Tag: statistics

J Robot Surg. 2025 Jun 24;19(1):323. doi: 10.1007/s11701-025-02499-8.

ABSTRACT

BACKGROUND: There is limited published data evaluating the safety of the da-Vinci-SP1098 platform and only a few utilize the Clavien-Dindo Classification (CDC). Comprehensive complication index (CCI) is developed to overcome the restrictions of the CDC. We aimed to compare the perioperative outcomes of hysterectomy for benign disease with the da-Vinci-SP1098 platform (SPORT-SP-H) with the multiport-XI-hysterectomy (MP-Xi-H).

METHODS: We conducted a retrospective cohort study incorporating a total of 96 patients at a tertiary academic center. Parameters included demographic features, Charlson comorbidity index, Surgical APGAR, indications, and concurrent procedures. Perioperative outcomes included CCI score, CDC grade, length of operation, estimated blood loss, intraoperative complications, length of stay, and conversion rate, sequelae, failure to cure, reoperation and emergency department visit within 1 month. Univariate and multivariate analysis for CCI, CDC and operation duration was undertaken.

RESULTS: Demographic factors were similar. Charlson’s comorbidity index (B = 1.43, 95% CI 0.17-2.6, p = 0.02) was found to be the only independent predictor of CCI in the multivariate analysis. There were no grade IV or higher CDC postoperative complications. Except CDC grade I, all were similar between the cohorts. Operation time was significantly longer in SPORT-SP-H (178, r 85-258) compared to MP-Xi-H (123.5, r 74-218, p < 0.0001). Length of hospital stay and other parameters were comparable between the groups (p > 0.05). Independent predictors of longer operation time were SPORT-SP-H, uterine weight and concurrent procedures.

CONCLUSIONS: SPORT-SP-Hysterectomy (SP1098) appears to be an alternative to multiport robotic hysterectomy but with a longer operating time. Morbidity is related to surgical complexity and patient comorbidities rather than the robotic platform.

PMID:40555946 | DOI:10.1007/s11701-025-02499-8

J Imaging Inform Med. 2025 Jun 24. doi: 10.1007/s10278-025-01572-w. Online ahead of print.

ABSTRACT

Second opinions in radiology are crucial for accurate diagnosis and patient management but often lack standardization, leading to inefficiencies and suboptimal reimbursement. We redesigned the second opinion workflow leveraging existing tools in the EMR. Summary statistics as well as post-implementation surveys were conducted among ordering providers and radiologists to gauge the process. Reimbursement data from August 2021 to October 2022 was also analyzed. The Abdomen division accounted for 47% of second opinion exams, followed by Neuroradiology at 26%, Chest at 17%, Nuclear Medicine at 9%, and MSK at 1%. CT scans comprised 64%, MR 26%, NM 9%, and US 1%. Survey participants reported an improvement in user-friendliness ratings for the second opinion process from 2 to 4.4 (p < 0.07), with substantial positive trends among ordering providers (Cohen’s d = 2.00). Satisfaction with perceived timeliness of report availability was high across both groups, and radiologists perceived workflow efficiency improved from 2.7 to 4 (p = 0.036). The new workflow achieved a 91.9% collection success rate. Standardizing the second opinion workflow enhances operational efficiency, user satisfaction and reimbursement, thereby improving patient care.

PMID:40555944 | DOI:10.1007/s10278-025-01572-w

Obes Surg. 2025 Jun 25. doi: 10.1007/s11695-025-08008-y. Online ahead of print.

ABSTRACT

BACKGROUND: Opioids are commonly used in general anesthesia for pain management. However, they are related to obvious side effects. Patients with obesity undergoing laparoscopic sleeve gastrectomy are at higher risk of experiencing adverse effects associated with opioids. However, there is great heterogeneity in how to select and combine antinociceptive drugs to replace opioids. This randomized controlled double-blind study was conducted to evaluate the use effect of opioid-free anesthesia (OFA) in obese patients undergoing laparoscopic sleeve gastrectomy on the quality of postoperative recovery.

METHODS: This prospective, parallel-group, double-blind, randomized controlled study included seventy-six patients undergoing laparoscopic sleeve gastrectomy in Beijing Friendship Hospital, Capital Medical University. Patients were randomly assigned to OFA group or opioid-based anesthesia (OBA) group. The primary outcome included the 15-item recovery quality scale (QOR-15). Secondary measures included intraoperative hemodynamic stability, intraoperative operation information, duration of until postoperative PACU Aldrete score > 9 points, anesthesia-related complication, and number of analgesic pump presses.

RESULTS: The scores of QOR-15 in OFA group were higher than that in OBA group at 24 h and 48 h after surgery. The total dose of propofol required in OFA group was statistically less than that in OBA group. Patients in the OBA group had significantly lower bispectral index (BIS) values and lower levels of MAP at T2 (after intubation) than those in the OFA group patients in the OBA group. Patients in the OFA group showed significantly lower levels of heart rate (HR) at T3 (after abdominal closure) when compared to the OBA group. The changing trend of visual analog scale (VAS) and OBAS scores recorded after surgery were similar between both groups and the VAS and Overall Benefit of Analgesia Scale (OBAS) scores in OBA group were obviously higher than those in OFA group in each time point. The Rhodes Index of Nausea and Vomiting in OBA group were obviously higher than those in OFA group in each time point.

CONCLUSIONS: OFA significantly improved postoperative recovery quality as evidenced by higher QOR-15 scores, reduced postoperative nausea and vomiting (PONV), lower pain scores and decreased opioid requirements compared to OBA. Although duration of awakening from anesthesia was prolonged, OFA demonstrated superior recovery outcomes and fewer complications supporting its clinical utility in obese patients undergoing laparoscopic sleeve gastrectomy.

PMID:40555931 | DOI:10.1007/s11695-025-08008-y

Geroscience. 2025 Jun 25. doi: 10.1007/s11357-025-01738-y. Online ahead of print.

ABSTRACT

Clinical care for patients with limited life expectancy often requires adjustments, prioritizing immediate benefits over long-term outcomes, as the relevance of future complications diminishes. This study identifies indicators of mortality risk in horses with chronic orthopaedic conditions to enhance individualized care and welfare. Over 3 years, 123 chronically lame horses and 6 healthy control horses at an animal sanctuary underwent regular (every 3 months) comprehensive health assessments and activity monitoring using wearable sensors. Data collected included body condition scores, musculoskeletal pain scores, lameness evaluations, and time budgets for eating, resting, and activity. Of the 123 chronically lame horses, 31 horses died (n = 31/123, 25.2%), with 10 succumbing to acute decompensation of their chronic condition (DAC, n = 10/123, 8.1%), while 21 were euthanized due to intractable pain or progressively deteriorating health and function (DCC, n = 21/123, 17.1%). Statistical modelling using death as outcome measure revealed body condition, pain scores, and time budget data to be strongly associated with equine mortality. Notably, low body condition score and reduced eating time predicted mortality in DAC horses, aligning with human studies linking weight loss to frailty and increased mortality risk. Additionally, depression-like behaviours were prevalent in DAC horses, mirroring the link between depression and mortality in humans. While pain scores were elevated in all deceased horses, weight loss was specific to DAC, suggesting multifactorial influences beyond pain. These findings provide a foundation for developing equine-specific tools to predict outcomes and guide clinical and end-of-life decisions, enabling individualized treatment to enhance the welfare and quality of life for aging horses. These insights may also offer valuable information for human medicine, particularly for at-risk groups such as individuals with cognitive impairments who may struggle to communicate their symptoms.

PMID:40555923 | DOI:10.1007/s11357-025-01738-y

Lifetime Data Anal. 2025 Jun 25. doi: 10.1007/s10985-025-09660-3. Online ahead of print.

ABSTRACT

We propose a joint model for multiple time-to-event outcomes where the outcomes have a cure structure. When a subset of a population is not susceptible to an event of interest, traditional survival models cannot accommodate this type of phenomenon. For example, for patients with melanoma, certain modern treatment options can reduce the mortality and relapse rates. Traditional survival models assume the entire population is at risk for the event of interest, i.e., has a non-zero hazard at all times. However, cure rate models allow a portion of the population to be risk-free of the event of interest. Our proposed model uses a novel truncated Gaussian copula to jointly model bivariate time-to-event outcomes of this type. In oncology studies, multiple time-to-event outcomes (e.g., overall survival and relapse-free or progression-free survival) are typically of interest. Therefore, multivariate methods to analyze time-to-event outcomes with a cure structure are potentially of great utility. We formulate a joint model directly on the time-to-event outcomes (i.e., unconditional on whether an individual is cured or not). Dependency between the time-to-event outcomes is modeled via the correlation matrix of the truncated Gaussian copula. A Markov Chain Monte Carlo procedure is proposed for model fitting. Simulation studies and a real data analysis using a melanoma clinical trial data are presented to illustrate the performance of the method and the proposed model is compared to independent models.

PMID:40555917 | DOI:10.1007/s10985-025-09660-3

Eur J Pediatr. 2025 Jun 24;184(7):437. doi: 10.1007/s00431-025-06275-6.

ABSTRACT

Bronchiolitis is a leading cause of hospitalization in infants, with RSV being the primary pathogen. In 2023, nirsevimab was approved for universal prophylaxis, demonstrating high effectiveness in reducing RSV-related hospitalizations. In Italy, nirsevimab was introduced in the vaccination schedule only during the current 2024-2025 epidemic season, with significant regional differences. In our region, Lazio, nirsevimab was introduced in late November 2024, leading only to a 43% overall reduction in RSV bronchiolitis hospitalizations compared to the previous season. The highest impact was observed in newborns immunized at birth (- 82.7%), while the catch-up group showed lower-than-expected benefits (- 29%). Immunized infants had significantly lower oxygen requirements (42.9% vs. 82.4% in non-immunized) and resulted to be approximately seven times more likely not to require oxygen compared to non-immunized patients.

CONCLUSION: Universal infant immunization against RSV marks a significant breakthrough in the natural history of bronchiolitis, and early and widespread nirsevimab administration appears to be crucial in minimizing RSV’s hospitalizations.

WHAT IS KNOWN: • Nirsevimab was approved in 2023 for the universal prophylaxis against RSV bronchiolitis. • Nirsevimab was was introduced in the Italian vaccination schedule only during the current 2024-2025 epidemic season, with significant regional differences.

WHAT IS NEW: • In Lazio, Italy, the delayed introduction of nirsevimab in November 2024 and the reduced vaccination coverage of the catch-up group resulted in a lower-than-expected reduction in RSV bronchiolitis hospitalizations. • Early and widespread administration of nirsevimab is crucial to maximizing its benefits and reducing severe RSV cases.

PMID:40555916 | DOI:10.1007/s00431-025-06275-6

Sleep Breath. 2025 Jun 24;29(4):225. doi: 10.1007/s11325-025-03398-w.

ABSTRACT

PURPOSE: Vitamin D is essential not only for skeletal health but also for regulating sleep. Recent studies suggest a link between vitamin D deficiency and poor sleep quality, including lower sleep efficiency and shorter sleep duration. This study aimed to investigate the relationship between sleep quality and serum vitamin D levels in healthy elderly individuals.

METHODS: This study examined the association between serum vitamin D levels and sleep quality in individuals aged 60 years and above residing in Taipei’s Health & Culture Village and Active Aging Center. A total of 465 participants were enrolled, with those exhibiting specific organ abnormalities or dysfunctions excluded. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and vitamin D levels were measured using enzyme-linked immunosorbent assay (ELISA). The relationships between vitamin D levels and PSQI scores were analyzed, with a focus on the daytime dysfunction component of the PSQI.

RESULTS: Among the seven domains of the PSQI, the daytime dysfunction domain had the strongest statistical association with serum vitamin D levels (p = 0.044). Participants without daytime dysfunction had significantly higher vitamin D levels than did those with daytime dysfunction (p = 0.04). No significant associations were detected between vitamin D levels and other factors, such as sex or age.

CONCLUSIONS: Higher serum vitamin D levels are associated with better sleep quality in elderly individuals, particularly in those without daytime dysfunction. This finding highlights the potential importance of maintaining adequate vitamin D levels to promote healthy sleep patterns in older adults.

PMID:40555884 | DOI:10.1007/s11325-025-03398-w

Am J Cardiovasc Drugs. 2025 Jun 24. doi: 10.1007/s40256-025-00739-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Whether ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) carry distinct prognoses after discharge remains a matter of debate. This study aimed to compare 1-year clinical outcomes between patients with STEMI and NSTEMI in a large, real-world cohort.

METHODS: Among 23,270 patients with acute coronary syndrome enrolled in the international PRAISE registry between 2003 and 2019, we included 21,789 patients with a diagnosis of either STEMI or NSTEMI. Clinical characteristics, discharge medications, and outcomes at 1 year were analyzed. The primary outcomes were all-cause mortality, re-infarction, and major bleeding. Multivariable logistic regression and propensity score matching were used to adjust for confounding. Subgroup and interaction analyses were also performed.

RESULTS: The cohort included 12,365 patients with STEMI and 9424 patients with NSTEMI. At baseline, patients with NSTEMI had more comorbidities, cardiovascular risk factors (except diabetes), and prior revascularization. Patients with STEMI were more frequently treated with statins, beta-blockers, and renin-angiotensin-aldosterone system inhibitors at discharge. At 1-year follow-up, overall outcomes were comparable between groups. Nonfatal reinfarction occurred more frequently in patients with NSTEMI (3.4% versus 2.8%, p = 0.022), but this association was not significant after adjustment (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.65-1.24, p = 0.519). Results from propensity score-matched analyses confirmed the absence of prognostic differences. Subgroup analyses revealed significant interactions for diabetes mellitus and completeness of revascularization.

CONCLUSIONS: After accounting for clinical and therapeutic variables, 1-year outcomes were largely similar in patients with STEMI and NSTEMI. Differences in reinfarction risk appear to be driven by baseline characteristics and treatment patterns, rather than infarct type itself.

PMID:40555879 | DOI:10.1007/s40256-025-00739-8

Ann Biomed Eng. 2025 Jun 24. doi: 10.1007/s10439-025-03781-4. Online ahead of print.

ABSTRACT

Functional tricuspid regurgitation (FTR) is closely associated with right ventricular (RV) dysfunction and pulmonary hypertension (PH), both of which contribute to increased morbidity and mortality in patients undergoing tricuspid valve repair or replacement. The biomechanical interplay between these factors remains complex, with conflicting evidence on the effects of edge-to-edge repair (TEER) on RV morphology and function. This study aimed to assess the acute impact of increased pulmonary pressure and RV dilation on TEER performance using an ex vivo pulsatile flow mock loop. A custom-designed clip, replicating state-of-the-art TEER devices, was tested on porcine heart samples under simulated FTR conditions with varying degrees of RV dilation and PH.Results demonstrated that the clip significantly improved valve coaptation, increasing transvalvular systolic pressure and reducing regurgitant flow. However, elevated PH and severe RV dilation compromised its effectiveness, leading to increased regurgitation and a higher risk of pathology recurrence. Statistical analysis identified PH as the primary driver of hemodynamic deterioration, whereas RV dilation predominantly influenced annular morphology. These findings suggest that while TEER provides initial hemodynamic benefits, its efficacy may be limited in advanced FTR cases with progressive RV dysfunction and PH. Further research is needed to evaluate long-term outcomes. Nonetheless, this ex vivo approach allowed for the isolation of key biomechanical mechanisms, offering valuable insights into the structural and functional relationships underlying disease progression.

PMID:40555876 | DOI:10.1007/s10439-025-03781-4

Eur Spine J. 2025 Jun 25. doi: 10.1007/s00586-025-09029-y. Online ahead of print.

ABSTRACT

Spinal tumors represent 15% of all central nervous system malignancies, with intramedullary spinal cord tumors (IMSCTs) being rare. Predominantly ependymomas and astrocytomas, IMSCTs often present late, leading to significant morbidity and mortality. Surgical excision is key but challenging due to the tumors’ complex, invasive nature. Treatment involves a multidisciplinary approach, considering tumor type and patient condition, ranging from subtotal to gross total resection, possibly with adjuvant therapy. This study uses machine learning on National Cancer Database data to predict postoperative outcomes, aiming to develop a risk calculator for clinicians to assess mortality and extended hospital stay risks post-surgery.

OBJECTIVE: This study investigates healthcare outcomes in patients undergoing surgical resection for intradural intramedullary spinal cord tumors (IMSCTs), employing the National Cancer Data Base (NCDB) to identify key variables. We aimed to develop supervised machine learning-based risk calculators to predict high-risk patients for mortality and extended length of stay (eLOS), stratifying IMSCTs by histology to enhance understanding and guide intervention strategies for adverse outcomes.

METHODS: Patients with surgically-treated IMSCTs (2004-2017) was conducted using the NCDB. We extracted demographic and comorbidity data, employing descriptive statistics and supervised machine learning algorithms to predict mortality and eLOS.

RESULTS: The study encompassed 7,243 surgically treated IMSCT cases, including 612 astrocytomas (8.5%), 6,041 ependymomas (83.4%), and 590 hemangioblastomas (8.1%). Mortality and eLOS rates were observed at 10.2% and 27.1%, respectively. Over 12 years (2004-2016), significant management shifts were noted for these spinal tumor types. The predictive models achieved AUCs of 0.721 for mortality and 0.586 for eLOS. Key predictive features for mortality included age, diagnosis year, behavior, histology, radiation, insurance status, patient-hospital distance, tumor grade and size, length of stay, subtotal resection (STR) to gross total resection (GTR), and sex. For eLOS, additional predictors were diagnosis-surgery interval, Charlson/Deyo score, and surgical approach. Web-based tools for both outcomes have been deployed: https://imsct-elos-predict.herokuapp.com/ ; https://imsct-risk-calcualor.herokuapp.com/ .

CONCLUSION: Our nationwide analysis underscores the evolution in IMSCT management and demonstrates the efficacy of machine learning in predicting mortality and eLOS, providing valuable insights for improved patient care.

PMID:40555868 | DOI:10.1007/s00586-025-09029-y