Propensity-matched Cohort Analysis Research Articles

Poor Bone Mineral Density Is Associated With Increased Risk of Urological Bone Metastases

To investigate whether a diagnosis of precancer poor bone mineral density (PBMD) is associated with higher risk of urological cancer bone metastasis. The PearlDiver Database was utilized to conduct a retrospective, propensity-matched cohort analysis of adult patients diagnosed with kidney, bladder, prostate, and testicular cancer with and without a prior diagnosis of PBMD, defined as osteopenia or osteoporosis. Unadjusted and adjusted odds ratios (OR) and 95% confidence intervals are used to compare the rate of newly diagnosed bone metastases between 6months and 3years of the initial cancer diagnosis between the experimental and control cohorts. Among 685,066 patients with urological cancers, precancer PBMD was associated with increased odds of bone metastasis at various time periods (1week, 6months, 1, 2, and 3years). The strongest association was appreciated within 1week of cancer diagnosis (kidney: adjusted odds ratio [aOR], 2.37, P<.001; bladder: [aOR], 2.37, P<.001; prostate: [aOR], 2.84, P<.001; testicular: [aOR], 4.45, P<.001). Bisphosphonates were associated with reduced risk of kidney ([aOR], 0.46, P<.001), bladder ([aOR], 0.61, P<.001), and prostate ([aOR], 0.66, P<.001) cancer bone metastasis. Our findings suggest urology patients with PBMD may be predisposed to forming bone metastases as well as presenting with metastatic disease at time of cancer diagnosis. As such, further studies are needed to elucidate whether PBMD plays a role in bone tropism and whether bone health pertains to prolonging bone-free metastasis.

Early Outcomes of Muscle Flap Closures in Posterior Thoracolumbar Fusions: A Propensity-Matched Cohort Analysis

Plastic surgery closure with muscle flaps after complex spinal reconstruction has become increasingly common. Existing evidence for this practice consists of small, uncontrolled, single-center cohort studies. We aimed to compare 30-day postoperative wound-related complication rates between flap closure and traditional closure after posterior thoracolumbar fusions (PTLFs) for non-infectious, non-oncologic pathologies using a national database. We performed a propensity-matched analysis using the 2012-2020 National Surgical Quality Improvement Program dataset to compare 30-day outcomes between PTLFs with flap closure versus traditional closure. A total of 100,799 PTLFs met our inclusion criteria. The use of flap closure with PTLF remained low but more than doubled from 2012 to 2020 (0.38% vs. 0.97%; P= 0.002). A higher proportion of flap closures had higher American Society of Anesthesiologists classifications and higher number of operated spine levels (all P < 0.001). We included 1907 PTLFs (630 for flap closure; 1257 for traditional closure) in the propensity-matched cohort. Unadjusted 30-day wound complication rates were 1.7% for flap and 2.1% for traditional closure (P= 0.76). After adjusting for operative time, wound complication, readmission, reoperation, mortality, and non-wound complication were not associated flap use (all P > 0.05). Plastic surgery closure was performed in patients with a higher comorbidity burden, suggesting consultation in sicker patients. Although higher rates of wound and non-wound complications were expected for the flap cohort, our propensity-matched cohort analysis of flap closure in PTLFs resulted in non-inferior odds of wound complications compared to traditional closure. Further study is needed to assess long-term complications in prophylactic flap closure in complex spine surgeries.

Risk of Complications After Endoscopic Retrograde Cholangiopancreatography in Pregnancy: A Propensity-Matched Analysis.

Studies have suggested higher complication rates after endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy. We performed a propensity-matched cohort analysis to assess the risk of ERCP-related complications among pregnant women in the United States. The TriNetX database was analyzed to identify pregnant and non-pregnant females between 18 and 50years of age who underwent ERCP. One-to-one propensity score matching was performed for age and race. Outcomes included risk of post-ERCP pancreatitis (PEP), gastrointestinal (GI) bleeding, perforation within 7days, and infections within 30days of ERCP. Subgroup analysis was performed to assess the risk of PEP based on indication for ERCP. The risk of PEP was higher in the pregnant cohort compared to controls, 10.3% vs 6.08%, adjusted odds ratio (aOR) 1.77, 95% confidence interval (CI) 1.20-2.61; p = 0.003. We found no difference in the risk of GI bleeding, perforation, and infections between the two cohorts. There was no difference in the risk of PEP in the pregnant cohort compared to controls who underwent ERCP for acute choledocholithiasis (4.2% vs 2.1%, aOR 1.98, 95% CI 0.97-4.03, p = 0.5) or ascending cholangitis (18.6% vs 14.7%, aOR 1.32, 95% CI 0.52-3.39, p = 0.55). There was no difference in the risk of PEP in the pregnant cohort after sensitivity analysis based on age, race, obesity, and indomethacin use. Pregnant females are at an increased risk of PEP but not GI bleeding, perforation, and infections when compared to non-pregnant controls. Clinicians should be cautious when proceeding with ERCP during pregnancy.

Staged circumferential lumbar fusions have less intraoperative complications and shorter operative time with no difference in 30-, 90-, and 1-year complications: a propensity-matched cohort analysis of 190 patients

Background contextCircumferential lumbar fusions (cLFs) are becoming more common with increasing and more minimally invasive anterior access techniques. Staging allows reassessment of indirect decompression and alignment prior to the posterior approach, and optimization of OR time management. Safety of staging has been well documented in deformity surgery but has yet to be delineated in less extensive, degenerative cLFs. PurposeThe purpose of this study is to compare perioperative complications and outcomes between staged versus single-anesthetic circumferential fusions in the lumbar spine. Study designPropensity-matched comparative observational cohort. Patient samplePatients who underwent cLFs for lumbar degenerative disease. Outcome measuresIn-hospital, 30-day, 90-day, and 1-year complications. MethodsFrom 123 patients undergoing single-anesthetic and 154 patients undergoing staged cLF, 95 patients in each group were propensity-matched based on age, sex, BMI, ASA score, smoking, revision, and number of levels. We compared perioperative, 30-day, 90-day, and 1-year complications between the two cohorts. ResultsMean days between stages was 1.58. Single-anesthetic cLF had longer total surgery time (304 vs 240 minutes, p<.001) but shorter total PACU total time (133 vs 196 minutes, p<.001). However, there was no difference in total anesthesia time (368 vs 374 minutes, p=.661) and total EBL (357 vs 320cc, p=.313). Intraoperative complications were nine incidental durotomies in the single-anesthetic and one iliac vein injury in the staged group (9% vs 1%, p=.018). There was no difference of in-hospital (38 vs 31, p=.291), 30-day (16 vs 23, p=.281), 90-day (10 vs 15, p=.391), 1-year complications (9 vs 12, p=.644), and overall cumulative 1-year complications (54 vs 56, p=.883) between the two cohorts. ConclusionSThere is a decrease in total surgical time and intraoperative complications during staged compared with single-anesthetic cLF with no difference in in-hospital, 30-day, 90-day, and 1-year complications between approaches.

Comparison of Pneumonia and Major Complications After Total Joint Arthroplasty With Spinal Versus General Anesthesia: A Propensity-matched Cohort Analysis.

Spinal anesthesia (SA) allows total joint arthroplasty to be done while minimizing opioids and systemic anesthetic agents compared with general anesthesia (GA). SA has been associated with shortened postoperative recovery; however, the relationship between SA, major postoperative complications, and pneumonia (PNA) remains unclear. Patients in a large, national database who underwent total hip arthroplasty or total knee arthroplasty from 2010 to 2020 were identified. 1:1 propensity score matching was used to create matched groups of patients who underwent SA and GA. The groups were matched by age, sex, chronic obstructive pulmonary disease, smoking status, Charlson Comorbidity Index, and American Society of Anesthesiology (ASA) classification. 1:1 matching was also done among the ASA classifications as a subanalysis. Overall, equally matched groups of 217,267 patients who underwent SA versus GA were identified. 850 patients (0.39%) developed postoperative PNA after GA versus 544 patients (0.25%) after SA ( P < 0.001). The risk of major complications was 6,922 (3.2%) in the GA group and 5,401 (2.5%) in the SA group ( P < 0.001). Similarly, the risk of unplanned postoperative reintubation was higher (0.18% versus 0.10%, P < 0.001) and mortality was higher (0.14% versus 0.09%, P < 0.001) in the GA group than in the SA group. In ASA 1 to 3 patients, the risk of PNA was 0.08% to 0.21% higher with GA than with SA. In ASA 4 patients, the risk of PNA was 0.42% higher in SA than in GA (1.92% versus 1.5%, P < 0.001) and the mortality rate was nearly doubled in GA than in SA (1.46% versus 0.77%, P = 0.017). Overall, GA was associated with a small but markedly higher rate of major complications, mortality, and PNA than SA in patients undergoing total joint arthroplasty when matching for differences in comorbidities. ASA 4 patients experienced the greatest increase in absolute risk of mortality with GA versus SA.

Outcome After Intestinal Transplantation From Living Versus Deceased Donors: A Propensity-matched Cohort Analysis of the International Intestinal Transplant Registry.

To describe the worldwide experience with living donation (LD) in intestinal transplantation (ITx) and compare short-term and long-term outcomes to a propensity-matched cohort of deceased donors. ITx is a rare life-saving procedure for patients with complicated intestinal failure (IF). Living donation (LD)-ITx has been performed with success, but no direct comparison with deceased donation (DD) has been performed. The Intestinal Transplant Registry (ITR) was created in 1985 by the Intestinal Transplant Association to capture the worldwide activity and promote center's collaborations. Based on the ITR, 4156 ITx were performed between January 1987 and April 2019, of which 76 (1.8%) were LD, including 5 combined liver-ITx, 7 ITx-colon, and 64 isolated ITx. They were matched with 186 DD-ITx for recipient age/sex, weight, region, IF-cause, retransplant, pretransplant status, ABO compatibility, immunosuppression, and transplant date. Primary endpoints were acute rejection and 1-/5-year patient/graft survival. Most LDs were performed in North America (61%), followed by Asia (29%). The mean recipient age was: 22 years; body mass index: 19kg/m²; and female/male ratio: 1/1.4. Volvulus (N=17) and ischemia (N=17) were the most frequent IF-causes. Fifty-two percent of patients were at home at the time of transplant. One-/5-year patient survival for LD and DD was 74.2/49.8% versus 80.3/48.1%, respectively ( P =0.826). One-/5-year graft survival was 60.3/40.6% versus 69.2/36.1%, respectively ( P =0.956). Acute rejection was diagnosed in 47% of LD versus 51% of DD ( P =0.723). Worldwide, LD-ITx has been rarely performed. This retrospective matched ITR analysis revealed no difference in rejection and in patient/graft survival between LD and DD-ITx.

Fewer Worsening Heart Failure Events With HeartLogic on top of Standard Care: a Propensity-Matched Cohort Analysis

The implantable cardiac defibrillator-based HeartLogic algorithm aims to detect impending fluid retention in patients with heart failure (HF). Studies show that HeartLogic is safe to integrate into clinical practice. The current study investigates whether HeartLogic provides clinical benefit on top of standard care and device telemonitoring in patients with HF. A multicenter, retrospective, propensity-matched cohort analysis was performed in patients with HF and implantable cardiac defibrillators, and it compared HeartLogic to conventional telemonitoring. The primary endpoint was the number of worsening HF events. Hospitalizations and ambulatory visits due to HF were also evaluated. Propensity score matching yielded 127 pairs (median age 68 years, 80% male). Worsening HF events occurred more frequently in the control group (2; IQR 0-4) compared to the HeartLogic group (1; IQR 0-3; P = 0.004). The number of HF hospitalization days was higher in controls than in the HeartLogic group (8; IQR 5-12 vs 5; IQR 2-7; P = 0.023), and ambulatory visits for diuretic escalation were more frequent in the control group than in the HeartLogic group (2; IQR 0-3 vs 1; IQR 0-2; P = 0.0001). Integrating the HeartLogic algorithm in a well-equipped HF care path on top of standard care is associated with fewer worsening HF events and shorter duration of fluid retention-related hospitalizations.

MO-0468 Impact of gross vascular invasion on NSCLC outcomes: propensity matched cohort analysis

MO-0468 Impact of gross vascular invasion on NSCLC outcomes: propensity matched cohort analysis

D45. Early Outcomes of Muscle Flap Closures in Complex Spine Surgeries: A Propensity-matched Cohort Analysis

PURPOSE: Plastic surgery closure with muscle flaps after complex spinal reconstruction has become popular. Existing evidence for this practice consists of small, uncontrolled, single-center cohort studies. We aimed to compare 30-day postoperative wound-related complications between flap closure and traditional closure after posterior thoracolumbar fusions (PTLFs) for non-infectious pathologies using a national database. METHOD: We performed a propensity-matched analysis using the 2010-2020 NSQIP dataset. RESULTS: Of 117,756 PTLFs meeting inclusion criteria, a higher proportion of flap closures had ASA Class III/IV than traditional closures (65.4% vs. 54.1%; p<0.001). 1,520 PTLFs (760 in each group) were included in the propensity-matched cohort. Unadjusted 30-day wound complication rates were 3.0% for flap and 1.6% for traditional closure (p=0.09). Surgeries were longer with flap closure (p<0.001). After adjusting for operative time, flap closure was associated with lower wound complication odds (AOR, 0.98; p=0.041) and prolonged LOS (AOR, 1.05; p=0.001). Readmission, reoperation, home discharge, mortality, and non-wound complication were not associated with flap use. CONCLUSION: Plastic surgery closure was performed in patients with higher ASA classifications, suggesting consultation in sicker patients. Our propensity-matched cohort analysis of flap closure in PTLFs resulted in lower odds of wound complications than traditional closure. Sequelae of longer procedure time in flap closure may contribute to longer LOS. Further study is needed to assess long-term complications in prophylactic flap closure in complex spine surgeries.

Sequential oral antibiotic in uncomplicated Staphylococcus aureus bacteraemia: a propensity-matched cohort analysis

ObjectivesWe aimed to analyse the efficacy and safety of oral sequential therapy (OST) in uncomplicated Staphylococcus aureus bacteraemia (SAB). MethodsSingle-centre observational cohort at a tertiary hospital in Spain, including all patients with the first SAB episode from January 2015 to December 2020. We excluded patients with complicated SAB and those who died during the first week. Patients were classified into the OST group (patients who received oral therapy after initial intravenous antibiotic therapy [IVT]), and IVT group (patients who received exclusively IVT). We performed a propensity-score matching to balance baseline differences. The primary composite endpoint was 90-day mortality or microbiological failure. Secondary endpoints included 90-day SAB relapse. ResultsOut of 407 SAB first episodes, 230 (56.5%) were included. Of these, 112 (n = 48.7%) received OST and 118 (51.3%) IVT exclusively. Transition to oral therapy was performed after 7 days (interquartile range, 4–11).The primary endpoint occurred in 10.7% (11/112) in OST vs. 30.5% (36/118) in IVT (p < 0.001). SAB relapses occurred in 3.6% (4/112) vs. 1.7% (2/118) (p 0.436). None of the deaths in OST were related to SAB or its complications.After propensity-score matching, the primary endpoint was not more frequent in the OST group (relative risk, 0.42; 95% CI, 0.22–0.79). Ninety-day relapses occurred similarly in both groups (relative risk, 1.35; 95% CI, 0.75–2.39). DiscussionAfter an initial intravenous antibiotic, patients with uncomplicated SAB can safely be switched to oral antibiotics without apparent adverse outcomes. This strategy could save costs and complications of prolonged hospital stays. Prospective randomized studies are needed.

Activation of the HeartLogic algorithm on top of heart failure care: a multicenter propensity-matched cohort analysis

Abstract Background Hospitalization for decompensated heart failure may be prevented by early detection of fluid retention. The multisensory HeartLogic™ algorithm, incorporated in a cardiac implantable electronic device (CIED) aims to detect impending fluid retention and thereby enables timely adjustment of medical therapy. However, it is to be investigated whether HeartLogic™ provides clinical benefit compared to heart failure care with conventional telemonitoring. This analysis investigates the effects of activating HeartLogic™ on top of heart failure care with telemonitoring on the number of episodes with fluid retention and heart failure related hospitalizations. Methods Heart failure patients with a CIED were recruited from the outpatient clinics of four European cardiology departments. All patients were included from January 2017 until December 2020, and followed-up for 365 days. Patients with a CIED and an activated HeartLogic™ algorithm were compared to a 1:1 propensity score-based matched control group consisting of patients with CIED on routine telemonitoring. Data of all episodes of (impending) fluid retention with ≥2 signs and symptoms of congestion were included for analyses. Results Data of 127 patients with an activated HeartLogic™ algorithm were adequately matched with 127 heart failure patients with a CIED on routine telemonitoring. Median age was 68 [59–75], majority of patients were male (80%), 46% had an ischemic etiology of heart failure. Total follow-up consisted of 254 patient years. During follow up, 77 (61%) individual patients with HeartLogic™ experienced an episode of fluid retention, compared to 85 (67%) induvial patients on routine telemonitoring. Patients with an activated HeartLogic™ algorithm had 1.62±1.78 events of fluid retention per patient year (PPY) compared to 2.61±3.71 events PPY in patients on routine telemonitoring, p&amp;lt;0.01 (Figure 1). Hospitalization for fluid retention occurred in 7 (6%) HeartLogic™ patients (0.06±0.27 hospitalizations PPY) compared to 13 (10%) patients on routine telemonitoring (0.15±0.45 PPY), p=0.07 (Figure 2A). Mean length of hospitalization in days PPY was 0.29±1.46 in patients with HeartLogic™ and 1.59±6.30 in patients on routine telemonitoring, p=0.02 (Figure 2B). Conclusion In a real-world multicenter heart failure population, activation of the HeartLogic™ algorithm was associated with a lower number of episodes of fluid retention per patient and a shorter duration of hospitalization for congestive heart failure. Funding Acknowledgement Type of funding sources: None.

Risk factors for early reoperation in patients after posterior lumbar interbody fusion surgery. A propensity-matched cohort analysis

BackgroundReoperation is usually associated with poor results and increased morbidity and hospital costs. However, the rates, causes, and risk factors for reoperation in patients undergoing lumbar spinal fusion surgery remain controversial. This study aimed to identify the risk factors for early reoperation after posterior lumbar interbody fusion surgery and to compare the clinical outcomes between patients who underwent reoperation and those who did not. MethodsWe investigated a multicenter medical record database of 1263 patients who underwent posterior lumbar interbody fusion surgery between 2012 and 2015. A total of 72 (5.7%) reoperations within two years after surgery were identified and were propensity-matched for age, sex, number of fusion segments, and surgeon's experience. ResultsWe analyzed a total of 114 patients (57 who underwent reoperation (R group) and 57 who did not (C group)). The mean age was 62.6 ± 13.4 years, with 78 men and 36 women. The mean number of fused segments was 1.2 ± 0.5. Surgical site infection was the most common cause of reoperation. There were significant differences in the incidence of diabetes mellitus (p = 0.024), preoperative ambulation status (p = 0.046), and ASA grade (p < 0.001) between the C and R groups. The recovery rate of the Japanese Orthopaedic Association score was significantly lower in the R group compared to the C group (R: 50.5 ± 28.8%, C: 63.9 ± 33.7%, p = 0.024). There were significant differences in the bone fusion rate (R: 63.2%, C: 96.5%, p < 0.001) and incidence of screw loosening (R: 31.6%; C: 10.5%; p = 0.006). ConclusionDiabetes mellitus, preoperative ambulation status, and ASA grade were significant risk factors for early reoperation following posterior lumbar interbody fusion surgery. The patients who underwent early reoperation had worse clinical outcomes than those who did not.

Hospitalization and survival of solid organ transplant recipients with coronavirus disease 2019: A propensity matched cohort study.

Solid organ transplant (SOT) recipients are predicted to have worse COVID-19 outcomes due to their compromised immunity. However, this association remains uncertain because published studies have had small sample sizes and variability in chronic comorbidity adjustment. In this retrospective cohort study conducted at a multihospital health system, we compared COVID-19 outcomes and survival up to 60 days following hospital admission in SOT recipients taking baseline immunosuppressants versus hospitalized control patients. The study included 4,562 patients who were hospitalized with COVID-19 (108 SOT recipients and 4,454 controls) from 03/2020 to 08/2020. Mortality at 60 days was higher for SOT recipients (17% SOT vs 10% control; unadjusted odds ratio (OR) = 1.74, 95% confidence interval (CI) 1.04-2.91, P = 0.04). We then conducted a 1:5 propensity matched cohort analysis (100 SOT recipients; 500 controls) using age, sex, race, body mass index, hypertension, diabetes, chronic kidney disease, liver disease, admission month, and area deprivation index. Within 28 days of admission, SOT recipients had fewer hospital-free days (median; 17 SOT vs 21 control; OR = 0.64, 95%CI 0.46-0.90, P = 0.01) but had similar ICU-free days (OR = 1.20, 95%CI 0.72-2.00, P = 0.49) and ventilator-free days (OR = 0.91, 95%CI 0.53-1.57, P = 0.75). There was no statistically significant difference in 28-day mortality (9% SOT vs 12% control; OR = 0.76, 95%CI 0.36-1.57, P = 0.46) or 60-day mortality (16% SOT vs 14% control; OR = 1.15, 95%CI 0.64-2.08, P = 0.64). Hospitalized SOT recipients appear to need additional days of hospital care but can achieve short-term mortality outcomes from COVID-19 that are similar to non-SOT recipients in a propensity matched cohort study.

COVID-19 and Influenza Coinfection Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample.

This study aims to provide comparative data on clinical features and in-hospital outcomes among U.S. adults admitted to the hospital with COVID-19 and influenza infection using a nationwide inpatient sample (N.I.S.) data 2020. Data were collected on patient characteristics and in-hospital outcomes, including patient's age, race, sex, insurance status, median income, length of stay, mortality, hospitalization cost, comorbidities, mechanical ventilation, and vasopressor support. Additional analysis was performed using propensity matching. In propensity-matched cohort analysis, influenza-positive (and COVID-positive) patients had higher mean hospitalization cost (USD 129,742 vs. USD 68,878, p = 0.04) and total length of stay (9.9 days vs. 8.2 days, p = 0.01), higher odds of needing mechanical ventilation (OR 2.01, 95% CI 1.19-3.39), and higher in-hospital mortality (OR 2.09, 95% CI 1.03-4.24) relative to the COVID-positive and influenza-negative cohort. In conclusion, COVID-positive and influenza-negative patients had lower hospital charges, shorter hospital stays, and overall lower mortality, thereby supporting the use of the influenza vaccine in COVID-positive patients.

Race-related differences in the economic, healthcare-access, and psychological impact of COVID-19: personal resources associated with resilience

BackgroundThe impact of the coronavirus disease 2019 (COVID) is worse among those with fewer financial resources, in jobs not amenable to remote work, and in denser living conditions. People of color are more likely to be among these vulnerable groups. Although race itself is a social construction and not based on underlying genetic/biological differences, this study investigated race/ethnicity differences in the negative repercussions of COVID and in the benefits of psychological and social resources.MethodsThis cross-sectional, web-based study (n = 4817) was administered to a heterogeneous United States sample in Spring/Summer 2020. Information was gathered on the following COVID-specific variables: Infection Status, Coping with Lockdown, Social Support, Post-traumatic Growth, Interpersonal Conflict, Worry about Self, Financial Impact on Family, Lack of Money, Inadequate Access to Healthcare, and Housing Instability. Resilience was operationalized as the ability to maintain a sense of wellness in the face of the pandemic, using the DeltaQuest Wellness measure. Multivariate linear regression (adjusting for demographics) and propensity-matched cohort analysis (matched on demographics) evaluated the impact of COVID-specific variables on Wellness in separate models for Whites and Non-Whites.FindingsBoth sets of models retained the same COVID-specific variables and explained about half of the variance in wellness. Coping with Lockdown, Social Support, and Post-traumatic Growth were associated with higher levels of Wellness in both Whites and Non-Whites, while Interpersonal Conflict and Worry about Self were associated with lower levels of Wellness. While these associations are similar, Non-Whites reported worse levels of some positive resources (e.g., social support) and more challenging levels of negative stressors (e.g., interpersonal, worry, financial). Non-Whites also reported much higher levels of post-traumatic growth.ConclusionCOVID was a source of worry and even conflict, but also unlocked people’s resources in use of health-enhancing behavioral strategies, social support, and renewed gratitude for sources of personal meaning and value. The similar relationships between Whites and Non-Whites on wellness and COVID-specific stressors across racial groups underscore that race is a social construction, not a biological fact. Focusing on a renewed appreciation for sources of personal meaning, and particularly faith, seemed to buffer much of the COVID-related stress for Non-Whites.

Highly versus less bioavailable oral antibiotics in the treatment of gram-negative bloodstream infections: a propensity-matched cohort analysis

ObjectivesIn this study, we evaluated the clinical outcomes associated with the use of highly bioavailable oral antibiotics (fluoroquinolones and trimethoprim-sulfamethoxazole) compared with the less-bioavailable oral antibiotics (β-lactams) in gram-negative bloodstream infections (BSIs). MethodsAmong hospitalized older adult patients in Ontario, Canada, discharged home on oral treatment for gram-negative BSI between 1 January 2017 and 31 December 2019, we used a matched cohort design to compare outcomes among those receiving highly versus less-bioavailable agents; hard-matching 1:1 on sex, BSI pathogen (Escherichia coli vs. non–E. coli), and infection source (urinary vs. non-urinary/unknown source) along with a propensity score, incorporating specific pathogen, patient, and infection characteristics. The primary outcome was the composite of 90-day all-cause mortality, recurrent BSI with the same pathogen (genus and species), and re-admission to any Ontario hospital. ResultsA total of 2012 patients were included in the study (1006 in each bioavailability category). Those who received highly (compared with less) bioavailable antibiotics at discharge had lower rates of the composite outcome (171/1006 [17.0%] vs. 216/1006 [21.5%]), adjusted odds ratio being 0.74 (95% CI, 0.60–0.92). Recurrent BSI at 90 days was the main driver for the composite outcome occurring in 64 (5.4%) and 107 (9.4%) patients of the highly and less-bioavailable groups, respectively (p < 0.001) (adjusted odds ratio, 0.56; 95% CI, 0.40–0.78). DiscussionUse of highly (compared with less) bioavailable antibiotics at discharge was associated with significantly better clinical outcomes among patients with gram-negative BSIs.

Activation of the HeartLogic algorithm on top of heart failure care: a multicenter propensity-matched cohort analysis

Abstract Background Hospitalization for decompensated heart failure may be prevented by early detection of fluid retention. The multisensory HeartLogic™ algorithm, incorporated in a cardiac implantable electronic device (CIED) aims to detect impending fluid retention and thereby enables timely adjustment of medical therapy. However, it is to be investigated whether HeartLogic™ provides clinical benefit compared to heart failure care with conventional telemonitoring. This analysis investigates the effects of activating HeartLogic™ on top of heart failure care with telemonitoring on the number of episodes with fluid retention and heart failure related hospitalizations. Methods Heart failure patients with a CIED were recruited from the outpatient clinics of four European cardiology departments. All patients were included from January 2017 until December 2020, and followed-up for 365 days. Patients with a CIED and an activated HeartLogic™ algorithm were compared to a 1:1 propensity score-based matched control group consisting of patients with CIED on routine telemonitoring. Data of all episodes of (impending) fluid retention with ≥2 signs and symptoms of congestion were included for analyses. Results Data of 127 patients with an activated HeartLogic™ algorithm were adequately matched with 127 heart failure patients with a CIED on routine telemonitoring. Median age was 68 [59–75], majority of patients were male (80%), 46% had an ischemic etiology of heart failure. Total follow-up consisted of 254 patient years. During follow up, 77 (61%) individual patients with HeartLogic™ experienced an episode of fluid retention, compared to 85 (67%) induvial patients on routine telemonitoring. Patients with an activated HeartLogic™ algorithm had 1.62±1.78 events of fluid retention per patient year (PPY) compared to 2.61±3.71 events PPY in patients on routine telemonitoring, p&amp;lt;0.01 (Figure 1). Hospitalization for fluid retention occurred in 7 (6%) HeartLogic™ patients (0.06±0.27 hospitalizations PPY) compared to 13 (10%) patients on routine telemonitoring (0.15±0.45 PPY), p=0.07 (Figure 2A). Mean length of hospitalization in days PPY was 0.29±1.46 in patients with HeartLogic™ and 1.59±6.30 in patients on routine telemonitoring, p=0.02 (Figure 2B). Conclusion In a real-world multicenter heart failure population, activation of the HeartLogic™ algorithm was associated with a lower number of episodes of fluid retention per patient and a shorter duration of hospitalization for congestive heart failure. Funding Acknowledgement Type of funding sources: None.

S57 Opioid Use Patterns in Patients With Chronic Pancreatitis and Concomitant Mental Illness: A Propensity-Matched Cohort Analysis

Introduction: Chronic pancreatitis (CP) is commonly associated with pain that can be difficult to manage. This can result in high rates of healthcare utilization and chronic opioid use. Many patients with CP have concomitant mental health disorders (MHDs) which may be associated with greater disease burden. Genetic links between CP-associated pain and MHDs have been described. Given the current opioid epidemic trend, it is critical to assess whether concomitant MHDs affect opioid usage patterns in patients with CP. The aim of this study was to identify whether patients with coexisting CP and mental illness have higher opioid usage compared to their counterparts without any diagnosed mental illness. Methods: This was a large cohort study using TriNetX, which links anonymized inpatient and outpatient electronic health record data from more than 80,000,000 patients. We created two cohorts: patients with chronic pancreatitis from 2010-2020 with and without co-existing mental health disorders. The cohorts underwent 1:1 propensity matching based on age, sex, race, ethnicity, and alcohol and nicotine dependence. The primary outcome was a new diagnosis of opioid use disorder at 3 years after the first diagnosis of CP. Secondary outcomes at 3 years included any opioid use, long-term opioid use, opioid overdose, and all-cause mortality. Results: After matching, two cohorts of 48,960 patients remained for analysis. All covariates were well-matched. In the MHD cohort, 51.6% had mood /affective disorders (F30-39), 49.5% had anxiety (F40-48), and 5.9% had non-mood psychotic (F20-29). At 3 years, the MHD cohort had a near 5-fold increase in the rate of opioid use disorder (7.1% vs 1.6%, OR =4.8, 95% CI 4.4-5.2). The MHD cohort also had significantly higher rates of any opiate use,(OR 1.5, 95% CI 1.4-1.5), long-term opioid use (OR 2.2, 95% CI 2.1-2.3), opioid overdose (OR 4.2, 95% CI 3.7-4.6), and all-cause mortality (OR 1.3, 95% CI 1.2-1.3) (Table). Conclusion: In propensity-matched cohorts, patients with CP and concomitant MHDs had higher rates of opioid use disorder, long-term use, overdose, and all-cause mortality compared with those without MHDs. As CP-related pain has been shown to be augmented in patients with MHDs – specifically depression – identifying this opioid risk is critical in the management of these patients. Table 1. - Measures of Association. CP w/ MHD: chronic pancreatitis with mental health disorder cohort, CP w/o MHD: chronic pancreatitis without mental health disorder cohort Outcome Patients with outcome (% risk), CP w/ MHD Patients with outcome (% risk), CP w/o MHD Odds Ratio (OR) 95% Confidence Interval (CI) p-value Opioid use disorder (dependence or abuse) 3,467 (7.1%) 767 (1.6%) 4.8 4.4-5.2 < 0.0001 Opiate use (ever) 13,846 (28.3%) 10,310 (21.1%) 1.5 1.4-1.5 < 0.0001 Adverse opiate event 592 (1.2%) 158 (0.3%) 3.8 1.4-1.5 < 0.0001 Opiate overdose 1,809 (3.7%) 448 (0.9%) 4.2 3.7-4.6 < 0.0001 Long-term opiate analgesic use 9,896 (20.2%) 5,046 (10.3%) 2.2 2.1-2.3 < 0.0001 All-cause mortality 6,958 (14.4%) 5,702 (11.8%) 1.3 1.2-1.3 < 0.0001

Mechanical thrombectomy in ischemic stroke after cardiovascular procedures: a propensity-matched cohort analysis

BackgroundStroke after a cardiovascular procedure (CVP) is a devastating complication adversely affecting outcome. Mechanical thrombectomy (MT) has not been investigated systematically in this population.ObjectiveTo carry out a retrospective study in...

Evaluation of Demographics and Management of Rectal Cancer by Age Group: A Retrospective Propensity Matched Cohort Analysis of the National Cancer Database

BackgroundData suggests there are demographic and biological differences in colon cancer between young and typical-onset patients. However, it is unclear if these differences persist in rectal cancer patients, exclusive of colon cancer. This is a retrospective review of a large national database to evaluate age-based differences in demographics, tumor features, and treatment among patients with rectal adenocarcinoma.MethodsThe National Cancer Database from 2004-2014 was queried for rectal adenocarcinoma. Patients were grouped by age at diagnosis: early-onset, defined as <40 years, mid-onset 40-49, and late-onset ≥50. Propensity matching controlled for demographic variation among cohorts. Pairwise Chi-square with Bonferroni correction was used for analysis.ResultsThirty thousand nine hundred seventy-eight patients were included: 1,249 (4%) early-onset, 4,156 (13%) middle-onset, and 25,573 (83%) late-onset. Significant differences existed between all three cohorts in nearly all demographic and pathologic metrics. Control for demographic variation revealed early-onset and middle-onset cohorts differed only with respect to the stage at presentation, while early-onset and late-onset cohorts differed more significantly on the basis of stage, histology, and oncologic management.ConclusionThe demographic differences observed demonstrate that patients under 50 should not be considered one cohort. Propensity matching led to a decrease in tumor trait differences among cohorts, suggesting that demographics other than age drive variation in tumor biology. Young patients received more aggressive management, implying the presence of an age bias. Age-based screening is likely insufficient and may exclude the rising proportion of young patients at risk for disease, while age-based management may lead to under- or overtreatment of patients at either end of the age spectrum.