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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Neurosurgery is a medical speciality of a surgical nature that focuses on the study and treatment &#40;prevention&#44; diagnosis&#44; evaluation&#44; therapy&#44; intensive care and rehabilitation&#41; of surgical or potentially surgical diseases of the central&#44; peripheral and autonomic nervous system&#44; including its coverings&#44; vascularisation and appendages such as the pituitary gland&#44; as well as the operative and non-operative management of pain&#44; regardless of the patient&#8217;s age&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This speciality is therefore responsible for the prevention&#44; diagnosis and treatment of adult and paediatric patients with potentially surgical disorders of the nervous system&#44; such as diseases of the brain&#44; meninges&#44; skull and its vascular supply&#44; including the carotid and vertebral arteries&#44; disease of the pituitary gland&#44; disorders of the spinal column and spinal cord and its meninges&#44; and disorders of the peripheral nerves in their entirety&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the tasks of the Sociedad Espa&#241;ola de Neurocirug&#237;a &#40;SENEC&#41; &#91;Spanish Society of Neurosurgery&#93; is to provide all the actors involved in the care of neurosurgical patients with the necessary tools to improve their quality of life&#44; guaranteeing their best possible care&#44; and to ensure the quality of that care&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The current Spanish Medical Association &#40;Organizaci&#243;n M&#233;dica Colegial&#8212;OMC&#41; nomenclature of medical procedures for the speciality of neurosurgery dates from 1989&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This nomenclature is now very outdated&#44; as it still includes obsolete procedures and does not incorporate new techniques&#46; Insurance companies base their fee scales on this nomenclature with some modifications&#44; with the result that the neurosurgeon&#39;s activity is being evaluated on the basis of fee scales that do not represent the complexity of current diagnoses and techniques&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Some specialities&#44; such as Rheumatology&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Ear&#44; Nose and Throat&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Orthopaedic Surgery and Traumatology and Ophthalmology&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> have updated not only their nomenclatures&#44; but also the complexity attributable to each of the items&#44; for the purpose of submitting them to the OMC as the official nomenclature for their speciality&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">SENEC decided to create a nomenclature for the speciality following this model&#46; The new nomenclature was sent to all SENEC members for modifications and the final version was ratified at the society&#8217;s assembly held in Santander in May 2023&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Working method</span><p id="par0035" class="elsevierStylePara elsevierViewall">We followed the working method used by other scientific societies&#44; in which the tasks involved in drawing up the new nomenclature were divided into two distinct&#44; successive parts&#58; first&#44; identification and selection of the medical procedures&#59; then&#44; establishing the degree of difficulty of each one&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Identification and selection of medical procedures in neurosurgery</span><p id="par0040" class="elsevierStylePara elsevierViewall">The current OMC nomenclature was used as a basis for the definition of the medical procedures&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The procedures were reviewed and assessed by the working group one by one&#46; Obsolete processes were removed&#44; new ones were added&#44; descriptors were modified and procedures with similar descriptions were grouped together&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A total of 255 medical procedures related to neurosurgery were identified&#44; some of which are common to other specialities &#40;for example&#44; anaesthetics and pain&#44; orthopaedic surgery and traumatology&#44; plastic and reconstructive surgery&#41;&#46; In specialities where the nomenclature had already been revised&#44; as in the case of Traumatology&#44; it has been assessed in the same way&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">They have been categorised into four groups of procedures&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">none-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Consultations and visits&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">none-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Therapeutic procedures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">none-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Diagnostic procedures&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">none-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Surgical interventions&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">The interventions in turn have been grouped into 5 areas&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">none-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Cerebrospinal fluid&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">none-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Peripheral nerve&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">none-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Pain&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">none-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Spinal disorders&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">none-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Brain disorders&#46;</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">Spinal disorders are further divided into cervical&#44; thoracic and lumbar spine disorders&#44; and within each of these&#44; they have been grouped by areas&#58; degenerative&#44; malformation&#44; tumour-related&#44; vascular and other&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Brain disorders are grouped into six areas&#58; traumatic&#44; tumour-related&#44; vascular&#44; infectious&#44; malformation and functional&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Certain procedures have been simplified&#44; such as consultations and visits&#44; where the distinction of hospital visits according to the day of admission or home visits has been removed&#44; and telematic consultation has been added&#46; Obsolete techniques&#44; such as ventriculography&#44; or others more typical of other specialities&#44; such as electroencephalography&#44; have also been removed from the nomenclature&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Degree of difficulty of medical procedures</span><p id="par0125" class="elsevierStylePara elsevierViewall">When calculating the degree of difficulty of each of the procedures&#44; three items were assessed&#58; the estimated level of training required to carry it out&#59; the time required to carry it out&#59; and the degree of responsibility involved&#46; Three criteria were taken into consideration &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Training and complexity&#58; this section assesses the time&#44; difficulty &#40;effort&#41; and resources &#40;investment&#41; used to acquire the training&#44; as well as the level of professional development required to perform the professional procedure with skill&#44; agility and safety&#46; Implicit in this is the degree of complexity&#47;difficulty of the medical procedure &#40;both technical and intellectual&#41;&#44; as well as the level of learning and experience required&#46; There are four categories of complexity&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">1</span><p id="par0135" class="elsevierStylePara elsevierViewall">Procedures that can be carried out by a specialist in training in their first two years&#44; such as external lumbar drainage&#44; placement of an intracranial pressure sensor or cervical traction&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">2</span><p id="par0140" class="elsevierStylePara elsevierViewall">Procedures that require a higher degree of training&#44; which can be performed by specialists in training from years three to five&#44; such as evacuation of an epidural haematoma&#44; ventriculoperitoneal shunt or external ventricular drainage&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">3</span><p id="par0145" class="elsevierStylePara elsevierViewall">Procedures that can be performed by a neurosurgery specialist with less than five years of experience&#44; which is the majority of them&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">4</span><p id="par0150" class="elsevierStylePara elsevierViewall">Interventions which&#44; due to their complexity&#44; require a level of specialist experience of more than five years&#44; such as functional or vascular neurosurgery&#46;</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Professional responsibility&#58; this assesses the degree to which a complication of the surgical procedure may result in the loss of structure and&#47;or function of a limb or the patient&#44; i&#46;e&#46; the potential serious or very serious risks to the patient &#40;grade III to V of the Dindo and Clavien Classification&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It is rated from 0 to 3&#44; according to whether the risk is less than 1&#37; &#40;0&#41;&#44; 1&#37;&#8211;5&#37; &#40;1&#41;&#44; 5&#37;&#8211;10&#37; &#40;2&#41; or more than 10&#37; &#40;3&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Average time&#58; considers the average time required for the medical procedure&#46; Establishing the average time for the most common surgical procedures was based on the estimated surgical times in various healthcare systems&#44; as well as the experience of the working group&#46; It should be noted that the average time does not refer to the simple surgical procedure&#44; but to the time required to perform the entire procedure from the time the patient enters the operating theatre until they leave&#46; This time includes&#58; pre-anaesthesia and anaesthesia&#44; patient positioning &#40;for example&#44; traction table&#44; Mayfield clamp&#41;&#44; surgical field assembly&#44; positioning of accessory instruments &#40;for example&#44; endoscope&#44; microscope&#44; navigator&#44; fluoroscope&#41;&#44; the actual surgical procedure from incision to closure&#44; awakening of the patient and transfer to bed and discharge from the operating theatre&#46; It does not include time between interventions for cleaning or staff breaks&#46; It is divided into four time bands and is rated from 0 to 3 according to on whether the estimated duration of the procedure is less than 45&#8239;min &#40;0&#41;&#44; 45&#8722;90&#8239;min &#40;1&#41;&#44; 90&#8722;120&#8239;min &#40;2&#41; or more than 120&#8239;min &#40;3&#41;&#46;</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The sum of the scores for each section attributes a degree of complexity to each procedure&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Taking these factors as a reference and taking into account the different levels of complexity and extent of the processes in our speciality&#44; 10 difficulty groups have been established&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Modifiers</span><p id="par0175" class="elsevierStylePara elsevierViewall">Additionally&#44; a number of modifiers have been added that can increase the complexity of the procedure&#44; as certain circumstances can add difficulty to and the amount of time necessary for the surgical procedure&#46; These factors are multiple and may involve special patient-specific circumstances &#40;such as obesity in spinal surgery&#41;&#44; certain characteristics of the disease to be treated &#40;a 2-cm meningioma is not the same as a 7-cm meningioma&#41;&#44; or the technological requirements necessary to perform surgery &#40;intraoperative neurophysiology or navigation&#44; for example&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Modifiers are established for each group of disorders&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">none-</span><p id="par0185" class="elsevierStylePara elsevierViewall">CSF disorder&#58; 0&#46;5 points are added if it is a reoperation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">none-</span><p id="par0190" class="elsevierStylePara elsevierViewall">Peripheral nerve&#58; 0&#46;5 points are added if it is a reoperation and 1 point if intraoperative neurophysiology is used&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">none-</span><p id="par0195" class="elsevierStylePara elsevierViewall">Pain&#58; 0&#46;5 points are added if it is a reoperation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">none-</span><p id="par0200" class="elsevierStylePara elsevierViewall">Spinal disorder&#58; 0&#46;5 points are added for reoperation&#44; BMI over 30 and three-level fusion&#44; while 1 point is added for fusion over more than three levels&#44; endoscopy&#44; use of navigation and intraoperative neurophysiology&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">none-</span><p id="par0205" class="elsevierStylePara elsevierViewall">Brain disorder&#58; 0&#46;5 points are added for reoperation&#46; 1 point is added for tumours larger than 3&#8239;cm&#44; and 2 points for tumours larger than 5&#8239;cm&#46; 1 point is added for angioblastic meningioma&#44; due to its difficulty&#46; 2 points are added for surgery for embolised aneurysm and ruptured aneurysm within the first three days&#44; with 1 point added for ruptured aneurysm surgery outside that period&#46; 2 points are added for Spetzler AVM surgery grade 3 or higher&#46; 1 point is added for the use of intraoperative angiography&#44; navigation and intraoperative neurophysiology&#46; 2 complexity point are added for awake surgery&#46;</p></li></ul></p><p id="par0210" class="elsevierStylePara elsevierViewall">There is also a general modifier&#44; which is the urgency of the procedure&#44; for which 1 point is added&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0215" class="elsevierStylePara elsevierViewall">The OMC nomenclature consists of 102 procedures and diagnoses&#44; while the current nomenclature has 255 procedures and diagnoses&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Procedures have been included that are common to other specialities but were included in the OMC nomenclature as specific to neurosurgery&#44; such as endovascular treatment of cerebrovascular disease&#46; In processes whose nomenclature had been updated by other specialities&#44; such as spinal disorders that had been updated by the Sociedad Espa&#241;ola de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a &#40;SECOT&#41; &#91;Spanish Society of Orthopaedic Surgery and Traumatology&#93;&#44; the criteria have been standardised&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The updated nomenclature for neurosurgery proposed by SENEC is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#59;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">93&#37; of the items correspond to treatments&#44; with 46&#37; for brain disorders&#44; 38&#37; for spinal disorders and the rest for CSF&#44; pain and peripheral nerve disorders&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Forty-two OMC codes have been removed&#44; either because the techniques were obsolete or disused &#40;such as external carotid ligation&#41;&#44; or because the concepts were poorly defined &#40;such as brain injuries and surgical treatment&#41; or vague &#40;clivus microsurgery&#41;&#46; Many of these codes are now listed more explicitly &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0240" class="elsevierStylePara elsevierViewall">Only 64&#37; of the items in the new nomenclature correspond to OMC nomenclature codes&#46; Some items in the new nomenclature correspond to several OMC codes&#44; for example&#44; cauda equina schwannoma could be coded as 1616 &#40;spinal tumours&#41;&#44; 1643 &#40;microsurgery of cauda equina tumours&#41; or 1647 &#40;intracranial or intramedullary schwannomas&#41;&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The items are divided into the different complexity groups as follows&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">none-</span><p id="par0250" class="elsevierStylePara elsevierViewall">Group 1&#58; 11</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">none-</span><p id="par0255" class="elsevierStylePara elsevierViewall">Group 2&#58; 13</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">none-</span><p id="par0260" class="elsevierStylePara elsevierViewall">Group 3&#58; 6</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">none-</span><p id="par0265" class="elsevierStylePara elsevierViewall">Group 4&#58; 9</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">none-</span><p id="par0270" class="elsevierStylePara elsevierViewall">Group 5&#58; 10</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">none-</span><p id="par0275" class="elsevierStylePara elsevierViewall">Group 6&#58; 17</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">none-</span><p id="par0280" class="elsevierStylePara elsevierViewall">Group 7&#58; 15</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">none-</span><p id="par0285" class="elsevierStylePara elsevierViewall">Group 8&#58; 18</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">none-</span><p id="par0290" class="elsevierStylePara elsevierViewall">Group 9&#58; 27</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">none-</span><p id="par0295" class="elsevierStylePara elsevierViewall">Group 10&#58; 129</p></li></ul></p><p id="par0300" class="elsevierStylePara elsevierViewall">By type of procedure&#44; 95&#37; of groups 8&#44; 9 and 10 comprise spinal and vertebral surgical disorders&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0305" class="elsevierStylePara elsevierViewall">It is the job of the scientific societies to describe the procedures specific to their speciality&#44; as well as to assess the difficulties and risks involved&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">The current nomenclatures are inadequate and largely outdated&#46; The OMC nomenclature includes numerous concepts that are obsolete and in other cases gives very vague definitions of procedures&#44; which do not reflect clinical practice&#46; The OMC nomenclature is based on the International Classification of Diseases &#40;ICD&#41;&#44; hence its anachronisms and lack of specificity&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">The nomenclature should faithfully reflect the characteristics of the procedures performed by the medical professional&#44; including aspects related to the nature of the disorder and the actions necessary for its diagnosis and&#47;or treatment&#44; which the current nomenclatures do not do&#46; One example of this is the surgical treatment of a meningioma&#44; which is grouped under a single code&#44; regardless of its location&#44; when the surgical technique&#44; the technological requirements and the risks associated with its treatment are radically different for a convexity meningioma compared to a petroclival meningioma&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">The specialities of Rheumatology&#44; Ear&#44; Nose and Throat and Ophthalmology have revised their nomenclatures and published the new versions&#44; while others&#44; such as Orthopaedic Surgery and Traumatology&#44; are in the process of doing so&#46; Following in their footsteps&#44; SENEC set out to complete this task&#44; adopting the same working methodology&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">The current nomenclature attempts to provide as exhaustive a description as possible of the range of different disorders related to the speciality of neurosurgery&#46; We have preferred to be repetitive in some concepts so that the codes faithfully reflect a particular disorder&#44; and leaving few processes in catch-all boxes&#46; This is why&#44; for example&#44; in spinal disease&#44; the same type of disorder &#40;meningioma&#41; is differentiated with different codes depending on whether it is located in the cervical&#44; thoracic or lumbar spine&#44; so that each code provides as much information as possible about the process it represents&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">The criteria of the previously published scales have been followed&#44; taking into account the professional experience required to carry out a specific medical procedure&#44; the time required to perform it and the risks that may arise from such a process&#46; It is a grading process that quite realistically defines the weight behind the management of that particular disease&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">It was considered appropriate to introduce a number of modifiers that can add complexity&#44; time and risk of complications to the medical procedure&#46; For example&#44; a tumour size modifier has been introduced in brain disorders&#44; as it does not take the same amount of time or carry the same risks to operate on a 2-cm tumour as on a 12-cm tumour&#46; A reoperation modifier has also been added&#44; which often results in longer surgical time and a higher risk of complications&#44; as has a body mass index modifier in spinal surgery&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">The nomenclatures are not a trivial matter&#46; They are used as a basis for assessing the activity of medical professionals&#44; both in terms of economics and statistics&#44; and could therefore lead to inaccurate evaluation of such activity&#46; Therefore&#44; having an updated and exhaustive list of neurosurgical procedures endorsed by SENEC is an essential step towards establishing the right rules of the game with healthcare providers&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">This problem is not specific to our speciality and SENEC would encourage other societies to update their nomenclatures&#46; We also recommend evaluating them according to the methodology described above&#44; in order to improve standardisation and increase their acceptance&#46; Specialist areas that share procedures with neurosurgery&#44; such as anaesthetics in the field of pain or radiology in the endovascular treatment of cerebral disease&#44; should follow the concepts and scales applied in this nomenclature&#44; in order to standardise the procedures&#44; just as SENEC has done with the spine procedures common to orthopaedic surgery and traumatology&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">In reference to the private sector&#44; insurance companies base their remuneration on scales derived from the OMC nomenclature&#44; which means that both the concepts and the remuneration are outdated&#46; It is not the task of SENEC to set the price of medical procedures&#44; but it is SENEC&#39;s responsibility to estimate the degree of complexity of these procedures&#44; and having an exhaustive and appropriate list of neurosurgical procedures will be of great help in setting appropriate prices&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">Last of all&#44; we back the recommendation of the Sociedad Espa&#241;ola de Otorrinolaringolog&#237;a &#40;SEORL&#41; &#91;Spanish Ear&#44; Nose and Throat Society&#93; suggesting that the OMC&#44; in its article on the revision of the nomenclature for their speciality&#44; should change the wording of the paragraph referring to the procedure for updating the nomenclature&#44; which currently reads as follows&#58; &#8220;Within the <span class="elsevierStyleItalic">OMC&#44; there will be a permanent Technical Committee that will assess the need to include new concepts in the nomenclature that have been previously submitted by the Scientific Associations of Healthcare Professionals or by Health Care Companies</span>&#8221;&#46; Like the SEORL&#44; SENEC is of the opinion that Health Care Companies should have no say in the updating of the nomenclature and its respective scales&#44; as they have neither the authority nor the scientific knowledge to determine the medical procedures of each speciality&#44; but should accept the nomenclature established by the medical professionals through their scientific societies in collaboration with the OMC&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0360" class="elsevierStylePara elsevierViewall">The new SENEC Neurosurgical Nomenclature contains updated terminology and will assist us not only by providing the portfolio of services&#44; but also to measure and appreciate the relative value of our activities and the approximate costs of the procedures and&#44; additionally&#44; as an aid to carrying out longitudinal comparative studies&#46; It should be used as a tool to improve patient care and minimise geographical variability in all care settings&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0365" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Update the list of medical acts in the specialty of Neurosurgery&#44; eliminating obsolete acts and adding the new surgical techniques developed in recent years&#44; so that they are faithfully adapted to the usual medical practice of our specialty&#44; as well as establishing the general principles and defining the grading criteria&#44; quantitative indicators and assessment scales&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The elaboration of the new nomenclator was divided into 3 phases&#58; 1&#41; identification and selection of medical acts&#44; 2&#41; establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion&#44; as well as the percentage and severity of the possible complications and 3&#41; consensus with the members of the SENEC through their individualized submission&#44; making the necessary adjustments and subsequent approval in the general assembly of SENEC&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The new nomenclator has 255 medical acts grouped into 4 groups&#58; consultations and visits&#44; therapeutic acts&#44; diagnostic procedures and surgical interventions&#46; 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete&#44; not related to the specialty or being too vague&#46; New techniques have been included and medical acts have been more precisely defined&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services&#44; measure and know the relative value of our activity and the approximate costs of the procedures&#44; and additionally&#44; to carry out longitudinal comparative studies&#46; It should be a tool to improve patient care and minimise geographic variability in all healthcare settings&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Purpose"
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            "titulo" => "Conclusions"
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      "es" => array:3 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Actualizar el nomencl&#225;tor de actos m&#233;dicos de la especialidad de Neurocirug&#237;a&#44; eliminando actos en desuso y a&#241;adiendo las nuevas t&#233;cnicas quir&#250;rgicas desarrolladas en los &#250;ltimos a&#241;os&#44; para que se adapte fielmente a la pr&#225;ctica m&#233;dica habitual de nuestra especialidad as&#237; como establecer los principios generales y definir los criterios de baremaci&#243;n&#44; indicadores cuantitativos y escalas de valoraci&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">La elaboraci&#243;n del nuevo nomencl&#225;tor se dividi&#243; en 3 fases&#58; 1&#41; identificaci&#243;n y selecci&#243;n de los actos m&#233;dicos&#44; 2&#41; establecimiento del grado de dificultad de cada uno de ellos basado en la experiencia y el tiempo necesarios para su realizaci&#243;n&#44; as&#237; como el porcentaje y gravedad de las posibles complicaciones y 3&#41; consenso con los miembros de la SENEC mediante su env&#237;o individualizado&#44; realizando los retoques necesarios y posterior aprobaci&#243;n en asamblea de la especialidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">El nuevo nomencl&#225;tor cuenta con 255 actos m&#233;dicos agrupados en 4 grupos&#58; consultas y visitas&#44; actos terap&#233;uticos&#44; procedimientos diagn&#243;sticos e intervenciones quir&#250;rgicas&#46; Se han eliminado 42 procedimientos recogidos en el nomencl&#225;tor de la OMC por obsoletos&#44; no ser propios de la especialidad o resultar demasiado vagos&#46; Se han introducido nuevas t&#233;cnicas y se han definido de forma m&#225;s precisa los actos m&#233;dicos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Este nomencl&#225;tor proporciona una terminolog&#237;a actualizada y servir&#225; para ofertar la cartera de servicios&#44; medir y conocer el valor relativo de nuestra actividad y de los costes aproximados de los procedimientos&#44; y adicionalmente&#44; para realizar estudios comparativos longitudinales&#46; Debe constituir una herramienta para mejorar la atenci&#243;n de los pacientes y minimizar la variabilidad geogr&#225;fica en todos los &#225;mbitos asistenciales&#46;</p></span>"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#42; <span class="elsevierStyleBold">Classification of surgical complications according to Dindo and Clavien</span>&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Grade I</span>&#58; any deviation from the normal postoperative course not requiring pharmacological treatment or surgical&#44; endoscopic or radiological intervention&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Grade II</span>&#58; complications requiring pharmacological treatment&#44; blood transfusion or parenteral nutrition&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Grade III</span>&#58; complications requiring surgical&#44; endoscopic or radiological intervention&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">IIIa&#58; intervention not under general anaesthesia&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">IIIb&#58; intervention under general anaesthesia&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Grade IV</span>&#58; life-threatening complications requiring Intensive Care Unit management&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">IVa&#58; single-organ dysfunction&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IVb&#58; multi-organ dysfunction&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Grade V</span>&#58; death of the patient&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">MIR&#58; M&#233;dico Interno Residente &#91;Medical Residency Programme&#93;&#59; NS&#58; neurosurgeon&#46;</p>"
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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"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Criterion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Definition&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indicator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Training and complexity</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">Time&#44; difficulty &#40;effort&#41; and resources &#40;investment&#41; required to acquire the necessary training and level of professional development to perform the professional procedure with skill&#44; agility and safety&#46; Implicit in this is the degree of complexity&#47;difficulty of the medical procedure &#40;both technical and intellectual&#41;&#44; as well as the level of learning and experience required&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amount of time in terms of continuing education and experience required to perform a surgical technique or procedure&#44; usually to a satisfactory standard and without complications</td><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">MIR 1&#8722;2&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="left" valign="\n
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                  \t\t\t\t">1&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">MIR 3&#8722;5&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&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">NS &#60;5 years&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&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">NS &#62;5 years&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Professional responsibility</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">Degree to which a complication of the surgical procedure may result in the loss of structure and&#47;or function of a limb or the patient&#44; i&#46;e&#46; the potential serious or very serious risks to the patient&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Average frequency of severe or very severe complications that will usually worsen the preoperative situation or require reoperation &#40;grade III to V Dindo and Cavien classification&#42;&#41;&#46;</td><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">&#60;1&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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">1&#8722;5&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&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">6&#8722;10&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&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
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                  \t\t\t\t">&#62;10&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Time required</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Average time required for the medical procedure</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">Surgical time required&#44; including patient preparation</td><td class="td" title="\n
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                  \t\t\t\t">&#60;45 min&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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
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                  \t\t\t\t">45&#8722;90 mins&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="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">90&#8722;120 min&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="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#62;120 min&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Updated nomenclature for the speciality of neurosurgery 2023&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
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            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"><th 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" scope="col" style="border-bottom: 2px solid black">OMC Code&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Therapeutic procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2726&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Attending to hospitalised patients&#46; Non-surgical admission from day 4 to day 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2727&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Attending to hospitalised patients&#46; Non-surgical admission&#46; Day 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2724&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Attending to hospitalised patients&#46; Non-surgical admission from day 2 to day 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0003&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Home visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3197&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Percutaneous peripheral nerve biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1541&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cisternography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1542&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intraoperative echoencephalography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1543&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intraoperative electroencephalogram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1546&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quantified electromyogram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1547&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CSF circulation study<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1548&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evoked potentials&#46; Intraoperative recording&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1551&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ventriculography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1152&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidural or subarachnoid drug administration<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1553&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intraventricular drug administration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1554&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidural or subarachnoid drainage placement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1556&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extracranial ventricular drainage placement &#40;for example&#44; peritoneum&#44; cava&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1561&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suturing scalp wounds&#46; Removal of foreign bodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1564&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intraparenchymal haematoma&#46; Trephining&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1566&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidural or spinal reservoir implantation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0964&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neurolysis and selective neurectomies&#46; Removal of scar neuromas 04&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1568&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgical revision&#44; replacement or removal of valve in hydrocephalus 02&#46;42&#44; 02&#46;43 &#40;as a single operation&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1573&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lumbar or cervicothoracic ganglionectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0567&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">External carotid ligation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1578&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intrathecal foreign bodies&#46; Extraction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3201&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brain injuries&#46; Surgical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1034&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Facial paralysis&#46; Reconstructive surgery by direct nerve grafting or 04&#46;79 cross-linked nerve grafts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1596&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spinal canal stenosis&#46; Surgical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1597&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fractures and dislocations of the thoracic-lumbar spine with spinal cord injuries&#46; 03&#46;53 surgical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1603&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trigeminal rhizotomy &#40;Frazier&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1605&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CSF fistula surgery complete treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1606&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Functional spinal surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1587&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intrapetrous facial nerve surgery&#46; Microsurgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1607&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Intracranial foreign bodies&#46; Craniectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1615&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="left" valign="\n
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                  \t\t\t\t">Brain lobectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1613&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dorsal rhizotomy&#44; myelotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1622&nbsp;\t\t\t\t\t\t\n
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                  \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">Posterior fossa surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1534&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cervical vertebral artery release&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1535&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Endocranial internal carotid ligation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1638&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="left" valign="\n
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                  \t\t\t\t">Skull base microsurgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1639&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="left" valign="\n
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                  \t\t\t\t">Clivus microsurgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1641&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="left" valign="\n
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                  \t\t\t\t">Parasellar region microsurgery&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Nomencl&#225;tor jerarquizado en reumatolog&#237;a"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Yoldi Mu&#241;oz"
                            1 => "M&#46;A&#46; Mart&#237;n Mart&#237;nez"
                            2 => "M&#46; Valero Exp&#243;sito"
                            3 => "C&#46; Plana Veret"
                            4 => "J&#46;L&#46; Andreu S&#225;nchez"
                            5 => "J&#46;V&#46; Moreno Muelas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.reuma.2018.11.010"
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                        "tituloSerie" => "Reumatol Cl&#237;n"
                        "fecha" => "2020"
                        "volumen" => "16"
                        "paginaInicial" => "3"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30745278"
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                  "contribucion" => array:1 [
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                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:7 [
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                            1 => "J&#46;M&#46; Maza-Solano"
                            2 => "R&#46; Ruiz-Rico Ruiz-Mor&#243;n"
                            3 => "A&#46; Bonilla P&#233;rez"
                            4 => "M&#46;A&#46; Sevilla Garc&#237;a"
                            5 => "C&#46; Casanova Gonz&#225;lez"
                            6 => "M&#46; Bernal Sprekelsen"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otorri.2021.02.003"
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                        "tituloSerie" => "Acta Otorrinolaringol Esp &#40;Engl Ed&#41;"
                        "fecha" => "2022"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuevo nomencl&#225;tor estandarizado en oftalmolog&#237;a&#58; Criterios e indicadores cuantitativos de baremaci&#243;n de actos m&#233;dicos"
                      "autores" => array:1 [
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                            2 => "J&#46;M&#46; Ben&#237;tez-del-Castillo"
                            3 => "J&#46; Garc&#237;a-Feijoo"
                            4 => "F&#46;J&#46; Mu&#241;oz-Negretea"
                            5 => "M&#46;S&#46; Figueroa"
                            6 => "J&#46;L&#46; Encinas-Mart&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.oftal.2020.07.019"
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                        "tituloSerie" => "Arch Soc Esp Oftalmolog&#237;a"
                        "fecha" => "2020"
                        "volumen" => "95"
                        "paginaInicial" => "591"
                        "paginaFinal" => "602"
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                    ]
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                      "titulo" => "What is a surgical complication&#63;"
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                          "autores" => array:2 [
                            0 => "D&#46; Dindo"
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                        "tituloSerie" => "World J Surg"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "939"
                        "paginaFinal" => "941"
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Journal Information
Vol. 35. Issue 2.
Pages 95-112 (March - April 2024)
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Vol. 35. Issue 2.
Pages 95-112 (March - April 2024)
Special article
A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures
Nuevo nomenclátor estandarizado de Neurocirugía: criterios e indicadores cuantitativos y cualitativos de baremación de actos médicos
Ángel Horcajadas Almansaa,
Corresponding author
, Luis Ley Urzaizb, Roberto Garcia Lealc, Francisco González Llanosd, Mónica Lara Almuniae, Ruben Martinez Laezf, Jose M. Torres Campag, Idoia Zaspe Cenozh, Jesús Lafuente Barazai
a Hospital Vithas, Granada, Spain
b Hospital Ramón y Cajal, Madrid, Spain
c Hospital Gregorio Marañón, Madrid, Spain
d Hospital Universitario de Toledo, Toledo, Spain
e Fundación Jiménez Diaz, Hospital Rey Juan Carlos, Hospital Ruber Internacional, Madrid, Spain
f Hospital Marqués de Valdecilla, Santander, Spain
g Centro Médico de Asturias, Oviedo, Spain
h Hospital Universitario de Navarra, Pamplona, Spain
i Hospital del Mar, Barcelona, Spain
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Tables (2)
Table 1. Criteria for determining the degree of difficulty of medical procedures.
Table 3. OMC codes that have been removed from the new nomenclature.
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Abstract
Purpose

Update the list of medical acts in the specialty of Neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales.

Methods

The elaboration of the new nomenclator was divided into 3 phases: 1) identification and selection of medical acts, 2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and 3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC.

Results

The new nomenclator has 255 medical acts grouped into 4 groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined.

Conclusions

This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimise geographic variability in all healthcare settings.

Keywords:
Nomenclator
Neurosurgery
Medical acts
Grading scale
Resumen
Objetivos

Actualizar el nomenclátor de actos médicos de la especialidad de Neurocirugía, eliminando actos en desuso y añadiendo las nuevas técnicas quirúrgicas desarrolladas en los últimos años, para que se adapte fielmente a la práctica médica habitual de nuestra especialidad así como establecer los principios generales y definir los criterios de baremación, indicadores cuantitativos y escalas de valoración.

Material y método

La elaboración del nuevo nomenclátor se dividió en 3 fases: 1) identificación y selección de los actos médicos, 2) establecimiento del grado de dificultad de cada uno de ellos basado en la experiencia y el tiempo necesarios para su realización, así como el porcentaje y gravedad de las posibles complicaciones y 3) consenso con los miembros de la SENEC mediante su envío individualizado, realizando los retoques necesarios y posterior aprobación en asamblea de la especialidad.

Resultados

El nuevo nomenclátor cuenta con 255 actos médicos agrupados en 4 grupos: consultas y visitas, actos terapéuticos, procedimientos diagnósticos e intervenciones quirúrgicas. Se han eliminado 42 procedimientos recogidos en el nomenclátor de la OMC por obsoletos, no ser propios de la especialidad o resultar demasiado vagos. Se han introducido nuevas técnicas y se han definido de forma más precisa los actos médicos.

Conclusiones

Este nomenclátor proporciona una terminología actualizada y servirá para ofertar la cartera de servicios, medir y conocer el valor relativo de nuestra actividad y de los costes aproximados de los procedimientos, y adicionalmente, para realizar estudios comparativos longitudinales. Debe constituir una herramienta para mejorar la atención de los pacientes y minimizar la variabilidad geográfica en todos los ámbitos asistenciales.

Palabras clave:
Nomenclátor
Neurocirugía
Actos médicos
Escalas de baremación

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