scholarly journals Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

2019 ◽  
Author(s):  
Shigenori Masaki ◽  
Takashi Kawamoto
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Survival Time ◽  
Oral Intake ◽  
Severe Pneumonia ◽  
The Elderly ◽  
Long Term Outcomes

AbstractBackgroundThe long-term outcomes of artificial nutrition and hydration (ANH) in the elderly with dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy (PEG) and total parenteral nutrition (TPN) are major methods of ANH. Although both can be a life-prolonging treatments, Japan has recently come to view PEG as representative of unnecessary life-prolonging treatment. Consequently, TPN is often chosen for ANH instead. This study aimed to compare the long-term outcomes between PEG and TPN in the elderly.MethodsThis single-center retrospective cohort study identified 253 elderly patients with dysphagia who received enteral nutrition via PEG (n=180) or TPN (n=73) between January 2014 and January 2017. The primary outcome was survival time. Secondary outcomes were oral intake recovery, discharge to home, and the incidence of severe pneumonia and sepsis. We performed one-to-one propensity score matching using a 0.05 caliper. The Kaplan–Meier method, log-rank test, and Cox proportional hazards model were used to analyze the survival time between groups.ResultsOlder patients with lower nutritional states, and severe dementia were more likely to receive TPN. Propensity score matching created 55 pairs. Survival time was significantly longer in the PEG group (median, 317 vs 195 days; P=0.017). The hazard ratio for PEG relative to TPN was 0.60 (95% confidence interval: 0.39–0.92; P=0.019). There were no significant differences between the groups in oral intake recovery and discharge to home. The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 25.5%, P=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 30.9%, P=0.018).ConclusionsPEG was associated with a significantly longer survival time, a higher incidence of severe pneumonia, and a lower incidence of sepsis compared with TPN. These results can be used in the decision-making process before initiating ANH.

scholarly journals Laparoscopic versus open rectal resection: a 1:2 propensity score–matched analysis of oncological adequateness, short- and long-term outcomes

2021 ◽  
Author(s):  
Giovanni Maria Garbarino ◽  
Giulia Canali ◽  
Giulia Tarantino ◽  
Gianluca Costa ◽  
Mario Ferri ◽  
...  
Keyword(s):  
Propensity Score ◽  
Anal Verge ◽  
Disease Free Survival ◽  
Oral Intake ◽  
High Volume ◽  
Long Term Outcomes ◽  
Surgical Specimen ◽  
N Stage ◽  
Short And Long Term

Abstract Background Laparoscopic resections for rectal cancer are routinely performed in high-volume centres. Despite short-term advantages have been demonstrated, the oncological outcomes are still debated. The aim of this study was to compare the oncological adequateness of the surgical specimen and the long-term outcomes between open (ORR) and laparoscopic (LRR) rectal resections. Methods Patients undergoing laparoscopic or open rectal resections from January 1, 2013, to December 31, 2019, were enrolled. A 1:2 propensity score matching was performed according to age, sex, BMI, ASA score, comorbidities, distance from the anal verge, and clinical T and N stage. Results Ninety-eight ORR were matched to 50 LRR. No differences were observed in terms of operative time (224.9 min. vs. 230.7; p = 0.567) and postoperative morbidity (18.6% vs. 20.8%; p = 0.744). LRR group had a significantly earlier soft oral intake (p < 0.001), first bowel movement (p < 0.001), and shorter hospital stay (p < 0.001). Oncological adequateness was achieved in 85 (86.7%) open and 44 (88.0%) laparoscopic resections (p = 0.772). Clearance of the distal (99.0% vs. 100%; p = 0.474) and radial margins (91.8 vs. 90.0%, p = 0.709), and mesorectal integrity (94.9% vs. 98.0%, p = 0.365) were comparable between groups. No differences in local recurrence (6.1% vs.4.0%, p = 0.589), 3-year overall survival (82.9% vs. 91.4%, p = 0.276), and disease-free survival (73.1% vs. 74.3%, p = 0.817) were observed. Conclusions LRR is associated with good postoperative results, safe oncological adequateness of the surgical specimen, and comparable survivals to open surgery.

scholarly journals Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants

2021 ◽  
Vol 18 (14) ◽  
pp. 7544
Author(s):  
Cornelia Wiechers ◽  
Wolfgang Bernhard ◽  
Rangmar Goelz ◽  
Christian F. Poets ◽  
Axel R. Franz
Keyword(s):  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Preterm Infant ◽  
Infant Nutrition ◽  
Postnatal Growth ◽  
Long Term Outcomes ◽  
Postmenstrual Age ◽  
Neonatal Nutrition ◽  
Early Parenteral Nutrition

Providing adequate amounts of all essential macro- and micronutrients to preterm infants during the period of extraordinarily rapid growth from 24 to 34 weeks’ postmenstrual age to achieve growth as in utero is challenging yet important, since early growth restriction and suboptimal neonatal nutrition have been identified as risk factors for adverse long-term development. Along with now well-established early parenteral nutrition, this review emphasizes enteral nutrition, which should be started early and rapidly increased. To minimize the side effects of parenteral nutrition and improve outcomes, early full enteral nutrition based on expressed mothers’ own milk is an important goal. Although neonatal nutrition has improved in recent decades, existing knowledge about, for example, the optimal composition and duration of parenteral nutrition, practical aspects of the transition to full enteral nutrition or the need for breast milk fortification is limited and intensively discussed. Therefore, further prospective studies on various aspects of preterm infant feeding are needed, especially with regard to the effects on long-term outcomes. This narrative review will summarize currently available and still missing evidence regarding optimal preterm infant nutrition, with emphasis on enteral nutrition and early postnatal growth, and deduce a practical approach.

Long-Term Outcomes of Infliximab Treatment in 582 Korean Patients with Crohn’s Disease: A Hospital-Based Cohort Study

2016 ◽  
Vol 61 (7) ◽  
pp. 2060-2067 ◽  
Author(s):  
Sang Hyoung Park ◽  
Sung Wook Hwang ◽  
Min Seob Kwak ◽  
Wan Soo Kim ◽  
Jeong-Mi Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Infliximab Treatment ◽  
Long Term Outcomes ◽  
Korean Patients

scholarly journals Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 162
Author(s):  
Christian-Alexander Behrendt ◽  
Thea Kreutzburg ◽  
Jenny Kuchenbecker ◽  
Giuseppe Panuccio ◽  
Mark Dankhoff ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Propensity Score ◽  
Acute Limb Ischemia ◽  
Insurance Claims ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Abdominal Aortic ◽  
Significant Difference

Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods. Results: Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, p = 0.031) and major bleeding (22.0% vs. 15.9%, p = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, p < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54–2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76–1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%). Conclusion: The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes.

Short-term and long-term outcomes in living donors for liver transplantation: Cohort study

2020 ◽  
Vol 84 ◽  
pp. 147-153
Author(s):  
Kosei Takagi ◽  
Yuzo Umeda ◽  
Ryuichi Yoshida ◽  
Nobuyuki Watanabe ◽  
Takashi Kuise ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cohort Study ◽  
Living Donors ◽  
Long Term Outcomes ◽  
Short Term
Sign in / Sign up

Export Citation Format

Share Document