Category: Statistics

J Arthroplasty. 2024 Oct 26:S0883-5403(24)01146-X. doi: 10.1016/j.arth.2024.10.106. Online ahead of print.

ABSTRACT

INTRODUCTION: The Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. The purpose of this study was to determine whether patients undergoing total hip arthroplasty (THA) in areas of high ADI (greater disadvantage) were associated with differences in 90-day: 1) medical complications; 2) emergency department (ED) utilizations; and 3) readmissions.

METHODS: A nationwide database was queried for primary THA patients from 2010 to 2020. The ADI is reported on a scale of 0 to 100, with higher numbers indicating greater disadvantage. Patients undergoing primary THA in regions associated with high ADI (90%+) were compared to those of lower ADI (0 to 89%). A total of 138,670 patients were evenly matched between the two cohorts following 1:1 propensity score matching by age, sex, and Elixhauser Comorbidity Index (ECI). Primary endpoints were 90-day medical complications, ED utilizations, and readmissions. Multivariable logistic regression models calculated the odds ratios (OR) and 95% confidence intervals (95% CI). P-values less than 0.01 were statistically significant.

RESULTS: Patients undergoing THA from high ADI had significantly higher rates and odds of developing any medical complications (13.00 versus 11.91%; OR: 1.09, P < 0.0001), including acute kidney injuries (1.83 versus 1.52%; OR: 1.20, P < 0.0001), myocardial infarctions (0.35 versus 0.24%; OR: 1.45, P = 0.0003), and surgical site infections (0.94 versus 0.76%; OR: 1.23, P = 0.0004). High ADI patients had significantly higher rates and odds of ED visits within 90 days (3.94 versus 3.67%; OR: 1.08, P = 0.008). There was no significant difference in readmissions (5.44 versus 5.69%; OR: 0.95, P = 0.034).

CONCLUSIONS: Socioeconomically disadvantaged patients have increased odds of 90-day medical complications and ED utilizations, despite comparable 90-day readmission rates. Measures of neighborhood disadvantage may be valuable metrics to inform healthcare policy and improve post-discharge care.

PMID:39490718 | DOI:10.1016/j.arth.2024.10.106

J Arthroplasty. 2024 Oct 26:S0883-5403(24)01015-5. doi: 10.1016/j.arth.2024.10.002. Online ahead of print.

ABSTRACT

BACKGROUND: Despite the prevalence of total hip arthroplasty (THA) as a treatment for hip-related conditions, there is limited research directly comparing the patient-reported outcome measures (PROMs) between primary and revision THA. This study compared the time to achieve minimal clinically important difference (MCID) between primary and revision THA.

METHODS: We conducted a retrospective analysis comparing 6,671 THAs (6,070 primary and 601 all-cause revision THAs) performed between 2016 and 2022. Patient-reported outcomes were evaluated using preoperative and postoperative scores of Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function-10a (PF-10a), and Hip Injury and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS). The time to achieve MCID was assessed using survival curves with and without interval-censoring, and statistical comparisons were performed using log-rank and weighted log-rank tests.

RESULTS: Comparing the time to achieve MCID without interval-censoring, primary THA demonstrated significantly faster median times than revision THA for PROMIS Global Physical (3.3 versus 3.9 months, P < 0.001), PROMIS PF-10a (3.6 versus 6.2 months, P < 0.001), and HOOS-PS (3.1 versus 4.0 months, P < 0.001). Similarly, when using interval-censoring, primary THA continued to achieve MCID significantly faster than revision THA for PROMIS Global Physical (0.23 to 0.24 versus 0.50 to 0.51 months, P < 0.001), PROMIS PF-10a (1.43 to 1.44 versus 3.03 to 3.04 months, P < 0.001), and HOOS-PS (0.87 to 0.87 versus 1.20 to 1.21 months, P < 0.001).

CONCLUSION: Across all PROMs, primary THA achieved MCID significantly faster than revision THA, irrespective of interval-censoring. These findings underscore the importance of setting realistic postoperative recovery expectations during perioperative patient counseling. Future studies should investigate the factors influencing time to achieve MCID and explore how to enhance revision THA techniques and perioperative management for improved patient outcomes.

PMID:39490716 | DOI:10.1016/j.arth.2024.10.002

J Arthroplasty. 2024 Oct 26:S0883-5403(24)01160-4. doi: 10.1016/j.arth.2024.10.120. Online ahead of print.

ABSTRACT

BACKGROUND: Socioeconomic status (SES)-an individual or group’s social standing or class, as measured by education, income, and occupation-has been associated with poor surgical outcomes in orthopaedics. Total knee (TKA) and total hip (THA) arthroplasties are the most commonly investigated orthopaedic surgeries regarding SES and patient-reported outcome measures (PROMs), yet the results are contradictory. The aim of this systematic review was to assess the impact of SES on PROMs following total joint arthroplasty (TJA).

METHODS: We performed a literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines utilizing MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Library from database inception (1971, 1974, and 1996, respectively) to August 2, 2023, to identify studies investigating SES and PROMs in adults undergoing primary elective TJA. Studies were included if they evaluated one of three SES variables (income, education, or employment status) and reported at least one-year scores using a validated PROM. There were two reviewers who independently screened studies and extracted data.

RESULTS: There were 16 studies included in this systematic review. A total of 55,875 arthroplasties, including 24,055 TKAs and 31,820 THAs, were analyzed. Of the studies, eight evaluated income, 15 evaluated education, and two evaluated employment status. The majority of studies investigating income found a statistically significant association between lower income and worse postoperative PROMs. There were ten studies, involving 90% of all patients from the included education studies, that found a statistically significant association between education and postoperative PROMs. There were two studies that found unemployed THA patients had lower improvements in PROMs compared to employed and retired patients.

CONCLUSION: Our systematic review found several significant associations between income, education, employment, and PROMs after TJA. Providers should pay special attention to lower-income, less educated, and unemployed patients. These patients may benefit from targeted interventions to achieve substantial clinical benefit after TJA.

PMID:39490715 | DOI:10.1016/j.arth.2024.10.120

Gastrointest Endosc. 2024 Oct 25:S0016-5107(24)03638-1. doi: 10.1016/j.gie.2024.10.039. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Individual randomized controlled trials (RCTs) and pairwise meta-analyses do not compare all commercially available endoscopic bariatric therapies (EBTs) head-to-head. Therefore, the choice among them is currently made by inference or indirect data. We aimed to assess the comparative efficacy and safety of EBTs through a network meta-analysis.

METHODS: We searched Medline, EMBASE, and Cochrane CENTRAL from inception for IGBs and from 2013 for ESG until May 2023. Only RCTs comparing any of the currently commercially available EBTs to controls were considered eligible. Outcomes included %total weight loss (%TWL), serious adverse events (SAEs), and intolerability.

RESULTS: We identified 821 citations, of which 10 and 8 were eligible for the qualitative and quantitative analysis, respectively. Considering %TWL at the time of IGB removal, all EBTs were associated with statistically higher %TWL than controls. There were no significant differences among EBTs. However, considering the %TWL at the follow-up closest to 12 months, both ESG and Spatz3 were more effective than Orbera, with no statistical difference between ESG and Spatz3. For both outcomes, p-score and ranking score suggested that ESG was probably associated with a greater weight loss (0.889272 and 0.899469 respectively), followed by Spatz3 (0.822894 and 0.842773 respectively), and Orbera (0.536968 and 0.507165 respectively).

CONCLUSIONS: All currently available FDA-approved EBTs are more effective than both diet plus lifestyle intervention and sham procedures with an acceptable safety profile. ESG seems the most effective and may be prioritized for patients fit for both ESG and IGB. Direct controlled trials between EBTs are warranted to confirm these findings.

PMID:39490693 | DOI:10.1016/j.gie.2024.10.039

Gastrointest Endosc. 2024 Oct 25:S0016-5107(24)03635-6. doi: 10.1016/j.gie.2024.10.036. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Refractory benign esophageal strictures (RBES) are defined by inadequate response to dilation. Early recognition of RBES allows for earlier initiation of aggressive therapy potentially leading to less morbidity and cost. We sought to establish a predictive model for RBES.

METHODS: Patients who underwent esophagogastroduodenoscopy (EGD) with esophageal dilation at Mayo Clinic Rochester were identified. In addition, a cohort of patients from a clinical database of patients with RBES managed with self-dilation was identified. Malignant strictures, Schatzki rings, and previously treated strictures were excluded. RBES was defined by inability to maintain a diameter ≥14mm over 5 dilation sessions. Multivariable logistic regression models were built to predict RBES.

RESULTS: 128 patients with index EGD and esophageal dilation were identified, with 25 meeting RBES criteria. An additional 63 RBES patients were identified from the self-dilation cohort for a total of 88 RBES and 103 non-RBES patients. Multivariable analysis yielded a strong predictive model, with a c-statistic of 0.85, identifying stricture length ≥ 2cm, diameter ≤ 7mm and proximal/diffuse stricture location as associated with a higher risk for RBES. Patients without any of these risk factors had a 2% risk of RBES while those with all 3 risk factors had a risk of 73% for RBES.

CONCLUSIONS: Risk of RBES can be predicted at index EGD based on stricture features. A predictive model for RBES was created based on readily available risk factors, which may guide an individualized therapeutic approach to patients with benign esophageal stricture, potentially reducing morbidity and cost.

PMID:39490691 | DOI:10.1016/j.gie.2024.10.036

Acad Pediatr. 2024 Oct 26:S1876-2859(24)00540-0. doi: 10.1016/j.acap.2024.10.010. Online ahead of print.

ABSTRACT

OBJECTIVE: To understand the association between food insecurity (FI) and housing insecurity (HI) risk, the effects of the COVID-19 pandemic on health-related activities among children with overweight or obesity, and caregivers’ and clinicians’ challenges and priorities related to pediatric weight management.

METHODS: We conducted surveys with caregivers of children with overweight and obesity and pediatric clinicians at two academic medical centers in the Greater Boston area. We used multivariable logistic regression models to examine associations between FI and HI risk and the effects of the COVID-19 pandemic on health-related activities and descriptive statistics to summarize caregivers’ and clinicians’ challenges and priorities related to pediatric weight management.

RESULTS: We analyzed data from surveys with 344 caregivers and 100 pediatric clinicians. Overall, 37% of caregivers endorsed both FI+HI, 18% FI alone, 10% HI alone, and 35% neither FI/HI. In the adjusted logistic regression models, combined FI+HI (reference: neither FI/HI) was significantly associated with higher odds of sleeping less (aOR 2.96 [95% confidence interval (CI): 1.46, 6.01]) and higher odds of spending less time outside (aOR 2.10 [95% CI: 1.06, 4.16]). Top priorities for pediatric weight management identified by both caregivers and clinicians were related to physical activity and availability of outdoor spaces.

CONCLUSIONS: Endorsement of both FI+HI was associated with children getting less sleep and spending less time outside during the COVID-19 pandemic. Future innovations in care plans for children with overweight and obesity should be adapted to a family’s social context and should incorporate caregivers’ and clinicians’ challenges and priorities.

PMID:39490687 | DOI:10.1016/j.acap.2024.10.010

J Mol Biol. 2024 Oct 26:168841. doi: 10.1016/j.jmb.2024.168841. Online ahead of print.

ABSTRACT

Microbiome research has increasingly underscored the profound link between microbial compositions and human health, with numerous studies establishing a strong correlation between microbiome characteristics and various diseases. However, the analysis of microbiome data is frequently compromised by inherent sparsity issues, characterized by a substantial presence of observed zeros. These zeros not only skew the abundance distribution of microbial species but also undermine the reliability of scientific conclusions drawn from such data. Addressing this challenge, we introduce GEMimp, an innovative imputation method designed to infuse robustness into microbiome data analysis. GEMimp leverages the node2vec algorithm, which incorporates both Breadth-First Search (BFS) and Depth-First Search (DFS) strategies in its random walks sampling process. This approach enables GEMimp to learn nuanced, low-dimensional representations of each taxonomic unit, facilitating the reconstruction of their similarity networks with unprecedented accuracy. Our comparative analysis pits GEMimp against state-of-the-art imputation methods including SAVER, MAGIC and mbImpute. The results unequivocally demonstrate that GEMimp outperforms its counterparts by achieving the highest Pearson correlation coefficient when compared to the original raw dataset. Furthermore, GEMimp shows notable proficiency in identifying significant taxa, enhancing the detection of disease-related taxa and effectively mitigating the impact of sparsity on both simulated and real-world datasets, such as those pertaining to Type 2 Diabetes (T2D) and Colorectal Cancer (CRC). These findings collectively highlight the strong effectiveness of GEMimp, allowing for better analysis on microbial data. With alleviation of sparsity issues, it could be greatly facilitated in downstream analyses and even in the field of microbiology.

PMID:39490678 | DOI:10.1016/j.jmb.2024.168841

J Affect Disord. 2024 Oct 25:S0165-0327(24)01808-1. doi: 10.1016/j.jad.2024.10.114. Online ahead of print.

ABSTRACT

INTRODUCTION: Osteoporosis, a significant public health concern, affects millions of adult women globally, leading to increased morbidity and fracture risk. Antidepressant use, prevalent in this demographic, is suggested to influence bone mineral density (BMD), yet evidence remains limited across antidepressant classes.

OBJECTIVE/AIM: We investigated the association between antidepressant use and osteoporosis in a representative sample of adult women in the United States, focusing on different classes of antidepressants and their potential associations with BMD and fracture risk.

METHODS: We conducted a cross-sectional analysis using data from ten cohorts of the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2000 to 2017-2020. The sample included adult women, with data collected on antidepressant use, BMD scores, and reported fractures. Statistical models adjusted for potential confounders such as Major Depressive Disorder (MDD), age, physical activity, and comorbidities.

RESULTS: Antidepressant use was associated with a 44 % increase in the odds of osteoporosis. Phenylpiperazines showed the highest association, followed by miscellaneous antidepressants and tricyclic antidepressants (TCAs). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) also demonstrated significant, though comparatively lower associations. The odds of fractures were elevated by 62 % among antidepressant users, particularly with phenylpiperazines and miscellaneous antidepressants. Increased antidepressant use duration significantly correlated with higher osteoporosis and fracture risks, regardless of the antidepressant class.

CONCLUSION: Our findings underscore the need for heightened awareness of the adverse effects of antidepressants on bone health, particularly in adult women. Careful consideration is necessary when prescribing these medications, especially in populations at risk for osteoporosis and MDD.

PMID:39490674 | DOI:10.1016/j.jad.2024.10.114

Bone. 2024 Oct 26:117309. doi: 10.1016/j.bone.2024.117309. Online ahead of print.

ABSTRACT

Despite its invasive character, bone biopsy followed by histomorphometry remains the gold standard for diagnosing and classifying many metabolic bone diseases. However, the interpretation of histomorphometric parameters requires comparison with average values obtained from a proper control group, which are only available for some populations, and reference standards still need to be published. Therefore, our objective was to estimate average values for bone histomorphometric parameters overall, by age, gender, and race (White and Black) categories of healthy adult individuals, based on a systematic review and meta-analysis of clinical studies. Relevant studies published in English with available results until December 2020 were identified by PubMed (Medline) search and consulting experts in the field. Out of 447 potentially relevant studies, 37 met the inclusion criteria. Meta-analysis using fixed-effects models was used to pool mean estimates and 95 % confidence intervals (CI) for 16 bone histomorphometry parameters. An age-by-gender trend was observed in most histomorphometry parameters. The mean estimates of bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), and trabecular number (Tb.N) decreased. In contrast, trabecular separation (Tb.Sp) increased from the youngest to the oldest age categories in both genders. Osteoblast surface (Ob.S/BS) and osteoclast surface (Oc.S/BS) decreased across all age categories in males. Mineralizing surface (MS/BS) increased from the youngest to the oldest age categories in females, while mineralization lag time (Mlt) increased in both genders. Furthermore, gender and race had a significant effect on several histomorphometry parameters. In conclusion, this meta-analysis provided mean estimates for normal values of histomorphometric parameters that clinicians may use when evaluating bone biopsies in patients. This enables the direct comparison of patients’ histomorphometric values with the suitable reference group regarding age, gender, and race.

PMID:39490656 | DOI:10.1016/j.bone.2024.117309

Eur J Vasc Endovasc Surg. 2024 Oct 25:S1078-5884(24)00906-7. doi: 10.1016/j.ejvs.2024.10.031. Online ahead of print.

ABSTRACT

OBJECTIVE: This retrospective, nationwide cohort study aimed compare periprocedural stroke or death within 30 days of the procedure (PPSD30) in patients who underwent carotid endarterectomy (CEA) or carotid stenting (CAS).

METHODS: This retrospective cohort study used data from the French hospital database PMSI. All patients who underwent CEA or CAS between 2010 and 2019 in France were included. Information on individual patients and hospital characteristics was retrieved. A random effects logistic regression model compared the occurrence of PPSD30 after CEA or CAS. High surgical risk was accounted for by using propensity score matching and adjusted for patient and hospital characteristics. Analyses were also stratified to consider symptomatic and asymptomatic patients separately.

RESULTS: Between 2010 and 2019, 164 248 patients underwent a carotid artery procedure in France: 156 561 CEA and 7 687 CAS (including about 25.0% asymptomatic women and 40.0% high risk patients). The PPSD30 rate was 1.5% overall (n = 2 514 patients) (1.5% after CEA vs. 2.4% after CAS), 1.3% in asymptomatic patients (1.2% after CEA vs. 1.8% after CAS), and 3.3% in symptomatic patients (3.1% after CEA vs. 6.5% after CAS). After matching and adjustment, the risk of PPSD30 was statistically significantly greater in patients who underwent CAS than in patients who underwent CEA (adjusted OR [aOR] 1.4, 95% CI 1.1 – 1.8 in overall patients; aOR 1.4, 95% CI 1.1 – 1.8 in asymptomatic patients; and aOR 2.7, 95% CI 1.8 – 4.0 in symptomatic patients).

CONCLUSION: This nationwide real life study showed that CEA performed better than CAS, more markedly in symptomatic patients, but also in asymptomatic patients. Moreover, many patients received procedures that were more likely to be harmful than beneficial according to conclusions from past randomised trials (i.e., all asymptomatic women, all high surgical risk patients, and all who had undergone CAS).

PMID:39490630 | DOI:10.1016/j.ejvs.2024.10.031