scholarly journals A Comparison of Various Surgical Treatments for Degenerative Cervical Myelopathy: A Propensity Score Matched Analysis

2020 ◽  
pp. 219256822097609
Author(s):  
Nathan J. Lee ◽  
Jun S. Kim ◽  
Paul Park ◽  
K. Daniel Riew
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
National Database ◽  
Cardiac Complications ◽  
Fisher Exact Test ◽  
Short Term ◽  
Chi Square ◽  
Exact Test ◽  
Independent Risk Factors

Study Design: Retrospective Cohort. Objective: To compare the short-term outcomes for Laminoplasty, Laminectomy/fusion, and ACDF. Methods: We utilized a prospectively-collected, multi-center national database with a propensity score matching algorithm to compare the short-term outcomes for laminoplasty, laminectomy/fusion, and multi-level (>3) ACDF (with and without corpectomy). Bivariate analyses involved both chi-square/fisher exact test and t-test/ANOVA on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes. Results: 546 patients remained after propensity score matching, with 182 patients in each cohort. ACDF required the longest operative time 188 ± 79 versus laminectomy/fusion (169 ± 75, p = 0.017), and laminoplasty (167 ± 66, p = 0.004). ACDF required the shortest hospital stay (LOS ≥ 2: ACDF 56.6%, laminoplasty 89.6%, laminectomy/fusion 93.4%, p < 0.05). ACDF had lower overall complications (ACDF 3.9%, laminoplasty 7.7%, laminectomy/fusion 11.5%, p < 0.05), mortality (ACDF 0%, laminoplasty 0.55%, laminectomy/fusion 2.2%, p < 0.05), and unplanned readmissions (ACDF 4.4%, laminoplasty 4.4%, laminectomy/fusion 9.9%, p < 0.05). No significant differences were seen in the other outcomes including DVT/PT, acute renal failure, UTI, stroke, cardiac complications, or sepsis. In the multivariate analysis, laminectomy/fusion (OR 17, reference: ACDF) and laminoplasty (OR10, reference: ACDF) were strong independent risk factors for LOS ≥ 2 days. Laminectomy/fusion (OR 3.2, reference: ACDF) was an independent predictor for any adverse events 30-days after surgery. Conclusions: Laminectomy/fusion carries the highest risk for morbidity, mortality, and unplanned readmissions in the short-term postoperative period. Laminoplasty and ACDF cases carry similar short-term complications risks. ACDF is significantly associated with the longest operative duration and shortest LOS without an increase in individual or overall complications, readmissions, or reoperations

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

scholarly journals MICROBE PATTERN AND RISK FACTORS OF DEEP NECK ABSCESS PATIENTS IN ATMA JAYA HOSPITAL

2021 ◽  
Vol 20 (1) ◽  
pp. 26-32
Author(s):  
Kendrick Klaudius Hartedja ◽  
Ricky Yue ◽  
Lucky H. Moehario
Keyword(s):  
Risk Factors ◽  
Oral Hygiene ◽  
Fisher Exact Test ◽  
Main Concern ◽  
Chi Square ◽  
Exact Test ◽  
Neck Abscess ◽  
Deep Neck Abscess ◽  
Male Patients ◽  
Age Range

Introduction: Deep neck abscess is a pus accumulation in the space and tissue of the cervical fascia caused by an infection and has the potential for several complications. Appropriate use of antibiotics can prevent these complications, but long culture time has been a main concern. Diabetes and oral hygiene are identified as commonly found risk factors for deep neck abscess. This study aims to analyze patients’ characteristics and the usage of antibiotics in treating deep neck abscess patients in Atma Jaya Hospital as well as assessing the effect of diabetes and oral hygiene as the causes for deep neck abscess. Methods: This was a cohort retrospective, descriptive analytic study. The samples were from 23 deep neck abscess patients undergoing treatment in Atma Jaya Hospital and met the inclusion and exclusion criteria. Chi square and Fisher exact test were used to determine the significance effect of diabetes and higiene oral in relation to deep neck abscess. Results: There were more male patients than female patients with age range 20-30 years old. Streptococcus viridans and Streptococcus pyogenes were the most common bacteria causing deep neck abscesses. Metronidazole, gentamicin and ceftriaxone were the most widely used antibiotics and it had shown great compatibility to fight against germs found in this disease. Statistical test results on the effect of oral hygiene oral to submandibular abscesses, peritonsillar, and Ludwig’s angina were p(AS)=0.605, p(AP)=1.000, and p(LA)=1.000, while of diabetes were p(AS)=0.685, p(AP)=0.657, and p(LA)=1.000. Conclusion: Deep neck abscess tends to occur in male patients of productive age. Metronidazole, gentamicin and ceftriaxone were the recommended empiric antibiotics. There was no significant relationship between oral hygiene and diabetes on the occurrence of deep neck abscesses.

Short-Term Outcomes of Primary Total Ankle Arthroplasty in Octogenarians: A National Database Analysis

2020 ◽  
pp. 193864002096054
Author(s):  
Matthew Partan ◽  
Nicholas Frane ◽  
Cesar Iturriaga ◽  
Prashant Matai ◽  
Adam Bitterman
Keyword(s):  
Risk Factors ◽  
The Elderly ◽  
Adverse Outcomes ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
National Database ◽  
Short Term ◽  
Ankle Arthroplasty ◽  
Increased Risk ◽  
Independent Risk Factors

Background Total ankle arthroplasty (TAA) is an increasingly popular option for end-stage ankle arthritis. Americans over the age of 80 years grew to 16.7 million in 2010, but there are scarce data assessing the outcomes of octogenarians undergoing TAA. This study evaluated (1) perioperative factors, (2) 30-day postoperative complications compared to a nonoctogenarian cohort, and (3) independent risk factors for adverse outcomes. Methods A national database registry was queried for patients who had undergone primary TAA. This yielded 1113 patients, under (n = 1059) and over (n = 54) age 80 years. Demographics and perioperative data were compared using Fisher’s exact, χ2, and independent-samples t tests. Logistic and Poisson regressions were used to calculate odds ratio (OR) of complications and independent risk factors. Results The octogenarian cohort had longer in-hospital length of stay (1.9 vs 2.5 days, P < .0001). Octogenarians were not significantly more likely to develop any complication (OR = 1.32; 95% confidence interval = 0.29-6.04; P = .722), or increased number of complications (OR = 1.18; 95% CI = 0.27-5.18; P = .820). Octogenarians had significantly increased risk of being discharged to rehab/skilled nursing (OR = 6.60; 95% CI = 2.16-20.15; P < .001) instead of home. Conclusion Although the elderly population may carry inherent risk factors, octogenarians do not present an increased risk of short-term complications following TAA. Levels of Evidence Therapeutic, Level III: Retrospective cohort study.

scholarly journals Prognostic Significance of Preoperative Serum Uric Acid-to-Lymphocyte Ratio in Hepatocellular Carcinoma Patients Undergoing Postoperative Transarterial Chemoembolization: A Propensity Score-Matching Study

2020 ◽  
Author(s):  
Shan-shan Hu ◽  
Li-heng Liu ◽  
Li-ping Tang
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Uric Acid ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Tumor Size ◽  
Lymphocyte Ratio ◽  
Low Level ◽  
Liver Cancers ◽  
Independent Risk Factors

Abstract BackgroundHepatocellular carcinoma (HCC) accounts for 85%–90% of primary liver cancers and is the seventh most common cancer worldwide. The purpose of this study is to determine an innovative and effective clinical index for prognosis prediction in HCC patients. MethodsA total of 132 patients with HCC were included in this research. A cohort of 72 cases was obtained through propensity score-matching. Patients were divided into high- and low-level groups based on the ratio of preoperative uric acid levels to lymphocytes. The differences in clinical characteristics and survival indicators were compared between the two groups.ResultsThere was a statistical difference between uric acid-to-lymphocyte ratio (ULR) level and tumor size (P < 0.01). Multivariate analysis showed that ULR (P = 0.03) and tumor size (P = 0.03) were independent risk factors for overall survival (OS). ULR (P < 0.04) and diabetes (P = 0.04) were independent risk factors for progression-free survival (PFS) in HCC patients. Further survival analysis of the entire cohort and propensity score-matching cohort showed that the OS and PFS in the high-level ULR group were significantly shorter than those in the low-level ULR group (log-rank P < 0.001). Conclusion This study demonstrated that ULR is a marker of poor prognosis in postoperative HCC patients, while high ULR levels predicted shorter OS and PFS.

scholarly journals Prediction of Factors Influencing the Timing and Prognosis of Early Tracheostomy in Patients with Multiple Rib Fractures using Propensity Score Matching Analysis

2021 ◽  
Author(s):  
Bing Zhang ◽  
GongKe Li ◽  
YuRong Wang ◽  
yong li
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Propensity Score ◽  
Tracheal Intubation ◽  
Propensity Score Matching ◽  
Rib Fractures ◽  
Early Tracheostomy ◽  
Multiple Rib Fractures ◽  
Propensity Score Matching Analysis ◽  
Independent Risk Factors

Abstract Objective To explore the factors affecting the timing and prognosis of early tracheostomy(within 7 days after tracheal intubation) in patients with multiple rib fractures. Methods A retrospective analysis of the medical history of 222 patients with multiple rib fractures who were admitted to the department of emergency intensive care unit(EICU) of the affiliated hospital of Yangzhou University from February 2015 to October 2019 underwent early tracheostomy. According to the time from tracheal intubation to tracheostomy after admission, the patients were divided into two groups: early tracheostomy group (within 7 days after tracheal intubation,ET) and late tracheostomy group (after the 7th day, LT). The propensity score matching analysis technique was used to compare the differences between the two groups in a 1:1 ratio. Results A total of 222 patients were enrolled, with 118 in the ET group and 104 in the LT group. After matching, 87 in the ET group and 87 in the LT group. The proportion of acute respiratory distress syndrome(ARDS)[59(67.8%)], the volume of pulmonary contusion (VPC)[33.8±11.4], and number of total rib fractures (NTRF)[10.8±2.7] in the ET were significantly higher than those in the LT group, P<0.05. Binary Logistic regression analysis showed that ARDS[OR=3.740, 95%CI(1.441, 9.711)], VPC[OR=1.087, 95%CI(1.052, 1.124)], and NTRF [OR=1.775, 95%CI(1.439, 2.188)] were independent risk factors for ET.The Pearson analysis showed that VPC and NTRF had significant correlation(R=0.369, P=0.01), ARDS and VPC had low degree correlation(R=0.179, P=0.018), while ARDS and NTRF had no significant correlation(R=0.132, P=0.110). Receiver operating characteristic(ROC)curve analysis showed that the area under VPC and NTRF curves [0.832(95%CI: 0.770~0.893),0.804(95%CI: 0.740~0.868)] were significantly more than the number of rib fractures(NFR), glasgow coma scale(GCS), and injury severity score(ISS), P<0.05. COX regression analysis showed that patients with underwent ET survived significantly better than the LT, P<0.05. Conclusions We found that ARDS, VPC, and NTFR were independent risk factors for ET; VPC ≥ 23.9% and (or) NTRF ≥ 8.5 could be used as predictors of ET in patients with multiple rib fractures. There was a linear relationship between NTRF and VPC. ET might benefit patients with multiple rib fractures.

scholarly journals Frequency of metabolic syndrome in stroke: a study in a tertiary health care centre in north Kerala

2017 ◽  
Vol 5 (9) ◽  
pp. 4143
Author(s):  
Swapna P. K.
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Young Adults ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Health Care Centre ◽  
Exact Test ◽  
Obesity Epidemic ◽  
The Metabolic Syndrome ◽  
The Impact

Background: Stroke is a leading cause of death and disability in developing countries beginning to affect young adults. Key components of the metabolic syndrome are important risk factors for stroke. This study intended to study the prevalence of metabolic syndrome in patients with stroke. Screening adolescents and young adults for components of metabolic syndrome will prove useful in clinical management, and its elements ultimately become important therapeutic targets for the reduction of stroke burden in the general population.Methods: Data was collected from 150 patients who were admitted with cerebrovascular accident (CVA) in the Department of Medicine. Frequency tests were conducted for various risk factors. Chi-square and Fisher exact test were used to test the significance of proportion of study parameters in the classes. The observations in this study were analysed using SPSS software.Results: Metabolic syndrome was present in 46% of the study population. Among the components of the metabolic syndrome, Hypertension was the most prevalent risk factor (68%). 67.14% of the population had 2 components of metabolic syndrome which predisposes them to a greater risk of developing metabolic syndrome over a period of few months to years.Conclusions: With the obesity epidemic, the impact of the metabolic syndrome is likely to increase. Thus, diagnosing and adequately managing metabolic syndrome is an important step in the preventing cerebrovascular disease. This study emphasises the need to target the population with one or more components of the metabolic syndrome as they are at high risk of developing stroke in the future.

scholarly journals Chemotherapy-induced nausea and vomiting (CINV) with carboplatin plus pemetrexed or carboplatin plus paclitaxel in patients with lung cancer: a propensity score-matched analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Toshinobu Hayashi ◽  
Mototsugu Shimokawa ◽  
Koichi Matsuo ◽  
Hirotoshi Iihara ◽  
Kei Kawada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Propensity Score ◽  
Nausea And Vomiting ◽  
Lung Cancer Patients ◽  
Pooled Data ◽  
Female Sex ◽  
Antiemetic Prophylaxis ◽  
Delayed Nausea ◽  
Independent Risk Factors

Abstract Background Patients with lung cancer who are treated with carboplatin-based chemotherapy regimens often experience chemotherapy-induced nausea and vomiting (CINV). However, knowledge on the effect of regimen and cofactors on the risk of CINV is limited. This study aimed to analyze and compare the incidence of CINV between lung cancer patients undergoing carboplatin plus pemetrexed (CBDCA+PEM) and those undergoing carboplatin plus paclitaxel (CBDCA+PTX) chemotherapy. Methods Pooled data of 240 patients from two prospective observational studies were compared using propensity score matching. Separate multivariate logistic regression analyses were used to identify risk factors for nausea and vomiting following chemotherapy. Results Delayed nausea was significantly more common in patients treated with CBDCA+PEM than in those treated with CBDCA+PTX (51.1% vs. 36.2%, P = 0.04), but the incidence of vomiting did not significantly differ between the two groups (23.4% vs. 14.9%, P = 0.14). The occurrence of CINV peaked on day 4 in the CBDCA+PTX group and on day 5 in the CBDCA+PEM group. Multivariate analysis showed that female sex, younger age, and CBDCA+PEM regimen were independent risk factors for delayed nausea, while female sex was an independent risk factor for delayed vomiting. Conclusions The CBDCA + PEM regimen has a higher risk of causing delayed nausea than the CBDCA + PTX regimen, and aggressive antiemetic prophylaxis should be offered to patients treated with CBDCA + PEM.

A year of hepatocellular carcinoma at a glance. Demographics, biochemical and radiological characteristics and treatment modalities from a specialized facility of Pakistan

2021 ◽  
pp. 1-6
Author(s):  
Laima Alam
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cross Sectional Study ◽  
Treatment Modalities ◽  
Fisher Exact Test ◽  
Tumour Staging ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Team Meetings ◽  
Contrast Enhanced Ct

Objectives:Relation of demographics of hepatocellular-carcinoma with the aetiology.Tumour characteristics in relation to anti-viral therapy and presence of viral-DNA/RNATreatment modalities offeredMethods: This cross-sectional study enrolled all the patients aged 18-70 years with diagnosed hepatocellular carcinoma either through Triphasic Contrast-Enhanced-CT scan and/or Magnetic Resonance Imaging or biopsy presenting to the Outpatient-Department or multi-disciplinary-team meetings for the year 2019. Demographic variables, biochemical analysis including liver profile and stage of cirrhosis, viral-status, tumour staging and the treatment modalities offered were all noted. ANOVA (normal) and Kruskal-Wallis (non-normal) tests were used to compare quantitative data whereas chi-square-test and fisher-exact-test were used to compare qualitative-data.Results: Out of 195 patients with hepatocellular carcinoma, 76% were males in their fifth to sixth decades of life, 96% had cirrhosis, 94% corresponded to viral hepatocellular-carcinoma (82% Hepatitis-C-Virus, 9% Hepatitis-B-Virus and 3% coinfection), 60% of the cirrhotics landed in Child-Pugh A category with tumour staging BCLC-B being the predominant one (43.6%) and single and multiple bilateral nodules were the commonest lesions encountered. Platelets and Alanine-Transaminase had a significant relation across aetiological groups. Lymph-nodes were the most common extra-hepatic organs for metastasis and the presence of viral PCR had a significant impact on the tumour aggressiveness. Thirty-two percent of the patients were amenable to curative treatment.Conclusion: Viral infection is the main cause of rising prevalence of this tumour in Pakistan. Treatment modalities are expensive and expertise are lacking. A nationwide cancer registry is required for the exact disease burden and tumour behaviour for our population. Continuous....

636 SHORT-TERM OUTCOME FOR HIGH-RISK PATIENTS AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Victor Plat ◽  
Wessel Stam ◽  
Boukje Bootsma ◽  
Jennifer Straatman ◽  
Thomas Klausch ◽  
...  
Keyword(s):  
High Risk ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Charlson Comorbidity Index ◽  
Short Term ◽  
Term Outcome ◽  
High Risk Patients ◽  
Short Term Outcome ◽  
Risk Patients ◽  
Comorbidity Index

Abstract   Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection, however it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. Methods This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Results Of 5438 patients, 945 and 431 high-risk patients underwent TTE and THE respectively. After propensity score matching, mortality (6.3% vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0% vs 2.2%, P = 0.020). Conclusion Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.

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