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in the Madrid Health Services &#40;SERMAS&#41; in Spain&#44; an approach for grouping procedures into standard operating times &#40;SOTs&#41; was developed&#46; In this system&#44; the most common interventions on the surgical waiting lists are each assigned an SOT descriptor&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> By combining data from diagnosis and procedures&#44; extracted from the International Classification of Diseases 9 Clinical Modification codes&#44; an SOT is obtained for each descriptor&#46; This value is associated with the standard intervention time&#44; the downtime&#44; and the weighting of the descriptor&#46; The standard intervention time is defined as the time needed for an expert surgical team to perform the intervention&#44; measured from when the patient enters the operating room until he or she leaves it&#46; Downtime is defined as the time necessary to prepare the operating room for the next operation&#46; The weighting of the intervention is related to the fees charged per surgical act&#46; The assignment of times for the different SOT groups is made through consensus of a group of experts&#46; An SOT is considered as equivalent to 60<span class="elsevierStyleHsp" style=""></span>minutes of surgery time&#59; for shorter times&#44; fractions of SOTs are used &#40;for example&#44; an SOT of 0&#46;3 would be equivalent to 18<span class="elsevierStyleHsp" style=""></span>minutes while one of 0&#46;5 would be equivalent to 30<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to manage the operating rooms appropriately&#44; the number of operations that a surgical department would be able to perform in a given time should be known&#46; This can be estimated through surgical productivity&#46; The operating room occupancy&#44; that is&#44; the percentage of time that the operating room is occupied by patients compared to the total time available&#44; is the most common approach for measuring performance&#46; It also provides a reflection of time spent operating during a surgical shift&#46; The occupancy is merely a mathematical calculation that does not take into account the time employed in preparing and cleaning the operating rooms between patients&#44; and so for large numbers of interventions&#44; occupancy is lower&#46; Occupancy is perhaps not the most appropriate measure of productivity of a dermatology operating room&#44; especially in the case of minor surgery&#44; where many short interventions are performed during each surgical shift&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Good time management goes hand in hand with improved surgical productivity&#44; with a decrease in expenditure on surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> With classification into SOT groups&#44; it is possible to measure the length of the surgical waiting list &#40;SWL&#41;&#44; surgical activity&#44; and efficiency of operating room utilization through the indicators of surgical scheduling adequacy &#40;SA1 and SA2&#41;&#46; SA1 for a shift is calculated as the ratio of time the operating room is available &#40;7 SOTs in a surgical shift of 7<span class="elsevierStyleHsp" style=""></span>hours&#41; and the sum of SOTs &#40;SOT interventions<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SOT downtime&#41; scheduled according to the SWL&#46; The SA1 indicator shows whether the surgical shift has been appropriately scheduled &#40;value close to 1&#41; or whether there is overbooking &#40;SA1<span class="elsevierStyleHsp" style=""></span>&#60;1&#41; or underbooking &#40;SA1<span class="elsevierStyleHsp" style=""></span>&#62;1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The SA2 indicator reflects the portion that the total sum of SOTs for the interventions performed represents with respect to the total time available&#59; it is thus an indicator of surgical productivity&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The 2 indicators can be used to reflect the balance between patients entering and leaving the SWL&#46; Given that 10&#37; of the patients included on the SWL will usually not undergo the scheduled operation&#44; the product SA1<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>SA2 should remain close to 0&#46;9 to ensure equilibrium&#46; With an ideal standard value for SA2 of 85&#37;&#44; the standard value of SA1 should be 1&#46;06 to maintain a product of 0&#46;9&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to analyze the surgical activity in our dermatology department&#44; comparing the different measures of productivity for the operating room&#44; and to assess the utility of SOT in the management of a dermatology operating room&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was a descriptive&#44; retrospective study of scheduled surgical activity performed in the dermatology department of Hospital Universitario de Fuenlabrada&#44; Madrid&#44; Spain&#44; between January 2005 and December 2010&#46; The Hospital Universitario de Fuenlabrada is a secondary care hospital in terms of size and services&#46; It covers the health areas of Fuenlabrada&#44; Moraleja de Enmedio&#44; and Humanes of the former district 9 &#40;until the formation of a single district in 2011&#41;&#44; with a catchment population of approximately 225&#160;000 inhabitants&#46; The demographic characteristics of the district reflect a young population with a high birth rate&#44; a high proportion of children&#44; and a lower proportion of elderly individuals than the mean value for the Community of Madrid&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The data collected in the study were taken from the computerized Selene medical records&#46; These include clinical information&#44; specific forms for dermatologic surgery&#44; nursing protocols&#44; a record of pathology results&#44; and the minimum basic dataset&#46; The data were transferred to a Microsoft Excel 2003 spreadsheet for analysis&#46; The statistical tests were performed using the SPSS 17&#46;0 Statistical package&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The interventions performed were grouped into 13 SOT descriptors&#44; according to the clinical information on each patient and the complexity of the procedure scheduled at the time of inclusion on the SWL&#46; Subsequently&#44; after surgery and once it was confirmed that the procedure had been performed&#44; descriptors were regrouped into 18 SOTs&#46; The procedures that did not fit in any of the predefined descriptors were included in a generic SOT descriptor for the remaining dermatologic interventions &#40;other DER&#41;&#46; The data on the procedures performed and the surgical shifts &#40;number of patients operated per shift&#44; SOT&#44; duration of each intervention&#41; were calculated&#46; The variables were analyzed using relative frequencies and comparison of the means&#46; The surgical productivity was studied using different indicators&#44; comparing traditional occupancy with the surgical productivity assessed using SOT&#46; The surgical adequacy measures SA1 and SA2 were calculated&#46; The relationship between the variables was assessed by calculating the covariance and the Pearson linear correlation coefficient&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">During the study period&#44; 11&#160;516 surgical procedures were performed in the dermatology department of the Hospital Universitario de Fuenlabrada&#46; This activity was undertaken in 1184 surgical shifts and involved 11&#160;481 patients &#40;99&#46;7&#37;&#41;&#46; Of these shifts&#44; 80&#37; had a standard duration of 420<span class="elsevierStyleHsp" style=""></span>minutes&#44; while 13&#37; lasted 330<span class="elsevierStyleHsp" style=""></span>minutes and 7&#37; corresponded to evening shifts lasting 300<span class="elsevierStyleHsp" style=""></span>minutes&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Seventy-one percent of the shifts &#40;n<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>884&#41; corresponded to minor surgery&#44; while the remaining 29&#37; &#40;n<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>340&#41; were major outpatient surgery &#40;MOS&#41; shifts with the participation of the anesthesiology department&#46; Thirty-five surgical interventions were emergency procedures and not included in the programmed surgical shift&#46; During the study period&#44; the distribution of shifts per year remained relatively stable&#44; with a mean of 197 shifts per year and a maximum number of shifts of 229 in 2007&#46; The ratio of minor surgery to MOS also remained relatively stable during the study period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The mean &#40;SD&#41; number of patients operated on in each surgical shift throughout the whole study period was 9&#46;7 &#40;2&#46;73&#41; patients&#46; A progressive increase in the mean number of patients per shift was observed over the years&#44; from a minimum of 8&#46;34 &#40;1&#46;66&#41; in 2005&#44; then 8&#46;45 &#40;1&#46;87&#41; in 2006&#44; 9&#46;83 &#40;2&#46;78&#41; in 2007&#44; 10&#46;15 &#40;2&#46;79&#41; in 2008&#44; and 10&#46;59 &#40;2&#46;92&#41; in 2009&#44; before reaching a maximum of 10&#46;73 &#40;2&#46;97&#41; in 2010&#46; For MOS procedures and minor surgery taken separately&#44; the mean &#40;SD&#41; number of patients per shift was 6&#46;91 &#40;1&#46;15&#41; and 10&#46;82 &#40;2&#46;35&#41;&#44; respectively&#46; Likewise&#44; by type of surgery&#44; there was also a progressive increase during the study in the number of patients per shift from a minimum of 6&#46;49 &#40;0&#46;92&#41; for MOS and 9&#46;21 &#40;1&#46;15&#41; for minor surgery in 2005 to a maximum of 7&#46;46 &#40;0&#46;93&#41; for MOS and 12&#46;05 &#40;2&#46;45&#41; for minor surgery in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The overall operating room occupancy during the study period was 71&#46;91&#37;&#44; with a trend towards a decrease from 77&#46;66&#37; in 2005 to 70&#46;35&#37; in 2010&#44; and a minimum of 66&#46;98&#37; in 2009&#46; The same decreasing trend is observed in the occupancy for MOS and minor surgery&#46; At all times&#44; the productivity of the minor surgery operating room &#40;overall occupancy of 70&#46;73&#37;&#41; was lower than that of the MOS &#40;overall occupancy of 74&#46;83&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The covariance of the variables patients per shift and occupancy was &#8722;1&#46;85 and the Pearson linear correlation coefficient was &#8722;0&#46;053&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Three SOT descriptors &#40;minor surgery&#44; nail surgery&#44; and malignant skin tumor with direct closure&#41; were sufficient to classify 88&#46;3&#37; of the procedures performed&#46; After surgery&#44; 86&#46;7&#37; of the interventions performed were reassigned to 4 SOT descriptors&#46; In descending order of frequency&#44; 58&#37; &#40;6683 procedures&#41; were classed as minor surgery&#44; with an SOT value of 0&#46;35 &#40;21 <span class="elsevierStyleHsp" style=""></span>minutes&#41;&#44; 10&#37; &#40;1157&#41; as multiple minor skin lesions&#44; 9&#46;4&#37; &#40;1080&#41; as nail surgery&#44; and 9&#46;3&#37; &#40;1068&#41; as malignant skin tumor with direct closure&#44; all with an SOT value of 0&#46;46 &#40;27<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#46; The remaining descriptors &#40;in total there were 18&#41; were used much less frequently &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Most dermatologic interventions &#40;91&#46;3&#37;&#41; were associated with an SOT downtime of 0&#46;15 &#40;9<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The mean of the SA1 indicator throughout the study was 1&#46;20&#44; with a trend towards a decrease over the years&#44; until reaching a minimum of 0&#46;98 in 2010&#46; By types of surgery&#44; the mean SA1 was 1&#46;28 for the MOS shifts and 1&#46;17 for the minor surgery shifts&#46; The SA1 indicator in minor surgery showed a progressive decrease from a maximum value of 1&#46;40 in 2005 to a minimum of 0&#46;99 in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The covariance of the variables patients per shift and occupancy was &#8722;0&#46;517 and the Pearson linear correlation coefficient was &#8722;0&#46;279 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The overall operating room productivity measured with the SA2 indicator was 96&#46;46&#37;&#44; with an increase from the value of 81&#46;69&#37; at the start of the study to 118&#46;23&#37; in 2010&#46; The productivity of the MOS shifts ranged from a minimum of 81&#46;12&#37; in 2005 to a maximum of 141&#46;38&#37; in 2010&#46; The minor surgery shifts also showed a trend towards increased surgical productivity during the study period&#44; with a minimum of 77&#46;20&#37; in 2006 and a maximum of 108&#46;94&#37; in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The covariance of the variables patients per shift and operating room productivity measured with SA2 was 26&#46;019 and the Pearson linear correlation coefficient was 0&#46;297 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The product of the SA1 and SA2 indicators&#44; both for minor surgery and MOS&#44; during the study period&#44; remained close to or above 0&#46;9 &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The surgical activity in our dermatology department has increased progressively over recent years&#46; The clear increase in activity&#44; both for minor surgery and MOS&#44; was driven by the increase in the number of patients operated on in each shift&#44; given that the number of surgical shifts per year remained relatively stable during the study period&#46; The overall occupancy of the dermatology operating room was 71&#46;91&#37;&#44; which is similar to that reported for other series&#44; where it ranges from 70&#37; to 85&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It is thought that implementation of measures to ensure a punctual start to the surgical shift&#44; a decrease in the downtimes between surgery&#44; and an increase in the number of patients scheduled per shift increases occupancy in all surgical departments&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; in our case&#44; occupancy did not improve but actually worsened after an increase in the number of patients per surgical shift&#44; probably as a result of the downtime between interventions&#46; The negative covariance value shows that there is an inverse relationship between the 2 variables&#44; and so it does not appear that increasing the number of patients is a useful way of improving occupancy in dermatology surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The classification into SOT groups considers the standard time that it would take to carry out an intervention&#44; according to the complexity and patient characteristics and the downtime associated with a given intervention&#46; This allows the available time to be better managed and appropriate planning of surgical resources&#46; In general&#44; it is considered that there is a good correlation between the real durations of each intervention and the SOT value established for each group&#46; This correlation is higher for interventions of less than 2<span class="elsevierStyleHsp" style=""></span>hours&#44; as would be the case for most dermatological interventions&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A relatively small number of SOT descriptors may be sufficient to define most of the surgical activity&#46; In our study&#44; 17 descriptors in total were used&#44; but 4 were sufficient to classify 86&#46;7&#37; of the interventions&#46; Although classification into SOT has obvious advantages for standardization&#44; and facilitates diagnostic and procedural coding&#44; it does not cover some interventions which are included generically as other DER&#46; Likewise&#44; it does not asses the possibility of correcting the times in university hospitals or surgery performed by residents&#44; both cases where the operations may take longer&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Classification by SOT allowed the surgical adequacy measures SA1 and SA2 to be assessed&#46; The overall SA1 value in our study was 1&#46;20&#44; with a progressive decline and a tendency to approach and even dip below the standard value of 1&#46;06&#59; this tendency was particularly marked for minor surgery&#46; The decrease in SA1 was significantly correlated with the increased number of patients per shift&#44; an observation that points to improved surgical scheduling over the years&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The overall operating room productivity measured with the SA2 indicator was 96&#46;46&#37;&#46; There are no other series of data published for dermatologic surgery with which to compare&#44; but this value is above 85&#37;&#44; and so is considered the ideal standard&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Over the years&#44; there was a progressive increase in the productivity measured with SA2&#44; both for MOS and for minor surgery&#44; and this increase correlated with an increase in the number of patients operated on per surgical shift&#46; There was also a statistically significant association between these 2 variables&#46; The SA1 and SA2 indicators better reflect the efforts to increase the surgical activity in the department over the last few years&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">With the SA1 and SA2 indicators&#44; it is possible to provide a graphical representation in which the product SA1<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>SA2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9 plots an equilibrium curve&#44; above which the SWL is reduced because the interventions would exceed 90&#37; of the entries&#44; measured with SOT&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If the data are broken down by year&#44; it is observed that minor surgery always remains above the equilibrium line and MOS does so for most years&#46; This reflects good management of the SWL&#46; Over the years&#44; the ratio of SA1 to SA2 indicators remains more stable for minor surgery than for MOS&#44; probably as a result of the greater complexity and variability of the MOS procedures&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">With classification into SOT descriptors&#44; it is possible to quantify the complexity of the procedures on the SWL and obtain indicators to assess surgical activity&#44; thereby improving the efficiency of the management of the surgical times&#46; It also allows a comparison of the activity performed by different professionals&#44; surgical departments&#44; and hospitals&#46; The approach can thus show which surgery is more efficient from the point of view of SA2&#44; assessing both the complexity of the procedures performed and the time needed to carry them out&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The increase in the number of patients operated per shift was followed by a decrease in the operating room occupancy&#44; particularly in the case of minor surgery&#44; due to the increase in downtime between patients&#46; The application of SOT allows a comparison of like with like to be made between surgical departments of traditional importance&#44; such as general surgery or traumatology&#44; and other departments with a very different surgical profile such as dermatology&#46; The grouping of SOT descriptors is a useful management tool but it needs regular review and updating to ensure that it tracks the changes in surgical practice&#46; The optimal functionality of this tool will depend on an appropriate coding of the times and procedures prior to and after surgery by the professionals involved&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Awareness on the part of surgeons of these basic management tools will enable better organization of the surgical activity&#44; and hence an improvement in the care provided&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the characteristics of the dermatologic surgery lists and to compare different indicators of surgical productivity&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective&#44; descriptive study of the routine surgical activity undertaken in the Dermatology Department of Fuenlabrada University Hospital&#44; Madrid&#44; Spain&#44; between January 2005 and December 2010&#46; Data about the procedures performed and about the surgical lists were analyzed and an analysis was made of operating room occupancy&#46; Surgical productivity was analyzed using standard operating times &#40;SOTs&#41; and surgical scheduling adequacy values &#40;SA1 and SA2&#41;&#46; Variables were recorded as relative frequencies&#46; Covariance and the Pearson linear correlation index were used for comparisons&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study period included a total of 11&#44;481 surgical sessions&#44; of which 71&#37; were minor surgery and the remainder were major outpatient surgery&#46; A mean of 9&#46;7 operations were performed in each session and the overall operating room occupancy was 71&#46;9&#37;&#46; Four SOT descriptors &#40;minor surgery&#44; multiple minor skin lesions&#44; nail surgery&#44; and malignant tumors with primary closure&#41; were sufficient to classify 86&#46;7&#37; of the operations performed&#46; The operating room down-time was 0&#46;15 SOT &#40;9<span class="elsevierStyleHsp" style=""></span>minutes&#41; in 91&#46;3&#37; of operations&#46; The mean SA1 index was 1&#46;20&#46; Overall surgical productivity measured using the SA2 index was 96&#46;46&#37;&#46; The Pearson correlation showed a statistically significant relationship between the increase in the number of patients per surgical session&#44; the reduction in operating room occupancy&#44; and the increase in SA2 operating room productivity&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The application of SOT descriptors enables us to quantify the complexity of the operations included in the surgical waiting list and to obtain indicators for the evaluation of surgical activity&#44; improving efficiency in surgical time management&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar las caracter&#237;sticas de las jornadas quir&#250;rgicas dermatol&#243;gicas y comparar distintos indicadores de rendimiento quir&#250;rgico&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo y retrospectivo de la actividad quir&#250;rgica programada realizada en el Servicio de Dermatolog&#237;a del Hospital Universitario de Fuenlabrada desde enero de 2005 a diciembre de 2010&#46; Se analizan datos relativos a los procedimientos realizados y a las jornadas quir&#250;rgicas&#46; Se analizan los &#237;ndices de ocupaci&#243;n&#44; de rendimiento quir&#250;rgico mediante tiempos quir&#250;rgicos est&#225;ndar &#40;TQE&#41; y los valores de adecuaci&#243;n quir&#250;rgica AQ1 y AQ2&#46; La medici&#243;n de las variables se realiza mediante frecuencias relativas&#46; Se ha calculado la covarianza y el &#237;ndice de correlaci&#243;n lineal de Pearson entre distintas variables&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo de estudio se realizaron 11&#46;481 jornadas quir&#250;rgicas&#46; El 71&#37; de las jornadas fueron de cirug&#237;a menor y el resto de CMA&#46; La media de pacientes intervenidos&#47;jornada fue de 9&#44;7&#46; El &#237;ndice global de ocupaci&#243;n de quir&#243;fano fue del 71&#44;91&#37;&#46; Cuatro descriptores TQE&#58; &#171;cirug&#237;a menor&#187;&#44; &#171;lesiones m&#250;ltiples menores de piel&#187;&#44; &#171;cirug&#237;a de la u&#241;a&#187; y &#171;tumor maligno de piel cierre directo&#187; fueron suficientes para clasificar el 86&#44;7&#37; de las cirug&#237;as realizadas&#46; El 91&#44;3&#37; de las intervenciones asociaron un tiempo muerto de TQE 0&#46;15 &#40;9<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; La media del indicador AQ1 fue de 1&#44;20&#46; El rendimiento de quir&#243;fano global medido mediante el indicador AQ2 fue del 96&#44;46&#37;&#46; El &#237;ndice de correlaci&#243;n de Pearson mostr&#243; relaci&#243;n estad&#237;sticamente significativa entre el incremento del n&#250;mero de pacientes&#47;jornada&#44; la disminuci&#243;n del &#237;ndice de ocupaci&#243;n y el aumento del rendimiento de quir&#243;fano AQ2&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La aplicaci&#243;n de los descriptores TQE permite cuantificar la complejidad de los procesos incluidos en LEQ y obtener indicadores para evaluar la actividad quir&#250;rgica&#44; mejorando la eficiencia en la gesti&#243;n de los tiempos quir&#250;rgicos&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; C&#243;rdoba S&#44; et al&#46; An&#225;lisis de la actividad quir&#250;rgica realizada en el Servicio de Dermatolog&#237;a del Hospital Universitario de Fuenlabrada &#40;2005-2010&#41;&#58; establecimiento de los tiempos quir&#250;rgicos est&#225;ndar&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;141&#8211;7&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Types of surgical shift over the study period&#46; MajS indicates major surgery&#59; MinS&#44; minor surgery&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Frequencies of the descriptors of standard operating times &#40;SOTs&#41; assigned to the surgeries performed&#46;</p>"
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        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">SA1 &#40;scheduling adequacy&#41; and SA2 &#40;operating room productivity&#41; by year for major outpatient surgery&#46;</p>"
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        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SA1 &#40;scheduling adequacy&#41; and SA2 &#40;operating room productivity&#41; by year for minor surgery&#46;</p>"
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        "identificador" => "tbl0005"
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        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Year of Procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Shifts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean No&#46; of Patients per Shift&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">SD&#44; Patients per Shift&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Occupancy&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">SD&#44; Occupancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Major surgery</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">70&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">340&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Minor surgery</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2005&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Shifts&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab183283.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patients per Shift and SA1 and SA2 Scheduling Indicators According to Surgery Type by Year&#46;</p>"
        ]
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Original Article
Analysis of the Surgical Activity in the Dermatology Department of Fuenlabrada University Hospital, Madrid, Spain, Between 2005 and 2010: Determination of the Standard Operating Times
Análisis de la actividad quirúrgica realizada en el Servicio de Dermatología del Hospital Universitario de Fuenlabrada (2005-2010): establecimiento de los tiempos quirúrgicos estándar
S. Córdobaa,
Corresponding author
scordoba.hflr@salud.madrid.org

Corresponding author.
, I. Caballerob, R. Navalónc, D. Martínez-Sáncheza, C. Martínez-Morána, J. Borbujoa
a Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain
b Área de control de Gestión, Hospital Universitario de Fuenlabrada, Madrid, Spain
c Área de Gestión de Pacientes, Hospital Universitario de Fuenlabrada, Madrid, Spain
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    "titulo" => "Analysis of the Surgical Activity in the Dermatology Department of Fuenlabrada University Hospital&#44; Madrid&#44; Spain&#44; Between 2005 and 2010&#58; Determination of the Standard Operating Times"
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        "titulo" => "An&#225;lisis de la actividad quir&#250;rgica realizada en el Servicio de Dermatolog&#237;a del Hospital Universitario de Fuenlabrada &#40;2005-2010&#41;&#58; establecimiento de los tiempos quir&#250;rgicos est&#225;ndar"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">SA1 &#40;scheduling adequacy&#41; and SA2 &#40;operating room productivity&#41; by year for major outpatient surgery&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Surgery accounts for a substantial part of the activity of a dermatology department&#46; Appropriate management is essential for the surgical procedures to run smoothly&#46; Currently&#44; hospital activity is recorded through traditional indicators &#40;mean duration of stay&#44; number of admissions&#44; mortality rate&#44; etc&#46;&#41; along with data collected from patient classification systems&#46; The diagnosis-related groups &#40;DRGs&#41; classify patients into homogeneous groups of similar clinical characteristics with similar resource usages&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The information needed to classify each patient according to the DRG system is extracted from the minimum basic dataset&#44; which is recorded for all patients admitted to hospital&#46; The DRGs have helped define new indicators for comparing the activity of different hospital departments and different hospitals&#46; However&#44; they are not particularly useful as a metric for the management of surgical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is complicated to measure the efficiency of surgical activity for several reasons&#46; The diseases requiring surgery vary greatly in complexity&#59; operations can range from minor procedures that can be performed in a few minutes to complicated ones that may even exceed the duration of a standard surgical shift&#46; There is thus a need for a specific patient classification system that enables patients to be grouped into a limited number of categories for which resource usage can be readily quantified&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From 2005 onwards&#44; in the Madrid Health Services &#40;SERMAS&#41; in Spain&#44; an approach for grouping procedures into standard operating times &#40;SOTs&#41; was developed&#46; In this system&#44; the most common interventions on the surgical waiting lists are each assigned an SOT descriptor&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> By combining data from diagnosis and procedures&#44; extracted from the International Classification of Diseases 9 Clinical Modification codes&#44; an SOT is obtained for each descriptor&#46; This value is associated with the standard intervention time&#44; the downtime&#44; and the weighting of the descriptor&#46; The standard intervention time is defined as the time needed for an expert surgical team to perform the intervention&#44; measured from when the patient enters the operating room until he or she leaves it&#46; Downtime is defined as the time necessary to prepare the operating room for the next operation&#46; The weighting of the intervention is related to the fees charged per surgical act&#46; The assignment of times for the different SOT groups is made through consensus of a group of experts&#46; An SOT is considered as equivalent to 60<span class="elsevierStyleHsp" style=""></span>minutes of surgery time&#59; for shorter times&#44; fractions of SOTs are used &#40;for example&#44; an SOT of 0&#46;3 would be equivalent to 18<span class="elsevierStyleHsp" style=""></span>minutes while one of 0&#46;5 would be equivalent to 30<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to manage the operating rooms appropriately&#44; the number of operations that a surgical department would be able to perform in a given time should be known&#46; This can be estimated through surgical productivity&#46; The operating room occupancy&#44; that is&#44; the percentage of time that the operating room is occupied by patients compared to the total time available&#44; is the most common approach for measuring performance&#46; It also provides a reflection of time spent operating during a surgical shift&#46; The occupancy is merely a mathematical calculation that does not take into account the time employed in preparing and cleaning the operating rooms between patients&#44; and so for large numbers of interventions&#44; occupancy is lower&#46; Occupancy is perhaps not the most appropriate measure of productivity of a dermatology operating room&#44; especially in the case of minor surgery&#44; where many short interventions are performed during each surgical shift&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Good time management goes hand in hand with improved surgical productivity&#44; with a decrease in expenditure on surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> With classification into SOT groups&#44; it is possible to measure the length of the surgical waiting list &#40;SWL&#41;&#44; surgical activity&#44; and efficiency of operating room utilization through the indicators of surgical scheduling adequacy &#40;SA1 and SA2&#41;&#46; SA1 for a shift is calculated as the ratio of time the operating room is available &#40;7 SOTs in a surgical shift of 7<span class="elsevierStyleHsp" style=""></span>hours&#41; and the sum of SOTs &#40;SOT interventions<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SOT downtime&#41; scheduled according to the SWL&#46; The SA1 indicator shows whether the surgical shift has been appropriately scheduled &#40;value close to 1&#41; or whether there is overbooking &#40;SA1<span class="elsevierStyleHsp" style=""></span>&#60;1&#41; or underbooking &#40;SA1<span class="elsevierStyleHsp" style=""></span>&#62;1&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The SA2 indicator reflects the portion that the total sum of SOTs for the interventions performed represents with respect to the total time available&#59; it is thus an indicator of surgical productivity&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The 2 indicators can be used to reflect the balance between patients entering and leaving the SWL&#46; Given that 10&#37; of the patients included on the SWL will usually not undergo the scheduled operation&#44; the product SA1<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>SA2 should remain close to 0&#46;9 to ensure equilibrium&#46; With an ideal standard value for SA2 of 85&#37;&#44; the standard value of SA1 should be 1&#46;06 to maintain a product of 0&#46;9&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to analyze the surgical activity in our dermatology department&#44; comparing the different measures of productivity for the operating room&#44; and to assess the utility of SOT in the management of a dermatology operating room&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was a descriptive&#44; retrospective study of scheduled surgical activity performed in the dermatology department of Hospital Universitario de Fuenlabrada&#44; Madrid&#44; Spain&#44; between January 2005 and December 2010&#46; The Hospital Universitario de Fuenlabrada is a secondary care hospital in terms of size and services&#46; It covers the health areas of Fuenlabrada&#44; Moraleja de Enmedio&#44; and Humanes of the former district 9 &#40;until the formation of a single district in 2011&#41;&#44; with a catchment population of approximately 225&#160;000 inhabitants&#46; The demographic characteristics of the district reflect a young population with a high birth rate&#44; a high proportion of children&#44; and a lower proportion of elderly individuals than the mean value for the Community of Madrid&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The data collected in the study were taken from the computerized Selene medical records&#46; These include clinical information&#44; specific forms for dermatologic surgery&#44; nursing protocols&#44; a record of pathology results&#44; and the minimum basic dataset&#46; The data were transferred to a Microsoft Excel 2003 spreadsheet for analysis&#46; The statistical tests were performed using the SPSS 17&#46;0 Statistical package&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The interventions performed were grouped into 13 SOT descriptors&#44; according to the clinical information on each patient and the complexity of the procedure scheduled at the time of inclusion on the SWL&#46; Subsequently&#44; after surgery and once it was confirmed that the procedure had been performed&#44; descriptors were regrouped into 18 SOTs&#46; The procedures that did not fit in any of the predefined descriptors were included in a generic SOT descriptor for the remaining dermatologic interventions &#40;other DER&#41;&#46; The data on the procedures performed and the surgical shifts &#40;number of patients operated per shift&#44; SOT&#44; duration of each intervention&#41; were calculated&#46; The variables were analyzed using relative frequencies and comparison of the means&#46; The surgical productivity was studied using different indicators&#44; comparing traditional occupancy with the surgical productivity assessed using SOT&#46; The surgical adequacy measures SA1 and SA2 were calculated&#46; The relationship between the variables was assessed by calculating the covariance and the Pearson linear correlation coefficient&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">During the study period&#44; 11&#160;516 surgical procedures were performed in the dermatology department of the Hospital Universitario de Fuenlabrada&#46; This activity was undertaken in 1184 surgical shifts and involved 11&#160;481 patients &#40;99&#46;7&#37;&#41;&#46; Of these shifts&#44; 80&#37; had a standard duration of 420<span class="elsevierStyleHsp" style=""></span>minutes&#44; while 13&#37; lasted 330<span class="elsevierStyleHsp" style=""></span>minutes and 7&#37; corresponded to evening shifts lasting 300<span class="elsevierStyleHsp" style=""></span>minutes&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Seventy-one percent of the shifts &#40;n<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>884&#41; corresponded to minor surgery&#44; while the remaining 29&#37; &#40;n<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>340&#41; were major outpatient surgery &#40;MOS&#41; shifts with the participation of the anesthesiology department&#46; Thirty-five surgical interventions were emergency procedures and not included in the programmed surgical shift&#46; During the study period&#44; the distribution of shifts per year remained relatively stable&#44; with a mean of 197 shifts per year and a maximum number of shifts of 229 in 2007&#46; The ratio of minor surgery to MOS also remained relatively stable during the study period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The mean &#40;SD&#41; number of patients operated on in each surgical shift throughout the whole study period was 9&#46;7 &#40;2&#46;73&#41; patients&#46; A progressive increase in the mean number of patients per shift was observed over the years&#44; from a minimum of 8&#46;34 &#40;1&#46;66&#41; in 2005&#44; then 8&#46;45 &#40;1&#46;87&#41; in 2006&#44; 9&#46;83 &#40;2&#46;78&#41; in 2007&#44; 10&#46;15 &#40;2&#46;79&#41; in 2008&#44; and 10&#46;59 &#40;2&#46;92&#41; in 2009&#44; before reaching a maximum of 10&#46;73 &#40;2&#46;97&#41; in 2010&#46; For MOS procedures and minor surgery taken separately&#44; the mean &#40;SD&#41; number of patients per shift was 6&#46;91 &#40;1&#46;15&#41; and 10&#46;82 &#40;2&#46;35&#41;&#44; respectively&#46; Likewise&#44; by type of surgery&#44; there was also a progressive increase during the study in the number of patients per shift from a minimum of 6&#46;49 &#40;0&#46;92&#41; for MOS and 9&#46;21 &#40;1&#46;15&#41; for minor surgery in 2005 to a maximum of 7&#46;46 &#40;0&#46;93&#41; for MOS and 12&#46;05 &#40;2&#46;45&#41; for minor surgery in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The overall operating room occupancy during the study period was 71&#46;91&#37;&#44; with a trend towards a decrease from 77&#46;66&#37; in 2005 to 70&#46;35&#37; in 2010&#44; and a minimum of 66&#46;98&#37; in 2009&#46; The same decreasing trend is observed in the occupancy for MOS and minor surgery&#46; At all times&#44; the productivity of the minor surgery operating room &#40;overall occupancy of 70&#46;73&#37;&#41; was lower than that of the MOS &#40;overall occupancy of 74&#46;83&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The covariance of the variables patients per shift and occupancy was &#8722;1&#46;85 and the Pearson linear correlation coefficient was &#8722;0&#46;053&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Three SOT descriptors &#40;minor surgery&#44; nail surgery&#44; and malignant skin tumor with direct closure&#41; were sufficient to classify 88&#46;3&#37; of the procedures performed&#46; After surgery&#44; 86&#46;7&#37; of the interventions performed were reassigned to 4 SOT descriptors&#46; In descending order of frequency&#44; 58&#37; &#40;6683 procedures&#41; were classed as minor surgery&#44; with an SOT value of 0&#46;35 &#40;21 <span class="elsevierStyleHsp" style=""></span>minutes&#41;&#44; 10&#37; &#40;1157&#41; as multiple minor skin lesions&#44; 9&#46;4&#37; &#40;1080&#41; as nail surgery&#44; and 9&#46;3&#37; &#40;1068&#41; as malignant skin tumor with direct closure&#44; all with an SOT value of 0&#46;46 &#40;27<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#46; The remaining descriptors &#40;in total there were 18&#41; were used much less frequently &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Most dermatologic interventions &#40;91&#46;3&#37;&#41; were associated with an SOT downtime of 0&#46;15 &#40;9<span class="elsevierStyleHsp" style=""></span>minutes&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The mean of the SA1 indicator throughout the study was 1&#46;20&#44; with a trend towards a decrease over the years&#44; until reaching a minimum of 0&#46;98 in 2010&#46; By types of surgery&#44; the mean SA1 was 1&#46;28 for the MOS shifts and 1&#46;17 for the minor surgery shifts&#46; The SA1 indicator in minor surgery showed a progressive decrease from a maximum value of 1&#46;40 in 2005 to a minimum of 0&#46;99 in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The covariance of the variables patients per shift and occupancy was &#8722;0&#46;517 and the Pearson linear correlation coefficient was &#8722;0&#46;279 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The overall operating room productivity measured with the SA2 indicator was 96&#46;46&#37;&#44; with an increase from the value of 81&#46;69&#37; at the start of the study to 118&#46;23&#37; in 2010&#46; The productivity of the MOS shifts ranged from a minimum of 81&#46;12&#37; in 2005 to a maximum of 141&#46;38&#37; in 2010&#46; The minor surgery shifts also showed a trend towards increased surgical productivity during the study period&#44; with a minimum of 77&#46;20&#37; in 2006 and a maximum of 108&#46;94&#37; in 2010 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The covariance of the variables patients per shift and operating room productivity measured with SA2 was 26&#46;019 and the Pearson linear correlation coefficient was 0&#46;297 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The product of the SA1 and SA2 indicators&#44; both for minor surgery and MOS&#44; during the study period&#44; remained close to or above 0&#46;9 &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The surgical activity in our dermatology department has increased progressively over recent years&#46; The clear increase in activity&#44; both for minor surgery and MOS&#44; was driven by the increase in the number of patients operated on in each shift&#44; given that the number of surgical shifts per year remained relatively stable during the study period&#46; The overall occupancy of the dermatology operating room was 71&#46;91&#37;&#44; which is similar to that reported for other series&#44; where it ranges from 70&#37; to 85&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It is thought that implementation of measures to ensure a punctual start to the surgical shift&#44; a decrease in the downtimes between surgery&#44; and an increase in the number of patients scheduled per shift increases occupancy in all surgical departments&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; in our case&#44; occupancy did not improve but actually worsened after an increase in the number of patients per surgical shift&#44; probably as a result of the downtime between interventions&#46; The negative covariance value shows that there is an inverse relationship between the 2 variables&#44; and so it does not appear that increasing the number of patients is a useful way of improving occupancy in dermatology surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The classification into SOT groups considers the standard time that it would take to carry out an intervention&#44; according to the complexity and patient characteristics and the downtime associated with a given intervention&#46; This allows the available time to be better managed and appropriate planning of surgical resources&#46; In general&#44; it is considered that there is a good correlation between the real durations of each intervention and the SOT value established for each group&#46; This correlation is higher for interventions of less than 2<span class="elsevierStyleHsp" style=""></span>hours&#44; as would be the case for most dermatological interventions&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A relatively small number of SOT descriptors may be sufficient to define most of the surgical activity&#46; In our study&#44; 17 descriptors in total were used&#44; but 4 were sufficient to classify 86&#46;7&#37; of the interventions&#46; Although classification into SOT has obvious advantages for standardization&#44; and facilitates diagnostic and procedural coding&#44; it does not cover some interventions which are included generically as other DER&#46; Likewise&#44; it does not asses the possibility of correcting the times in university hospitals or surgery performed by residents&#44; both cases where the operations may take longer&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Classification by SOT allowed the surgical adequacy measures SA1 and SA2 to be assessed&#46; The overall SA1 value in our study was 1&#46;20&#44; with a progressive decline and a tendency to approach and even dip below the standard value of 1&#46;06&#59; this tendency was particularly marked for minor surgery&#46; The decrease in SA1 was significantly correlated with the increased number of patients per shift&#44; an observation that points to improved surgical scheduling over the years&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The overall operating room productivity measured with the SA2 indicator was 96&#46;46&#37;&#46; There are no other series of data published for dermatologic surgery with which to compare&#44; but this value is above 85&#37;&#44; and so is considered the ideal standard&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Over the years&#44; there was a progressive increase in the productivity measured with SA2&#44; both for MOS and for minor surgery&#44; and this increase correlated with an increase in the number of patients operated on per surgical shift&#46; There was also a statistically significant association between these 2 variables&#46; The SA1 and SA2 indicators better reflect the efforts to increase the surgical activity in the department over the last few years&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">With the SA1 and SA2 indicators&#44; it is possible to provide a graphical representation in which the product SA1<span class="elsevierStyleHsp" style=""></span>x<span class="elsevierStyleHsp" style=""></span>SA2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9 plots an equilibrium curve&#44; above which the SWL is reduced because the interventions would exceed 90&#37; of the entries&#44; measured with SOT&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If the data are broken down by year&#44; it is observed that minor surgery always remains above the equilibrium line and MOS does so for most years&#46; This reflects good management of the SWL&#46; Over the years&#44; the ratio of SA1 to SA2 indicators remains more stable for minor surgery than for MOS&#44; probably as a result of the greater complexity and variability of the MOS procedures&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">With classification into SOT descriptors&#44; it is possible to quantify the complexity of the procedures on the SWL and obtain indicators to assess surgical activity&#44; thereby improving the efficiency of the management of the surgical times&#46; It also allows a comparison of the activity performed by different professionals&#44; surgical departments&#44; and hospitals&#46; The approach can thus show which surgery is more efficient from the point of view of SA2&#44; assessing both the complexity of the procedures performed and the time needed to carry them out&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The increase in the number of patients operated per shift was followed by a decrease in the operating room occupancy&#44; particularly in the case of minor surgery&#44; due to the increase in downtime between patients&#46; The application of SOT allows a comparison of like with like to be made between surgical departments of traditional importance&#44; such as general surgery or traumatology&#44; and other departments with a very different surgical profile such as dermatology&#46; The grouping of SOT descriptors is a useful management tool but it needs regular review and updating to ensure that it tracks the changes in surgical practice&#46; The optimal functionality of this tool will depend on an appropriate coding of the times and procedures prior to and after surgery by the professionals involved&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Awareness on the part of surgeons of these basic management tools will enable better organization of the surgical activity&#44; and hence an improvement in the care provided&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xpalclavsec85015"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres97858"
          "titulo" => array:5 [
            0 => "Resumen"
            1 => "Objetivo"
            2 => "Material y m&#233;todo"
            3 => "Resultados"
            4 => "Conclusiones"
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec85014"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and Methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of Interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-02-12"
    "fechaAceptado" => "2012-05-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec85015"
          "palabras" => array:4 [
            0 => "Surgery"
            1 => "Management"
            2 => "Occupancy index"
            3 => "Standard operating time"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec85014"
          "palabras" => array:4 [
            0 => "Cirug&#237;a"
            1 => "Gesti&#243;n"
            2 => "&#205;ndice de ocupaci&#243;n"
            3 => "Tiempo quir&#250;rgico est&#225;ndar"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the characteristics of the dermatologic surgery lists and to compare different indicators of surgical productivity&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective&#44; descriptive study of the routine surgical activity undertaken in the Dermatology Department of Fuenlabrada University Hospital&#44; Madrid&#44; Spain&#44; between January 2005 and December 2010&#46; Data about the procedures performed and about the surgical lists were analyzed and an analysis was made of operating room occupancy&#46; Surgical productivity was analyzed using standard operating times &#40;SOTs&#41; and surgical scheduling adequacy values &#40;SA1 and SA2&#41;&#46; Variables were recorded as relative frequencies&#46; Covariance and the Pearson linear correlation index were used for comparisons&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study period included a total of 11&#44;481 surgical sessions&#44; of which 71&#37; were minor surgery and the remainder were major outpatient surgery&#46; A mean of 9&#46;7 operations were performed in each session and the overall operating room occupancy was 71&#46;9&#37;&#46; Four SOT descriptors &#40;minor surgery&#44; multiple minor skin lesions&#44; nail surgery&#44; and malignant tumors with primary closure&#41; were sufficient to classify 86&#46;7&#37; of the operations performed&#46; The operating room down-time was 0&#46;15 SOT &#40;9<span class="elsevierStyleHsp" style=""></span>minutes&#41; in 91&#46;3&#37; of operations&#46; The mean SA1 index was 1&#46;20&#46; Overall surgical productivity measured using the SA2 index was 96&#46;46&#37;&#46; The Pearson correlation showed a statistically significant relationship between the increase in the number of patients per surgical session&#44; the reduction in operating room occupancy&#44; and the increase in SA2 operating room productivity&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The application of SOT descriptors enables us to quantify the complexity of the operations included in the surgical waiting list and to obtain indicators for the evaluation of surgical activity&#44; improving efficiency in surgical time management&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar las caracter&#237;sticas de las jornadas quir&#250;rgicas dermatol&#243;gicas y comparar distintos indicadores de rendimiento quir&#250;rgico&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo y retrospectivo de la actividad quir&#250;rgica programada realizada en el Servicio de Dermatolog&#237;a del Hospital Universitario de Fuenlabrada desde enero de 2005 a diciembre de 2010&#46; Se analizan datos relativos a los procedimientos realizados y a las jornadas quir&#250;rgicas&#46; Se analizan los &#237;ndices de ocupaci&#243;n&#44; de rendimiento quir&#250;rgico mediante tiempos quir&#250;rgicos est&#225;ndar &#40;TQE&#41; y los valores de adecuaci&#243;n quir&#250;rgica AQ1 y AQ2&#46; La medici&#243;n de las variables se realiza mediante frecuencias relativas&#46; Se ha calculado la covarianza y el &#237;ndice de correlaci&#243;n lineal de Pearson entre distintas variables&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo de estudio se realizaron 11&#46;481 jornadas quir&#250;rgicas&#46; El 71&#37; de las jornadas fueron de cirug&#237;a menor y el resto de CMA&#46; La media de pacientes intervenidos&#47;jornada fue de 9&#44;7&#46; El &#237;ndice global de ocupaci&#243;n de quir&#243;fano fue del 71&#44;91&#37;&#46; Cuatro descriptores TQE&#58; &#171;cirug&#237;a menor&#187;&#44; &#171;lesiones m&#250;ltiples menores de piel&#187;&#44; &#171;cirug&#237;a de la u&#241;a&#187; y &#171;tumor maligno de piel cierre directo&#187; fueron suficientes para clasificar el 86&#44;7&#37; de las cirug&#237;as realizadas&#46; El 91&#44;3&#37; de las intervenciones asociaron un tiempo muerto de TQE 0&#46;15 &#40;9<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; La media del indicador AQ1 fue de 1&#44;20&#46; El rendimiento de quir&#243;fano global medido mediante el indicador AQ2 fue del 96&#44;46&#37;&#46; El &#237;ndice de correlaci&#243;n de Pearson mostr&#243; relaci&#243;n estad&#237;sticamente significativa entre el incremento del n&#250;mero de pacientes&#47;jornada&#44; la disminuci&#243;n del &#237;ndice de ocupaci&#243;n y el aumento del rendimiento de quir&#243;fano AQ2&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La aplicaci&#243;n de los descriptores TQE permite cuantificar la complejidad de los procesos incluidos en LEQ y obtener indicadores para evaluar la actividad quir&#250;rgica&#44; mejorando la eficiencia en la gesti&#243;n de los tiempos quir&#250;rgicos&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; C&#243;rdoba S&#44; et al&#46; An&#225;lisis de la actividad quir&#250;rgica realizada en el Servicio de Dermatolog&#237;a del Hospital Universitario de Fuenlabrada &#40;2005-2010&#41;&#58; establecimiento de los tiempos quir&#250;rgicos est&#225;ndar&#46; Actas Dermosifiliogr&#46; 2013&#59;104&#58;141&#8211;7&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1097
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            "Tamanyo" => 141713
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Types of surgical shift over the study period&#46; MajS indicates major surgery&#59; MinS&#44; minor surgery&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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            "Tamanyo" => 530307
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Frequencies of the descriptors of standard operating times &#40;SOTs&#41; assigned to the surgeries performed&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1146
            "Ancho" => 1681
            "Tamanyo" => 235517
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">SA1 &#40;scheduling adequacy&#41; and SA2 &#40;operating room productivity&#41; by year for major outpatient surgery&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1153
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            "Tamanyo" => 258223
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SA1 &#40;scheduling adequacy&#41; and SA2 &#40;operating room productivity&#41; by year for minor surgery&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Year of Procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Shifts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean No&#46; of Patients per Shift&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">SD&#44; Patients per Shift&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Occupancy&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">SD&#44; Occupancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Major surgery</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  """
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                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; of Shifts&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">199&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;975&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">118&#46;23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;730&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 15782190
Original language: English
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