Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon: Utilidad de los índices de propensión (propensity scores)

Martínez-Ramos, David; Escrig-Sos, Javier; Miralles-Tena, Juan Manuel; Rivadulla-Serrano, M. I.; Daroca-José, José María; Sanchís, José Luis Salvador

doi:10.4321/s1130-01082008000700002

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…Propensity matching has been well described, but one of the weaknesses of this technique is that propensity scores tend to overestimate treatment effects because of survivor bias—only those patients contributing to the risk prediction model are those that survived to undergo treatment. 33,34 Rather than propensity score matching, we used logistic regression models using the Dartmouth-Manitoba claims-based modification of the Charlson comorbidity index. This methodology, although limited in the extent of clinical precision, has been validated broadly in surgical and nonsurgical settings.…”

Section: Discussionmentioning

confidence: 99%

Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms

Goodney

Tavris

Lucas

et al. 2010

Journal of Vascular Surgery

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Introduction Several reports suggest unexpectedly high rates of late abdominal aortic aneurysm (AAA) rupture occur after endovascular AAA repair (EVAR). However, a population-based study examining causes of late death after EVAR vs open surgical repair has not been performed. Methods We performed a retrospective cohort study of patients undergoing infrarenal AAA repair using information from the Medicare inpatient hospital discharge records (MedPAR files), physician claim files (Part B files, 20% sample), and Medicare Denominator Files for the years 2001 to 2004. Using the Social Security Death Index, we identified all “late” deaths, defined as deaths occurring >30 days and after hospital discharge. We used the National Death Index to identify cause of death information; in particular, those deaths that were likely caused by late rupture. We compared causes of late death and survival between EVAR and open repair using Wilcoxon log-rank and rank-sum tests. Results Between 2001 and 2004, 13,971 patients underwent AAA repair (6119 EVAR, 7852 open repair). After a mean follow-up of 1.6 years in the EVAR cohort and 1.9 years in the open cohort, mortality rates were similar across repair type (15.4% EVAR, 15.9% open repair), with an adjusted odds ratio for death after open repair of 0.98 (95% confidence interval, 0.90–1.07). Of the 2194 documented deaths, 523 occurred before discharge or ≤30 days, and 1671 occurred >30 days and after hospital discharge. Cause of death information for the 1671 late deaths was available from the National Death Index for 1515 (91%). The 15 most common codes for causes of late death were dominated by cardiac disease (atherosclerotic heart disease, acute myocardial infarction) and pulmonary disease (lung cancer, respiratory failure). Causes of late death with specific mention of aneurysm were identified in 37 patients (2.4% of all deaths), but this event was not more common in EVAR or open repair (15 [0.3%] in the EVAR group, 22 [0.3%], in the open repair group; P=.71). Conclusions Late deaths from aneurysm rupture after EVAR or open repair appear to be relatively infrequent and similarly distributed across procedure type. Our results emphasize that the effectiveness of EVAR is comparable to open AAA repair in preventing aneurysm-related death.

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Section: Discussionmentioning

confidence: 99%

Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms

Goodney

Tavris

Lucas

et al. 2010

Journal of Vascular Surgery

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“…Most studies that have analyzed the influence of these physician-/center-related factors, particularly volume, on the variability of the process and outcome of cancer surgery are retrospective (7) and based on clinical-administrative databases (8). This explains why the most frequently examined outcome is hospital mortaliManagement and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study M This fact could explain the differences observed in some prospective studies with primary data (which enable the inclusion of a greater number of variables and have follow-ups which extend beyond the hospital period), in which the relationship between volume and outcomes is less consistent (8,9).…”

Section: Introductionmentioning

confidence: 99%

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Espallargues

Almazán

Tebé

et al. 2009

Rev. esp. enferm. dig.

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Background: most studies that analyze the influence of structure factors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume.Objective: to study variations in the process and outcomes of oncologic surgery for esophagus, stomach, pancreas, liver metastases and rectum cancers in Catalonia, as well as the factors associated with these variations.Patients and method: a retrospective (2002) and prospective (2003-05) multicenter cohort study. Data forms were designed to collect patient, process, and care outcome characteristics before surgery, at hospital discharge, and at 3 and 6 months after discharge. Main outcome measures were hospital and followup mortality, complications, re-interventions, and relapse rates.Results: 49 hospitals (80%) participated in the retrospective phase, 44 of which (90%) also participated in the prospective phase: 3,038 patients (98%) were included. No differences were observed in the profile of operated patients according to hospital level of complexity, but clinical-pathological staging and other functional status variables could not be assessed because of over 20% of missing values. There was significant variability in the volume of interventions as well as in certain aspects of the healthcare process depending on type of cancer and center complexity. High rates of esophageal cancer mortality (18.2% at discharge, 27.3% at 6 months) and of complications and re-interventions for all cancers assessed, especially rectal cancer (18.4% re-interventions at 6 months), were identified.Conclusions: the study of the variability identified will require adequate risk-adjustment and should take into account different structure factors. It is necessary that information included in medical records be improved.Key words: Digestive cancer. Surgery. Medical practice variations. Structure, process, and outcomes of care. INTRODUCTIONOne of the aspects that is most debated in oncologic surgery and other fields (both surgical and medical procedures) is the relationship between the volume of patients having undergone surgery and clinical outcomes. It has been 30 years since the relationship between increased volume and improved outcomes was described (1). However, this relationship is not always observed, and the reasons why it occurs remain unknown. Several hypotheses, especially relating to surgeon-related technical factors (2-6), have been considered. However, if better outcomes are obtained in several different procedures or pathologies, healthcare organization and coordination factors should also be sought. This may be especially useful in the case of oncology, where it is necessary for professionals from different specialties to work together in tackling with diagnosis and treatment: surgery, oncology, as well as the site's central and general services.Most studies that have analyzed the influence of these physician-/center-related factors, particularly volume, on the variability of the process and outcome of cancer surgery are retrosp...

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Clinico-pathological and oncological differences between right and left-sided colon cancer (stages I-III): analysis of 950 cases

et al. 2017

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Influencia de la especialización del cirujano en los resultados tras cirugía por cáncer de colon: Utilidad de los índices de propensión (propensity scores)

Cited by 5 publications

References 26 publications

Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms

Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms

Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Clinico-pathological and oncological differences between right and left-sided colon cancer (stages I-III): analysis of 950 cases

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