Multicenter Propensity Score Research Articles

Percutaneous edge-to-edge therapy with PASCAL or MitraClip: a multicenter propensity score matched comparison

Abstract Background The MitraClip is the worldwide established transcatheter edge-to-edge repair system with over 100,000 treated patients. The recently approved PASCAL repair system is well adopted in the field of percutaneous mitral regurgitation (MR) treatment with growing acceptance both in mitral and tricuspid valves. The aim of this retrospective multicenter study was to compare the Edwards' PASCAL System with the Abbott MitraClip System in terms of procedural results and short-term outcome. Methods We retrospectively evaluated patient data of three high volume German centers that performed percutaneous edge to edge procedures either with the MitraClip or the PASCAL repair system. Primary endpoint was the amount of MR reduction. Secondary endpoints were residual MR at discharge, technical success, device success and 30-day mortality. Results Between 2018 and 2020 a total of 412 procedures were performed in the three centers. 216 cases were performed with the MitraClip compared to 196 procedures done with the PASCAL repair system. Patients were male in 55.6% of the cases (50.5% in the MitraClip cohort compared to 61.2% in the PASCAL cohort, p=0.028), mean Logistic Euro-Score II was 4.42 (3.58 in the MitraClip and 3.23 in the PASCAL cohort, p=0.038) and reduced LVEF beyond 45% was seen in 42.6% of the cases (49.5% in the MitraClip compared to 35.3% in the PASCAL cohort, p=0.004). Severe MR at baseline was seen in 98.5% in the MitraClip cohort compared to 98.6% in the PASCAL cohort, p=0.909). Mean number of implanted devices was 1.41±0.56 in the MitraClip cohort and 1.37±0.55 in the PASCAL cohort (p=0.401). Procedures were successfully conducted with both edge-to-edge systems (device success rate 93.2% in the MitraClip cohort and 94.0% in the PASCAL cohort, p=0.775), leading to comparably good results (final MR ≤2 in 94.4% with the MitraClip compared to 95.9% with the PASCAL system, p=0.448) and very good results (final MR ≤1 in 72.6% in the MitraClip compared to 79.5% in the PASCAL cohort, p=0.102). After propensity score matching for adjustment of major differences among the two treatment strategies (including age, gender, MR etiology, EROA, Severe MR (III and IV), reduced LVEF and Mitral Valve orifice area) the achieved mean MR reduction remains comparable (2.29±0.82 with the MitraClip compared to 2.46±0.82 with the PASCAL system, p=0.191). In multivariate regression analysis STS Score independently correlates with a very good final result while device choice did not show a significant impact in this cohort. Conclusion In this retrospective multicenter study both the MitraClip and PASCAL system performed excellent with comparable procedural success rates. Achieved final average reduction of MR Grade was 2.29±0.82 with the MitraClip and 2.46±0.82 with the PASCAL system. Funding Acknowledgement Type of funding sources: None.

Transarterial infusion chemotherapy with FOLFOX for advanced hepatocellular carcinoma: a multi-center propensity score matched analysis of real-world practice.

To compare the treatment effectiveness and safety among transarterial infusion chemotherapy (TAI) with FOLFOX regimen, transarterial chemoembolization (TACE), and sorafenib in patients with BCLC stage C hepatocellular carcinoma (HCC). The data of consecutive patients with BCLC stage C HCC treated with TAI, TACE, or sorafenib from January 2015 to December 2018 at three centers were retrospectively analyzed. Propensity-score matched (PSM) analysis was pairwise performed to reduce selection bias. Treatment effectiveness and safety were evaluated and compared using the Kaplan-Meier method, log-rank test, Cox regression models, and χ2 test. The median overall survival (OS) in the matched TAI cohort was significantly longer than the sorafenib cohort (19.6 vs. 7.5 months, P=0.009), and the TACE cohort (estimated 27.8 vs. 6.6 months, P<0.001). The difference in median progression-free survival (PFS) between the matched TAI and sorafenib cohorts was not significant (5.8 vs. 2.3 months, P=0.219). The median PFS in the matched TAI cohort was significantly longer than the TACE cohort (6.5 vs. 2.8 months, P<0.001). The objective response rate (ORR) in the matched TAI cohort was significantly higher than the sorafenib cohort (36.4% vs. 0.0%, P<0.001) and the TACE cohort (48.7% vs. 4.7%, P<0.001). The incidences of adverse events (AEs) were similar among these three cohorts. TAI with FOLFOX regimen was an effective and safe therapy that improved survival of patients with BCLC stage C HCC.

A multicenter propensity score matched analysis in 73,843 patients of an association of nutritional risk with mortality, length of stay and readmission rates

The reported prevalences and effects of nutritional risk vary widely in the literature because of both methodological differences (e.g., screening tools and statistical analyses) and different patient populations. In this study the authors analyzed in-hospital mortality, 30-d mortality, readmission within 4 mo, and justified length of stay (jLoS) (determined by governmental assessment to justify financial compensation) in hospitalized patients nutritionally at risk compared with hospitalized patients not at risk. This was a multicenter retrospective cohort study in 6 Belgian hospitals among inpatients in 2018. Propensity score matching was applied, including comorbidity score and exact matching for hospital, age group, sex, type of admission, living situation, and medical specialty. In total, 73,843 of 85,677 patients were screened at admission, with 16,141 found to have nutritional risk (prevalence of 21.9%). Oncology patients had the highest risk prevalence of 38.3%, whereas patients receiving plastic or reconstructive surgery had a prevalence of 5.2%. Patients nutritionally at risk had higher odds of dying in the hospital (5.1% compared with 3.3%; OR: 1.56; 95% CI: 1.37, 1.76), dying within 30 d of admission (6.8% compared with 4.3%; OR: 1.62; 95% CI: 1.45, 1.81) and being readmitted within 4 mo after discharge (35.5% compared with 32.9%; OR: 1.12; 95% CI: 1.07, 1.18). These differences were consistent across hospitals. The association between being nutritionally at risk and jLoS was ambiguous. One out of 5 patients included in this study was nutritionally at risk. Using propensity score matching, higher odds of in-hospital mortality, readmission, and 30-d mortality were observed. In contrast to oft-reported increased length of stay with poor nutrition, propensity matched data for jLoS suggested that this association was less pronounced in this cohort.

Spotlight on laparoscopy in the surgical resection of locally advanced rectal cancer: multicenter propensity score match study.

Purpose This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality.Methods Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 minimally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height.Results Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P=0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P=0.445), reoperation in 8 vs. 7 (P=0.789), clinical anastomotic leak was found in 3 vs. 2 (P=0.670), and 30-day mortality rates was 2 vs. 1 (P>0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P=0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resection between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P=0.284).Conclusion This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

Survival of Patients with Lung Cancer in the Setting of Liver Cirrhosis: A Multicenter Propensity Score Matching Study.

PurposeThe survival outcome of lung cancer patients with coexisting liver cirrhosis has thus far received limited attention in the literature. In this study, we evaluated whether liver cirrhosis is an independent risk factor for the survival of patients with lung cancer.Materials and MethodsWe conducted a retrospective, multicenter, propensity-matched study of lung cancer patients with and without liver cirrhosis. To determine differences in survival, we sought to identify risk factors associated with poor outcomes using Kaplan–Meier survival analysis and Cox proportional hazards regression.ResultsThere were no statistically significant differences in the baseline clinical characteristics of patients between the cirrhosis and non-cirrhosis groups. The median overall survival of patients with and without cirrhosis was 13.07 months (95% confidence interval [CI]: 10.56–16.84) and 13.67 months (95% CI: 10.42–16.91), respectively (p=0.76). Cox proportional hazards regression analysis revealed that liver cirrhosis was not an independent risk factor for poor outcome (hazard ratio [HR]: 1.057, 95% CI: 0.805–1.388, p=0.690). In patients with cirrhosis, lower serum albumin levels, higher Charlson Comorbidity Index score, advanced-stage lung cancer, and treatment modality were factors associated with poor outcome. Increase in serum albumin by 1 g was associated with a 30% reduction in the risk of mortality (HR: 0.700, 95% CI: 0.494–0.993, p=0.045). While every point increase in the Charlson Comorbidity Index score by 1 point was linked to a 9% higher risk of mortality (HR: 1.090, 95% CI: 1.023–1.161, p=0.007).ConclusionThe survival rates of lung cancer patients with and without cirrhosis did not differ significantly. Higher serum albumin levels and lower Charlson Comorbidity Index scores were associated with improved survival.

Effect of preoperative potassium iodide administration on Graves’ disease surgery: a propensity score analysis

BackgroundPreoperative administration of a saturated solution of potassium iodide (SSKI) is recommended in the guidelines for the management of hyperthyroidism due to Graves’ disease. Studies addressing its effect on complications after thyroidectomy are inconclusive. MethodsRetrospective multicenter Propensity Score study of patients undergoing total thyroidectomy for Graves’ disease, from January 2013 to September 2019 in two tertiary centers in Madrid, Spain. Patients were given SSKI prior to surgery or not according to surgeons’ preferences.Electronic clinical records were reviewed searching: baseline characteristics surgical variables, pathological findings, and postoperative complications. ResultsNinety patients were analyzed: 44 received SSKI and 46 were not given SSKI.No significant differences were found in the main postoperative complications with or without SSKI: transient hypoparathyroidism (40.9% vs. 50%), permanent hypoparathyroidism (6.8% vs. 13%), transient recurrent laryngeal nerve (RLN) palsy (2.3% vs. 8.7%), definitive RLN palsy (2.3% vs. 2.2%), or cervical hematoma (2.3% vs. 4.3%). ConclusionPreoperative administration of SSKI had no impact on postoperative complications after thyroidectomy for Graves’ disease.

Laparoscopic versus EUS-guided gastroenterostomy for gastric outlet obstruction: an international multicenter propensity score–matched comparison (with video)

In the management of gastric outlet obstruction (GOO), EUS-guided gastroenterostomy (EUS-GE) seems to be safe and more effective than enteral stent placement. However, comparisons with laparoscopic GE (L-GE) are scarce. Our aim was to perform a propensity score-matched comparison between EUS-GE and L-GE. An international, multicenter, retrospective analysis was performed of consecutive EUS-GE and L-GE procedures in 3 academic centers (January 2015 to May 2020) using propensity score matching to minimize selection bias. A standard maximum propensity score difference of .1 was applied, also considering underlying disease and oncologic staging. Overall, 77 patients were treated with EUS-GE and 48 patients with L-GE. By means of propensity score matching, 37 patients were allocated to both groups, resulting in 74 (1:1) matched patients. Technical success was achieved in 35 of 37 EUS-GE-treated patients (94.6%) versus 100% in the L-GE group (P= .493). Clinical success, defined as eating without vomiting or GOO Scoring System≥2, was achieved in 97.1% and 89.2%, respectively (P= .358). Median time to oral intake (1 [interquartile range {IQR}, .3-1.0] vs 3 [IQR, 1.0-5.0] days, P< .001) and median hospital stay (4 [IQR, 2-8] vs 8 [IQR, 5.5-20] days, P< .001) were significantly shorter in the EUS-GE group. Overall (2.7% vs 27.0%, P= .007) and severe (.0% vs 16.2%, P= .025) adverse events were identified more frequently in the L-GE group. For patients with GOO, EUS-GE and L-GE showed almost identical technical and clinical success. However, reduced time to oral intake, shorter median hospital stay, and lower rate of adverse events suggest that the EUS-guided approach might be preferable.

The role of early video capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: A multi-center propensity score matching study.

Video capsule endoscopy (VCE) is a first-line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients. A total of 997 patients that underwent VCE at Renji Hospital and Nagoya University from May 15, 2002, to December 28, 2016, were included in this study. We matched patients that underwent early VCE within 14days of bleeding (early group, n=678) to patients that did not (late group, n=319) via 1:1 propensity score matching (PSM). We then compared VCE diagnostic rates and the prevalence of post-VCE rebleeding in patients with initial negative VCE findings within 1year between these groups before and after PSM. Following PSM, early VCE was associated with a significantly higher rate of OGIB diagnosis (56.4% vs 45.5%, P=0.001) and with a significantly lower incidence of rebleeding within 1year following treatment (24.7% vs 36.7%, P=0.041). In univariate and multivariate analyses, VCE timing (odds ratio 0.648; 95% confidence interval 0.496-0.847, P=0.001 and odds ratio 0.666; 95% confidence interval 0.496-0.894, P=0.007, respectively) was found to be linked with a higher rate of positive findings. Early VCE can improve the reliability of OGIB diagnosis while also reducing rates of post-VCE rebleeding. This suggests that timely and accurate diagnosis can help to improve OGIB patient treatment and prognosis.

Mesh fixation to fascia during incisional hernia repair results in increased prevalence of pain at long-term follow up: a multicenter propensity score matched prospective observational study

BackgroundPatient-reported outcomes such as postoperative pain are critical for the evaluation of outcomes after incisional hernia repair. The aim of this study is to determine the long-term impact of mesh fixation on postoperative pain in patients operated by open and laparoscopic technique.MethodsA multicenter prospective observational cohort study was conducted from September 2011 until March 2016 in nine hospitals across Switzerland. Patients undergoing elective incisional hernia repair were included in this study and stratified by either laparoscopic or open surgical technique. Propensity score matching was applied to balance the differences in baseline characteristics between the treatment groups. Clinical follow-up was conducted 3, 12 and 36 months postoperatively to detect hernia recurrence, postoperative pain and complications.ResultsThree-hundred-sixty-one patients were included into the study. No significant differences in hernia recurrence and pain at 3, 12 and 36 months postoperatively were observed when comparing the laparoscopic with the open treatment group. Mesh fixation by sutures to fascia versus other mesh fixation led to significantly more pain at 36 months postoperatively (32.8% vs 15.7%, p = 0.025).ConclusionsAt long-term follow-up, no difference in pain was identified between open and laparoscopic incisional hernia repair. Mesh fixation by sutures to fascia was identified to be associated with increased pain 36 months after surgery. Omitting mesh fixation by sutures to the fascia may reduce long-term postoperative pain after hernia repair.

A multicenter propensity score analysis of FOLFIRINOX vs gemcitabine plus nab-paclitaxel administered to patients with metastatic pancreatic cancer: results from the NAPOLEON study.

Fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX, FFX) and gemcitabine plus nab-paclitaxel (GnP) are considered standard treatments for patients with metastatic pancreatic cancer. Direct comparisons are not available that establish which is optimal. We conducted a propensity score-adjusted analysis of patients with metastatic pancreatic cancer to identify the therapeutic advantages of these standard therapies. We used clinical data as part of a multicenter retrospective study of patients with unresectable or recurrent pancreatic cancer treated with FFX or GnP (NAPOLEON study). FFX and GnP were initially administered to 102 and 153 patients, respectively. The GnP group comprised more patients of advanced age, worse performance status, lower body mass index, recurrence, and lower albumin concentrations. Median overall survival (OS) and progression-free survival (PFS) were 11.5months and 5.8months in the FFX group and 11.1months and 5.9months in the GnP group, respectively. Propensity score-adjusted analysis indicated that the administration of FFX or GnP was not independently associated with OS (adjusted hazard ratio [HR] 1.06; 95% confidence interval [CI] 0.76-1.47; P = 0.73). Similarly, the difference in PFS was not significant between groups (adjusted HR 0.93; 95% CI 0.68-1.26; P = 0.62). Gastrointestinal disorders were more common in the FFX group, whereas the frequencies of hematological, nervous system, and skin disorders were higher in the GnP group. The efficacies of FFX and GnP were comparable, although safety profiles differed and should be considered in selecting treatment.

Assessing the Impact of Minimally Invasive Liver Surgery in the Overweight and Obese: An International Multicenter Propensity Score Matched Analysis

Purpose: Despite the worldwide increase of obesity prevalence and widespread expansion of minimally invasive liver surgery (MILS), the safety and efficacy of MILS in obese patients is still a matter of debate. The aim of this study is to investigate possible advantages of MILS over open liver surgery (OLS) among patients with different classes of bodyweight. Methods: A multicenter database including 14,709 patients who underwent liver surgery in 16 centers in 8 countries (2000-2019) was assessed and only patients with BMI-comprehensive data were included. Patients were stratified according to bodyweight (BMI≤24.9(n=2884), 25≥BMI≤ 29.9(n=2828), 30≥BMI≤34.9(n=926), 35≥BMI≤39.9(n=269), and BMI≥40(n=73)), and divided according to surgical approach. Outcomes were compared after propensity-score matching (PSM). Results: In the included 6,980 patients, increasing BMI was associated with higher ASA scores, increased intraoperative blood loss (IOBL), rate of wound complications and use of MILS. Furthermore, increasing BMI was associated with lower rates of previous abdominal surgery, preoperative chemotherapy, malignant disease, multiple tumors, major concurrent procedures, bile leak and length of stay (LOS) (p<0.02). 937, 833, 279, 84 and 20 patients were matched 1:1 in the respective BMI-classes. After PSM, MILS was associated with lower operative time, IOBL, rate of complications and LOS in all strata (p<.05) and a lower rate of Clavien-Dindo ≥ 3 complications in the BMI ≥ 40 stratum (p=0.008). Conclusion: The advantages of MILS over OLS persist across different BMI-classes with a trend towards increased benefits in morbidly obese patients. Whilst obesity was initially considered a relative contraindication for MILS, these results advocate for a wider adoption in this relatively frail patient population.

International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy

BackgroundDespite a lack of high-level evidence, current guidelines recommend laparoscopic left lateral sectionectomy (LLLS) as the routine approach over open LLS (OLLS). Randomized studies and propensity score matched studies on LLLS vs OLLS for all indications, including malignancy, are lacking. MethodsThis international multicenter propensity score matched retrospective cohort study included consecutive patients undergoing LLLS or OLLS in six centers from three European countries (January 2000–December 2016). Propensity scores were calculated based on nine preoperative variables and LLLS and OLLS were matched in a 1:1 ratio. Short-term operative outcomes were compared using paired tests. ResultsA total of 560 patients were included. Out of 200 LLLS, 139 could be matched to 139 OLLS. After matching, baseline characteristics were well balanced. LLLS was associated with shorter operative time (144 (110–200) vs 199 (138–283) minutes, P < 0.001), less blood loss (100 (50–300) vs 350 (100–750) mL, P = 0.005) and a 3-day shorter postoperative hospital stay (4 (3–7) vs 7 (5–9) days, P < 0.001). ConclusionThis international multicenter propensity score matched study confirms the superiority of LLLS over OLLS based on shorter postoperative hospital stay, operative time, and less blood loss thus validating current guideline advice.

Repeat hepatectomy for patients with early and late recurrence of hepatocellular carcinoma: A multicenter propensity score matching analysis

BackgroundRepeat hepatectomy is a feasible treatment modality for intrahepatic recurrence after hepatectomy of hepatocellular carcinoma, yet the survival benefit remains ill-defined. The objective of the current study was to define long-term, oncologic outcomes after repeat hepatectomy among patients with early and late recurrence. MethodsPatients undergoing curative-intent repeat hepatectomy for recurrent hepatocellular carcinoma were identified using a multi-intuitional database. Early and late recurrence was defined by setting 1 year after initial hepatectomy as the cutoff value. Patient clinical characteristics, overall survival, and disease-free survival were compared among patients with early and late recurrence before and after propensity score matching. ResultsAmong all the patients, 81 had early recurrence and 129 had late recurrence from which 74 matched pairs were included in the propensity score matching analytic cohort. Before propensity score matching, 5-year overall survival and disease-free survival after resection of an early recurrence were 41.7% and 17.9%, respectively, which were worse compared with patients who had resection of a late recurrence (57.0% and 39.4%, both P < .01). After propensity score matching, 5-year overall survival and disease-free survival among patients with early recurrence were worse compared with patients with late recurrence (41.0% and 19.2% vs 64.3% and 43.2%, both P < .01). After adjustment for other confounding factors on multivariable Cox-regression analysis, early recurrence remained independently associated with decreased overall survival and disease-free survival (hazard ratio 2.22, 95% confidence interval 1.35–3.34, P = .001; hazard ratio 1.86, 95% confidence 1.26–2.74, P = .002). ConclusionRepeat hepatectomy for early recurrence was associated with worse overall survival and disease-free survival compared with late recurrence. These data may help inform patients and selection of patients being considered for repeat hepatectomy of recurrent hepatocellular carcinoma.

The Risk of Complications after Carpal Tunnel Release in Patients Taking Acetylsalicylic Acid as Platelet Inhibition: A Multicenter Propensity Score-Matched Study.

Carpal tunnel release is one of the most common procedures in hand surgery. There is only scarce evidence regarding whether platelet inhibitors increase the risk of developing postoperative hemorrhage in carpal tunnel release. This is a multicenter, propensity score-matched study including 635 carpal tunnel releases in 497 patients. Multivariate regression models were adjusted with the propensity score, which was developed to mitigate differences in patients with and without platelet inhibition with acetylsalicylic acid. Propensity score matching provides results close to the statistical quality of randomized controlled trials. The primary study endpoint was postoperative bleeding complication, defined as acute bleeding leading to reoperation or hematoma leading to physician visit. Patient satisfaction, functional outcome measured with the Boston Carpal Tunnel Questionnaire, and onset of surgical-site infection were also analyzed. Bleeding complications were observed in 56 procedures (8.8 percent). After propensity score matching, there was no significant difference between the patients with and without acetylsalicylic acid treatment (p = 0.997). History of thyroid disease (p = 0.035) and of rheumatoid arthritis (p = 0.026) were independent risk factors, whereas higher body mass index might have a beneficial effect (p = 0.006). Patients with postoperative bleeding had significantly impaired functional outcome as measured with the Boston Carpal Tunnel Questionnaire (p = 0.026). Median satisfaction in the investigated study population was 10 of 10 points and did not differ significantly between the antiplatelet and the non-antiplatelet cohorts (p = 0.072) CONCLUSION:: Carpal tunnel release under platelet inhibition with acetylsalicylic acid is safe and can be performed without interruption of such medication. Therapeutic, III.

The use of intra-abdominal drain in minimally invasive right colectomy: a propensity score matched analysis on postoperative outcomes.

No evidences supporting or not the use of intra-abdominal drain (AD) in minimally invasive right colectomies have been published. This study aims to assess the outcomes on its use after robotic or laparoscopic right colectomies. This is a multicenter propensity score matched study including patients who underwent minimally invasive right colectomy with (AD group) or without (no-AD group) the use of AD between February 1, 2007, and January 31, 2018. AD patients were matched to no-AD patients in a 1:1 ratio. Main outcomes were postoperative morbidity and mortality and anastomotic leak. A total of 653 patients were included. Of 149 (22.8%) no-AD patients, 124 could be matched. The rate of postoperative complications (AD n= 26, 21% vs. no-AD n= 26, 21%; p= 1.000), mortality (AD n= 2, 1.6% vs. no-AD n= 1, 0.8%; p= 1.000), anastomotic leak (AD n= 2, 1.6% vs. no-AD n= 5, 4.0%; p= 0.453), and wound infection (AD n= 9, 7.3% vs. no-AD n= 6, 4.8%; p= 0.581) did not significantly differ between the groups. Time to oral feeding was significantly shorter in the no-AD group [2 (1-3) vs. 3 (2-3), p= 0.0001]. The median length of hospital stay was 8 (IQR 7-9) in the AD group while it was 6 (IQR 5-9) in the no-AD group (p= 0.010). In conclusion, the use of AD after minimally invasive right colectomies has no influence on postoperative morbidity and mortality rates.

Early and late outcomes following aortic root enlargement: A multicenter propensity score–matched cohort analysis

ObjectiveThe safety and efficacy of aortic root enlargement (ARE) at the time of aortic valve replacement (AVR) remains unknown. The objective of this multicenter study was to compare AVR with ARE to AVR for early and late mortality and secondary safety outcomes. MethodsClinical and administrative databases in Ontario, Canada, were linked to obtain patients undergoing AVR with or without ARE from 2008 to 2017. Baseline characteristics were compared and 1:1 propensity score matching was performed to account for differences in baseline characteristics. Early outcomes were compared in the matched groups. Late mortality was compared using Kaplan-Meier survival curves and a Cox-proportional hazard model. ResultsSixteen thousand six hundred fifty-six patients undergoing AVR in 11 Ontario institutions were reviewed. Patients who underwent ARE were younger, nonurgent, more likely to be men and had lower rates of hypertension, ischemic heart disease, and congestive heart failure. Propensity score matching yielded similar groups for comparison, with 809 pairs for AVR versus AVR with ARE. There was no difference in 30-day mortality between AVR with ARE versus AVR (2.0% vs 2.1%; P = 1.00). Rates of chest reopening for bleeding, permanent pacemaker implantation, and blood transfusions were similar. Late mortality over 8 years was similar between AVR with ARE and AVR (P = .45). In a sensitivity analysis, results were similar in 525 pairs comparing AVR with coronary artery bypass grafting and ARE to AVR with coronary artery bypass grafting, except that chest reopening for bleeding was higher with AVR with coronary artery bypass grafting and ARE (7.2% vs 3.2%; P = .006). ConclusionsThe addition of ARE to isolated AVR can be safely performed to increase implanted prosthesis size without compromising early mortality. Additional studies with longer follow-up are necessary.

Transarterial Infusion Chemotherapy with FOLFOX for Advanced Hepatocellular Carcinoma: A Multi-Center Propensity Score Matched Analysis of Real-World Practice

Background: To compare the treatment effectiveness and safety among transarterial infusion chemotherapy (TAI) with FOLFOX regimen, transarterial chemoembolization (TACE), and sorafenib in patients with BCLC stage C hepatocellular carcinoma (HCC). Methods: The data of consecutive patients with BCLC stage C HCC treated with TAI, TACE, or sorafenib from January 2015 to December 2018 at three centers were retrospectively analyzed. Propensity-score matched (PSM) analysis was pairwise performed (TAI vs. TACE and TAI vs. sorafenib) to reduce selection bias. Treatment effectiveness and safety were evaluated and compared using the Kaplan-Meier method, log-rank test, Cox regression models, and I‡2 test. Findings: The median overall survival (OS) in the matched TAI group was significantly longer than the sorafenib group (19*6 months vs. 7*5 months, p=0*009), and the TACE group (estimated 27*8 months vs. 6*6 months, p<0*001). The difference in median progression-free survival (PFS) between the matched TAI and sorafenib groups was not significant (5*8 months vs. 2*3 months, p=0*219). The median PFS in the matched TAI group was significantly longer than the TACE group (6*5 months vs. 2*8 months, p<0*001). The objective response rate (ORR) in the matched TAI group was significantly higher than the sorafenib group (36*4% vs. 0*0%, p<0*001) and the TACE group (48*7% vs. 4*7%, p<0*001). The incidences of adverse events (AEs) were similar among these three groups. Interpretation: TAI with FOLFOX regimen was an effective and safe therapy that improved survival of patients with BCLC stage C HCC. Funding Statement: This study was supported by the National Natural Science Foundation of China (No. 81871985); Natural Science Foundation of Guangdong Province (No. 2018A0303130098 and No. 2017A030310203); Medical Scientific Research Foundation of Guangdong Province (No. A2017477); Science and Technology Planning Project of Guangzhou (No. 201903010017 and No. 201904010479); Clinical Trials Project (5010 Project) of Sun Yat-sen University (No. 5010-2017009). Declaration of Interests: All authors declared no conflicts of interest. Ethics Approval Statement: This study was conducted according to the ethical guidelines of the 1975 Declaration of Helsinki, and it was reviewed and approved by the Institutional Review Board at the Sun Yat-sen University Cancer Center (No. B2018-126-01). Informed consent was obtained from each patient for the data to be used for research.

Real-life Performance of Edoxaban in Elderly Patients With Atrial Fibrillation: a Multicenter Propensity Score–Matched Cohort Study

PurposeThe purpose of the current study was to compare the efficacy and safety of edoxaban versus vitamin K antagonist (VKA) therapy among a cohort of elderly patients (ie, those aged ≥75 years) with atrial fibrillation (AF) in a real-life setting. MethodsA propensity score–matched cohort observational study was performed comparing the safety and efficacy of edoxaban versus VKA therapy among a cohort of elderly (aged ≥75 years) patients with AF in a real-life setting. Follow-up data were obtained through outpatient visits at 1, 3, and every 6 months. The primary safety outcome was major bleeding. The primary efficacy outcome was the composite of stroke, transient ischemic attack, and systemic embolism. FindingsA total of 130 patients receiving edoxaban 60 mg (EDO) treatment were compared with the same number of VKA recipients. The mean follow-up was 16 (2.6) months. The cumulative incidence of thromboembolic events in the EDO and VKA groups was 1.5% (2 of 130) and 2.3% (3 of 130), respectively (P < 0.6). The cumulative incidence of major bleeding events was 1.5% (2 of 130) in the EDO group and 3.1% (4 of 130) in the VKA group (P < 0.4). The total anticoagulant therapy discontinuation rate was 2.3% (3 of 130) in the EDO group and 4.6% (6 of 130) in the VKA group (P < 0.3). A nonsignificant trend in improved adherence was observed between the EDO and VKA groups (81% vs 78%; P = 0.6). ImplicationsEdoxaban therapy showed a good real-life performance among elderly patients (aged ≥75 years) with AF.

Comparative effectiveness of loop diuretics on mortality in the treatment of patients with chronic heart failure – A multicenter propensity score matched analysis

BackgroundLoop diuretics are given to the majority of patients with chronic heart failure (HF). Whether the different pharmacological properties of the three guideline-recommended loop diuretics result in differential effects on survival is unknown. Methods6293 patients with chronic HF using either bumetanide, furosemide or torasemide were identified in three European HF registries. Patients were individually matched on both the respective propensity scores for receipt of the individual drug and dose-equivalents thereof. ResultsDuring a follow-up of 35,038 patient-years, 652 (53.7%), 2179 (51.9%), and 268 (30.4%) patients died amongst those prescribed bumetanide, furosemide, and torasemide, respectively. In univariable analyses of the general sample, bumetanide and furosemide were both associated with higher mortality as compared with torasemide treatment (HR 1.50, 95% CI 1.31–1.73, p < 0.001, and HR 1.34, CI 1.18–1.52, p < 0.001, respectively). Mortality was higher in bumetanide users when compared to furosemide users (HR 1.11, 95% CI 1.02–1.20, p = 0.01). However, there was no significant association between loop diuretic choice and all-cause mortality in any of the matched samples (bumetanide vs. furosemide, HR 1.03, 95% CI 0.93–1.14, p = 0.53; bumetanide vs. torasemide, HR 0.98, 95% CI 0.78–1.24, p = 0.89; furosemide vs. torasemide, HR 1.02, 95% CI 0.84–1.24, p = 0.82). The results were confirmed in subgroup analyses with respect to age, sex, left ventricular ejection fraction, NYHA functional class, cause of HF, rhythm, and systolic blood pressure. ConclusionsIn patients with HF, mortality is not affected by the choice of individual loop diuretics.

Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study.

PurposeSurgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis.MethodsA prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix ‘p.’ Patient characteristics and surgical outcomes were compared.ResultsThe propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% vs. 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% vs. 13.7%, P = 0.067), a lower rate of wound infection (1.5% vs. 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days vs. 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS.ConclusionEIS can be a useful option for selected adult patients with complicated appendicitis.