scholarly journals Comparison of Two Circular-Stapled Techniques for Esophageal Cancer: A Propensity-Matched Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Hang Lin ◽  
Ge’ao Liang ◽  
Huiping Chai ◽  
Yongde Liao ◽  
Chunfang Zhang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Anastomotic Leakage ◽  
Logistic Regression Analysis ◽  
Leakage Rate ◽  
Stapled Anastomosis ◽  
Ivor Lewis ◽  
Anastomotic Leakage Rate

ObjectiveThe optimal technique for the thoracoscopic construction of an intrathoracic esophagogastric anastomosis continues to be a subject of controversy. The aim of this study was to compare the perioperative outcomes of circular-stapled anastomosis using a transorally inserted anvil (Orvil™) with those of circular-stapled anastomosis using a transthoracically placed anvil (non-Orvil™) in totally minimally invasive Ivor Lewis esophagectomy (Ivor Lewis TMIE).MethodsThe data of 272 patients who underwent Ivor Lewis TMIE for esophageal cancer at multiple centers were collected from January 1, 2014 to December 31, 2017. After propensity score matching (1:1) for patient baseline characteristics, 65 paired cases were selected for statistical analysis. Logistic regression analysis was performed to investigate the significant factors of anastomotic leakage.ResultsIn the propensity score-matched analysis, compared with the non-Orvil™ group, the Orvil™ group was associated with a significantly shorter operation time (p=0.031), less intraoperative hemorrhage (p<0.001), lower need for intraoperative transfusions (p=0.009), earlier postoperative oral feeding time (p=0.010), longer chest tube duration (p<0.001), shorter postoperative hospital stays (p=0.001), lower total hospitalization costs (p<0.001) and a lower postoperative anastomotic leakage rate (p=0.033). Multivariate logistic regression analysis showed that anastomotic technique and pulmonary infection were independent factors for the development of postoperative anastomotic leakage (p< 0.05).ConclusionsOrvil™ anastomosis exhibited better perioperative effects than non-Orvil™ anastomosis after the propensity score-matched analysis. Remarkably, the Orvil™ technique contributed to a lower postoperative anastomotic leakage rate than the non-Orvil™ technique.

scholarly journals Effect of Hypothermia in the Emergency Department on the Outcome of Trauma Patients: A Cross-Sectional Analysis

2018 ◽  
Vol 15 (8) ◽  
pp. 1769 ◽  
Author(s):  
Ting-Min Hsieh ◽  
Pao-Jen Kuo ◽  
Shiun-Yuan Hsu ◽  
Peng-Chen Chien ◽  
Hsiao-Yun Hsieh ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Body Temperature ◽  
Propensity Score ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Trauma Patients ◽  
Body Temperatures ◽  
Multivariate Logistic Regression ◽  
Mortality Outcome

This study aimed to assess whether hypothermia is an independent predictor of mortality in trauma patients in the condition of defining hypothermia as body temperatures of <36 °C. Data of all hospitalized adult trauma patients recorded in the Trauma Registry System at a level I trauma center between 1 January 2009 and 12 December 2015 were retrospectively reviewed. A multivariate logistic regression analysis was performed in order to identify factors related to mortality. In addition, hypothermia and normothermia were defined as temperatures <36 °C and from 36 °C to 38 °C, respectively. Propensity score-matched study groups of hypothermia and normothermia patients in a 1:1 ratio were grouped for mortality assessment after adjusting for potential confounders such as age, sex, preexisting comorbidities, and injury severity score (ISS). Of 23,705 enrolled patients, a total of 401 hypothermic patients and 13,368 normothermic patients were included in this study. Only 3.0% of patients had hypothermia upon arrival at the emergency department (ED). Compared to normothermic patients, hypothermic patients had a significantly higher rate of abbreviated injury scale (AIS) scores of ≥3 in the head/neck, thorax, and abdomen and higher ISS. The mortality rate in hypothermic patients was significantly higher than that in normothermic patients (13.5% vs. 2.3%, odds ratio (OR): 6.6, 95% confidence interval (CI): 4.86–9.01, p < 0.001). Of the 399 well-balanced propensity score-matched pairs, there was no significant difference in mortality (13.0% vs. 9.3%, OR: 1.5, 95% CI: 0.94–2.29, p = 0.115). However, multivariate logistic regression analysis revealed that patients with low body temperature were significantly associated with the mortality outcome. This study revealed that low body temperature is associated with the mortality outcome in the multivariate logistic regression analysis but not in the propensity score matching (PSM) model that compared patients with hypothermia defined as body temperatures of <36 °C to those who had normothermia. These contradicting observations indicated the limitation of the traditional definition of body temperature for the diagnosis of hypothermia. Prospective randomized control trials are needed to determine the relationship between hypothermia following trauma and the clinical outcome.

scholarly journals A Composite Index Predicts Disease Progression in Early Stages of COVID-19: a Propensity Score-matched Cohort Study

2020 ◽  
Author(s):  
Jianjun Xu ◽  
Shaobo Hu ◽  
Suzhen Li ◽  
Weimin Wang ◽  
Yuzhe Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Disease Progression ◽  
Logistic Regression Analysis ◽  
Independent Predictor ◽  
Early Stage ◽  
Multivariable Logistic Regression Analysis ◽  
Matched Cohort ◽  
Early Stages

Abstract Background: Thus far, studies on COVID-19 have focused on the epidemiology of the disease and clinical characteristics of patients (14-19), as well as on the risk factors associated with mortality during hospitalization in critical COVID-19 cases. However, no research has been performed on the prediction of progression in patients in the early stages of the disease. The aim of this work was to identify the early predictors of COVID-19 progression.Methods: The study included 338 patients with COVID-19 treated at two hospitals in Wuhan, Chian, from December, 2019 to March, 2020. Predictors of the progression of COVID-19 from mild to severe stages were selected by the logistic regression analysis. The predictive accuracy was evaluated further in the propensity score-matched cohort.Results: COVID-19 progression to severe and critical stages was confirmed in 78(23.1%) patients. The average value of the neutrophil-to-lymphocyte ratio (NLR) was higher in patients in the disease progression group than in the improvement group. Multivariable logistic regression analysis revealed that elevated NLR, LDH, and IL-10, were independent predictors of disease progression. The optimal cut-off value of NLR for predicting the progression of COVID-19 was 3.75. In the propensity score-matched cohort, NLR ≥ 3.75 was still an independent predictor of COVID-19 progression after multivariate analysis.Conclusions: The performed analysis demonstrates that NLR qualifies as an independent predictor of disease progression in COVID-19 patients at the early stage of the disease. The combined evaluation of NLR and LDH improved the accuracy of the prediction of COVID-19 progression. Assessment of predictors might facilitate early identification of COVID-19 patients at high risk for disease progression and ensure timely administration of appropriate treatment to prevent mild cases from becoming severe.

scholarly journals Risk of postpolypectomy bleeding in patients taking direct oral anticoagulants or clopidogrel

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gwang-Un Kim ◽  
Sinwon Lee ◽  
Jaewon Choe ◽  
Sung Wook Hwang ◽  
Sang Hyoung Park ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Logistic Regression Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Thromboembolic Events

AbstractThe usage of direct oral anticoagulants (DOACs) to prevent and treat thromboembolic events is gradually increasing. We aimed to evaluate the outcomes of patients taking DOACs after polypectomy. We retrospectively reviewed 131 patients taking DOACs and 270 taking clopidogrel who underwent polypectomy between November 2010 and December 2017. The risk of delayed postpolypectomy bleeding (PPB) was evaluated and compared. A total of 989 polyps were removed (320 polyps in the DOAC and 669 polyps in the clopidogrel group). DOACs and clopidogrel were discontinued for 2.8 ± 1.7 days and 5.8 ± 2.5 days before polypectomy, respectively. DOACs and clopidogrel were restarted on 1.6 ± 2.9 days and 1.7 ± 1.1 days after polypectomy, respectively. According to per polyp analysis, delayed PPB rate was 1.6% in both groups (p = 0.924). Logistic regression analysis was performed after propensity score matching and revealed that DOACs did not increase the delayed PPB risk compared to clopidogrel (OR 0.929, 95% CI 0.436–1.975, p = 0.847). With the majority following the antithrombotic discontinuation guidelines, the incidence of delayed PPB was 3.1% in the patients taking DOACs. The delayed PPB risk was not greater in those taking DOACs than in those taking clopidogrel.

Is a small coil more effective as a finishing coil for the embolization of intracranial aneurysms? Outcomes using GALAXY G3™ MINI micro-coils as finishing coils in a single center

2021 ◽  
pp. 159101992110118
Author(s):  
Sang-Uk Kim ◽  
Joon Huh ◽  
Hyun-Goo Lee ◽  
Won-Joo Jeong ◽  
Dal-Soo Kim ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Logistic Regression Analysis ◽  
Packing Density ◽  
Coil Embolization ◽  
Odds Ratio ◽  
Total Population ◽  
Outer Diameter

Objective The purpose of this study was to compare the outcomes of coil embolization using a 0.009 inches primary outer diameter coil as finishing coil (FC) to that of 0.01 inches. Methods From February and August 2020, 131 aneurysms that performed coil embolization using FC with a second loop diameter of 1 mm, were reviewed retrospectively, conducting propensity score matching and logistic regression analysis. Angiographic results such as, occlusion grade, packing density, failure and event were compared between 0.009 inches coil of GALAXY G3™ MINI microcoil (n = 54) and 0.01 inches coils (n = 77). Results There were no statistically significant differences between two groups, but more events occurred in the 0.009 group. (Odds ratio, 3.65; 95% CI, 1.06-12.55; P = 0.031) In the results of coil embolization, successful occlusion occlusion (complete occlusion and residual neck) was identified more in the 0.01 group. After propensity score matching, the variables in each group were similar, but the successful occlusion was higher in the 0.01 group as in the total population. Events tended to occur more frequently in the 0.009 inch group, and logistic regression analysis showed slightly higher events in the angled microcatheter. (48.3% versus 76.9%., P = 0.075), Also, the 0.009 inch FC is an independent risk factor. (Odds ratio, 3.84; 95% CI, 1.07-13.80; P = 0.039) Conclusions Using 0.01 inches coils as FC increased the packing density after the procedure, and showed more successful occlusion than using a 0.009 inches coil. The probability of unexpected events was observed more than three times in the 0.009 inch group.

Dexmedetomidine and Mortality From Sepsis Requiring Mechanical Ventilation: A Japanese Nationwide Retrospective Cohort Study

2020 ◽  
pp. 088506662094215
Author(s):  
Shotaro Aso ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Logistic Regression Analysis ◽  
Instrumental Variable ◽  
Diagnosis Procedure Combination ◽  
Instrumental Variable Analysis ◽  
Mechanically Ventilated ◽  
Variable Analysis

Background: Dexmedetomidine has a mild sedative effect and may reduce mortality in mechanically ventilated critically ill patients. However, few studies have examined the effects of dexmedetomidine in patients with sepsis who require mechanical ventilation. The aim of this study was to investigate the association between dexmedetomidine and mortality in patients with sepsis requiring mechanical ventilation, using a nationwide inpatient database in Japan. Methods: Using the Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2016, we identified adult patients with sepsis who required mechanical ventilation for more than 2 days. Patients were divided into those who received dexmedetomidine and those who received midazolam or propofol within 1 day after admission. Logistic regression analysis, propensity score-matched analysis, and instrumental variable analysis were performed to compare all-cause 28-day mortality and duration of mechanical ventilation between the groups. Results: In total, 50 671 were eligible patients, including dexmedetomidine group (n = 13 759) and propofol or midazolam group (n = 36 912). The dexmedetomidine group had significantly lower all-cause 28-day mortality compared with the group receiving midazolam or propofol, as shown by the logistic regression analysis (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.73-0.84), the propensity score–matched analysis (OR: 0.85; 95% CI: 0.80-0.91), and the instrumental variable analysis (OR: 0.64; 95% CI: 0.57-0.73). The duration of mechanical ventilation in the dexmedetomidine group was significantly shorter than that in the midazolam or propofol group. Conclusions: Dexmedetomidine was associated with a reduction in all-cause 28-day mortality and duration of mechanical ventilation.

scholarly journals Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Oliver Birkelbach ◽  
Rudolf Mörgeli ◽  
Claudia Spies ◽  
Maria Olbert ◽  
Björn Weiss ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Logistic Regression Analysis ◽  
Frailty Status ◽  
Frailty Assessment ◽  
Care Facilities

Abstract Background Frailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk. Objective This study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines. Design Retrospective observational analysis. Setting Single center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017. Patients Patients 65 years old or older were evaluated for frailty using Fried’s 5-point frailty assessment prior to elective non-cardiac surgery. Patients were classified into non-frail (0 criteria, reference group), pre-frail (1–2 positive criteria) and frail (3–5 positive criteria) groups. Main outcome measures The incidence of postoperative complications was assessed until discharge from the hospital, using the roster from the National VA Surgical Quality Improvement Program. Propensity score matching and logistic regression analysis were performed. Results From 1186 elderly patients, 46.9% were classified as pre-frail (n = 556), and 11.4% as frail (n = 135). The rate of complications were significantly higher in the pre-frail (34.7%) and frail groups (47.4%), as compared to the non-frail group (27.5%). Similarly, length of stay (non-frail: 5.0 [3.0;7.0], pre-frail: 7.0 [3.0;9.0], frail 8.0 [4.5;12.0]; p < 0.001) and discharges to care facilities (non-frail:1.6%, pre-frail: 7.4%, frail: 17.8%); p < 0.001) were significantly associated with frailty status. After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail (OR 1.78; 95% CI 1.04–3.05) and frail (OR 2.08; 95% CI 1.21–3.60) patients. Conclusions The preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk. Significantly increased length of hospitalisation and discharges to care facilities were also observed. Implementation of routine frailty assessments appear to be an effective tool in identifying patients with increased risk. Now future studies are needed to investigate whether patients benefit from optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk stratification.

In-hospital mortality and length of hospital stay with craniotomy versus craniectomy for acute subdural hemorrhage: a multicenter, propensity score–matched analysis

2020 ◽  
Vol 133 (2) ◽  
pp. 504-513 ◽  
Author(s):  
Keita Shibahashi ◽  
Kazuhiro Sugiyama ◽  
Jun Tomio ◽  
Hidenori Hoda ◽  
Akio Morita
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Logistic Regression Analysis ◽  
Decompressive Craniectomy ◽  
Length Of Hospital Stay ◽  
Absolute Difference ◽  
Subdural Hemorrhage

OBJECTIVEThe optimal surgical treatment for acute subdural hemorrhage (ASDH) remains controversial. The purpose of this study was to compare outcomes in patients who underwent craniotomy with those in patients who underwent decompressive craniectomy for the treatment of ASDH.METHODSUsing the Japan Trauma Data Bank, a nationwide trauma registry, the authors identified patients aged ≥ 18 years with ASDH who underwent surgical evacuation after blunt head trauma between 2004 and 2015. Logistic regression analysis was used to estimate a propensity score to predict decompressive craniectomy use. They then used propensity score–matched analysis to compare patients who underwent craniotomy with those who underwent decompressive craniectomy. To identify the potential benefits and disadvantages of decompressive craniectomy among different subgroups, they estimated the interactions between treatment and the subgroups using logistic regression analysis.RESULTSOf 236,698 patients who were registered in the database, 1788 were eligible for propensity score–matched analysis. The final analysis included 514 patients who underwent craniotomy and 514 patients who underwent decompressive craniectomy. The in-hospital mortality did not differ significantly between the groups (41.6% for the craniotomy group vs 39.1% for the decompressive craniectomy group; absolute difference −2.5%; 95% CI −8.5% to 3.5%). The length of hospital stay was significantly longer in patients who underwent decompressive craniectomy (median 23 days [IQR 4–52 days] vs 30 days [IQR 7–60 days], p = 0.005). Subgroup analyses demonstrated qualitative interactions between decompressive craniectomy and the patient subgroups, suggesting that patients who were more severely injured (Glasgow Coma Scale score < 9 and probability of survival < 0.64) and those involved in high-energy injuries may be good candidates for decompressive craniectomy.CONCLUSIONSThe results of this study showed that overall, decompressive craniectomy did not appear to be superior to craniotomy in ASDH treatment in terms of in-hospital mortality. In contrast, there were significant differences in the effectiveness of decompressive craniectomy between the subgroups. Thus, future studies should prioritize the identification of a subset of patients who will possibly benefit from the performance of each of the procedures.

scholarly journals Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5653
Author(s):  
Jiwon Han ◽  
Ah-Young Oh ◽  
Chang-Hoon Koo ◽  
Yu Kyung Bae ◽  
Yong-Tae Jeon
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Spine Surgery ◽  
Logistic Regression Analysis ◽  
Kidney Injury ◽  
Volatile Anesthetics

The effects of anesthetics on acute kidney injury (AKI) after spine surgery have not been evaluated fully. This study compared propofol-based total intravenous anesthesia (TIVA) and volatile anesthetics in the development of AKI after spine surgery. This retrospective study reviewed patients who underwent spine surgery between 2015 and 2019. A logistic regression analysis was performed to identify risk factors for AKI. Additionally, after propensity score matching, the incidence of AKI was compared between TIVA and volatile groups. Of the 4473 patients, 709 were excluded and 3764 were included in the logistic regression. After propensity score matching, 766 patients from each group were compared, and we found that the incidence of AKI was significantly lower in the TIVA group (1% vs. 4.2%, p < 0.001). In the multivariate logistic regression analysis, the risk factors for postoperative AKI were male sex (OR 1.85, 95% CI 1.18–3.06), hypertension (OR 2.48, 95% CI 1.56–3.94), anemia (OR 2.66, 95% CI 1.76–4.04), and volatile anesthetics (OR 4.69, 95% CI 2.24–9.84). Compared with volatile anesthetics, TIVA is associated with a reduced risk of AKI for patients who have undergone spine surgery.

ANALISIS HUBUNGAN SARANA, PENGETAHUAN, DAN SIKAP BIDAN PRAKTIK MANDIRI DENGAN KEPATUHAN MENJALANKAN STANDAR PELAYANAN ANTENATAL CARE DI KOTA PADANGSIDIMPUAN

2019 ◽  
Vol 2 (1) ◽  
pp. 27-33
Author(s):  
Megawati Sinambela ◽  
Evi Erianty Hasibuan
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Logistic Regression Analysis ◽  
Care Service ◽  
Multivariate Logistic Regression Analysis ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
The North

Antenatal care is a service provided to pregnant women to monitor, support maternal health and detect mothers whether normal or problematic pregnant women. According to the WHO, globally more than 70% of maternal deaths are caused by complications of pregnancy and childbirth such as hemorrhage, hypertension, sepsis, and abortion. Based on data obtained from the profile of the North Sumatra provincial health office in 2017, in the city of Padangsidimpuan in 2017 the coverage of ANC visits reached (76.58%) and had not reached the target in accordance with the 2017 Provincial Health Office strategy plan (95%). This type of research was an observational analytic study with a cross sectional design. The population in this study were independent practice midwives who were in the Padangsidimpuan, the sample in this study amounted to 102 respondents. The technique of collecting data used questionnaires and data analysis used univariate, bivariate and multivariate analysis with logistic regression analysis. Based on bivariate analysis showed that there was a relationship between facilities, knowledge and attitudes of independent midwives with compliance with the standards of antenatal care services with a value of p <0.05. The results of the study with multivariate logistic regression analysis showed that the factors associated with the compliance of independent midwives in carrying out antenatal care service standards were attitudes with values (p = 0.026).

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