Propensity scores: Methods, considerations, and applications in the Journal of Thoracic and Cardiovascular Surgery

McMurry, Timothy L.; Hu, Yinin; Blackstone, Eugene H.; Kozower, Benjamin D.

doi:10.1016/j.jtcvs.2015.03.057

Cited by 135 publications

(78 citation statements)

References 32 publications

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“…To control for potential differences in the characteristics of the patients between the sutureless group and conventional group, propensity-score matching was used [14][15][16] . Using a logistic regression model, which included variables such as age, gender, weight, neonatal status and TAPVC type, propensity scores were computed as the conditional probability of receiving cases.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Sutureless and Conventional Techniques to Repair Total Anomalous Pulmonary Venous Connection

Zhang

Zhuang

et al. 2016

Seminars in Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Comparison of Sutureless and Conventional Techniques to Repair Total Anomalous Pulmonary Venous Connection

Zhang

Zhuang

et al. 2016

Seminars in Thoracic and Cardiovascular Surgery

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“…1, 16 Using a well described statistical method of propensity score matching, we identified a subset of patients with equal likelihood to undergo LEB or IEI to compare outcomes between similar patients. 17 …”

Section: Discussionmentioning

confidence: 99%

“…However, propensity matching on all available variables mitigates this bias to allow careful interpretation of these results. 17 …”

Section: Discussionmentioning

confidence: 99%

Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention

Mehaffey

Hawkins

Fashandi

et al. 2017

Journal of Vascular Surgery

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Objective Lower extremity bypass (LEB) has traditionally been the gold standard in the treatment of critical limb ischemia (CLI). Infrainguinal endovascular intervention (IEI) has become more commonly performed than LEB but comparative outcomes are limited. We sought to compare rates of Major Adverse Limb Events (MALE) and Major Adverse Cardiovascular Events (MACE) after LEB and EI in a propensity score matched, national cohort of patients with CLI. Methods The National Surgical Quality Improvement Program (NSQIP) Vascular Targeted Files (2011–2014) for LEB and IEI were merged. CLI patients were identified by ischemic rest pain and/or tissue loss. Patients were matched on a 1:1 basis for propensity to undergo LEB or IEI. Primary outcomes were 30-day MALE and MACE. Within the propensity matched cohort multivariate logistic regression was used to identify independent predictors of MALE and MACE. Results A total of 13,294 LEB and IEI were identified with 8,066 cases performed for CLI. Propensity matching identified 3,848 cases (1,924 per group). There were no differences in preoperative variables between the propensity matched LEB and IEI groups (all P>.05). At 30 days, rates of MALE were significantly lower in the LEB group (9.2% LEB vs IEI 12.2%, P=.003). On multivariate logistic regression, bypass with single segment saphenous vein vs IEI (OR 0.7 [0.54, 0.92], P=.01), and bypass with alternative conduit (prosthetic/spliced vein/composite) vs IEI (OR 0.7 [0.56, 0.98], P=.04), antiplatelet therapy (OR 0.8 [0.58, 1.00], P=.049), and statin therapy (OR 0.8 [0.62, 0.99], P=.04) were protective against MALE while infrageniculate intervention (OR 1.4 [1.09, 1.72], P=.01) and a history of prior bypass of the same arterial segment (OR 1.8 [1.41, 2.41], P<.0001) were predictive. Rates of 30-day MACE were not significantly different (4.9% LEB vs 3.7% IEI, P=.07) between the groups. Independent predictors of MACE included age (OR 1.02 [1.01, 1.04], P=.01), steroid use (OR 1.8 [1.08, 2.99], P=.03), congestive heart failure (OR 1.7 [1.00,1.96], P=.02), beta-blocker use (OR 1.6 [1.09, 1.43], P=.01), dialysis (OR 2.3 [1.55,3.45], P<.0001), totally dependent functional status (OR 3.1 [1.25, 7.58], P=.02), and suboptimal conduit for LEB compared to IEI (OR 1.6 [1.08, 2.36], P=.02). Conclusions Within this large, propensity-matched, national cohort, LEB predicted lower risk-adjusted 30-day MALE compared to IEI. Furthermore, there was no difference in 30-day MACE between the groups despite higher inherent risk with open surgical procedures. Therefore, the present study supports the effectiveness and primacy of LEB for revascularization in CLI.

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“…Due to the large spectrum of clinical presentation of TAD that may have influenced survival, we have adopted one-to-one propensity score matching based on sex, age, acuity of dissection (acute vs. subacute or chronic) and clinical presentation (complicated vs. uncomplicated) to minimize potential bias. Because the decision to stent also depended on the surgeon on duty in this study, we considered the participating center as an obligatory covariate according to McMurry's recommendations for building a propensity score (20). We did not consider introducing more variables into the scoring model to avoid excluding too many patients from the study.…”

Section: Discussionmentioning

confidence: 99%

Associated bare stenting of distal aorta with a Djumbodis® system versus conventional surgery in type A aortic dissection

Caus¹,

Сирота²,

Nader³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The effectiveness of additional stenting of the distal aorta as compared to conventional surgery alone in type A aortic dissection (TAD) has yet to be proven. Methods:We conducted this multicenter comparative study to evaluate the effects of antegrade bare stenting of the dissected aorta beyond the distal anastomosis with a Djumbodis ® device system (DDS).Outcomes that were measured included early outcomes, overall mortality from aortic cause and late aortic events including re-interventions. A consecutive series of 134 patients operated on in two participating centers were distributed into study and control groups according to the treatment received: conventional surgery with DDS (DJ group, n=42) or without (control group, n=92).Results: Operative mortality was 21.4% and 17.6% in the DJ and control groups, respectively (P=0.9), and was within pre-specified alarm lines for both groups. In multivariate analysis, the only independent predictor of operative mortality was the presence of any complication (cardiac tamponade or malperfusion, P=0.05), which occurred more in the DJ group (OR =1.3; non-significant). Sixty patients were included into the matched survivors cohorts study (propensity scoring). The aortic event-free survival at 7 years for early survivors was 77%±10% and 48%±11% in the matched DJ group and control group, respectively (HR =0.66). Late mortality from an aortic cause was 10% and 20% in the matched DJ group and control group, respectively (RR =0.5). Actuarial freedom from aortic or vascular interventions was 71%±10% and 67%±9% in the matched DJ and control group, respectively. Operative mortality was not influenced by the use of DDS as compared to conventional surgery alone for TAD. Conclusions:We observed a trend towards better organ perfusion in the DJ group postoperatively, and more aortic events and deaths of aortic cause in the control group during follow-up.

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Propensity scores: Methods, considerations, and applications in the Journal of Thoracic and Cardiovascular Surgery

Abstract: Improved statistical practice is needed when using propensity scoring. This article suggests standard criteria for using this method in Journal publications.

Cited by 135 publications

References 32 publications

Comparison of Sutureless and Conventional Techniques to Repair Total Anomalous Pulmonary Venous Connection

Comparison of Sutureless and Conventional Techniques to Repair Total Anomalous Pulmonary Venous Connection

Lower extremity bypass for critical limb ischemia decreases major adverse limb events with equivalent cardiac risk compared with endovascular intervention

Associated bare stenting of distal aorta with a Djumbodis® system versus conventional surgery in type A aortic dissection

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