bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum Readmissions Among Women With Diabetes
Authors: Mourad Mirella , Wen Timothy , Friedman Alexander M. , Lonier Jacqueline Y. , D'Alton Mary E. , Zork Noelia 
Published: December 2019

OBJECTIVE:
To estimate whether women with diabetes are at risk for 60-day postpartum readmissions and associated complications.

METHODS:
The Nationwide Readmissions Database from 2010 to 2014 was analyzed to determine risk for 60-day postpartum readmissions among women with type 1 diabetes mellitus (DM), type 2 DM, gestational diabetes mellitus (GDM), and unspecified DM compared with women with no diabetes. Secondary outcomes included evaluating risk for overall severe maternal morbidity during readmissions, as well as wound complications, acute diabetic complications such as diabetic ketoacidosis, venous thromboembolism, and hypertensive diseases of pregnancy. Billing data were used to ascertain both exposures and outcomes. Adjusted log-linear regression models including demographic, hospital, medical and obstetric, and hospital factors were performed with adjusted risk ratios (aRRs) and with 95% Cis as measures of association.

RESULTS:
Of an estimated 15.7 million delivery hospitalizations, 1.1 million occurred among women with diabetes, of whom 3.2% had type 1 DM, 9.1% type 2 DM, 86.6% GDM, and 1.1% unspecified diabetes. Compared with women without diabetes (1.5% risk for readmission), risk for readmission was significantly higher for women with type 1 DM (4.4%), unspecified diabetes (4.0%), type 2 DM (3.9%), and GDM (2.0%) (P<.01). After adjusting for hospital, demographic, medical, and obstetric risk factors, type 1 DM (aRR 1.77, 95% CI 1.69–1.87), type 2 DM (aRR 1.46, 95% CI 1.42–1.51), unspecified (aRR 1.73, 95% CI 1.59–1.89) and gestational diabetes (aRR 1.16, 95% CI 1.14–1.17) retained increased risk. Among women with diabetes public insurance, lower ZIP code income quartiles, and hospitals with high safety net burdens were associated with higher risk for readmission. In both unadjusted and adjusted analyses, all diabetes diagnoses were associated with readmissions for wound complications, hypertensive diseases of pregnancy, and severe maternal morbidity.

CONCLUSION:
Although overall risk for readmission is low, pregnancies complicated by pregestational diabetes in particular are at increased risk. Women in this high-risk group should receive coordinated care and be monitored closely in the postpartum period.
Pregnancy-Associated Atypical Hemolytic Uremic Syndrome
Authors: Gupta Megha , Govindappagari Shravya , Burwick Richard M. 
Published: December 2019

OBJECTIVE:
To evaluate disease presentation, diagnosis, treatment, and clinical outcomes in pregnancy-associated atypical hemolytic uremic syndrome (aHUS).

DATA SOURCES:
We searched PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, Web of Science, EMBASE and Google Scholar, from inception until March 2018.

METHODS OF STUDY SELECTION:
We included English-language articles describing aHUS in pregnancy or postpartum. The diagnosis of aHUS was characterized by hemolysis, thrombocytopenia, and renal failure and was distinguished from typical diarrhea-associated hemolytic uremic syndrome. Patients were excluded if individual data could not be obtained, the diagnosis was unclear, or an alternative etiology was more likely, such as thrombotic thrombocytopenic purpura or Shiga toxin–producing Escherichia coli. Reports were appraised by two reviewers, with disagreements adjudicated by a third reviewer.

TABULATION, INTEGRATION, AND RESULTS:
The search identified 796 articles. After review of titles, abstracts, and full text, we identified 48 reports describing 60 unique cases of pregnancy-associated aHUS, with 66 pregnancies. Twelve cases involved pregnancy in women with known aHUS, and 54 cases involved first-episode pregnancy-associated aHUS. Women with known aHUS, particularly those with baseline creatinine at or above 1.5 mg/dL, had a high rate of adverse pregnancy outcomes. For first-episode pregnancy-associated aHUS, diagnosis most often occurred postpartum (94%), after a cesarean delivery (70%), in nulliparous women (58%). Preceding obstetric complications were common and included fetal death, preeclampsia, and hemorrhage. Diagnosis was usually made clinically, based on the triad of microangiopathic hemolysis, thrombocytopenia, and renal failure. Additional testing included renal biopsy, complement genetic testing, and ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) testing. Treatment modalities included corticosteroids, plasma exchange, dialysis, and eculizumab. More women with first-episode pregnancy-associated aHUS achieved disease remission when treated with eculizumab, compared with those not treated with eculizumab (88% vs 57%, P=.02).

CONCLUSION:
Pregnancy-associated aHUS usually presents in the postpartum period, often after a pregnancy complication, and eculizumab is effective for achieving disease remission.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42019129266.
Interpregnancy Weight Change and Hypertension During Pregnancy
Authors: Martínez-Hortelano Jose Alberto , Cavero-Redondo Iván , Álvarez-Bueno Celia , Sanabria-Martínez Gema , Poyatos-León Raquel , Martínez-Vizcaíno Vicente 
Published: December 2019

OBJECTIVE:
To synthesize evidence regarding the association between interpregnancy weight change and hypertensive disorders of pregnancy.

DATA SOURCES:
MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were systematically searched from the databases’ interception until April 2019. Search strategy included the terms: “interpregnancy,” “intergestational,” “hypertension” and “hypertensive disorders.”

METHODS OF STUDY SELECTION:
Studies that assessed the relationship between interpregnancy weight change and hypertensive disorders of pregnancy were included. Twelve studies and 415,605 women were included in this systematic review and meta-analysis. We used Mendeley reference manager during the review process. Odds ratios (ORs) for the most adjusted models reported by the included articles and the corresponding 95% CIs were calculated. The no weight change category defined by each study was used as the reference category.

TABULATION, INTEGRATION, AND RESULTS:
Overall, there was an increased risk of hypertensive disorders of pregnancy associated with interpregnancy weight gain (OR 1.37; 95% CI 1.21–1.53; I2=62.1%; P<.001). Additionally, interpregnancy weight loss was associated with lower risk of developing hypertensive disorders of pregnancy (OR 0.87; 95% CI 0.75–0.99; I2=54.9%; P=.01), Finally, meta-regression showed that interpregnancy weight gain was associated with a graded increase in the risk of hypertensive disorders of pregnancy.

CONCLUSION:
This systematic review and meta-analysis provides evidence that interpregnancy weight gain is associated with an increased risk of hypertensive disorders of pregnancy, gestational hypertension, and preeclampsia.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42018103002.
Patient-Centered Outcomes After Modified Vestibulectomy
Authors: Das Deepanjana , Davidson Emily R. W. , Walters Mark , Farrell Ruth M. , Ferrando Cecile A. 
Published: December 2019

OBJECTIVE:
To describe patient outcomes after modified vestibulectomy for vulvodynia.

METHODS:
This is a mixed-methods study of patients who had undergone modified vestibulectomy for vulvodynia at a tertiary care hospital from 2009 through 2016. Demographics, preoperative and postoperative examinations, symptoms, and treatments were obtained through retrospective review. Prospective semistructured interviews were conducted from 2018 through 2019 to address patient-reported changes in pain and sexual function. Qualitative analysis was performed using a grounded theory approach.

RESULTS:
Twenty-two patients underwent modified vestibulectomy from 2009 through 2016. Age ranged from 22 to 65 years and mean body mass index was 24.3±5.4. The majority of patients were premenopausal (57%), sexually active (68%), and partnered (76%). Postoperatively, data on pain improvement were retrieved on 18 patients, of which 17 (94%) reported improvement. Patients used pelvic floor physical therapy, medications, and lubricants both preoperatively and postoperatively. For the qualitative analysis, thematic saturation was achieved with 14 interviews. Of 14 participants interviewed, 13 (93%) reported improvement with pain after surgery, 11 (79%) reported satisfaction with surgery, 8 (57%) reported satisfaction with sexual function, and 11 (79%) reported recommending the surgery to others. The following lead themes were identified: vulvodynia symptoms significantly affect quality of life; there is difficulty and delay in diagnosis owing to lack of information and awareness among patients and health care providers; and surgical success and satisfaction are influenced by patient perceptions with sexual dysfunction often persisting despite vulvar pain improvement.

CONCLUSION:
Vulvodynia patients report improvement in pain and high overall satisfaction after modified vestibulectomy, but more variable long-term effects on sexual function.
Risk of Ankle Fusion or Arthroplasty After Operatively and Nonoperatively Treated Ankle Fractures: A Matched Cohort Population Study
Authors: Axelrod Daniel , Veljkovic Andrea , Zochowski Thomas , Marks Paul , Mahomed Nizar , Wasserstein David 
Published: December 2019

Objectives:
To define the risk and incidence of post-traumatic ankle arthritis requiring ankle arthroplasty or fusion after ankle fracture in a large cohort and compare that rate to matched healthy patients from the general population.

Design:
Multiple databases were used to identify patients either treated surgically or nonsurgically for ankle fractures. Each patient was matched to 4 individuals from the general population (13.5 million) with no previous treatment for ankle fracture. Ankle fusion and replacement incidence was compared using the Kaplan–Meier analysis.

Main Outcome Measurement:
Incidence of arthroplasty or fusion in all patients managed for rotational ankle fractures.

Results:
We identified 44,133 and 88,266 patients who had undergone operative management of ankle fracture (OAF) or nonoperative management of ankle fracture (NOAF) by an orthopaedic surgeon, respectively. Three hundred six (0.65%) patients who had OAF eventually underwent fusion or arthroplasty after a median 2.8 and 6.9 years, respectively. Among NOAF, n = 236 (0.17%) patients underwent fusion or arthroplasty after a median of 3.2 and 5.6 years, respectively. Surgical treatment, older age, comorbidity, and postinjury infection significantly increased the risk of fusion/arthroplasty. Compared with matched controls, the risk of fusion/arthroplasty was not independent of time, following an exponential decay pattern. OAF patient risk of fusion/arthroplasty was >20 times the general population in the 3 years after injury and approached the risk of NOAF by 14 years.

Conclusions:
Compared with a matched control group, and after adjustment for medical comorbidity, rotational ankle fractures requiring surgical open reduction internal fixation increased the likelihood of arthroplasty or fusion by 3.5 times. This study allows for accurate prognostication of patient risk of arthroplasty or fusion, using patient- and injury-specific risk factors, both immediately after the initial injury and then subsequently during the follow up.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Hospital and Surgeon Variation in Patient-reported Functional Outcomes After Lumbar Spine Fusion
Authors: Khor Sara , Lavallee Danielle C. , Cizik Amy M. , Bellabarba Carlo , Dagal Armagan , Hart Robert A. , Howe Christopher R. , Martz R. Dean , Shonnard Neal , Flum David R. 
Published: December 2019

Study Design.
Statewide retrospective cohort study using prospectively collected data from the Spine Care and Outcomes Assessment Program, capturing ∼75% of the state's spine fusion procedures.

Objective.
The aim of this study was to estimate the variation in patient-reported outcomes (PROs) 1 year after elective lumbar fusion surgery across surgeons and hospitals; and to discuss the potential impact of guiding patient selection using a PRO prediction tool.

Summary of Background Data.
Despite an increasing interest in incorporating PROs as part of the move toward value-based payment and to improve quality, limited evidence exists on how PROs vary across hospitals and surgeons, a key aspect of using these metrics for quality profiling.

Methods.
We examined patient-reported functional improvement (≥15-point reduction in the Oswestry Disability Index [ODI]) and minimal disability (reaching ≤22 on the ODI) 1 year after surgery in 17 hospitals and 58 surgeons between 2012 and 2017. Outcomes were risk-adjusted for patient characteristics with multiple logistic regressions and reliability-adjusted using hierarchical models.

Results.
Of the 737 patients who underwent lumbar fusion (mean [SD] age, 63 [12] years; 60% female; 84% had stenosis; 70% had spondylolisthesis), 58.7% achieved functional improvement and 42.5% reached minimal disability status at 1 year. After adjusting for patient factors, there was little variation between hospitals and surgeons (maximum interclass correlation was 3.5%), and this variation became statistically insignificant after further reliability adjustment. Avoiding operation on patients with <50% chance of functional improvement may reduce current surgical volume by 63%.

Conclusion.
Variations in PROs across hospitals and surgeons were mainly driven by differences in patient populations undergoing lumbar fusion, suggesting that PROs may not be useful indicators of hospital or surgeon quality. Careful patient selection using validated prediction tools may decrease differences in outcomes across hospitals and providers and improve overall quality, but would significantly reduce surgical volumes.

Level of Evidence: 3
Surgical Treatment of Patients With Dual Hip and Spinal Degenerative Disease
Authors: Yang Daniel S. , Li Neill Y. , Mariorenzi Michael C. , Kleinhenz Dominic T. , Cohen Eric M. , Daniels Alan H. 
Published: December 2019

Study Design.
Retrospective study.

Objective.
To determine how lumbar spinal fusion-total hip arthroplasty (LSF-THA) operative sequence would affect THA outcomes.

Summary of Background Data.
Outcomes following THA in patients with a history of lumbar spinal degenerative disease and fusion are incompletely understood.

Methods.
The PearlDiver Research Program (www.pearldiverinc.com) was used to identify patients undergoing primary THA. Patients were divided into four cohorts: 1) Primary THA without spine pathology, 2) remote LSF prior to hip pathology and THA, and patients with concurrent hip and spinal pathology that had 3) THA following LSF, and 4) THA prior to LSF. Postoperative complications and opioid use were assessed with multivariable logistic regression to determine the effect of spinal degenerative disease and operative sequence.

Results.
Between 2007 and 2017, 85,595 patients underwent primary THA, of whom 93.6% had THA without lumbar spine degenerative disease, 0.7% had a history of remote LSF, and those with concurrent hip and spine pathology, 1.6% had THA prior to LSF, and 2.4% had THA following LSF. Patients with hip and lumbar spine pathology who underwent THA prior to LSF had significantly higher rates of dislocation (aOR = 2.46, P < 0.0001), infection (aOR = 2.65, P < 0.0001), revision surgery (aOR = 1.91, P < 0.0001), and postoperative opioid use at 1 month (aOR: 1.63, P < 0.001), 3 months (aOR = 1.80, P < 0.001), 6 months (aOR: 2.69, P < 0.001), and 12 months (aOR = 3.28, P < 0.001) compared with those treated with THA following LSF.

Conclusion.
Patients with degenerative hip and lumbar spine pathology who undergo THA prior to LSF have a significantly increased risk of postoperative dislocation, infection, revision surgery, and prolonged opioid use compared with THA after LSF. Surgeons should consider the surgical sequence of THA and LSF on outcomes for patients with this dual pathology. Shared decision making between patients, spine surgeons, and arthroplasty surgeons is necessary to optimize outcomes in patients with concomitant hip and spine pathology.

Level of Evidence: 3
3D-printed Titanium Prosthetic Reconstruction of the C2 Vertebra
Authors: Hunn Samuel A.M. , Koefman Alex J. , Hunn Andrew W.M. 
Published: December 2019

Study Design.
Three patients were treated at our center with patient-specific three-dimensional (3D)-printed titanium prostheses for the reconstruction of structurally compromised C2 vertebrae.

Objective.
To describe our surgical and device design approach to these clinical scenarios and evaluate their outcomes.

Summary of Background Data.
There are a limited but increasing number of case reports and series describing the use of 3D-printed prostheses for high cervical surgery.

Methods.
We have collated and reviewed three cases using patient-specific 3D-printed prostheses.

Results.
We report two cases arising from neoplastic destruction; one resulting from metastatic medullary thyroid carcinoma, and the other from multiple myeloma. We additionally describe a case of C2 compromise as a complication of rheumatoid arthritis. All patients included in this report achieved successful surgical outcomes and symptom relief without significant complication. Clinical and radiological follow-up has demonstrated good outcomes in all cases up to 14-months postprocedure.

Conclusions.
These cases describe successful use of custom 3D-printed prostheses for reconstruction of the anterior vertebral column through C2, and add to the emerging body of literature detailing the use of custom prostheses for complex spinal surgery.

Level of Evidence: 4.
Analysis of Heterogeneity in Survival Benefit of Immunotherapy in Oncology According to Patient Demographics and Performance Status
Authors: Butaney Mohit , Satkunasivam Raj , Goldberg Hanan , Freedland Stephen J. , Patel Sandip P. , Hamid Omid , Pal Sumanta K. , Klaassen Zachary , Wallis Christopher J.D. 
Published: December 2019

Objectives:
Immunotherapy (IO) has become standard of care (SOC) for many advanced malignancies, although identifying patients likely to benefit remains difficult. We sought to assess whether demographic factors are associated with response to IO, compared with SOC systemic therapy, using stratified meta-analysis.

Methods:
A systematic review of MEDLINE, PubMed, Embase, and Scopus from inception to October 2, 2018. Randomized controlled trials comparing IO to SOC in patients with advanced solid organ malignancies were included if results were stratified by age, performance status (PS), or race, assessing overall survival (OS). Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for each group using random-effects models independently.

Results:
We identified 21 eligible randomized controlled trials, including 20 stratified by age, 17 by PS, and 4 by race. Patients with PS 0 (HR, 0.74; 95% CI, 0.63-0.86) and PS≥1 (HR, 0.75; 95% CI, 0.68-0.83) had similar OS benefits from IO compared with SOC (P=0.80). There was no difference on the basis of patient race (white vs. nonwhite) (P=0.46). IO demonstrated an OS benefit for younger (below 65 y: HR, 0.73; 95% CI, 0.65-0.82) and older (65 y and above: HR, 0.79; 95% CI, 0.71-0.88) patients with no difference between age groups (P=0.27). Among prespecified subgroup analyses, there was significant effect modification in 2 subgroups: younger patients in the first-line setting (P=0.03) and those receiving anti-CTLA-4 drugs (P=0.05).

Conclusions:
When examining OS using stratified meta-analysis, we did not demonstrate significant differences in IO efficacy according to patient age, PS or race, though data on race were sparse.
Curative Intent Radiotherapy Delivered Within the Last Year of Life
Authors: Tseng Yolanda D. , Mezheritsky Irina , Halasz Lia M. , Lo Simon S. , Loggers Elizabeth T. 
Published: December 2019

Objectives:
We studied a cohort of cancer patients that underwent curative-intent radiation within the last year of life (LYOL). Given the unexpectedly short survival, we evaluated the proportion with relapsed/refractory disease, determined causes of death, and explored whether treatment intent was associated with aggressiveness of care at the end of life.

Materials and Methods:
We extracted and linked claims data and radiotherapy records for patients seen at a single academic institution that died between October 1, 2014, and September 30, 2015.

Results:
Among 870 cancer patients, 290 were irradiated within the LYOL, of which 287 had treatment intent recorded (101 curative-intent, 186 palliative-intent). The majority of curative-intent patients had hematologic malignancies and/or underwent transplant (44.6%), followed by head and neck (9.9%) and gastrointestinal malignancies (9.9%). Half (n=49; 48.5%) had relapsed/refractory disease at the time of curative-intent radiation, including 13 with metastatic disease. Tumor progression (n=65; 64.4%) was the most common cause of death, followed by treatment-related mortality (n=27; 26.7%), of which transplant/hematologic malignancy patients (n=19) were the majority. Compared with palliative-intent patients, curative-intent patients had significantly higher rates of chemotherapy use within 14 days of death (P=0.04), intensive care unit stay within 30 days of death (P<0.00001), and death in the intensive care unit (P=0.001).

Conclusions:
Cancer patients that receive curative-intent radiation in the LYOL appear to be heterogeneous and receive more aggressive care at the end of life compared with palliative-intent patients. Categorizing radiation as curative in patients with metastatic disease may reflect inappropriate decision-making among physicians. Additional studies are needed to understand how radiation oncologists categorize treatment as curative and whether prognostication models may help discriminate patients undergoing curative-intent radiation that have limited life expectancies.
Vital Status Ascertainment for a Historic Diverse Cohort of U.S. Women
Authors: Pollack Anna Z. , Hinkle Stefanie N. , Liu Danping , Yeung Edwina H. , Grantz Katherine L. , Mumford Sunni L. , Perkins Neil , Sjaarda Lindsey A. , Mills James L. , Mendola Pauline , Zhang Cuilin , Schisterman Enrique F. 
Published: December 2019

Background:
Studies linking large pregnancy cohorts with mortality data can address critical questions about long-term implications of gravid health, yet relevant US data are scant. We examined the feasibility of linking the Collaborative Perinatal Project, a large multiracial U.S. cohort study of pregnant women (n = 48,197; 1959–1966), to death records.

Methods:
We abstracted essential National Death Index (NDI) (1979–2016) (n = 46,428). We performed a linkage to the Social Security Administration Death Master File through 2016 (n = 46,450). Genealogists manually searched vital status in 2016 for a random sample of women (n = 1,249). We conducted agreement analyses for women with abstracted data among the three sources. As proof of concept, we calculated adjusted associations between mortality and smoking and other sociodemographic factors using Cox proportional hazards regression.

Results:
We successfully abstracted identifying information for most of the cohort (97%). National Death Index identified the greatest proportion of participants deceased (35%), followed by genealogists (31%) and Death Master File (23%). Estimates of agreement (κ [95% confidence interval]) between National Death Index and Death Master File were lower (0.52 [0.51, 0.53]) than for National Death Index and genealogist (0.66 [0.61, 0.70]). As expected, compared with nonsmokers, smoking ≥1 pack per day was associated with elevated mortality for all vital sources and was strongest for National Death Index.

Conclusions:
Linking this historic cohort with mortality records was feasible and agreed reasonably on vital status when compared with other data sources. Such linkage enables future examination of pregnancy conditions in relation to mortality in a diverse U.S. cohort.