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Zang H, Hu A, Xu X, Ren H, Xu L. Development of machine learning models to predict perioperative blood transfusion in hip surgery. BMC Med Inform Decis Mak 2024; 24:158. [PMID: 38840126 PMCID: PMC11155147 DOI: 10.1186/s12911-024-02555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Allogeneic Blood transfusion is common in hip surgery but is associated with increased morbidity. Accurate prediction of transfusion risk is necessary for minimizing blood product waste and preoperative decision-making. The study aimed to develop machine learning models for predicting perioperative blood transfusion in hip surgery and identify significant risk factors. METHODS Data of patients undergoing hip surgery between January 2013 and October 2021 in the Peking Union Medical College Hospital were collected to train and test predictive models. The primary outcome was perioperative red blood cell (RBC) transfusion within 72 h of surgery. Fourteen machine learning algorithms were established to predict blood transfusion risk incorporating patient demographic characteristics, preoperative laboratory tests, and surgical information. Discrimination, calibration, and decision curve analysis were used to evaluate machine learning models. SHapley Additive exPlanations (SHAP) was performed to interpret models. RESULTS In this study, 2431 hip surgeries were included. The Ridge Classifier performed the best with an AUC = 0.85 (95% CI, 0.81 to 0.88) and a Brier score = 0.21. Patient-related risk factors included lower preoperative hemoglobin, American Society of Anesthesiologists (ASA) Physical Status > 2, anemia, lower preoperative fibrinogen, and lower preoperative albumin. Surgery-related risk factors included longer operation time, total hip arthroplasty, and autotransfusion. CONCLUSIONS The machine learning model developed in this study achieved high predictive performance using available variables for perioperative blood transfusion in hip surgery. The predictors identified could be helpful for risk stratification, preoperative optimization, and outcomes improvement.
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Affiliation(s)
- Han Zang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Ai Hu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Xuanqi Xu
- Key Laboratory of High Confidence Software Technologies (Peking University), Ministry of Education, Beijing, 100084, China
- School of Computer Science, Peking University, Beijing, 100084, China
| | - He Ren
- Beijing HealSci Technology Co., Ltd., Beijing, 100176, China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China.
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Şanal L, Günaydın S, Tatar M. Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey. Adv Ther 2024; 41:716-729. [PMID: 38110651 PMCID: PMC10838852 DOI: 10.1007/s12325-023-02733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient's endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs. METHODS Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February 11, 2019 and July 24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution's perspective. RESULTS There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20 months, the hospital's cardiovascular surgery department saved 6,596,934 TRY (€342,302). CONCLUSION This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey.
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Affiliation(s)
- Laser Şanal
- Transfusion Center, Ministry of Health, Ankara Bilkent City Hospital Campus, Ankara, Turkey.
| | - Serdar Günaydın
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara Bilkent City Hospital Campus, Ankara, Turkey
| | - Mehtap Tatar
- Vitale Health Economics, Policy and Consultancy, London, UK
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Tatar M, Alkış N, Yıldırım Güçlü Ç, Bermede O, Erdemli B, Günaydın S. Cost-Effectiveness and Budget Impact of Comprehensive Anemia Management, The First Pillar of Patient Blood Management, on the Turkish Healthcare System. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:415-426. [PMID: 35669886 PMCID: PMC9166278 DOI: 10.2147/ceor.s360944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Mehtap Tatar
- Polar Health Economics and Policy, Ankara, Turkey
- Correspondence: Mehtap Tatar, Polar Health Economics and Policy, Mustafa Kemal Mah. Dumlupınar Bulvarı No:266 Tepe Prime İş Merkezi A Blok No 18, 06800 Çankaya, Ankara, Turkey, Tel +90 532 5538324, Email
| | - Neslihan Alkış
- Department of Anesthesiology and Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Çiğdem Yıldırım Güçlü
- Department of Anesthesiology and Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Onat Bermede
- Department of Anesthesiology and Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Bülent Erdemli
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Serdar Günaydın
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara City Hospital Campus, Ankara, Turkey
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Institutionally Adopted Perioperative Blood Management Program Significantly Decreased the Transfusion Rate of Patients Having Primary Total Hip Replacement Surgery. Adv Orthop 2021; 2021:2235600. [PMID: 34631171 PMCID: PMC8497117 DOI: 10.1155/2021/2235600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
Perioperative transfusion in patients undergoing orthopedic surgery increases the number of postoperative complications. Thus, we have introduced an institution-tailored perioperative blood management program (PBM) to decrease the amount of blood transfused in patients going through primary total hip replacement (THR) surgery. We have conducted a before-after observational cohort study in two predetermined observational periods. Demographic and clinical data, ASA scores, laboratory parameters, features of surgical procedure, and anesthesia were registered. Parameters of perioperative fluid administration, transfusion rate, and postoperative complications were also assessed. One hundred patients in the first and 108 patients in the second observational period were enrolled. Eventhough the ratio of posttraumatic THR procedures increased (9% vs. 17%), the PBM protocol has been utilized effectively and a significant decrease in perioperative blood transfusion rate has been observed (61% vs. 21%). The abolishment of routine preoperative LMWH prophylaxis (90% vs. 16%), intraoperative use of tranexamic acid (10% vs. 84%), and the encouraged exploitation of our postoperative observational facility (5% vs. 39%) were abided by our colleagues. Patients still requiring transfusion had lower preoperative hemoglobin levels (129 vs. 147 g/l), scored higher in ASA (ASA III: 46% vs. 19%), and more often presented postoperative hypotension (40% vs. 7%), oliguria (23% vs. 5%), and infections (9% vs. 2%). We conclude that the individualized perioperative blood management protocol was successfully implemented and yielded a lower transfusion rate and better outcomes. Our study suggests that a partial, institution-tailored PBM program may be suitable and beneficial in countries where the modalities of perioperative blood management are limited.
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Autologous fibrin sealant application in cardiac surgery - a single-centre observational study. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 18:75-79. [PMID: 34386047 PMCID: PMC8340632 DOI: 10.5114/kitp.2021.107467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
Introduction To minimize the risk of blood loss and post-transfusion complications in patients undergoing cardiovascular surgery, different strategies are used. Aim To analyse the efficacy of the intraoperative use of autologous fibrin glue to seal suture lines of cardiac and vascular structures. Material and methods The early results of 62 patients who underwent complex cardiac operations in extracorporeal circulation were analysed. In a half of them Vivostat autologous fibrin sealant in addition to the routine haemostatic agents was applied (study group), whereas in the second group (matched-pair control group) only standard haemostatics were used. Among many other factors, special attention was paid to postoperative drainage and blood products used. Results The mean age of the patients and prevalence of comorbidities did not differ between groups. Generally, in the study group fewer haemostatic agents were used. For example, Preveleak tissue glue was applied in 3.2% of studied cases compared to one third of control patients (p = 0.008). The thoracic drainage on either day 0 or day 1 was also similar. The number of patients who received blood products did not differ between groups. More importantly, there were no significant differences in in-hospital mortality and prevalence of other postoperative complications. Conclusions In this study it was found that application of autologous fibrin glue was safe and might limit use of standard haemostatic agents. Taking into account the lack of potential threats related to the transmission of infections and immune responses, it may be an interesting alternative to the previously used local haemostatics.
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Hofmann A, Spahn DR, Holtorf AP. Making patient blood management the new norm(al) as experienced by implementors in diverse countries. BMC Health Serv Res 2021; 21:634. [PMID: 34215251 PMCID: PMC8249439 DOI: 10.1186/s12913-021-06484-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/06/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient blood management (PBM) describes a set of evidence-based practices to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This concepts aims to detect and treat anemia, minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process. In combination with blood loss, anemia is the main driver for transfusion and all three are independent risk factors for adverse outcomes including morbidity and mortality. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds. METHODS Semi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country and underwent qualitative content analysis. Clustering the resulting implementation measures by levels of intervention for PBM implementation informed a PBM implementation framework. RESULTS A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration. CONCLUSION The implementation matrix resulting from this research helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to design, initiate and develop strategies and plans to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.
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Affiliation(s)
- Axel Hofmann
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
- University of Western Australia Faculty of Health and Medical Sciences, Perth, Australia
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, CH4055 Basel, Switzerland
- Faculty of the College of Pharmacy, University of Utah, Salt Lake City, UT USA
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Drabinski T, Zacharowski K, Meybohm P, Rüger AM, Ramirez de Arellano A. Estimating the Epidemiological and Economic Impact of Implementing Preoperative Anaemia Measures in the German Healthcare System: The Health Economic Footprint of Patient Blood Management. Adv Ther 2020; 37:3515-3536. [PMID: 32562124 PMCID: PMC7370967 DOI: 10.1007/s12325-020-01372-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study aimed to quantify the potential epidemiological and health economic benefits of implementing preoperative anaemia measures (PAMs) in clinical practice in the German healthcare system. METHODS An evidence-based health economic model was developed to assess the possible impact of implementing PAMs, the first pillar of patient blood management (PBM), in a German population. The analysis of two risk factors-iron-deficiency anaemia (IDA) and receipt of a red blood cell concentrate (RBC) transfusion during elective surgery-allowed the estimation of relative risks (RRs), average cost per patient, average length of hospital stay, and avoided hospital deaths after the implementation of PAMs. RESULTS A total of 4,591,060 patients who had undergone elective surgery during 2015 were identified, of which 29,170 (0.64%) were diagnosed with preoperative IDA. These patients had an increased RR of receiving a RBC transfusion during surgery (RR 5.031; 95% confidence interval [CI] 4.928, 5.136) and increased mortality risk (RR 3.630; 95% CI 3.401, 3.874) versus patients without IDA. Patients who received a RBC transfusion during surgery had a 24.6-times higher risk of death than those who did not (RR 24.593; 95% CI 24.121, 25.075). Average cost of treatment was €7883 in patients with IDA, €21,744 in patients with IDA and RBC transfusion, and €4560 in patients without risk factors. The model identified 29,714 patients (0.65%) who had received a RBC transfusion and who potentially had IDA but remained undiagnosed before surgery. Hypothetical implementation of PAMs would have resulted in an estimated annual net hospital direct cost saving of €1029 million (1.58%) of total hospital direct costs of the German healthcare system and 3036 hospital deaths (0.07%) avoided. CONCLUSIONS This model estimated the impact of implementing PAMs for patients with IDA undergoing elective surgery. A significant number of deaths, costly treatments, and hospital days could have been avoided by the introduction of PAMs in routine clinical practice in Germany.
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Affiliation(s)
- Thomas Drabinski
- Institut für Mikrodaten-Analyse (IfMDA), Harmsstr. 13, 24114, Kiel, Germany.
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Patrick Meybohm
- Clinic and Polyclinic for Anaesthesiology, Intensive Medicine and Pain Therapy, University Hospital Würzburg, Würzburg, Germany
| | - Alexandra M Rüger
- Vifor Pharma, Baierbrunner Str. 29 (Eingang Baierbrunner Str. 27), 81379, Munich, Germany
- Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany
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Platelet-rich plasma for sports-related muscle, tendon and ligament injuries: an umbrella review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:465-478. [PMID: 31846610 DOI: 10.2450/2019.0274-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been used in different non-transfusion indications due to its role in tissue regeneration and healing. The aim of this overview of systematic reviews (umbrella review) is to provide a summary of the existing research syntheses related to PRP use for sports-related muscle, tendon and ligament injuries. MATERIALS AND METHODS Literature searches were performed in MEDLINE, Embase, and Cochrane Library to identify systematic reviews focusing on PRP use for sports-related muscle, tendon and ligament injuries. The methodological quality of included studies was assessed using the checklist for systematic reviews and research syntheses developed by the Joanna Briggs Institute and the GRADE assessment. RESULTS Twenty-two studies met the inclusion criteria. Five studies evaluated PRP use for acute muscle injury, and 17 evaluated PRP use for tendon and ligament injury. Studies were heterogeneous in terms of the dose and number of PRP injections, and the control groups. Three of the 5 reviews evaluating acute muscle injury concluded that PRP had no effect on the outcomes considered. One review shows superior efficacy of rehabilitation exercise compared to PRP. One review shows that PRP may result in an earlier return to sport for acute grade I-II injury. Eight out of the 17 reviews evaluating PRP for tendon and ligament injuries show a statistically significant (p<0.05) difference in pain and/or function outcome measures favouring PRP compared to controls, although most of the observed differences were small. Adverse events data and quality of life outcomes were rarely analysed or reported in the included studies and were considered clinically insignificant. DISCUSSION In most of the included reviews, the available evidence was judged to be of low/very low quality due to risk of bias, inconsistency and imprecision, thus making the level of certainty of these findings low and not adequate to support the general use of PRP in this setting.
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Feng S, Greenberg J, Moloo H, Thavorn K, McIsaac DI. Hospital cost associated with anemia in elective colorectal surgery: a historical cohort study. Can J Anaesth 2019; 66:877-885. [PMID: 31044414 DOI: 10.1007/s12630-019-01379-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/28/2018] [Accepted: 01/20/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Anemia is highly prevalent in the colorectal surgery population, affecting 30-70% of patients. Anemia is associated with significant morbidity and mortality; however, there is a lack of evidence on how much anemia impacts healthcare costs. This study aims to determine the hospital cost of index surgical admission, postoperative length of stay, and transfusion rate associated with preoperative anemia in elective major colorectal surgery. METHODS This historical cohort study included 851 adult inpatients having elective colorectal surgery at a tertiary care academic health sciences network between April 2010 and February 2016. Anemia was defined as hematocrit ≤ 39%. The primary outcome was total hospital costs standardized to 2016 CAD. Secondary outcomes were postoperative length of stay and transfusion. Multivariable regression analyses and propensity score methods were used to measure adjusted associations between anemia and outcomes. RESULTS Before surgery, 381/851 (45%) patients were anemic. The mean (standard deviation [SD]) cost of index admission for an elective colorectal surgery was 20,040 (23,219) CAD. Anemia was associated with an adjusted 14% relative increase in costs (95% confidence interval [CI], 6 to 23; P < 0.001). The total hospitalization cost attributable to anemia was 3,027 CAD (95% CI, 2,670 to 3,388). Hospital costs and length of stay were highly associated; anemia was associated with an 18% increase in length of stay (95% CI, 7 to 30; P < 0.001) and increased transfusion rates (risk ratio, 4.7; 95% CI, 2.71 to 8.33; P < 0.001). CONCLUSION Over 2,600 CAD per index surgical admission is attributable to preoperative anemia. Preoperative interventions with per patient cost of less than 2,600 CAD could be cost effective at the hospital level. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03476707); registered 26 March, 2018.
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Affiliation(s)
- Simon Feng
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Joshua Greenberg
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Husein Moloo
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. .,Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Civic Campus, Room B311, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
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