scholarly journals Patient characteristics and procedural outcomes of moderate sedation for endoscopic procedures in patients with obesity: A retrospective, propensity score-matched study

2021 ◽  
Vol 09 (11) ◽  
pp. E1674-E1679
Author(s):  
Shashank Garg ◽  
Shorabuddin Syed ◽  
Abhilash Perisetti ◽  
Sumant Inamdar ◽  
John Vargo
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Recovery Time ◽  
Patient Characteristics ◽  
Obese Patients ◽  
Withdrawal Time ◽  
Moderate Sedation ◽  
Endoscopic Procedures ◽  
Matched Study ◽  
Procedural Outcomes

Abstract Background Endoscopic procedures are performed commonly with moderate sedation. Obesity can pose a challenge in its safe administration. This study was aimed at assessing outcomes of endoscopy procedures performed with moderate sedation in obese patients. Patients and methods This was a retrospective study of patients undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy with moderate sedation from July 17, 2017 to December 31, 2019. Demographics, comorbidities, outpatient medications and procedure-related outcomes (procedure time, recovery time, cardiopulmonary adverse events, 7-day post-procedure hospitalization, cecal intubation time, withdrawal time, tolerance of moderate sedation and sedation medications administered) were compared for patient with and without obesity after propensity score matching. Standard statistical methods were used for analysis. Results A total of 7601 procedures were performed with moderate sedation for 5746 patients. Propensity score matching identified 1360 and 1740 pairs of EGDs and colonoscopies with moderate sedation for patients with and without obesity. Recovery time was found to be shorter for obese patients undergoing EGD (OR: 0.989, 95 % CI: 0.981–.998; P = 0.01). Obese patients did not differ from non-obese patients in any other procedure-related outcomes for EGDs or colonoscopies. Conclusions Outcomes for endoscopy procedures performed with moderate sedation were noted to be similar between obese and non-obese patients. These findings suggest that moderate sedation can be used safely for endoscopic procedures in patients with obesity.

Hospitalized with stroke at the weekend: Higher cost and risk of early death?

2021 ◽  
pp. 174749302199259
Author(s):  
Marco Ghiani ◽  
Sabrina Mueller ◽  
Ulf Maywald ◽  
Thomas Wilke
Keyword(s):  
Propensity Score ◽  
Cerebral Infarction ◽  
Propensity Score Matching ◽  
Disease Severity ◽  
Patient Characteristics ◽  
Weekend Effect ◽  
Health Claims ◽  
Hospital Death ◽  
Stroke Severity ◽  
Baseline Characteristics

Objectives Previous studies have shown that weekend hospitalizations are associated with poorer health outcomes and higher mortality (“weekend effect”). However, few of these studies have adjusted for disease severity and little is known about the effect on costs. This work investigates the weekend effect and its costs for patients with cerebral infarction in Germany, adjusting for patient characteristics and proxies of stroke severity. Methods Adult patients with a cerebral infarction hospitalization 10th revision of the International statistical classification of diseases and related health problems (ICD-10: I63) between 01 January 2014 and 30 June 2017 were included from German health claims (AOK PLUS dataset). Propensity score matching was used to match patients hospitalized on weekends or on public holidays (weekend group) with patients hospitalized during the working week (workday group), based on baseline characteristics and proxies for disease severity such as concomitant diagnoses of aphasia, ataxia, and coma, or peg tube at index hospitalization. Matched cohorts were compared in terms of in-hospital, 7-day, and 30-day mortality, as well as risk and costs of stroke and rehabilitation stays in the year after first stroke. Results Of 32,311 patients hospitalized with cerebral infarction between 01 January 2014 and 30 June 2017, 8409 were in the weekend group and 23,902 in the workday group. After propensity score matching, 16,730 patients were included in our study (8365 per group). Matched cohorts did not differ in baseline characteristics or stroke severity. In the weekend group, the risk of in-hospital death (11.2%) and the seven-day mortality rate (6.8%) were 13.1% and 17.2% higher than in the workday group, respectively (both p < 0.01). The hazard ratio for death in the weekend group was 1.1 ( p = 0.043). The risks of subsequent stroke hospitalization and rehabilitation stays for a stroke were 8.4% higher and 5.5% higher in the weekend group (both p = 0.02). As a result, the stroke-related hospitalization and rehabilitation costs per patient year were, respectively, 5.6% and 8.0% higher in the weekend group (both p = 0.01). Conclusions A significant weekend effect emerged after controlling for observable patient characteristics and proxies of stroke severity. This effect also resulted in higher costs for patients admitted on weekends.

Abstract 13950: Predicted Heart Mass and BMI: Evaluating Undersized Heart Transplantation in Obese vs. Non-Obese Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Samuel T Kim ◽  
Mark R Helmers ◽  
Peter Altshuler ◽  
Amit Iyengar ◽  
Jason Han ◽  
...  
Keyword(s):  
Propensity Score ◽  
Heart Transplantation ◽  
Propensity Score Matching ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Obese Patients ◽  
Heart Transplants ◽  
Term Survival ◽  
Heart Mass

Introduction: Although guidelines for heart transplant currently recommend against donors weighing ≥ 30% less than the recipient, recent studies have shown that the detriment of under-sizing may not be as severe in obese recipients. Furthermore, predicted heart mass (PHM) has been shown to be more reliable for size matching compared to metrics such as weight and body surface area. In this study, we use PHM to characterize the effects of undersized heart transplantation (UHT) in obese vs. non-obese recipients. Methods: Retrospective analysis of the UNOS database was performed for heart transplants from Jan. 1995 to Sep. 2020. Recipients were stratified by obese (BMI ≥ 30) and non-obese (30 > BMI ≥ 18.5). Undersized donors were defined as PHM ≥ 20% less than recipient PHM. Obese and non-obese populations separately underwent propensity score matching, and Kaplan-Meier estimates were used to graph survival. Multivariable Cox proportional-hazards analyses were used to adjust for confounders and estimate the hazard ratio for death attributable to under-sizing. Results: Overall, 50,722 heart transplants were included in the analysis. Propensity-score matching resulted in 2,214, and 1,011 well-matched pairs, respectively, for non-obese and obese populations. UHT in non-obese recipients resulted in similar 30-day mortality (5.7% vs. 6.3%, p = 0.38), but worse 15-year survival (38% vs. 35%, P = 0.04). In contrast, obese recipients with UHT saw similar 30-day mortality (6.4% vs. 5.5%, p = 0.45) and slightly increased 15-year survival (31% vs. 35%, P = 0.04). Multivariate Cox analysis showed that UHT resulted in an adjusted hazard ratio of 1.08 (95% CI 1.01 - 1.16) in non-obese recipients, and 0.87 (95% CI 0.78 - 0.98) in obese recipients. Conclusions: Non-obese patients with UHT saw worse long-term survival, while obese patients with UHT saw slightly increased survival. These findings may warrant reevaluation of the current size criteria for obese patients awaiting a heart.

Laparoscopic versus open liver resection for hepatocellular carcinoma: Case-matched study with propensity score matching

2015 ◽  
Vol 63 (3) ◽  
pp. 643-650 ◽  
Author(s):  
Ho-Seong Han ◽  
Ahmed Shehta ◽  
Soyeon Ahn ◽  
Yoo-Seok Yoon ◽  
Jai Young Cho ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Open Liver Resection ◽  
Matched Study

Laparoscopic Versus Open Liver Resection for Benign Tumors and Lesions: A Case Matched Study with Propensity Score Matching

2019 ◽  
Vol 29 (12) ◽  
pp. 1518-1525 ◽  
Author(s):  
Simon Wabitsch ◽  
Anika Kästner ◽  
Philipp K. Haber ◽  
Christian Benzing ◽  
Felix Krenzien ◽  
...  
Keyword(s):  
Liver Resection ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Benign Tumors ◽  
Open Liver Resection ◽  
Matched Study

scholarly journals The Efficacy of Acupuncture on Tic Disorders in Children: A Retrospective and Propensity Score-Matched Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Hai-Zhen You ◽  
Yi-Fang Zhou ◽  
Ping-Bo Yu ◽  
Jing Xie ◽  
Jia Chen ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Conventional Treatment ◽  
Alternative Therapy ◽  
Preliminary Evidence ◽  
Tic Disorders ◽  
Control Group ◽  
Observation Group ◽  
Matched Study ◽  
Vocal Tics

Background : Acupuncture has been considered as a complementary or alternative therapy for children with tic disorders (TD), but its efficacy remains largely unknown. This study retrospectively examined the efficacy of acupuncture treatment for TD in children over the course of 12 weeks.Methods: Data were collected from Traditional Chinese Medicine clinics in a public pediatric hospital in Shanghai between June 2020 and March 2021. A total of 250 patients with TD were included in the study, with 122 patients exposed to acupuncture therapy combined with conventional treatment (observation group), and 128 patients exposed to conventional treatment alone (control group). Propensity score matching analyses were used to balance baseline characteristics, resulting in 78 matched patients for each group. Reductions in the Yale Global Tic Severity Scale (YGTSS) total score were analyzed in the two groups after 12 weeks of treatment.Results: The two groups reached equilibrium in terms of baseline demographic characteristics and YGTSS total score after the propensity score matching (P &gt; 0.05). Compared to the control group, the reduction in the YGTSS total score after 12 weeks of treatment was greater for the observation group (OR = 2.94, 95% CI: 1.03, 8.39, P = 0.04), and this association was stronger for patients who had significant vocal tics (β = 0.29, 95% CI: 0.88, 2.68, P = 0.001). The clinical efficacy for the observation group was significantly better than the control group.Conclusions: We provided preliminary evidence supporting the therapeutic effect of acupuncture for TD in children. Hence, our findings indicate that acupuncture could be an adjuvant treatment efficacious for TD in children, especially for vocal tics.

scholarly journals Effectiveness of Inner Traction Facilitated Endoscopic Submucosal Dissection using Rubber Band and Clips for Colorectal Neoplasms: A Propensity Score-matched Study

2021 ◽  
Author(s):  
Guanyi Liu ◽  
Xinyue Guo ◽  
Yunlong Cai ◽  
Long Rong ◽  
Weidong Nian ◽  
...  
Keyword(s):  
Propensity Score ◽  
Endoscopic Submucosal Dissection ◽  
Propensity Score Matching ◽  
Colorectal Neoplasms ◽  
Rubber Band ◽  
Lateral Spreading ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection ◽  
Matched Study

Abstract Background Colorectal endoscopic submucosal dissection (ESD) is a technically demanding but effective treatment for superficial neoplasms. We conducted a study to compare the effectiveness and safety of inner traction facilitated ESD using rubber band and clip (RAC-ESD) with conventional ESD.Methods We retrospectively evaluated 622 consecutive patients underwent colorectal ESD between January 2016 and December 2019. To overcome selection bias, we used propensity score matching (1:4) between RAC-ESD and conventional ESD. The frequency of en bloc resections, R0 resections, curative resections, procedure speed and complications were evaluated.Results After propensity score matching, 35 patients were included in RAC-ESD group and 140 were included in conventional ESD group. RAC-ESD resulted in a significant increase in resection speed (0.14 vs. 0.09 cm2/min; P=0.003). There were no significant differences in en bloc, R0 and curative resection rates between two groups. In subgroup analysis, the resection speed of RAC-ESD was significantly higher than conventional ESD when the lesions were equal to or larger than 2cm, macroscopically presenting as lateral spreading tumor, and located in transverse colon to ascending colon.Conclusions RAC-ESD is safe and effective in treating colorectal neoplasms, especially in lesions presenting particular difficulty.

scholarly journals Comparison of the Effects of Sugammadex, Neostigmine, and Pyridostigmine on Postoperative Nausea and Vomiting: A Propensity Matched Study of Five Hospitals

2020 ◽  
Vol 9 (11) ◽  
pp. 3477
Author(s):  
Jong Ho Kim ◽  
Man-Sup Lim ◽  
Jun Woo Choi ◽  
Haewon Kim ◽  
Young-Suk Kwon ◽  
...  
Keyword(s):  
Propensity Score ◽  
Confidence Interval ◽  
General Anesthesia ◽  
Propensity Score Matching ◽  
Postoperative Nausea ◽  
Odds Ratio ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Patient Groups ◽  
Matched Study

Thus far, few studies have compared the effects of sugammadex and cholinesterase inhibitors on postoperative nausea and vomiting (PONV), and the results have been controversial. Here, we compared the effects of sugammadex, neostigmine, and pyridostigmine on PONV by means of a five hospital analysis with propensity score matching. We analyzed adults aged ≥ 18 years who underwent general anesthesia between January 2014 and December 2019. Following propensity score matching, 7793 patients were included in each of the neostigmine and sugammadex matched patient groups (absolute standardized difference (ASD), 0.01–0.07), and 10,197 patients were included in each of the pyridostigmine and sugammadex matched patient groups (ASD, 0.01–0.02), while 19,377 patients were included in each of the pyridostigmine and neostigmine matched patient groups. (ASD, 0.01–0.19). The odds of PONV were low in the sugammadex group (odds ratio, 0.65; 95% confidence interval, 0.59–0.72; p < 0.0001) and pyridostigmine group (odds ratio, 0.22; 95% confidence interval, 0.20–0.24; p < 0.0001) compared to the neostigmine group, while there was no difference between sugammadex and pyridostigmine (odds ratio, 0.95; 95% confidence interval, 0.86–1.04; p = 0.281). Therefore, sugammadex and pyridostigmine may lower the incidence of PONV compared to neostigmine in patients undergoing general anesthesia.

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