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Erben Y, Brott TG. The Challenge of Preventing Carotid Artery Stroke in Properly Medically Managed Patients: Lessons From SPACE-2. J Vasc Surg 2023; 77:1575-1577. [PMID: 36893947 DOI: 10.1016/j.jvs.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL.
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Impact of neighborhood social disadvantage on carotid artery disease presentation, management, and discharge outcomes. J Vasc Surg 2023; 77:1700-1709.e2. [PMID: 36787807 DOI: 10.1016/j.jvs.2023.01.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Recent studies have highlighted that race and socioeconomic status serve as important determinants of disease presentation and perioperative outcomes in carotid artery disease. However, these investigations only focus on individual factors of social disadvantage, and fail to account for community factors that may drive disparities. Area Deprivation Index (ADI) is a validated measure of neighborhood adversity that offers a more comprehensive assessment of social disadvantage. We examined the impact of ADI ranking on carotid artery disease severity, management, and postoperative outcomes. METHODS We identified patients who underwent carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), and transcarotid artery revascularization (TCAR) in the Vascular Quality Initiative registry between 2016 and 2020. Patients were assigned ADI scores of 1 to 100 based on zip codes and grouped into quintiles, with higher quintiles reflecting increasing adversity. Outcomes assessed included disease presentation, intervention type, and discharge patterns. Logistic regression was used to evaluate independent associations between ADI quintiles and these outcomes. RESULTS Among 91,904 patients undergoing carotid revascularization, 9811 (10.7%) were in the lowest ADI quintile (Q1), 18,905 (20.6%) in Q2, 25,442 (27.7%) in Q3, 26,099 (28.4%) in Q4, and 11,647 (12.7%) in Q5. With increasing ADI quintiles, patients were more likely to present with symptomatic disease (Q5, 52.1% vs Q1, 46.6%; P < .001), and stroke vs transient ischemic attack (Q5, 63.1% vs Q1, 53.5%; P < .001); they also more frequently underwent CAS vs CEA (Q5, 46.4% vs Q1, 33.9%; P < .001), and specifically tfCAS vs TCAR (Q5, 54.2% vs Q1, 33.9%; P < .001). In adjusted analyses, higher ADI quintiles remained as independent risk factors for presenting with symptomatic disease and stroke and undergoing CAS and tfCAS. Across ADI quintiles, patients were more likely to experience death (Q5, 0.8% vs Q1, 0.4%; P < .001), stroke/death (Q5, 2.1% vs Q1, 1.6%; P = .001), failure to discharge home (Q5, 11.5% vs Q1, 8.0%; P < .001) and length of stay >2 days (Q5, 33.3% vs Q1, 26.3%; P < .001) following revascularization. CONCLUSIONS Among carotid revascularization patients, those with greater neighborhood social disadvantage had greater disease severity and more frequently underwent tfCAS. These patients also had higher rates of death and stroke/death, were less frequently discharged home, and had prolonged hospital stays. Greater efforts are needed to ensure that patients in higher ADI quintiles undergo better carotid surveillance and are treated appropriately for their carotid artery disease.
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Kim Y, Lee S, Tanious A, Decarlo CS, Png CYM, Patel SS, Mohapatra A, Dua A. The Weekend Effect in Carotid Endarterectomy for Symptomatic Carotid Stenosis. Vasc Endovascular Surg 2022; 56:284-289. [PMID: 35133190 DOI: 10.1177/15385744211061901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BackgroundRecent studies report a limited window in which carotid endarterectomy (CEA) provides the greatest benefit for symptomatic carotid stenosis. Given the time-sensitive nature of CEA for symptomatic stenosis, it is important to understand whether patient outcomes are adversely affected by undergoing CEA over the weekend. Currently, it is unclear whether CEA is impacted by the "weekend effect" phenomenon. Methods A multi-institutional database was queried for all patients undergoing CEA for symptomatic carotid artery stenosis from 2015 to 2020 via ICD-9 codes. A total of 288 patients were identified during the study period. Univariate and multivariate analysis were used to compare outcomes based on weekend vs weekday surgery. Results A total of 261 patients (90.6%) underwent weekday CEA, as compared to 27 (9.4%) on the weekend. There were no differences in age, race, gender, or medical comorbidities between groups. Primary surgeon specialty was predominantly vascular surgery (77.0% weekday and 74.1% weekend) followed by neurosurgery (19.9% weekday and 25.9% weekend). Operative time was similar between groups (3.1 (weekday) vs 2.9 hr (weekend), P = .33) as well as estimated blood loss (100 vs 100 mL, P = .54). Hospital length of stay did not differ between groups (P = .69). Combined stroke and 30-day mortality rate was 2.0% on weekdays, compared to 3.7% on weekends (P = .75). On multivariate analysis, weekend surgery was not predictive of postoperative stroke or 30-day mortality (odds ratio .11 [95% CI: -1.57 to 1.85], P = .90). Conclusion In our multi-institutional experience, we did not identify a "weekend effect" in patients undergoing CEA for symptomatic carotid artery stenosis. Surgical revascularization should not be withheld on account of a weekend procedure in similar academic medical centers.
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Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Sujin Lee
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Adam Tanious
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Charles S Decarlo
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Chien-Yi Maximilian Png
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Shiv S Patel
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Abhisekh Mohapatra
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, 2348Massachusetts General Hospital, Boston, MA, USA
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Taylor BS, Patel S, Hilden P, Otite F, Lee K, Gupta G, Khandelwal P. The weekend effect on mechanical thrombectomy: A nationwide analysis before and after the pivotal 2015 trials. Brain Circ 2022; 8:137-145. [PMID: 36267433 PMCID: PMC9578310 DOI: 10.4103/bc.bc_23_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES: MATERIALS AND METHODS: RESULTS: CONCLUSIONS:
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Mo Y, Zhang B, Pan Y, Qin Q, Ye Y, Li X, Huang L, Jiang W. Impact of the weekday of the first intensity-modulated radiotherapy treatment on the survival outcomes of patients with nasopharyngeal carcinoma: A multicenter cohort study. Oral Oncol 2021; 116:105258. [PMID: 33706048 DOI: 10.1016/j.oraloncology.2021.105258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study's purpose was to assess whether the weekday on which intensity-modulated radiotherapy (IMRT) is initiated influences survival outcomes in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS A total of 1440 patients with NPC who received IMRT were enrolled in this study between January 2010 and June 2016. The patients were divided into five groups according to the weekday of their first radiotherapy treatment. Group 1 (n = 322), Group 2 (n = 322), Group 3 (n = 286), Group 4 (n = 292) and Group 5 (n = 218) received first radiotherapy on Monday, Tuesday, Wednesday, Thursday and Friday respectively. Differences in the rates of overall survival (OS), disease-free survival (DFS), loco-regional relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) were compared among the five groups using the Kaplan-Meier method and Cox regression models. RESULTS No significant differences were found in OS, DFS, LRRFS or DMFS among the five groups. The Cox regression analysis showed that the weekday on which the radiotherapy was initiated was not an independent predictor of OS (Hazard Ratio [HR], 1.056; 95%CI: 0.959-1.164, P = 0.268), DFS (HR, 1.067; 95% CI: 0.980-1.161, P = 0.137), LRRFS (HR, 1.069; 95% CI: 0.914-1.249, P = 0.404) and DMFS (HR, 1.027; 95% CI: 0.929-1.134, P = 0.607). The subgroup analysis showed no significant differences among the five groups. CONCLUSIONS This study showed that the day of the week that patients with nasopharyngeal carcinoma begin radiotherapy has no effect on their survival outcomes.
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Affiliation(s)
- Yunyan Mo
- Department of Radiation Oncology, Guilin Medical University Affiliated Hospital, Guilin 541001, China
| | - Bin Zhang
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou 543002, China
| | - Yufei Pan
- Department of Radiation Oncology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin 541004, China
| | - Qinghua Qin
- Department of Radiation Oncology, Guilin Medical University Affiliated Hospital, Guilin 541001, China
| | - Yaomin Ye
- Department of Radiation Oncology, Guilin Medical University Affiliated Hospital, Guilin 541001, China
| | - Xi Li
- Department of Radiation Oncology, Guilin Medical University Affiliated Hospital, Guilin 541001, China
| | - Liying Huang
- Department of Radiation Oncology, Guilin Medical University Affiliated Hospital, Guilin 541001, China
| | - Wei Jiang
- Department of Radiation Oncology, Guilin Medical University Affiliated Hospital, Guilin 541001, China.
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Ferrah N, Walker SR. Weekend Carotid Endarterectomies are Not Associated with a Greater Risk of Stroke and/or Death in Australia and New Zealand. Ann Vasc Surg 2020; 71:145-156. [PMID: 32800885 DOI: 10.1016/j.avsg.2020.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data from multiple surgical studies and settings have reported an increase in adverse events in patients admitted or treated on weekends. The aim of this study was to investigate short-term outcomes for patients undergoing carotid endarterectomy (CEA) in Australia and New Zealand based on the day of surgery. METHODS This is a retrospective observational cohort study. Analysis of 7,857 CEAs recorded for more than 4 years in the Australasian Vascular Audit database was performed. Multivariate logistic regression was used to compare the following outcomes between CEAs performed during the week and on the weekend: (1) in-hospital stroke and/or death; (2) other postoperative complications; and (3) shorter (2 days or less) length of stay (LOS). RESULTS A total of 7,857 CEAs were recorded, with significantly more procedures performed during the week (n = 7,333, P < 0.001). There was no statistically significant difference in the frequency of stroke and/or death or other complications between CEAs performed during the week or on the weekend (P = 0.294 and P = 0.806, respectively). However, there was a significant difference in LOS for procedures performed during the weekend, with more of these patients being discharged within 2 days compared with procedures performed during the week (56.8% vs. 51.5%; P = 0.003). Multivariable logistic regression found no effect of day of the week on the odds of postoperative stroke and/or death (P = 0.685). Day of surgery was also not associated with greater odds of other complications (P = 0.925). However, CEAs performed by nonconsultants had significantly lower adjusted odds of other complications (3.1% vs. 4.1%; P = 0.033). The adjusted odds of having a shorter LOS were significantly greater for operations taking place on the weekend (P = 0.003). CONCLUSIONS In Australia and New Zealand, there appears to be no disadvantage to performing CEA on the weekend, in terms of stroke and/or death. Level of experience of the primary operator does not affect rates of stroke and/or death after CEA. Weekend CEA is associated with a shorter hospital LOS.
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Affiliation(s)
- Noha Ferrah
- Department of Vascular and Endovascular Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Stuart R Walker
- Department of Vascular and Endovascular Surgery, Royal Hobart Hospital, Hobart, Tasmania, Australia; Clinical School, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
PURPOSE OF REVIEW This review overviews perioperative stroke as it pertains to specific surgical procedures. RECENT FINDINGS As awareness of perioperative stroke increases, so does the opportunity to potentially improve outcomes for these patients by early stroke recognition and intervention. Perioperative stroke is defined to be any stroke that occurs within 30 days of the initial surgical procedure. The incidence of perioperative stroke varies and is dependent on the specific type of surgery performed. This chapter overviews the risks, mechanisms, and acute evaluation and management of perioperative stroke in four surgical populations: cardiac surgery, carotid endarterectomy, neurosurgery, and non-cardiac/non-carotid/non-neurological surgeries.
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Affiliation(s)
- Megan C Leary
- Department of Neurology, Lehigh Valley Hospital and Health Network, 1250 S Cedar Crest Blvd, Suite 405, Allentown, PA, 18103-6224, USA. .,Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Preet Varade
- Department of Neurology, Lehigh Valley Hospital and Health Network, 1250 S Cedar Crest Blvd, Suite 405, Allentown, PA, 18103-6224, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Darling RC. Timing of urgent carotid endarterectomy for stroke: how to optimize outcomes for patients. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:131-132. [PMID: 32077674 DOI: 10.23736/s0021-9509.20.11278-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- R Clement Darling
- Division of Vascular Surgery, Albany Medical Center Hospital, Albany Medical College, Albany, NY, USA -
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Assessment of the "Weekend Effect" in Lower Extremity Vascular Trauma. Ann Vasc Surg 2019; 66:233-241.e4. [PMID: 31863955 DOI: 10.1016/j.avsg.2019.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studies suggest that patients admitted on weekends may have worse outcomes as compared with those admitted on weekdays. Lower extremity vascular trauma (LEVT) often requires emergent surgical intervention and might be particularly sensitive to this "weekend effect." The objective of this study was to determine if a weekend effect exists for LEVT. METHODS The National and Nationwide Inpatient Sample Database (2005-2014) was queried to identify all adult patients who were admitted with an LEVT diagnosis. Patient and hospital characteristics were recorded or calculated and outcomes including in-hospital mortality, amputation, length of stay (LOS), and discharge disposition were assessed. Independent predictors of outcomes were identified using multivariable regression models. RESULTS There were 9,282 patients admitted with LEVT (2,866 weekend admissions vs. 6,416 weekday admissions). Patients admitted on weekends were likely to be younger than 45 years (68% weekend vs. 55% weekday, P < 0.001), male (81% weekend vs. 75% weekday, P < 0.001), and uninsured (22% weekend vs. 17% weekday, P < 0.001) as compared with patients admitted on weekdays. There were no statistically significant differences in mortality (3.8% weekend vs. 3.3% weekday, P = 0.209), amputation (7.2% weekend vs. 6.6% weekday, P = 0.258), or discharge home (57.4% weekend vs. 56.1% weekday, P = 0.271). There was no clinically significant difference in LOS (median 7 days weekend vs. 7 days weekday), P = 0.009. On multivariable regression analyses, there were no statistically significant outcome differences between the groups. CONCLUSIONS This study did not identify a weekend effect in LEVT patients in the United States. This suggests that factors other than the day of admission may be important in influencing outcomes after LEVT.
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Galyfos G, Sigala F, Bazigos G, Filis K. Weekend effect among patients undergoing elective vascular surgery. J Vasc Surg 2019; 70:2038-2045. [PMID: 31147130 DOI: 10.1016/j.jvs.2019.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/07/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Several studies have described a higher mortality among patients admitted or operated during the weekend for various diseases. However, pooled data on patients undergoing elective vascular surgery procedures are sparse. METHODS The PubMed, Embase, Scopus, and Cochrane Library databases were systematically searched to identify eligible studies. Studies comparing short-term mortality (≤30 days) between patients undergoing elective vascular surgery during the weekend and working days were included. When studies included patients undergoing mixed types of surgery, only the vascular surgery subgroups were evaluated. Urgent/emergency vascular procedures were excluded according to certain definitions provided by each study. Data were analyzed by using the StatsDirect Statistical software (Version 2.8.0, StatsDirect Ltd, Cambridge, UK). RESULTS Overall, four retrospective studies including 131,201 patients undergoing elective vascular surgery (on working days, n = 130,163; on the weekend, n = 1038) were evaluated. The pooled short-term mortality risk was higher among patients operated during the weekend compared with working days (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.58-3.67; P = .0004). This weekend effect was more evident among patients undergoing abdominal aortic aneurysm repair and carotid surgery (OR, 3.62 [95% CI, 1.49-8.82; P = .0046] and OR, 3.48 [95% CI, 1.15-10.54; P = .027], respectively). In the United States, the weekend effect was more evident among patients undergoing aortic aneurysm repair (OR, 3.61; 95% CI, 1.99-6.53; P < .0001). However, data from Canada originated from one study on patients undergoing carotid and peripheral arterial surgery only. CONCLUSIONS Elective vascular surgery is associated with a higher short-term mortality risk when conducted over the weekend. Improvement of perioperative management during these days may be necessary to improve outcomes.
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Affiliation(s)
- George Galyfos
- First Department of Propaedeutic Surgery, National and Kapodistriakon University of Athens, Hippocration Hospital, Athens, Greece.
| | - Fragiska Sigala
- First Department of Propaedeutic Surgery, National and Kapodistriakon University of Athens, Hippocration Hospital, Athens, Greece
| | - Gerasimos Bazigos
- First Department of Propaedeutic Surgery, National and Kapodistriakon University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- First Department of Propaedeutic Surgery, National and Kapodistriakon University of Athens, Hippocration Hospital, Athens, Greece
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Galyfos G, Sigala F, Filis K. Letter by Galyfos et al Regarding Article, "Weekend Effect in Carotid Endarterectomy". Stroke 2019; 50:e110. [PMID: 30879434 DOI: 10.1161/strokeaha.118.024303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- George Galyfos
- First Department of Propedeutic Surgery, National and Kapodistrian University of Athens Medical School Hippocration Hospital, Athens, Greece
| | - Fragiska Sigala
- First Department of Propedeutic Surgery, National and Kapodistrian University of Athens Medical School Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- First Department of Propedeutic Surgery, National and Kapodistrian University of Athens Medical School Hippocration Hospital, Athens, Greece
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O'Donnell TFX, Wyers MC. Response by O'Donnell and Wyers to Letter Regarding Article, "The Weekend Effect in Carotid Endarterectomy". Stroke 2019; 50:e111. [PMID: 30879435 DOI: 10.1161/strokeaha.119.024441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas F X O'Donnell
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Mark C Wyers
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
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