Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
Although the clinical application of robot-assisted esophagectomy (RE) has increased globally, its advantages over conventional thoracoscopic esophagectomy (TE) remain unclear. The aim of this study was to evaluate the short-term outcomes of RE compared with TE in patients with esophageal cancer in a nationwide cohort.
We retrospectively analyzed patients who underwent RE or TE for esophageal cancer between April 2018 and March 2022 by extracting data from the Diagnosis Procedure Combination, a Japanese national inpatient database. Instrumental variable analysis was employed to compare the short-term outcomes between the two groups. The primary outcomes included respiratory complications and unplanned reintubation.
Among 7003 eligible patients from 69 hospitals, 1971 (28.1%) and 5032 (71.9%) underwent RE and TE, respectively. Respiratory complications, unplanned reintubation, and anastomotic leakage occurred in 1501 (21.4%), 475 (6.8%), and 904 patients (12.9%), respectively. Instrumental variable analysis demonstrated that the incidence of respiratory complications [odds ratio 0.65 (95% CI: 0.52–0.81) P < 0.001], unplanned reintubation [0.44 (0.31–0.62) P < 0.001], and anastomotic leakage [0.73 (0.56–0.94) P = 0.013] was significantly lower in the RE group compared with the TE group.
RE was associated with better short-term outcomes, including fewer respiratory complications, unplanned reintubation, and anastomotic leakage, compared with TE.
Daisuke Kurita, Y. Seto, Y. Hirano et al.· Diseases of the esophagus· 0 citations
The optimal surgical approach for knee arthroplasty remains under debate regarding reducing systemic complications. Although unicompartmental knee arthroplasty (UKA) is generally considered less invasive than total knee arthroplasty (TKA), it remains unclear whether this advantage persists across age groups. This study aimed to compare the risk of major systemic complications between UKA and TKA across age categories using a large-scale nationwide database. Patients who underwent UKA or TKA between July 2010 and March 2022 were identified from the Diagnosis Procedure Combination database in Japan. The primary outcome was a composite of postoperative in-hospital death and major systemic complications requiring additional interventions. Rates of postoperative red blood cell (RBC) transfusion were also evaluated as a secondary outcome. Stabilized inverse probability of treatment weighting (IPTW) using propensity scores was applied to compare outcomes between the groups. The cohort included 36,235 UKA and 322,424 TKA cases. After stabilized IPTW adjustment, the composite outcome occurred less frequently after UKA than after TKA (risk ratio [RR] 0.65; 95% confidence interval [CI] 0.50–0.85; p = 0.001). The RBC transfusion rate was also reduced in the UKA group (RR, 0.09; 95% CI 0.08–0.11; p < 0.001). In subgroup analyses stratified by age (≤ 79 and ≥ 80 years), UKA was associated with a lower incidence of the composite outcome compared with TKA in patients aged ≤ 79 years (RR 0.48; 95% CI 0.34–0.68; p < 0.001), whereas no significant difference between UKA and TKA was observed among patients aged ≥ 80 years (RR 0.92; 95% CI 0.62–1.35; p = 0.670). The rate of RBC transfusion was lower in the UKA group across age groups (for ≤ 79 years, RR 0.07; 95% CI 0.05–0.09; p < 0.001; for ≥ 80 years, RR 0.12; 95% CI 0.10–0.14; p < 0.001). RBC transfusion rates were consistently lower following UKA across age groups. While UKA was associated with fewer major systemic complications than TKA in patients aged ≤ 79 years, no such difference was observed in patients aged ≥ 80 years. In very elderly patients, careful perioperative risk assessment remains essential when considering UKA, similar to that for TKA.
M. Kawata, S. Aso, K. Kawaguchi et al.· Knee Surgery and Related Res...· 0 citations
We investigated the association between blood pressure (BP) and the risk of cardiovascular disease (CVD) in individuals with non-proteinuric chronic kidney disease (CKD) without diabetes. Using a large-scale nationwide administrative claims and health checkup database in Japan, we identified 287,238 non-diabetic adults with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and negative/trace proteinuria. We examined the association between BP and CVD events by modeling BP both as a continuous variable and as a categorical variable according to the 2017 ACC/AHA guideline classification. The primary outcome was a composite of myocardial infarction, stroke, heart failure, and atrial fibrillation. Multivariable Cox regression analyses showed that higher systolic BP (SBP) was associated with increased CVD risk (hazard ratio [HR] 1.05 per 10 mmHg; 95% CI 1.04-1.05). Compared with normal BP, the HRs were 1.03 (95% CI 1.00-1.07) for elevated BP, 1.08 (1.05-1.11) for stage 1 hypertension, and 1.20 (1.17-1.24) for stage 2 hypertension. Restricted cubic spline analysis showed an increase in CVD risk at SBP levels above ~130 mmHg. However, among individuals receiving antihypertensive medication, a U-shaped association was observed, with an increased risk also evident at SBP levels below ~130 mmHg. In individuals with non-proteinuric CKD without diabetes, higher SBP was positively associated with increased cardiovascular risk. However, a U-shaped association observed among individuals receiving antihypertensive treatment suggests that the relationship between BP and cardiovascular risk may be complex in this population, highlighting the potential importance of individualized clinical assessment.
Yuta Suzuki, Masachika Nishikawa, Hidehiro Kaneko et al.· Hypertension Research· 0 citations
Background: Older adults, children, and low-income populations are recognized as vulnerable to climate-related health risks. However, evidence on morbidity risks by functional status remains limited. This study investigated the association between ambient temperature and all-cause hospitalization by functional dependency in Japan. Methods: We obtained daily hospitalization data from the Diagnosis Procedure Combination database and meteorological data for nine Japanese prefectures between 2012 and 2019, comprising over 10 million admissions. Functional status at admission was assessed using the Barthel Index (0–100), with scores >60 classified as functionally independent and ≤60 as functionally dependent. A time-stratified case-crossover design with conditional quasi-Poisson regression was applied to estimate temperature–hospitalization associations. Results: Among functionally independent individuals, relative risks (RRs) were 0.93 (95% confidence interval [CI]: 0.90, 0.96) at extreme cold (5th percentile) and 1.02 (95% CI: 1.01, 1.04) at extreme heat (95th percentile), with the temperature of peak risk (cold) (TPR [cold]) at the 35th percentile (TPR [cold] RR: 1.08 [1.05, 1.10]). Functionally dependent people showed higher risks at extreme cold (RR: 1.11; 95% CI: 1.07, 1.15), comparable risks at TPR (cold) (23rd percentile), and extreme heat (RR: 1.03; 95% CI: 1.02, 1.04). Compared with independent individuals, functionally dependent individuals had higher cold risks, with ratios of RR of 1.20 (95% CI: 1.14, 1.26) at extreme cold and 1.05 (95% CI: 1.01, 1.09) at TPR (cold). These disparities persisted across age and sex subgroups. Conclusions: Temperature-related hospitalization risks vary by functional status. Functionally dependent individuals are particularly vulnerable to cold exposure, highlighting the importance of targeted cold-weather preparedness strategies.
Hana Takeuchi, Vera Ling Hui Phung, Yoshihisa Miyamoto et al.· Environmental Epidemiology· 0 citations
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