Patients undergoing non-elective paraesophageal hernia repair (PEHR) have worse perioperative out... more Patients undergoing non-elective paraesophageal hernia repair (PEHR) have worse perioperative outcomes. Because they are usually older and sicker, however, these patients may be more prone to adverse events, independent of surgical urgency. Our study aimed to determine whether non-elective PEHR is associated with differential postoperative outcome compared to elective repair, using propensity-score weighting. We abstracted data for patients undergoing PEHR (n = 924; non-elective n = 171 (19 %); 1997-2010). Using boosted regression, we generated a propensity-weighted dataset. Odds of 30-day/in-hospital mortality and major complications after non-elective surgery were determined. Patients undergoing non-elective repair were significantly older, had more adverse prognostic factors, and significantly more major complications (38 versus 18 %; p < 0.001) and death (8 versus 1 %; p < 0.001). After propensity weighting, median absolute percentage bias across 28 propensity-score variables improved from 19 % (significant imbalance) to 5.6 % (well-balanced). After adjusting propensity-weighted data for age and comorbidity score, odds of major complications were still nearly two times greater (OR 1.67, CI 1.07-2.61) and mortality nearly three times greater (OR 2.74, CI 0.93-8.1) than for elective repair. Even after balancing significant differences in baseline characteristics, non-elective PEHR was associated with worse outcomes than elective repair. Symptomatic patients should be referred for elective repair by experienced surgeons.
15 Background: Historically, the AJCC esophageal staging system separated patients into prognosti... more 15 Background: Historically, the AJCC esophageal staging system separated patients into prognostic groups based on tumor, node, and metastasis (TNM) classifications. In 2010, the 7th edition (AJCC 7) significantly modified esophageal squamous cell cancer (ESCC) staging by separating ESCC from adenocarcinoma, incorporating tumor grade and location for node negative cancers, and stratifying by the number of involved regional nodes for node positive cancers. Our study aim was to determine whether AJCC 7 stage groupings provide improved survival prognostication compared to 6th edition (AJCC 6). Methods: We abstracted pathology and survival for 150 consecutive ESCC patients who underwent esophagectomy (1994-2012); 44 patients received induction therapy. AJCC 6 and AJCC 7 stages were assigned and overall survival analyzed from esophagectomy to death or most recent alive contact and censored at 60 months. Discriminatory ability and homogeneity within subgroups was assessed with Kaplan-Meie...
Page 1. Nitric oxide: A clinical primer Ryan M. Levy, MD; Jose M. Prince, MD; Timothy R. Billiar,... more Page 1. Nitric oxide: A clinical primer Ryan M. Levy, MD; Jose M. Prince, MD; Timothy R. Billiar, MD Definitions Nitric oxide (NO) is a gaseous, electrically neutral free radical. Freely soluble in both water and lipid, it diffuses along ...
Page 1. Dispute: A Salary Cap in Major League Baseball Ryan Levy COSC 627-Ellis April 20 th , 200... more Page 1. Dispute: A Salary Cap in Major League Baseball Ryan Levy COSC 627-Ellis April 20 th , 2006 Page 2. A Salary Cap in Major League Baseball At the end of every season the New York Yankee's owner, George Steinbrenner, ...
Patients undergoing non-elective paraesophageal hernia repair (PEHR) have worse perioperative out... more Patients undergoing non-elective paraesophageal hernia repair (PEHR) have worse perioperative outcomes. Because they are usually older and sicker, however, these patients may be more prone to adverse events, independent of surgical urgency. Our study aimed to determine whether non-elective PEHR is associated with differential postoperative outcome compared to elective repair, using propensity-score weighting. We abstracted data for patients undergoing PEHR (n = 924; non-elective n = 171 (19 %); 1997-2010). Using boosted regression, we generated a propensity-weighted dataset. Odds of 30-day/in-hospital mortality and major complications after non-elective surgery were determined. Patients undergoing non-elective repair were significantly older, had more adverse prognostic factors, and significantly more major complications (38 versus 18 %; p < 0.001) and death (8 versus 1 %; p < 0.001). After propensity weighting, median absolute percentage bias across 28 propensity-score variables improved from 19 % (significant imbalance) to 5.6 % (well-balanced). After adjusting propensity-weighted data for age and comorbidity score, odds of major complications were still nearly two times greater (OR 1.67, CI 1.07-2.61) and mortality nearly three times greater (OR 2.74, CI 0.93-8.1) than for elective repair. Even after balancing significant differences in baseline characteristics, non-elective PEHR was associated with worse outcomes than elective repair. Symptomatic patients should be referred for elective repair by experienced surgeons.
15 Background: Historically, the AJCC esophageal staging system separated patients into prognosti... more 15 Background: Historically, the AJCC esophageal staging system separated patients into prognostic groups based on tumor, node, and metastasis (TNM) classifications. In 2010, the 7th edition (AJCC 7) significantly modified esophageal squamous cell cancer (ESCC) staging by separating ESCC from adenocarcinoma, incorporating tumor grade and location for node negative cancers, and stratifying by the number of involved regional nodes for node positive cancers. Our study aim was to determine whether AJCC 7 stage groupings provide improved survival prognostication compared to 6th edition (AJCC 6). Methods: We abstracted pathology and survival for 150 consecutive ESCC patients who underwent esophagectomy (1994-2012); 44 patients received induction therapy. AJCC 6 and AJCC 7 stages were assigned and overall survival analyzed from esophagectomy to death or most recent alive contact and censored at 60 months. Discriminatory ability and homogeneity within subgroups was assessed with Kaplan-Meie...
Page 1. Nitric oxide: A clinical primer Ryan M. Levy, MD; Jose M. Prince, MD; Timothy R. Billiar,... more Page 1. Nitric oxide: A clinical primer Ryan M. Levy, MD; Jose M. Prince, MD; Timothy R. Billiar, MD Definitions Nitric oxide (NO) is a gaseous, electrically neutral free radical. Freely soluble in both water and lipid, it diffuses along ...
Page 1. Dispute: A Salary Cap in Major League Baseball Ryan Levy COSC 627-Ellis April 20 th , 200... more Page 1. Dispute: A Salary Cap in Major League Baseball Ryan Levy COSC 627-Ellis April 20 th , 2006 Page 2. A Salary Cap in Major League Baseball At the end of every season the New York Yankee's owner, George Steinbrenner, ...
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