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Hajibandeh S, Scarpa E, Kaur N, Alessandri G, Kumar N. Prognostic significance of socioeconomic deprivation in patients with colorectal liver metastasis undergoing liver resection: a retrospective cohort study. Langenbecks Arch Surg 2024; 409:31. [PMID: 38191745 DOI: 10.1007/s00423-023-03220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024]
Abstract
AIMS To evaluate the effect of socioeconomic deprivation on overall survival (OS) in patients undergoing liver resection for colorectal liver metastasis (CRLM). METHODS The STROCSS guideline for observational studies was followed to conduct a single-centre retrospective cohort study. All consecutive patients undergoing resection of CRLM between 2013 and 2021 were considered eligible for inclusion. The Welsh Index of Multiple Deprivation (WIMD) rank was used to determine socioeconomic deprivation status of each patient. Prognostic significance of socioeconomic deprivation was determined by Kaplan-Meier survival statistics and stepwise Cox proportional-hazards regression model. RESULTS A total of 455 patients were eligible for inclusion; 237 patients were classed as least socioeconomically deprived and 218 patients as most socioeconomically deprived. Kaplan-Meier survival statistics showed that socioeconomic deprivation was associated with significantly lower probability of overall survival (HR: 1.55, 95% CI 1.23-1.95; logrank test: P = 0.0001). The stepwise Cox proportional-hazards regression analysis identified socioeconomic deprivation as predictor of OS (HR: 1.56, P = 0.0003) alongside the following variables: ASA status 1 (HR: 0.43, P = 0.0349), presence of extrahepatic disease (HR: 1.51, P = 0.0075), number of tumours (HR: 1.07, P = 0.0221), size of largest tumour (HR: 1.01, P = 0.0003), extended hemihepatectomy (HR: 3.24, P = 0.0018) and absence of recurrence (HR: 0.55, P < 0.0001). CONCLUSIONS Socioeconomic deprivation reduces the probability of long-term overall survival following liver resection in patients with CRLM. This should be taken into account at different levels of health care planning for management of patients with CRLM including preoperative risk assessment, health care need assessment and allocation of resources.
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Affiliation(s)
- Shahab Hajibandeh
- Cardiff Liver Unit, University Hospital of Wales, Cardiff & Vale NHS Trust, Cardiff, CF14 4XW, UK.
| | - Emanuele Scarpa
- Cardiff Liver Unit, University Hospital of Wales, Cardiff & Vale NHS Trust, Cardiff, CF14 4XW, UK
| | - Namratha Kaur
- Cardiff Liver Unit, University Hospital of Wales, Cardiff & Vale NHS Trust, Cardiff, CF14 4XW, UK
| | - Giorgio Alessandri
- Cardiff Liver Unit, University Hospital of Wales, Cardiff & Vale NHS Trust, Cardiff, CF14 4XW, UK
| | - Nagappan Kumar
- Cardiff Liver Unit, University Hospital of Wales, Cardiff & Vale NHS Trust, Cardiff, CF14 4XW, UK
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Cicuttini FM, Tran TD, Hussain SM, Wluka AE, Fisher JRW. Determinants of worse care for non-COVID-19 health or disability needs in Australia in the first month of COVID-19 restrictions: A national survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2559-e2570. [PMID: 34985789 DOI: 10.1111/hsc.13699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 10/17/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
We examined the effect of person-related factors on capacity to obtain needed healthcare for non-COVID-19 health conditions/disabilities under COVID-19 restrictions. This was an anonymous online survey of Australian residents ≥18 years (3rd April to 2nd May 2020). We determined the ability to obtain care needed for non-COVID-19 health conditions/disabilities, experience of COVID-19, COVID-19 restrictions and sociodemographic characteristics using study-specific questions; and clinically significant depressive and anxiety symptoms using Patient Health Questionnaire 9 and Generalised Anxiety Disorder Scale 7 respectively. We calculated the population attributable fraction (PAF) to determine the proportion of worse access to non-COVID-19 health/disability care attributable to independent risk factors. 13,829 (91.5%) participants had complete data. 6,712 (46.4%) identified a need for healthcare/disability services (<45 years 42.1%, ≥45 years 50.3%). 31.6% aged <45 years and 24.3% aged ≥45 years reported worse access to health/disability care than experienced prior to the pandemic. In those aged <45 years the PAF was highest for depressive symptoms (21.4%; 95% CI 12.6%-29.3%) and anxiety (PAF 19.9%, 12.3%-26.9%). with a PAF of 49.6% (40.1%-57.6%) if any one of the following was being experienced: doing unpaid work; being a student; depressive symptoms; symptoms of anxiety; experiencing high adverse impact of COVID-19 restrictions. In those ≥45 years, PAF was highest for having depressive symptoms (PAF 20.9%, 16.6-24.8) with a PAF of 44.1% (36.0%-51.2%) if any one of the following was being experienced: depressive symptoms; symptoms of anxiety; doing unpaid work; living alone; being in lowest socioeconomic quintile; main source of income from government benefits; any personal experience of COVID-19. The identified risk factors, which include many that characterise those with worse health outcomes generally, explained 44%-50% of worse access to necessary health/disability care. These data have the potential to inform targeted strategies aimed at reducing a post-pandemic escalation of poor health outcomes, especially in vulnerable populations.
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Affiliation(s)
- Flavia M Cicuttini
- Musculoskeletal Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thach Duc Tran
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sultana Monira Hussain
- Musculoskeletal Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anita E Wluka
- Musculoskeletal Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane R W Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Saks BR, Ouyang VW, Domb ES, Jimenez AE, Maldonado DR, Lall AC, Domb BG. Equality in Hip Arthroscopy Outcomes Can Be Achieved Regardless of Patient Socioeconomic Status. Am J Sports Med 2021; 49:3915-3924. [PMID: 34739305 DOI: 10.1177/03635465211046932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Access to quality health care and treatment outcomes can be affected by patients' socioeconomic status (SES). PURPOSE To evaluate the effect of patient SES on patient-reported outcome measures (PROMs) after arthroscopic hip surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Demographic, radiographic, and intraoperative data were prospectively collected and retrospectively reviewed on all patients who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear between February 2008 and September 2017 at one institution. Patients were divided into 4 cohorts based on the Social Deprivation Index (SDI) of their zip code. SDI is a composite measure that quantifies the level of disadvantage in certain geographical areas. Patients had a minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool-12, and visual analog scale (VAS) for both pain and satisfaction. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for the mHHS, NAHS, and VAS pain score. Rates of secondary surgery were also recorded. RESULTS A total of 680 hips (616 patients) were included. The mean follow-up time for the entire cohort was 30.25 months. Division of the cohort into quartiles based on the SDI national averages yielded 254 hips (37.4%) in group 1, 184 (27.1%) in group 2, 148 (21.8%) in group 3, and 94 (13.8%) in group 4. Group 1 contained the most affluent patients. There were significantly more men in group 4 than in group 2, and the mean body mass index was greater in group 4 than in groups 1 and 2. There were no differences in preoperative radiographic measurements, intraoperative findings, or rates of concomitant procedures performed. All preoperative and postoperative PROMs were similar between the groups, as well as in the rates of achieving the MCID or PASS. No differences in the rate of secondary surgeries were reported. CONCLUSION Regardless of SES, patients were able to achieve significant improvements in several PROMs after hip arthroscopy for FAIS and labral tear at the minimum 2-year follow-up. Additionally, patients from all SES groups achieved clinically meaningful improvement at similar rates.
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Affiliation(s)
- Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA
| | - Vivian W Ouyang
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Elijah S Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA.,American Hip Institute, Chicago, Illinois, USA
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Brands M, Verbeek A, Geurts S, Merkx T. Follow-up after oral cancer treatment-Transition to a personalized approach. J Oral Pathol Med 2021; 50:429-434. [PMID: 33270280 DOI: 10.1111/jop.13147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines for follow-up after oral cancer treatment are not site-specific and encompass the entire head and neck area rather than the oral cavity alone. This one-size-fits-all protocol disregards the differences in aetiology, treatment and differential distribution of new disease between the subsites. With the effectiveness of follow-up in early detection of new disease being put into question, the focus of follow-up programmes might shift to other aspects of survivorship care. Personalization of follow-up is important, considering patient-specific features and needs. Furthermore, the COVID-19 pandemic urges us to rethink our follow-up practice. FINDINGS This paper discusses ways in which routine follow-up in patients treated for oral cancer can be optimized. Patients with a high risk of new disease might benefit from an intensified follow-up regimen, whilst patients with a low risk of new disease, a low chance of cure or limited life expectancy could benefit from a de-intensified follow-up regimen. The latter could include a shorter follow-up period and focus on goals other than early detection of new disease. Education of patients to report new symptoms early is of vital importance as the majority of new disease presents symptomatically. Other health care professionals such as specialist nurses and dentists need to play an important leading role in survivorship care. Remote consultations may be useful to perform more efficient and patient-centred follow-up care. CONCLUSION Routine follow-up needs to be seen as an integrated part of an individualized survivorship plan that is provided by the entire multidisciplinary team.
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Affiliation(s)
- Marieke Brands
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University Hospital Monklands, Airdrie, UK.,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - André Verbeek
- Department for Health Evidence, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sandra Geurts
- Department of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thijs Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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Wan YI, McGuckin D, Fowler AJ, Prowle JR, Pearse RM, Moonesinghe SR. Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies. Br J Anaesth 2020; 126:642-651. [PMID: 33220938 DOI: 10.1016/j.bja.2020.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is associated with health inequalities. We explored relationships between socioeconomic group and outcomes after elective surgery in the UK National Health Service (NHS). METHODS We combined data from two observational studies in 115 NHS hospitals and determined socioeconomic group using the Index of Multiple Deprivation (IMD) quintiles based on place of residence. Postoperative complications and 3-yr survival were assessed using logistic and Cox regression. Univariate analyses were adjusted for age differences between IMD quintiles. Multivariable analyses were used to account for other baseline risk factors including sex and comorbid disease. Results are reported as n (%), hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals. RESULTS Postoperative complications developed in 971/9051 patients (10.7%) and 1597/9043 patients (17.7%) died within 3 yr. Complication rates increased with deprivation (reference group least-deprived IMD5): IMD1 (OR=1.44 [1.17-1.78]; P<0.001), IMD2 (OR=1.38 [1.12-1.70]; P<0.01), IMD3 (OR=1.09 [0.88-1.35]: P=0.44), IMD4 (OR=0.89 [0.71-1.11]; P=0.30). More patients from the most deprived quintile died (IMD1) (n=349, 18.8%) compared with the least deprived (IMD5) (n=297, 15.9%) with a trend across the socioeconomic spectrum (P=0.01). After age adjustment, patients in the most deprived areas experienced reduced 3-yr survival: IMD1 (HR=1.43 [1.23-1.67]; P<0.0001), IMD2 (HR=1.35 [1.15-1.57]; P<0.001), IMD3 (HR=1.04 [0.89-1.23]; P=0.60), and IMD4 (HR=1.11 [0.95-1.30]; P=0.19). This finding persisted in risk-adjusted analyses. Increased complication rates only partially explained this reduced survival. CONCLUSIONS Socioeconomic deprivation is associated with worse long-term outcomes after elective surgery. This risk factor should be considered when planning perioperative care for patients from deprived areas.
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Affiliation(s)
- Yize I Wan
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK.
| | - Dermot McGuckin
- Centre for Perioperative Medicine, Department of Targeted Intervention, UK; Surgical Outcomes Research Centre, University College London, London, UK
| | - Alexander J Fowler
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK
| | - John R Prowle
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK
| | - S Ramani Moonesinghe
- Centre for Perioperative Medicine, Department of Targeted Intervention, UK; Surgical Outcomes Research Centre, University College London, London, UK; Health Services Research Centre, National Institute of Academic Anaesthesia, London, UK
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