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BACKGROUND: Most research on preoperative anxiety has focused on non-Latino populations. A study performed in the USA found that children from Spanish-speaking Latino families experienced higher anxiety than children from English-speaking families. AIMS: To report the incidence and level of preoperative anxiety in native Spanish-speaking children living in their home country and to assess risk factors associated with higher anxiety levels. METHODS: Data were collected from 204 children aged 2-12 undergoing elective surgery in a Chilean hospital. Patients' demographic data, surgery-related information, and self-reported parental anxiety were collected. Children's anxiety was measured using the Modified Yale Preoperative Anxiety Scale. An anxiety score greater than 30 indicated significant anxiety. The main outcome for analyzing risk factors was children's anxiety level in the operating room. RESULTS: Significant preoperative anxiety was observed in 41.7% (95% CI: 34.8%-48.8%) of patients, with median anxiety score of 26.6 (IQR, 23.4-46.6). A significant positive correlation was observed between self-reported parental anxiety in the preoperative holding room and children's anxiety in the operating room (r = .153, P = .02), with a higher median difference when mothers are present in anesthesia induction (36.8 vs 30.7, respectively; P = .006). Linear regression analysis found previous negative surgical experience to be associated with higher anxiety levels in the operating room (ß = 16.057, P = .014). CONCLUSIONS: Spanish-speaking children undergoing elective surgery in their home country experienced significant rates of preoperative anxiety. Parental anxiety and previous negative surgical experience were risk factors associated with higher anxiety levels.

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Los centros de cirugía ambulatoria han contribuido al progreso de esta cirugía y se caracterizan por ser eficientes, productivos, rentables y generar alta satisfacción. Construir un centro de cirugía ambulatoria requiere constituir un equipo multidisciplinario encargado de desarrollar un proyecto que evalúe la viabilidad económica, seleccione el tipo de centro a construir, determine el tamaño y el diseño del centro y defina la dotación de personal; con esta información se realiza la evaluación económica final que decide la factibilidad de construir el centro. Organizar el inicio de actividades y el funcionamiento de este servicio requiere determinar horarios, modalidad de trabajo, flujos de circulación y funciones del personal, a través de protocolos que definan, describan y coordinen todos los procesos clínicos y administrativos involucrados desde la indicación de la cirugía hasta el alta del paciente. La eficiencia del pabellón quirúrgico es determinante en el funcionamiento de un centro de cirugía ambulatoria. Varios factores contribuyen a la eficiencia de pabellón, y el más crítico de estos es el tiempo entre cirugías o tiempo de recambio de pacientes, el cual es factible de optimizar. La cirugía ambulatoria es una modalidad de trabajo quirúrgico que requiere un servicio clínico propio, adecuadamente planificado, diseñado y organizado para lograr sus objetivos y ventajas.

Ambulatory surgery centers have contributed to the progress of ambulatory surgery and they are characterized by its efficiency, productivity and to produce high satisfaction. To build an outpatient surgery center a multidisciplinary team should be responsible to develop a project that to assess the economic viability, to select the type of center, to determine the size and the design of center and to set de staffing; with this information the final economic evaluation that decide the feasibility to build the center must be performed. To organize the launch activities and the operation of this service requires determining schedules, working mode, traffic flows and staff functions through protocols that to define, to describe and to coordinate all clinic and administrative process involved from the surgery indication to the patient discharge. The operating room efficiency is determining factor in the ambulatory surgery center functioning. Several factors contribute to the operating room efficiency, the most critical of which is the time between surgical procedures o turnover time and this time is feasible to optimize. Ambulatory surgery is a mode of surgical work requiring its own clinical service properly planned, designed and organized to achieve its objectives and advantages.

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INTRODUCTION: We performed an agreement study of the AO and the Tronzo classifications of fractures of the trochanteric area to determine if they allow communication among practitioners with different levels of expertise. MATERIAL AND METHODS: Complete radiographs of 70 patients with trochanteric fractures were classified by nine evaluators (three hip sub-specialists, three orthopaedic surgery residents and three medical interns) using the AO and the Tronzo classifications. After a six-week interval, all cases were presented in a random sequence for repeat evaluation. The Kappa coefficient (k) was used to determine inter- and intra-observer agreement. RESULTS: Inter-observer: considering the main AO fracture types, the agreement was moderate for sub-specialists (k = 0.60 [0.50-0.70]), residents (k = 0.58 [0.48-0.69]) and medical interns (k = 0.56 [0.45-0.69]). Using AO sub-types, all groups achieved fair agreement (sub-specialists: k = 0.31 [0.25-0.38]; residents: k = 0.32 [0.26-0.38]; medical interns: k = 0.30 [0.24-0.36]). For the Tronzo classification, sub-specialists (k = 0.56 [0.48-0.65]) and residents (k = 0.47 [0.39-0.55]) obtained moderate agreement; medical interns reached fair agreement (k = 0.33 [0.25-0.41]). Intra-observer: considering the main AO fracture types, sub-specialists (k = 0.79 [0.69-0.89]), residents (k = 0.71 [0.60-0.81]) and medical interns (k = 0.70 [0.59-0.82]) obtained substantial agreement. Considering AO sub-types, sub-specialists (k = 0.50 [0.45-0.56]) and medical interns (k = 0.54 [0.48-0.69]) achieved moderate agreement; residents (k = 0.39 [0.33-0.45]) achieved fair agreement. Using the Tronzo classification, all groups obtained substantial agreement (sub-specialists: k = 0.66 [0.58-0.74]; residents: k = 0.63 [0.55-0.71]; medical interns: k = 0.68 [0.60-0.76]). CONCLUSION: The AO classification allows an adequate communication when considering the main fracture types; the agreement within sub-types is not satisfactory. The Tronzo classification does not allow reliable communication between medical professionals.

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