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Influencia de ser intervenido en un Hospital Universitario en la supervivencia de pacientes llevados a procedimiento de reemplazo valvular afiliados al régimen contributivo en Colombia entre 2016 y 2019

dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacional
dc.contributor.advisorBuitrago, Giancarlo
dc.contributor.authorMaldonado-Cañón, Kevin
dc.date.accessioned2023-07-19T19:19:01Z
dc.date.available2023-07-19T19:19:01Z
dc.date.issued2023-07-17
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/84236
dc.descriptionilustraciones, diagramas
dc.description.abstractObjetivos: Determinar la asociación de ser intervenido en un hospital universitario con la supervivencia en pacientes afiliados al régimen contributivo en Colombia llevados por primera vez a reemplazo valvular entre 2016 y 2019. Materiales y Métodos: Estudio retrospectivo de cohortes basado en registros administrativos. Como desenlaces se presentan el tiempo al evento de muerte y las incidencias acumuladas de muerte, reingreso y re-intervención. Se configura una muestra artificial mediante la ponderación de la probabilidad inversa del tratamiento por puntajes de propensión para estimar el efecto marginal de la exposición ajustado por variables sociodemográficas, comorbilidades, vía y peso de la intervención. Resultados: De una muestra de 3,690 procedimientos correspondientes a 3,551 pacientes, 1,065 (30%) fueron intervenidos en un hospital universitario. La mediana de edad fue 64.9 (18.1-91.5), siendo 38.6% de los pacientes ≤60 años y 6.8% ≥80 años. Las incidencias acumuladas de muerte a 30, 90 días y un año fueron de 5.9%, 8% y 10.9%, respectivamente. 23.7% presentaron un reingreso a 90 días y 3.8% una reintervención al año. Los pacientes intervenidos en un hospital universitario tienen menor riesgo de muerte a 30 días (OR 0.51; IC95% 0.29-0.92); sin embargo, no se identificó asociación alguna con la supervivencia en términos de tiempo al evento de muerte (HR 1.09, IC95% 0.80-1.50), o con los demás desenlaces. Conclusiones: Se presenta un punto de partida hacia la investigación de una exposición no estudiada en nuestro país con potencial valor no solo para la medicina clínica cardiovascular, sino para el entendimiento del hospital universitario como hipóstasis de una sinergia académico-asistencial. (Texto tomado de la fuente)
dc.description.abstractObjectives: We aim to evaluate the association of being operated on in a university hospital with the survival of patients affiliated with the contributory regime in Colombia who underwent a first heart-valve replacement between 2016 and 2019. Materials and Methods: A retrospective cohort study based on administrative records was conducted. The time-to-death event and cumulative incidences of death, readmission, and re-operation are presented as outcomes. An artificial sample is configured through the Inverse Probability of Treatment Weighting to estimate the marginal effect of exposure, adjusting for sociodemographic variables, comorbidities, technique, and weight of the intervention. Results: From a sample of 3,690 procedures corresponding to 3,551 patients, 1,065 (30%) were operated on in a university hospital. The median age was 64.9 (18.1-91.5), 38.6% of patients were ≤60 years, and 6.8% ≥80 years. The cumulative incidences of death at 30, 90 days, and one year were 5.9%, 8%, and 10.9%, respectively. In addition, 23.7% presented a readmission within 90 days and 3.8% a reintervention within a year. Odds of 30-day mortality are lower for patients operated on in a university hospital (OR 0.51; 95%CI 0.29-0.92); however, no association was identified with the survival in terms of time-to-event (death) (HR 1.09, 95%CI 0.80-1.50), or with the other outcomes. Conclusions: We presented a first step towards researching an exposure that has not been studied in our country with potential value not only for cardiovascular medicine but also for understanding the university hospitals as the essential nature of reality of an academic-clinical synergy.
dc.format.extentxii, 82 páginas
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.publisherUniversidad Nacional de Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.ddc610 - Medicina y salud::617 - Cirugía, medicina regional, odontología, oftalmología, otología, audiología
dc.titleInfluencia de ser intervenido en un Hospital Universitario en la supervivencia de pacientes llevados a procedimiento de reemplazo valvular afiliados al régimen contributivo en Colombia entre 2016 y 2019
dc.typeTrabajo de grado - Maestría
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.versioninfo:eu-repo/semantics/acceptedVersion
dc.publisher.programBogotá - Medicina - Maestría en Epidemiología Clínica
dc.description.degreelevelMaestría
dc.description.degreenameMagíster en Ciencias Epidemiología Clínica
dc.identifier.instnameUniversidad Nacional de Colombia
dc.identifier.reponameRepositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourlhttps://repositorio.unal.edu.co/
dc.publisher.facultyFacultad de Medicina
dc.publisher.placeBogotá, Colombia
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotá
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.subject.decsAnálisis de Supervivencia
dc.subject.decsSurvival Analysis
dc.subject.decsPrótesis Valvulares Cardíacas
dc.subject.decsHeart Valve Prosthesis
dc.subject.proposalEnfermedades de las Válvulas Cardíacas
dc.subject.proposalPrótesis Valvulares Cardíacas
dc.subject.proposalImplantación de Prótesis de Válvulas Cardíacas
dc.subject.proposalReemplazo Valvular
dc.subject.proposalHospitales de Enseñanza
dc.subject.proposalHospitales Universitarios
dc.subject.proposalHeart Valve Diseases
dc.subject.proposalHeart Valve Prosthesis
dc.subject.proposalHeart Valve Prosthesis Implantation
dc.subject.proposalValve Replacement
dc.subject.proposalTeaching Hospitals
dc.subject.proposalUniversity Hospitals
dc.title.translatedInfluence of being operated on in a University Hospital on the survival of patients undergoing a valve replacement procedure affiliated with the contributory regime in Colombia between 2016 and 2019
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.contentText
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2
dcterms.audience.professionaldevelopmentEstudiantes
dcterms.audience.professionaldevelopmentInvestigadores
dcterms.audience.professionaldevelopmentMaestros
dcterms.audience.professionaldevelopmentMedios de comunicación
dcterms.audience.professionaldevelopmentPúblico general
dc.contributor.orcidKevin Maldonado Cañón [0000000316495290]
dc.contributor.cvlacKevin Maldonado Cañón [0001889706]
dc.contributor.researchgateKevin-Maldonado-Canon [2179280748]


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