Common principal components, Linear Discriminant Function, Monte Carlo Simulation, Proportional Covariance Matrices,
IMPORTANCE Multidisciplinary perioperative assessment for patients undergoing complex oncologic head and neck cancer (HNC) surgery is widely implemented. However, to our knowledge, the association of multiprofessional preoperative assessment, information, and briefing with postoperative outcomes has not been evaluated. OBJECTIVE To compare postoperative complications, length of hospital stay (LOS), readmissions, mortality, and costs per case among patients undergoing complex oncologic HNC surgery before and after the implementation of a comprehensive preoperative multiprofessional assessment and information day (MUPAID). DESIGN, SETTING, AND PARTICIPANTSThis retrospective, single-center case-control study was conducted at a tertiary referral head and neck anticancer center/university cancer institute and compared patients with HNC who were undergoing complex oncological surgeries between January 2012 and July 2018 before (control group) and after (intervention group) implementation of the institutional MUPAID. Data analysis was conducted between 2019 and 2020. The intervention group comprised patients who participated in the MUPAID beginning in February 2015. These patients were assessed by a multiprofessional team and provided with structured and comprehensive information on the surgical procedure and its functional, social, financial, and psychological effects, as well as the postoperative care, rehabilitation, and follow-up period. Patients in the control group had also undergone complex oncologic HNC surgery and were selected through surgical procedure codes. MAIN OUTCOMES AND MEASURESThe end points were postoperative rate and severity of complications, LOS, readmissions, mortality, and costs per case. RESULTSThe study included 161 patients, 81 in the intervention (25 women [30.9%]) and 80 in the control group (18 women [22.5%]). The groups showed no relevant differences in sociodemographic, disease, and procedural characteristics. The intervention cohort presented with fewer major local and systemic complications (Clavien-Dindo score, III-V: 34.6% vs 52.5%; difference proportion, −0.179; 95% CI, −0.33 to −0.03), shorter median LOS (12 days [IQR, 10-16 days] vs 16 days [IQR,[11][12][13][14][15][16][17][18][19][20] days; effect size, 0.482; 95% CI Cohen d, 0.152-0.812) and decreased median charge per case
WHAT THIS PAPER ADDS This analysis compares the efficiency of interwoven nitinol stents with drug eluting stents for treatment of atherosclerotic lesions in the femoropopliteal artery with regard to clinically driven target lesion re-intervention at 12 months. Inverse probability treatment weighting was used to remove biased estimates given by data collection from non-randomly assigned treatment. The data do not provide conclusive evidence to favour one stent over the other including calcified lesions or popliteal artery involvement. Randomised controlled comparisons of different stent platforms with longer term follow up are needed to individualise treatment for patients with symptomatic femoropopliteal lesions. Objectives: Information on performance of different stent platforms in endovascular revascularisation of femoropopliteal lesions is controversial and scarce. Methods: Interwoven nitinol (INS, Supera) were compared with drug eluting (DES, Zilver PTx) stents with primary intervention for femoropopliteal lesions. The primary endpoint was time to clinically driven target lesion revascularisation (CD-TLR) within 12 months. Secondary endpoints were time to death, amputation and composite of death, amputation and CD-TLR. Due to the retrospective analysis, inverse probability treatment weighted (IPTW) Cox models were calculated to reach more similar patient populations with weights for the average treatment effect of the population. The two sensitivity analyses were propensity score matching and adjustment for covariates. Results: At 12 months, the cumulative incidence of CD-TLR in the INS group (13%) and DES group (18%) did not differ (HR 1.36, 95% CI 0.56e3.31). A significant interaction between stents used and grade of calcification was observed (p ¼ .006). HR for CD-TLR was 6.4 (95% CI 1.3e32.5) in none to mildly calcified favouring INS, and 0.3 (95% CI 0.1e1.3) for moderate to severely calcified lesions favouring DES. Stent efficiency did not differ comparing treatment of popliteal lesions (HR 0.80; 95% CI 0.21e3.13). Sensitivity analyses confirmed the primary efficacy outcome for either adjusted (HR 1.16; 95% CI 0.51e2.62) or matched analysis (HR 1.35; 95% CI 0.50e3.62)). Interaction of stents with calcification grade was lost for adjusted (HR 0.28; 95% CI 0.06e 1.19) and matched analysis (HR 0.53; 95% CI 0.10e2.91). Conclusion: Both stents (INS and DES) showed comparable results regarding CD-TLR in femoropopliteal lesions, so that one stent could not be favoured over the other, even for calcified or popliteal artery lesions.
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