scholarly journals Overcoming a travel burden to high-volume centers for treatment of retroperitoneal sarcomas is associated with improved survival

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Robin Schmitz ◽  
Mohamed A. Adam ◽  
Dan G. Blazer
Keyword(s):  
Tumor Grade ◽  
High Volume ◽  
National Study ◽  
Short Term ◽  
Term Survival ◽  
Low Volume ◽  
Retroperitoneal Sarcomas ◽  
Centralized Care ◽  
Travel Burden

Abstract Background Guidelines recommend treatment of retroperitoneal sarcomas (RPS) at high-volume centers. However, high-volume centers may not be accessible locally. This national study compared outcomes of RPS resection between local low-volume centers and more distant high-volume centers. Methods Patients treated for RPS were identified from the National Cancer Database (1998–2012). Travel distance and annual hospital volume were divided into quartiles. Two groups were identified: (1) short travel to low-volume hospitals (ST/LV), (2) long travel to high-volume hospitals (LT/HV). Outcomes were adjusted for clinical, tumor, and treatment characteristics. Results Two thousand five hundred ninety-nine patients met the inclusion criteria. The LT/HV cohort was younger and more often white (p < 0.01). The LT/HV group had more comorbidities, higher tumor grade, and more often radical resections and radiotherapy (all p < 0.05). The ST/LV group underwent significantly more R2 resections (4.4% vs. 2.6%, p = 0.003). Thirty-day mortality was significantly lower in the LT/HV group (1.2% vs. 2.8%, p = 0.0026). Five-year survival was better among the LT/HV group (63% vs. 53%, p < 0.0001). After adjustment, the LT/HV group had a 27% improvement in overall survival (HR 0.73, p = 0.0009). Conclusions This national study suggests that traveling to high-volume centers for the treatment of RPS confers a significant short-term and long-term survival advantage, supporting centralized care for RPS.

Institutional volume affects long-term survival following lung transplantation in the USA

2019 ◽  
Vol 56 (2) ◽  
pp. 271-276 ◽  
Author(s):  
Arman Kilic ◽  
Thomas G Gleason ◽  
Hiroshi Kagawa ◽  
Ahmet Kilic ◽  
Ibrahim Sultan
Keyword(s):  
Lung Transplantation ◽  
High Volume ◽  
Term Survival ◽  
Long Term Survival ◽  
Kaplan Meier ◽  
The Usa ◽  
Institutional Volume ◽  
Low Volume ◽  
The Impact

Abstract OBJECTIVES The aim of this study was to evaluate the impact of institutional volume on long-term outcomes following lung transplantation (LTx) in the USA. METHODS Adults undergoing LTx were identified in the United Network for Organ Sharing registry. Patients were divided into equal size tertiles according to the institutional volume. All-cause mortality following LTx was evaluated using the risk-adjusted multivariable Cox regression and the Kaplan–Meier analyses, and compared between these volume cohorts at 3 points: 90 days, 1 year (excluding 90-day deaths) and 10 years (excluding 1-year deaths). Lowess smoothing plots and receiver-operating characteristic analyses were performed to identify optimal volume thresholds associated with long-term survival. RESULTS A total of 13 370 adult LTx recipients were identified. The mean annual centre volume was 33.6 ± 20.1. After risk adjustment, low-volume centres were found to be at increased risk for 90-day mortality, [hazard ratio (HR) 1.56, P < 0.001], 1-year mortality excluding 90-day deaths (HR 1.46, P < 0.001) and 10-year mortality excluding 1-year deaths (HR 1.22, P < 0.001). These findings persisted when the centre volume was modelled as a continuous variable. The Kaplan–Meier analysis also demonstrated significant reductions in survival at each of these time points for low-volume centres (each P < 0.001). The 10-year survival conditional on 1-year survival was 37.4% in high-volume centres vs 28.0% in low-volume centres (P < 0.001). The optimal annual volume threshold for long-term survival was 26 LTx/year. CONCLUSIONS The institutional volume impacts long-term survival following LTx, even after excluding deaths within the first post-transplant year. Identifying the processes of care that lead to longer survival in high-volume centres is prudent.

scholarly journals The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction

2021 ◽  
Vol 18 (18) ◽  
pp. 9634
Author(s):  
Marek Czajkowski ◽  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Jarosław Kosior ◽  
Dorota Nowosielecka ◽  
...  
Keyword(s):  
Clinical Success ◽  
Technical Difficulty ◽  
High Volume ◽  
Lead Extraction ◽  
Short Term ◽  
Term Survival ◽  
Major Complications ◽  
Related Risk ◽  
Short Term Mortality

Background: Little is known about lead-related venous stenosis/occlusion (LRVSO), and the influence of LRVSO on the complexity and outcomes of transvenous lead extraction (TLE) is debated in the literature. Methods: We performed a retrospective analysis of venograms from 2909 patients who underwent TLE between 2008 and 2021 at a high-volume center. Results: Advanced LRVSO was more common in elderly men with a high Charlson comorbidity index. Procedure duration, extraction of superfluous leads, occurrence of any technical difficulty, lead-to-lead binding, fracture of the lead being extracted, need to use alternative approach and lasso catheters or metal sheaths were found to be associated with LRVSO. The presence of LRVSO had no impact on the number of major complications including TLE-related tricuspid valve damage. The achievement of complete procedural or clinical success did not depend on the presence of LRVSO. Long-term mortality, in contrast to periprocedural and short-term mortality, was significantly worse in the groups with LRSVO. Conclusions: LRVSO can be considered as an additional TLE-related risk factor. The effect of LRVSO on major complications including periprocedural mortality and on short-term mortality has not been established. However, LRVSO has been associated with poor long-term survival.

Hospital Volume, Margin Status, and Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

2012 ◽  
Vol 78 (2) ◽  
pp. 225-229 ◽  
Author(s):  
Marco La Torre ◽  
Giuseppe Nigri ◽  
Linda Ferrari ◽  
Giulia Cosenza ◽  
Matteo Ravaioli ◽  
...  
Keyword(s):  
Pancreatic Surgery ◽  
Hospital Volume ◽  
Survival Rates ◽  
High Volume ◽  
Margin Status ◽  
Negative Margin ◽  
Term Survival ◽  
Modeling And Analysis ◽  
Low Volume

An association between hospital surgical volume and short- and long-term outcomes after pancreatic surgery has been demonstrated. Identification of specific factors contributing to this relationship is difficult. In this study, the authors evaluated if margin status can be identified as a measure of surgical quality, affecting overall survival, as a function of hospital pancreaticoduodenectomy volume. A systematic review of the literature was performed. Two models for analysis were created, dividing the 18 studies identified into quartiles and two quantiles based on the average annual hospital pancreatectomy volume. Regression modeling and analysis of variance were used to find an association between hospital volume, margin status, and survival. Increasing hospital volume was associated with a significantly increased negative margin status rate: 55 per cent for low-volume, 72 per cent for medium-volume, 74.3 per cent for high-volume, and 75.7 per cent for very high-volume centers ( P = 0.008). The negative margin status rates were 64 per cent and 75.1 per cent for volume centers with less and more than 12 pancreaticoduodenectomies/year, respectively ( P = 0.04). Low-volume centers negatively affected both margin positive resection and 5-year survival rates, compared with high-volume centers. Margin status rate after pancreaticoduodenectomy could, therefore, be considered a measure of quality for selection of hospitals dedicated to pancreatic surgery.

scholarly journals Association between hospital liver transplantation volume and mortality after liver re-transplantation

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255655
Author(s):  
Seung-Young Oh ◽  
Eun Jin Jang ◽  
Ga Hee Kim ◽  
Hannah Lee ◽  
Nam-Joon Yi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hospital Mortality ◽  
High Volume ◽  
Case Volume ◽  
Term Survival ◽  
Healthcare Insurance ◽  
Comorbidity Index ◽  
Low Volume ◽  
The Relationship

Background The relationship between institutional liver transplantation (LT) case volume and clinical outcomes after liver re-transplantation is yet to be determined. Methods Patients who underwent liver re-transplantation between 2007 and 2016 were selected from the Korean National Healthcare Insurance Service database. Liver transplant centers were categorized to either high-volume centers (≥ 64 LTs/year) or low-volume centers (< 64 LTs/year) according to the annual LT case volume. In-hospital and long-term mortality after liver re-transplantation were compared. Results A total of 258 liver re-transplantations were performed during the study period: 175 liver re-transplantations were performed in 3 high-volume centers and 83 were performed in 21 low-volume centers. In-hospital mortality after liver re-transplantation in high and low-volume centers were 25% and 36% (P = 0.069), respectively. Adjusted in-hospital mortality was not different between low and high-volume centers. Adjusted 1-year mortality was significantly higher in low-volume centers (OR 2.14, 95% CI 1.05–4.37, P = 0.037) compared to high-volume centers. Long-term survival for up to 9 years was also superior in high-volume centers (P = 0.005). Other risk factors of in-hospital mortality and 1-year mortality included female sex and higher Elixhauser comorbidity index. Conclusion Centers with higher case volume (≥ 64 LTs/year) showed lower in-hospital and overall mortality after liver re-transplantation compared to low-volume centers.

Short-term weight loss after hospitalization predicts long-term survival in patients with chronic heart failure

2006 ◽  
Vol 31 (03) ◽  
Author(s):  
M Lainscak ◽  
S von Haehling ◽  
A Sandek ◽  
I Keber ◽  
M Kerbev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Chronic Heart Failure ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Parenteral Nutrition and Oxidant Load in Neonates

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2631
Author(s):  
Kandeepan Karthigesu ◽  
Robert F. Bertolo ◽  
Robert J. Brown
Keyword(s):  
Parenteral Nutrition ◽  
Storage Temperature ◽  
Oral Feeding ◽  
Published Data ◽  
Short Term ◽  
Antioxidant Defences ◽  
Term Survival ◽  
Nutrient Sources ◽  
Short Term Survival

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.

An oncology clinical trial design with randomization adaptive to both short- and long-term responses

2017 ◽  
Vol 28 (7) ◽  
pp. 2015-2031 ◽  
Author(s):  
Hao Liu ◽  
Xiao Lin ◽  
Xuelin Huang
Keyword(s):  
Trial Design ◽  
Clinical Trial Design ◽  
Therapeutic Benefit ◽  
Survival Outcome ◽  
Operating Characteristics ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Term Response

In oncology clinical trials, both short-term response and long-term survival are important. We propose an urn-based adaptive randomization design to incorporate both of these two outcomes. While short-term response can update the randomization probability quickly to benefit the trial participants, long-term survival outcome can also change the randomization to favor the treatment arm with definitive therapeutic benefit. Using generalized Friedman’s urn, we derive an explicit formula for the limiting distribution of the number of subjects assigned to each arm. With prior or hypothetical knowledge on treatment effects, this formula can be used to guide the selection of parameters for the proposed design to achieve desirable patient number ratios between different treatment arms, and thus optimize the operating characteristics of the trial design. Simulation studies show that the proposed design successfully assign more patients to the treatment arms with either better short-term tumor response or long-term survival outcome or both.

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