Retrospective Propensity Score-matched Analysis Research Articles

EFFECT OF OPIOID ABUSE AND DEPENDANCE ON OUTCOMES OF PATIENTS HOSPITALIZED WITH COPD: A 5-YEAR ANALYSIS

SESSION TITLE: Obstructive Lung Diseases 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Use of opioids is prevalent in patients with COPD which raises concern about potential respiratory complications in this population. The aim of this study is to analyze the outcomes of patients admitted for COPD or COPD exacerbation with a history of opioid abuse or dependence. METHODS: This is a retrospective propensity score matched analysis utilizing the 2010 to 2014 Nationwide Inpatient Sample, the largest inpatient database in the United States. The study population comprised of 23,074 patients over age 18 with a primary diagnosis of COPD or COPD exacerbation with and without a secondary diagnosis of opioid abuse or dependence. The outcomes of interest were mortality, non-invasive ventilation (NIV) use, endotracheal intubation and length of stay. Multivariate logistic regression was performed to test for independent associations between variables of interest. Diagnoses and procedures were identified using ICD-9-CM codes. Analysis was performed using STATA 14.2. RESULTS: Patients in the opioid group were more likely to be intubated during hospitalization when compared to non-opioid users (OR 1.68, p<0.05). However, no difference in mortality was seen (OR 0.53, p=0.182). NIV utilization did not differ among the groups (OR 1.05 p=0.67) and no difference in length of stay was found (additional 0.042 days, p=0.3). CONCLUSIONS: Opioid dependence and abuse increase the risk of intubation in patients hospitalized for COPD but did not affect mortality. No differences were seen in NIV utilization or length of stay. Further research is needed to better understand the role of chronic opioid use and abuse in patients admitted for COPD. CLINICAL IMPLICATIONS: Clinicians should be aware of the potential adverse respiratory outcomes of opioid dependance or abuse in patients who are hospitalized for COPD related complications. DISCLOSURES: No relevant relationships by Felipe Bolivar Rincon, source=Web Response No relevant relationships by Joseph Mathew, source=Web Response No relevant relationships by Christian Olivo Freites, source=Web Response No relevant relationships by Di Pan, source=Web Response No relevant relationships by Sathish Pondaiah, source=Web Response No relevant relationships by Fernando Vazquez de Lara, source=Web Response

OPERA: OUTCOMES IN PATIENTS WITH PARA-PNEUMONIC PLEURAL EFFUSION WHO REQUIRE ADMISSION

SESSION TITLE: Pleural Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 02:15 pm - 03:15 pm PURPOSE: Pleural effusions are present in 15% to 44% of patients admitted with pneumonia. There are limited data on outcomes in patients with pneumonia admitted with para-pneumonic pleural effusions (PPE). The aim of this study was to analyze the outcomes in such patients. METHODS: This is a retrospective propensity score matched analysis utilizing the 2010 to 2014 Nationwide Inpatient Sample, the largest inpatient database in the United States. The study population comprised 186,928 adult patients with a primary diagnosis of pneumonia with and without a secondary diagnosis of pleural effusion. Patients with malignant pleural effusions and congestive heart failure were excluded. The outcomes of interest were non-invasive ventilation (NIV), endotracheal intubation and invasive mechanical ventilation, tracheostomy, mortality, hospital (LOS), mortality and disposition on discharge. Logistic regression was performed to test for independent associations between variables of interest. Diagnoses and procedures were identified using ICD-9-CM codes. Analysis was performed using STATA 14.2. RESULTS: Baseline characteristics including age, sex, race and Charlson comorbidity index of patients with and without PPE were matched. Patients with PPE were found to have a significantly higher need for NIV (OR 1.5, p<0.001), intubation and invasive mechanical ventilation (OR 2.52, p<0.001), and tracheostomy (OR 3.96, p<0.001) compared to those without PPE. Such patients were also found to have higher mortality (OR 1.67, p<0.001), longer hospital LOS (7.09 vs 4.42 days, p < 0.001) and were more likely to be discharged to a skilled nursing facility (OR 1.52, p < 0.001). CONCLUSIONS: Pneumonia complicated by PPE is associated with high morbidity and mortality. CLINICAL IMPLICATIONS: Prompt identification of pleural effusions in patients admitted with pneumonia and early intervention might be key to prevent adverse outcomes. DISCLOSURES: No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Di Pan, source=Web Response No relevant relationships by Sathish Pondaiah, source=Web Response No relevant relationships by Adil Shujaat, source=Web Response No relevant relationships by Fernando Vazquez de Lara, source=Web Response

A Retrospective Propensity Score-Matched Early Thromboembolic Event Analysis of Prothrombin Complex Concentrate vs Fresh Frozen Plasma for Warfarin Reversal Prior to Emergency Neurosurgical Procedures

Reversal of therapeutic anticoagulation prior to emergency neurosurgical procedures is required in the setting of intracranial hemorrhage. Multifactor prothrombin complex concentrate (PCC) promises rapid efficacy but may increase the probability of thrombotic complications compared to fresh frozen plasma (FFP). To compare the rate of thrombotic complications in patients treated with PCC or FFP to reverse therapeutic anticoagulation prior to emergency neurosurgical procedures in the setting of intracranial hemorrhage at a level I trauma center. Sixty-three consecutive patients on warfarin therapy presenting with intracranial hemorrhage who received anticoagulation reversal prior to emergency neurosurgical procedures were retrospectively identified between 2007 and 2016. They were divided into 2 cohorts based on reversal agent, either PCC (n = 28) or FFP (n = 35). The thrombotic complications rates within 72 h of reversal were compared using the χ2 test. A multivariate propensity score matching analysis was used to limit the threat to interval validity from selection bias arising from differences in demographics, laboratory values, history, and clinical status. Thrombotic complications were uncommon in this neurosurgical population, occurring in 1.59% (1/63) of treated patients. There was no significant difference in the thrombotic complication rate between groups, 3.57% (1/28; PCC group) vs 0% (0/35; FFP group). Propensity score matching analysis validated this finding after controlling for any selection bias. In this limited sample, thrombotic complication rates were similar between use of PCC and FFP for anticoagulation reversal in the management of intracranial hemorrhage prior to emergency neurosurgical procedures.

Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right-Sided Heart Remodeling After Mitral-Valve Surgery: A Propensity-Score Matching Analysis.

BackgroundThis study assessed the role of surgical ablation for atrial fibrillation (AF) in decreasing tricuspid regurgitation (TR) and right‐sided heart remodeling in patients after mitral valve procedure.Methods and ResultsBetween 1994 and 2014, 1568 consecutive patients with AF undergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation of AF was used. Propensity‐score matching (PSM) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate‐to‐severe TR, as well as echocardiography indices in long‐term follow‐up, were compared in 406 matched patient pairs (ablated and nonablated groups). The nonablated group showed significantly higher risks of death (hazard ratio [HR], 1.644; 95% CI, 1.081–2.501; P=0.020), reoperation (HR, 2.644; 95% CI, 1.299–5.466; P=0.008), and moderate‐to‐severe TR (HR, 1.436; 95% CI, 1.059–1.948; P=0.020), associated with a significantly deteriorated cardiac function, progression of TR, and right‐sided heart remodeling after 5‐year follow‐up. In a subgroup comparison of ablated patients with sinus rhythm versus AF recurrence, a PSM analysis was performed at the 5‐year follow‐up. The recurrent group showed significantly higher risks of moderate‐to‐severe TR (HR, 2.427; 95% CI, 1.261–4.671; P=0.008). AF recurrence was associated with progressive TR and significant deterioration in right‐sided heart remodeling.ConclusionsIn a retrospective PSM analysis, mitral valve disease with AF was associated with TR progression as well as right‐sided heart remodeling, which are alleviated by surgical ablation.

Survival benefit of gastrectomy for gastric cancer in patients ≥85 years old: A retrospective propensity score-matched analysis

The purpose of this study was to compare the long-term outcomes of patients ≥85years old with gastric cancer who underwent curative distal gastrectomy or best supportive care alone. Among 241 consecutive patients aged ≥85years who were diagnosed with gastric cancer, we retrospectively examined the cases of 56 patients that were treated with curative distal gastrectomy and 55 patients that were treated with best supportive care alone. To reduce selection bias, we conducted a propensity score-matching analysis. The patients' propensity scores were estimated using a logistic regression model based on the following variables: sex, age, clinical cancer stage, performance status score, and each item of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score. Overall survival was compared using the Kaplan-Meier method and log-rank test. Thirty pairs of patients were generated via propensity score matching. The clinical characteristics of the 2 groups were well matched. The median overall survival time was 57.3months after distal gastrectomy, while it was 16.0months after best supportive care (P=.0002). Subgroup analyses of each sex showed that in males there was no significant difference in overall survival between distal gastrectomy and best supportive care (P=.37) while the overall survival of females was significantly better after distal gastrectomy than after best supportive care (P<.0001). Our propensity score-matched study suggested that distal gastrectomy results in significantly better long-term survival than best supportive care alone in female patients with gastric cancer aged ≥85years. In males, the indications for operation should be carefully determined.

Impact of mild preoperative renal insufficiency on in-hospital and long-term outcomes after off-pump coronary artery bypass grafting: a retrospective propensity score matching analysis

BackgroundMild preoperative renal insufficiency is not rare in patients receiving isolated off-pump coronary artery bypass grafting surgery (OPCAB) surgery. However, there is less study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and follow-up outcomes after isolated OPCAB surgery. This single-centre, retrospective propensity score matching study aimed to evaluate the impact of mild preoperative renal insufficiency on in-hospital and long-term outcomes after first isolated OPCAB surgery.MethodsAfter propensity score matching, 1236 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 undergoing first isolated OPCAB surgery from January 2007 to December 2011 were entered into this study and were divided to normal group (eGFR ≥ 90 ml/min/1.73 m2, n = 618) and mild group (eGFR of 60–89 ml/min/1.73 m2, n = 618). The in-hospital and long-term outcomes were investigated and retrospectively analyzed.ResultsThe 2 propensity score-matched groups had similar baseline and procedural characteristics except the baseline eGFR. Thirty-five patients died during the same hospitalization or within 30 days of operation, with a surgical mortality of 2.8 %. Sixty-seven patients died during follow-up, with a long-term survival of 94.1 %. Univariate factor analysis showed that the 2 propensity score-matched groups have similar rates among in-hospital outcomes. Kaplan-Meier curves displayed a similar in-hospital survival between the 2 groups (χ2 = 0.728, p = 0.393), while a better long-term survival in patients with normal preoperative renal function compared with mild preoperative renal insufficiency (χ2 = 4.722, p = 0.030). After Cox proportional model was used, the hazard ratio for long-term mortality in patients with mild preoperative renal insufficiency compared with normal preoperative renal function was 1.72 (95 % CI 1.06–2.83, p = 0.032).ConclusionsMild preoperative renal insufficiency compared with normal preoperative renal function reduced long-term survival, without evidence of worse in-hospital outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-016-0422-2) contains supplementary material, which is available to authorized users.

Ulinastatin administration is associated with a lower incidence of acute kidney injury after cardiac surgery: a propensity score matched study.

BackgroundSystemic inflammation is involved in the development of acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass (CPB). Ulinastatin, a urinary trypsin inhibitor (UTI), possesses a variety of anti-inflammatory effects. Therefore, we hypothesized that the administration of ulinastatin would reduce the occurrence of AKI in patients undergoing cardiac surgery with CPB.MethodsA retrospective propensity score matched analysis was used to evaluate the effect of ulinastatin on the development of AKI in patients undergoing first documented cardiac surgery with CPB between January 2008 and December 2012 in our hospital. Multiple logistic regression models were also employed to identify the association between UTI administration and development of AKI.ResultsA total of 2072 patients who underwent cardiac surgery with CPB met the inclusion criteria. Before propensity score matching, variables such as age, baseline creatinine, CPB duration, red blood cells transfused, and hematocrit were statistically different between the ulinastatin (UTI) group and the control group. On the basis of propensity scores, 409 UTI patients were successfully matched to the 409 patients from among those 1663 patients without UTI administration. After propensity score matching, no statistically significant differences in the baseline characteristics were found between the UTI group and the control group. The propensity score matched cohort analysis revealed that AKI and the need for renal replacement therapy occurred more frequently in the control group than in the UTI group (40.83 % vs. 30.32 %, P = 0.002; 2.44 % vs. 0.49 %, P = 0.02, respectively). However, there were no significant differences in mortality, length of intensive care unit stay, and length of hospital stay between the UTI group and the control group. Using multivariate logistic regression analysis, we found ulinastatin played a protective role in the development of AKI after cardiac surgery (odds ratio 0.71, 95 % confidence interval 0.56–0.90, P = 0.005).ConclusionsThis study shows that ulinastatin was associated with a lower incidence of AKI after cardiac surgery, suggesting that the administration of ulinastatin may be favorable for those patients undergoing cardiac surgery with CPB.

Intraoperative neuromonitoring in single-level spinal procedures: a retrospective propensity score-matched analysis in a national longitudinal database.

Retrospective propensity score-matched analysis on a national database (MarketScan) between 2006 and 2010. To compare rates of neurological deficits after elective single-level spinal procedures with and without intraoperative neuromonitoring, as well as associated payment differences and geographic variance. Intraoperative neurophysiologic monitoring is a technique that may contribute to avoiding permanent neurological injury during some spine surgery procedures. However, it is unclear whether all patients undergoing spine surgery benefit from neuromonitoring. An identified 85,640 patients underwent single-level spinal procedures including anterior cervical discectomy and fusion (ACDF), lumbar fusion, lumbar laminectomy, or lumbar discectomy. Neuromonitoring was identified with appropriate Current Procedural Terminology (CPT) codes. Cohorts were balanced on baseline comorbidities and procedure characteristics using propensity score matching. Trauma and spinal tumors cases were excluded. Patients (12.66%) received neuromonitoring intraoperatively. Lumbar laminectomies had reduced 30-day neurological complication rate with neuromonitoring (0.0% vs. 1.18%, P=0.002). Neuromonitoring did not correlate with reduced intraoperative neurological complications in ACDFs (0.09% vs. 0.13%), lumbar fusions (0.32% vs. 0.58%), or lumbar discectomy (1.24% vs. 0.91%). With the addition of neuromonitoring, payments for ACDFs increased 16.24% ($3842), lumbar fusions 7.84% ($3540), lumbar laminectomies 24.33% ($3704), and lumbar discectomies 22.54% ($2859). Significant geographic variation was evident. Some states had no recorded single-level spinal cases with concurrent neuromonitoring. Rates for ACDFs and lumbar fusions, laminectomies, and discectomies ranged as high as 61%, 58%, 22%, and 21%, respectively. With intraoperative neurological monitoring in single-level procedures, neurological complications were decreased only among lumbar laminectomies. No difference was observed in ACDFs, lumbar fusions, or lumbar discectomies. There was a significant increase in total payments associated with the index procedure and hospitalization. We demonstrate significant geographic variation in neuromonitoring. 3.

Comparison of Vertebroplasty, Kyphoplasty, and Nonsurgical Management of Vertebral Compression Fractures and Impact on US Healthcare Resource Utilization.

Study DesignRetrospective propensity score-matched cohort analysis of the Thomson Reuters MarketScan database.PurposeTo compare the outcomes of vertebral compression fracture (VCF) treatment options, with an emphasis on reoperation, complications, costand overall healthcare resource use between 2005 and 2009 in the United States.Overview of LiteratureOptions for the treatment of VCFs include conservative management, kyphoplasty, and vertebroplasty. The cost-effectiveness of surgical intervention for VCF has been criticized, and some suggest their outcomes to be similar to placebo.MethodsPatients 18 years of age and older who developed a VCF were identified and separated into three treatment cohorts: vertebroplasty, kyphoplasty, and non-surgical. Propensity score matching was performed to match patients between cohorts. Main outcomes assessed included reoperation, complications, healthcare resource use and associated cost. Outcomes were compared at three separate time intervals (patients at index hospitalization; patients with at least 2-year follow-up data; and those with at least 4-year follow-up data).ResultsTwenty thousand seven hundred forty patients were identified with VCFs, yielding 7,290 after propensity score matching. The mean age of the patients was 78±12 years; and 5,507 (75.5%) were female. All reoperation rates ranged from 6%-17%, while complication rates ranged from 7%-10%, which did not differ significantly among the three cohorts at all follow-up periods. Overall costs were noted to be significantly greater in both the kyphoplasty and vertebroplasty groups at 1-year follow-up, not at 2-year and 4-year follow-up.ConclusionsOur data suggests that the treatment of a VCF patient will likely be associated with similar long-term operative and complication rates regardless of treatment modality.

Statin therapy in patients with atypical chest pain and mild-to-moderate coronary stenosis on 64-slice multidetector coronary computed tomography; a retrospective propensity score matching analysis

The effect of computed tomography (CT)-guided statin therapy on patients with atypical chest pain and mild-to-moderate coronary artery disease has not been elucidated yet. A total of 1,952 patients who had 1-69 % stenosis on CT were reviewed retrospectively. After propensity score matching, 643 patients who were prescribed statins after CT (statin users) and 643 patients without statin therapy (statin non-users) were compared. Major cardiovascular events included all-cause death, acute coronary syndrome and stroke. During a median of 42 months' follow-up, all-cause death was reported in 17 patients (1.3 %), of whom 6 (0.9 %) were statin users and 11 (1.7 %) statin nonusers. Major cardiovascular events developed in 6.1 % in the statin user group and 5.6 % in the statin non-users (P = 0.812). When evaluated according to plaque subtypes, statins showed significant benefit in patients who had non-calcified or mixed plaque (HR 0.47, 95 % CI 0.22-1.01, P = 0.047). However, in patients with calcified plaques, statins had no benefit in reducing adverse events (P = 0.620). In most patients with mild-to-moderate coronary artery stenosis on CT, statin therapy has no beneficial effect on reducing adverse events. However, in patients with non-calcified or mixed plaques, statin therapy showed a significant benefit. • Multidetector CT now identifies numerous subjects with mild-to-moderate coronary stenosis. • Statin therapy has little beneficial effect on patients with calcified plaques. • However, statins reduce adverse events in those with non-calcified or mixed plaques.