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      A comparison between bronchial blockers and double-lumen tubes for patients undergoing lung resection: A propensity score-matched cohort study

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          Abstract

          Objective: The aim of this study is to compare the effect of bronchial blockers (BB) and double-lumen tubes (DLT) on patients' postoperative recovery after lung resection.

          Method: 4,636 patients undergoing lung resection and receiving either BB or DLT intubation were reviewed and matched using the propensity score matching method. The primary outcome was the surgical duration. The secondary outcomes included diagnostic results of postoperative chest X-ray, postoperative oxygenation index, incidence of hypercapnia, hypoxemia and sore throat, chest tube duration, incidence of ICU admission, length of hospital stay and incidence of the 30-day readmission.

          Results: After matching, 401 patients receiving BB were matched to 3,439 patients receiving DLT. There was no statistical difference on the surgical duration between the two groups (P>0.05). However, compared with the DLT group, patients in the BB group showed more infiltrate especially at the surgery side (14.96% versus 9.07%, P<0.001) based on the chest X-ray, together with higher incidence of ICU admission (5.23% versus 2.61%, P<0.05). Additionally, no statistical differences were found between the two groups about chest tube duration, oxygenation index, incidence of hypercapnia, hypoxemia and sore throat, duration of surgery, hospital stays and 30-day readmission (P>0.05).

          Conclusions: Compared with the DLT, patients receiving BB technique tend to have increased pulmonary infiltrate (especially the surgery side) and higher incidence of ICU admission at the early post-operative stage, which may have an influence on the patients' recovery.

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          Most cited references36

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          An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies

          The propensity score is the probability of treatment assignment conditional on observed baseline characteristics. The propensity score allows one to design and analyze an observational (nonrandomized) study so that it mimics some of the particular characteristics of a randomized controlled trial. In particular, the propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects. I describe 4 different propensity score methods: matching on the propensity score, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, and covariate adjustment using the propensity score. I describe balance diagnostics for examining whether the propensity score model has been adequately specified. Furthermore, I discuss differences between regression-based methods and propensity score-based methods for the analysis of observational data. I describe different causal average treatment effects and their relationship with propensity score analyses.
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            Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)

            Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element. Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society and the European Society for Thoracic Surgery. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care. Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery. These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery.
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              False discovery rate control is a recommended alternative to Bonferroni-type adjustments in health studies.

              Procedures for controlling the false positive rate when performing many hypothesis tests are commonplace in health and medical studies. Such procedures, most notably the Bonferroni adjustment, suffer from the problem that error rate control cannot be localized to individual tests, and that these procedures do not distinguish between exploratory and/or data-driven testing vs. hypothesis-driven testing. Instead, procedures derived from limiting false discovery rates may be a more appealing method to control error rates in multiple tests. Controlling the false positive rate can lead to philosophical inconsistencies that can negatively impact the practice of reporting statistically significant findings. We demonstrate that the false discovery rate approach can overcome these inconsistencies and illustrate its benefit through an application to two recent health studies. The false discovery rate approach is more powerful than methods like the Bonferroni procedure that control false positive rates. Controlling the false discovery rate in a study that arguably consisted of scientifically driven hypotheses found nearly as many significant results as without any adjustment, whereas the Bonferroni procedure found no significant results. Although still unfamiliar to many health researchers, the use of false discovery rate control in the context of multiple testing can provide a solid basis for drawing conclusions about statistical significance. Copyright © 2014 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Int J Med Sci
                Int J Med Sci
                ijms
                International Journal of Medical Sciences
                Ivyspring International Publisher (Sydney )
                1449-1907
                2022
                25 September 2022
                : 19
                : 11
                : 1706-1714
                Affiliations
                [1 ]Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
                [2 ]Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
                Author notes
                ✉ Corresponding authors: Feng Xiao, MD, PhD, Department of Anesthesiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province, China (E-mail: xiaofengcsu@ 123456csu.edu.cn ). Junmei Xu, MD, PhD, Department of Anesthesiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan Province, China (E-mail: xujunmei001@ 123456csu.edu.cn ).

                *These authors contributed equally to this work.

                Competing Interests: The authors have declared that no competing interest exists.

                Article
                ijmsv19p1706
                10.7150/ijms.75835
                9553856
                36237986
                8f8d749c-f147-4c69-b958-2f6711001c8f
                © The author(s)

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.

                History
                : 5 June 2022
                : 16 September 2022
                Categories
                Research Paper

                Medicine
                bronchial blocker (bb),double-lumen tube (dlt),one-lung ventilation (olv),lung resection,postoperative recovery,postoperative morbidity,propensity score matching,retrospective study

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