Retrospective Propensity-matched Analysis Research Articles

Acute kidney injury following contrast media administration in the septic patient: A retrospective propensity-matched analysis

PurposeTo determine the risk for acute kidney injury (AKI) attributable to intravenous contrast media (CM) administration in septic patients. Materials and methodsThis was a single-center retrospective propensity matched cohort analysis performed in the emergency department (ED) of an academic medical center. All visits for patients ≥18 years who met sepsis diagnostic criteria and had serum creatinine (SCr) measured both on arrival to the ED and again 48 to 72 h later were included. Of 4171 visits, 1464 patients underwent contrast-enhanced CT (CECT), 976 underwent unenhanced CT and 1731 underwent no CT at all. ResultsThe primary outcome was incidence of AKI. Logistic regression and between-groups odds ratios with and without propensity-score matching were used to test for an independent association between CM administration and AKI. Incidence of AKI was 7.2%, 9.4% and 9.7% in those who underwent CECT, unenhanced CT and no CT. CM administration was not associated with increased incidence of AKI. ConclusionsSepsis is a medical emergency proven to benefit from early diagnosis and rapid initiation of treatment, which is often aided by CECT. Our findings argue against withholding CM for fear of precipitating AKI in potentially septic patients.

Outcomes Following Three-Factor Inactive Prothrombin Complex Concentrate Versus Recombinant Activated Factor VII Administration During Cardiac Surgery

To compare outcomes following inactive prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa) administration during cardiac surgery. Retrospective propensity-matched analysis. Academic tertiary-care center. Patients undergoing cardiac surgery requiring cardiopulmonary bypass who received either rFVIIa or the inactive 3-factor PCC. Outcomes following intraoperative administration of rFVIIa (263) or factor IX complex (72) as rescue therapy to treat bleeding. In the 24 hours after surgery, propensity-matched patients receiving PCC versus rFVIIa had significantly less chest tube outputs (median difference -464 mL, 95% confidence interval [CI] -819 mL to -110 mL), fresh frozen plasma transfusion rates (17% v 38%, p = 0.028), and platelet transfusion rates (26% v 49%, p = 0.027). There were no significant differences between propensity-matched groups in postoperative stroke, deep venous thrombosis, pulmonary embolism, myocardial infarction, or intracardiac thrombus. Postoperative dialysis was significantly less likely in patients administered PCC versus rFVIIa following propensity matching (odds ratio = 0.3, 95% CI 0.1-0.7). No significant difference in 30-day mortality in patients receiving PCC versus rFVIIa was present following propensity matching. Use of rFVIIa versus inactive PCCs was significantly associated with renal failure requiring dialysis and increased postoperative bleeding and transfusions.

Electric Motorized Morcellator Versus Transvaginal Extraction for Myoma Retrieval After Laparoscopic Myomectomy: A Propensity-matched Analysis

Study ObjectiveTo compare surgery-related outcomes of electric motorized morcellator (EMM) and transvaginal extraction (TVE) for myoma retrieval after laparoscopic myomectomy. DesignA retrospective propensity-matched analysis of prospectively collected data (Canadian Task Force classification II-2). SettingA university teaching hospital. PatientsOne hundred women undergoing laparoscopic myomectomy. InterventionsLaparoscopic myomectomy followed by myoma retrieval via TVE or EMM. Measurements and Main ResultsFifty propensity-matched patient pairs (100 patients) undergoing laparoscopic myomectomy followed by myoma retrieval via TVE or EMM were studied. No significant differences were observed in baseline patient characteristics. Operative times were similar between groups (66 vs 73 minutes in the TVE and EMM group, respectively, p = .19). However, patients undergoing TVE experienced lower specimen retrieval time than patients undergoing extraction via EMM (5 [3–30] vs 7 [3–35] minutes, p < .001). Blood loss, transfusion, and complication rates were similar between groups. One retrieval-related complication occurred in the EMM group (bleeding from an incision using a morcellator requiring resuture). The need for an analgesic rescue dose was lower in the TVE group compared with patients in the EMM group (p = .03). Although overall satisfaction levels were similar between groups, TVE is related to higher cosmetic outcomes compared with EMM (9.5 [±0.6] vs 8.5 [±1], p < .001). ConclusionTVE upholds the effectiveness of EMM, minimizing the operative time and potentially postoperative pain. Further large prospective studies are needed.

The effects of discharge to an intermediate care unit after a critical illness: A 5-year cohort study

PurposeThe impact of the intermediate care unit (IMCU) on post–intensive care unit (ICU) outcomes is controversial. Materials and MethodsWe analyzed admissions from January 2003 to December 2008 from a mixed ICU in a teaching hospital in Brazil with a high patient-to-nurse ratio (3.5:1 on the ICU, 11:1 on the IMCU, 20-25:1 on the ward). A retrospective propensity-matched analysis was performed with data from 690 patients who were discharged after at least 3 days of ICU stay. ResultsOf the 690 patients, 160 (23%) were discharged to the IMCU. A total of 399 propensity-matched patients were compared: 298 were discharged to the ward and 101 were discharged to the IMCU. Ninety-day mortality rate was similar between the IMCU and ward patients (22% vs 18%, respectively, P = .37), as was the unplanned ICU readmission rate (P = .63). In a multivariate logistic regression, discharge to the IMCU had no effect on the 90-day mortality rate (P = .27). ConclusionsIn a resource-limited setting with a high patient-to-nurse ratio, discharge to IMCU had no impact on 90-day mortality rate and on unplanned readmission rate. The impact of discharge to the IMCU on the outcome for critically ill patients should be evaluated in further studies.