Propensity Score-matched Comparison Research Articles

Personality trait development across the transition to retirement.

In this study, we examined trajectories of Big Five personality development in the 5 years before and after retirement. Our sample was composed of 690 retirees (ages 51-81) and a propensity-score matched comparison group of 532 nonretirees drawn from a nationally representative longitudinal study of the Netherlands. Participants contributed data across a maximum of 6 measurement waves over a period of 7 years. In the month after retirement, participants experienced sudden increases in openness and agreeableness followed by gradual declines in these traits over the next 5 years. Emotional stability increased before and after retirement. The transition to retirement was not associated with changes in conscientiousness or extraversion. Further, we found significant individual differences in development across the transition to retirement for each personality trait but could not identify any moderators that accounted for these individual differences. These results contribute to our understanding of personality development in older adulthood as well as the temporal dynamics of personality change in response to major life events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Efficacy analysis of Da Vinci robotic and laparoscopic distal gastrectomy for gastric cancer using propensity score matching

Objective To investigate the clinical efficacy of Da Vinci robotic and laparoscopic distal gastrectomy for gastric cancer. Methods The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 171 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanchang University from January 2015 to October 2016 were collected. There were 110 males and 61 females, aged from 38 to 81 years, with a median age of 57 years. Of 171 patients, 70 undergoing Da Vinci robotic distal gastrectomy for gastric cancer and 101 undergoing laparoscopic distal gastrectomy were allocated into the robotic group and laparoscopic group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after the propensity score matching; (2) intraoperative and postoperative situations; (3) situations of pathological examination; (4) follow-up. Patients were followed up by outpatient examination and telephone interview to detect severe complications and survival after discharge up to October 2018. The overall survival time was from the operation data to end of follow-up or time of death. The propensity score matching was used to perform 1∶1 matching by Empower Stats. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute number, and comparison between groups was analyzed using the chi-square test and comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) The propensity score matching conditions and comparison of general data between the two groups after the propensity score matching: 124 of 171 patients had successful matching, including 62 in each group. The body mass index (BMI) and tumor diameter before matching were (24.2±2.4)kg/m2 and (50±13)mm in the robotic group, (25.1±2.1)kg/m2 and (45±14)mm in the laparoscopic group, showing statistically significant differences between the two groups (t=-2.676, 2.045, P 0.05). (2) Intraoperative and postoperative situations: the total operation time, volume of intraoperative blood loss, level of C-reactive protein at day 1 postoperatively, level of C-reactive protein at day 3 postoperatively, volume of totally abdominal drainage were (147±13)minutes, (115±12)mL, (52.2±7.2)mg/L, (33.7±11.9)mg/L, 353.5 mL (range, 267.0-1 350.0 mL) in the robotic group, and (140±12)minutes, (131±12)mL, (58.2±7.4)mg/L, (41.1±16.9)mg/L, 397.0 mL (range, 255.0-1 600.0 mL) in the laparoscopic group, respectively, showing statistically significant differences in the above indexes between the two groups (t=3.163, -7.814, -4.631, -2.840, Z=-4.351, P 0.05). Conclusions Compared with laparoscopic surgery, Da Vinci robotic distal gastrectomy for gastric cancer has advantages in postoperative recovery and minimally invasion. There are similar 2-year overall survival rates in the two groups. Key words: Gastric neoplasms; Gastric cancer; Da Vinci robotic surgery system; Laparoscopy; Propensity score matching; Clinical efficacy

Is the model “loans‐plus‐savings” better for microfinance in Eastern Europe and Central Asia? A propensity score matching comparison

AbstractMicrofinance institutions are gradually evolving into multiservice organizations offering not only loans but also savings, and other financial and nonfinancial services. We contribute to the literature aimed at identifying how combining credit with savings affects outreach and sustainability in microfinance institutions (MFIs). We apply the propensity score matching method as well as its augmented dose–response version to compare the performance of loans‐plus‐savings MFIs with that of lending‐only in a sample of 710 observations from Eastern Europe and Central Asia. Owing to our unique capital structure data, we control for the use of subsidized capital, which related work ignores while existing evidence points to tradeoffs between subsidies and savings. We find that financial performance and breadth of outreach are positively associated with savings mobilization, while the evidence on depth of outreach points to a possible mission drift.

PT364 - Propensity-score matched comparison of oncologic and functional outcomes between radical nephroureterectomy and segmental ureterectomy

PT364 - Propensity-score matched comparison of oncologic and functional outcomes between radical nephroureterectomy and segmental ureterectomy

Palmar Warming for Radial Artery Vasodilation to Facilitate Transradial Access: A Randomized Controlled Trial

PurposeTo investigate the efficacy of palmar warming to induce radial artery vasodilation. Materials and MethodsAfter informed consent was obtained, healthy volunteers (n = 45) were randomized 2:1 in palmar warming and control groups, respectively, for this prospective, randomized, single-blind clinical trial (NCT03620383). The palmar warming group was given a warm, commercially available, air-activated heat pack (Kobayashi Consumer Products LLC, Dalton, Georgia) to hold in the left hand for palmar warming. The control group was given a deactivated version of the same heat pack. Left radial artery cross-sectional area (CSA) measurements were obtained at baseline and in 5-minute intervals up to 20 minutes in both groups. Differences in the trends of changes in the radial artery CSA between palmar warming and control groups were examined with the age- and sex-adjusted repeated measure analysis of variance. Propensity score-matched treatment effect analysis was conducted to quantify the effect of heat on radial artery CSA. ResultsThe palmar warming group and the control group were significantly different in terms of subject sex (males/females: 7/23 and 10/5, respectively; P = .005) and baseline CSA (2.5±0.2 mm2 vs 3.2±0.3 mm2, respectively; P = .014). Radial artery CSA showed an increasing trend over time in the palmar warming group compared to a stable trend over time in the control group (P < .0001). Propensity score-matched comparison showed a 43.9% increase (95% confidence interval: 34.1%–53.8%) in CSA in the palmar warming group compared to the control group (P < .0001). ConclusionsThe palmar warming technique is effective at dilating the radial artery and may be a beneficial technique to facilitate transradial access.

Elective Total Shoulder Arthroplasty in Octogenarians: A Safe Procedure.

There has been a lack of studies investigating the perioperative course of total shoulder arthroplasty (TSA) performed in the increasingly octogenarian (≥80 years old) population in a large sample size. The purpose of this study was to compare perioperative complications between primary TSA performed in octogenarians and that performed in younger populations (<70 and 70 to 79 years old) from the National Surgical Quality Improvement Program database. Patients who underwent primary TSA between January 2005 and December 2015 were identified from the National Surgical Quality Improvement Program database and stratified into three age groups: <70, 70 to 79, and ≥80 years old. Patient characteristics and comorbidities were compared between the three groups. Propensity score-matched comparisons were then performed for length of hospital stay, 30-day perioperative complications, and readmissions. Risk factors and reasons for readmission in the octogenarians were characterized. This study included 3,007 patients who were <70 years old, 2,155 patients who were 70 to 79 years old, and 900 octogenarian patients. Statistical analysis was carried out after matching for propensity score. While no significant differences in perioperative complications were observed between the octogenarians and 70- to 79-year-olds, significantly higher rates of readmission (4.2% versus 1.7%; P = 0.002), pneumonia (1.1% versus 0.0%; P = 0.002), and urinary tract infection (1.8% versus 0.2%; P = 0.001) were found in the octogenarians compared with <70-year-olds. In addition, the octogenarians also had a slightly longer length of hospital stay compared with the younger populations (0.6 days longer than <70-year-olds and 0.4 days longer than 70- to 79-year-olds; both P < 0.001). These data suggest that primary TSA can safely be considered for octogenarians with only mildly increased morbidities. However, greater preoperative optimization or post-discharge care for octogenarians may be warranted to reduce the rates of readmission.

Clopidogrel versus Ticagrelor for Secondary Prevention after Coronary Artery Bypass Grafting

We sought to evaluate the outcomes of postoperative three-month dual antiplatelet therapy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) following off-pump coronary artery bypass grafting (OPCAB) with exclusively arterial grafts. Between 2013–2016, dual antiplatelet therapy (DAPT) with either aspirin + clopidogrel (ASA + CPD group, n = 100) or aspirin + ticagrelor (ASA + TCG group, n = 169) was prescribed postoperatively in 269 NSTE-ACS patients after total arterial OPCAB. Patients with indications for other oral anticoagulants were excluded from the study. Three-month DAPT was completed in 259 patients (96%); ASA + CPD group (n = 94) vs. ASA + TCG group (n = 165). A one-to-one propensity score matching was performed. Unadjusted comparison between the groups showed no significant difference in overall survival (P = 0.253) and composite outcome of major adverse cerebrovascular and cardiovascular event (MACCE) and major bleeding (P = 0.276). The rate of freedom from composite outcome at one year in the ASA + CPD and ASA + TCG groups was 91 ± 3% and 93 ± 2%, respectively. In multivariable analysis, being in the ASA + TCG group did not increase the risk of the composite outcome of MACCE and major bleeding (P = 0.972, hazard ratio: 1.0, 95% confidence interval: 0.4–2.3). Propensity score-matched comparison (76 pairs) showed no significant difference in the overall survival (P = 0.423) and composite outcome between the groups (P = 0.442). In the setting of exclusive arterial grafting, post-OPCAB three-month DAPT showed acceptable outcomes in patients with NSTE-ACS. There was no significant difference in overall survival or composite outcome of MACCE and major bleeding between the ASA + CPD and ASA + TCG groups.

Inflammatory bowel disease and bipolar disorder: A population-based cross-sectional study

BackgroundTo date, some experimental studies showed that inflammatory bowel disease (IBD) and bipolar disorder (BD) may share similar biological pathways. Nevertheless, only a few western studies have attempted to demonstrate the potential association between IBD and BD, and relevant findings are still conflicting. Therefore, this cross-sectional study aimed to evaluate the relationship between IBD and BD using a nationwide database in Taiwan. MethodThis study used data from the National Health Insurance Research Database. In total, 3590 patients with IBD and 14,360 propensity score-matched comparison patients without IBD were included in this study. Conditional logistic regressions were performed to evaluate the association between BD and IBD. ResultsResults showed that BD was found in 26 (0.72%) patients with IBD and in 49 (0.34%) matched comparison patients without IBD. After adjustment, the adjusted odds ratio (OR) of BD for IBD patients was 2.10 (95% confidence interval (CI): 1.30∼3.38) compared to the comparison group. Additionally, this study showed that adjusted OR of BD for ulcerative colitis patients were 2.23 (95% CI: 1.31∼3.82) compared to the comparison group. Limitationswe could not precisely determine the causal association between BD and IBD. ConclusionsWe concluded that patients with IBD were more likely to have BD than those comparison patients without IBD.

Three-Year Nationwide Experience with Transanal Total Mesorectal Excision for Rectal Cancer in the Netherlands: A Propensity Score-Matched Comparison with Conventional Laparoscopic Total Mesorectal Excision

Transanal total mesorectal excision (TaTME) is a relatively new and demanding technique for rectal cancer treatment. Results from national datasets are absent and comparative data with laparoscopic TME (lapTME) are scarce. Therefore, this study aimed to evaluate the initial TaTME experience in the Netherlands, by comparing outcomes with conventional lapTME. Patients with rectal cancer who underwent curative TaTME or lapTME were selected from the nationwide and mandatory Dutch ColoRectal Audit (DCRA), between January 2015 and December 2017. Primary outcome was circumferential resection margin (CRM) involvement. Secondary outcomes included operative details and short-term (<30 days) clinical course. Propensity score matching was performed for 7 factors. There were 3,777 patients included for analysis (TaTME, n= 416, lapTME, n= 3361). Transanal TME was performed in 38 hospitals and lapTME in 90 hospitals. Before matching, the patient category within the TaTME group was technically more challenging in terms of tumor height and preoperative threatened margins. After 1:1 matching, 396 patients were included in each group, with comparable baseline characteristics. Circumferential resection margin involvement was 4.3% after TaTME and 4.0% after lapTME (p= 1.000). Conversion rate was significantly lower in TaTME (1.5% vs 8.6%, p < 0.001). Anastomotic leak rate was not significantly different (16.5% vs 12.2%, p= 0.116). Other postoperative outcomes were also comparable between the groups. Significant independent risk factors for CRM involvement in TaTME were preoperative threatened margin on MRI (odds ratio [OR] 5.48, 95% CI 1.33 to 22.54) and conversion (OR 30.12, 95% CI 3.70 to 245.20). This first nationwide study shows early experience with adoption of TaTME in the Netherlands. Considering that current data represent initial TaTME experience, acceptable short-term outcomes were demonstrated when compared with the well-established lapTME.

Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients

BackgroundFor comparison of laparoscopic IPOM versus sublay technique for elective incisional hernia repair, the number of cases included in randomized controlled trials and meta-analyses is limited. Therefore, an urgent need for more comparative data persists.MethodsIn total, 9907 patients with an elective incisional hernia repair and 1-year follow-up were selected from the Herniamed Hernia Registry between September 1, 2009 and June 1, 2016. Using propensity score matching, 3965 (96.5%) matched pairs from 4110 laparoscopic IPOM and 5797 sublay operations were formed for comparison of the techniques.ResultsComparison of laparoscopic IPOM versus open sublay revealed disadvantages for the sublay operation regarding postoperative surgical complications (3.4% vs. 10.5%; p < 0.001), complication-related reoperations (1.5% vs. 4.7%; p < 0.001), and postoperative general complications (2.5% vs. 3.7%; p = 0.004). The majority of surgical postoperative complications were surgical site infection, seroma, and bleeding. Laparoscopic IPOM had disadvantages in terms of intraoperative complications (2.3% vs. 1.3%; p < 0.001), mainly bleeding, bowel, and other organ injuries. No significant differences in the recurrence and pain rates at 1-year follow-up were observed.ConclusionLaparoscopic IPOM was found to have advantages over the open sublay technique regarding the rates of both surgical and general postoperative complications as well as complication-related reoperations, but disadvantages regarding the rate of intraoperative complications.

Recent advances in thoracoscopic esophagectomy for esophageal cancer.

Technical advances and developments in endoscopic equipment and thoracoscopic surgery have increased the popularity of minimally invasive esophagectomy (MIE). However, there is currently no established scientific evidence supporting the use of MIE as an alternative to open esophagectomy (OE). To date, a number of single-institution studies and several meta-analyses have demonstrated acceptable short-term outcomes of thoracoscopic esophagectomy for esophageal cancer, and we recently reported one of the largest propensity score-matched comparison studies between MIE and OE for esophageal cancer, based on a nationwide Japanese database. We found that, in general, MIE had a longer operative time and less blood loss than OE. Moreover, compared to OE, MIE was associated with a lower rate of pulmonary complications such as pneumonia, and both methods had similar mortality rates. Although MIE may reduce the occurrence of postoperative respiratory complications, MIE and OE seem to have comparable short-term outcomes. However, the oncological benefit to patients undergoing MIE remains to be scientifically proven, as no randomized controlled trials have been conducted to verify each method's impact on the long-term survival of cancer patients. An ongoing randomized phase III study (JCOG1409) is expected to determine the impact of each method with regard to short- and long-term outcomes.

Revolutionizing Estimation and Inference for Program Evaluation Using Bayesian Methods.

Policy makers seek to replace the "thumbs up-thumbs down" of conventional hypothesis testing with statements about the probability that program effects on key outcomes exceed policy-relevant thresholds. We develop a Bayesian model that addresses the shortcomings of a typical frequentist approach to estimating the effects of the Comprehensive Primary Care (CPC) initiative, a Centers for Medicare and Medicaid Services demonstration. We compare findings from the two approaches to illustrate the relative merits of introducing additional assumptions through Bayesian methods. We apply Bayesian and frequentist methods to estimate the effects of CPC on total Medicare expenditures per beneficiary per month for Medicare beneficiaries attributed to participating practices. Under both paradigms, we estimated program effects using difference-in-differences regressions comparing the change in Medicare expenditures between baseline and follow-up for Medicare patients attributed to 497 primary care practices participating in CPC to Medicare patients attributed to 908 propensity score-matched comparison practices. Results from the Bayesian and frequentist models are comparable for the overall sample, but in regional subsamples, the Bayesian model produces more precise etimates that exhibit less variation over time. The Bayesian results also permit probabilistic inference about the magnitudes of effects, offering policy makers the ability to draw conclusions about practically meaningful thresholds. Carefully developed Bayesian models can enhance precision and plausibility and offer a more nuanced understanding of where and when program effects occur, without imposing undue assumptions. At the same time, these methods frame conclusions in flexible, intuitive terms that respond directly to policy makers' needs.

Outcome of laparoscopic paraesophageal hernia repair in octogenarians: a registry-based, propensity score-matched comparison of 360 patients

BackgroundParaesophageal hernias (PEH) tend to occur in elderly patients and the assumed higher morbidity of PEH repair may dissuade clinicians from seeking a surgical solution. On the other hand, the mortality rate for emergency repairs shows a sevenfold increase compared to elective repairs. This analysis evaluates the complication rates after elective PEH repair in patients 80 years and older in comparison with younger patients.MethodsIn total, 3209 patients with PEH were recorded in the Herniamed Registry between September 1, 2009 and January 5, 2018. Using propensity score matching, 360 matched pairs were formed for comparative analysis of general, intraoperative, and postoperative complication rates in both groups.ResultsOur analysis revealed a disadvantage in general complications (6.7% vs. 14.2%; p = 0.002) for patients ≥ 80 years old. No significant differences were found between the two groups for intraoperative (4.7% vs. 5.8%, p = 0.627) and postoperative complications (2.2% vs. 2.8%, p = 0.815) or for complication-related reoperations (1.7% vs. 2.2%, p = 0.791).ConclusionsDespite a higher risk of general complications, PEH repair in octogenarians is not in itself associated with increased rates of intraoperative and postoperative complications or associated reoperations. Therefore, PEH repair can be safely offered to elderly patients with symptomatic PEH, if general medical risk factors are controlled.

Propensity score-matched comparison of short-term and long-term outcomes between endoscopic submucosal dissection and surgery for treatment of early gastric cancer in a Western setting.

Endoscopic submucosal dissection (ESD) is a standard treatment option for early gastric cancer (EGC) in Asia; however, data about ESD efficacy in Western populations are limited. Furthermore, outcomes of EGC treatment after ESD or surgery have not been compared in Western cohorts. This study aimed to compare short-term and long-term results of ESD and surgery for EGC. This retrospective case-control study included patients with EGC treated in two largest cancer centers in Eastern Lithuania between 2005 and 2016. Propensity score nearest-neighbor 1:1 matching, based on clinicopathologic characteristics, was performed between patients who underwent ESD and surgery. The primary endpoint of the study was 5-year disease-free survival (DFS). Of 260 eligible patients, 42 (16.1%) underwent ESD. After matching, two well-balanced groups consisting of 42 patients in each were analyzed. The operation time (83 vs. 151min., p = 0.001) and postoperative hospitalization stay (5.4 vs. 13.4 days, p = 0.001) was significantly shorter in the ESD group. 5-year DFS rate was significantly higher in the surgery group (97.6% vs. 77.5%, p = 0.002). However, this difference was reduced after exclusion of non-curative ESD cases (97.6% vs. 89.7%, p = 0.099). There was no significant difference in 5-year OS rate between the study groups (73.8% vs. 69.0%, p = 0.599). ESD might be an excellent alternative to surgery for EGC if curative resection is achieved. Non-curative ESD is associated with poor DFS and high rate of recurrence. Additional surgery should be recommended after non-curative ESD whenever treatment-associated risk is acceptable.

Comparing Risperidone and Olanzapine to Tetrabenazine for the Management of Chorea in Huntington Disease: An Analysis from the Enroll-HD Database.

Huntington's chorea (HC) is commonly managed with neuroleptic medications, though there is little evidence to support their use. This study aimed to perform a real-world comparison of the efficacy of risperidone and olanzapine to tetrabenazine (TBZ) for HC. The Enroll-HD database was used to perform a propensity score-matched comparison of risperidone and olanzapine to TBZ, regarding their efficacy in controlling chorea. Participants with motor manifest Huntington's disease (HD) were grouped according to their use of risperidone, olanzapine, or TBZ. For the three groups, independent propensity score matching was performed on participants' baseline total functional score (TFC), baseline total motor score (TMS), disease burden score, CAG repeat length, baseline age, region, sex, and body mass index. Independent samples t test was used to calculate the differences between the groups in the annual rate of change of the TMS from the baseline to the second available visit. The risperidone (n = 72) and olanzapine groups (n = 77) had annualized increases (worsening) in the TMS of only 1.47 points and 3.20 points, respectively, compared to 5.70 points in the two matched TBZ groups (n = 72) (P = 0.019) and (n = 77) (P = 0.143), respectively. In the absence of prospective data, this analysis of the Enroll-HD database found that the neuroleptics risperidone and olanzapine seemed to at least be comparable to TBZ at controlling HC. These results demonstrate that neuroleptics may have comparable efficacy to TBZ for the treatment of HC. Further prospective studies are needed to confirm these findings.

A propensity score-matched comparison of laparoscopic distal versus total gastrectomy for middle-third advanced gastric cancer

BackgroundThe optimal resection extent for middle-third advanced gastric cancer (AGC) still remains controversial. This study aimed to assess the long-term oncologic outcomes of laparoscopy-assisted distal gastrectomy (LADG) versus laparoscopy-assisted total gastrectomy (LATG) for middle-third AGC. MethodsA retrospective cohort study was conducted using data from 464 patients who underwent LADG or LATG between September 2007 and March 2013. Propensity score matching (PSM) were used for reducing the confounding effects to compare the long-term oncologic outcomes between two groups. Cox regression analysis was performed to clarify the prognostic factors. ResultsAfter PSM was performed, a well-balanced cohort of 376 patients (188 LADG and 188 LATG) was further analyzed. Of interest, the LADG group had a significantly shorter operative time (244.6 ± 28.0 vs. 259.1 ± 30.1, P < 0.0001), less operative blood loss (142.9 ± 50.9 vs. 157.8 ± 54.1, P = 0.006), earlier day of first flatus (2.6 ± 0.8 vs. 2.9 ± 0.9, P = 0.014), fewer number of retrieved lymph nodes (36.5 ± 7.9 vs. 41.4 ± 9.8, P < 0.0001), and shorter postoperative hospital stay (9.7 ± 1.3 vs. 10.7 ± 1.4, P < 0.0001) than the LATG group. However, no significant differences were observed in days of eating liquid diet (P = 0.626) and days of eating soft diet (P = 0.353). The incidence of overall and severe postoperative complications (Clavien-Dindo grade ≥ IIIa) following the LADG group were significantly fewer than the LATG group (overall, 24.5% vs. 34.6%, P = 0.032; severe, 4.8% vs. 11.2%, P = 0.022). In addition, the LADG group had significantly more favorable overall survival (OS) and disease-free survival (DFS) rates than the LATG group (5-year OS rate, 55.6% vs. 41.8%, P = 0.002; 5-year DFS rate, 45.9% vs. 32.8%, P < 0.001). In multivariate analyses, resection extent was not an independent prognostic factor for OS and DFS. ConclusionsThis PSM cohort analysis has indicated LADG with D2 lymphadenectomy appeared to be safe and reasonable option for patients with middle-third AGC in general. LADG could contribute to improved survival.

Aortic valve replacement with or without myocardial revascularization in octogenarians. Can minimally invasive extracorporeal circuits improve the outcome?

The positive impact of minimally invasive extracorporeal circuits (MiECC) on patient outcome is expected to be most evident in patients with limited physiologic reserves. Nevertheless, most studies have limited their use to low-risk patients undergoing myocardial revascularization. As such, there is little evidence to their benefit outside this patient population. We, therefore, set out to explore their potential benefit in octogenarians undergoing aortic valve replacement (AVR) with or without concomitant myocardial revascularization. Based on the type of the utilized ECC, we performed a retrospective propensity score-matched comparison among all octogenarians (n = 218) who received a primary AVR with or without concomitant coronary artery bypass grafting in our institution between 2003 and 2010. A MiECC was utilized in 32% of the patients. The propensity score matching yielded 52 matched pairs. The 30-day postoperative mortality (2% vs. 10%; p=0.2), the incidence of low cardiac output (0% vs. 6%; p=0.2) and the Intensive Care Unit (ICU) stay (2.5 ± 2.6 vs. 3.8 ± 4.7 days; p=0.06) were all in favour of the MiECC group, but failed to reach statistical significance while the 90-day postoperative mortality did (2% vs. 16%; p=0.02). MiECCs have a positive influence on the outcome of octogenarians undergoing AVR with or without concomitant coronary artery bypass grafting. Their use should, therefore, be extended beyond isolated coronary artery bypass graft (CABG) surgery.

Association of a Care Coordination Model With Health Care Costs and Utilization

The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland. To determine whether the Johns Hopkins Community Health Partnership (J-CHiP) was associated with improved outcomes and lower spending. Nonrandomized acute care intervention (ACI) and community intervention (CI) Medicare and Medicaid participants were analyzed in a quality improvement study using difference-in-differences designs with propensity score-weighted and matched comparison groups. The study spanned 2012 to 2016 and took place in acute care hospitals, primary care clinics, skilled nursing facilities, and community-based organizations. The ACI analysis compared outcomes of participants in Medicare and Medicaid during their 90-day postacute episode with those of a propensity score-weighted preintervention group at Johns Hopkins Community Health Partnership hospitals and a concurrent comparison group drawn from similar Maryland hospitals. The CI analysis compared changes in outcomes of Medicare and Medicaid participants with those of a propensity score-matched comparison group of local residents. The ACI bundle aimed to improve transition planning following discharge. The CI included enhanced care coordination and integrated behavioral support from local primary care sites in collaboration with community-based organizations. Utilization measures of hospital admissions, 30-day readmissions, and emergency department visits; quality of care measures of potentially avoidable hospitalizations, practitioner follow-up visits; and total cost of care (TCOC) for Medicare and Medicaid participants. The CI group had 2154 Medicare beneficiaries (1320 [61.3%] female; mean age, 69.3 years) and 2532 Medicaid beneficiaries (1483 [67.3%] female; mean age, 55.1 years). For the CI group's Medicaid participants, aggregate TCOC reduction was $24.4 million, and reductions of hospitalizations, emergency department visits, 30-day readmissions, and avoidable hospitalizations were 33, 51, 36, and 7 per 1000 beneficiaries, respectively. The ACI group had 26 144 beneficiary-episodes for Medicare (13 726 [52.5%] female patients; mean patient age, 68.4 years) and 13 921 beneficiary-episodes for Medicaid (7392 [53.1%] female patients; mean patient age, 52.2 years). For the ACI group's Medicare participants, there was a significant reduction in aggregate TCOC of $29.2 million with increases in 90-day hospitalizations and 30-day readmissions of 11 and 14 per 1000 beneficiary-episodes, respectively, and reduction in practitioner follow-up visits of 41 and 29 per 1000 beneficiary-episodes for 7-day and 30-day visits, respectively. For the ACI group's Medicaid participants, there was a significant reduction in aggregate TCOC of $59.8 million and the 90-day emergency department visit rate decreased by 133 per 1000 episodes, but hospitalizations increased by 49 per 1000 episodes and practitioner follow-up visits decreased by 70 and 182 per 1000 episodes for 7-day and 30-day visits, respectively. In total, the CI and ACI were associated with $113.3 million in cost savings. A care coordination model consisting of complementary bundled interventions in an urban academic environment was associated with lower spending and improved health outcomes.

Benefit and Risk of Minimally Invasive Mitral Valve Repair for Type II Dysfunction - Propensity Score-Matched Comparison.

Despite the cosmetic benefits of the minimally invasive approach for mitral disease, the clinical benefit and risk are not fully known. We investigated the benefit and risk of minimally invasive mitral valve (MV) repair for type II dysfunction using propensity score-matched analysis. Methods and Results: Since 2001, 602 patients have undergone MV repair for type II dysfunction (464 with conventional median sternotomy and 138 with the minimally invasive approach). One-to-one matched analysis using the estimated propensity score based on 23 factors resulted in 93 well-matched patient pairs. There was no in-hospital death in both groups. The operation time was significantly shorter (P=0.002), blood transfusion was less frequent (P=0.04), extubation at the day of surgery was more frequently performed (P=0.017), and the length of hospital stay was significantly shorter in the minimally invasive group than in the sternotomy group (P<0.0001). On postoperative (P=0.02) and 1-year echocardiography (P=0.04), ejection fraction was lower in the minimally invasive group than in the sternotomy group. There were no significant differences in postoperative cerebral infarction, aortic dissection, deep sternal infection, or mid-term outcome between the groups. Standard sternotomy and the minimally invasive approach provide similar good quality of MV repair for type II dysfunction. The minimally invasive approach is more likely to contribute to fast-track perioperative treatment than the standard sternotomy approach.

A propensity score matching analysis of hepatectomy and radiofrequency ablation for patients with solitary hepatocellular carcinoma less than or equal to 5 cm and portal hypertension

Objective To compare the clinical efficacy of hepatectomy and radiofrequency ablation (RFA) for patients with solitary hepatocellular carcinoma (HCC) less than or equal to 5 cm (≤5 cm) and portal hypertension (PHT). Methods The propensity score matching and retrospective case-control study was conducted. The clinicopathological data of 154 patients with solitary HCC ≤ 5 cm and PHT who were admitted to the Qingdao University between January 2011 and July 2016 were collected. Of 154 patients, 61 and 93 underwent R0 hepatectomy and RFA, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between groups after the propensity score matching: patients′ data were matched by the propensity score matching, patients undergoing hepatectomy and RFA were respectively allocated into the hepatectomy group and RFA group; (2) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect postoperative tumor-free and overall survival up to July 31, 2018. Patients received enhanced scans of computed tomography (CT) or magnetic resonance imaging (MRI) in 1 month postoperatively, and then reexaminations of liver function, level of alpha-fetoprotein (AFP), B ultrasound and pulmonary CT within 3 months postoperatively, once every 3 months from 3 months postoperatively to 2 years and once every 6 months after 2 years postoperatively. Measurement data with skewed distribution were described as M (range). Comparisons of count data were analyzed using chi-square test. The Logistic regression model was used for the propensity score matching. The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) The propensity score matching conditions and comparison of general data between groups after the propensity score matching: 118 of 154 patients had successful matching, including 59 in each group. There were statistically significant differences in the tumor diameter and level of preoperative albumin (Alb) before the propensity score matching between groups (χ2=11.050, 6.687, P 0.05). (2) Follow-up and survival: all the 154 patients were followed up for 4.5-91.4 months before the propensity score matching, with a median time of 44.4 months. The postoperative 1-, 2-, 3- and 5-year tumor-free survival rates were respectively 88.1%, 79.5%, 64.1%, 40.3% in patients of hepatectomy group and 84.9%, 68.6%, 52.8%, 43.4% in patients of RFA group, with no statistically significant difference in the tumor-free survival between groups (χ2=0.997, P>0.05). The postoperative 1-, 2-, 3- and 5-year overall survival rates were respectively 95.1%, 88.5%, 85.0%, 70.1% in patients of hepatectomy group and 100.0%, 95.7%, 85.6%, 73.7% in patients of RFA group, with no statistically significant difference in the overall survival between groups (χ2=0.053, P>0.05). One hundred and eighteen patients were followed up for 4.5-91.4 months after the propensity score matching, with a median time of 49.4 months. The postoperative 1-, 2-, 3- and 5-year tumor-free survival rates were respectively 89.4%, 82.3%, 66.4%, 41.7% in patients of hepatectomy group and 83.1%, 64.2%, 47.4%, 38.5% in patients of RFA group, with no statistically significant difference in the tumor-free survival between groups (χ2=2.612, P>0.05). The postoperative 1-, 2-, 3- and 5-year overall survival rates were respectively 94.9%, 89.8%, 86.1%, 70.8% in patients of hepatectomy group and 100.0%, 91.5%, 79.4%, 67.6% in patients of RFA group, with no statistically significant difference in the overall survival between groups (χ2=0.383, P>0.05). Conclusion The both hepatectomy and RFA are reliable radical treatments for solitary HCC ≤ 5 cm and PHT. Key words: Hepatocellular carcinoma; Portal hypertension; Hepatectomy; Radiofrequency ablation; Prognosis; Propensity score matching