Independent Effects Research Articles

PENGARUH KOMPETENSI, INDEPENDENSI, DAN SKEPTISME PROFESIONAL TERHADAP KEMAMPUAN AUDITOR MENDETEKSI KECURANGAN

This research aims to see the effect of competence, independence, and professional skepticism on the auditor's ability to detect fraud. This research was conducted using a literature study method obtained from theoretical studies and relevant previous research. The results of this literature study research indicate that competence has a positive effect on the auditor's ability to detect fraud, independence has a positive effect on detecting fraud in auditors, and professional skepticism also has a positive effect on the auditor's ability to detect fraud.

PURE vs. mixed clear cell ovarian carcinomas: Is there any impact on survival?

ObjectiveOur primary aim in this study is to define the clinical characteristics of patients with clear-cell ovarian carcinoma and evaluate the prognostic factors affecting survival. Study designRecords of 85 patients, operated between 2000 and 2018, for an adnexal mass and whose final pathology reported clear cell ovarian carcinoma were reviewed. The study considered demographic data, clinical characteristics of the patients, as well as pure and mixed-type clear cell histology. The patients' follow-up time, disease-free and overall survival recorded. The primary outcomes were disease-free survival (DFS) and overall survival (OS). ResultsThe median age of the patients at diagnosis was 52. In 64.7 % of the cases, clear cell histology was pure, while the others (35.3 %) were mixed. Patients with ovarian endometriosis constituted 27.1 % of the whole population. The median OS for the entire population was 92 months (95 %CI:72–124). On univariate and multivariate analyses, advanced age was found to have a significant independent impact on OS and DFS (p < 0.05) and, was associated with a worse prognosis. Also, the multivariate analyses showed that the presence of endometriosis has a significant independent impact on OS (p < 0.05). When examining the relationship between the histological origin (mixed vs. pure) and 5-year survival, the mixed type showed longer OS and DFS rates (76.8 % vs. 69.8 %, 61.5 % vs. 53.8 %), the difference was not statistically significant (p > 0.05). ConclusionThis retrospective study showed that although mixed type histological origin was associated with higher OS and DFS rates compared to pure type in patients with CCOC, the difference was not statistically significant. Advanced age and the presence of endometriosis was found to have a significant independent effect on OS and DFS and was associated with a worse prognosis. Overall, this study provides useful insights into the clinical characteristics of patients with CCOC and identifies important prognostic factors affecting survival.

PENGARUH PREFERENSI KLIEN, PENGALAMAN AUDITOR, DAN INDEPENDENSI AUDITOR TERHADAP AUDIT JUDGEMENT PADA KANTOR AKUNTAN PUBLIK DI KOTA PEKANBARU

The purpose of this study is to analyze the effect of client preferences, auditor experience, and auditor independence on audit judgment at a public accounting firm in Pekanbaru City. The population in this study are all Public Accounting Firms located in Pekanbaru City which are registered in the Directory of the Indonesian Institute of Certified Public Accountants (IAPI). The type of research conducted is quantitative research. Data was collected by distributing questionnaires which were filled out directly by all auditors working at the Public Accounting Firm in Pekanbaru City. Then the data obtained were analyzed using multiple linear regression analysis techniques, descriptive statistical test, classical assumption test, coefficient of determination test, t test, and f test. The results showed that simultaneously client preference, auditor experience, and Auditor Independence had a significant effect on audit judgment at the Public Accounting Firm in Pekanbaru City. Partially, client preference has a significant effect on Audit Judgment, Auditor Experience has a significant effect on Audit Judgment, and Auditor Independence has a significant effect on Audit Judgment at Public Accounting Firms in Pekanbaru City.

Multiple sources of unconscious-information processing affect a single response: independent unconscious priming effects

At present there is little knowledge on whether and how multiple pieces of unconscious information can simultaneously affect a single conscious response. In the present study, we manipulated the congruency relation between a masked prime arrow and the target arrow, as well as that between masked flankers and the target arrow. The results demonstrated that the masked prime and flankers produced independent unconscious priming effects on the response to the target. In the process of studying the above phenomenon, two secondary findings were made. First, although the prime congruency effect was obtained, the flanker congruency effect was smaller when the flankers were displayed simultaneously with the target than when they were displayed sequentially before the target. This suggested that priming stimulation required enough time to be processed to a sufficient extent to produce an unconscious priming effect. Second, when the prime stimulus was removed, leaving only the flankers, the flanker priming effect increased, suggesting that the attention attracted to the prime and its conscious mask could also reduce the flanker congruency effect. These results observed across several experiments were replicated in one within-subjects experiment. We proposed an “independent unconscious influence hypothesis” for the phenomenon. This hypothesis was further integrated into a more comprehensive unconscious information processing model. The possible causes of the observed phenomena were discussed.

Examining the Moderating Effect of Board Independence on Ownership Structure and Corporate Risk: A Case Study of Nairobi Securities Exchange

Corporate governance and the risk management are the integral components of modern business management. This research paper aimed at investigating how and whether the presence of independent directors on the board influences the relationship between ownership structure and corporate risk. The composition and independence of a company's board of directors play a crucial role in determining the level of corporate risk. This research delved into the intricate dynamics between these elements to understand how they influence corporate risk. Specifically, the research aimed to examine how board independence acts as a moderating factor on the relationship between ownership structure and corporate risk. By examining the Kenyan context, this study contributes to the broader understanding of corporate governance in emerging markets. The paper relied on Agency Theory, Mean Variance-Portfolio Theoryagency theory ,mean variance-portfolio theory, the stewardship theory and resource dependence theory (RDT). The research employed use of causal research design. The study population was sixty-four (64) firms listed at Nairobi Securities Exchange as at 31st December 2021. Secondary data sources included financial reports, annual reports, and surveys. Data analysis was conducted using quantitative techniques like mean, standard deviation and regression, with the help of statistical software STATA. The statistical results revealed significant moderating effect of board independence on the relationship between ownership structure and corporate risk. The findings have offered practical insights to corporate managers, investors, policymakers, and researchers, aiding them in making informed decisions and formulating effective governance and risk management strategies.

Air pollution and serious bleeding events in high-risk older adults

ImportanceDespite biological plausibility, very few epidemiologic studies have investigated the risks of clinically significant bleeding events due to particulate air pollution. ObjectiveTo measure the independent and synergistic effects of PM2.5 exposure and anticoagulant use on serious bleeding events. DesignRetrospective cohort study (2008–2016). SettingNationwide Medicare population. ParticipantsA 50% random sample of Medicare Part D-eligible Fee-for-Service beneficiaries at high risk for cardiovascular and thromboembolic events. ExposuresFine particulate matter (PM2.5) and anticoagulant drugs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin). Main outcomes and measuresThe outcomes were acute hospitalizations for gastrointestinal bleeding, intracranial bleeding, or epistaxis. Hazard ratios and 95% CIs for PM2.5 exposure were estimated by fitting inverse probability weighted marginal structural Cox proportional hazards models. The relative excess risk due to interaction was used to assess additive-scale interaction between PM2.5 exposure and anticoagulant use. ResultsThe study cohort included 1.86 million high-risk older adults (mean age 77, 60% male, 87% White, 8% Black, 30% anticoagulant users, mean PM2.5 exposure 8.81 μg/m3). A 10 μg/m3 increase in PM2.5 was associated with a 48% (95% CI: 45%–52%), 58% (95% CI: 49%–68%) and 55% (95% CI: 37%–76%) increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis, respectively. Significant additive interaction between PM2.5 exposure and anticoagulant use was observed for gastrointestinal and intracranial bleeding. ConclusionsAmong older adults at high risk for cardiovascular and thromboembolic events, increasing PM2.5 exposure was significantly associated with increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis. In addition, PM2.5 exposure and anticoagulant use may act together to increase risks of severe gastrointestinal and intracranial bleeding. Thus, clinicians may recommend that high-risk individuals limit their outdoor air pollution exposure during periods of increased PM2.5 concentrations. Our findings may inform environmental policies to protect the health of vulnerable populations.

The Genetic Architecture of the Root System during Seedling Emergence in Populus euphratica under Salt Stress and Control Environments

The growth of the Populus euphratica root system is of great significance for its survival under adverse environmental stress. In harsh saline-stress environments, the proportion, morphology, and functionality of the taproots and lateral roots and how they manifest specific adaptive structures, growth strategies, and potential genetic controls are still subjects for further exploration. In this study, we delve into the fundamental patterns and trade-offs of root morphology and functionality by constructing an environment-induced differential interaction equation (EDIE) to model the independent and interactive growth of the root system while considering the influence of environmental conditions. We identify 93 key QTLs in the control group and 44 key QTLs in the salt-stress group, of which 2 QTLs are significant in both environments. By constructing ODE-based QTL networks, we explore in depth how these loci regulate the growth of the root system under different environmental conditions while considering their independent direct effects and epistatic effects among loci. This study elucidates the intrinsic factors that influence the variations in taproots and lateral roots, providing crucial insights into the relationship between root morphology and functionality.

The impact of coach and parent-created motivational climate on moral behaviours of Chinese student-athletes: examining the independent and interactive effects

ABSTRACT The purpose of this study was to examine the impact of coach- and parent-created motivational climates on the moral behaviour of Chinese student-athletes and to determine whether there were any interactive effects between them. To build on previous research, we proposed the hypothesis of independent effects and two types of interactive effects: synergistic interaction, where both parties work together, and compensatory interaction, where one party complements the other when it underperforms. To test our hypotheses, we gathered data from 255 Chinese student-athletes (159 male, 96 female, M age = 17.55) on their perceived motivational climate created by their coaches and parents, and their self-evaluations of moral behaviour. The hierarchical regression analysis showed that both mastery and performance climates created by coaches and parents had independent effects on all moral behaviours. Additionally, synergistic and compensatory interactive effects were observed on certain moral behaviours. Our study emphasises the crucial role of coaches and parents working together to establish a positive and supportive mastery motivational climate that encourages moral behaviour among Chinese student-athletes.

Effects of Exercise Training and L-Arginine Loaded Chitosan Nanoparticles on Hippocampus Histopathology, β-Secretase Enzyme Function, APP, Tau, Iba1and APOE-4 mRNA in Aging Rats.

The objective of this study was to evaluate the combined and independent effects of exercise training and L-Arginine loaded chitosan nanoparticles (LA CNPs) supplementation on hippocampal Tau, App, Iba1, and ApoE gene expression, oxidative stress, β-secretase enzyme activity, and hippocampus histopathology in aging rats. Thirty-five male Wistar rats were randomly assigned to five groups (n = 7 in each): Young (8 weeks old), Old (20 months old), old + L-arginine supplementation (Old Sup), old + exercise (Old Exe) and old + L-arginine supplementation + exercise (Old Sup + Exe). LA CNPs were administered to the supplement groups through gavage at a dosage of 500mg/kg/day for 6-weeks. Exercise groups were subjected to a swimming exercise program five days/week for the same duration. Upon the completion of their interventions, the animals underwent behavioral and open-field task tests and were subsequently sacrificed for hippocampus genetic and histopathological evaluation. For histopathological analysis of brain, Cresyl violet staining was used. Congo Red staining was employed to confirm amyloid plaques in the hippocampus. Expressions of Tau, App, Iba1, and ApoE genes were determined by real-time PCR. In contrast to the Old group, Old Exe and Old Sup + Exe groups spent more time in the central space in the open field task (p < 0.05) and have more live cells in the hippocampus. Old rats (Old, Old Sup and Old Exe groups) exhibited a significant Aβ peptide accumulation and increases in APP, Tau, Iba1, APOE-4 mRNA and MDA, along with decreases in SOD compared to the young group (p < 0.05). However, LA CNPs supplementation, exercise, and their combination (Old Sup, Old Exe and Old Sup + Exe) significantly reduced MDA, Aβ plaque as well as APP, Tau, Iba1, and APOE-4 mRNA compared to the Old group (p < 0.05). Consequently, the administration of LA CNPs supplements and exercise might regulate the risk factors of hippocampus cell and tissue.

Equivalencies Between Ad Hoc Strategies and Multivariate Models for Meta-Analysis of Dependent Effect Sizes

Meta-analyses of educational research findings frequently involve statistically dependent effect size estimates. Meta-analysts have often addressed dependence issues using ad hoc approaches that involve modifying the data to conform to the assumptions of models for independent effect size estimates, such as by aggregating estimates to obtain one summary estimate per study, conducting separate analyses of distinct subgroups of estimates, or combinations thereof. We show that these ad hoc approaches correspond exactly to certain multivariate models for dependent effect sizes. Specifically, we describe classes of multivariate random effects models that have likelihoods equivalent to those of models for effect sizes that have been averaged by study, classified into subgroups, or both. The equivalencies also apply to robust variance estimation methods.

PENGARUH RASIO KEMANDIRIAN DAERAH, EFEKTIFITAS PENDAPATAN ASLI DAERAH, DAN PENGELOLAAN BELANJA DAERAH TERHADAP KINERJA KEUANGAN DAERAH

This study aims to test and analyze the effect of independence, effectiveness of local original income and regional expenditure on regional financial performance at the Regional Finance and Asset Management Agency of West Nusa Tenggara Province (RFAMA). This research is quantity with the type of data in the form of documentary data. The population used in this study is all regencies and cities in East Java Province consisting of 2 cities and 8 regencies contained in the Regional Finance and Asset Management Agency of West Nusa Tenggara Province (RFAMA) with an observation period in 2011-2021. The sampling technique in this study is a purposive sampling technique with a sample number of 110 data. The study was analyzed by simple linear regression using the SPSS program. The results of this study show that Regional Independence and Regional Revenue Effectiveness do not affect Regional Financial Performance, on the contrary, Regional Expenditure has a positive effect on Regional Financial Performance.

Long-term prognosis after stapled and hand-sewn ileal pouch–anal anastomoses for familial adenomatous polyposis: a multicenter retrospective study

PurposeThe long-term prognosis of stapled and hand-sewn ileal pouch–anal anastomoses in familial adenomatous polyposis patients in Japan remains unknown. This study aimed to compare the overall survival in familial adenomatous polyposis patients who underwent stapled or hand-sewn ileal pouch–anal anastomosis.MethodsThis multicenter retrospective study was conducted at 12 institutions in Shizuoka Prefecture, Japan. The clinical outcomes of 53 eligible familial adenomatous polyposis patients who underwent stapled (n = 24) and hand-sewn (n = 29) ileal pouch–anal anastomosis were compared.ResultsThe median follow-up duration was 171.5 months. The incidence of adenoma in the remnant rectum or anal transitional zone and metachronous rectal cancer was significantly more common in stapled ileal pouch–anal anastomosis (adenoma: stapled, 45.8%, vs. hand-sewn, 10.3%, p = 0.005; metachronous rectal cancer: 29.2%, vs. none, p = 0.002). The number of deaths was remarkably higher in stapled ileal pouch–anal anastomosis (p = 0.002). Metachronous rectal cancer was the most common cause of death. Overall survival was worse in stapled ileal pouch–anal anastomosis than in hand-sewn ileal pouch–anal anastomosis (120 months, 90.7% vs. 96.6%; 240 months, 63.7% vs. 96.6%; p = 0.044). Cox regression analysis revealed the independent effects of preoperative advanced colorectal cancer and stapled ileal pouch–anal anastomosis on overall survival.ConclusionStapled ileal pouch–anal anastomosis negatively affected the overall survival of familial adenomatous polyposis patients. Therefore, hand-sewn ileal pouch–anal anastomosis is recommended for better prognosis in these patients.

Looking beyond the mean: quantile regression for comparative physiologists.

Statistical analyses that physiologists use to test hypotheses predominantly centre on means, but the tail ends of the response distribution can behave quite differently and underpin important scientific phenomena. We demonstrate that quantile regression (QR) offers a way to bypass some limitations of least squares regression (LSR) by building a picture of independent variable effects across the whole distribution of a dependent variable. We used LSR and QR with simulated and real datasets. With simulated data, LSR showed no change in the mean response but missed significant effects in the tails of the distribution found using QR. With real data, LSR showed a significant change in the mean response but missed a lack of response in the upper quantiles which was biologically revealing. Together, this highlights that QR can help to ask and answer more questions about variation in nature.

Effect of psychosocial factors on autonomic nervous system activity in patients with heart failure.

Autonomic imbalance predicts worse clinical outcomes in patients with heart failure (HF). Managing the variables affecting heart rate variability (HRV) might improve the clinical outcomes of patients with HF. This study aimed to investigate variables affecting HRV. We assessed autonomic nervous system activity (low-frequency [Lf], high-frequency [Hf], and Lf/Hf ratio) in 60 patients with HF, employing standard measures to capture short-term HRV. To estimate the independent effects of variables such as well-known cardiac risk factors and psychosocial conditions on HRV, multivariate analyses were conducted. For psychosocial variables, we assessed depression and quality of life in patients and their family caregivers. We also assessed the self-care behavior of patients and their caregivers' burden. Depression in family caregivers and self-care behavior of patients were independently associated with a decreased Hf (β-coefficient = 0.309, P = .039 and β-coefficient = -0.029, P = .047, respectively). Depression of family caregivers and self-care behavior of patients may affect HRV in patients with HF.

How does the radio enhancement of broad absorption line quasars relate to colour and accretion rate?

ABSTRACT The origin of radio emission in different populations of radio-quiet quasars is relatively unknown, but recent work has uncovered various drivers of increased radio-detection fraction. In this work, we pull together three known factors: optical colour (g − i), C iv distance (a proxy for L/LEdd), and whether or not the quasar contains broad absorption lines (BALQSOs) which signify an outflow. We use SDSS (Sloan Digital Sky Survey) DR14 spectra along with the LOFAR Two Metre Sky Survey Data Release 2 and find that each of these properties have an independent effect. BALQSOs are marginally more likely to be radio-detected than non-BALQSOs at similar colours and L/LEdd, moderate reddening significantly increases the radio-detection fraction and the radio detection increases with L/LEdd above a threshold for all populations. We test a widely used simple model for radio wind shock emission and calculate energetic efficiencies that would be required to reproduce the observed radio properties. We discuss interpretations of these results concerning radio-quiet quasars more generally. We suggest that radio emission in BALQSOs is connected to a different physical origin than the general quasar population since they show different radio properties independent of colour and C iv distance.

Evaluating the impact of pre-diagnostic use of statins and testosterone replacement therapy on mortality outcomes in older men with hormone-related cancers: Surveillance, Epidemiology, and End Results-Medicare 2007-2015.

The link between the pre-diagnostic use of statins and testosterone replacement therapy and their impact on hormone-related cancers, prostate cancer, colorectal cancer, and male breast cancer survival remains a topic of controversy. Further, there is a knowledge gap concerning the joint effects of statins and testosterone replacement therapy on hormone-related cancer survival outcomes. To examine the independent and joint effects of pre-diagnostic use of statins and testosterone replacement therapy on the risk of all-cause and cause-specific mortality among older men diagnosed with hormone-related cancers, including prostate cancer, colorectal cancer, and male breast cancer. In 41,707 men (≥65 years) of Surveillance, Epidemiology, and End Results-Medicare 2007-2015, we identified 31,097 prostate cancer, 10,315 colorectal cancer, and 295 male breast cancer cases. Pre-diagnostic prescription of statins and testosterone replacement therapy was ascertained and categorized into four groups (Neither users, statins alone, testosterone replacement therapy alone, and Dual users). Multivariable-adjusted Cox proportional hazards and competing-risks (Fine-Gray subdistribution hazard) models were conducted. No significant associations were found in Cox-proportional hazard models for hormone-related cancers. However, in the Fine-Gray competing risk models among high-grade hormone-related cancers, statins alone had an 11% reduced risk of hormone-related cancer-specific death (hazard ratio: 0.89; 95% confidence interval: 0.81-0.99; p 0.0451). In the prostate cancer cohort with both statistical models, the use of testosterone replacement therapy alone had a 24% lower risk of all-cause death (hazard ratio: 0.76; 95% confidence interval: 0.59-0.97; p 0.0325) and a 57% lower risk of prostate cancer-specific death (hazard ratio: 0.43; 95% confidence interval: 0.24-0.75; p 0.0029). Similar inverse associations were found among aggressive prostate cancer cases with testosterone replacement therapy alone and statins alone. No significant associations were found in the colorectal cancer and male breast cancer sub-groups. Pre-diagnostic use of statins and testosterone replacement therapy showed a survival benefit with reduced mortality in high-grade hormone-related cancer patients (only statins) and aggressive prostate cancer patients in both statistical models. Findings of testosterone replacement therapy use in aggressive prostate cancer settings could facilitate clinical trials. Further studies with extended follow-up periods are needed to substantiate these findings.

Association between weight-for-length percentile and ICU length of stay in patients with a single ventricleundergoing bidirectional Glenn repair: A retrospective cohort study.

Poor weight gain has been identified as an independent risk factor for increased surgical morbidity and mortality for patients with single-ventricle physiology undergoing staged surgical palliation. Conversely, excessive weight gain has also emerged as an independent risk factor predicting increased morbidity and mortality in a single-center study. Given this novel single-center concept, we investigated the impact of excessive weight on patients with single-ventricle physiology undergoing bidirectional Glenn palliation in a multicenter study model. Patients from the Pediatric Heart Network Single Ventricle Reconstruction Trial (n = 387) were analyzed in a retrospective cohort study examining the independent effect of weight percentile on intensive care unit (ICU) length of stay (LOS) and ventilator days. Locally estimated scatterplot smoothing (LOESS) regression was used to plot weight-for-length (WFL) percentiles by ICU LOS and ventilator days. Unadjusted and adjusted ordinal regression was used to model ICU LOS and ventilator days. Scatterplots and LOESS regression curves demonstrated increasing ICU LOS and ventilator days for increasing WFL percentiles. Unadjusted ordinal regression analysis of ICU LOS demonstrated a trend of increasing ICU LOS for increasing WFL percentiles that was not statistically significant (P = 0.11). A similar trend was demonstrated in adjusted ordinal regression that was not statistically significant (P = 0.48). Unadjusted and adjusted ordinal regression analysis of ventilator days did not reach statistical significance (P = 0.07). Excessive weight gain has a clinically relevant but not statistically significant association with increased ICU LOS and ventilator days for those patients in the >90th WFL percentile for age.

Socioeconomic inequalities in deaths of despair: Age heterogeneity in Canada's working age population

PurposeAlthough prior literature documented socioeconomic inequalities in deaths of despair among working age population, it is unclear whether and how (a) the link between socioeconomic status and deaths of despair differs by age (b) each measure of socioeconomic status has independent effects on deaths of despair. This study aims to reduce these knowledge gaps. MethodsUsing data from a large scale nationally representative linked dataset (2011 Canadian Census Health and Environment Cohorts), this study employed Fine-Gray subdistribution hazard models to estimate the link between socioeconomic status and deaths of despair due to suicide, drug overdose, and alcoholic liver disease among working age population (N = 4,076,530). Age stratified analysis was conducted to examine age heterogeneity. ResultsSocioeconomic status, such as housing tenure, employment status, household income, and education level, was associated with deaths of despair among working age population. Age differences in the association between socioeconomic status and deaths of despair were found. While education level was pronounced for deaths of despair for younger adults, a combination of socioeconomic status was significantly associated with deaths of despair for those in late adulthood. ConclusionsSocioeconomic inequalities in deaths of despair are manifest among Canadian working age population. This study lends support the social and health policies aimed at reducing gaps in mortalities.

The Perceived Influence Model of Trust: Toward a Multi-Trustee Theory

Prior research investigating situations involving one trustor and multiple trustees often examines how a trustor’s trust in one party affects their amount of trust in another party. This paper fills a gap by predicting the effects of trust. The Perceived Influence (PI) Model of Trust is an individual-level model focused on the perceptions of a trustor. It builds upon the Mayer et al. (1995) model by integrating insights from literature on task interdependence and expanding to two trustees. The PI model describes and explains three possibilities for how a trustor’s trust in two trustees may combine to form a sense of aggregate multi-trustee trust via: (1) additive effects, such that the trustor’s trust in each of the trustees has independent effects on the aggregate; (2) compulsory effects, such that increasing the amount of trust in one trustee increases the effect of trust in the other trustee; and (3) compensatory effects, such that increasing trust in one trustee decreases the effect of trust in the other trustee. We propose that the theoretical mechanism explaining which of these three possibilities takes place is the trustor’s perceived influence of the trustees, which is tightly linked to perceptions of task requirements necessary to attenuate the trustor’s risk. The PI model begins to fill an important gap in the literature pertaining to pervasive, but rarely considered, multi-trustee situations, and proposes the importance of trustor perceptions of trustee influence and task requirements for future models of trust.

The Effect of Laparoscopic Gastric Ischemic Preconditioning Prior to Esophagectomy on Anastomotic Stricture Rate and Comparison with Esophagectomy-Alone Controls.

Benign anastomotic stricture is a recognized complication following esophagectomy. Laparoscopic gastric ischemic preconditioning (LGIP) prior to esophagectomy has been associated with decreased anastomotic leak rates; however, its effect on stricture and the need for subsequent endoscopic intervention is not well studied. This was a case-control study at an academic medical center using consecutive patients undergoing oncologic esophagectomies (July 2012-July 2022). Our institution initiated an LGIP protocol on 1 January 2021. The primary outcome was the occurrence of stricture within 1year of esophagectomy, while secondary outcomes were stricture severity and frequency of interventions within the 6months following stricture. Bivariable comparisons were performed using Chi-square, Fisher's exact, or Mann-Whitney U tests. Multivariable regression controlling for confounders was performed to generate risk-adjust odds ratios and to identify the independent effect of LGIP. Of 253 esophagectomies, 42 (16.6%) underwent LGIP prior to esophagectomy. There were 45 (17.7%) anastomotic strictures requiring endoscopic intervention, including three patients who underwent LGIP and 42 who did not. Median time to stricture was 144 days. Those who underwent LGIP were significantly less likely to develop anastomotic stricture (7.1% vs. 19.9%; p=0.048). After controlling for confounders, this difference was no longer significant (odds ratio 0.46, 95% confidence interval 0.14-1.82; p=0.29). Of those who developed stricture, there was a trend toward less severe strictures and decreased need for endoscopic dilation in the LGIP group (all p<0.20). LGIP may reduce the rate and severity of symptomatic anastomotic stricture following esophagectomy. A multi-institutional trial evaluating the effect of LGIP on stricture and other anastomotic complications is warranted.