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Shergill ES, Udwadia FR, Grubisic M, Salata K, Misskey J, Faulds J. Comparative study of left vertebral artery revascularization in patients with and without aberrant left vertebral anatomy. J Vasc Surg 2024; 79:991-996. [PMID: 38262566 DOI: 10.1016/j.jvs.2024.01.018] [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: 11/12/2023] [Revised: 01/04/2024] [Accepted: 01/17/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Left vertebral artery revascularization is indicated in surgery involving zone 2 of the aortic arch and is typically accomplished indirectly via subclavian artery revascularization. For aberrant left vertebral anatomy, direct revascularization is indicated. Our objective was to compare the outcomes of direct vertebral artery revascularization with indirect subclavian artery revascularization for treating aortic arch pathology and to identify predictors of mortality. METHODS A retrospective cohort study was conducted at a single tertiary hospital, including patients who underwent open or endovascular vertebral artery revascularization from 2005 to 2022. Those who underwent direct vertebral revascularization were compared with those who were indirectly revascularized via subclavian artery revascularization. The outcomes of interest were a composite outcome (any of death, stroke, nerve injury, and thrombosis) and mortality. Univariate logistic regression models were fitted to quantify the strength of differences between the direct and indirect revascularization cohorts. Cox regression was used to identify mortality predictors. RESULTS Of 143 patients who underwent vertebral artery revascularization, 21 (14.7%) had a vertebral artery originating from the aortic arch. The median length of stay was 10 days (interquartile range, 6-20 days), and demographics were similar between cohorts. The incidence of composite outcome, bypass thrombosis, and hoarseness was significantly higher in the direct group (42.9% vs 18.0%, P = .019; 33.3% vs 0.8%, P < .0001; 57.1% vs 18.0%, P < .001, respectively). The direct group was approximately three times more likely to experience the composite outcome (odds ratio, 3.41; 95% confidence interval, 1.28, 9.08); similarly, this group was approximately six times more likely to have hoarseness (odds ratio, 5.88; 95% confidence interval, 2.21, 15.62). There was no significant difference in mortality rates at 30 days, 1, 3, 5, and 10 years of follow-up. Age, length of hospital stay, and congestive heart failure were identified as predictors of higher mortality. After adjusting for these covariates, the group itself was not an independent predictor of mortality. CONCLUSIONS Direct vertebral revascularization was associated with higher rates of composite outcome (death, stroke, nerve injury, and thrombosis), bypass thrombosis and hoarseness. Patients with aberrant vertebral anatomy are at higher risks of these complications compared with patients with standard arch anatomy. However, after adjusting for other factors, mortality rates were not significantly different between the groups.
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Affiliation(s)
- Eimaan S Shergill
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Farhad R Udwadia
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Maja Grubisic
- Department of Mathematics & Statistics, Langara College, Vancouver, BC, Canada
| | - Konrad Salata
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Misskey
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jason Faulds
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
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Abstract
OBJECTIVE Many studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020. STUDY SELECTION All original studies reporting faculty rank stratified by gender worldwide were included. DATA EXTRACTION AND SYNTHESIS Study screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models. RESULTS Our search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010-2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12). CONCLUSIONS Gender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists. PROSPERO REGISTRATION NUMBER CRD42020197414.
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Affiliation(s)
- Ben Li
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jean Jacob-Brassard
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Fahima Dossa
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Konrad Salata
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Health Sciences Library, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Elisa Greco
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammed Al-Omran
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Jacob-Brassard J, Al-Omran M, Salata K, Hussain MA, Kayssi A, Roche-Nagle G, de Mestral C. A survey of Canadian surgeons on the indications for home care nursing following vascular surgery. Can J Surg 2021; 64:E149-E154. [PMID: 33666391 PMCID: PMC8064247 DOI: 10.1503/cjs.001220] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Recent evidence suggests that home care nursing is variably prescribed after vascular surgery, and may reduce emergency department visits and hospital readmissions. We therefore sought to characterize the indications for home care nursing following vascular surgery from the surgeon’s perspective. Methods An online survey was distributed to the 141 members of the Canadian Society for Vascular Surgery with questions related to home care nursing after carotid endarterectomy (CEA), endovascular aortic aneurysm repair (EVAR), open abdominal aortic aneurysm (AAA) repair and open or hybrid revascularization for peripheral arterial disease (PAD). We included all questionnaires in our analysis; the frequency denominator changes according to the number of respondents who completed each survey item. Results There were 46 survey respondents (33% of 141) from across the country. A total of 28 (62% of 45) worked in a teaching hospital. Home care nursing was routinely prescribed by 5%, 10%, 31% and 41% of respondents following CEA, EVAR, open AAA repair and open or hybrid revascularization for PAD, respectively. Across all procedure types, the same procedure-related criteria were most often deemed to warrant a prescription for home care nursing: surgical site infection, wound complications (e.g., open wound, lymphatic leak) and use of negative-pressure wound therapy. Across all procedure types, lack of social support, physical frailty and cognitive impairment were most frequently identified as patient-specific considerations for prescribing home care nursing. Few respondents reported restrictions or standards that informed their prescribing practice. Conclusion Most surgeon respondents agreed on the indications for home care nursing after vascular surgery. However, evidence-based standards to guide patient selection for home care nursing after vascular surgery are needed.
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Affiliation(s)
- Jean Jacob-Brassard
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle)
| | - Mohammed Al-Omran
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle)
| | - Konrad Salata
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle)
| | - Mohamad A Hussain
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle)
| | - Ahmed Kayssi
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle)
| | - Graham Roche-Nagle
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle)
| | - Charles de Mestral
- From the Department of Surgery, University of Toronto, Toronto, Ont. (Jacob-Brassard, Al-Omran, Salata, Hussain, Kayssi, Roche-Nagle); the Li Ka Shing Knowledge Institute of St. Michaels Hospital, Toronto, Ont. (Al-Omran, Salata, Hussain, de Mestral); the Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ont. (Kayssi); and the Peter Munk Cardiac Center of the University Health Network, Toronto, Ont. (Roche-Nagle)
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de Mestral C, Hussain MA, Austin PC, Forbes TL, Sivaswamy A, Kayssi A, Salata K, Wijeysundera HC, Verma S, Al-Omran M. Regional health care services and rates of lower extremity amputation related to diabetes and peripheral artery disease: an ecological study. CMAJ Open 2020; 8:E659-E666. [PMID: 33109531 PMCID: PMC7595755 DOI: 10.9778/cmajo.20200048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The care necessary to prevent amputation from diabetes and peripheral artery disease (PAD) remains disjointed in many jurisdictions. To help inform integrated regional care, this study explores the correlation between regional health care services and rates of lower extremity amputation. METHODS This ecological study included 14 administrative health regions in Ontario, Canada. All diabetes- or PAD-related major (above ankle) amputations (Apr. 1, 2007, to Mar. 31, 2017) were identified among residents 40 years of age and older. For each region, age-and sex-adjusted amputation rates were calculated as well as per capita counts of key health providers (podiatrists and chiropodists, as well as surgeons) and health care utilization among study patients in the year before the first major amputation (physician visits, publicly funded podiatry visits, emergency department visits, hospital admissions, home care nursing, minor amputation, limb revascularization). RESULTS A total of 11 658 patients with major amputation were identified (of whom 79.2% had diabetes and 96.5% had PAD). There was wide regional variation in amputation rates: 2.53 to 11.77 per 100 000 person-quarters. At a regional level, the proportion of study patients who received revascularization showed the strongest negative correlation with amputation rates. The regional proportion of study patients who saw a vascular surgeon showed the strongest negative correlation with amputation rates, relative to other health provider visits. Other measures of health care utilization among patients correlated poorly with regional amputation rates, as did the regional provider counts. The results were similar when we restricted the analysis to diabetes-related amputations. INTERPRETATION Amputation rates related to diabetes and PAD vary widely across Ontario. Access to vascular assessment and revascularization must be integrated into regional amputation prevention efforts.
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Affiliation(s)
- Charles de Mestral
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont.
| | - Mohamad A Hussain
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Peter C Austin
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Thomas L Forbes
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Atul Sivaswamy
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Ahmed Kayssi
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Konrad Salata
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Harindra C Wijeysundera
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Subodh Verma
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute (de Mestral, Hussain, Salata, Verma, Al-Omran), St. Michael's Hospital; ICES Central (de Mestral, Austin, Sivaswamy, Salata); Department of Surgery (de Mestral, Hussain, Forbes, Kayssi, Salata, Verma, Al-Omran), Faculty of Medicine, University of Toronto; Sunnybrook Research Institute (Austin, Kayssi, Wijeysundera), Sunnybrook Health Sciences Centre; Peter Munk Cardiac Centre (Austin, Forbes), University Health Network; Department of Medicine (Wijeysundera), Faculty of Medicine, University of Toronto; Diabetes Action Canada (de Mestral, Forbes, Kayssi, Al-Omran), Toronto, Ont
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Salata K, Almaghlouth I, Hussain MA, de Mestral C, Greco E, Aljabri BA, Mamdani M, Forbes TL, Verma S, Al-Omran M. Outcomes of abdominal aortic aneurysm repair among patients with rheumatoid arthritis. J Vasc Surg 2020; 73:1261-1268.e5. [PMID: 32950628 DOI: 10.1016/j.jvs.2020.08.134] [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: 02/12/2020] [Accepted: 08/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In the present study, we compared the outcomes of elective abdominal aortic aneurysm (AAA) repair in patients with and without rheumatoid arthritis (RA) stratified by the type of surgery. METHODS A retrospective population-based cohort study was conducted from 2003 to 2016. Linked administrative health data from Ontario, Canada were used to identify all patients aged ≥65 years who had undergone elective open or endovascular AAA repair during the study period. Patients were identified using validated procedure and billing codes and matching using propensity scores. The primary outcome was survival. The secondary outcomes were major adverse cardiovascular events (MACE)-free survival (defined as freedom from death, myocardial infarction, and stroke), reintervention, and secondary rupture. RESULTS Of 14,816 patients undergoing elective AAA repair, a diagnosis of RA was present for 309 (2.0%). The propensity-matched cohort included 234 pairs of RA and control patients. The matched cohort was followed up for a mean ± standard deviation of 4.93 ± 3.35 years, and the median survival was 6.76 and 7.31 years for the RA and control groups, respectively. Cox regression analysis demonstrated no statistically significant differences in the hazards for death, MACE, reintervention, or secondary rupture. Analysis of the differences in outcomes stratified by repair approach also showed no statistically significant differences in the hazards for death, MACE, reintervention, or secondary rupture. CONCLUSIONS We found no statistically significant differences in survival, MACE, reintervention, or secondary rupture among patients with RA undergoing elective AAA repair compared with controls. Further studies are required to evaluate the impact of comorbidities and antirheumatic medications on the outcomes of elective AAA repair.
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Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; College of Medicine Research Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad A Hussain
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elisa Greco
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Badr A Aljabri
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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Salata K, Hussain MA, de Mestral C, Greco E, Awartani H, Aljabri BA, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Population-based long-term outcomes of open versus endovascular aortic repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2020; 71:1867-1878.e8. [DOI: 10.1016/j.jvs.2019.06.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/11/2019] [Indexed: 12/22/2022]
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Hussain MA, Al-Omran M, Salata K, Sivaswamy A, Forbes TL, Sattar N, Aljabri B, Kayssi A, Verma S, de Mestral C. Population-based secular trends in lower-extremity amputation for diabetes and peripheral artery disease. CMAJ 2020; 191:E955-E961. [PMID: 31481423 DOI: 10.1503/cmaj.190134] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The evolving clinical burden of limb loss secondary to diabetes and peripheral artery disease remains poorly characterized. We sought to examine secular trends in the rate of lower-extremity amputations related to diabetes, peripheral artery disease or both. METHODS We included all individuals aged 40 years and older who underwent lower-extremity amputations related to diabetes or peripheral artery disease in Ontario, Canada (2005-2016). We identified patients and amputations through deterministic linkage of administrative health databases. Quarterly rates (per 100 000 individuals aged ≥ 40 yr) of any (major or minor) amputation and of major amputations alone were calculated. We used time-series analyses with exponential smoothing models to characterize secular trends and forecast 2 years forward in time. RESULTS A total of 20 062 patients underwent any lower-extremity amputation, of which 12 786 (63.7%) underwent a major (above ankle) amputation. Diabetes was present in 81.8%, peripheral artery disease in 93.8%, and both diabetes and peripheral artery disease in 75.6%. The rate of any amputation initially declined from 9.88 to 8.62 per 100 000 between Q2 of 2005 and Q4 of 2010, but increased again by Q1 of 2016 to 10.0 per 100 000 (p = 0.003). We observed a significant increase in the rate of any amputation among patients with diabetes, peripheral artery disease, and both diabetes and peripheral artery disease. Major amputations did not significantly change among patients with diabetes, peripheral artery disease or both. INTERPRETATION Lower-extremity amputations related to diabetes, peripheral artery disease or both have increased over the last decade. These data support renewed efforts to prevent and decrease the burden of limb loss.
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Affiliation(s)
- Mohamad A Hussain
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Mohammed Al-Omran
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Konrad Salata
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Atul Sivaswamy
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Thomas L Forbes
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Naveed Sattar
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Badr Aljabri
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Ahmed Kayssi
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Subodh Verma
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Charles de Mestral
- Divisions of Vascular Surgery (Hussain, Al-Omran, Salata, de Mestral) and Cardiac Surgery (Verma), St. Michael's Hospital; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Al-Omran, Verma, de Mestral); Department of Surgery (Hussain, Salata, Forbes, Kayssi), University of Toronto; Diabetes Action Canada (Hussain, Al-Omran, Salata, Forbes, Kayssi), Toronto, Ont.; King Saud University-Li Ka Shing Collaborative Research Program (Aljabri, Verma) and Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; ICES (Sivaswamy, de Mestral); Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, Toronto, Ont.; Institute of Cardiovascular and Medical Sciences (Sattar), University of Glasgow, Glasgow, Scotland, United Kingdom; Division of Vascular Surgery (Kayssi), Sunnybrook Health Sciences Centre, Toronto, Ont.
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8
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Syed MH, Salata K, Hussain MA, Zamzam A, de Mestral C, Wheatcroft M, Harlock J, Awartani D, Aljabri B, Verma A, Razak F, Verma S, Al-Omran M. The economic burden of inpatient diabetic foot ulcers in Toronto, Canada. Vascular 2020; 28:520-529. [PMID: 32379584 DOI: 10.1177/1708538120923420] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/15/2022]
Abstract
OBJECTIVE Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. METHODS We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. RESULTS Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14-1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17-1.34). Propensity-scored matched analyses confirmed these results. CONCLUSION Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.
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Affiliation(s)
- Muzammil H Syed
- Faculty of Science, McMaster University, Hamilton, Canada.,Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada
| | - Konrad Salata
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Charles de Mestral
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Diabetes Action Canada, Toronto, Canada
| | - Mark Wheatcroft
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - John Harlock
- Department of Surgery, Hamilton General Hospital, Hamilton, Canada.,Division of Vascular Surgery, Hamilton General Hospital, Hamilton, Canada
| | - Deana Awartani
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Badr Aljabri
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Amol Verma
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Fahad Razak
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Subodh Verma
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Diabetes Action Canada, Toronto, Canada.,Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
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9
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Salata K, Hussain MA, Al-Omran M. Letter by Salata et al Regarding Article, "Utilization of Advanced Cardiovascular Therapies in the United States and Canada: An Observational Study of New York and Ontario Administrative Data". Circ Cardiovasc Qual Outcomes 2020; 13:e006569. [PMID: 32366115 DOI: 10.1161/circoutcomes.120.006569] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, ON, Canada (K.S., M.A.H., M.A.-O.)
| | - Mohamad A Hussain
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, ON, Canada (K.S., M.A.H., M.A.-O.)
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, ON, Canada (K.S., M.A.H., M.A.-O.).,Department of Surgery, King Saud University, Riyadh, Saudi Arabia (M.A.-O.)
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10
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Salata K, Abdallah FW, Hussain MA, de Mestral C, Greco E, Aljabri B, Mamdani M, Mazer CD, Forbes TL, Verma S, Al-Omran M. Short-term outcomes of combined neuraxial and general anaesthesia versus general anaesthesia alone for elective open abdominal aortic aneurysm repair: retrospective population-based cohort study †. Br J Anaesth 2020; 124:544-552. [PMID: 32216957 DOI: 10.1016/j.bja.2020.01.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/05/2020] [Accepted: 01/25/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone. METHODS A retrospective population-based cohort study was conducted from 2003 to 2016. All patients ≥40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes. RESULTS A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37-0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60-0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49-0.89), respiratory failure (OR=0.41; 95% CI, 0.36-0.47), and limb complications (OR=0.30; 95% CI, 0.25-0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15-1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits. CONCLUSIONS Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.
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Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Faraj W Abdallah
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, University of Ottawa, Ottawa, ON, Canada; Department of Anaesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Elisa Greco
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Badr Aljabri
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada
| | - C David Mazer
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network and Toronto, University of Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
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11
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Rokoszak V, Syed MH, Salata K, Greco E, de Mestral C, Hussain MA, Aljabri B, Verma S, Al-Omran M. A systematic review and meta-analysis of plain versus drug-eluting balloon angioplasty in the treatment of juxta-anastomotic hemodialysis arteriovenous fistula stenosis. J Vasc Surg 2020; 71:1046-1054.e1. [DOI: 10.1016/j.jvs.2019.07.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
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12
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Salata K, Syed M, Hussain MA, de Mestral C, Greco E, Mamdani M, Tu JV, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Statins Reduce Abdominal Aortic Aneurysm Growth, Rupture, and Perioperative Mortality: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 7:e008657. [PMID: 30371297 PMCID: PMC6404894 DOI: 10.1161/jaha.118.008657] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background There are no recognized pharmacological treatments for abdominal aortic aneurysms (AAA), although statins are suggested to be beneficial. We sought to summarize the literature regarding the effects of statins on human AAA growth, rupture, and 30‐day mortality. Methods and Results We conducted a systematic review and meta‐analysis of randomized and observational studies using the Cochrane CENTRAL database, MEDLINE, and EMBASE up to June 15, 2018. Review, abstraction, and quality assessment were conducted by 2 independent reviewers, and a third author resolved discrepancies. Pooled mean differences and odds ratios with 95% confidence intervals were calculated using random effects models. Heterogeneity was quantified using the I2 statistic, and publication bias was assessed using funnel plots. Our search yielded 911 articles. One case‐control and 21 cohort studies involving 80 428 patients were included. The risk of bias was low to moderate. Statin use was associated with a mean AAA growth rate reduction of 0.82 mm/y (95% confidence interval 0.33, 1.32, P=0.001, I2=86%). Statins were also associated with a lower rupture risk (odds ratio 0.63, 95% confidence interval 0.51, 0.78, P<0.0001, I2=27%), and preoperative statin use was associated with a lower 30‐day mortality following elective AAA repair (odds ratio 0.55, 95% confidence interval 0.36, 0.83, P=0.005, I2=57%). Conclusions Statin therapy may be associated with reduction in AAA progression, rupture, and lower rates of perioperative mortality following elective AAA repair. These data argue for widespread statin use in AAA patients. Clinical Trial Registration URL: http://www.crd.york.ac.uk. Unique identifier: CRD42017056480.
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Affiliation(s)
- Konrad Salata
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Muzammil Syed
- 3 Faculty of Science McMaster University Hamilton Ontario Canada
| | - Mohamad A Hussain
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Charles de Mestral
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Elisa Greco
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Muhammad Mamdani
- 4 Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART) Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.,5 Leslie Dan Faculty of Pharmacy University of Toronto Ontario Canada.,6 Department of Medicine Faculty of Medicine University of Toronto Ontario Canada.,7 Institute of Health Policy, Management and Evaluation Dalla Lana Faculty of Public Health University of Toronto Ontario Canada.,8 Institute for Clinical Evaluative Sciences at Sunnybrook Hospital Toronto Ontario Canada
| | - Jack V Tu
- 7 Institute of Health Policy, Management and Evaluation Dalla Lana Faculty of Public Health University of Toronto Ontario Canada.,8 Institute for Clinical Evaluative Sciences at Sunnybrook Hospital Toronto Ontario Canada.,9 Division of Cardiology Department of Medicine Schulich Heart Program Sunnybrook Hospital Toronto Ontario Canada.,10 Schulich Heart Research Program Sunnybrook Research Institute at Sunnybrook Hospital Toronto Ontario Canada
| | - Thomas L Forbes
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,11 Division of Vascular Surgery Toronto General Hospital Toronto Ontario Canada
| | - Deepak L Bhatt
- 12 Brigham and Women's Hospital Heart and Vascular Center Boston MA.,13 Harvard Medical School Boston MA
| | - Subodh Verma
- 14 Division of Cardiac Surgery Department of Surgery University of Toronto Ontario Canada.,15 Division of Cardiac Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada
| | - Mohammed Al-Omran
- 1 Division of Vascular Surgery Department of Surgery University of Toronto Ontario Canada.,2 Division of Vascular Surgery Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada.,16 Department of Surgery King Saud University Riyadh Kingdom of Saudi Arabia
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13
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de Mestral C, Hsu AT, Talarico R, Lee DS, Hussain MA, Salata K, Al-Omran M, Tanuseputro P. End-of-life care following leg amputation in patients with peripheral artery disease or diabetes. Br J Surg 2019; 107:64-72. [DOI: 10.1002/bjs.11367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/10/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
Abstract
Background
The aim was to characterize end-of-life care in patients who have had a leg amputated for peripheral artery disease (PAD) or diabetes.
Methods
This was a population-based retrospective cohort study of patients with PAD or diabetes who died in Ontario, Canada, between 2011 and 2017. Those who had a leg amputation within 3 years of death were compared with a control cohort of deceased patients with PAD or diabetes, but without leg amputation. The patients were identified from linked health records within the single-payer healthcare system. Place and cause of death, as well as health services and costs within 90 days of death, were compared between the amputee and control cohorts. Among amputees, multivariable regression models were used to characterize the association between receipt of home palliative care and in-hospital death, as well as time spent in hospital at the end of life.
Results
Compared with 213 300 controls, 3113 amputees were less likely to die at home (15·5 versus 24·9 per cent; P < 0·001) and spent a greater number of their last 90 days of life in hospital (median 19 versus 8 days; P < 0·001). Amputees also had higher end-of-life healthcare costs across all sectors. However, receipt of palliative care was less frequent among amputees than controls (inpatient: 13·4 versus 16·8 per cent, P < 0·001; home: 14·5 versus 23·8 per cent, P < 0·001). Among amputees, receipt of home palliative care was associated with a lower likelihood of in-hospital death (odds ratio 0·49, 95 per cent c.i. 0·40 to 0·60) and fewer days in hospital (rate ratio 0·84, 0·76 to 0·93).
Conclusion
Palliative care is underused after amputation in patients with PAD or diabetes, and could contribute to reducing in-hospital death and time spent in hospital at the end of life.
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Affiliation(s)
- C de Mestral
- Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - A T Hsu
- ICES, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - D S Lee
- ICES, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - M A Hussain
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - K Salata
- Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - M Al-Omran
- Li Ka Shing Knowledge Institute of St Michaels Hospital, Toronto, Ontario, Canada
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - P Tanuseputro
- ICES, Toronto, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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14
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de Mestral C, Hussain MA, Austin PC, Forbes TL, Wijeysundera HC, Sivaswamy A, Kayssi A, Salata K, Verma S, Al-Omran M. Population-Based Correlation of Regional Intensity of Health Care Utilization and Rates of Amputation Due Diabetes and Peripheral Arterial Disease. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.747] [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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Salata K, Abdallah F, Hussain MA, de Mestral C, Greco E, Aljabri BA, Mamdani M, Forbes TL, Verma S, Al-Omran M. Combined Neuraxial and General Anesthesia Significantly Improves Perioperative Outcomes Following Elective Open Abdominal Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.07.046] [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: 11/28/2022]
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de Mestral C, Kayssi A, Al-Omran M, Salata K, Hussain MA, Roche-Nagle G. Home Care Nursing After Elective Vascular Surgery: An Opportunity to Reduce Emergency Department Visits and Hospital Readmission. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.07.044] [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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de Mestral C, Wijeysundera HC, Kayssi A, Austin PC, Salata K, Hussain MA, Forbes TL, Sivaswamy A, Verma S, Al-Omran M. Long-Term Health Care Costs in Patients with Diabetes or Peripheral Arterial Disease Who Require Lower Extremity Amputation: A Population-Based Analysis. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.801] [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: 10/25/2022]
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Luzzi C, Salata K, Djaiani C, Gershinsky M, Rao V, Carroll J, Katznelson R. Selective serotonin re-uptake inhibitors: risk of blood product transfusion and inotrope requirements in patients undergoing cardiac surgery. J Thorac Dis 2019; 11:3496-3504. [PMID: 31559056 DOI: 10.21037/jtd.2019.07.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/06/2022]
Abstract
Background Patients undergoing cardiac surgery exhibit a high prevalence of concomitant depression. The first-line pharmacological treatment modality for depression includes selective serotonin re-uptake inhibitors (SSRIs). Despite their efficacy, SSRIs are not without their own side-effects. Methods We conducted a retrospective observational study to determine if preoperative SSRI therapy was associated with higher rates of perioperative blood product transfusion, and higher incidence of inotropic requirements in patients undergoing elective cardiac surgery. A total of 2,943 patients were included in the study. Patients undergoing emergency surgery or surgery without cardiopulmonary bypass (CPB) were excluded. Based on preoperative SSRI status patients were classed into either SSRI group (n=95), or non-SSRI group (n=2,848). Data was acquired from the Toronto Anesthesia Perioperative Outcomes Database. Results Baseline preoperative variables included age, sex, body surface area, smoking history, past medical history, preoperative medications, baseline hemoglobin, creatinine, and planned surgical procedures. Perioperative transfusion of blood products and inotropic utilization were collected. Univariate analysis showed that patients in SSRI group were more likely to be female, have history of congestive heart failure, preoperative anemia, and likelihood of having more complex surgery, received more inotropes and fresh frozen plasma, and were more likely to have chest reopening for bleeding. There was no difference in postoperative morbidity and mortality between the SSRI and non-SSRI groups. Separate statistical models were constructed to determine association between transfusion of red blood cells, fresh frozen plasma, platelets, composite inotrope use, and SSRI therapy. SSRI variable was not significant in any of the multivariate models, indicating the lack of evidence of association between the SSRIs and either blood product transfusion, or inotrope requirements. Significant predictors of blood product transfusion included smaller body surface area, female gender, older age, low baseline hemoglobin levels, elevated creatinine, increased CPB, presence of deep hypothermic circulatory arrest, complex cardiac surgery, history diabetes mellitus, and congestive heart failure. Predictors of inotrope use included older age, elevated creatinine, increased CPB time, history of diabetes mellitus, and congestive heart failure. Conclusions The current study suggests that modifying preoperative therapy pertinent to SSRI treatment in patients undergoing elective cardiac surgery is not warranted.
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Affiliation(s)
- Carla Luzzi
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Konrad Salata
- Division of Vascular Surgery, Toronto General Hospital, Toronto, Canada
| | - Carine Djaiani
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Maxim Gershinsky
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Canada
| | - Jo Carroll
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
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Li B, Khan S, Salata K, Hussain MA, de Mestral C, Greco E, Aljabri BA, Forbes TL, Verma S, Al-Omran M. A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm. J Vasc Surg 2019; 70:954-969.e30. [DOI: 10.1016/j.jvs.2019.01.076] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/11/2019] [Indexed: 01/09/2023]
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Salata K, Hussain MA, de Mestral C, Greco E, Aljabri BA, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Comparison of Outcomes in Elective Endovascular Aortic Repair vs Open Surgical Repair of Abdominal Aortic Aneurysms. JAMA Netw Open 2019; 2:e196578. [PMID: 31290986 PMCID: PMC6624804 DOI: 10.1001/jamanetworkopen.2019.6578] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Knowledge regarding the long-term outcomes of elective treatment of abdominal aortic aneurysm (AAA) using endovascular aortic repair (EVAR) is increasing. However, data with greater than 10 years' follow-up remain sparse and are lacking from population-based studies. OBJECTIVE To determine the long-term outcomes of EVAR compared with open surgical repair (OSR) for elective treatment of AAA. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study used linked administrative health data from Ontario, Canada, to identify all patients 40 years and older who underwent elective EVAR or OSR for AAA repair from April 1, 2003, to March 31, 2016, with follow-up terminating on March 31, 2017. A total of 17 683 patients were identified using validated procedure and billing codes and were propensity score matched. Analysis was conducted from June 26, 2018, to January 16, 2019. EXPOSURES Elective EVAR or OSR for AAA. MAIN OUTCOMES AND MEASURES The primary outcome was overall survival. Secondary outcomes were major adverse cardiovascular event-free survival, defined as being free of death, myocardial infarction, or stroke; reintervention; and secondary rupture. RESULTS Among 17 683 patients who received elective AAA repairs (mean [SD] age, 72.6 [7.8] years; 14 286 [80.8%] men), 6100 (34.5%) underwent EVAR and 11 583 (65.5%) underwent OSR. From these patients, 4010 well-balanced propensity score-matched pairs of patients were defined, with a mean (SD) age of 73.0 (7.6) years and 6583 (82.1%) men. In the matched cohort, the mean (SD) follow-up was 4.4 (2.7) years, and maximum follow-up was 13.8 years. The overall median survival was 8.9 years. Compared with OSR, EVAR was associated with a higher survival rate up to 1 year after repair (91.0% [95% CI, 90.1%-91.9%] vs 94.0% [95% CI, 93.3%-94.7%]) and a higher major adverse cardiovascular event-free survival rate up to 4 years after repair (69.9% [95% CI, 68.3%-71.3%] vs 72.9% [95% CI, 71.4%-74.4%]). Cumulative incidence of reintervention was higher among patients who underwent EVAR compared with those who underwent OSR at the 7-year follow-up (45.9% [95% CI, 44.1%-47.8%] vs 42.2% [95% CI, 40.4%-44.0%]). Survival analyses demonstrated no statistically significant differences in long-term survival, reintervention, and secondary rupture for patients who underwent EVAR compared with those who underwent OSR. Kaplan-Meier analysis suggested superior long-term major adverse cardiovascular event-free survival among patients who underwent EVAR compared with those who underwent OSR (32.6% [95% CI, 26.9%-38.4%] vs 14.1% [95% CI, 4.0%-30.4%]; stratified log-rank P < .001) during a maximum follow-up of 13.8 years. CONCLUSIONS AND RELEVANCE Endovascular aortic repair was not associated with a difference in long-term survival during more than 13 years' maximum follow-up. The reasons for these findings will require studies to consider specific graft makes and models, adherence to instructions for use, and types and reasons for reintervention.
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Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mohamad A. Hussain
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Elisa Greco
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Badr A. Aljabri
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L. Forbes
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Subodh Verma
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
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AlHamzah M, Eikelboom R, Hussain MA, Syed MH, Salata K, Wheatcroft M, Verma S, Al-Omran M. Knowledge gap of peripheral artery disease starts in medical school. J Vasc Surg 2019; 70:241-245.e2. [DOI: 10.1016/j.jvs.2018.12.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/16/2018] [Indexed: 11/27/2022]
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Li B, Salata K, de Mestral C, Hussain MA, Aljabri BA, Lindsay TF, Verma S, Al-Omran M. Perceptions of Canadian Vascular Surgeons Toward Pharmacologic Risk Reduction in Patients with Peripheral Artery Disease: 2018 Update. Ann Vasc Surg 2019; 58:166-173.e4. [DOI: 10.1016/j.avsg.2018.11.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/30/2018] [Indexed: 12/24/2022]
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de Mestral C, Kayssi A, Al-Omran M, Salata K, Hussain MA, Roche-Nagle G. Home care nursing after elective vascular surgery: an opportunity to reduce emergency department visits and hospital readmission. BMJ Qual Saf 2019; 28:901-907. [DOI: 10.1136/bmjqs-2018-009161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/27/2023]
Abstract
BackgroundEvents occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research.ObjectiveTo quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission.MethodsPatients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006–2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge.ResultsThe cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario’s 14 administrative health regions (range 16%–84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92.ConclusionHome care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.
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Khan S, Li B, Salata K, Aljabri BA, Hussain MA, Khan M, de Mestral C, Verma S, Al-Omran M. The Current Status of Lithoplasty in Vascular Calcifications: A Systematic Review. Surg Innov 2019; 26:588-598. [PMID: 31074330 DOI: 10.1177/1553350619848557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/15/2022]
Abstract
Background. Lithoplasty is a method of alleviating vessel stenosis by using localized high-speed pressure waves to disrupt calcium deposits. A systematic review of the literature was performed to summarize the early outcomes of lithoplasty in peripheral and coronary artery disease. Methods. We searched EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials from database inception to July 2018 for original studies describing the use of lithoplasty. Study selection and data extraction were performed in duplicate, with a third author resolving discrepancies. Results. A total of 9 records were included from the 201 studies eligible for screening. In total, 211 patients with vascular calcification lesions underwent lithoplasty. The patients on average had an age of 73.2 years and had a maximum follow-up period of 5.5 months. Most lesions (72%, 152/212) were in peripheral artery beds, with the remainder occurring in coronary vessels. Lesioned vessels typically had severe calcium burden 62.6% (131/210), with an average initial stenosis of 76.6% (range, 68.1%-77.8%). After treatment, the average residual stenosis was 21.0% (range, 13.3%-26.2%), with a mean acute gain of vessel diameter of 2.5 mm. A limited number of type D dissections occurred, with a total of 2.4% (5/211) of patients requiring stent implantation. Conclusions. Recent studies suggest that lithoplasty is a promising intervention to decrease vessel stenosis in both peripheral artery disease and coronary artery disease, with minimal occurrence of major adverse events. Further research studies, with more rigorous study designs, are needed to determine the effectiveness of lithoplasty in vascular calcifications.
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Affiliation(s)
| | - Ben Li
- 1 University of Toronto, ON, Canada
| | - Konrad Salata
- 1 University of Toronto, ON, Canada.,2 Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
| | - Badr A Aljabri
- 1 University of Toronto, ON, Canada.,2 Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.,3 King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad A Hussain
- 1 University of Toronto, ON, Canada.,2 Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
| | | | - Charles de Mestral
- 1 University of Toronto, ON, Canada.,2 Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
| | - Subodh Verma
- 1 University of Toronto, ON, Canada.,2 Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
| | - Mohammed Al-Omran
- 1 University of Toronto, ON, Canada.,2 Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.,3 King Saud University, Riyadh, Kingdom of Saudi Arabia
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Salata K, Hussain MA, de Mestral C, Greco E, Aljabri BA, Sabongui S, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Trends in elective and ruptured abdominal aortic aneurysm repair by practice setting in Ontario, Canada, from 2003 to 2016: a population-based time-series analysis. CMAJ Open 2019; 7:E379-E384. [PMID: 31147379 PMCID: PMC6544505 DOI: 10.9778/cmajo.20180173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/22/2022] Open
Abstract
BACKGROUND Recent years have seen centralization of vascular surgery services in Ontario. We sought to examine the trends in overall and approach-specific elective and ruptured abdominal aortic aneurysm repair by hospital type (teaching v. community). METHODS We conducted a population-based time-series analysis of elective and ruptured abdominal aortic aneurysm repairs in Ontario, Canada, from 2003 to 2016. Quarterly cumulative incidences of repairs per 100 000 Ontarians aged 40 years and older were calculated. We fit exponential smoothing models to the data stratified by approach and hospital type to examine repair trends. RESULTS We identified 19 219 elective and 2722 ruptured repairs between 2003 and 2016. The cumulative incidences of overall elective repair and elective open surgical repair decreased by 1.15% (p = 0.008) and 67% (p < 0.001), respectively, in teaching hospitals and by 23% (p < 0.001) and 60% (p < 0.001), respectively, in community hospitals. The cumulative incidence of elective endovascular repair increased 667% in teaching hospitals (p < 0.001). Elective endovascular repair began in community centres after 2010 and increased to 0.98/100 000 (p < 0.001), resulting in a rebound in overall elective repair in the community. Overall ruptured repairs and ruptured open repairs decreased by 84% (p < 0.001) and 88% (p = 0.002), respectively, at community hospitals. Ruptured endovascular repairs at community hospitals increased from no procedures before 2006 to 0.03/100 000 in 2016 (p = 0.005). INTERPRETATION There has been substantial uptake of endovascular aortic repair in teaching and community hospitals in Ontario, and community hospital uptake of endovascular repair has begun decentralization of abdominal aortic aneurysm repair. Increased experience and training in endovascular repair and reduced specialized care requirements will probably lead to continued decentralization.
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Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Mohamad A Hussain
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Charles de Mestral
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Elisa Greco
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Badr A Aljabri
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Sandra Sabongui
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Muhammad Mamdani
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Thomas L Forbes
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Deepak L Bhatt
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Subodh Verma
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont
| | - Mohammed Al-Omran
- Division of Vascular Surgery (Salata, Hussain, de Mestral, Greco, Aljabri, Sabongui, Al-Omran), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.; Department of Surgery (Aljabri), King Saud University, Riyadh, Kingdom of Saudi Arabia; Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Mamdani), University of Toronto; Division of Vascular Surgery (Forbes), Peter Munk Cardiac Centre, University Health Network, and University of Toronto, Toronto, Ont.; Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Division of Cardiac Surgery (Verma), Li Ka Shing Knowledge Institute of St. Michael's Hospital, and University of Toronto, Toronto, Ont.
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Salata K, Hussain MA, Mestral CD, Greco E, Mamdani M, Tu JV, Forbes TL, Bhatt DL, Verma S, Al-Omran M. The impact of randomized trial results on abdominal aortic aneurysm repair rates from 2003 to 2016: A population-based time-series analysis. Vascular 2019; 27:417-426. [DOI: 10.1177/1708538119829582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives The uptake of endovascular aortic repair for elective and ruptured abdominal aortic aneurysm repair is not well studied. We aimed to examine the trends in open surgical repair and endovascular aortic repair of eAAA and rAAA and to examine the effects of randomized trial publications on elective open surgical repair and endovascular aortic repair rates. Methods We conducted a population-based time-series analysis of eAAA and rAAA repairs in Ontario, Canada from 2003 to 2016. We examined changes in overall and approach-specific rates of eAAA and rAAA repair using exponential smoothing models. Interventional autoregressive integrated moving average models were fit to the eAAA rates to examine the impact of randomized trial results on these rates. Results We identified 19,489 eAAA (12,232 open (63%) and 7257 endovascular (37%)) and 2732 rAAA (2466 open (90%) and 266 endovascular (10%)) repairs from 2003 to 2016. The rate of eAAA repair declined from 6.39/100,000 in 2003 to 5.59/100,000 in 2016 (13% decrease, p = 0.17). The rate of elective open surgical repair decreased nearly three-fold from 6.07/100,000 to 2.12/100,000 ( p < 0.0001), while elective endovascular aortic repair increased approximately 10-fold (0.32/100,000 to 3.47/100,000, p < 0.0001). The rate of ruptured open surgical repair decreased from 1.62/100,000 to 0.37/100,000 ( p < 0.44), while ruptured endovascular aortic repair uptake increased (0.00/100,000 to 0.12/100,000, p < 0.25). The mid-term results of the DREAM and EVAR-1 trials were associated with a decrease in the rate of elective open surgical repair decline after 2010 ( p = 0.01). Conclusions While elective open surgical repair use has significantly decreased from 2003 to 2016, elective endovascular aortic repair use has significantly increased. The DREAM and EVAR-1 results significantly impacted the observed rates of elective open surgical repair only. The reasons for these trends require further characterization.
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Affiliation(s)
- Konrad Salata
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Elisa Greco
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada
| | - Jack V Tu
- Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada
- Division of Cardiology, Department of Medicine, Schulich Heart Program, Sunnybrook Hospital, Toronto, ON, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute at Sunnybrook Hospital, Toronto, ON, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Subodh Verma
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Salata K, Syed M, Hussain M, de Mestral C, Greco E, Mamdani M. Statins Reduce Abdominal Aortic Aneurysm Growth, Rupture, and Perioperative Mortality: A Systemic Review and Meta-Analysis. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hussain MA, Al-Omran M, Salata K, Sivaswamy A, Verma S, Forbes TL, Kayssi A, de Mestral C. A call for integrated foot care and amputation prevention pathways for patients with diabetes and peripheral arterial disease across Canada. Can J Public Health 2019; 110:253-255. [PMID: 30617989 DOI: 10.17269/s41997-018-0166-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Mohamad A Hussain
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond Street, 7-080 Bond Wing, Toronto, Ontario, M5B 1W8, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond Street, 7-080 Bond Wing, Toronto, Ontario, M5B 1W8, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Diabetes Action Canada Working Group on Foot Care and Amputation Prevention, Toronto, Canada
| | - Konrad Salata
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond Street, 7-080 Bond Wing, Toronto, Ontario, M5B 1W8, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Subodh Verma
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond Street, 7-080 Bond Wing, Toronto, Ontario, M5B 1W8, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Diabetes Action Canada Working Group on Foot Care and Amputation Prevention, Toronto, Canada
| | - Thomas L Forbes
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond Street, 7-080 Bond Wing, Toronto, Ontario, M5B 1W8, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Diabetes Action Canada Working Group on Foot Care and Amputation Prevention, Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Kayssi
- Department of Surgery, University of Toronto, Toronto, Canada.,Diabetes Action Canada Working Group on Foot Care and Amputation Prevention, Toronto, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Sunnybrook Research Institute of Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Charles de Mestral
- Li Ka Shing Knowledge Institute of St. Michaels Hospital, 30 Bond Street, 7-080 Bond Wing, Toronto, Ontario, M5B 1W8, Canada. .,ICES, Toronto, Ontario, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada. .,Diabetes Action Canada Working Group on Foot Care and Amputation Prevention, Toronto, Canada.
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Syed M, Salata K, Hussain M, de Mestral C, Verma S, Wheatcroft M, Harlock J, Verma A, Razak F, Al-Omran M. MS02.8 Economic and Clinical Burden of Diabetic Foot Ulcers: A Multicentre Study. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.011] [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: 10/28/2022] Open
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Al-Omran M, Salata K, Hussain M, de Mestral C, Greco E, Tu J, Mamdani M, Forbes T, Bhatt D, Verma S. PO297 Time-series Analysis of Elective and Ruptured Abdominal Aortic Aneurysm Repair Trends From 2003 to 2016. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.239] [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] Open
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Hussain M, de Mestral C, Salata K, Tu J, Sivaswamy A, Verma S, Forbes T, Kayssi A, Al-Omran M. MS03.2 Peripheral Artery Disease and Diabetes-related Amputations: Temporal Trends and Geographic Variation. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.014] [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] Open
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Salata K, Hussain MA, de Mestral C, Greco E, Mamdani M, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Prevalence of Elective and Ruptured Abdominal Aortic Aneurysm Repairs by Age and Sex From 2003 to 2016 in Ontario, Canada. JAMA Netw Open 2018; 1:e185418. [PMID: 30646400 PMCID: PMC6324588 DOI: 10.1001/jamanetworkopen.2018.5418] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Age and sex are important considerations in assessing and individualizing therapy for abdominal aortic aneurysm (AAA) repair. OBJECTIVE To determine the prevalence of open and endovascular elective AAA (EAAA) and ruptured AAA (RAAA) repair by age and sex. DESIGN, SETTING, AND PARTICIPANTS In this retrospective, population-based, cross-sectional, time-series analysis in Ontario, Canada, from April 1, 2003, to March 31, 2016, all patients undergoing AAA repair who were older than 39 years were included. EXPOSURES Elective AAA and RAAA repair with open surgical repair (OSR) or endovascular aortic repair (EVAR). MAIN OUTCOMES AND MEASURES Age- and sex-standardized rates of EAAA and RAAA repair with OSR and EVAR. RESULTS From 2003 to 2016, 19 489 EAAA repairs (12 232 [63%] OSR and 7257 [37%] EVAR) and 2732 RAAA repairs (2466 [90%] OSR and 266 [10%] EVAR) were identified. The mean (SD) age was 72.7 (8.1) years in the EAAA subgroup and 73.5 (8.9) years in the RAAA subgroup; 15 813 patients (81%) in the EAAA subgroup and 2178 (80%) in the RAAA subgroup were men. The rates of EAAA by age quintile and sex decreased over the study period except among patients older than 79 years (1.3 per 100 000 population in 2003 to 2.2 per 100 000 population in 2016; 70% increase; P < .001). The rates of elective OSR decreased across all age and sex subgroups (range, 38%-74% decrease; P ≤ .009 for all subgroups) except among patients older than 79 years (1.3 per 100 000 population at baseline to 0.56 per 100 000 population in the second quarter of 2016; 53% decrease; P = .05). The rates of elective EVAR significantly increased across all age and sex subgroups (range, 566%-1585% increase; P ≤ .04 for all subgroups). Elective EVAR became the dominant treatment approach for aneurysms in men around 2010, whereas it maintained parity among women in 2016. The RAAA repair rate decreased over the study period in all subgroups (range, 32%-91% decrease; P ≤ .001 for all subgroups), but the decrease was not significant among women (80% decrease; P = .08). Similarly, the rates of ruptured OSR decreased among all subgroups (range, 47%-91% decrease; P < .001), but the decrease was not significant among women (87% decrease; P = .54). Ruptured EVAR showed significant uptake in all subgroups. CONCLUSIONS AND RELEVANCE Among patients with AAA in Ontario, Canada, use of EVAR appeared to increase from 2003 to 2016, whereas OSR use appeared to decrease. These findings were most pronounced among elective procedures for men and older patients. The delayed increase in the use of EVAR among women may reflect continued anatomical constraints for women seeking elective repair.
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Affiliation(s)
- Konrad Salata
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mohamad A. Hussain
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Charles de Mestral
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Elisa Greco
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training, Li Ka Shing Knowledge Institute, St Michael’s Hospital Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas L. Forbes
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Subodh Verma
- Department of Surgery, Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Department of Surgery, Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia
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de Mestral C, Hsu AT, Talarico R, Hussain MA, Salata K, Al-Omran M, Tanuseputro P. LEA 9. End-of-Life Care After Major Amputation for Diabetes or Peripheral Arterial Disease. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.08.020] [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] [Indexed: 11/28/2022]
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Salata K, Hussain MA, De Mestral C, Greco E, Mamdani M, Tu JV, Forbes TL, Verma S, Al-Omran M. Validation of abdominal aortic aneurysm repair codes in Ontario administrative data. CLIN INVEST MED 2018; 41:E148-E155. [DOI: 10.25011/cim.v41i3.30858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 09/30/2018] [Indexed: 11/03/2022]
Abstract
Purpose: To determine the positive predictive values (PPV) of Ontario administrative data codes for the identification of open (OSR) and endovascular (EVAR) repairs of elective (eAAA) and ruptured (rAAA) abdominal aortic aneurysms.
Methods: We randomly identified 319 eAAA and rAAA repairs at two Toronto hospitals between April 2003 and March 2015, using administrative health data in Ontario, Canada. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes I71.3 and I71.4, were used to identify rAAA and eAAA patients, respectively. A blinded retrospective chart review was conducted and served as the gold standard comparator. Re-abstracted records were compared to Canadian Classification of Health Interventions (CCI) and Ontario Health Insurance Plan (OHIP) codes in the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) and OHIP databases. We calculated the PPV and 95% confidence intervals (95% CI) of individual and combined procedure and billing codes for elective and ruptured OSR and EVAR (eOSR, eEVAR, rOSR, and rEVAR).
Results: Permutation of codes allowed identification of eOSR with 95% PPV (95% CI 88, 98), eEVAR with 96% PPV (95% CI 90, 99), rOSR with 87% PPV (95% CI 79, 93) and rEVAR with 91% PPV (95% CI 59, 100).
Conclusions: Diagnostic, procedure and billing code combinations allow identification of eOSR, eEVAR, rOSR and rEVAR patients in Ontario administrative data with a high degree of certainty.
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Hussain MA, Al-Omran M, Salata K, Tu JV, Sivaswamy A, Verma S, Forbes TL, Kayssi A, de Mestral C. Lower Limb Amputations in Patients With Diabetes and Peripheral Artery Disease: A Time-Series Analysis of Trends (2005-2016). J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.170] [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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Hussain MA, Saposnik G, Raju S, Salata K, Mamdani M, Tu JV, Bhatt DL, Verma S, Al-Omran M. Impact of Statins on Clinical Outcomes After Carotid Endarterectomy and Stenting: A Population-Based Cohort Study. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.148] [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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Jacob-Brassard J, Salata K, Kayssi A, Hussain M, Forbes T, Al-Omran M, de Mestral C. Knowing When Not to Intervene: A Systematic Review of Nonoperative Management in Blunt Thoracic Aortic Injury. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.143] [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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Salata K, Hussain MA, de Mestral C, Greco E, Mamdani M, Tu JV, Forbes TL, Bhatt DL, Verma S, Al-Omran M. Age- and Sex-Stratified Trends in Elective and Ruptured Abdominal Aortic Aneurysm Repair from 2003 to 2016. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.182] [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: 11/27/2022]
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AlHamzah M, Hughes B, Salata K, Hussain MA, Al-Omran M. The Feasibility and Accuracy of Automated Blood Pressure Cuff Ankle-Brachial Index Measurements in Outpatients’ Screening. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.181] [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: 10/28/2022]
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Hussain MA, Saposnik G, Raju S, Salata K, Mamdani M, Tu JV, Bhatt DL, Verma S, Al‐Omran M. Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization. J Am Heart Assoc 2018; 7:e009745. [PMID: 30369318 PMCID: PMC6201401 DOI: 10.1161/jaha.118.009745] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/09/2018] [Indexed: 01/27/2023]
Abstract
Background Statins are commonly used for the prevention of cardiovascular events; however, statins are underutilized in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and outcomes after carotid revascularization. Methods and Results In this population-level retrospective cohort study, we identified all individuals aged ≥66 years who underwent carotid endarterectomy or stenting in Ontario, Canada (2002-2014). The primary outcome was a composite of 1-year stroke, myocardial infarction, or death (major adverse cardiac and cerebrovascular events). Five-year risks were also examined. Adjusted hazard ratios were computed using inverse probability of treatment weighting based on propensity scores. A total of 7893 of 10 723 patients (73.6%) who underwent carotid revascularization were on preprocedural statin therapy; moderate- or high-dose therapy was utilized by 7384 patients (68.9%). The composite rate of 1-year major adverse cardiac and cerebrovascular events was lower among statin users (adjusted hazard ratio: 0.76; 95% confidence interval, 0.70-0.83). Patients who were on persistent long-term statin therapy after the carotid procedure continued to experience significantly lower risk of major adverse cardiac and cerebrovascular events at 5 years (adjusted hazard ratio: 0.75, 95% confidence interval, 0.71-0.80). The beneficial associations with statin use were observed regardless of type of carotid revascularization procedure, carotid artery symptom status, or statin dose. Conclusions Continuous statin therapy was associated with a 25% lower risk of long-term adverse cardiovascular events in patients with significant carotid disease. Along with other supportive evidence, statins should be considered in patients undergoing carotid revascularization, and efforts are required to increase statin use in this undertreated population.
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Affiliation(s)
- Mohamad A. Hussain
- Division of Vascular SurgerySt. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoOntarioCanada
| | - Gustavo Saposnik
- Division of NeurologySt. Michael's HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada
- Department of MedicineUniversity of TorontoOntarioCanada
- Institute of Health Policy, Management, and EvaluationUniversity of TorontoOntarioCanada
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
| | - Sneha Raju
- Department of SurgeryUniversity of TorontoOntarioCanada
| | - Konrad Salata
- Division of Vascular SurgerySt. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoOntarioCanada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada
- Institute of Health Policy, Management, and EvaluationUniversity of TorontoOntarioCanada
- Leslie Dan Faculty of PharmacyUniversity of TorontoOntarioCanada
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
- King Saud University‐Li Ka Shing Collaborative Research ProgramKing Saud UniversityRiyadhKingdom of Saudi Arabia
| | - Jack V. Tu
- Department of MedicineUniversity of TorontoOntarioCanada
- Institute of Health Policy, Management, and EvaluationUniversity of TorontoOntarioCanada
- Institute for Clinical Evaluative SciencesTorontoOntarioCanada
- Division of CardiologySchulich Heart CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart & Vascular CenterHarvard Medical SchoolBostonMA
| | - Subodh Verma
- Division of Cardiac SurgerySt. Michael's HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoOntarioCanada
- King Saud University‐Li Ka Shing Collaborative Research ProgramKing Saud UniversityRiyadhKingdom of Saudi Arabia
| | - Mohammed Al‐Omran
- Division of Vascular SurgerySt. Michael's HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge Institute of St. Michael's HospitalTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoOntarioCanada
- King Saud University‐Li Ka Shing Collaborative Research ProgramKing Saud UniversityRiyadhKingdom of Saudi Arabia
- Department of SurgeryKing Saud UniversityRiyadhKingdom of Saudi Arabia
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De Mestral C, Salata K, Hussain M, Kayssi A, Al-Omran M, Roche-Nagle G. Evaluating Quality Metrics and Cost After Discharge: A Population-Based Cohort Study of Value in Health Care Following Elective Major Vascular Surgery. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.06.016] [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: 10/28/2022]
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Syed MH, Hussain MA, Khoshhal Z, Salata K, Altuwaijri B, Hughes B, Alsaif N, de Mestral C, Verma S, Al-Omran M. Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study. Can J Surg 2018; 61:257-263. [PMID: 30067184 PMCID: PMC6066379 DOI: 10.1503/cjs.012417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Rates of hospital readmission following surgery can serve as a marker for quality of care. The aim of this study was to establish the rates and causes of readmission and emergency department visits after vascular surgery and to understand how these patients are managed. METHODS We conducted a prospective observational cohort study including all inpatients who underwent major vascular surgery between September 2015 and June 2016 at a tertiary vascular care centre in Toronto. Patients were followed at 30 days after discharge via telephone interview. RESULTS We enrolled 133 patients (94 men [70.7%] and 39 women [29.3%] with a mean age of 65.3 years). The most common index admission diagnosis was peripheral artery disease (67 patients [50.4%]). At 30 days, 19 patients (14.8%) had been readmitted or had visited the emergency department, most commonly after lower extremity revascularization (19.4%). Ten patients were readmitted a mean of 16.8 days following discharge; surgical site infection was the most common cause for readmission (3 patients). The most common treatment was antimicrobial therapy (4 patients). The mean hospital length of stay was 14.4 days. Nine patients presented to the emergency department a mean of 10.6 days after discharge; 6 reported a wound issue, and most (6 of 9) were managed with oral antibiotic treatment. CONCLUSION Early readmission/emergency department visits after lower extremity revascularization surgery in patients with peripheral artery disease are common and are often due to surgical site infection or wound-related issues. Follow-up within 7-10 days and a specialized wound care team may help reduce the occurrence of these events.
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Affiliation(s)
- Muzammil H Syed
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Mohamad A Hussain
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Zeyad Khoshhal
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Konrad Salata
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Beidaa Altuwaijri
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Bertha Hughes
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Norah Alsaif
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Charles de Mestral
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Subodh Verma
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Mohammed Al-Omran
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
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Hussain MA, Al-Omran M, Salata K, Tu JV, Sivaswamy A, Verma S, Forbes TL, de Mestral C. IP215. Population-Based Secular Trends in Lower Extremity Amputations for Diabetes and Peripheral Artery Disease. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.194] [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: 10/16/2022]
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Hussain MA, Raju S, Salata K, Mamdani M, Tu JV, Bhatt DL, Verma S, Al-Omran M. PC062. Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.276] [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: 12/01/2022]
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Hussain M, Alali A, Mamdani M, Saposnik G, Salata K, Nathens A. Risk of Intracranial Hemorrhage After Carotid Artery Stenting Versus Endarterectomy: A Population-Based Study. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.03.005] [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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Salata K, Syed M, Hussain MA, Eikelboom R, de Mestral C, Verma S, Al-Omran M. Renin-angiotensin system blockade does not attenuate abdominal aortic aneurysm growth, rupture rate, or perioperative mortality after elective repair. J Vasc Surg 2018; 67:629-636.e2. [DOI: 10.1016/j.jvs.2017.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022]
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Hussain MA, Mamdani M, Tu JV, Saposnik G, Salata K, Bhatt DL, Verma S, Al-Omran M. Association between operator specialty and outcomes after carotid artery revascularization. J Vasc Surg 2018; 67:478-489.e6. [DOI: 10.1016/j.jvs.2017.05.123] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/18/2017] [Indexed: 01/18/2023]
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Hussain MA, Alali AS, Mamdani M, Tu JV, Saposnik G, Salata K, de Mestral C, Verma S, Al-Omran M. Risk of Intracranial Hemorrhage After Carotid Endarterectomy Versus Stenting. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.032] [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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Salata K, Syed M, Hussain M, Alsaif N, Verma S, Al-Omran M. The Impact of Statins on Abdominal Aortic Aneurysm Growth, Rupture, and Perioperative Outcomes: A Systematic Review and Meta-Analysis. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.015] [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: 10/19/2022]
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AlHamzah M, Eikelboom R, Syed M, Salata K, Hussain MA, Al-Omran M. Physicians' Peripheral Arterial Disease Knowledge Gap Starts in Medical School. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.051] [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: 11/24/2022]
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