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Zhang Z, Mostofian F, Ivanovic J, Gilbert S, Maziak DE, Shamji FM, Sundaresan S, Villeneuve PJ, Seely AJE. All grades of severity of postoperative adverse events are associated with prolonged length of stay after lung cancer resection. J Thorac Cardiovasc Surg 2017; 155:798-807. [PMID: 29103816 DOI: 10.1016/j.jtcvs.2017.09.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/28/2017] [Accepted: 09/16/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether all grades of severity of postoperative adverse events are associated with prolonged length of stay in patients undergoing pulmonary cancer resection. METHODS This was a retrospective cohort study of all patients who underwent pulmonary resection with curative intent for malignancy at The Ottawa Hospital, Division of Thoracic Surgery (January 2008 to July 2015). Postoperative adverse events were collected prospectively with the Thoracic Morbidity & Mortality System, based on the Clavien-Dindo severity classification. Patient demographics, comorbidities, preoperative investigations, cardiopulmonary assessment, pathologic staging, operative characteristics, and length of stay were retrospectively reviewed. Prolonged hospital stay was defined as >75th percentile for each procedure performed (wedge resection 6 days, segmentectomy 6 days, lobectomy 7 days, extended lobectomy 8 days, pneumonectomy 10 days). Univariable and multivariable logistic regression analyses were conducted to identify factors associated with prolonged hospital stay. RESULTS Of 1041 patients, 579 (55.6%) were female, 610 (58.1%) were >65 years old, 232 (22.3%) experienced prolonged hospital stay, and 416 (40.0%) patients had ≥1 postoperative adverse event. Multivariable analyses identified significant (P < .05) factors associated with prolonged hospital stay to be (odds ratio; 95% confidence interval): lower diffusion capacity of the lung for carbon monoxide (0.99; 0.98-0.99), surgical approach: open thoracotomy (1.8; 1.3-2.5), and presence of any postoperative adverse event: Grade I (5.8; 3.3-10.2), Grade II (6.0; 4.0-8.9), Grade III (11.4; 7.0-18.7), and Grade IV (19.40; 7.1-55.18). CONCLUSIONS Lower diffusion capacity of the lung for carbon monoxide, open thoracotomy approach, and the development of any postoperative adverse event, including minor events that required no additional therapy, were factors associated with prolonged hospital stay.
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Affiliation(s)
- Zach Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fargol Mostofian
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jelena Ivanovic
- School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Donna E Maziak
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Farid M Shamji
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sudhir Sundaresan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Patrick J Villeneuve
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew J E Seely
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology, Public Health, and Preventative Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Granger CL, Holland AE, Gordon IR, Denehy L. Minimal important difference of the 6-minute walk distance in lung cancer. Chron Respir Dis 2015; 12:146-54. [DOI: 10.1177/1479972315575715] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The 6-minute walk distance (6MWD) is one of the most commonly used measures of functional capacity in lung cancer, however, the minimal important difference (MID) has not been established. The aims of this exploratory study are, in lung cancer, to estimate (1) the MID of the 6MWD and (2) relationship between 6MWD, demographic and disease-related factors. Fifty-six participants with stage I–IV lung cancer completed the 6MWD prior to treatment and 10 weeks later. No exercise intervention occurred. Additional measures included European Organization for Research and Treatment of Cancer questionnaire (EORTC-QLQ-C30) and questionnaires assessing function, physical activity and symptoms. MID was calculated using anchor- and distribution-based methods. The mean 6MWD decline in participants classed as deteriorated was 60 m compared with 16 m in participants classed as not-deteriorated ( p = 0.01). The receiver operating curve indicated a cut-off value for clinically relevant change to be 42 m (95% confidence interval (CI) 6–75) (area under curve = 0.66, 95% CI 0.51–0.81) or a 9.5% change. Distribution-based methods indicated an MID between 22 m (95% CI 18–26) and 32 m (95% CI 20–42). Higher 6MWD correlated with better function ( r = −0.42, p = 0.001), physical activity ( r = 0.56, p < 0.005) and dyspnoea ( r = −0.44, p = 0.001). The MID for deterioration of the 6MWD in lung cancer is estimated to be between 22 m and 42 m or a change of 9.5%.
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Affiliation(s)
- Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
- Department of Physiotherapy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
| | - Anne E Holland
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Alfred Hospital, Prahran, Victoria, Australia
| | - Ian R Gordon
- Statistical Consulting Centre, The University of Melbourne, Parkville, Victoria, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia
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Santa Mina D, Matthew AG, Hilton WJ, Au D, Awasthi R, Alibhai SMH, Clarke H, Ritvo P, Trachtenberg J, Fleshner NE, Finelli A, Wijeysundera D, Aprikian A, Tanguay S, Carli F. Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial. BMC Surg 2014; 14:89. [PMID: 25394949 PMCID: PMC4246547 DOI: 10.1186/1471-2482-14-89] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 10/02/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An emerging field of research describes the role of preoperative health behaviours, known as prehabilitation. The preoperative period may be a more physically and emotionally salient time to introduce and foster chronic adherence to health behaviours, such as exercise, in patients compared to post-treatment during recovery. Moreover, physical and psychosocial improvements during the preoperative period may translate into an enhanced recovery trajectory with reduced operative complications and postoperative adverse effects. No studies have assessed prehabilitation for men with prostate cancer undergoing radical prostatectomy. METHODS/DESIGN This is a multi-centre, pilot randomized control trial conducted at two Canadian urban teaching hospitals. 100 men undergoing radical prostatectomy for prostate cancer with no contraindications to exercise will be recruited and randomized to the prehabiliation program or usual care. Prehabilitation participants will engage in a preoperative, individualized exercise program including pelvic floor muscle strengthening instructions and a healthy lifestyle guide for men with prostate cancer. These participants will be asked to engage in 60 minutes of home-based, unsupervised, moderate-intensity exercise on 3-4 days per week. Usual care participants will receive the same pelvic floor muscle strengthening instructions and healthy lifestyle guide only. We will assess the feasibility of conducting an adequately powered trial of the same design via recruitment rate, programmatic adherence/contamination, attrition, and safety. Estimates of intervention efficacy will be captured through measurements at baseline (4-8 weeks preoperatively), within 1 week prior to surgery, and postoperatively at 4, 12, and 26 weeks. Efficacy outcomes include: fatigue, quality of life, urinary incontinence, physical fitness, body composition, aerobic fitness, pain, and physical activity volume. DISCUSSION The primary outcome of this study is to determine the feasibility of conducting a full-scale, randomized controlled trial of prehabilitation versus usual care and to estimate effect sizes that will inform sample size determinations for subsequent trials in this field. To our knowledge, this is the first study to examine a structured presurgical exercise program for men undergoing radical prostatectomy for prostate cancer. This trial will advance our understanding of strategies to efficiently and effectively use the preoperative period to optimize postoperative recovery. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02036684.
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Affiliation(s)
- Daniel Santa Mina
- />Kinesiology Program, University of Guelph-Humber, Toronto, ON Canada
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | - Andrew G Matthew
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - William J Hilton
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | - Darren Au
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Guelph, Guelph, ON Canada
| | | | - Shabbir MH Alibhai
- />University of Toronto, Toronto, ON Canada
- />University Health Network, Toronto, ON Canada
| | - Hance Clarke
- />University of Toronto, Toronto, ON Canada
- />University Health Network, Toronto, ON Canada
| | - Paul Ritvo
- />Kinesiology and Health Sciences Department, York University, Toronto, ON Canada
- />Cancer Care Ontario, Toronto, ON Canada
| | - John Trachtenberg
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Neil E Fleshner
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Antonio Finelli
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | - Duminda Wijeysundera
- />Prostate Centre, Princess Margaret Cancer Centre, Toronto, ON Canada
- />University of Toronto, Toronto, ON Canada
| | | | - Simon Tanguay
- />McGill University Health Centre, Montreal, QC Canada
| | - Franco Carli
- />McGill University Health Centre, Montreal, QC Canada
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Santa Mina D, Guglietti CL, Alibhai SMH, Matthew AG, Kalnin R, Ahmad N, Lindner U, Trachtenberg J. The effect of meeting physical activity guidelines for cancer survivors on quality of life following radical prostatectomy for prostate cancer. J Cancer Surviv 2013; 8:190-8. [PMID: 24317972 DOI: 10.1007/s11764-013-0329-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 11/12/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Daniel Santa Mina
- Kinesiology Program, The University of Guelph-Humber, Room GH-308-G, 207 Humber College Boulevard, Toronto, ON, Canada, M9W 5L7,
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Shih CL, Chen CH, Sheu CF, Lang HC, Hsieh CL. Validating and improving the reliability of the EORTC qlq-c30 using a multidimensional Rasch model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:848-854. [PMID: 23947980 DOI: 10.1016/j.jval.2013.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 04/11/2013] [Accepted: 05/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) has not been examined while taking into account the correlation between subscales. The reliability of the EORTC QLQ-C30 subscales is modest, thus limiting their utility in both clinical and research settings. The purpose of this study was to validate the factor structure of multiple-item subscales of the EORTC QLQ-C30 and to improve their reliability by means of an item response analysis by using the multidimensional partial credit model. METHODS A total of 2295 patients with complete data were used for the analysis. One- and nine-dimensional partial credit models were used to fit the data to validate the construct validity of the multiple-item subscales of the QLQ-C30. RESULTS The model comparison showed that the nine-dimensional factor structure of multiple-item subscales was satisfactory. The multidimensional partial credit model fit data of the multiple-item subscales of the QLQ-C30 reasonably well. The estimated test reliabilities of each domain obtained from the multidimensional approach were higher than those obtained from the unidimensional approach. CONCLUSIONS The constructs represented by the multiple-item subscales of the QLQ-C30 were validated. The improved reliability of the multiple-item subscales of the QLQ-C30 under the multidimensional approach can facilitate their applications in clinical and research settings.
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Affiliation(s)
- Ching-Lin Shih
- Center for Teacher Education, National Sun Yat-sen University, Kaohsiung, Taiwan
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Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties. BMC Cancer 2013; 13:135. [PMID: 23514337 PMCID: PMC3623892 DOI: 10.1186/1471-2407-13-135] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/07/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed. METHOD OBJECTIVES To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. DATA SOURCES A systematic review of articles using electronic databases MEDLINE (1950-2012), CINAHL (1982-2012), EMBASE (1980-2012), Cochrane Library (2012), Expanded Academic ASAP (1994-2012), Health Collection Informit (1995-2012) and PEDRO (1999-2012). Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter- or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist. RESULTS Thirteen outcome measures were identified. Thirty-one studies evaluating measurement properties of the outcome measures in participants with NSCLC were included. Functional capacity was assessed using the six- and twelve-minute walk tests; incremental- and endurance-shuttle walk tests; and the stair-climbing test. Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness. Physical activity was measured using accelerometers and pedometers. Only the construct validity for accelerometers and pedometers was reported. Muscle strength was measured using hand-held dynamometry, hand-grip dynamometry, manual muscle test, one-repetition maximum and the chair-stand test, however only two studies reported reliability and measurement error and one study reported construct validity. CONCLUSION Currently there is a gap in the literature regarding the measurement properties of commonly used outcome measures in NSCLC participants, particularly reliability, measurement error and responsiveness. Further research needs to be conducted to determine the most suitable outcome measures for use in trials involving NSCLC participants.
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BuSaba NY, Schaumberg DA. Predictors of prolonged length of stay after major elective head and neck surgery. Laryngoscope 2007; 117:1756-63. [PMID: 17690609 DOI: 10.1097/mlg.0b013e3180de4d85] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE/HYPOTHESIS Longer length of stay (LOS) after elective surgery is associated with an increased use of health care resources and higher costs. The objectives of this study were to determine the perioperative factors that predict a prolonged LOS after elective major head and neck operations and to test the hypothesis that factors related to process of care (intra- and postoperative) independently predict prolonged LOS after adjustment for preoperative patient characteristics. STUDY DESIGN Prospective hospital-based cohort study. METHODS The National VA Surgical Quality Improvement Program data were accessed for seven head and neck operations: radical neck dissection (RND) (n = 398), modified RND (n = 891), total laryngectomy (n = 431), total laryngectomy with RND (n = 747), hemiglossectomy with unilateral RND (n = 201), composite resection (n = 105), and composite resection with RND (n = 312). Prolonged LOS was defined as exceeding the 75th percentile for the LOS distribution of each operation. Multivariable logistic regression analysis was performed to identify factors that predicted prolonged LOS. RESULTS Sixty-eight variables were analyzed among 3,050 patients who qualified for inclusion. Preoperative patient characteristics that predicted prolonged LOS were older age, poorer functional status, consumption of more than two drinks of alcohol per day, history of chronic obstructive pulmonary disease, and diabetes mellitus. Intraoperative processes that predicted prolonged LOS were a longer operative time and transfusion of erythrocytes. The postoperative variables that predicted a prolonged LOS were a return to the operating room within 30 days of the index operation and the occurrence of two or more operative complications. CONCLUSION Several intraoperative processes and postoperative adverse events contributed additional predictive information for prolonged LOS, after consideration of preoperative patient characteristics.
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Affiliation(s)
- Nicolas Y BuSaba
- Division of Otolaryngology, VA Boston HealthCare System, Boston, Massachusetts, USA.
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