Tag: statistics

JAMA Netw Open. 2025 Aug 1;8(8):e2524773. doi: 10.1001/jamanetworkopen.2025.24773.

ABSTRACT

IMPORTANCE: Restaurants are increasingly interested in capitalizing on consumer interest in environmental sustainability by marketing their products with ecolabels, which signal when foods are more environmentally sustainable. Ecolabels could improve the healthfulness of restaurant meal selections and reduce their carbon footprint, but this potential remains largely untested.

OBJECTIVE: To test whether displaying ecolabels on restaurant menus improves the healthfulness and reduces the carbon footprint of restaurant meal selections.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted online in September to October 2024. A national sample of US adults (aged ≥18 years) was recruited. Participants were randomly assigned to the ecolabel or control arm. Participants viewed a restaurant menu mimicking a popular full-service restaurant and selected items they wanted to order. Statistical analyses were based on the intention-to-treat principle.

INTERVENTIONS: In the ecolabel arm, participants viewed a menu that displayed ecolabels next to entrées and appetizers with a lower carbon footprint (ie, below the median of 1.625 kg of carbon dioxide equivalent [CO2e] emissions per item). In the control arm, participants viewed a menu that did not display ecolabels.

MAIN OUTCOMES AND MEASURES: The outcomes included overall healthfulness (assessed using Ofcom Nutrient Profiling Model scores; range: 0-100, with higher scores indicating healthier items), nutrient content, and total carbon footprint of participants’ entrée and appetizer selections and entire orders (including beverages and desserts).

RESULTS: A total of 3147 participants completed the online trial (1560 men [50%]; mean [SD] age, 34.5 [12.5] years). Participants in the ecolabel arm did not select entrées and appetizers (average differential effect [ADE], 0.45 [95% CI, -0.18 to 1.09]; P = .16; Cohen d = 0.05) or entire orders (ADE, 0.47 [95% CI, -0.09 to 1.03]; P = .10; Cohen d = 0.06) that were statistically significantly healthier compared with the selections of participants in the control arm. Participants in the ecolabel arm selected entrées and appetizers (ADE, 0.87 [95% CI, 0.12-1.62] g; P = .02; Cohen d = 0.08) and entire orders (ADE, 0.82 [95% CI, 0.07-1.56] g; P = .03; Cohen d = 0.08) with more fiber, compared with the selections of participants in the control arm, but did not select entrées and appetizers or entire orders with statistically significantly different amounts of protein, sugar, saturated fat, or calorie content. Participants in the ecolabel arm selected entrées and appetizers (ADE, -0.78 [95% CI, -1.25 to -0.32] kg of CO2e emissions; P < .001; Cohen d = -0.12) and entire orders (ADE, -0.81 [95% CI, -1.27 to -0.34] kg of CO2e emissions; P < .001; Cohen d = -0.12) with lower carbon footprints than the selections of participants in the control arm.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, menu ecolabels reduced the carbon footprint of restaurant meal selections without worsening nutritional quality. Ecolabels could be a scalable, low-cost strategy to reduce the carbon emissions of restaurant food choices.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06584539.

PMID:40758354 | DOI:10.1001/jamanetworkopen.2025.24773

JAMA Netw Open. 2025 Aug 1;8(8):e2525057. doi: 10.1001/jamanetworkopen.2025.25057.

ABSTRACT

IMPORTANCE: Alzheimer disease special care units (ASCUs) are associated with improved outcomes for residents with dementia, yet they are unavailable in most nursing homes.

OBJECTIVES: To examine racial and ethnic disparities in the availability of ASCUs and whether more generous Medicaid payments are associated with reduced disparities.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used 2009-2019 Certification and Survey Provider Enhanced Reporting data and resident assessments from Medicare- and Medicaid-certified nursing homes in the US, as well as state Medicaid payment-to-cost ratios for 2019. Statistical analysis was performed from September to December 2024.

EXPOSURE: The percentages of Black residents and Hispanic residents in a facility and the state mean nursing homes’ ratio of Medicaid payment to estimated Medicaid cost of care.

MAIN OUTCOMES AND MEASURES: The main outcome was whether a nursing home had an ASCU. Multivariable logistic regression was conducted on ASCUs, and then separate logistic regressions were performed for states with different quartiles of Medicaid payment-to-cost ratios.

RESULTS: Most of the 13 229 nursing homes in the study were for profit (9561 [72.3%]) and were part of a chain (7775 [58.8%]). The overall mean (SD) Medicaid payment-to-cost ratio among all states was 0.87 (0.13) (range, 0.58-1.29). Each 1% increase in the percentage of Black residents was associated with a 0.1% decrease in the probability of having an ASCU. Compared with facilities with 0% to 0.8% of Black residents, the odds of having an ASCU were 37% lower in nursing homes with 4.3% to 15.2% Black residents (odds ratio [OR], 0.63; 95% CI, 0.53-0.74), and 45% lower in nursing homes with 15.2% or more of Black residents (OR, 0.55; 95% CI, 0.46-0.65). Compared with facilities with no Hispanic residents, the odds of having an ASCU were 27% lower in those with 3.7% or more of Hispanic residents (OR, 0.73; 95% CI, 0.62-0.86). In states with Medicaid payment-to-cost ratios between 0.58 and 0.81, nursing homes with 15.2% or more of Black residents were 68% less likely to have an ASCU (OR, 0.32; 95% CI, 0.21-0.50). This difference decreased to 45% in states with Medicaid payment-to-cost ratios between 0.82 and 0.94 (OR, 0.55; 95% CI, 0.44-0.69) and almost disappeared in states with Medicaid payment-to-cost ratios greater than 0.94 (OR, 0.86; 95% CI, 0.53-1.40). Higher Medicaid payment-to-cost ratios were not associated with reduced disparities among Hispanic residents.

CONCLUSIONS AND RELEVANCE: This cohort study of nursing homes suggests that racial and ethnic disparities in ASCU availability narrowed in states where Medicaid payment rates cover a greater share of costs. Racial disparities in specialized dementia care may be mitigated and even eliminated by more generous Medicaid payments.

PMID:40758352 | DOI:10.1001/jamanetworkopen.2025.25057

JAMA Netw Open. 2025 Aug 1;8(8):e2525064. doi: 10.1001/jamanetworkopen.2025.25064.

ABSTRACT

IMPORTANCE: Cognitive behavioral therapy (CBT) has the most empirical support for treatment of binge eating. Appetitive traits, including food responsiveness and satiety responsiveness, impact how individuals interact with the current obesogenic environment. The regulation of cues (ROC) plus behavioral weight loss (BWL) intervention was specifically developed to target food responsiveness, satiety responsiveness, and energy reduction.

OBJECTIVE: To evaluate the feasibility and efficacy of ROC+BWL and CBT over 5 months of treatment and 6 months of follow-up and to explore whether clinical binge eating was a moderator of outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted from March 2019 to April 2023 among veterans at a university clinic. Eligible participants were veterans who met criteria for Binge Eating Disorder (BED) or subthreshold BED, had a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45, were aged 18 to 65 years, and were free of other exclusionary criteria. Data were analyzed from January 2024 to June 2025.

INTERVENTION: The ROC+BWL intervention uniquely targets food responsiveness, satiety responsiveness, and energy reduction. CBT focuses on disrupting the dietary restraint/binge eating cycle by changing maladaptive thoughts and behaviors. Participants were randomized to receive either ROC+BWL or CBT for 5 months.

MAIN OUTCOMES AND MEASURES: The main outcomes were feasibility and change in binge eating (measured as loss of control) and body weight, assessed at midtreatment (2.5 months), posttreatment (5 months), and a 6-month follow-up (11 months).

RESULTS: A total of 1853 veterans inquired about participation and 1724 were excluded or declined to participate. The final sample included 129 veterans (mean [SD] age, 47.1 [11.3] years; 76 [59%] male; mean [SD] BMI, 34.8 [4.7]), with 63 randomized to ROC+BWL and 66 to CBT. A total of 123 veterans (95%) provided data posttreatment, and 115 veterans (89%) provided data at the 6-month follow-up. Attendance and acceptability ratings did not differ between treatments. ROC+BWL resulted in a greater reduction in risk of binge eating than CBT at midtreatment (difference in probability, -0.20; 95% credible interval [CrI], -0.30 to -0.11), posttreatment (difference in probability, -0.23; 95% CrI, -0.22 to -0.19), and at the 6-month follow-up (difference in probability, -0.21; 95% CrI, -0.21 to -0.18). ROC+BWL also resulted in greater weight loss at midtreatment (difference in BMI change, -0.68; 95% CrI, -1.23 to -0.12) and posttreatment (difference in BMI change, -0.71; 95% CrI, -1.40 to -0.01) assessments than CBT, but significant differences were no longer observed at the 6-month follow-up (difference in BMI change, -0.22; 95% CrI, -0.98 to 0.54). Results were more pronounced among veterans with BED.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial among veterans with binge eating and obesity, ROC+BWL resulted in greater decreases in binge eating compared with CBT. Although ROC+BWL resulted in greater weight loss compared with CBT during treatment, these differences were not maintained. Thus, ROC+BWL could be an alternate model to treat BED among veterans, but effects on weight need further research.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03678766.

PMID:40758351 | DOI:10.1001/jamanetworkopen.2025.25064

JAMA Netw Open. 2025 Aug 1;8(8):e2525147. doi: 10.1001/jamanetworkopen.2025.25147.

ABSTRACT

IMPORTANCE: The limited success of major depressive disorder (MDD) treatments is largely due to the disorder’s etiological and pathophysiological heterogeneity. Addressing this heterogeneity is essential for developing accurate prognostic models and personalized treatment strategies.

OBJECTIVE: To characterize MDD heterogeneity using a mechanism-first latent profile analysis based on environmental, neurostructural, and neurofunctional indicators, and to validate profiles via associations with MDD course, severity, and antidepressant treatment remission.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from 2 Canadian Biomarker Integration Network in Depression (CAN-BIND) studies: CAN-BIND-1 (2014-2017), a multicenter outpatient antidepressant trial, and CAN-BIND-4 (2015-2018), a single-site study. Data analyses were completed from February to September 2024. Participants meeting Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic criteria for unipolar depression were included. Individuals with lifetime bipolar, psychotic, substance use disorder, acute suicidality, and neurological disorders were excluded.

EXPOSURE: In CAN-BIND-1, patients received 10 to 20 mg of escitalopram daily; nonresponders at 8 weeks received aripiprazole augmentation for 8 additional weeks. CAN-BIND-4 was observational.

MAIN OUTCOMES AND MEASURES: Primary outcomes were latent profiles derived from childhood maltreatment (CM; semistructured interview); hippocampal, amygdala, thalamus structural volume (SV); anterior cingulate thickness (image segmentation); and DMN functional connectivity (average time series of the blood oxygen level-dependent signal). Secondary outcomes included associations with MDD course, symptom severity (including anhedonia, measured using Montgomery-Åsberg Depression Rating Scale), and remission rates.

RESULTS: In a sample of 309 adults with clinical depression (mean [SD] age, 33.81 [13.17] years; 206 female [66.67%]), 4 profiles emerged: (1) low CM and high SV, (2) low CM and low SV, (3) high CM and high SV, and (4) high CM and low SV with default mode network hypoconnectivity. Profile 4 was associated with the worst course, with the highest morbidity (mean number of years of morbidity, 19.91 years; 95% CI, 12.45-20.69 years), anhedonia (mean, 10.72; 95% CI, 9.74-11.70), and lowest remission rate (mean, 21.5%; 95% CI, 17.6%-23.5%) at week 16. Profile 3 had the highest remission rates (mean, 90.9%; 95% CI, 63.4%-118.0%).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of 309 adults with depression, 4 latent profiles were identified. Default mode network hypoconnectivity defined profile 4, supporting its role as a key neural indicator of antidepressant response. CM was associated with both the highest and lowest remission rates, indicating it does not uniformly project negative outcomes and suggesting that neurobiological resilience in the context of childhood trauma may have contributed to more favorable clinical outcomes; further research is needed to refine clinical applications.

PMID:40758349 | DOI:10.1001/jamanetworkopen.2025.25147

JAMA Netw Open. 2025 Aug 1;8(8):e2525336. doi: 10.1001/jamanetworkopen.2025.25336.

ABSTRACT

IMPORTANCE: Enrollment in Medicare Advantage (MA) is expected to continue growing. Previous studies have examined differences in the use and quality of home health care between MA and traditional Medicare, but less is known about outcomes among patients receiving care from agencies with greater exposure to MA patients.

OBJECTIVE: To examine the association between home health agency (HHA) experience with caring for MA patients and quality of care delivered.

DESIGN, SETTING, PARTICIPANTS: This cohort study included patients continuously enrolled in MA and who received HHA care in 2019. The data analysis was performed between July 16, 2024, and January 16, 2025.

EXPOSURE: Medicare beneficiaries who received home health care from agencies with differing levels of MA specialization.

MAIN OUTCOMES AND MEASURES: Primary outcomes included hospitalizations during the HHA episode and after HHA discharge (at 30 and 90 days), length of stay, and total number of visits. Secondary outcomes included postdischarge mortality and nursing home admission. The outcomes were measured using instrumental variable analysis. The treatment variable was a continuous measure of the HHA-level share of MA patients. The instrumental variable was the differential distance from the nearest MA-specialized HHA to nearest non-MA-specialized HHA (based on the 75th percentile of the HHA-level share of MA patients from January 1 to December 31, 2019 [ie, ≥36.4%]).

RESULTS: The study included 749 719 MA patients who received HHA care in 2019 (mean [SD] age, 76.2 [10.4] years; 61.6% female; 26.3% with dual eligibility), of whom 65.4% received care from an MA-specialized HHA and 34.6% received care from a non-MA-specialized HHA. A 1-mile increase in differential distance was associated with a lower likelihood of admission to more MA-specialized HHAs (0.3 percentage points; SE, 0.015 percentage points; F statistic, 450.73). In the instrumental variable analysis, receiving care from more specialized HHAs was associated with a shorter length of stay (coefficient [SE], -15.14 [2.84] days) and fewer total HHA visits (coefficient [SE], -9.40 [1.15] visits) alongside more hospitalizations and nursing home admissions after discharge from the HHA.

CONCLUSION AND RELEVANCE: In this cohort study of MA patients who received HHA care, those receiving care from more MA-specialized HHAs had lower service use during the HHA episode, but no clear differences compared with non-MA-specialized HHAs were observed in care use after discharge. These findings are important given the costs associated with delivering HHA care and the expected growth in MA enrollment.

PMID:40758348 | DOI:10.1001/jamanetworkopen.2025.25336

Infect Dis (Lond). 2025 Aug 4:1-10. doi: 10.1080/23744235.2025.2533319. Online ahead of print.

ABSTRACT

BACKGROUND: Many Greenlanders move from Greenland, a tuberculosis (TB) high-incidence country, to Denmark, a TB low-incidence country. Surprisingly, according to official statistics, the TB incidence among Greenlanders in Denmark is much higher than in Greenland.

OBJECTIVES: This study investigates factors contributing to the extraordinarily high TB incidence among Greenlanders residing in Denmark.

METHODS: Retrospective, register-based cohort study including all Greenlanders ≥18 years notified with TB in Denmark and Greenland, and Danes ≥18 years with TB in Denmark, 2006-2022. Demographic and microbiological characteristics were compared across groups using parametric and non-parametric statistical tests.

RESULTS: The TB incidence was extraordinarily high among Greenlanders in Denmark (341/100,000; n = 813), compared to Danes in Denmark (2/100,000; n = 1799) and Greenlanders in Greenland (149/100,000; n = 1088). Additionally, they were more often part of a TB cluster (75.6%) compared to Danes in Denmark (53.3%) and Greenlanders in Greenland (64.0%) and demonstrated very high rates of recurrent TB (23.9%), with 75.6% of cases being reinfections involving new Mycobacterium tuberculosis strains.

CONCLUSION: TB poses a significant public health challenge for Greenlanders in Denmark. Their high incidence combined with elevated clustering and reinfection rates suggest substantial active TB transmission, and their cluster distribution indicates that many infections are locally acquired rather than reactivations of infection acquired in Greenland. Greenlanders with TB in Denmark are likely part of a socially marginalised minority with TB high-risk behaviours similar to Danes developing TB. These findings highlight the need for targeted TB prevention and control strategies for Greenlanders residing in Denmark.

PMID:40758341 | DOI:10.1080/23744235.2025.2533319

Eur J Psychotraumatol. 2025 Dec;16(1):2534310. doi: 10.1080/20008066.2025.2534310. Epub 2025 Aug 4.

ABSTRACT

Background: Individuals with pre-existing heavy alcohol use, prior traumatic exposures, and psychiatric disorders were considered an at-risk group for increased alcohol use and problems in the context of the COVID-19 pandemic.Objective: This study recruited from a multi-centre longitudinal cohort study of US military service members/veterans with combat exposure to examine the trajectories of alcohol use and problems in the context of a prolonged stressor.Methods: Individuals who endorsed heavy drinking and completed a measure of PTSD symptoms prior to the pandemic were invited to participate in a longitudinal survey study at three time points, three months apart, during the second year of the pandemic. Participants (N = 44) completed surveys assessing alcohol consumption and alcohol-related problems (via the AUDIT), PTSD symptoms (via the PCL-5), and infection mitigation behaviours (via a COVID-19 specific survey). Random intercept models were fitted to the longitudinal data for each of these outcomes, covarying for demographics, pandemic quarantine/physical distancing experience, pre-pandemic baseline alcohol consumption and PTSD symptoms, and time-varying alcohol consumption and alcohol-related problems as well as PTSD symptoms.Results: We did not find an increase in alcohol consumption or problems over time. However, pre-pandemic alcohol consumption predicted alcohol consumption over time (B = 0.52, SE = 0.11, p < .01). Time-varying alcohol consumption and PTSD symptoms predicted alcohol problems over time (B = 0.84, SE = 0.18, p < .01; B = 0.04, SE = 0.02, p < .05, respectively).Conclusions: Findings highlight the relevance of pre-existing hazardous alcohol consumption prior to stressors as well as ongoing consumption and PTSD symptoms as risk factors for alcohol-related problems. Findings captured more chronic impacts of pandemic stressors and demonstrated that heavy drinking and PTSD are notable risk factors for alcohol-related problems even if in the context of stabilizing, albeit still high, alcohol use.

PMID:40758273 | DOI:10.1080/20008066.2025.2534310

Clin Transplant. 2025 Aug;39(8):e70267. doi: 10.1111/ctr.70267.

ABSTRACT

BACKGROUND: To examine national trends and regional variability in the procurement of solid organs recovered for research from deceased donors in the United States.

METHODS: A retrospective cohort study of the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) deceased donor registry data was conducted, including all deceased donors who underwent surgery for organ recovery from April 2015 to December 2023. The study classified each donated organ (liver, heart, pancreas, lung, kidney, and intestine) into four categories: not recovered, recovered for transplant, recovered for research, recovered for other purposes/discarded, with a focus on organs recovered for research.

RESULTS: Among 107,485 deceased organ donors across 58 organ procurement organizations (OPOs), organs recovered for research included 2491 intestines, 6494 hearts, 6627 livers, 9098 kidneys, 10,711 pancreata, and 13,025 lungs. Research organ recovery showed an upward trend, particularly for pancreata. Median percentage of organ recovery for research across the OPOs, varied significantly by organ type: intestines (65.4%), pancreata (36.1%), lungs (28.3%), heart (11.3%), liver (7.1%), and kidneys (3.8%), with no significant correlation between OPO donor organ volumes and research organ recovery rates. Analysis of the 2021 data showed a higher median percentage of research organ recovery in Tier 1 OPOs (13.8%) compared to Tier 2 (10.8%) and Tier 3 (11.4%), though these differences were not statistically significant (p = 0.18).

CONCLUSION: Given the opacity of existing practices and unrealized potential of research organs, our findings warrant the need for improved surveillance, centralized tracking, and a robust framework for research organ recovery.

PMID:40758272 | DOI:10.1111/ctr.70267

Clin Rheumatol. 2025 Aug 4. doi: 10.1007/s10067-025-07620-8. Online ahead of print.

ABSTRACT

OBJECTIVES: The prevalence of sedentary behavior, hyperuricemia, and gout is increasing worldwide. However, the relationships between sedentary behavior and the risk of hyperuricemia and gout in American adults remain unclear. Therefore, we aim to investigate the association between sedentary behavior and the risk of hyperuricemia and gout.

METHODS: Adults aged ≥ 20 years from the 2007-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed, with sedentary time assessed via questionnaires and serum uric acid levels measured through laboratory tests. Gout was confirmed by a physician or health professional. Hyperuricemia was defined as a serum uric acid level of ≥ 7.0 mg/dL in men and ≥ 5.7 mg/dL in women. Weighted logistic regression models and restricted cubic spline analyses were used to examine the associations between sedentary time and hyperuricemia and gout. Mediation analysis was used to explore the potential mediating role of hyperuricemia.

RESULTS: A total of 17,634 participants were included in the analysis. The prevalence of hyperuricemia was 20.24% (3569/17,634), and gout was 4.11% (725/17,634). After adjusting for multiple covariates, weighted logistic regression indicated that higher sedentary time (> 8 h/day) was associated with increased risk of hyperuricemia and gout, with adjusted odds ratios (OR) of 1.18 (95% CI: 1.01, 1.39) and 1.41 (95% CI: 1.04, 1.93), respectively. Restricted cubic spline analysis revealed a nonlinear association between sedentary time and the risks of hyperuricemia and gout. Subgroup analyses showed that chronic kidney disease (CKD) stage (P = 0.012) and sex (P = 0.04) modified the association between sedentary time and hyperuricemia, while sex alone modified the association with gout (P = 0.04). The results of the sensitivity analyses remained robust. The results of the mediation analysis showed that hyperuricemia played a mediating role between sedentary time and gout, with a mediation proportion of 15.93%.

CONCLUSION: Sedentary time increases the risk of hyperuricemia and gout in US adults, especially in men and those with advanced CKD, with hyperuricemia acting as a key mediator. Key Points • Sedentary time of more than 8 h per day is significantly associated with an 18% increased risk of hyperuricemia and a 41% increased risk of gout, compared to less than 4 h per day among US adults. • The association between sedentary time and hyperuricemia is more pronounced among males and individuals with advanced stages of chronic kidney disease, while the association with gout is significantly modified by sex, with a stronger effect observed in males. • Hyperuricemia plays a mediating role between sedentary time and gout, with a mediation proportion of 15.93%.

PMID:40758258 | DOI:10.1007/s10067-025-07620-8

J Bronchology Interv Pulmonol. 2025 Aug 4;32(4):e01022. doi: 10.1097/LBR.0000000000001022. eCollection 2025 Oct 1.

ABSTRACT

BACKGROUND: This study aimed to evaluate the trends in the use of endobronchial valve (EBV) and video-assisted thoracoscopic surgery (VATS) for bronchopulmonary fistula (BPF) between 2016 and 2021, and to compare their clinical and economic outcomes.

METHODS: We conducted a retrospective analysis of national inpatient data from 2016 to 2021 to identify patients (age ≥18 y) with BPF who underwent EBV or VATS. Patients who had both EBV and VATS were excluded. We examined the annual procedure volumes, mean costs, length of stay (LOS), and in-hospital mortality rates. Statistical analyses were performed to compare outcomes between the 2 interventions.

RESULTS: Out of 13,245 patients with BPF, 660 underwent EBV and 535 underwent VATS. The total number of yearly EBV increased from 65 to 230 (P=0.043) and the total number of yearly VATS increased from 65 to 180 (P=0.854). Mortality rate (P=0.843), total cost (P=0.735), and LOS (P=0.337) remained stable for EBV patients. We observed a reduced mortality trend for VATS patients (P=0.041), while total cost (P=0.839), and LOS (P=0.886) remained stable.

CONCLUSION: EBV has become significantly more prevalent in BPF management. This could be due to increasing expertise and demand for a procedure for patients too critical to undergo VATS. VATS was associated with a mortality reduction between 2016 and 2021, which could be attributed to more strict patient selection.

PMID:40758241 | DOI:10.1097/LBR.0000000000001022