scholarly journals Comparing treatments via the propensity score: stratification or modeling?

2012 ◽  
Vol 12 (1) ◽  
pp. 29-43 ◽  
Author(s):  
Jessica A. Myers ◽  
Thomas A. Louis
2008 ◽  
Vol 108 (6) ◽  
pp. 979-987 ◽  
Author(s):  
Jean-Luc Fellahi ◽  
Jean-Jacques Parienti ◽  
Jean-Luc Hanouz ◽  
Benoît Plaud ◽  
Bruno Riou ◽  
...  

Background Catecholamines, mainly dobutamine, are often administered without institutional guidelines or prespecified algorithms in cardiac surgery. The current study assessed the consequences on clinical outcome of catecholamines simply based on the clinical judgment of the anesthesiologists after cardiopulmonary bypass in adult cardiac surgery. Methods Consecutive patients were enrolled in a nonrandomized cohort study. Factors associated with perioperative use of catecholamines and with outcomes were recorded prospectively to conduct bias adjustment, including propensity scores. Major cardiac morbidity (i.e., ventricular arrhythmia, use of an intraaortic balloon pump and postoperative myocardial infarction) and all-cause intrahospital mortality were the primary and secondary endpoints, respectively. Results are expressed as odds ratio (OR) [95% confidence interval]. Results During the study, 84 of 657 patients (13%) received catecholamines, most often dobutamine (76 of 84, 90%). A higher incidence of both major cardiac morbidity (30 vs. 9%; P < 0.001; OR, 4.2 [2.5-7.3]) and all-cause intrahospital mortality (8 vs. 1%; P < 0.001; OR, 12.9 [3.7-45.2]) was observed in the catecholamine group compared with the control group. After adjusting for channeling bias and confounding factors, catecholamine administration remained significantly associated with major cardiac morbidity after propensity score stratification (OR, 2.1 [1.0-4.4]; P < 0.05), propensity score covariance analysis (OR, 2.3 [1.0-5.0]; P < 0.05), marginal structural models (OR, 1.8 [1.3-2.5]; P < 0.001), and propensity score matching (OR, 3.0 [1.2-7.3]; P < 0.02), but not with all-cause intrahospital mortality. Conclusions These results suggest that dobutamine should only be administered when the benefit is judged to outweigh the risks.


2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Lu Shi

There is controversy over to what degree banning sugar-sweetened beverage (SSB) sales at schools could decrease the SSB intake. This paper uses the adolescent sample of 2005 California Health Interview Survey to estimate the association between the availability of SSB from school vending machines and the amount of SSB consumption. Propensity score stratification and kernel-based propensity score matching are used to address the selection bias issue in cross-sectional data. Propensity score stratification shows that adolescents who had access to SSB through their school vending machines consumed 0.170 more drinks of SSB than those who did not (). Kernel-based propensity score matching shows the SSB consumption difference to be 0.158 on the prior day (). This paper strengthens the evidence for the association between SSB availability via school vending machines and the actual SSB consumption, while future studies are needed to explore changes in other beverages after SSB becomes less available.


2018 ◽  
Vol 14 (3) ◽  
pp. 695-700 ◽  
Author(s):  
Markus Neuhäuser ◽  
Matthias Thielmann ◽  
Graeme D. Ruxton

2020 ◽  
Author(s):  
Derek W. Brown ◽  
Thomas J. Greene ◽  
Michael D. Swartz ◽  
Anna V. Wilkinson ◽  
Stacia M. DeSantis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kozmik ◽  
J Pisarenko ◽  
N Mainhard ◽  
W Weissenberger ◽  
F Mourad ◽  
...  

Abstract Background Left atrial appendix, as an essential source of systemic embolism and stroke in patients with atrial fibrillation, can be excluded during cardiac surgery, however the clinical benefit is as yet uncertain. Methods A total of 376 out of 3741 consecutive patients with atrial fibrillation presenting a high risk for stroke (CHA2DS2-VASc-Score ≥2 for men and ≥3 for women) who underwent heart surgery with cardiopulmonary bypass between 01/2012 and 12/2015 were analysed for mortality and stroke rate at 30 days, 12 and 24 months. Patients with concomitant LAA-closure alone (group1; n=107) were compared to patients with concomitant surgical ablation and LAA-closure (group2; n=85), and patients without surgical ablation and no LAA-closure (group3; n=184) as controls. To further adjust for pre- and intraoperative risk factors, a propensity score stratification analysis based on patients age, gender, EuroSCORE-2, CHA2DS2-VASc-Score and type of procedure was performed. Results Patients age was 72±8 years (mean±SD) and 33% were female. EuroSCORE-2 was 8.7±7.7%, 5.7±3.9%, and 5.4±8.4% and CHA2DS2-VASc-Score was 4.2±1.5, 3.9±1.4, and 4.1±1.4 on average for the respective groups. Mortality did not differ between groups at 30 days, 12 and 24 months. The incidence of stroke was 1.9% at 30 days, 4.8% at 12 and 6.7% at 24 months in group1. There was no stroke at 30 days and 12 months and 1.3% at 24 months in group2, and 1.8% at 30 days, 3.0% at 12 and 24 months in control group3. The overall mortality at 24 months was 27.1%, 20% and 24.6% respectively. After propensity score stratification, stroke rate showed significant benefit in group 2 (P=0.05) at 12 months and a hazard ratio of 0.17, 95% confidents limits 0.02–1.50, (P=0.08) at 24 months, whereas overall mortality did not significantly differ between the groups at 12 and 24 months follow-up. Conclusions In this propensity score stratification analysis, patients undergoing cardiac surgery with surgical ablation and concomitant LAA-closure had significant fewer strokes at 12 months follow-up compared to patients undergoing cardiac surgery with LAA-closure alone. Overall mortality did not significantly differ between the groups. Therefore, a concomitant LAA closure during heart surgery without additional surgical ablation does not show any clinical benefit in terms of reduced stroke rate or survival until 12 and 24 months follow-up.


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