trasplante es buena. No obstante, es importante reducir los costos de atención en la medida posible y una posibilidad es disminuyendo la estancia hospitalaria. Objetivo: Evaluar que factores se asocian con aumento en días de estancia y costos de pacientes post - operados de trasplante renal. Material y métodos: Se realizó un estudio observacional, transversal, retrospectivo, en pacientes post operados de trasplante renal en el Centenario Hospital Miguel Hidalgo. Resultados: Se incluyeron 98 pacientes post-trasplantados de riñón en el CHMH, 56 ingresaron al servicio de Cirugía General y el restante 42 a la Unidad de Cuidados Intensivos (UCI). Entre los pacientes con cuidados post-operatorios en la UCI el tiempo de estancia fue 4.0±0.9 días en comparación con el servicio de Cirugía General, donde la estancia hospitalaria media fue 4.2±1.5 días (p=0.674). Los costos globales de atención en los pacientes ingresados a la UCI fueron $84074.8±13707.8 MXN y entre los pacientes atendidos por el servicio de Cirugía General fueron $76329.6±21291.3 (p=0.201). La estancia hospitalaria fue mayor en los que recibieron cuidados post-operatorios en UCI (5.1±2.0 días) que en Cirugía General (4.5±2.6 días); el costo de atención total fue de $88,869.49 en los ingresados a UCI en compración con cirugía general $80.292.33. Conclusiones: En pacientes con complicaciones transoperatorias, los que recibieron cuidados post -operatorios en UCI tuvieron mayor tiempo de estancia hospitalaria y mayores costos de atención promedio. Palabras clave: Enfermedad renal crónica, Trasplante renal, Donador vivo, Costo de atención hospitalaria.

Introduction: Chronic kidney disease is a pandemic that affects about 10% of the adult population globally. The cost of transplantation is high, although its costbenefit ratio is good. However, it is important to reduce the costs of care as much as possible and one possibility is reducing hospital stay. Objective: To assess wich factors are associated with the time of hospital stay and costs of care in posttransplanted kidney patients. Material and methods: An observational, crosssectional, retrospective study was carried out in patients post-operated from kidney trasplantation at the Centenario Hospital Miguel Hidalgo. Results: 98 posttransplant kidney patients were included, 56 entered to the General Surgery service to receive post-operative care and the remaining 42 to the Intermediate Intensive Care Unit (ICU). Among the patients with post-operative care in the ICU, the length of stay was 4.0 ± 0.9 days and in those admitted to the post-operative period in the General Surgery Service, the average hospital stay was 4.2 ± 1.5 days (p= 0.674). While, the overall costs of care in patients admitted to the ICU were $ 84074.8 ± 13707.8 MXN and among the patients who were treated in the post-operative period in the General Surgery Service were $ 76329.6 ± 21291.3 (p = 0.201). After multivariate analysis, among the patients with intraoperative complications the hospital stay was greater in those who received post-operative care in the ICU (5.1 ± 2.0 days) than in General Surgery (4.5 ± 2.6 days); and the total cost of care was $ 88,869.49 in those admitted to the ICU than in those admitted to general surgery $ 80,292.33. Conclusions: In patients without intraoperative complications there were no differences in hospital stay or in the costs of care; but among those with intraoperative complications, those who received post-operative care in the ICU had a longer hospital stay and higher average care costs. It is recommended to evaluate the possibility of providing postoperative care in the General Surgery Service instead of in the Intermediate Intensive Therapy. Keywords: Chronic kidney disease, Kidney transplant, Live donor, Postoperative management.