Outcomes in octogenarians and the effect of comorbidities after intact abdominal aortic aneurysm repair in the Netherlands: a nationwide cohort study

Objective: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined.Methods: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality.Results: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age >= 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR.Conclusion: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered.Development and application of statistical models for medical scientific researc

Outcomes in Octogenarians and the Effect of Comorbidities After Intact Abdominal Aortic Aneurysm Repair in the Netherlands: A Nationwide Cohort Study

OBJECTIVE: Age is an independent risk factor for mortality after both elective open surgical repair (OSR) and endovascular aneurysm repair (EVAR). As a result of an ageing population, and the less invasive nature of EVAR, the number of patients over 80 years (octogenarians) being treated is increasing. The mortality and morbidity following aneurysm surgery are increased for octogenarians. However, the mortality for octogenarians who have either low or high peri-operative risks remains unclear. The aim of this study was to provide peri-operative outcomes of octogenarians vs. non-octogenarians after OSR and EVAR for intact aneurysms, including separate subanalyses for elective and urgent intact repair, based on a nationwide cohort. Furthermore, the influence of comorbidities on peri-operative mortality was examined. METHODS: All patients registered in the Dutch Surgical Aneurysm Audit (DSAA) undergoing intact AAA repair between 2013 and 2018, were included. Patient characteristics and peri-operative outcomes (peri-operative mortality, and major complications) of octogenarians vs. non-octogenarians for both OSR and EVAR were compared using descriptive statistics. Multivariable logistic regression analyses were used to examine whether age and the presence of cardiac, pulmonary, or renal comorbidities were associated with mortality. RESULTS: This study included 12 054 EVAR patients (3 015 octogenarians), and 3 815 OSR patients (425 octogenarians). Octogenarians in both the EVAR and OSR treatment groups were more often female and had more comorbidities. In both treatment groups, octogenarians had significantly higher mortality rates following intact repair as well as higher major complication rates. Mortality rates of octogenarians were 1.9% after EVAR and 11.8% after OSR. Age ≥ 80 and presence of cardiac, pulmonary, and renal comorbidities were associated with mortality after EVAR and OSR. CONCLUSION: Because of the high peri-operative mortality rates of octogenarians, awareness of the presence of comorbidities is essential in the decision making process before offering aneurysm repair to this cohort, especially when OSR is considered

A Method for Evaluating Animal Usability (MEAU)

Animal Computer Interaction, aims to design user centered interactions that result in good user experiences (UX). During evaluation, the quality of the UX is assessed by measuring the degree to which the interaction between the user and the artefact meets the users’ needs and preferences, as evidenced by their behavior. A key measure of the UX is usability. When evaluating usability for different species, ACI researchers face two major challenges: the differences in cognitive, physical and sensory capabilities between human evaluators and animal users, with the implications these differences have for assessing the users’ behavior; and the human-centric focus of most usability evaluation methods currently available. To address these challenges, this paper proposes a Method for Evaluating Animal Usability (MEAU), here tailored to Mobility Assistance Dogs as the users, and illustrates its application during a study that compared the canine usability of different access controls

Effect of Fish Oil on Ventricular Tachyarrhythmia and Death in Patients With Implantable Cardioverter Defibrillators: The Study on Omega-3 Fatty Acids and Ventricular Arrhythmia (SOFA) Randomized Trial

Context Very-long-chain n-3 polyunsaturated fatty acids (omega-3 PUFAs) from fish are thought to reduce risk of sudden death, possibly by reducing susceptibility to cardiac arrhythmia. Objective To study the effect of supplemental fish oil vs placebo on ventricular tachyarrhythmia or death. Design, Setting, and Patients The Study on Omega-3 Fatty acids and ventricular Arrhythmia ( SOFA) was a randomized, parallel, placebo-controlled, double-blind trial conducted at 26 cardiology clinics across Europe. A total of 546 patients with implantable cardioverter-defibrillators ( ICDs) and prior documented malignant ventricular tachycardia ( VT) or ventricular fibrillation ( VF) were enrolled between October 2001 and August 2004. Patients were randomly assigned to receive 2 g/d of fish oil ( n= 273) or placebo ( n= 273) for a median period of 356 days ( range, 14-379 days). Main Outcome Measure Appropriate ICD intervention for VT or VF, or all-cause death. Results The primary end point occurred in 81 ( 30%) patients taking fish oil vs 90 ( 33%) patients taking placebo ( hazard ratio [ HR], 0.86;95% confidence interval [ CI], 0.64-1.16; P=. 33). In prespecified subgroup analyses, the HR was 0.91 ( 95% CI, 0.661.26) for fish oil vs placebo in the 411 patients who had experienced VT in the year before the study, and 0.76 ( 95% CI, 0.52-1.11) for 332 patients with prior myocardial infarctions. Conclusion Our findings do not indicate evidence of a strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs