Generalized Estimating Equations Research Articles

Antihypertensive drug treatment and the risk for intra-hemodialysis hypotension.

Antihypertensive medications are often prescribed to manage hypertension in hemodialysis (HD) patients, and intradialytic hypotension (IDH) is a common complication in these patients. We investigated the risk of IDH in incident HD patients who initiated treatment with antihypertensive drugs in monotherapy. The study was conducted as an emulation of a randomized clinical trial in 4072 incident HD patients who started anti-hypertensive drug treatment between January 2016 to December 2019. The primary outcome was the occurrence of IDH during HD sessions. The Gener alised Estimating Equation (GEE) analysis was adjusted by inverse probability treatment weighting (IPTW). Calcium channel blocker (CCB) use was associated with an IDH incidence rate of 7.4 events per person-year (95% CI: 6.2-8.6). Compared to CCB use, use of beta and alpha-beta blockers was strongly associated with a higher likelihood of IDH (OR [95% CI] 2.27 [1.50-3.43]). Use of angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (OR [95% CI] 1.71 [1.14-2.57]) and diuretics (OR [95% CI] 1.52 [1.07-2.16]) were also associated with higher likelihood of IDH compared to CCB use. The study suggests that using beta and alpha-beta blockers, ACE inhibitors or angiotensin II receptor blockers, and diuretics may increase the risk of IDH in HD patients compared to CCB use.

Sodium fluctuation as a parameter in predicting mortality in general hospitalized patients

BackgroundDysnatremia is the most common electrolyte disorder in hospitalized patients. Sodium fluctuation level may be a better parameter in dysnatremia management. We aimed to examine the association between sodium fluctuation level during hospitalization and mortality and to evaluate its value in predicting poor prognosis among general hospitalized patients.MethodsData were collected from patients admitted to Peking Union Medical College Hospital. The generalized estimated equation (GEE) was used to examine the relationship between sodium fluctuation level and mortality. Receiver-operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff value and the area under the ROC curve (AUC).ResultsSodium fluctuation level showed a dose-dependent association with increased mortality in general hospitalized patients. After adjusting age, sex, length of hospital stay, and Charlson comorbidity index, the ORs of group G2 to G6 were 5.92 (95% CI 5.16–6.79), 26.45 (95% CI 22.68–30.86), 50.71 (95% CI 41.78–61.55), 104.38 (95% CI 81.57–133.58), and 157.64 (95% CI 112.83–220.24), respectively, p trend <0.001. Both normonatremia and dysnatremia patients on admission had the dose-dependent associations similar to general hospitalized patients. The AUC of sodium fluctuation level was 0.868 (95% CI 0.859–0.877) in general hospitalized patients, with an optimal cutoff point of 7.5 mmol/L, a sensitivity of 76.5% and a specificity of 84.2%.ConclusionWe determined that sodium fluctuation level had a dose-dependent association with increased mortality in general hospitalized patients. Sodium fluctuation level could be used to develop a single parameter system in predicting mortality in general hospitalized patients with acceptable accuracy, sensitivity, and specificity.

PrEP use in a U.S. national sample of trans men and other trans masculine men who have sex with men: a longitudinal analysis

INTRODUCTION: Efforts to improve PrEP uptake among gay men, transgender women, and Black cisgender women are evident across the US, responding to epidemiologic data showing a disproportionate HIV burden in these communities. However, transgender men and other trans masculine people (TMSM)—those assigned female at birth who identify otherwise and have sex with cisgender men—are often excluded from these statistics. This community has unique vulnerabilities and prevention needs. National HIV prevention and planning have yet to include transgender men as a group with increased vulnerability to HIV seroconversion. This study follows a cohort of TMSM to characterize PrEP use longitudinally. METHODS: Using data from a prospective U.S. national cohort of TMSM not on PrEP, we analyzed annual PrEP uptake, discontinuation, and other HIV prevention measures over 24 months. We also used generalized estimating equations (GEE) modeling to assess demographic, healthcare access, gender-affirming, and behavioral factors associated with PrEP uptake over time. RESULTS: Our cohort of 196 TMSM was demographic and regionally diverse. 29% of our sample reported uptake of PrEP in 24-months, with about one-third of users discontinuing within one-year. Health insurance, having had lower surgery, used PEP or recently having a STI were associated with increased odds of PrEP use. CONCLUSION: We found low uptake of PrEP and high discontinuation rates in a U.S. national sample of TMSM over 24 months, despite significant need for HIV prevention. It is vital to increase efforts and investments to support this neglected community.

Associations between the keratinized mucosa width and the underlying alveolar bone dimensions at partial edentulous molar sites: a retrospective cross-sectional study

BackgroundThe assessment of hard and soft tissue at edentulous sites is important for subsequent implant treatment design. The aim of the present study was to explore the associations between the keratinized mucosa width (KMW) and the underlying alveolar bone dimensions at partial edentulous molar sites.MethodsIn this retrospective study, a total of 110 patients with at least one missing molar were selected. The buccal KMW of the edentulous molar sites was evaluated. Cone-beam computed tomography scans were collected, and the height discrepancy between the alveolar crest and the buccal bone plate (HC−B) as well as the alveolar bone height (ABH) were measured. The KMW was compared among the HC−B and ABH groups at both maxillary and mandibular sites. Linear regression and generalized estimation equations (GEEs) were used to explore the associations between the KMW and alveolar bone dimensions at α = 0.05.ResultsAmong the 110 patients, 158 edentulous molar sites were analyzed. The average HC−B and ABH were significantly lower at the maxillary sites (1.26 ± 1.62 mm, 11.62 ± 3.94 mm) than at the mandibular sites (3.67 ± 2.85 mm, 14.91 ± 3.01 mm, p < 0.001). The KMW was significantly lower at sites with HC−B > 2 mm than at sites with HC−B ≤ 2 mm both in the maxilla and mandible (p < 0.001). No significant differences were found between the KMW at sites with ABH < 10 mm and sites with ABH ≥ 10 mm (p > 0.05). Linear regression and GEEs analyses revealed that the HC−B was significantly associated with the KMW (B = -0.339, p < 0.001), while the association between the KMW and the ABH was not statistically significant (B = -0.046, p = 0.352).ConclusionsThe buccal KMW at edentulous molar sites was significantly associated with the HC−B. Alveolar ridges presenting with a sloped configuration were more prone to possess a narrower band of keratinized mucosa. Both hard and soft tissue augmentation should be considered for implant treatment at these sites. The correlations of dynamic changes between the KMW and alveolar bone dimensions after tooth extraction should be further investigated.

Longitudinal lung function trajectories in response to azithromycin therapy for chronic lung disease in children with HIV infection: a secondary analysis of the BREATHE trial

BackgroundChronic lung disease (CLD) is common among children with HIV (CWH) including in those taking antiretroviral therapy (ART). Azithromycin has both antimicrobial and anti-inflammatory effects and has been effective in improving lung function in a variety of lung diseases. We investigated lung function trajectories among CWH with CLD on ART enrolled in a randomized controlled trial of adjuvant azithromycin. We also investigated factors that modified the effect of azithromycin on lung function.MethodsThe study used data from a double-blinded placebo-controlled trial conducted in Malawi and Zimbabwe of 48 weeks on azithromycin (BREATHE: ClinicalTrials.gov NCT02426112) among CWH aged 6 to 19 years taking ART for at least six months who had a forced expiratory volume in one second (FEV1) z-score <-1.0. Participants had a further follow-up period of 24 weeks after intervention cessation. FEV1, forced vital capacity (FVC) and FEV1/FVC were measured at baseline, 24, 48 and 72-weeks and z-scores values calculated. Generalized estimating equations (GEE) models were used to determine the mean effect of azithromycin on lung-function z-scores at each follow-up time point.ResultsOverall, 347 adolescents (51% male, median age 15 years) were randomized to azithromycin or placebo. The median duration on ART was 6.2 (interquartile range: 3.8–8.6) years and 56.2% had an HIV viral load < 1000copies/ml at baseline. At baseline, the mean FEV1 z-score was − 2.0 (0.7) with 44.7% (n = 155) having an FEV1 z-score <-2, and 10.1% had microbiological evidence of azithromycin resistance. In both trial arms, FEV1 and FVC z-scores improved by 24 weeks but appeared to decline thereafter. The adjusted overall mean difference in FEV1 z-score between the azithromycin and placebo arms was 0.004 [-0.08, 0.09] suggesting no azithromycin effect and this was similar for other lung function parameters. There was no evidence of interaction between azithromycin effect and baseline age, lung function, azithromycin resistance or HIV viral load.ConclusionThere was no observed azithromycin effect on lung function z-scores at any time point suggesting no therapeutic effect on lung function.Trial registrationClinicalTrials.gov NCT02426112. First registered on 24/04/2015.

Acceptability and preliminary effects of the volunteer-supported Meaningful Moments program to engage older adults with advanced dementia on a hospital-based specialized dementia care unit: a mixed methods study

BackgroundNamaste Care offers practical skills for healthcare providers, volunteers, and families to meaningfully engage individuals with dementia in activities (e.g., music, massage, reminiscing, socialization, aromatherapy, snacks). A hospital-based specialized dementia care unit for patients with mid- to late-stage dementia offered an adapted version of the Namaste Care program, which was called Meaningful Moments. The aim of this study was to assess the acceptability and preliminary effects of this novel approach using trained volunteers for older adults with mid- to late-stage dementia.MethodsA mixed methods multiphase design was used. Qualitative description was used to explore acceptability of the Meaningful Moments program delivered over 6 months through focus groups (e.g., charge nurses, therapeutic recreationists, nurses, social workers) and individual interviews with one volunteer and two family members. A prospective pre-post-test study design was used to evaluate the preliminary effects of the program for patients with dementia and family members. Outcomes included quality of life, neuropsychiatric symptoms, and pain for patients with dementia and family carer role stress and the quality of visits for families. Data were collected from June 2018 to April 2019. Descriptive analyses of participants’ characteristics were expressed as a mean (standard deviation [SD]) for continuous variables and count (percent) for categorical variables. Focus group and individual interview data were analyzed using thematic analysis. The generalized estimating equations (GEE) method was used to assess change in the repeated measures outcome data.ResultsA total of 15 patients received the Meaningful Moments interventions. Families, staff, and volunteers perceived that patients experienced benefits from Meaningful Moments. Staff, volunteers, and families felt fulfilled in their role of engaging patients in the Meaningful Moments program. Individualized activities provided by volunteers were perceived as necessary for the patient population. There were no statistically significant improvements in patient outcomes. There was a statistically significant decline in family carer role stress.ConclusionsUsing a one-on-one approach by volunteers, patients experienced perceived benefits such as improved mood and opportunities for social interactions. There is a need for tailored activities for older adults with advanced dementia through practical strategies that can offer benefit to patients.

Impact of vertical alveoloplasty on changes in keratinized mucosa width following full-arch immediate implant placement and rehabilitations: A prospective case series.

This prospective case series aimed to investigate the effect of vertical alveoloplasty on the changes in keratinized mucosa width (KMW) following full-arch immediate implant placement and rehabilitation. A total of 17 potential edentulous patients were enrolled and received implant placement and full-arch implant-supported immediate rehabilitations. The main outcome was to analyze the effect of vertical alveoloplasty on the changes in KMW. The amount of vertical alveoloplasty during implant surgery as well as the changes in KMW at buccal aspects from the day of surgery to 6 months post-surgery were recorded on the implant-level using a periodontal probe. The secondary outcome was to analyze the other possible factors that affected the changes in KMW. The included factors were the initial KMW, the distribution of implants in the maxilla and mandible, the distribution of implants in the anterior and posterior regions, the distribution of implants in extraction sockets and healed ridges, and gender. Mann-Whitney non-parametric tests and multiple linear regression adjusted by generalized estimating equations (GEE) were used to statistically analyze the data. A total of 121 implant positions were analyzed. The KMW was 4.1± 2.0mm on the day of the surgery and 4.1± 1.7mm 6 months post-surgery. The mean changes in KMW following 6 months were -0.1± 1.6mm (p = 0.824). From the results of GEE, the vertical amount of alveoloplasty had no significant effect on changes in KMW. Both initial KMW and the distribution of implants in the anterior and posterior regions had significant impacts on the changes in KMW (p<0.0001). The amount of vertical alveoloplasty during implant surgery has no significant impact on the KMW. The KMW remained stable from baseline to 6 months after alveoloplasty, implant placement, and immediate rehabilitations in potential edentulous arches. The initial KMW and the distribution of implants in the anterior and posterior regions were the possible factors affecting changes in KMW.

Anxiety Symptoms Influence Food Consumption Differently Depending on Nutritional Status During the COVID-19 Pandemic: A Longitudinal Study with University Students

Background Anxiety symptoms are factors that directly affect eating habits, but this interference can be heterogeneous depending on the nutritional status of the individuals. Objectives To analyze whether the presence of anxiety symptoms at the beginning of the pandemic influenced the change in food consumption according to its purpose and extent of processing during a one-year follow-up and whether this association occurs equally with excess weight and without excess weight university students. Methods This longitudinal study was carried out with 583 university students from a public Higher Education Institution (HEI) in Brazil. The Generalized Estimating Equation (GEE) was used to verify whether anxiety symptoms were associated with changes in food consumption over time. Results The results showed that previous moderate/severe anxiety symptoms were associated with an increased frequency of consumption of both fresh or minimally processed foods (β: 0.2 95%CI: 0.1; 0.7 p = 0.013) and ultra-processed foods (β: 5.6 95%CI: 1.8; 17.7 p = 0.003), but with different magnitudes. In university students who were not excess weight, previous moderate/severe anxiety symptoms were associated with a reduction in the frequency of consumption of fresh or minimally processed foods (β: −2.0 95%CI: −3.5; −0.5 p = 0.008), while in those who were excess weight, there was an increase in consumption of ultra-processed foods (β: 4.5 95%CI: 2.2; 6.8 p < 0.001). Conclusion This study confirms the influence of anxiety symptoms on food consumption according to the extent and purpose of processing. In addition, these results emphasize the role of psychological distress in the university population, and that this factor can affect excess weight and without excess weight individuals differently.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. ClinicalTrials.gov Identifier: NCT03385629.

Critical Event Checklists for Simulated In-Hospital Dysrhythmias in Children with Heart Disease.

Children with heart disease are at increased risk of unstable dysrhythmias and in-hospital cardiac arrest (IHCA). Clinician adherence to lifesaving processes of care is an important contributor to improving patient outcomes. This study evaluated whether critical event checklists improve adherence to lifesaving processes during simulated acute events secondary to unstable dysrhythmias. A randomized controlled trial was conducted in a cardiac ward in a tertiary care, academic children's hospital. Unannounced simulated emergencies involving dysrhythmias in pediatric patients with underlying cardiac disease were conducted weekly. Responders were pediatric and anesthesiology residents, respiratory therapists, and bedside registered nurses. Six teams were randomized into two groups-three received checklists (intervention) and three did not (control). Each team participated in four simulated scenarios over a 4-week pediatric cardiology rotation. Participants received a brief slideshow presentation, which included a checklist orientation, at the start of their rotation. Simulations were video and audio recorded and those with three or more participants were included for analysis. The primary outcome was team adherence to lifesaving processes, expressed as the percentage of completed critical management steps. Secondary outcomes included participant perceptions of the checklist usefulness in identifying and managing dysrhythmias. We used generalized estimating equations (GEE) models, which accounted for clustering within groups, to evaluate the effects of the intervention. A total of 24 simulations were conducted; one of the 24 simulations was excluded due to an insufficient number of participants. In our GEE analysis, 81.21% (78.96%, 83.47%) of critical steps were completed with checklists available versus 68.06% (59.38%, 76.74%) without checklists (p = 0.004). Ninety-three percent of study participants reported that they would use the checklists during an unstable dysrhythmia of a child with underlying cardiac disease. Checklists were associated with improved adherence to lifesaving processes during simulated resuscitations for unstable pediatric dysrhythmias. These findings support the use of scenario specific checklists for the management of unstable dysrhythmias in simulations involving pediatric patients with underlying cardiac disease. Future studies should investigate whether checklists are as effective in actual pediatric in-hospital emergencies.

O-297 Prediction of pregnancy outcomes of single vitrified-warmed blastocyst transfer using combination of an automatic classification algorithm applied on cleavage stage embryos and blastocyst morphology

Abstract Study question Does combination of embryo assessment algorithm on cleavage-stage based on the automatic annotation of morphokinetic and blastocyst morphology in embryo selection improve implantation outcomes? Summary answer Combination of embryo assessment algorithm on cleavage-stage based on the automatic morphokinetic annotation and blastocyst morphological evaluation was showed significantly predictive for implantation outcomes. What is known already Conventional morphological assessment is still the gold standard for embryo selection. Timelapse monitoring of embryo development may represent a superior way to culture and select embryos in vitro. Nowadays, time-lapse culture systems are becoming more popular, many algorithms have been developed for embryo selection based on embryo morphokinetics, providing additional information for morphological assessment. However, manual annotations of developmental events and application of algorithms can be time-consuming and subjective processes. Automation of morphokinetic annotation can be a potential approach that reduces subjectivity in embryo selection. Study design, size, duration The observational, retrospective study was conducted in a single centre between 2020-2023 and included 511 single vitrified-warmed blastocyst transfer cycles. Blastocyst selected for transfer on Day 5,6 based on conventional morphological evaluation. Embryos were evaluated on Day 3 with a score from 1 (best) to 5 (worst) (from highest to lowest developmental potential) by the automatic embryo assessment algorithm. The correlation of the algorithms scoring and pregnancy outcomes was qualified by generalized estimating equations (GEEs). Participants/materials, setting, methods Embryos were cultured in timelapse GERI incubator and classified on day 3 by automatic embryo assessment algorithm depending on four parameters: P2 (t3-t2), P3 (t4-t3), oocyte age, and number of cells. The correlation of the algorithms scoring and pregnancy outcomes was qualified by generalized estimating equations (GEEs). Three GEE model using embryo assessment algorithm, conventional morphological assessment, and a combination of both classification system as the predictor were compared. Main results and the role of chance The implantation rate was higher with lower the scores generated by the embryo assessment algorithm. A GEE model showed the negative association between higher embryo score and lower odds of implantation. The OR of Score 3; 4; 5 vs 1 were 0.335; 0.259; 0.245 (95% CI 0.194-0.580; 0.138-0.485; 0.111-0.544, P = 0.000), respectively, for implantation. The AUC of the model using embryo assessment algorithm for implantation potential = 0.641. The AUC of the model combining both embryo assessment algorithm and conventional morphological assessment for implantation potential = 0.733. The differences were statistically significant (z-statistic = 3.896, p = 0.0001). Limitations, reasons for caution The sample size was enough to confirm the ability of the model for embryo selection. However, the retrospective nature of this study may be a limitation. Wider implications of the findings Using combination of timelapse technology with automated embryo assessment and conventional morphological assessment can predict the success rates of assisted reproduction cycles. To our knowledge, this is the first study using embryo dataset from single vitrified-warmed blastocyst transfer cycles with this embryo assessment algorithm. Trial registration number not applicable

P-046 Ejaculatory abstinence: is there any association with embryo developmental competence? A Retrospective Study in time-lapse incubators

Abstract Study question Is ejaculatory abstinence (EA) associated with fertilization and blastocyst development in ICSI cycles with embryo culture in time-lapse incubators? Summary answer There is no association between length of EA and fertilization, blastocyst development or morphology. What is known already Semen analysis is pivotal in medically assisted reproduction (MAR), serving as a significant indicator of male partners’ health. The period of EA is a relevant factor that can affect sperm quality. Numerous studies described EA association with clinical outcomes, while its impact on embryological results remains inconclusive. Recent meta-analyses, despite a conflicting literature, highlighted positive effects of shorter abstinence periods. A recent study suggested that prolonged abstinence might reduce fertilization rate in ICSI cycles without time-lapse imaging, thereby reducing usable zygotes’ rate Study design, size, duration Retrospective study including all oocytes (N = 7164) from 1148 ICSI cycles (N = 902 couples) cultured in time-lapse incubators at a single IVF center between January 2020 and December 2022. Only non-donor fresh gametes were included (Mean Maternal age: 38.5±4 years; Paternal Age: 41±5.6 years). The primary embryological outcomes were fertilization rate and type, and blastocyst development per inseminated oocyte and per 2PN-zygote. Secondary outcomes were euploidy, day of blastocyst development and Gardner’s morphology. Participants/materials, setting, methods Semen analysis was conducted according to WHO. All oocytes were cultured up to day7 in EmbryoScope or GERI incubators with continuous media and refresh in day5 (if needed). If requested, PGT-A was performed to assess full-chromosome uniform aneuploidies. Univariate and multivariate logistic regressions were conducted. Possible confounders were assessed among ovarian stimulation, maternal, paternal, sperm, and IVF cycles characteristics. Associations were confirmed with Generalized estimating equations (GEE) to account for repeated measurements among oocytes’ cohort. Main results and the role of chance Logistic regressions and GEE were conducted to assess associations between possible confounders and blastocyst development per inseminated metaphase-II oocyte. Maternal age, sperm concentration, and motility A+B were associated. The same confounders were reported on blastocyst development among 2PN-zygotes. The days of EA (1-8 days) did not show any association with fertilization (p = 0.198) or blastocyst development per metaphase-II oocyte (p = 0.495). No association was reported with abnormal fertilization, neither combining all abnormalities in a single group, nor clustering them as 1PN, 3PN, 3.1PN, and multi-PN. An increasing trend was reported in blastocyst development among 2PN-zygotes according to the length of EA (1-day: 17/37,45.9%; 2-days: 190/424,44.8%; 3-days: 1405/2574,54.6%; 4-day: 746/1410,52.9%; 5-days: 450/827,54.4%; 6-days: 70/133,52.6%; 7-days: 46/101,45.5%; 8-days: 85/162,52.5%), but this was not significant in a multivariate logistic regression (p = 0.887). Length of EA showed no association with euploidy (p = 0.424), nor with day of development (p = 0.966) and Gardner’s inner cell mass (p = 0.204) or trophectoderm (p = 0.428) morphology. Limitations, reasons for caution This study is inherently limited by its retrospective design. The limited number of cycles included was balanced using time-lapse incubators to improve the accuracy of fertilization check and benefit from an undisturbed embryo culture environment. Artificial Intelligence will be implemented to automate developmental timings’ annotation and objectify embryo quality assessment. Wider implications of the findings The length of EA seems not associated with embryological outcomes, adding to the controversy on this topic. Here, we included only ICSI cycles with blastocyst culture conducted in time-lapse to enhance the quality of the evidence. Larger datasets and diverse settings are now required, especially enriched with poor prognosis patients. Trial registration number not applicable

O-298 Embryo long-term storage does not affect ART outcome: analysis of 58,001 vitrified blastocysts

Abstract Study question Does duration of storage affect clinical outcome in frozen embryo transfer (FET) cycles? Summary answer Long-term storage does not affect live birth rate (LBR) in elective and non-elective FET cycles. What is known already Despite the success rates provided by the embryo vitrification programs, some studies found an association between the duration of cryo-storage and decreased clinical outcome, raising concern about the potential negative effect that prolonged storage may have on embryos. Study design, size, duration This was a retrospective multicenter study including a total of 58001 vitrified/warmed day-5 blastocysts from two different populations according to the reason for FET: elective FET which involved patients undergoing freeze all cycles (N = 16,615 blastocysts and 16,615 patients); and non-elective FET including 41,386 embryos from 25,571 patients. FETs were performed in the period between January 2010 and December 2020. Participants/materials, setting, methods Main outcome was live birth rate (LBR) and secondary outcomes were embryo survival, miscarriage, clinical and ongoing pregnancy rates. The impact of storage time and the potential confounding variables was assessed by univariate analyses. Those covariables found to significantly modify the LBR were included in a multivariable logistic regression. GEE (generalized estimated equation) was performed to allow the analysis of repeated measurements. Odds ratios (OR) and 95% confidence intervals (CI) were provided. Main results and the role of chance The blastocysts sample was clustered into deciles which provided specific storage duration categories that ranked from ≤0.67 to ≥ 4.34 and ≤1.8 to ≥ 34.81 months in freeze-all and non-elective FET, respectively. In the freeze-all group, maximum storage time was 34.8 months (2.9 years), while it was 121.2 months (10.1 years) in the non-elective FET group. Embryo survival did not show statistical differences across the categories of storage time in freeze-all and non-elective FET groups. In the freeze-all group, statistical differences were found for LBR across some, but not all the subgroups of storage duration. Similarly, in the non-elective FET group, LBR among the deciles showed statistical differences in some comparisons but not in all. However, after adjusting for confounding variables, the multivariate analysis showed no association between storage time and LBR in both groups. Blastocyst quality, body mass index (BMI), number of retrieved oocytes, endometrial preparation, male factor and uterine factor were related to the drop in the LBR in the freeze-all group (p &amp;lt; 0.05). In the non-elective FET group, the variables that showed significant association with the LBR were age at retrieval and at FET, number of embryos transferred, number of retrieved oocytes, BMI, endometrial preparation, sperm origin and female factor. Limitations, reasons for caution The retrospective design of the study represents its main limitation. Wider implications of the findings Our results demonstrate the safety of long-term cryo-storage. This is reassuring for both IVF practitioners and patients especially considering the exponential increase in FET cycles observed in the last decades. Trial registration number Not applicable

P-437 Are serum progesterone levels predictive for reproductive outcomes in artificial cycles if individualized luteal phase support is only administered when progesterone is below 5 ng/ml?

Abstract Study question Do serum progesterone levels predict reproductive outcomes in artificial cycles when individualized luteal phase support is administered only if progesterone falls below 5 ng/ml? Summary answer The low 5 ng/ml progesterone threshold appears to be sufficient for the patient not to require additional progesterone injections when progesterone is above 5 ng/ml. What is known already Serum progesterone (P4) level is negatively associated with ongoing pregnancy rate (OPR) and miscarriage rate in artificially prepared frozen embryo transfer (FET) cycles using standard micronized vaginal progesterone (MVP) for luteal phase support. Individualized luteal support is considered a successful rescue strategy in cycles with low serum progesterone levels eliminating the effect of P4 levels on outcome. Cut-off levels for this rescue strategy range from 8.8 to 10 ng/ml. Study design, size, duration A retrospective single-centre cohort study including a total of 1,016 vitrified-warmed single blastocyst transfers performed at a tertiary fertility centre between October 2021 and December 2022. Blastocysts of ≥ 3CC Gardner score were eligible for vitrification on day 5 or day 6 (Vit-kit or Vit-kit NX, FuijiFilm). Embryos were warmed and subsequently transferred on the same day which was day 5 in the cycle, regardless if the embryo was vitrified on day 5 or day 6. Participants/materials, setting, methods We included 595 patients undergoing an artificially prepared embryo transfer (ET) cycle using MVP 800mg BID for luteal phase support. Serum P4 levels were determined on the day of ET with the initiation of additional injections of subcutaneous P4 from the day after ET in patients with P4 &amp;lt; 5ng/ml. Primary endpoint was OPR. Multivariable logistic regression was performed to correct for confounders. Generalized estimating equations (GEE) models were fitted for primary and secondary outcomes. Main results and the role of chance OPR was comparable for the 3 groups: 9/40 (22.5%) for patients with P4 &amp;lt;5ng/ml, 64/275 (23.3%) for patients with P4 5-10 ng/ml and 181/701 (25.8%) for patients with P4 &amp;gt;10ng/ml (p = 0.377). No significant association between P4 category and likelihood for OPR was found after adjusting for confounders. Early clinical miscarriage rate was significantly different between the 3 groups: 5/40 (12.5%) in patients with P4 &amp;lt;5ng/ml, 26/275 (9.5%) with P4 5-10ng/ml and 37/701 (5.3%) with P4 &amp;gt;10ng/ml (P = 0.005). Limitations, reasons for caution Higher clinical miscarriage rate in cycles with a P4 level under 10 ng/ml questions the efficacy of rescue progesterone in cycles with a low P4. The patient population also exists of a subgroup of PGT-a tested cycles which was not included as a potential confounder in this analysis. Wider implications of the findings The 5 ng/ml P4 threshold appears to be sufficient for the patient not to require additional P4 injections when P4 is above 5 ng/ml. Consequently, a significantly lower proportion of cycles would need to be supplemented with rescue progesterone; 3.8% versus 31.3% for the 10 ng/mL cut off. Trial registration number ONZ-2023-0223

O-159 Domestic and cross-border reproductive care among same-sex male intended parents: comparing live birth rates (LBRs) in a national retrospective cohort in the United States (U.S.)

Abstract Study question How common is cross-border reproductive care (CBRC) in the U.S. among international same-sex male intended parents? Do CBRC LBRs differ compared to domestic counterparts? Summary answer A substantial number of international same-sex male intended parents seek CBRC in the U.S. LBRs per transfer are reassuring and comparable to domestic counterparts. What is known already Same-sex male intended parents often work with a gestational carrier to have a genetically related child(ren); however, restrictive and/or discriminatory policies in their home countries may prevent access. Intended parents may seek CBRC in countries like the U.S. due to favorable regulations. However, the volume of CBRC activity among same-sex male intended parents has been difficult to estimate accurately due to poor sexual orientation data collection. Capitalizing on national databases that identify same-sex male intended parents is the first step to describing CBRC trends and their associated outcomes in a marginalized population that is often excluded in the literature. Study design, size, duration This national retrospective cohort study included U.S. based gestational carrier embryo transfer cycles from the Society for Assisted Reproductive Technology (SART) database in the years 2017–2020. Among participating clinics (n = 488), 6,168 cycles among same-sex male intended parents were identified. Relative risks (RRs) for LBRs per transfer were compared for cycles including domestic (i.e., U.S. based, n = 3,052) and internationally based (n = 3,080) patients. LBR and country data were missing for 546 and 36 cycles, respectively. Participants/materials, setting, methods The inclusion criteria were transfer cycles among male patients with male partners. Unadjusted and adjusted RRs for LBRs per transfer were calculated to compare domestic (reference) and internationally based groups using multivariable Poisson and logistic regression models with generalized estimating equations (GEEs). Models were adjusted for donor age, transfer type (i.e., fresh, frozen), day of transfer, number of embryos transferred, male infertility, and the use of intracytoplasmic sperm injection, assisted hatching, and preimplantation genetic testing. Main results and the role of chance Between 2017 and 2020, 6,168 cycles with an embryo transfer to a gestational carrier occurred among same-sex male intended parents in the U.S. In half of the cycles, the U.S. was a destination for CBRC (50%, n = 3,080) among which (48%, n = 1,540) were from one of 23 European countries. Regarding countries of residence for CBRC cycles (n = 3,080), those most reported were China (23%), France (19%), Israel (13%), Spain (11%), the United Kingdom (6.1%), Australia (4.1%), Germany (3.7%), Italy (2.6%), Switzerland (1.5%), Canada (1.5%), Belgium (1.4%), Singapore (1.0%), Taiwan (1.2%), Norway (1.2%) and The Netherlands (0.92%). Additionally, there were 76 cycles from 8 countries in South America (2.3%), 9 cycles from 6 countries in Africa (0.27%), and 3 cycles from 2 countries in Central America (0.089%). Most cycles were in the U.S. West (72%, n = 4,441; e.g., California [47%]). Median oocyte age was 26 years (interquartile range 24,28) with a majority of cycles involving single embryo transfer (78%, n = 4,802). LBR per transfer was 69% (n = 3,867). There was no statistical difference between live births for domestic versus CBRC cycles in the unadjusted (RR 1.14, 95% confidence interval [CI] 0.96, 1.37; p: 0.141) or adjusted regression models (aRR 1.06, 95% CI 0.86, 1.32; p: 0.572). Limitations, reasons for caution The SART surveillance system captures most (∼90%) but not all embryo transfer cycles in the US. Current gender identity data were not available. Only the individual identified as the patient (and not the partner) indicated country of residence. The rationale for pursuing CBRC in the U.S could not be explored. Wider implications of the findings This study highlights a substantial amount of CBRC among same-sex male intended parents choosing the US for reproductive care. Implementing improved sexual orientation and gender identity data collection strategies are critical to filling CBRC data deserts not only among same-sex male intended parents but all sexual and gender minority populations. Trial registration number Not applicable

P-429 Measuring serum progesterone levels on the day of a fresh blastocyst transfer is debatable as there is no evidence for correlation with ongoing pregnancy results

Abstract Study question Does serum progesterone (P4) level on the day of a fresh blastocyst transfer relate to ongoing pregnancy rate (OPR)? Summary answer OPR after a fresh single blastocyst transfer seems not to be associated with serum P4 level on the day of transfer. What is known already Several studies have suggested an optimal serum P4 threshold for embryo transfers in frozen embryo transfer cycles. However, for fresh embryo transfers, data are scarce and conflicting. Study design, size, duration A retrospective single-center cohort study was performed on 598 complete data cycles, retained out of 631 consecutive fresh single blastocyst transfer cycles. Data were collected from patients undergoing a fresh IVF/ICSI cycle with autologous oocytes at a tertiary fertility center between June 2022 and August 2023. Participants/materials, setting, methods A total of 482 unique patients underwent one or more single fresh blastocyst transfers using micronized vaginal progesterone (MVP) 800mg BID for luteal phase support starting day after oocyte retrieval. Serum P4 levels were determined on day of transfer. The primary endpoint was OPR, positive hCG-test and early pregnancy loss (EPL) were secondary endpoints. Unadjusted and adjusted generalized estimating equations (GEE) assessed P4 level association with the endpoints, using an exchangeable working correlation matrix. Main results and the role of chance No association was identified between P4 levels on day of transfer and OPR after accounting for maternal age, blastocyst quality, P4 and estradiol level at last ultrasound, BMI and endometrial thickness. Data were grouped according to 10/50/90 and 25/50/75 percentiles, resulting in groups &amp;lt; = or &amp;gt; 27ng/ml and &amp;lt; = or &amp;gt; 40ng/ml, with omission of 90th and 75th percentile groups due to right-skewed distribution. With serum P4 levels higher than 40ng/ml, the probability of a positive hCG-test significantly increased (OR 1.79, CI 1.11-2.91; p = 0.018). No significant difference was observed in patients with serum P4 &amp;lt; = or &amp;gt; 27ng/ml (OR 1.23, CI 0.66-2.30; p = 0.506). Regarding OPR, no significant differences were observed when comparing patients with serum P4 &amp;lt; = or &amp;gt; 27/ng/ml or &amp;lt; = or &amp;gt; 40ng/ml (OR 0.88, CI 0.42-18.85; p = 0.736 and OR 1.41, CI 0.83-2.37; p = 0.203, respectively). Moreover, EPL did not significantly differ between serum P4 level groups (OR 1.93, CI 0.61-6.13; p = 0.265 and OR 1.2, CI 0.51-2.84; p = 0.674). Age (p &amp;lt; 0.001) and embryo quality (p &amp;lt; 0.001) are significantly related with OPR. Additionally, late follicular progesterone levels and OPR are significantly associated (OR 2.39, CI 1.16-4.95 in patients with P4 &amp;lt; = or &amp;gt; 27/ng/ml and OR 2.21, CI 1.07-4.55 in patients with &amp;lt; =40ng/ml and &amp;gt;40ng/ml). Limitations, reasons for caution Limitations include the retrospective design and the lack of live birth outcome data. Progesterone levels exceeding 60 ng/ml were not further analyzed to their precise value but grouped as 60 plus which did not allow to identify potential detrimental effects of very high P4 levels on treatment outcome. Wider implications of the findings Our data suggest that measuring P4 on the day of a single blastocyst transfer with MVP luteal phase support may not be indicative of OPR or the risk of EPL. This raises questions regarding the necessity for routine P4 measurements as well as the development of rescue strategies. Trial registration number ONZ-2023-0628

P-710 Comparison of cumulative delivery rates per aspiration cycle in patients fulfilling Bologna and POSEIDON criteria

Abstract Study question Do cumulative delivery rates (CDRs) per aspiration cycle differ in low-prognosis patients according to the Bologna and POSEIDON (Patient-Oriented-Strategies-Encompassing IndividualizeD-Oocyte-Number) classification criteria? Summary answer The CDR was 8.7% in Bologna and 22.7% in POSEIDON. The odds of achieving live-birth were ∼3-fold higher in POSEIDON than in the Bologna group. What is known already Bologna criteria were generated to address the heterogeneity in the definition of the Poor Ovarian Response (POR). However, patients meeting these criteria may not be homogeneous in terms of the number of oocytes retrieved and live birth rate. Subsequently, as a more inclusive classification, the POSEIDON criteria were proposed to stratify low-prognosis patients according to female age and suboptimal response to ovarian stimulation. To our knowledge, there is a paucity of data comparing CDRs between the POSEIDON and Bologna groups. Study design, size, duration Retrospective cohort study including 1250 patients undergoing their first ovarian egg retrieval cycle at Hacettepe University IVF Center in Ankara between 2017 and 2023. Exclusion criteria were female age &amp;gt;45 years old, body mass index &amp;gt;35 kg/m2, azoospermia, pre-implantation genetic testing (PGT) for structural rearrangement or monogenic disorders, fertility preservation cycles, dual-stimulation cycles, premature ovarian insufficiency, and hypogonadotropic hypogonadism. The primary outcome measured was CDR defined by ICMART (International Committee for Monitoring Assisted Reproductive Technologies). Participants/materials, setting, methods The Bologna patients have at least two of the following three features; female-age ≥40 or prior ovarian surgery, AMH&amp;lt;1.1ng/ml or antral-follicle-count (AFC)&amp;lt;5-7, and obtaining ≤3 oocytes in prior conventional stimulation. POSEIDON patients were categorized into four groups; younger(&amp;lt;35) and older(≥35) women with AMH≥1.2/AFC≥5 experiencing an unexpected poor(&amp;lt;4 oocytes-retrieved) or suboptimal(4–9 oocytes-retrieved) response, along with respective younger and older counterparts with AMH&amp;lt;1.1/AFC&amp;lt;5. Non-POSEIDON patients were those with AMH≥1.2/AFC≥5 and &amp;gt;9 oocytes-retrieved. General-Estimated-Equation(GEE) analysis was employed. Main results and the role of chance Out of 1250 patients, 79.6% were classified as POSEIDON, with sub-groups as follows: 5.28% Group 1a, 23.4% Group 1b, 3.6% Group 2a, 10.1% Group 2b, 14.64% Group 3, and 22.48% Group 4. The number of patients meeting Bologna criteria was 17.4% (218). For POSEIDON patients, median[IQR] values were: age 34 [30-38], AMH 1.33 [0.65-2.69], oocytes retrieved 4 [2-6], and embryo transfers 1 [1-2]. For non-POSEIDON patients: age 30 [27-33], AMH 4.63 [2.93-7.07], oocytes retrieved 13 [11-15], and embryo transfers 2 [1-3]. In Bologna patients: age 40 [36-42], AMH 0.46 [0.20-0.76], oocytes retrieved 2 [1-3], and embryo transfers 1 [0-1]. For non-Bologna patients: age 31 [28-36], AMH 2.30 [1.17-4.29], oocytes retrieved 6 [3-9], and embryo transfers 1 [1-2]. CDR for non-POSEIDON: 49.8%; Group 1a, 24.2%; Group 1b, 34.1%; Group 2a, 15.6%; Group 2b, 27.6%; Group 3, 20.8%; Group 4, 10.7%. In clustered-GEE analysis, using non-POSEIDON as reference, odds ratios (ORs) for live birth were: Group 1a OR 0.32 [0.18 - 0.60]; Group 1b OR 0.52 [0.37-0.74]; Group 2a OR 0.19 [0.08-0.43]; Group 2b OR 0.38 [0.24-0.61]; Group 3 OR 0.26 [0.17-0.41]; Group 4 OR 0.12 [0.08-0.19]. CDR for the Bologna group: 8.7% (OR: 0.10, 0.06-0.16); non-Bologna patients: 32.4% [OR: 0.48, 0.39-0.60]. Limitations, reasons for caution The limitations of the study encompass its retrospective cohort design and the variability introduced by different individuals conducting antral follicle counts using 2D ultrasonography. Wider implications of the findings Significant CDR differences exist between Bologna and Poseidon groups. POSEIDON patients show ∼2-fold lower CDR than normal responders, and Bologna patients exhibit ∼4-fold lower CDR than non-Bologna patients. Poseidon criteria cover a broader range of low-prognosis patients, while meeting Bologna criteria indicates a narrower, more specific group with poorer outcomes. Trial registration number N/A

P-634 Medroxyprogesterone acetate as an alternative to gonadotropin-realeasing hormone antagonist in vitrified oocyte donation cycles: embryo assessment and clinical outcome

Abstract Study question Could Medroxyprogesterone Acetate (MPA) be a good alternative to gonadotropin-realeasing hormone (GnRH) antagonist in vitrified oocyte donation cycles? Summary answer MPA is a good alternative to GnRH antagonist in vitrified oocyte donation cycles, ensuring comparable embryo quality and clinical outcome. What is known already Progestin-primed ovarian stimulation (PPOS), such as oral administration MPA in the follicular phase appears to be an effective alternative to conventional protocols, as it prevents premature LH surge and ovarian hyperstimulation syndrome. The drawback of these treatments is that it requires vitrification of oocytes or embryos because the endometrium is out of phase when embryo transfer is performed. Our previous studies have shown similar oocyte retrieval rates in fertility preservation cycles and comparable clinical outcomes in fresh donation cycles. Our objective is to expand evidence on PPOS, extending its success to new populations like vitrified donation cycles. Study design, size, duration This retrospective cohort study performed at IVI Valencia compared the effect of the MPA (10 mg/day) versus ganirelix (0.25 mg/day) on egg donors undergoing ovarian stimulation whose eggs were vitrified after retrieval. Donor cycles were divided intro groups, with 495 cycles in the MPA group and 307 in the ganirelix group. After oocyte donations and warming, the artificial intelligence based embryo assessment and clinical outcome were compared and analyzed for the two study populations Participants/materials, setting, methods 497 recipients using oocytes from the MPA group and 307 from the ganirelix group were included in the study. Post-oocyte donation and warming, a follow-up of 10,108 oocytes was performed, analyzing survival, fertilization, and blastocyst development. The embryo score obtained with the deep learning based model iDAScore v2, and the ASEBIR evaluation performed by embryologists were compared between both study populations. Finally, comprehensive clinical outcome comparisons were conducted between the two study populations. Main results and the role of chance The mean number of thawed oocytes was significantly different* between the two groups (12.80±3.54 in the MPA group vs. 12.20±3.58 in the antagonist group). Survival, fertilization, and blastocyst development rates showed no significant differences (89.83%, 76.38% and 66.22% respectively in the MPA group and 88.67%, 76.75% and 64.29% in the antagonist group). However, ASEBIR embryo assessment showed a significantly higher percentage of embryos classified as A and B in MPA group* (10.5% and 58.0% respectively vs. 7.2% and 53.6%), and more C embryos* in the antagonist group (34.3% vs. 39.2%). Artificial intelligence-based embryo assessment revealed no significant differences between the two groups*, with mean evaluations being 4.97±2.60 in the MPA group and 5.07±2.68 in the antagonist group. Regarding clinical outcomes, the MPA group had significantly higher number of frozen embryos per cycle* (4.08±2.07 in the MPA group vs. 3.65±2.00 in the antagonist group) but no disparities in implantation, clinical pregnancy, ongoing pregnancy, live birth and cumulative live birth rates. A generalized estimation equation highlighted that the study group (MPA or antagonist) did not significantly impact the live birth rate, but was significantly influenced instead by the number of thawed oocytes, recipient BMI, and transferred embryo quality assessed with iDAScore*. (*p&amp;lt;.05) Limitations, reasons for caution This project is limited by its retrospective and single-center nature. Despite being the largest sample size ever reported for PPOS in vitrified donation cycles, the number of patients included could be considered low. Consequently, it would be advisable to conduct a multicenter RCT to confirm the conclusions of this study. Wider implications of the findings The administration of MPA as a gonadotropin adjuvant demonstrates clinical outcomes comparable to those achieved with ganirelix in vitrified oocyte donation cycles. Its user-friendly application encourages the wider adoption of this protocols. These promising results promote the widespread use of MPA-based protocols in vitrified oocyte donation cycles. Trial registration number not applicable

Sperm whale demographics in the Gulf of Alaska and Bering Sea/Aleutian Islands: An overlooked female habitat.

Sperm whales exhibit sexual dimorphism and sex-specific latitudinal segregation. Females and their young form social groups and are usually found in temperate and tropical latitudes, while males forage at higher latitudes. Historical whaling data and rare sightings of social groups in high latitude regions of the North Pacific, such as the Gulf of Alaska (GOA) and Bering Sea/Aleutian Islands (BSAI), suggest a more complex distribution than previously understood. Sperm whales are the most sighted and recorded cetacean in marine mammal surveys in these regions but capturing their demographic composition and habitat use has proven challenging. This study detects sperm whale presence using passive acoustic data from seven sites in the GOA and BSAI from 2010 to 2019. Differences in click characteristics between males and females (i.e., inter-click and inter-pulse interval) was used as a proxy for animal size/sex to derive time series of animal detections. Generalized additive models with generalized estimation equations demonstrate how spatiotemporal patterns differ between the sexes. Social groups were present at all recording sites with the largest relative proportion at two seamount sites in the GOA and an island site in the BSAI. We found that the seasonal patterns of presence varied for the sexes and between the sites. Male presence was highest in the summer and lowest in the winter, conversely, social group peak presence was in the winter for the BSAI and in the spring for the GOA region, with the lowest presence in the summer months. This study demonstrates that social groups are not restricted to lower latitudes and capture their present-day habitat use in the North Pacific. It highlights that sperm whale distribution is more complex than accounted for in management protocol and underscores the need for improved understanding of sperm whale demographic composition to better understand the impacts of increasing anthropogenic threats, particularly climate change.

Effect of pericapsular nerve group block and suprainguinal fascia iliaca block on postoperative analgesia and stress response in elderly patients undergoing hip arthroplasty: a prospective randomized controlled double-blind trial

BackgroundAs a novel regional analgesic technique, ultrasound-guided pericapsular nerve group (PENG) block has some potential advantages, and we designed a randomized clinical trial (RCT) to investigate whether the ultrasound-guided PENG block combined with general anesthesia can better reduce stress response, maintain intraoperative hemodynamic stability, and reduce postoperative analgesia in elderly hip arthroplasty compared with ultrasound-guided suprainguinal fascia iliaca block (SIFIB) combined with general anesthesia.MethodsSeventy-four subjects were enrolled over an 8-month period (20 April 2023 to 31 December 2023). All patients were divided into the test group (group P) and the control group (group S) using the envelope as the randomization method. The test group was treated with preoperative ultrasound-guided PENG block analgesia combined with general anesthesia and the control group was treated with preoperative ultrasound-guided SIFIB analgesia combined with general anesthesia. The primary outcome selected was the patient Visual Analogue Scale (VAS) score at 12 h postoperatively.ResultsAfter generalized estimating equations (GEE) analysis, there was a statistically significant difference in the main effect of postoperative VAS score in group P compared with group S (P = 0.009), the time effect of VAS score in each group was significantly different (P < 0.001), and there was no statistically significant difference in the group-time interaction effect (P = 0.069). There was no statistically significant difference in the main effect of intraoperative mean arterial pressure (MAP) change (P = 0.911), there were statistically significant differences in the time effect of MAP in each group (P < 0.001), and there were statistically significant differences in the interaction effect (P < 0.001).ConclusionsIn summary, we can conclude that in elderly patients undergoing hip fracture surgery, postoperative analgesia is more pronounced, intraoperative hemodynamic parameters are more stable, and intraoperative stress is less induced in patients receiving SIFIB than in patients receiving PENG block.