Category: Statistics

Anesth Analg. 2022 Mar 1;134(3):540-547. doi: 10.1213/ANE.0000000000005884.

ABSTRACT

The use of large data sources such as registries and claims-based data sets to perform health services research in anesthesia has increased considerably, ultimately informing clinical decisions, supporting evaluation of policy or intervention changes, and guiding further research. These observational data sources come with limitations that must be addressed to effectively examine all aspects of health care services and generate new individual- and population-level knowledge. Several statistical methods are growing in popularity to address these limitations, with the goal of mitigating confounding and other biases. In this article, we provide a brief overview of common statistical methods used in health services research when using observational data sources, guidance on their interpretation, and examples of how they have been applied to anesthesia-related health services research. Methods described involve regression, propensity scoring, instrumental variables, difference-in-differences, interrupted time series, and machine learning.

PMID:35180171 | DOI:10.1213/ANE.0000000000005884

Anesth Analg. 2022 Mar 1;134(3):455-462. doi: 10.1213/ANE.0000000000005871.

ABSTRACT

BACKGROUND: Overutilization of operating theaters (OTs) occurs when actual surgery duration exceeds scheduled duration, which could potentially result in delays or cancelations in subsequent surgeries. We investigate the association between the timing of elective surgery scheduling and OT overutilization.

METHODS: A cross-sectional retrospective study was conducted using electronic health record data of 27,423 elective surgeries from July 1, 2016, to July 31, 2018, at a mid-Atlantic academic medical center with 56 OTs. The scheduling precision of each surgery is measured using the ratio of the actual (A) over the scheduled or forecast (F) length of surgery to derive the predictor variable of A/F (actual-to-forecast ratio [AF]). Student t test and χ2 tests analyzed differences between OTs reserved within and over 7 days of surgery for continuous and dichotomous variables, respectively. Hierarchical regression models, controlling for potential confounds from the hospital environment, clinicians’ work experience and workloads, patient factors, scheduled OT length, and operational and team factors isolated the association between OTs reserved within 7 days of the elective surgery with AF.

RESULTS: The Student t test indicates that OTs reserved within 7 days of surgery had significantly higher AF (1.13 ± 0.53 vs 1.08 ± 0.41; P < .001). In-depth Student t test analyses for 4 patient groups, namely, outpatient, extended recovery, admission after surgery, and inpatient, indicate that AF was only significantly different for OTs reserved within 7 days for the admission after surgery group (1.15 ± 0.47 vs 1.09 ± 0.35; P < .001) but did not reach statistical significance among the outpatient, extended recovery, and inpatient groups. After controlling for potential confounds, hierarchical regression for the admission after surgery group reveals that OTs reserved within 7 days took 2.7% longer than the scheduled length of surgery (AFbeta, 0.027; 95% CI, 0.003-0.051; P = .027).

CONCLUSIONS: Elective surgeries scheduled within 7 days of surgery were associated with significantly higher likelihood of OT overutilization for surgical patients who will be admitted after surgery. Further studies at other hospitals and a longer period of time are needed to ascertain a potential “squeeze-in” effect.

PMID:35180161 | DOI:10.1213/ANE.0000000000005871

J Glaucoma. 2022 Feb 18. doi: 10.1097/IJG.0000000000001999. Online ahead of print.

ABSTRACT

PRECIS: This cross-sectional study of 20 patients with primary open-angle glaucoma, 20 with exfoliative glaucoma, 20 with exfoliation syndrome showed that exfoliative group had a significantly lower smell identification level as compared with the control groups.

PURPOSE: To investigate smell sensitivity in primary open-angle glaucoma (POAG), exfoliative glaucoma (XFG) and exfoliation syndrome (XFS) in comparison with healthy controls.

MATERIALS AND METHODS: This prospective, cross-sectional study included 20 patients with POAG, 20 with XFG, and 20 with XFS. The control group coonsisted of 20 age- and sex- matched healthy subjects with no evidence of ocular disease. The Sniffin’ Sticks smell test was used to determine the, threshold values, and to assess the ability of smell identification, and differentiation in all patients One eye per patient was included for statistical purposes. One-way analysis of variance (ANOVA) was used to compare the differences between the groups. Tukey honestly significant difference (HSD) was used as a post-hoc test when significant differences were detected among the three groups.

RESULTS: The XFG, POAG, and control groups showed a significant difference in the odor discrimination, odor identification, and threshold discrimination identification scores. The median (minimum-maximum) smell threshold levels for the POAG, XFG, and XFS groups and healthy controls were 4.5 (0-7.5), 4 (0-7.5), 5 (4.5-6), and 5.5 (4-7.5), respectively. The smell differentiation values for the POAG, XFG, and XFS groups and healthy controls were 12 (2-14), 8 (0-13), 11 (10-13), and 12 (9-14), respectively. Smell sensitivity for the POAG, XFG, and XFS groups and healthy controls were 26 (4-30.5), 19 (0-29.5), 28.3 (22.8-30.5), and 29 (26.5-32), respectively. The smell sensitivity and differentiation were significantly different among the groups (P<0.001). The XFG group had a significantly lower smell identification level than the POAG, XFS, and control groups.

CONCLUSION: Patients with XFS and XFG revealed reduced smell sensitivity and identification compared to patients with POAG and those without glaucoma. These findings provide new insights into neural degeneration and pseudoexfoliation.

PMID:35180155 | DOI:10.1097/IJG.0000000000001999

J Cardiovasc Surg (Torino). 2022 Feb;63(1):2-7. doi: 10.23736/S0021-9509.21.12172-X.

ABSTRACT

INTRODUCTION: Surgical endarterectomy represents the gold standard for the treatment of atherosclerotic lesions of the groin vessels. Endovascular treatment such as atherectomy with or without drug coated angioplasty (DCA) of the so called no stenting zones, i.e. inguinal and popliteal vessels, is gaining growing acceptance as alternative option to open surgery. This systematic review aims to scrutiny the current clinical evidence regarding atherectomy and DCA for the common artery (CFA).

EVIDENCE ACQUISITION: We conducted an exhaustive research in multiple platforms (Medline, PubMed, Cochrane, Google Scholar, Embase) on studies over atherectomy and angioplasty for inguinal atherosclerotic lesions published between 2000 and 2021. As search strategy we used a wide list of MeSH items, words, synonyms. Bibliographies of review articles were checked for further relating studies regarding atherectomy of CFA. A qualitative and quantitative data analysis was carried out.

EVIDENCE SYNTHESIS: Fifteen studies were included in the qualitative review. Not all studies were focused only on atherectomy of inguinal vessels, despite including such treatment. Hence, data regarding this treatment were not exhaustive. A fairly homogeneous data analysis was possible in 7 of 15 studies. The remaining 8 studies were qualitatively analyzed but not included in the statistical analysis. In all 7 included studies directional atherectomy and DCA under filter protection were carried out. In this subgroup, overall, 497 patients were treated with atherectomy. Sixty-eight percent of the patients were males. Rutherford class from 1-3 dominated against 4-6 (63% vs. 37%). Mean technical success rate was 96%, with a primary and secondary patency rate of 92% and 98% respectively at one year. Procedure related vascular complications ranged from 1% to 6%.

CONCLUSIONS: Current literature about atherectomy for inguinal arteries is scant, data are inhomogeneous and so are treatment modalities. Nevertheless, the results of this systematic review suggest that this endovascular strategy is feasible with good short and midterm results. Prospective trials with larger patient cohorts are necessary to confirm these preliminary results.

PMID:35179336 | DOI:10.23736/S0021-9509.21.12172-X

Andrology. 2022 Feb 18. doi: 10.1111/andr.13162. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate clinical outcomes, radiation exposure and procedural costs associated with percutaneous varicocele embolization using coils and sclerosing agents (SA) in a cohort of young-adult men.

MATERIALS AND METHODS: Data from consecutive men treated with percutaneous varicocele embolization using coils and SA between 2017 and 2021 were analyzed. The allocation was based on a change of policy occurred in June 2020 with the substitution of coils with SA (before and after study). Semen analysis values were based on 2010 WHO reference criteria. Anatomic variants of gonadal veins were categorized according to Jargiello et al. Intraoperative radiation dose and procedural costs were collected for each patient. Descriptive statistics and linear regression models were used to describe the association between clinical parameters with procedural costs and radiation exposure.

RESULTS: One hundred sixteen men were included, of whom 76 (65.5%) received coils and 40 (34.5%) received SA. Baseline characteristics of the two study groups did not differ. A type 3 Jargiello anatomic variation of left gonadal vein was found in 45.7% of cases. Radiation dose was lower in the SA group as compared to the coils one [13.2 (7-43) vs. 19.8 (12-57) Gy/cm² ; p<0.001]. Similarly, procedural costs were lower for the SA group [169.6 (169-199) € vs. 642.5 (561-775) €; p<0.001]. At follow up, pain and sperm variables significantly improved in both groups (p<0.01), without differences among the embolic materials. Linear regression model revealed that coils use was associated with higher radiation exposure (beta 8.8, p = 0.02) than SA after accounting for anatomic variation of gonadal vein, BMI and vascular access.

CONCLUSIONS: SA and coils for varicocele embolization are equally safe and effective. The use of SA was associated with lower radiation exposure and procedural costs than coils. These results should be considered in terms of public health cost and patient’s safety. This article is protected by copyright. All rights reserved.

PMID:35179316 | DOI:10.1111/andr.13162

Orthop Surg. 2022 Feb 18. doi: 10.1111/os.13188. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze the efficacy of modified Allgöwer-Donati suture (MADS) technique on cosmetic outcomes compared with vertical mattress suture (VMS) technique in spinal surgery wounds.

METHODS: This randomized controlled trial was conducted at the First Hospital of Lanzhou University (Gansu, China) from September 2019 to August 2020. The patients were randomly divided into two groups, a VMS group and a MADS group, by staff not involved in the treatment using a computer-based random number table program (no restrictions on age or sex). Both procedures were performed by the same group of physicians as well as assistants. All suture wounds were completed by the same person. The primary endpoint was the scar area, and the postoperative scar area was scored by the Patient and Observer Scar Scale Assessment (POSAS). The scar area was calculated by ImageJ software. The second outcome measure was wound complications, including poor wound healing, wound edge necrosis, and infection. The trial was recorded in the Chinese Clinical Trial Register on 18 August 2019 (ChiCTR1900024548).

RESULTS: A total of 143 patients were included: 72 in the VMS group and 71 in the MADS group. There was no significant difference in their demographics in terms of age (49.71 ± 8.91 vs 50.15 ± 6.79 years, P = 0.737), sex (M/F, 30/41 vs 31/41, P = 0.923), suture time (3.39 ± 0.22 vs 3.47 ± 0.25 s/mm, P = 0.057), or body mass index (BMI, 23.88 ± 3.50 vs 24.05 ± 3.50, P = 0.765) for MADS to VMS. The postoperative scar area was compared between the two groups transversely on day 12, the MADS wound scars decreased by 58.95% (75,133.24/127,452.58). In the POSAS evaluation, after MADS treatment, surface area score decreased from 5 (4, 5) to 2 (2, 3) (P < 0.0001), observer’s overall opinion from 5 (4, 5) to 3 (2, 3) (P < 0.0001), itching from 3 (3, 4) to 3 (2, 3) (P = 0.001), color from 4 (4, 5) to 3 (2-4) (P < 0.0001), stiffness 4 (3-4.75) to 3 (3, 4) (P < 0.0001), or thickness from 4 (3-5) to 4 (3, 4) (P = 0.004). In terms of overall opinion evaluation, the MADS showed a significant difference in observer’s overall opinion to the VMS (5 (4, 5) vs 3 (2, 3), P < 0.0001) and in patient’s overall opinion 5 (5, 6) to 3 (3, 4), (P < 0.0001). There was no significant statistical difference in poor wound healing (3 vs 0, P = 0.245), wound edge necrosis (3 vs 0, P = 0.245), and infection (1 vs 0, P = 1.000) with the MADS to the VMS.

CONCLUSION: The results of this study show that the MADS effectively reduced the surgical scar area to 58.95% with no additional adverse events compared with that of the VMS in spine surgery.

PMID:35179312 | DOI:10.1111/os.13188

Cancer Med. 2022 Feb 18. doi: 10.1002/cam4.4607. Online ahead of print.

ABSTRACT

BACKGROUND: More than a third of thyroid carcinoma (TC) patients require treatment with radioactive iodine (RAI), but the timing of initial RAI therapy after thyroidectomy remains controversial.

METHODS: We included 1224 differentiated thyroid carcinoma (DTC) patients during 2015-2019, divided them into the early (≤3 months) and the delayed (>3 months) groups based on the interval between surgery and the initial RAI. Clinical outcomes were assessed within 6-8 months of treatment with RAI, including excellent response (ER), indeterminate response (IDR), biochemical incomplete (BIR) and structural incomplete response (SIR). Further transformed them into dichotomous outcomes, we therefore introduced the ordered/binary logistic regression to assess the relation of time interval and quaternary/dichotomous outcomes, respectively. Finally, we conducted a meta-analysis for cohort study to investigate the effect of timing of RAI therapy on the prognosis of TC.

RESULTS: Delay RAI therapy beyond 3 months reduced the IR (BIR + SIR) rate in the present cohort study (RR = 0.67, 95% CI: 0.49-91). Following meta-analysis including 38,688 DTC patients confirmed these results (RR = 0.77, 95% CI: 0.66-0.91), further revealed the duration of treatment does not influence OS (pooled RR = 1.05, 95% CI: 0.83-1.33).

CONCLUSION: Delayed initial RAI therapy beyond 3 months but no later than 6 months did not impair the prognosis of TC.

PMID:35179295 | DOI:10.1002/cam4.4607

Cancer Med. 2022 Feb 18. doi: 10.1002/cam4.4611. Online ahead of print.

ABSTRACT

BACKGROUND: Case reports of bladder carcinosarcoma (BCS) indicate high rates of recurrence and metastasis and poor prognosis. However, the differences in clinicopathologic characteristics and prognosis between BCS and conventional bladder cancer histologies (transitional cell carcinoma [TCC], squamous cell carcinoma [SCC] and adenocarcinoma [AC]) have not been fully clarified in a large study. Therefore, we conducted a large population-based study to further investigate these differences.

PATIENTS AND METHODS: Information on patients with BCS and conventional bladder cancer (TCC, SCC or AC) was extracted from the Surveillance, Epidemiology, and End Results database. Categorical variables were compared using Pearson’s chi-squared test or Fisher’s exact test. Survival analysis was carried out using the Kaplan-Meier method, and differences in survival were assessed using the log-rank test. Propensity score matching analysis was conducted to calibrate the differences between the baseline characteristics, after which Cox regression analysis was applied to calculate the hazard ratios and 95% confidence intervals of BCS compared to other subtypes. Subgroup analysis and related interaction were tested to evaluate the consistency and heterogeneity of results.

RESULTS: We enrolled 152 patients with BCS and 180,196 patients with TCC, SCC or AC. Our results showed that BCS was associated with poor differentiation, advanced stage and an unfavourable overall survival and cancer-specific survival. BCS had a worse prognosis than TCC and AC, but no statistically significant difference in survival was noted between BCS and SCC.

CONCLUSIONS: BCS is a more aggressive bladder cancer than TCC and AC but is comparable to SCC. These findings broaden our understanding of BCS and may be helpful in clinical practice.

PMID:35179304 | DOI:10.1002/cam4.4611

Laryngoscope. 2022 Feb 18. doi: 10.1002/lary.30069. Online ahead of print.

ABSTRACT

OBJECTIVES: With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS).

STUDY DESIGN: Case-control study.

METHODS: This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS.

RESULTS: The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively).

CONCLUSION: Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS.

LEVEL OF EVIDENCE: 4 Laryngoscope, 2022.

PMID:35179239 | DOI:10.1002/lary.30069

Int J Geriatr Psychiatry. 2022 Mar;37(3). doi: 10.1002/gps.5696.

ABSTRACT

BACKGROUND: Older age is a substantial risk factor for serious illness from COVID-19. Moreover, isolation and quarantine are more likely to cause physical, mental and social deprivation in older age. Information and Communication Tools are means to prevent such consequences.

OBJECTIVE: This study aimed therefore to investigate the impact of the COVID-19 lockdown measures on the usage of an innovative technical support system deployed in Austria (AT) and Luxembourg (LU) consisting of several tools that allow independent living in older age.

METHODS: Thirty-nine older adults (11 male; 28 female) with a mean age of 74.3 (SD 7.3) years were included in the study. In total, 18 older people were recruited in AT and 21 in LU. Descriptive statistics were computed, and longitudinal models were fitted for technology use and self-reported mood.

RESULTS: The number of older adults using the system significantly decreased from the time before lockdown (39 [100%]) to during lockdown (26 [67%]) and thereafter (23 [59%]; p < 0.001). Multiple comparisons revealed a significant reduction in the average number of events for calendar and medication tools, but a substantial increase in communication and messaging events. Self-reported well-being declined during the lockdown and increased afterwards back to baseline levels.

CONCLUSION: Communication was the main reason for using the support system. In addition, strategies and interventions are essential to support older adults when using information technology in the prolonged phases of the pandemic to sustain independent living.

CLINICAL TRIAL REGISTRATION: The DAPAS protocol was published at www.researchgate.net. DOI: 10.13140/RG.2.2.24233.34401.

PMID:35179240 | DOI:10.1002/gps.5696