scholarly journals Differences in Hospitalization Outcomes of Kidney Disease between Patients Who Received Care by Nephrologists and Non-Nephrologist Physicians: A Propensity-Score-Matched Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5269
Author(s):  
Chien-Wun Wang ◽  
Yu Yang ◽  
Chun-Chieh Yeh ◽  
Yih-Giun Cherng ◽  
Ta-Liang Chen ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Kidney Diseases ◽  
Research Data ◽  
Physician Specialty ◽  
Logistic Regressions ◽  
Matched Study ◽  
Complications And Mortality ◽  
Reduced Risk ◽  
Age Category

The influence of physician specialty on the outcomes of kidney diseases (KDs) remains underexplored. We aimed to compare the complications and mortality of patients with admissions for KD who received care by nephrologists and non-nephrologist (NN) physicians. We used health insurance research data in Taiwan to conduct a propensity-score matched study that included 17,055 patients with admissions for KD who received care by nephrologists and 17,055 patients with admissions for KD who received care by NN physicians. Multivariable logistic regressions were conducted to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for 30-day mortality and major complications associated with physician specialty. Compared with NN physicians, care by nephrologists was associated with a reduced risk of 30-day mortality (OR 0.29, 95% CI 0.25–0.35), pneumonia (OR 0.82, 95% CI 0.76–0.89), acute myocardial infarction (OR 0.68, 95% CI 0.54–0.87), and intensive care unit stay (OR 0.78, 95% CI 0.73–0.84). The association between nephrologist care and reduced admission adverse events was significant in every age category, for both sexes and various subgroups. Patients with admissions for KD who received care by nephrologists had fewer adverse events than those who received care by NN physicians. We suggest that regular nephrologist consultations or referrals may improve medical care and clinical outcomes in this vulnerable population.

scholarly journals Comparison of hospital complications and mortality for stroke patients treated by male vs female physicians: a propensity-score matched study

2019 ◽  
Author(s):  
Fai Lam ◽  
Ta-Liang Chen ◽  
Chao-Shun Lin ◽  
Chun-Chuan Shih ◽  
Chun-Chieh Yeh ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Research Database ◽  
Stroke Patients ◽  
Female Physicians ◽  
Stroke Outcomes ◽  
Physician Gender ◽  
Matching Procedure ◽  
Matched Study ◽  
Complications And Mortality

Abstract Background: The association between physician gender and the outcomes of stroke patients is not yet fully understood. The aim of this study was to evaluate outcomes after stroke hospitalization between patients who received female physicians’ care (FPC) vs male physicians’ care (MPC). Methods: We used Taiwan’s National Health Insurance Research Database 2000-2009 claims data to conduct a stroke cohort study that included 493,223 hospitalized stroke patients. Using a matching procedure by propensity score, we selected 25,160 stroke patients with FPC and 25,160 stroke patients with MPC for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of poststroke complications and in-hospital mortality between patients with FPC and MPC. Results: Compared with patients with MPC, stroke patients with FPC had significantly lower risks of poststroke pneumonia (OR 0.87, 95% CI 0.81-0.94), septicemia (0.79, 95% CI 0.70-0.88), acute renal failure (OR 0.78, 95% CI 0.65-0.95), admission to the intensive care unit (OR 0.73, 95% CI 0.69-0.77), and 30-day in-hospital mortality (OR 0.64, 95% CI 0.55-0.75). However, the risk of urinary tract infection (OR 1.16, 95% 1.09-1.23) was higher in patients with FPC than in those with MPC. Lower rates of poststroke adverse events in patients with FPC were noted in further analysis, including different morbidities and various types of stroke. Conclusions: Stroke patients with FPC showed reduced complications and mortality compared with MPC patients. Our findings warrant randomized control trials in the future to validate the influence of physician gender on stroke outcomes.

scholarly journals Adverse Outcomes after Non-Cardiac Surgeries in Patients with Heart Failure: A Propensity-Score Matched Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1501
Author(s):  
Po-Han Lo ◽  
Chuen-Chau Chang ◽  
Chun-Chieh Yeh ◽  
Li-Chin Sung ◽  
Yih-Giun Cherng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Surgical Care ◽  
Adverse Outcomes ◽  
Patients With Heart Failure ◽  
Matching Procedure ◽  
Basic Characteristics ◽  
Matched Study ◽  
The Impact ◽  
Complications And Mortality

The impact of heart failure (HF) on postoperative outcomes is not completely understood. Our purpose is to investigate complications and mortality after noncardiac surgeries in people who had HF. In the analyses of research data of health insurance in, we identified 32,808 surgical patients with preoperative HF and 32,808 patients without HF undergoing noncardiac surgeries. We used a matching procedure with propensity score and considered basic characteristics, coexisting diseases, and information of index surgery between patients with and without HF. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for complications and mortality after noncardiac surgeries in patients with HF were analyzed in multivariate logistic regressions. HF increased the risks of postoperative acute myocardial infarction (OR 2.51, 95% CI 1.99–3.18), pulmonary embolism (OR 2.46, 95% CI 1.73–3.50), acute renal failure (OR 1.97, 95% CI 1.76–2.21), intensive care (OR 1.93, 95% CI 1.85–2.01), and 30-day in-hospital mortality (OR 1.80, 95% CI 1.59–2.04). Preoperative emergency care, inpatient care, and injections of diuretics and cardiac stimulants due to heart failure were also associated with mortality after surgery. Patients with HF had increased complications and mortality after noncardiac surgeries compared with those without HF. The surgical care team may consider revising the protocols for perioperative care in patients with HF.

scholarly journals The Association of Intraoperative driving pressure with postoperative pulmonary complications in open versus closed abdominal surgery patients – a posthoc propensity score–weighted cohort analysis of the LAS VEGAS study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guido Mazzinari ◽  
◽  
Ary Serpa Neto ◽  
Sabrine N. T. Hemmes ◽  
Goran Hedenstierna ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adverse Events ◽  
Abdominal Surgery ◽  
Las Vegas ◽  
Cohort Analysis ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Driving Pressure ◽  
Postoperative Pulmonary Complications ◽  
Open Abdominal Surgery

Abstract Background It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our primary objective was to determine and compare the association of time–weighted average ΔP (ΔPTW) with PPCs. We also tested the association of ΔPTW with intraoperative adverse events. Methods Posthoc retrospective propensity score–weighted cohort analysis of patients undergoing open or closed abdominal surgery in the ‘Local ASsessment of Ventilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events. Results The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔPTW was not different between groups. The association of ΔPTW with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], P <  0.001 versus 1.05 [95%CI 1.05 to 1.05], P <  0.001; risk difference 0.05 [95%CI 0.04 to 0.06], P <  0.001). The association of ΔPTW with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 [95%CI 1.12– to 1.14], P <  0.001 versus 1.07 [95%CI 1.05 to 1.10], P <  0.001; risk difference 0.05 [95%CI 0.030.07], P <  0.001). Conclusions ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery. Trial registration LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).

scholarly journals Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss prison

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Stéphanie Baggio ◽  
Vladan Starcevic ◽  
Patrick Heller ◽  
Karen Brändle ◽  
Irina Franke ◽  
...  
Keyword(s):  
Propensity Score ◽  
Aggressive Behavior ◽  
Propensity Score Matching ◽  
Potential Role ◽  
Behavioral Disinhibition ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Logistic Regressions ◽  
Relationship Of ◽  
The Relationship

Abstract Background Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. Methods Data were extracted from the electronic database of an “open” Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010–2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. Results After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. Conclusions Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

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