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Delorme T, Cottenet J, Abo-Alhassan F, Bernard A, Ortega-Deballon P, Quantin C. Does intraperitoneal mesh increase the risk of bowel obstruction? A nationwide French analysis. Hernia 2024; 28:419-426. [PMID: 37770815 DOI: 10.1007/s10029-023-02885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Incisional hernias are associated with a reduced quality of life. Mesh reinforcement of the abdominal wall is the current standard for incisional hernia repair (IHR), since it reduces the risk of recurrence. The best position for the mesh remains controversial, and each position has advantages and disadvantages. OBJECTIVE In this nationwide population-based study, we aimed to determine whether IHR with intraperitoneal mesh is associated with an increased risk of bowel obstruction. PATIENTS AND METHODS Using the French hospital database (PMSI), which collects data from all public and private hospitals, two patient cohorts were created and compared. Patients having undergone a laparoscopic IHR with intraperitoneal mesh (IPOM) in 2013 or 2014 due to a laparotomy performed in the 4 previous years were the IPOM group. Patients hospitalized for any other acute disease (i.e., without IHR) in 2013 and 2014, but having a similar laparotomy in the 4 previous years were the control group. Both cohorts were followed until 2019 in search of any episode of bowel obstruction. RESULTS A total of 815 patients were included in the IPOM group and matched to 1630 control patients. The 5 year bowel obstruction rate was 7.36% in the IPOM group and 4.42% in the control group (p < 0.01). In the multivariate analysis, after adjustment on age and obesity, incisional hernia repair with laparoscopic IPOM increased the risk of bowel obstruction in the 5 years following surgery (HR = 1.712; 95% CI 1.208-2.427; p = 0.0025). CONCLUSIONS Patients having undergone laparoscopic IPOM have an increased risk of bowel obstruction compared with patients who have a similar surgical history but no IHR.
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Affiliation(s)
- Théophile Delorme
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, Dijon, 21079, France
| | - Jonathan Cottenet
- Department of Medical Information, Dijon University Hospital, Dijon, France
| | - Fawaz Abo-Alhassan
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, Dijon, 21079, France
| | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, Dijon, 21079, France.
- INSERM, Université de Bourgogne, CHU Dijon Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France.
| | - Catherine Quantin
- Department of Medical Information, Dijon University Hospital, Dijon, France
- INSERM, Université de Bourgogne, CHU Dijon Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
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Bernard A, Cottenet J, Quantin C. Is the Validity of Logistic Regression Models Developed with a National Hospital Database Inferior to Models Developed from Clinical Databases to Analyze Surgical Lung Cancers? Cancers (Basel) 2024; 16:734. [PMID: 38398124 PMCID: PMC10886576 DOI: 10.3390/cancers16040734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/11/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
In national hospital databases, certain prognostic factors cannot be taken into account. The main objective was to estimate the performance of two models based on two databases: the Epithor clinical database and the French hospital database. For each of the two databases, we randomly sampled a training dataset with 70% of the data and a validation dataset with 30%. The performance of the models was assessed with the Brier score, the area under the receiver operating characteristic (AUC ROC) curve and the calibration of the model. For Epithor and the hospital database, the training dataset included 10,516 patients (with resp. 227 (2.16%) and 283 (2.7%) deaths) and the validation dataset included 4507 patients (with resp. 93 (2%) and 119 (2.64%) deaths). A total of 15 predictors were selected in the models (including FEV1, body mass index, ASA score and TNM stage for Epithor). The Brier score values were similar in the models of the two databases. For validation data, the AUC ROC curve was 0.73 [0.68-0.78] for Epithor and 0.8 [0.76-0.84] for the hospital database. The slope of the calibration plot was less than 1 for the two databases. This work showed that the performance of a model developed from a national hospital database is nearly as good as a performance obtained with Epithor, but it lacks crucial clinical variables such as FEV1, ASA score, or TNM stage.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, 21000 Dijon, France;
| | - Jonathan Cottenet
- Service de Biostatistiques et d’Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France;
| | - Catherine Quantin
- Service de Biostatistiques et d’Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France;
- CESP, Inserm, UVSQ, Université Paris-Saclay, 94807 Villejuif, France
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Moret A, Madelaine L, Hanna HA, Bernard A, Pagès PB. [Complications after pulmonary segmentectomy: Impact of the surgical approach]. Rev Mal Respir 2023; 40:666-674. [PMID: 37798174 DOI: 10.1016/j.rmr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/14/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Pulmonary segmentectomy is becoming increasingly widespread but remains technically challenging. The aim of this study was to evaluate the impact of the surgical approach applied on postoperative complications after pulmonary segmentectomy. METHODS All patients having undergone pulmonary segmentectomy by thoracotomy, videothoracoscopy or robot-assisted surgery from 1st January 2018 to 31st December 2021 were included. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were operative time, length of hospital stay, 30-day readmission rate, 30-day and 90-day mortality. RESULTS Two hundred and twenty-three patients were included, 30% (n=67) in the thoracotomy group, 9.4% (n=21) in the videothoracoscopy group and 60.5% (n=135) in the robot-assisted surgery group. There was no difference in the occurrence of postoperative complications according to type of approach (P=0.564), 26.9% of patients (n=60) had at least one postoperative complication. There was no significant difference between the groups in terms of operative time (P=0.385), length of hospital stay (P=0.107), 30 and 90-day mortality (P=0.124 and P=0.249, respectively). Mini-invasive surgery significantly reduced the 30-day readmission rate (P=0.049). CONCLUSION The surgical approach applied does not influence the postoperative complications of pulmonary segmentectomy.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Service de chirurgie thoracique, centre hospitalier Métropole Savoie, Chambéry, France
| | - L Madelaine
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - H Abou Hanna
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - A Bernard
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - P-B Pagès
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Inserm, UMR 1231, CHU de Dijon, université de Bourgogne, Dijon, France.
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Pouhin A, Coscas R, Crespy V, Poupardin O, Pais-De-Barros JP, Bouchot O, Bernard A, Steinmetz E. Comparative Evaluation of Two Paclitaxel-Coated Stents in an Experimental Setting. J Endovasc Ther 2023:15266028231198033. [PMID: 37727972 DOI: 10.1177/15266028231198033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Unlike paclitaxel-coated balloons, pre-clinical data comparing different paclitaxel-coated stents (PCSs) are weak. The study objective was to compare the features of the 2 main PCSs: Eluvia® (Boston Scientific, Marlborough, MA) versus ZilverPTX® (Cook Medical, Bloomington, IN). METHOD Analysis was carried out on 12 pigs divided into 2 groups: Eluvia® (n=6) and ZilverPTX® (n=6). The pigs received the PCS corresponding to their group in each external iliac artery and were paired one by one, to examine 6 different post-implantation timepoints: after 30 minutes, 6 hours, 24 hours, 3 days, 7 days, and 14 days. The paclitaxel concentration measurements and the histological analysis were carried out under blind testing on the plasma, arterial, lymph node, and muscle samples. A linear regression model and Wilcoxon Mann-Whitney test were used to study the variables. RESULTS The plasma paclitaxel rate decrease over 24 hours after PCS implantation was significantly different between the two groups, expressed by the correlation coefficient 0.19 (0.14-0.23; p<0.001) with an undetectable concentration at the 10th hour for Eluvia® versus 3 days for ZilverPTX®. Significantly higher paclitaxel concentrations with ZilverPTX® PCS were observed in muscle samples at each timepoint: extensor digitorum brevis 3.2 (1.17-5.23; p=0.005), biceps femoris 4.27 (2.27-6.26; p<0.001), semi-tendinosus 3.79 (1.85-5.73; p=0.001), tibialis anterior 3.0 (1.37-4.64; p=0.001), and in the femoral nodes 2.27±1.74 ng/g versus 0.14±0.13 ng/g (p<0.001). Histological analysis revealed a trend for more marked intimal inflammation in the arteries stented with ZilverPTX® (p=0.063), especially after the 7th and 14th days. CONCLUSION Such a difference in the concentration of paclitaxel in the plasma, muscles, and lymph nodes between the two stents was higher than expected based on differences in device design. The clinical consequences of these results remain to be elucidated, particularly regarding the concerning presence of paclitaxel in muscles and adjacent lymph nodes. CLINICAL IMPACT This experimental study compares 2 paclitaxel-coated stents. It demonstrates that differences in stent designs and drug features (coatings and concentrations) translate into differences in terms of concentrations of paclitaxel in the plasma, muscles, and lymph nodes. Our results favor the Eluvia® stent over the ZilverPTX® stent, although more studies are required to confirm this conclusion.
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Affiliation(s)
- Alexandre Pouhin
- Department of Vascular Surgery, Dijon University Hospital, Dijon, France
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France
- UMR 1018, Inserm-Paris11-CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paris, France
| | - Valentin Crespy
- Department of Vascular Surgery, Dijon University Hospital, Dijon, France
| | - Olivia Poupardin
- Research Society, Farming Division, Auxois-Sud, Biossan, Créancey, France
| | | | - Olivier Bouchot
- Department of Cardiac Surgery, Dijon University Hospital, Dijon, France
| | - Alain Bernard
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Eric Steinmetz
- Department of Vascular Surgery, Dijon University Hospital, Dijon, France
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Soilly AL, Aho Glélé LS, Bernard A, Abou Hanna H, Filaire M, Magdaleinat P, Marty-Ané C, Tronc F, Grima R, Baste JM, Thomas PA, Richard De Latour B, Pforr A, Pagès PB. Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01). BMC Health Serv Res 2023; 23:1004. [PMID: 37723516 PMCID: PMC10507914 DOI: 10.1186/s12913-023-09962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/24/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Lungsco01 is the first study assessing the real benefits and the medico-economic impact of video-thoracoscopy versus open thoracotomy for non-small cell lung cancer in the French context. METHODS Two hundred and fifty nine adult patients from 10 French centres were randomised in this prospective multicentre randomised controlled trial, between July 29, 2016, and November 24, 2020. Survival from surgical intervention to day 30 and later was compared with the log-rank test. Total quality-adjusted-life-years (QALYs) were calculated using the EQ-5D-3L®. For medico-economic analyses at 30 days and at 3 months after surgery, resources consumed were valorised (€ 2018) from a hospital perspective. First, since mortality was infrequent and not different between the two arms, cost-minimisation analyses were performed considering only the cost differential. Second, based on complete cases on QALYs, cost-utility analyses were performed taking into account cost and QALY differential. Acceptability curves and the 95% confidence intervals for the incremental ratios were then obtained using the non-parametric bootstrap method (10,000 replications). Sensitivity analyses were performed using multiple imputations with the chained equation method. RESULTS The average cumulative costs of thoracotomy were lower than those of video-thoracoscopy at 30 days (€9,730 (SD = 3,597) vs. €11,290 (SD = 4,729)) and at 3 months (€9,863 (SD = 3,508) vs. €11,912 (SD = 5,159)). In the cost-utility analyses, the incremental cost-utility ratio was €19,162 per additional QALY gained at 30 days (€36,733 at 3 months). The acceptability curve revealed a 64% probability of efficiency at 30 days for video-thoracoscopy, at a widely-accepted willingness-to-pay threshold of €25,000 (34% at 3 months). Ratios increased after multiple imputations, implying a higher cost for video-thoracoscopy for an additional QALY gain (ratios: €26,015 at 30 days, €42,779 at 3 months). CONCLUSIONS Given our results, the economic efficiency of video-thoracoscopy at 30 days remains fragile at a willingness-to-pay threshold of €25,000/QALY. The economic efficiency is not established beyond that time horizon. The acceptability curves given will allow decision-makers to judge the probability of efficiency of this technology at other willingness-to-pay thresholds. TRIAL REGISTRATION NCT02502318.
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Affiliation(s)
- Anne-Laure Soilly
- Direction of Clinical Research and Innovation, Clinical Research Unit-Methodological Support Network, CHU Dijon-Bourgogne, 21000, Dijon, France.
| | | | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Halim Abou Hanna
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | - Marc Filaire
- Department of Thoracic Surgery and Endocrine Surgery, Centre Jean Perrin, Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Charles Marty-Ané
- Department of Thoracic and Cardiovascular Surgery, Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France
| | - François Tronc
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | - Renaud Grima
- Department of Thoracic Surgery, HCL, Hôpital Louis Pradel, Bron, France
| | | | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, North University Hospital, Aix-Marseille University & APHM, Marseille, France
| | | | - Arnaud Pforr
- Department of Thoracic and Vascular Surgery, Avignon, Avignon, CH, France
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Bernard A, Cottenet J, Pagès PB, Quantin C. Mortality and failure-to-rescue major complication trends after lung cancer surgery between 2005 and 2020: a nationwide population-based study. BMJ Open 2023; 13:e075463. [PMID: 37699626 PMCID: PMC10503350 DOI: 10.1136/bmjopen-2023-075463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVES To estimate the evolution of quality indicators (30-day mortality and failure-to-rescue) inpatients who underwent lung cancer surgery in France over the past 15 years and to study the potential influencing factors. DESIGN Retrospective cohort study using data from the French hospital database (PMSI). SETTING Nationwide population-based study. PARTICIPANTS All patients who underwent pulmonary resection for lung cancer in France (2005-2020) were included (N=1 57 566). Characteristics of patients (age, gender, comorbidities), surgery (surgical approach, type of resection, extent of resection) and hospital (type of hospital, hospital volume for pulmonary resections) were retrieved. PRIMARY AND SECONDARY OUTCOME MEASURES We studied two outcome indicators: 30-day mortality and failure-to-rescue. We used regression-based techniques (including interrupted time-series) to assess the effects of patient and hospital characteristics on 30-day mortality and failure-to-rescue (number of deaths among patients with at least one major postoperative complication within the 30 days after surgery), adjusting for case mix. RESULTS The 30-day mortality rate increased from 3.8% in 2005 to 4.9% in 2010 and then decreased to 2.9% in 2020. The failure-to-rescue rate decreased from 12.2% in 2005 to 7.1% in 2020. The pneumonectomy rate decreased significantly over time (18.1% in 2005 to 4.8% in 2020) and had the greatest contribution on the reduction of mortality between two periods (2005-2010/2015-2020). The use of video-assisted thoracoscopic surgery or robot-assisted surgery had a great influence on the reduction of mortality (16% of the observed difference in mortality) between the two periods, as did hospital volume. CONCLUSIONS The change in surgical practices, particularly the reduction in pneumonectomies, could be one of the main reasons for reduction in postoperative mortality and failure-to-rescue in France since 2011. Hospital volume is another important factor in reducing postoperative mortality. Our study should encourage the use of technological or organisational innovation, such as changes in surgical practice and cancer surgery authorisations, to improve quality of care.
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Affiliation(s)
| | - Jonathan Cottenet
- Service de Biostatistiques et d'Information Médicale (DIM) ; INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, CHU Dijon, Dijon, France
| | | | - Catherine Quantin
- Service de Biostatistiques et d'Information Médicale (DIM) ; INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, CHU Dijon, Dijon, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
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Viennet M, Tapia S, Cottenet J, Bernard A, Ortega-Deballon P, Quantin C. Increased risk of colon cancer after acute appendicitis: a nationwide, population-based study. EClinicalMedicine 2023; 63:102196. [PMID: 37680941 PMCID: PMC10480545 DOI: 10.1016/j.eclinm.2023.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Background Acute appendicitis is the most common digestive disease requiring emergency surgery. Colorectal cancer is the third most common cancer in France. An increased risk of colorectal cancer after acute appendicitis has been suggested. We aimed to assess the frequency of hospitalization for colon cancer after appendicitis in a nationwide analysis. Methods Using the French Hospital Discharge Database (PMSI), we included all patients aged 18-59 years presenting with acute appendicitis between 2010 and 2015. Univariate and multivariate analyses were performed to compare colon cancer occurrence in these patients vs a control-matched population with a hospital stay for trauma in the same period. Patients presenting strong risk factors for colorectal cancer were excluded. Findings A total of 230,349 patients with acute appendicitis (exposed group) were included. We used a propensity score to match each exposed patient with two unexposed patients (controls) to ensure the comparability of the groups, resulting in a control group of 460,698 patients. Univariate analysis found significantly more colon cancer in the appendicitis group, especially during the first year after appendicitis (5 per 10,000 vs 1 per 10,000, p < 0.000, this corresponds to 111 patients in the appendicitis group), namely within the first 6 months. Survival analysis confirmed patients treated for appendicitis present a 4 times higher risk of being diagnosed with colon cancer than control patients during the first year of follow-up (sHR = 4.67 (95% CI: 3.51-6.21), and 8 times higher during the first 6 months (sHR = 8.39; 95% CI: 5.41-12.99). The association was even more marked for right-sided colon cancer (sHR = 8.25; 95% CI: 5.03-13.54 during the 1st year). While the risk of diagnosis of colon cancer was also significant for patients over 40 years, it was even greater in patients under 40 years, who had between a 6-fold and 12-fold increase in risk. Interpretation In this population-based study, we found that acute appendicitis seems to be a warning sign for colon cancer (reverse causality) in both middle-aged and younger adults. The risk of presenting with cancer colon was higher during the first six months after acute appendicitis. This raises the issue of routine diagnostic work-up in adults presenting with acute appendicitis. Funding Regional Council of Burgundy.
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Affiliation(s)
- Manon Viennet
- Department of Digestive Surgical Oncology, Dijon University Hospital, Dijon, France
| | - Solène Tapia
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Alain Bernard
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, Dijon University Hospital, Dijon, France
- Inserm CIC 1432 Clinical Investigation Unit, Dijon University Hospital, Dijon, France
- Inserm Unit 1231, Locoregional Therapy in Surgical Oncology, Dijon, France
| | - Catherine Quantin
- Department Medical Information, Dijon University Hospital, Dijon, France
- Inserm CIC 1432 Clinical Investigation Unit, Dijon University Hospital, Dijon, France
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Bernard A, Cottenet J, Pages PB, Quantin C. Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study. Cancers (Basel) 2023; 15:3283. [PMID: 37444392 DOI: 10.3390/cancers15133283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). METHODS All patients who underwent limited resection or lobectomy for lung cancer in France were included from the national hospital administrative database (2013-2020). We described between-hospital differences in the MIA rate over four periods (2013-2014, 2015-2016, 2017-2018, and 2019-2020). The potential influence of the hospital volume, hospital type, and period on the adjusted MIA rate was estimated by a multilevel linear regression. RESULTS From 2013 to 2020, 77,965 patients underwent a lobectomy or limited resection for lung cancer. The rate of the MIA increased significantly over the four periods (50% in 2019-2020). Variability decreased over time in 7/12 regions. The variables included in the multilevel model were significantly related to the adjusted rate of the MIA. Variability between regions was considerable since 18% of the variance was due to systematic differences between regions. CONCLUSIONS We confirm that the MIA is part of the surgical techniques used on a daily basis for the treatment of lung cancer. However, this technology is mostly used by surgeons in high volume institutions.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Jonathan Cottenet
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France
| | - Pierre-Benoit Pages
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Catherine Quantin
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 21000 Dijon, France
- Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, Le Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Université Paris-Saclay (UVSQ), 94800 Villejuif, France
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Bernard C, Morgant MC, Jazayeri A, Perrin T, Malapert G, Jazayeri S, Bernard A, Bouchot O. Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction. Biomedicines 2023; 11:979. [PMID: 36979958 PMCID: PMC10046680 DOI: 10.3390/biomedicines11030979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/21/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
During the acute phase of myocardial infarction, the culprit artery must be revascularized quickly with angioplasty. Surgery then completes the procedure in a second stage. If emergency surgery is performed, the resulting death rate is high; 15-20% of patients are operated on within the first 48 h after the myocardial infarction. The timing of surgical revascularization and the patient's preoperative state influence the mortality rate. We aimed to evaluate the impact of surgery delay on morbimortality. Between 2007 and 2017, a retrospective monocentric study was conducted including 477 haemodynamically stable patients after myocardial infarction who underwent an urgent coronary bypass. Three groups were described, depending on the timing of the surgery: during the first 4 days (Group 1, n = 111, 23%), 5 to 10 days (Group 2, n = 242, 51%) and after 11 days (Group 3, n = 124, 26%). The overall thirty-day mortality was 7.1% (n = 34). The death rate was significantly higher in Group 1 (n = 16; 14% vs. n = 10; 4.0% vs. n = 8; 6%, p < 0.01). The mortality risk factors identified were age (OR: 1.08; CI 95%: 1.04-1.12; p < 0.001), peripheral arteriopathy (OR: 3.31; CI 95%: 1.16-9.43; p = 0.024), preoperative renal failure (OR: 6.39; CI 95%: 2.49-15.6; p < 0.001) and preoperative ischemic recurrence (OR: 3.47; CI 95%: 1.59-7.48; p < 0.01). Ninety-two patients presented with preoperative ischemic recurrence (19%), with no difference between the groups. The optimal timing for the surgical revascularization of MI seems to be after Day 4 in stable patients. However, timing is not the only factor influencing the death rate: the patient's health condition and disease severity must be considered in the individual management strategy.
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Affiliation(s)
- Chloé Bernard
- Department of Cardiac Surgery, Dijon University Hospital, 21000 Dijon, France
| | | | - Aline Jazayeri
- Department of Cardiac Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Thomas Perrin
- Department of Digestive Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Ghislain Malapert
- Department of Cardiac Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Saed Jazayeri
- Department of Cardiac Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Alain Bernard
- Department of Cardiac Surgery, Dijon University Hospital, 21000 Dijon, France
| | - Olivier Bouchot
- Department of Cardiac Surgery, Dijon University Hospital, 21000 Dijon, France
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Bernard A, Cottenet J, Pages PB, Quantin C. Is there variation between hospitals within each region in postoperative mortality for lung cancer surgery in France? A nationwide study from 2013 to 2020. Front Med (Lausanne) 2023; 10:1110977. [PMID: 36999073 PMCID: PMC10043397 DOI: 10.3389/fmed.2023.1110977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionThe practice of thoracic surgery for lung cancer is subject to authorization in France. We evaluated the performance of hospitals using 30-day post-operative mortality as a quality indicator, estimating its distribution within each region and measuring its variability between regions.Material and methodsAll data for patients who underwent pulmonary resection for lung cancer in France (2013–2020) were collected from the national hospital administrative database. Thirty-day mortality was defined as any patient who died in hospital (including transferred patients) within the first 30 days after the operation and those who died later during the initial hospitalization. The Standardized Mortality ratio (SMR) was the smoothed, adjusted, hospital-specific mortality rate divided by the expected mortality. To describe the variation in hospital mortality between hospitals in each region, we used different commonly used indicators of variation such as coefficients of variation (CV), interquartile interval or range (IQR), extreme ratio, and systematic component of variance (SCV).ResultsIn 2013–2020, 87,232 patients underwent lung resection for cancer in France. The number of deaths was 2,537, a rate of 2.91%. The median SMR of 199 hospitals was 0.99 with an IQR of 0.86 to 1.18 and a CV of 0.25. Among the regions that had the most hospitals performing lung resections for cancer, the extreme ratio was >2, which means that the maximum value is twice as high as the minimum value. The SCV between hospitals was >10 for two of these regions, which is considered indicative of very high variation. For the other regions (with few hospitals performing lung resections for cancer), the variation between hospitals was lower. Globally, the variability between regions concerning the SMR was moderate, 6% of the variance was due to differences across regions. On the contrary, the hospital volume was significantly related to the SMR (p = 0.003) with a negative linear trend, whatever the region.ConclusionThis work shows significant differences in the practices of the various hospitals within regions. However, overall, the variability in the 30-day mortality rate between regions was moderate. Our findings raises questions regarding the regionalization of major surgical procedures in France.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Pierre-Benoit Pages
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Service de Biostatistiques et d'Information Médicale (DIM), CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Inserm, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Villejuif, France
- *Correspondence: Catherine Quantin
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11
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Magnin J, Bernard A, Cottenet J, Lequeu JB, Ortega-Deballon P, Quantin C, Facy O. Impact of hospital volume in liver surgery on postoperative mortality and morbidity: nationwide study. Br J Surg 2023; 110:441-448. [PMID: 36724824 DOI: 10.1093/bjs/znac458] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND This nationwide retrospective study was undertaken to evaluate impact of hospital volume and influence of liver transplantation activity on postoperative mortality and failure to rescue after liver surgery. METHODS This was a retrospective study of patients who underwent liver resection between 2011 and 2019 using a nationwide database. A threshold of surgical activities from which in-hospital mortality declines was calculated. Hospitals were divided into high- and low-volume centres. Main outcomes were in-hospital mortality and failure to rescue. RESULTS Among 39 286 patients included, the in-hospital mortality rate was 2.8 per cent. The activity volume threshold from which in-hospital mortality declined was 25 hepatectomies. High-volume centres (more than 25 resections per year) had more postoperative complications but a lower rate of in-hospital mortality (2.6 versus 3 per cent; P < 0.001) and failure to rescue (5 versus 6.3 per cent; P < 0.001), in particular related to specific complications (liver failure, biliary complications, vascular complications) (5.5 versus 7.6 per cent; P < 0.001). Liver transplantation activity did not have an impact on these outcomes. CONCLUSION From more than 25 liver resections per year, rates of in-hospital mortality and failure to rescue declined. Management of specific postoperative complications appeared to be better in high-volume centres.
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Affiliation(s)
- Josephine Magnin
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Alain Bernard
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, University Hospital of Dijon, Dijon, France.,Department of Thoracic and Cardiovascular Surgery, University Hospital of Dijon, Dijon, France
| | - Jonathan Cottenet
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, University Hospital of Dijon, Dijon, France
| | - Jean-Baptiste Lequeu
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Catherine Quantin
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, University Hospital of Dijon, Dijon, France
| | - Olivier Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
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Madelaine L, Bernard A, Abou Hanna H, Aurélien M, Pagès PB. Pulmonary artery resection with autologous pericardial conduit to avoid pneumonectomy in lung neoplasms surgery: How to do it? JTCVS Tech 2023; 18:145-147. [PMID: 37096081 PMCID: PMC10122186 DOI: 10.1016/j.xjtc.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023] Open
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Braillon A, Bernard A, Leclercq T, Duloquin G, Comby PO, Loffroy R, Midulla M, Ricolfi F, Bejot Y, Guenancia C. Prediction of atrial fibrillation by cardiac imaging added to the acute stroke CT protocol. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Fuzeau A, Dion F, Angoulvant D, Ivanes F, Genet T, Delhommais A, Vermes E, Pucheux J, Cazeneuve N, Bernard A. Incidence, risk factors and multimodality imaging of post STEMI left ventricular thrombus, a monocentric one-year follow-up study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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15
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Pezel T, Dreyfus J, Mouhat B, Thebaut C, Audureau E, Bernard A, Lavie Badie Y, Bohbot Y, Fard D, Biere L, Le Ven F, Fauvel C, Donal E, Mansencal N, Coisne A. Efficacy of simulation-based training on transoesophageal echocardiography learning in a multicentre randomised controlled trial: SIMULATOR study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence on the impact of simulation-based training in transesophageal echocardiography (TEE) is scarce.
Purpose
We aimed to assess the efficacy of simulation-based versus traditional teaching on TEE knowledge and skills for cardiology residents.
Methods
Between November 2020 and November 2021, all consecutive cardiology residents inexperienced from TEE were randomised (1:1, n=324) through 42 French University Centers into two groups with or without simulation support (either a simulation group or a traditional group). The coprimary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the feelings of residents were also assessed. An economic analysis was also performed.
Results
While the theoretical and practical test scores were similar between the two groups before the training (respectively P=0.80 and P=0.51), the residents in the simulation group displayed higher theoretical test and practical test scores after the training than those in the traditional group (respectively 47.2±15.6% vs. 38.3±19.8%, P<0.0001 and 74.5±17.7% vs. 59.0±25.1%, P<0.0001). Subgroups analyses showed that the efficacy of the simulation training was even greater when performed at the beginning of residency (P<0.0001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group (respectively 8.3±1.4 min vs. 9.4±1.2 min, P<0.0001). Finally, residents' feelings were better in the simulation group than in the traditional group across all components (P<0.0001). Compared to the traditional group, the average additional cost per resident of the simulation program was respectively €1,785, €942 or €662 for 20, 40 and 60 residents.
Conclusion
Simulation-based teaching on TEE showed a significant improvement in knowledge, skills, and feelings of cardiology residents as well as a reduction in the duration to complete the examination.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere , Paris , France
| | - J Dreyfus
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | - B Mouhat
- University of Besançon , Besancon , France
| | - C Thebaut
- University Hospital of Limoges , Limoges , France
| | - E Audureau
- Henri-Mondor University Hospital, Unité de Recherche Clinique et Statistiques , Créteil , France
| | - A Bernard
- University of Tours - Faculty of Medicine , Tours , France
| | - Y Lavie Badie
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - D Fard
- Henri-Mondor University Hospital, Unité de Recherche Clinique et Statistiques , Créteil , France
| | - L Biere
- University Hospital of Angers , Angers , France
| | - F Le Ven
- University Hospital of Brest , Brest , France
| | - C Fauvel
- University Hospital of Rouen , Rouen , France
| | - E Donal
- Hospital Pontchaillou of Rennes , Rennes , France
| | - N Mansencal
- Ambroise Pare Universitary Hospital, Cardiology , Paris , France
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Pialot B, Bernard A, Liebgott H, Varray F. Sensitivity Enhancement Using Chirp Transmission for an Ultrasound Arthroscopic Probe. IEEE Trans Ultrason Ferroelectr Freq Control 2022; 69:2776-2784. [PMID: 35312619 DOI: 10.1109/tuffc.2022.3160880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Meniscal tear in the knee joint is a highly common injury that can require an ablation. However, the success rate of meniscectomy is highly impacted by difficulties in estimating the thin vascularization of the meniscus, which determines the healing capacities of the patient. Indeed, vascularization is estimated using arthroscopic cameras that lack of high sensitivity to blood flow. Here, we propose an ultrasound method for estimating the density of vascularization in the meniscus during surgery. This approach uses an arthroscopic probe driven by ultrafast sequences. To enhance the sensitivity of the method, we propose to use a chirp-coded excitation combined with a mismatched compression filter robust to the attenuation. This chirp approach was compared to a standard ultrafast emission and a Hadamard-coded emission using a flow phantom. The mismatched filter was also compared to a matched filter. Results show that, for a velocity of a few millimeters per second, the mismatched filter gives a 4.4-10.4-dB increase of the signal-to-noise ratio (SNR) compared to the Hadamard emission and a 3.1-6.6-dB increase compared to the matched filter. Such increases are obtained for a loss of axial resolution of 13% when comparing the point spread functions (PSFs) of the mismatched and matched filters. Hence, the mismatched filter allows increasing significantly the probe capacity to detect slow flows at the cost of a small loss in axial resolution. This preliminary study is the first step toward an ultrasensitive ultrasound arthroscopic probe able to assist the surgeon during meniscectomy.
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17
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Berrada-Gomez MP, Roch-Simon P, Bernard A, Rakotomalala S, Bigonne H, Ferret PJ. P22-22 Exposure data of cosmetic products for patients undergoing cancer treatments. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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18
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Aprile E, Abe K, Agostini F, Ahmed Maouloud S, Alfonsi M, Althueser L, Angelino E, Angevaare J, Antochi V, Antón Martin D, Arneodo F, Baudis L, Baxter A, Bellagamba L, Bernard A, Biondi R, Bismark A, Brown A, Bruenner S, Bruno G, Budnik R, Capelli C, Cardoso J, Cichon D, Cimmino B, Clark M, Colijn A, Conrad J, Cuenca-García J, Cussonneau J, D’Andrea V, Decowski M, Di Gangi P, Di Pede S, Di Giovanni A, Di Stefano R, Diglio S, Elykov A, Farrell S, Ferella A, Fischer H, Fulgione W, Gaemers P, Gaior R, Galloway M, Gao F, Glade-Beucke R, Grandi L, Grigat J, Higuera A, Hils C, Hoetzsch L, Howlett J, Iacovacci M, Itow Y, Jakob J, Joerg F, Joy A, Kato N, Kavrigin P, Kazama S, Kobayashi M, Koltman G, Kopec A, Landsman H, Lang R, Levinson L, Li I, Li S, Liang S, Lindemann S, Lindner M, Liu K, Lombardi F, Long J, Lopes J, Ma Y, Macolino C, Mahlstedt J, Mancuso A, Manenti L, Manfredini A, Marignetti F, Marrodán Undagoitia T, Martens K, Masbou J, Masson D, Masson E, Mastroianni S, Messina M, Miuchi K, Mizukoshi K, Molinario A, Moriyama S, Morå K, Mosbacher Y, Murra M, Müller J, Ni K, Oberlack U, Paetsch B, Palacio J, Peres R, Pienaar J, Pierre M, Pizzella V, Plante G, Qi J, Qin J, Ramírez García D, Reichard S, Rocchetti A, Rupp N, Sanchez L, dos Santos J, Sarnoff I, Sartorelli G, Schreiner J, Schulte D, Schulze Eißing H, Schumann M, Scotto Lavina L, Selvi M, Semeria F, Shagin P, Shi S, Shockley E, Silva M, Simgen H, Takeda A, Tan PL, Terliuk A, Thers D, Toschi F, Trinchero G, Tunnell C, Tönnies F, Valerius K, Volta G, Wei Y, Weinheimer C, Weiss M, Wenz D, Wittweg C, Wolf T, Xu Z, Yamashita M, Yang L, Ye J, Yuan L, Zavattini G, Zhang Y, Zhong M, Zhu T, Zopounidis J. Emission of single and few electrons in XENON1T and limits on light dark matter. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.106.022001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bernard A, Le May C, Martin JC, Delaby P, Le Bourgot C, Ledoux S, Besnard P. La voie tryptophan/Kynurenine : un nouveau lien entre obésité nutritionnelle, chirurgie bariatrique et perception orosensorielle des lipides. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Pezel T, Bernard A, Lavie-Badie Y, Dreyfus J, Bohbot Y, Fard D, Nguyen L, Biere L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Fauvel C, Ternacle J, Cautela J, Le Tourneau T, Donal E, Lafitte S, Mansencal N, Coisne A. SIMULATOR study: Multicentre randomized study to assess the impact of SIMULation-bAsed Training on transoesophageal echocardiOgraphy leaRning for cardiology residents. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Pages PB, Cottenet J, Bonniaud P, Tubert-Bitter P, Piroth L, Cadranel J, Bernard A, Quantin C. Impact of the SARS-CoV-2 Epidemic on Lung Cancer Surgery in France: A Nationwide Study. Cancers (Basel) 2021; 13:cancers13246277. [PMID: 34944896 PMCID: PMC8699699 DOI: 10.3390/cancers13246277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. This study aimed to assess the impact of SARS-CoV-2 on activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in 2020 at the national level in France. Our study shows a decrease in the volume of LC resections, especially during the first lockdown. We also show that only 0.43% of patients hospitalized for LC surgery during 2020 developed a SARS-CoV-2 infection, but this low rate is counterbalanced by a high IHM (21%) in these 51 patients. Our findings suggest that, even if the IHM is high, LC surgery is feasible during a pandemic provided that the general guidance protocols edited by the surgical societies are respected. Therefore, this study provides further arguments to encourage teams to test for COVID-19 prior to surgery and patients to be vaccinated. Abstract Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. The aim of this study was to assess the impact of the SARS-CoV-2 epidemic on surgical activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in France. All data for adult patients who underwent pulmonary resection for LC in France in 2020, collected from the national administrative database, were compared to 2018–2019. The effect of SARS-CoV-2 on the risk of IHM and severe complications within 30 days among LC surgery patients was examined using a logistic regression analysis adjusted for age, sex, comorbidities and type of resection. There was a slight decrease in the volume of LC resections in 2020 (n = 11,634), as compared to 2018 (n = 12,153) and 2019 (n = 12,227), with a noticeable decrease in April 2020 (the peak of the first wave of epidemic in France). We found that SARS-CoV-2 (0.43% of 2020 resections) was associated with IHM and severe complications, with, respectively, a sevenfold (aOR = 7.17 (3.30–15.55)) and almost a fivefold (aOR = 4.76 (2.31–9.80)) increase in risk. Our study suggests that LC surgery is feasible even during a pandemic, provided that general guidance protocols edited by the surgical societies are respected.
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Affiliation(s)
- Pierre-Benoit Pages
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, 21079 Dijon, France; (P.-B.P.); (A.B.)
- INSERM UMR 1231, Centre Hospitalier Universitaire Bocage, University of Burgundy, 21079 Dijon, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, University of Burgundy Franche-Comté, BP 77908, 21079 Dijon, France;
| | - Philippe Bonniaud
- Faculty of Medicine, University of Bourgogne-Franche-Comté, 21000 Dijon, France; (P.B.); (L.P.)
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit Department, Dijon University Hospital, BP 77908, 21079 Dijon, France
| | - Pascale Tubert-Bitter
- High-Dimensional Biostatistics for Drug Safety and Genomics, Paris-Saclay University, UVSQ, Inserm, CESP, 94800 Villejuif, France;
| | - Lionel Piroth
- Faculty of Medicine, University of Bourgogne-Franche-Comté, 21000 Dijon, France; (P.B.); (L.P.)
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21079 Dijon, France
- Infectious Diseases Department, Dijon University Hospital, BP 77908, 21079 Dijon, France
| | - Jacques Cadranel
- Chest Department and Constitutive Center for Rare Pulmonary Disease, Hôpital Tenon, AP-HP, Inflammation-Immunopathology-Biotherapy Department (DHU i2B) and Sorbonne University, 75020 Paris, France;
| | - Alain Bernard
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, 21079 Dijon, France; (P.-B.P.); (A.B.)
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital, University of Burgundy Franche-Comté, BP 77908, 21079 Dijon, France;
- High-Dimensional Biostatistics for Drug Safety and Genomics, Paris-Saclay University, UVSQ, Inserm, CESP, 94800 Villejuif, France;
- Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, 21079 Dijon, France
- Correspondence: ; Tel.: +(33)-3-80-29-34-65; Fax: +(33)-3-80-29-39-73
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22
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Vallejo Bustamante J, Wu NJ, Fermon C, Pannetier-Lecoeur M, Wakamura T, Watanabe K, Taniguchi T, Pellegrin T, Bernard A, Daddinounou S, Bouchiat V, Guéron S, Ferrier M, Montambaux G, Bouchiat H. Detection of graphene's divergent orbital diamagnetism at the Dirac point. Science 2021; 374:1399-1402. [PMID: 34882473 DOI: 10.1126/science.abf9396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- J Vallejo Bustamante
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - N J Wu
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France.,Université Paris-Saclay, CNRS, Institut des Sciences Moléculaires d'Orsay, Orsay, France
| | - C Fermon
- SPEC, CEA, CNRS, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | | | - T Wakamura
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France.,NTT Basic Research Laboratories, NTT Corporation, Atsugi, Kanagawa, Japan
| | - K Watanabe
- Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba 305-0044, Japan
| | - T Taniguchi
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science, 1-1 Namiki, Tsukuba 305-0044, Japan
| | - T Pellegrin
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - A Bernard
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - S Daddinounou
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - V Bouchiat
- Néel Institute, CNRS, 38000 Grenoble, France
| | - S Guéron
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - M Ferrier
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - G Montambaux
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - H Bouchiat
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
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Fauchier L, Bisson A, Bodin A, Herbert J, Spiesser PH, Pierre B, Clementy N, Babuty D, Bernard A, Lip GYH. All-cause mortality and cardiovascular death in 52091 patients with hypertrophic cardiomyopathy. A nationwide cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) have high risk of death related to cardiovascular (CV) death. Improvements in risk stratification are needed to help identify those HCM patients at higher risk of all-cause death and cardiovascular death.
Methods
This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adultshospitalized with isolated HCM. The overall sample of 52,091 patients was randomly partitioned into derivation (n=26,067) and validation (n=26,024) populations. A logistic regression model was used to construct HCM death and CV-death scores in the derivation sample, which were compared to the Charlson index, Frailty index and CHA2DS2VASc scores using c-indexes and calibration analysis.
Results
In 52,091 patients with isolated HCM, 12,676 (24.0%) died during follow-up of 3.0±2.8 years (median 2.3, interquartile range 0.4–5.0). Rate of all-cause death was 8.10%/year (7.96–8.24) and was 2.76%/year (2.68–2.84) for CV death.Independent predictors of CV death in HCM were older age, diabetes mellitus, heart failure, history of pulmonary edema, atrial fibrillation, ventricular tachycardia or fibrillation, ischemic stroke, while smoking and poor nutrition were associated with better survival (all p<0.05). In addition to these, male sex, vascular disease, alcohol related diagnoses, kidney disease, lung disease, liver disease anemia and cancer were independent predictors of all-cause death. In the derivation cohort, c-indexes for the HCM death score were 0.720 (0.713–0.727) for all-cause death and 0.695 (0.685–0.705) for CV death. For the HCM CV-death score, c-indexes were 0.679 (0.671–0.686) for all-cause death and 0.723 (0.712–0.733) for CV death. Performances were very similar in the validation cohort. Both scores had good calibrations. Charlson and Frailty indexes however had a better clinical usefulness than the HCM death score and HCM CV-death scores for predicting all-cause death. Decision curve analysis for CV death demonstrated that the HCM CV-death score had the best clinical usefulness of all the tested risk scores.
Conclusion
HCM patients have a high risk of all-cause and CV mortality. Independent predictors of CV-mortality in HCM were used to derive and validate a simple risk prediction model (French HCM CV-mortality score) which performed better than clinical scores, Charlson Index and Frailty Index; showing the best clinical usefulness, with good calibration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P H Spiesser
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - G Y H Lip
- City Hospital, Centre for Cardiovascular Sciences, Birmingham, United Kingdom
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Alifano M, Daffré E, Iannelli A, Brouchet L, Falcoz PE, Le Pimpec Barthes F, Bernard A, Pages PB, Thomas PA, Dahan M, Porcher R. The Reality of Lung Cancer Paradox: The Impact of Body Mass Index on Long-Term Survival of Resected Lung Cancer. A French Nationwide Analysis from the Epithor Database. Cancers (Basel) 2021; 13:cancers13184574. [PMID: 34572801 PMCID: PMC8471205 DOI: 10.3390/cancers13184574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Obesity could have a protective effect in patients with lung cancer. We assessed the prognostic role of preoperative BMI on survival in patients who underwent lung resection for NSCLC. A total of 54,631 consecutive patients with resectable lung cancer within a 15-year period were extracted from Epithor (the French Society of Thoracic and Cardiovascular Surgery database). Patient subgroups were defined according to body mass index (BMI): underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). Underweight was associated with lower survival (unadjusted HRs 1.24 (1.16-1.33)) compared to normal weight, whereas overweight and obesity were associated with improved survival (0.95 (0.92-0.98) and 0.88 (0.84-0.92), respectively). The impact of BMI was confirmed when stratifying for sex or Charlson comorbidities index (CCI). Among patients with obesity, a higher BMI was associated with improved survival. After adjusting for period of study, age, sex, WHO performance status, CCI, side of tumor, extent of resection, histologic type, and stage of disease, the HRs for underweight, overweight, and obesity were 1.51 (1.41-1.63), 0.84 (0.81-0.87), and 0.80 (0.76-0.84), respectively. BMI is a strong and independent predictor of survival in patients undergoing surgery for NSCLC.
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Affiliation(s)
- Marco Alifano
- Thoracic Surgery Department, Cochin Hospital, University of Paris, 75014 Paris, France;
- Correspondence:
| | - Elisa Daffré
- Thoracic Surgery Department, Cochin Hospital, University of Paris, 75014 Paris, France;
| | - Antonio Iannelli
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice, 06108 Nice, France;
| | - Laurent Brouchet
- Thoracic Surgery Department, Hôpital Larrey, CHU Toulouse, 31000 Toulouse, France; (L.B.); (M.D.)
| | - Pierre Emmanuel Falcoz
- Thoracic Surgery Department, Nouvel Hôpital Civil de Strasbourg, University of Strasbourg, 67000 Strasbourg, France;
| | | | - Alain Bernard
- Thoracic Surgery Department, Dijon University Hospital, 21000 Dijon, France; (A.B.); (P.B.P.)
| | - Pierre Benoit Pages
- Thoracic Surgery Department, Dijon University Hospital, 21000 Dijon, France; (A.B.); (P.B.P.)
| | - Pascal Alexandre Thomas
- Thoracic Surgery Department, Hopital-Nord-APHM, Aix-Marseille University, 13005 Marseille, France;
| | - Marcel Dahan
- Thoracic Surgery Department, Hôpital Larrey, CHU Toulouse, 31000 Toulouse, France; (L.B.); (M.D.)
| | - Raphael Porcher
- Centre of Research Epidemiology and Statistics (CRESS), University of Paris, INSERM U1153, 75014 Paris, France;
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Lequeu JB, Cottenet J, Facy O, Perrin T, Bernard A, Quantin C. Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients. HPB (Oxford) 2021; 23:1410-1417. [PMID: 33622649 DOI: 10.1016/j.hpb.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND FTR appears as a major cause of postoperative mortality (POM). Hospital volume has an impact on FTR in pancreatic surgery but no study has investigated this relationship more specifically in DP. METHODS We analysed patients with DP between 2009 and 2018 through a nationwide database. FTR definition was mortality among patients who experiment major complications. The cutoff between high and low volume centers was 20 pancreatectomies per year. RESULTS Some 10,632 patients underwent DP, 5048 (47.5%) were operated in 602 (95.4%) low volume centers and 5584 (52.5%) in 29 (4.6%) high volume centers. Overall FTR occurred in 11.2% of patients and was significantly reduced in high volume centers compared to low volume centers (10.2% vs 12.5%, p = 0.047). In multivariate analysis, surgery in a high volume center was a protective factor for POM (OR = 0.570, CI95% [0.505-0.643], p < 0.001) and also for FTR (OR = 0.550, CI95% [0.486-0.630], p < 0.001). CONCLUSION Hospital volume has a positive impact on FTR in DP. Patients with higher risk of FTR are men, with high modified Charlson comorbidity index, malignant conditions and open procedures.
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Affiliation(s)
- Jean-Baptiste Lequeu
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France.
| | - Jonathan Cottenet
- Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France
| | - Olivier Facy
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France
| | - Thomas Perrin
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France
| | - Alain Bernard
- Dijon University Hospital, Department of Thoracic Surgery, Dijon F-21000, France
| | - Catherine Quantin
- Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France
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Bernard A, Poupon-Nedelec M, Robichon C, Gommez-Berrada MP, Ferret PJ. Usage patterns of facial cosmetic products in Asia. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levron A, El Chehab H, Agard E, Bernard A, Verrecchia S, Badri Y, Dot C. Impact of estimated total keratometry on the refractive outcomes of the XY1AT toric intraocular lens in cataract surgery. J Fr Ophtalmol 2021; 44:e487-e492. [PMID: 34340885 DOI: 10.1016/j.jfo.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- A Levron
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
| | - H El Chehab
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - E Agard
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - A Bernard
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - S Verrecchia
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - Y Badri
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - C Dot
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France; French Military Health Service Academy of Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
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Moret A, Madelaine L, Cottenet J, Sophie Mariet A, Quantin C, Bernard A, Pagès PB. [Readmissions after lung resection in France: The PMSI database]. Rev Mal Respir 2021; 38:673-680. [PMID: 34175166 DOI: 10.1016/j.rmr.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. METHOD All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. RESULTS From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause readmissions rate was 24.9% (n=27,540). Patients after pneumonectomy had a readmission rate of 37% (n=4918) and 23% after lobectomy (n=2684) (P<0.0001). For the first period, we counted 10 hospitals with a standardized readmissions rate above the 99.8 limit and 10 hospitals above the 95% limit. For the second period, 8 hospitals had a standardized readmission rate above the 99.8% limit and 11 hospitals above the 95% limit. For the third period, 7 hospitals had a standardized readmission rate above the 99.8% limit and 6 hospitals above the 95% limit. CONCLUSION Readmissions to hospital 30 days after major lung resection for cancer in France declined little during these three periods. Measures to prevent readmissions should be introduced.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France
| | - L Madelaine
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France; Inserm UMR 1231, université de Bourgogne, Dijon, France
| | - J Cottenet
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France
| | - A Sophie Mariet
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France
| | - C Quantin
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France; Inserm, CIC 1432, Centre d'investigation clinique, hôpital de Dijon, université de Bourgogne, Dijon, France; Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, Paris, France
| | - A Bernard
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France.
| | - P B Pagès
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France; Inserm UMR 1231, université de Bourgogne, Dijon, France
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Berg E, Madelaine L, Baste JM, Dahan M, Thomas P, Falcoz PE, Martinod E, Bernard A, Pagès PB. Interest of anatomical segmentectomy over lobectomy for lung cancer: a nationwide study. J Thorac Dis 2021; 13:3587-3596. [PMID: 34277052 PMCID: PMC8264688 DOI: 10.21037/jtd-20-2203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
Background Anatomical segmentectomy is an alternative to lobectomy for early-stage lung cancer (LC) or in patients at high risk. The main objective of this study was to compare the morbidity and mortality associated with these two types of pulmonary resection using data from the French National Epithor database. Methods All patients who underwent lobectomy or segmentectomy for early-stage LC from January 1st 2014 to December 31st 2016 were identified in the Epithor database. The primary endpoint was morbidity; the secondary endpoint was postoperative mortality. Propensity score matching was implemented and used to balance groups. The results were reported as odds ratios (OR) and 95% confidence intervals (CI). Results During the study period, 1,604 segmentectomies (9.78%) and 14,786 lobectomies (90.22%) were performed. After matching, the segmentectomy group experienced significantly less atelectasis (OR 0.54; 95% CI: 0.4–0.75, P<0.0001), pneumonia (OR 0.72; 95% CI: 0.55–0.95, P=0.02), prolonged air leaks (OR 0.75; 95% CI: 0.64–0.89, P=0.001) or bronchopleural fistula (OR 0.35; 95% CI: 0.14–0.83, P=0.017), and fewer patients had at least one complication (OR 0.7; 95% CI: 0.62–0.78, P<0.0001). According to the Clavien-Dindo classification, postoperative complications were significantly less severe in the segmentectomy group (OR 0.52; 95% CI: 0.37–0.74, P<0.0001). There was no significant difference in postoperative mortality at 30 days (OR 0.67; 95% CI: 0.38–1.20, P=0.18), 60 days (OR 0.78; 95% CI: 0.42–1.47, P=0.4), or 90 days (OR 0.77; 95% CI: 0.45–1.34, P=0.36). Conclusions Anatomical segmentectomy is an alternative surgical approach that could reduce postoperative morbidity, but it does not appear to affect mortality.
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Affiliation(s)
- Elodie Berg
- CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France
| | | | | | | | | | | | | | - Alain Bernard
- CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France
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Bernard A, Cottenet J, Aho S, Doussot A, Mariet AS, Facy O, Quantin C. Detecting Hospital Outliers in Post-Pancreatectomy Care Using Funnel Plots from 2009-2018 Based on Nationwide Medico-Administrative Data. World J Surg 2021; 45:2210-2217. [PMID: 33821349 PMCID: PMC8154844 DOI: 10.1007/s00268-021-06078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
Objectives Our objective was to identify hospitals with unusual mortality rates for major pancreatectomies over a period of ten years using 30-day mortality data from the French national database. Methods Data for all patients who underwent pancreatectomy were extracted from the national medico-economic database (Programme de Médicalisation des Systèmes d'Information). To identify quality outliers for each hospital, the observed-to-expected 30-day mortality rates were used as a quality indicator. Results A total of 19 494 patients underwent a major pancreatectomy in France between January 2009 and December 2018. The overall 30-day mortality rate was 4.8% (n = 944). For the 2009–2014 period, the funnel plot showed that 10 of the 176 hospitals lie outside the central 95% region and 7 lie outside the central 99.8% region. For the 2015–2018 period, out of 176 hospitals, 6 lie outside the central 95% region and 2 lie outside the central 99.8% region. The change in standardized mortality ratios between 2009–2014 and 2015–2018 testing for differences from the overall change, they were there 4 hospitals lie outside the central 95% region and 0 lie outside the central 99.8% region. Conclusion Over time, the improvement in hospital quality was weak. This study suggests that there is a pressing need to reorganize the supply of care for pancreatic surgery in France.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, Dijon University Hospital, CHU Dijon, Hôpital du Bocage, 14 rue Gaffarel, BP 77908, 21079, Dijon, France.
| | - Jonathan Cottenet
- Department of Biostatistics, Dijon University Hospital, University of Burgundy, Dijon, France
| | - Serge Aho
- Bacteriology and Hospital Hygiene Department, Nantes University Hospital, Nantes, France
| | - Alexandre Doussot
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France
| | - Anne-Sophie Mariet
- Department of Biostatistics, Dijon University Hospital, University of Burgundy, Dijon, France
| | - Olivier Facy
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Department of Biostatistics, Dijon University Hospital, University of Burgundy, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Centre, Dijon University Hospital, University of Burgundy, Dijon, France.,INSERM, UVSQ, Pasteur Institute, Paris-Saclay University, Paris, France
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Lacout M, David C, Bernard A, Saint Etienne C, Clerc JM, Quilliet L, Dion F, Caze C. prognostic evaluation of patients benefiting from a trans aortic valve replacement according to the type of aortic stenosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Aortic Stenosis (AS) is a common condition in patients over 75 years. Latest ESC recommendations differentiate 4 types of AS according to: Indexed Stroke Volume (SVi), mean gradient and left ventricular ejection fraction (LVEF). The aim of our study is to evaluate prognosis of patients who have had a transcatheter aortic valve replacement (TAVR), in terms of mortality, according to the 4 types of AS.
Methods
This study compares prognosis of 620 patients who had TAVR between January 1, 2015 and December 31, 2018. Patients were classified into 4 groups according to AS type: high gradient; low gradient, low flow, low LVEF; low gradient, low flow, normal LVEF; low gradient, normal flow.
Results
69 patients (11.1%) died within 12 months of the procedure: 49 in the high gradient group (9.4%); 13 in the low gradient, low flow, low LVEF group (47.1%); 1 in the low gradient, low flow, normal LVEF group (5%); 6 in the low gradient, normal flow, normal LVEF group (18.2%). All-cause mortality at one year follow-up is higher in low-gradient, low-flow, altered LVEF group (p = 0.0004) than in other groups. Patients in this group were significantly more often admitted for heart failure than patients in high-gradient group (p = 0.009).
Conclusion
A complete echocardiography evaluation is needed to evaluate AS, its severity and type. Patients in the low gradient, low flow, low LVEF group have an independent risk of mortality at 12 months higher than other groups and are more hospitalized than patients in the high gradient group.
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Affiliation(s)
- M Lacout
- Hospital Pontchaillou of Rennes, cardiology, Rennes, France
| | - C David
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - A Bernard
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - C Saint Etienne
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - JM Clerc
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - L Quilliet
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - F Dion
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - C Caze
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
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Marchand L, Luyton C, Bernard A. Glucagon-like peptide-1 (GLP-1) receptor agonists in type 2 diabetes and long-term complications: FOCUS on retinopathy. Diabet Med 2021; 38:e14390. [PMID: 32799379 DOI: 10.1111/dme.14390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 01/22/2023]
Affiliation(s)
- L Marchand
- Department of Endocrinology and Diabetes, Centre Hospitalier Saint Joseph Saint Luc, Lyon
| | - C Luyton
- Department of Endocrinology and Diabetes, Centre Hospitalier Saint Joseph Saint Luc, Lyon
| | - A Bernard
- Department of Ophthalmology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite
- Department of Ophthalmology, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
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Bernard A, Leclercq T, Béjot Y, Duloquin G, Comby P, Ricolfi F, Guenancia C. High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke CT protocol. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Quignon P, da Mata P, Faraj F, Guibert S, Bernard A, Léonardi J, Loundou AD, Vitte J, Charpin D. Altitude healing effect in severe asthmatic children. Respir Med Res 2020; 79:100810. [PMID: 33540154 DOI: 10.1016/j.resmer.2020.100810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/25/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The beneficial effect of a climatic treatment in children with asthma was established quite some time ago, but the mechanism of this beneficial effect has not been fully elucidated. We investigated the role of the cytokines of the TH2 pathway, reactive oxygen species (ROS) and reactive nitrogen species (RNS) over the course of a high-altitude climatic therapy. METHODS A group of 67 children originating from various French towns suffering from uncontrolled severe asthma was sent via their medical specialists, to the Briançon climatic area. They were monitored over the course of an entire school year. During this time, they returned home for 15 days during the Christmas holidays. At each stage, assessment of asthma control, lung function examination (peak flow meter and spirometry), and measurement of exhaled NO, ROS and RNS in exhaled breath condensate (EBC), and the level of cytokines in the plasma of the TH2 pathway were carried out. RESULTS The degree of asthma control improved at high altitude and worsened upon returning home. The average value of the peak expiratory flow also improved during the first 3 months but then worsened upon returning home, while the other spirometric parameters did not change. The level of expired NO and the scores for quality of life underwent a similar change. The level of RNS and ROS in the EBC did not change significantly. Besides, a marked and statistically significant decrease in the level of IL-13 and IL-10 was noted. CONCLUSION The beneficial effect of a climatic stay of children suffering from allergic asthma at altitude appears to be linked with less allergenic stimulation.
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Affiliation(s)
- P Quignon
- CEMBREU, 35, rue Croix de Bretagne, 05100 Briançon, France.
| | - P da Mata
- Instituto Clínico de Alergologia, avenue de Berna No. 30, 4(e) B 1050-042, Lisbon, Portugal.
| | - F Faraj
- Centre Les Jeunes Pousses, 34 A, avenue de la République, 05100 Briançon, France
| | - S Guibert
- Centre Les Hirondelles, 17, rue Maisonnette, 05100 Villar-Saint-Pancrace, France
| | - A Bernard
- Centre La Guisane, rue de la Croix de Bretagne, 05100 Villar-Saint-Pancrace, France
| | - J Léonardi
- Centre La Guisane, rue de la Croix de Bretagne, 05100 Villar-Saint-Pancrace, France
| | - A D Loundou
- Department of Medical Statistics, Aix Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France.
| | - J Vitte
- Aix-Marseille University IRD, AP-HM, MEPHI, Immunology Department, 19-21, boulevard Jean-Moulin, 13005 Marseille, France.
| | - D Charpin
- Pulmonology Unit, La Timone Hospital, Aix Marseille University, 264, rue Saint-Pierre, Marseille, France.
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Lantelme P, Bisson A, Lacour T, Herbert J, Ivanes F, Bourguignon T, Quilliet L, Angoulvant D, Harbaoui B, Bonnet M, Bernard A, Babuty D, Saint-Etienne C, Deharo P, Fauchier L. Impact of the timing of coronary revascularization relative to the transcatheter aortic valve implantation procedure: insights from a propensity score analysis based on a nationwide analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The significance and the management of coronary artery disease (CAD) are disputed in patients treated by transcatheter aortic valve implantation (TAVI). In the presence of a significant CAD eligible for percutaneous coronary intervention (PCI), the issue of the timing of PCI relative to TAVI is unsettled. To answer this question, the present study aimed at comparing the short-term and long-term outcome in patients treated by staged PCI within a 90-day time interval before or after TAVI.
Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with TAVI between 2014 and 2018. Patients treated with PCI in the preceding 90 days before the TAVI procedure (pre-TAVI PCI) or subsequent 90 days after the TAVI procedure (post-TAVI PCI) were included. All-cause mortality, cardiovascular mortality, stroke, myocardial infarction and a combined cardiovascular endpoint were assessed at 30 days after the last procedure (short-term) and during the whole follow-up (long-term). Propensity score matching was used for the analysis of outcomes.
Results
8613 patients met the inclusion criteria with a vast majority of pre-TAVI PCI patients (N=8324) as opposed to post-TAVI PCI (N=229). After propensity score matching, 2 groups of 227 patients with comparable characteristics were obtained. At 30 days, no significant difference was observed for any of the outcome tested with the exception of myocardial infarction more frequent in post-TAVI PCI (OR 2.43 [1.17–5.07]). After a mean [SD] follow-up of 459 [569] days, all outcomes were identical between subgroups. The figure below illustrates the Kaplan Meier curve for all-cause mortality.
Conclusions
Our study based on a French nationwide database shows that PCI is performed pre-TAVI in a majority of cases, with no significant impact on outcome. Deferring PCI after TAVI seems safe and may provide an opportunity to make the decision on more objective parameters while the stenosis has been removed (such as FFR or IFR). In any case, the timing of PCI relative to TAVI does not seem to represent a concern and should be decided on an individual basis.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Lantelme
- Croix-Rousse Hospital - HCL, Lyon, France
| | - A Bisson
- University Hospital of Tours, Cardiology, Tours, France
| | - T Lacour
- University Hospital of Tours, Cardiology, Tours, France
| | - J Herbert
- University Hospital of Tours, Cardiology, Tours, France
| | - F Ivanes
- University Hospital of Tours, Cardiology, Tours, France
| | - T Bourguignon
- University Hospital of Tours, Cardiology, Tours, France
| | - L Quilliet
- University Hospital of Tours, Cardiology, Tours, France
| | - D Angoulvant
- University Hospital of Tours, Cardiology, Tours, France
| | - B Harbaoui
- Croix-Rousse Hospital - HCL, Lyon, France
| | - M Bonnet
- Croix-Rousse Hospital - HCL, Lyon, France
| | - A Bernard
- University Hospital of Tours, Cardiology, Tours, France
| | - D Babuty
- University Hospital of Tours, Cardiology, Tours, France
| | | | - P Deharo
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - L Fauchier
- University Hospital of Tours, Cardiology, Tours, France
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Fauchier L, Bisson A, Deharo P, Bodin A, Herbert J, Lacour T, Quilliet L, Ivanes F, Clerc J, Saint Etienne C, Bourguignon T, Babuty D, Bernard A. Development of a claims-based EuroSCORE II in patients with aortic stenosis needing surgical or transcatheter aortic valve replacement using electronic hospital records: a nationwide study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prediction of operative risk in patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) remains a challenge, particularly in high-risk patients. The EuroSCORE II is now commonly used to improve risk prediction. Large analyses from administrative database have provided opportunities for conducting health research in the field of structural heart disease interventions but may have a lack of granularity and do not routinely include EuroSCORE II, which may result in a risk of uncontrolled biases. We sought to approximate the EuroSCORE II using only administrative claims data to enable the operative risk to be assessed without clinical or paraclinical performance measures.
Methods
Based on the administrative hospital-discharge database, we collected information for all patients with AS treated with SAVR or TAVI between 2010 and 2019 in France. A total of 78,085 SAVR and 60,821 patients with AS treated with transcatheter aortic valve replacement (TAVR) were found in the database. For each patient, the EuroSCORE II was estimated using the formulas available at the EuroSCORE website. Age, gender, extracardiac arteriopathy, poor mobility, previous cardiac surgery, chronic lung disease, active endocarditis, diabetes on insulin, recent MI, dialysis are items available in the PMSI database using the ICD-10 or CCAM codes. For renal impairment, NYHA class, LVEF, pulmonary hypertension, “critical preoperative state” and urgent intervention, different proxies were built based on ICD-10 codes likely to represent increasing severity of these items.
Results
In the cohort of patients with SAVR, mean estimated EuroSCORE II was 3.3±1.1 while all-cause death at day 30 after SAVR was 3.8%. In the cohort of patients with TAVI, mean estimated EuroSCORE II was 3.8±1.0 while all-cause death at day 30 after TAVI was 5.5%. In the whole cohort, the area under the curve (AUC) of the estimated EuroSCORE II for predicting the risk of all-cause death at day 30 was 0.72 (95% CI 0.71–0.73) and was higher in patients treated with SAVR (AUC 0.76, 95% CI 0.75–0.77) than in those treated with TAVI (AUC 0.67, 95% CI 0.65–0.68, p<0.00001 for DeLong test). The observed versus predicted risks of all-cause death at day 30 post-TAVI OR SAVR within risk deciles are shown in Figure 1. Calibration of the prediction score was satisfying across the 10 deciles and a predicted 30-day mortality rate of approximately 15%.
Conclusions
Claims data alone can be used to identify individuals with AS at operative risk when they are considered for SAVR or TAVI. The Claims-based EuroSCORE II might be used in research with large datasets for confounding adjustment or risk prediction. It provides hospitals and health systems with a low-cost, systematic way to identify a group of patients who are at greater risk of adverse outcomes with these interventions and for whom a more specific approach might be useful.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P Deharo
- APHM La Timone Hospital, Marseille, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Lacour
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - L Quilliet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J.M Clerc
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - C Saint Etienne
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Bourguignon
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Nguyen PT, Boral LI, O’Brien J, Zhang D, Gao Y, Bernard A. Reducing Inappropriate Overutilization of the Massive Transfusion Protocol. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Massive transfusion protocols (MTPs) make it possible to deliver blood products to exsanguinating patients in an efficient, sustained, and immediate manner. However, overutilization of MTPs continues to remain a significant problem for hospital blood banks. The study aims to address the characteristics of possibly inappropriate MTP activations during the first phase (cooler) at a level 1 trauma academic medical center.
Methods
This was a retrospective review of 328 phase 1 MTPs out of 696 total MTPs performed during a two-year period (Jan 1, 2017 and Dec 31, 2018) and divided into three categories: trauma, non-trauma surgery, and medicine services. We assumed that a possibly inappropriate MTP for trauma cases would show an Assessment of Blood Component (ABC) score of 1 or less and physicians used clinical discretion. For possibly inappropriate MTP non- trauma surgical and medicine cases, we devised a new system where we looked at only whether the blood pressure was equal to or less than 90 mm Hg and/or the pulse was greater than or equal to 120 beats per minute. If there was a score of 0 where there were neither vital sign criteria, then the MTP was considered possibly inappropriate.
Results
For trauma service, there were 43/168 (25.6%) cases that had an ABC score of 0, 49/168 (29.2%) cases that had an ABC score of 1, 53/168 (31.5%) cases that had an ABC score of 2, 21/168 (12.5%) cases that had an ABC score of 3, and only 2/168 (1.2%) case that had an ABC score of 4. Non-trauma surgery service had 31/51 (60.8%) cases with a new score of 0, 20/51 (39.2%) cases with a new score of 1, and 0/51 (0%) cases with a new score of 2. Medicine services had 57/109 (52.3%) patients with a new score of 0, 47/109 (43.1%) patients with a new score of 1, and 5/109 (4.6%) patients with a new score of 2. Non-trauma surgery service had the greatest possibly inappropriate MTP activations [31/51 cases (60.8%)], followed by trauma [92/168 (54.8%) cases] and medicine [57/109 (52.3%) cases].
Conclusion
Our study shows greater overutilization with MTPs using clinical judgment than with using the ABC criteria. Non-trauma surgery service had the greatest number of possibly inappropriate MTP activations at our hospital without having a significantly abnormal pulse or blood pressure. While ABC criteria is already liberal for activating an MTP, physician discretion appears to be more liberal in activating a possibly inappropriate MTP.
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Affiliation(s)
- P T Nguyen
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - L I Boral
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - J O’Brien
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - D Zhang
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - Y Gao
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - A Bernard
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
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Heren-Le Bastard C, Bernard A, Fliss R, Legouvello S, Allain P. [Psychometric validation of an Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA). French translation of the article]. J Fr Ophtalmol 2020; 44:S0181-5512(20)30447-2. [PMID: 34756385 DOI: 10.1016/j.jfo.2020.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Handicap evaluation in adults with acquired or progressive congenital visual loss allows for identification of the individual's specific needs and targeted therapy (medical, technical, rehabilitative and psychological). Currently, the subjective dimension of the handicap remains poorly explored in the field of visual loss. Our questionnaire aims to understand the whole of these subjective impacts. It differs from existing quality of life scales in ophthalmology in its approach centered on the process of adaptation, individual resources (technical, cognitive, psychic and environmental), and investigation of the perception of the handicap. The goal of the present study is to validate this questionnaire, which could be used in any adult with a visual handicap, regardless of the extent of the visual loss, its etiology, or the type of treatment or compensatory mechanisms. MATERIALS AND METHODS The Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA) is composed of 28 items relating to perception of the visual impairment, its impact, and adaptive resources. They are divided into 3 sub-categories: perception of daily life and relationships (10 items), Perception of visual status and compensatory mechanisms (8 items), and Psychological impact of the visual handicap (10 items). The responses are graded on a Likert scale. Factor analysis and verification of psychometric qualities were performed based on the responses of 446 subjects. The discriminatory validity of the NEI-VFQ 25 was proven with 99 subjects. Reliability over time (mean interval between T1 and T2=49.43 days) was measured in 31 subjects. Sensitivity to change between pre- and post-management (mean interval between T1 and T2=410 days) was tested in 123 subjects. RESULTS Internal consistency was very good for the global scale (α=.90) as well as for the 3 sub-dimensions (α=.86; α=.79; α=.80). The discriminatory validity was satisfactory (r=.70). This result had to be interpreted as a function of the qualitative specificity of the questionnaire. The questionnaire enjoyed good reproducibility over time with regard to its total score and relatively satisfactory reproducibility with regard to its sub-dimensions. Sensitivity to change was very high and accounted for adaptations to the disability over time. CONCLUSION The QUEPAHVA displays good psychometric qualities. It constitutes a new means of evaluation. Its potential applications are many. It permits evaluation of the needs of the individual and adaptation of the protocol of care. Its use in institutions may support a step forward in the science of evaluation and continued improvement in quality of care.
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Affiliation(s)
- C Heren-Le Bastard
- Centre régional basse vision et troubles de l'audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France; Laboratoire de psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, Maison de la recherche Germaine Tillion, université Angers, université Nantes, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France.
| | - A Bernard
- Équipe BePsyLab, université d'Angers, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France
| | - R Fliss
- Département de neurologie, CHU Angers, 49033 Angers, France; Centre de réadaptation Les Capucins, 49100 Angers, France
| | - S Legouvello
- Centre régional basse vision et troubles de l'audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France
| | - P Allain
- Laboratoire de psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, Maison de la recherche Germaine Tillion, université Angers, université Nantes, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France; Département de neurologie, CHU Angers, 49033 Angers, France
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Heren-Le Bastard C, Bernard A, Fliss R, Legouvello S, Allain P. Psychometric validation of an Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA). J Fr Ophtalmol 2020; 43:e341-e350. [PMID: 33020020 DOI: 10.1016/j.jfo.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Handicap evaluation in adults with acquired or progressive congenital visual loss allows for identification of the individual's specific needs and targeted therapy (medical, technical, rehabilitative and psychological). Currently, the subjective dimension of the handicap remains poorly explored in the field of visual loss. Our questionnaire aims to understand the whole of these subjective impacts. It differs from existing quality of life scales in ophthalmology in its approach centered on the process of adaptation, individual resources (technical, cognitive, psychic and environmental), and investigation of the perception of the handicap. The goal of the present study is to validate this questionnaire, which could be used in any adult with a visual handicap, regardless of the extent of the visual loss, its etiology, or the type of treatment or compensatory mechanisms. MATERIALS AND METHODS The Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA) is composed of 28 items relating to perception of the visual impairment, its impact, and adaptive resources. They are divided into 3 sub-categories: Perception of daily life and relationships (10 items), Perception of visual status and compensatory mechanisms (8 items), and Psychological impact of the visual handicap (10 items). The responses are graded on a Likert scale. Factor analysis and verification of psychometric qualities were performed based on the responses of 446 subjects. The discriminatory validity of the NEI-VFQ 25 was proven with 99 subjects. Reliability over time (mean interval between T1 and T2=49.43 days) was measured in 31 subjects. Sensitivity to change between pre- and post-management (mean interval between T1 and T2=410 days) was tested in 123 subjects. RESULTS Internal consistency was very good for the global scale (α=.90) as well as for the 3 sub-dimensions (α=.86; α=.79; α=.80). The discriminatory validity was satisfactory (r=.70). This result had to be interpreted as a function of the qualitative specificity of the questionnaire. The questionnaire enjoyed good reproducibility over time with regard to its total score and relatively satisfactory reproducibility with regard to its sub-dimensions. Sensitivity to change was very high and accounted for adaptations to the disability over time. CONCLUSION The QUEPAHVA displays good psychometric qualities. It constitutes a new means of evaluation. Its potential applications are many. It permits evaluation of the needs of the individual and adaptation of the protocol of care. Its use in institutions may support a step forward in the science of evaluation and continued improvement in quality of care.
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Affiliation(s)
- C Heren-Le Bastard
- Centre Régional Basse Vision et Troubles de l'Audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France; Laboratoire de Psychologie des Pays-de-la-Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, UNIV Nantes, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers cedex 01, France.
| | - A Bernard
- Équipe BePsyLab, Université d'Angers, 5 bis, Boulevard Lavoisier, 49045 Angers cedex 01, France
| | - R Fliss
- Département de Neurologie, CHU Angers, 49033 Angers, France; Centre de réadaptation Les Capucins, 49100 Angers, France
| | - S Legouvello
- Centre Régional Basse Vision et Troubles de l'Audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France
| | - P Allain
- Laboratoire de Psychologie des Pays-de-la-Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, UNIV Nantes, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers cedex 01, France; Département de Neurologie, CHU Angers, 49033 Angers, France
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Malouf R, Marchal C, Paget-Bailly S, Westeel V, Bernard A. Limited resections versus lobectomy for stage I non-small cell lung cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd013728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Reem Malouf
- National Perinatal Epidemiology Unit (NPEU); University of Oxford; Oxford UK
| | | | - Sophie Paget-Bailly
- Methodological and Quality of Life in Oncology Unit; University Hospital of Besançon; Besançon France
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
| | - Virginie Westeel
- Methodological and Quality of Life in Oncology Unit; University Hospital of Besançon; Besançon France
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France
- Department of Thoracic Oncology; University Hospital of Besançon; Besançon France
| | - Alain Bernard
- Chirurgie Cardio-Vasculaire et Thoracique; CHU Dijon; Dijon Cedex France
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Die Loucou J, Pagès PB, Falcoz PE, Thomas PA, Rivera C, Brouchet L, Baste JM, Puyraveau M, Bernard A, Dahan M. Validation and update of the thoracic surgery scoring system (Thoracoscore) risk model. Eur J Cardiothorac Surg 2020; 58:350-356. [DOI: 10.1093/ejcts/ezaa056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The performance of prediction models tends to deteriorate over time. The purpose of this study was to update the Thoracoscore risk prediction model with recent data from the Epithor nationwide thoracic surgery database.
METHODS
From January 2016 to December 2017, a total of 56 279 patients were operated on for mediastinal, pleural, chest wall or lung disease. We used 3 recommended methods to update the Thoracoscore prediction model and then proceeded to develop a new risk model. Thirty-day hospital mortality included patients who died within the first 30 days of the operation and those who died later during the same hospital stay.
RESULTS
We compared the baseline patient characteristics in the original data used to develop the Thoracoscore prediction model and the validation data. The age distribution was different, with specifically more patients older than 65 years in the validation group. Video-assisted thoracoscopy accounted for 47% of surgeries in the validation group compared but only 18% in the original data. The calibration curve used to update the Thoracoscore confirmed the overfitting of the 3 methods. The Hosmer–Lemeshow goodness-of-fit test was significant for the 3 updated models. Some coefficients were overfitted (American Society of Anesthesiologists score, performance status and procedure class) in the validation data. The new risk model has a correct calibration as indicated by the Hosmer–Lemeshow goodness-of-fit test, which was non-significant. The C-index was strong for the new risk model (0.84), confirming the ability of the new risk model to differentiate patients with and without the outcome. Internal validation shows no overfitting for the new model
CONCLUSIONS
The new Thoracoscore risk model has improved performance and good calibration, making it appropriate for use in current clinical practice.
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Affiliation(s)
- Julien Die Loucou
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Pierre-Benoit Pagès
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
- INSERM UMR 1231, Dijon University Hospital, University of Burgundy, Dijon, France
| | | | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Hopital-Nord-APHM, Aix-Marseille University, Marseille, France
| | - Caroline Rivera
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hopital Larrey, CHU Toulouse, Toulouse, France
| | | | - Marc Puyraveau
- Department of Biostatistics and Epidemiology, CHU Besançon, Besançon, France
| | - Alain Bernard
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Marcel Dahan
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
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Abstract
Gout is a chronic disease due to the deposition of monosodium urate microcrystals in joints and tissues. Its incidence and prevalence are increasing worldwide in close relation with the epidemic of obesity and metabolic syndrome. Gout is related to chronic hyperuricemia that should be treated to ensure the reduction or even the disappearance of acute attacks ("gout flares") and to reduce the size and number of tophi. If arthritis of the first metatarsophalangeal joint is the most typical form, other joints may be affected, including the spine. Demonstration of urate microcrystals arthritis allows diagnosis of gout but, in the absence of possibility of performing joint puncture, imaging may be useful for providing complementary diagnostic elements. Appropriate care is essential to reduce the number of flares and the evolution towards gouty arthropathy but also in terms of public health in order to reduce costs related to this pathology.
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Affiliation(s)
- A Scuiller
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti
| | - T Pascart
- Service de rhumatologie, hôpital Saint-Philibert, université de Lille, 59462 Lomme cedex, France
| | - A Bernard
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti
| | - E Oehler
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti.
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Fauchier L, Bisson A, Herbert J, Lacour T, Bourguignon T, Etienne CS, Bernard A, Deharo P, Bernard L, Babuty D. Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement. Clin Microbiol Infect 2020; 26:1368-1374. [PMID: 32036047 DOI: 10.1016/j.cmi.2020.01.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in aortic stenosis (AS). Infective endocarditis (IE) in patients with prosthetic heart valves is associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after TAVI are conflicting. We evaluated these issues in patients with percutaneous TAVI vs. isolated surgical AVR (SAVR) at a nationwide level. METHODS Based on the administrative hospital discharge database, the study collected information for all patients with aortic stenosis treated with AVR in France between 2010 and 2018. RESULTS A total of 47 553 patients undergoing TAVI and 60 253 patients undergoing isolated SAVR were identified. During a mean follow-up of 2.0 years (median (25th to 75th percentile) 1.2 (0.1-3.4) years), the incidence rates of IE were 1.89 (95% confidence interval (CI) 1.78-2.00) and 1.40 (95% CI 1.34-1.46) events per 100 person-years in unmatched TAVI and SAVR patients, respectively. In 32 582 propensity-matched patients (16 291 with TAVI and 16 291 with SAVR), risk of IE was not different in patients treated with TAVI vs. SAVR (incidence rates of IE 1.86 (95% CI 1.70-2.04) %/year vs 1.71 (95% CI 1.58-1.85) %/year respectively, relative risk (RR) 1.09, 95% CI 0.96-1.23). In these matched patients, total mortality was higher in TAVI patients with IE (43.0% 95% CI 37.3-49.3) than in SAVR patients with IE (32.8% 95% CI 28.6-37.3; RR 1.32, 95% CI 1.08-1.60). DISCUSSION In a nationwide cohort of patients with AS, treatment with TAVI was associated with a risk of IE similar to that following SAVR. Mortality was higher for patients with IE following TAVI than for those with IE following SAVR.
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Affiliation(s)
- L Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France.
| | - A Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - J Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France; Service d'information Médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, France
| | - T Lacour
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - T Bourguignon
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France
| | - C Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - A Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - P Deharo
- Département de Cardiologie, Centre Hospitalier Universitaire Timone, Inserm, Inra, C2VN, France et Faculté de Médecine, Université Aix-Marseille, Marseille, France
| | - L Bernard
- Service de Médecine interne et Maladies Infectieuses, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France
| | - D Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
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Bernard C, Morgant M, Jazayeri A, Bernard A, Bouchot O. Optimal timing of coronary artery bypass grafting in hemodynamically stable patients after myocardial infarction and definition of poor prognostic factors. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fauchier L, Bernard A, Bisson A, Lacour T, Herbert J, Ivanes F, Bourguignon T, Clerc JM, Quilliet L, Guillon Grammatico L, Angoulvant D, Saint Etienne C, Babuty D. 4070Clinical impact of mitral regurgitation before or following transcatheter aortic valve replacement in patients with aortic stenosis: a nationwide multivariable analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Patients undergoing transcatheter aortic valve replacement (TAVR) may have concomitant mitral regurgitation (MR). The impact of MR at baseline or after TAVR on subsequent prognosis remains to be more precisely determined. We analysed the impact of MR before or after TAVR on prognosis in the systematic analysis of patients treated with TAVR at a nationwide level.
Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Cox regression was used for the analysis of predictors of events during follow-up.
Results
A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Moderate/severe MR was present at baseline (MRb) in 9.5% of the patients. Few patients (1.6%) revealed moderate/severe MR post-TAVR (MRpt). Mean follow-up was 1.31±1.61 years. MRb was associated with an increased cardiovascular mortality (Hazard ratio 1.29, 95% CI 1.20–1.39) and total mortality (Hazard ratio 1.15, 95% CI 1.10–1.21). However, MRb was not an independent predictor in multivariable analysis, neither for cardiovascular mortality (adjusted HR 1.06, 95% CI 0.98–1.14) nor for total mortality (adjusted HR 1.01, 95% CI 0.96–1.07). MRpt was not a predictor of cardiovascular or total mortality. Older age, male sex, history of pulmonary edema/cardiogenic shock, atrial fibrillation, myocardial infarction, diabetes, renal failure, liver disease, pulmonary disease, previous cancer and anemia at baseline independently predicted mortality during follow-up. All of them (but history of cancer) were also independent predictor of cardiovascular death.
Conclusion
Baseline MR was associated with increased cardiovascular and totality mortality following TAVR but was not an independent predictor of any of them. By contrast, several other predictors of cardiovascular and total mortality were identified. This suggests that MR should not be directly considered to establish the strategy for TAVR decision or for avoiding TAVR-related futility.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Lacour
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Bourguignon
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J M Clerc
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - L Quilliet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - D Angoulvant
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - C Saint Etienne
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Fauchier L, Bisson A, Herbert J, Lacour T, Ivanes F, Bourguignon T, Clerc JM, Quilliet L, Lantelme P, Angoulvant D, Babuty D, Guillon Grammatico L, Bernard A, Saint Etienne C. P1794Futility risk model development and validation among patients with aortic stenosis treated with transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Risk-benefit assessment for transcatheter aortic valve replacement (TAVR) is still a matter of debate. A sizeable group of patients do not fully benefit from intervention despite a technically successful procedure. We therefore sought to identify patients with a bad outcome early after the procedure, and to develop a prediction model and calculator for identification of these patients.
Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Multivariate logistic regression was used to select the risk factors of early all-cause death in first year after TAVR procedure (considered as futility) for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the C-statistic.
Results
A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Mean follow-up was 1.31±1.61 years and 9,338 deaths were recorded (yearly rate 14.9%), among which 4,562 (49%) occurred in first year after TAVR procedure. The final logistic regression model included older age, male sex, history of hospital stay with heart failure, history of acute pulmonary oedema, atrial fibrillation, previous stroke, vascular disease, diabetes, renal disease, liver disease, pulmonary disease, anemia, history of cancer, metastasis and denutrition,. The area under the curve (AUC) for the score was 0.696 (95% CI 0.688–0.704). This score outperformed frailty index and Charlson comorbidity index for identifying futility. AUC was 0.677 (95% CI 0.669–0.86) for internal validation. The Hosmer–Lemeshow goodness of fit test had a p-value of 0.10 suggesting that the model was accurate. We further divided the model into 4 groups with 5%, 12%, 19% and 30% futility, respectively. The low-risk group consisted of 60% of the patients and the high-risk group consisted of 4% of these patients.
Conclusion
This futility prediction score established from a large nationwide cohort of patients treated with TAVR may provide a relevant insight for optimizing healthcare decision. It may facilitate identification of patients who, despite an apparently successful procedure, have risk of death that may outweigh the benefit of an anticipated TAVR.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Lacour
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Bourguignon
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J M Clerc
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - L Quilliet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P Lantelme
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Angoulvant
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - C Saint Etienne
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Trada Y, Law P, Bernard A, Foote M, Barbour A, Lambie D, Smithers M, Burmeister B, Pinkham M. FDG-PET Response Assessment in Patients with Locally Advanced Nodal Melanoma Undergoing High-Dose Neo-Adjuvant or Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bernard A, Falcoz PE, Thomas PA, Rivera C, Brouchet L, Baste JM, Puyraveau M, Quantin C, Pages PB, Dahan M. Comparison of Epithor clinical national database and medico-administrative database to identify the influence of case-mix on the estimation of hospital outliers. PLoS One 2019; 14:e0219672. [PMID: 31339906 PMCID: PMC6655697 DOI: 10.1371/journal.pone.0219672] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022] Open
Abstract
Background The national Epithor database was initiated in 2003 in France. Fifteen years on, a quality assessment of the recorded data seemed necessary. This study examines the completeness of the data recorded in Epithor through a comparison with the French PMSI database, which is the national medico-administrative reference database. The aim of this study was to demonstrate the influence of data quality with respect to identifying 30-day mortality hospital outliers. Methods We used each hospital’s individual FINESS code to compare the number of pulmonary resections and deaths recorded in Epithor to the figures found in the PMSI. Centers were classified into either the good-quality data (GQD) group or the low-quality data (LQD) group. To demonstrate the influence of case-mix quality on the ranking of centers with low-quality data, we used 2 methods to estimate the standardized mortality rate (SMR). For the first (SMR1), the expected number of deaths per hospital was estimated with risk-adjustment models fitted with low-quality data. For the second (SMR2), the expected number of deaths per hospital was estimated with a linear predictor for the LQD group using the coefficients of a logistic regression model developed from the GQD group. Results Of the hospitals that use Epithor, 25 were classified in the GQD group and 75 in the LQD group. The 30-day mortality rate was 2.8% (n = 300) in the GQD group vs. 1.9% (n = 181) in the LQD group (P <0.0001). The between-hospital differences in SMR1 appeared substantial (interquartile range (IQR) 0–1.036), and they were even higher in SMR2 (IQR 0–1.19). SMR1 identified 7 hospitals as high-mortality outliers. SMR2 identified 4 hospitals as high-mortality outliers. Some hospitals went from non-outlier to high mortality and vice-versa. Kappa values were roughly 0.46 and indicated moderate agreement. Conclusion We found that most hospitals provided Epithor with high-quality data, but other hospitals needed to improve the quality of the information provided. Quality control is essential for this type of database and necessary for the unbiased adjustment of regression models.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
- * E-mail:
| | | | - Pascal Antoine Thomas
- Department of Thoracic Surgery, Hopital-Nord-APHM, Aix-Marseille University, Marseille, France
| | - Caroline Rivera
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
| | - Laurent Brouchet
- Department of Thoracic Surgery, Hopital Larrey, CHU Toulouse, Toulouse, France
| | | | - Marc Puyraveau
- Department of Biostatistics and Epidemiology CHU Besançon, Besançon, France
| | - Catherine Quantin
- Department of Biostatistics and Medical Informatics, Dijon University Hospital, Dijon, France
- INSERM, CIC 1432, Clinical Investigation Center, clinical epidemiology/clinical trials unit, Dijon University Hospital, University of Burgundy, Dijon, France
| | - Pierre Benoit Pages
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
- INSERM UMR 866, Dijon University Hospital, University of Burgundy, Dijon, France
| | - Marcel Dahan
- Department of Thoracic Surgery, Hopital Larrey, CHU Toulouse, Toulouse, France
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Abstract
Background Two surgical strategies called video-assisted thoracoscopy surgery (VATS) and thoracotomy are used for lobectomy following lung cancer diagnosis. The aim of this study was to assess the total cost of each technique (thoracotomy and VATS) during hospitalization in France. Methods A micro-costing methodology from the hospital perspective was implemented to assess the hospitalization costs, using direct observations, interviews, and data collection based on medical records in four hospitals. The average real cost of each technique was compared. Results From the hospital perspective, VATS was more expensive than thoracotomy but the difference was not significant (€6,941.30 vs. €5,950.11). Conclusions According to this micro-costing study, thoracotomy seems to be the less expensive technique for the hospital. Our data will be included in a cost-utility analysis to assess the medico-economic impact of the VATS strategy.
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Affiliation(s)
- Maud Charvin
- Department of Health Economy, CHU Dijon, Dijon, France
| | - Hans Martin Späth
- EA 4129 P2S Parcours Santé Systémique, University Claude Bernard Lyon 1, University Lyon 1, Lyon, France
| | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
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