Estimating Surgical Volume – Outcome Relationships Applying Survival Models: Accounting for Frailty and Hospital Fixed Effects

2003 ◽  
pp. 133-144
Author(s):  
Barton H. Hamilton ◽  
Vivian H. Ho
Keyword(s):  
Fixed Effects ◽  
Survival Models ◽  
Surgical Volume ◽  
Volume Outcome

Network meta-analysis (NMA) of pembrolizumab for first-line (1L) treatment of recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18012-e18012
Author(s):  
Karthik Ramakrishnan ◽  
Ali Mojebi ◽  
Dieter Ayers ◽  
Diana Romana Chirovsky ◽  
Rebekah Borse ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Fixed Effects ◽  
Goodness Of Fit ◽  
Proportional Hazards ◽  
Treatment Options ◽  
Deviance Information Criterion ◽  
Progression Free Survival ◽  
Survival Models ◽  
Base Case ◽  
Eligibility Criteria

e18012 Background: In the KEYNOTE-048 trial, pembrolizumab as monotherapy (P) and in combination with platinum+5FU chemotherapy (P+C) versus cetuximab+platinum+5FU (EXTREME regimen) significantly improved overall survival (OS) in the combined positive score (CPS) ≥1 (hazard ratio: 0.74; 95% confidence interval: 0.61-0.90) and total (0.72; 0.60-0.87) R/M HNSCC populations, respectively, and was approved by the FDA in these patient populations. While the EXTREME regimen is considered standard of care in 1L R/M HNSCC, other systemic treatment options including cetuximab+platinum+docetaxel (TPEx regimen), platinum+paclitaxel/taxane (Pt+T), and platinum+5FU (Pt+F) are also commonly used. Due to lack of head-to-head comparisons with pembrolizumab, an NMA was conducted to estimate the comparative efficacy of P and P+C versus these interventions in 1L R/M HNSCC. Methods: A systematic literature review (SLR) was conducted on November 13, 2019 to identify randomized controlled trials for the relavant interventions. Data were extracted for the OS and progression-free survival (PFS) outcomes. NMA analyses were conducted for the total population and for the CPS ≥1 and CPS ≥20 subgroups in a Bayesian framework using proportional hazards (base case) and time-varying (sensitivity analysis) treatment-effect models. The deviance information criterion was used to compare the goodness-of-fit of the alternative survival models. Results: The SLR identified 28 trials, of which six trials matched the trial eligibility criteria of KEYNOTE-048 and were included in the NMA. Results from the fixed-effects NMA for P and P+C are summarized in table below for the FDA indicated population. Improvement in OS was noted for P and P+C versus EXTREME, Pt+T, and Pt+F, and a trend in improved OS versus TPEx was observed. The sensitivity analysis showed improved OS over time across all comparisons. PFS was improved with P and P+C versus Pt+F and comparable versus other interventions. These results were generally consistent for P and P+C in the CPS (CPS ≥1 or CPS ≥20) patient subgroups. Additionally, NMA results versus EXTREME were consistent with the KEYNOTE-048 trial results. Conclusions: Pembrolizumab (P or P+C), showed improved OS and comparable PFS outcomes versus alternative 1L R/M HNSCC interventions, consistent with the efficacy results versus EXTREME observed in the KEYNOTE-048 trial. [Table: see text]

scholarly journals Association between surgical volume and failure of primary total hip replacement in England and Wales: findings from a prospective national joint replacement register

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e033045 ◽  
Author(s):  
Adrian Sayers ◽  
Fiona Steele ◽  
Michael R Whitehouse ◽  
Andrew Price ◽  
Yoav Ben-Shlomo ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Joint Replacement ◽  
Survival Models ◽  
Surgical Volume ◽  
Case Volume ◽  
Index Procedure ◽  
England And Wales ◽  
Total Hip ◽  
Private And Public ◽  
Using Data

ObjectiveTo investigate the association of volume of total hip arthroplasty (THA) between consultants and within the same consultant in the previous year and the hazard of revision using multilevel survival models.DesignProspective cohort study using data from a national joint replacement register.SettingElective THA across all private and public centres in England and Wales between April 2003 and February 2017.ParticipantsPatients aged 50 years or more undergoing THA for osteoarthritis.InterventionThe volume of THA conducted in the preceding 365 days to the index procedure.Main outcome and measureRevision surgery (excision, addition or replacement) of a primary THA.ResultsOf the 579 858 patients undergoing primary THA (mean baseline age 69.8 years (SD 10.2)), 61.1% were women. Multilevel survival found differing results for between and within-consultant effects. There was a strong volume–revision association between consultants, with a near-linear 43.3% (95% CI 29.1% to 57.4%) reduction of the risk of revision comparing consultants with volumes between 1 and 200 procedures annually. Changes in individual surgeons (within-consultant) case volume showed no evidence of an association with revision.ConclusionSeparation of between-consultant and within-consultant effects of surgical volume reveals how volume contributes to the risk of revision after THA. The lack of association within-consultants suggests that individual changes to consultant volume alone will have little effect on outcomes following THA.These novel findings provide strong evidence supporting the practice of specialisation of hip arthroplasty. It does not support the practice of low-volume consultants increasing their personal volume as it is unlikely their results would improve if this is the only change. Limiting the exposure of patients to consultants with low volumes of THA and greater utilisation of centres with higher volume surgeons with better outcomes may be beneficial to patients.

Surgical Volume/Outcome Debate

2017 ◽  
Vol 265 (2) ◽  
pp. 270 ◽  
Author(s):  
Keith D. Lillemoe
Keyword(s):  
Surgical Volume ◽  
Volume Outcome

scholarly journals Determinants of the success of equity crowdfunding campaigns

2020 ◽  
Vol 31 (84) ◽  
pp. 560-573
Author(s):  
Israel José dos Santos Felipe ◽  
Bruno César Franca Ferreira
Keyword(s):  
Logistic Regression ◽  
Fixed Effects ◽  
Financial Resources ◽  
Survival Models ◽  
Financial Intermediaries ◽  
Financial Efficiency ◽  
Investment Performance ◽  
Equity Crowdfunding ◽  
Marginal Effects ◽  
Financial Goal

ABSTRACT Given that equity crowdfunding has grown significantly in Brazil and that this market has been frequently sought by startups as an alternative to scarce credit, this study investigated the elements that determine the success of their financing campaigns. The article fills the gap related to the absence of studies analyzing the probability and time of success of startup financing. In Brazil, the research on this is still in its infancy and there has been little discussion regarding what can determine the success of this type of financing. The findings presented here provide managerial contributions for different stakeholders, ranging from platform managers and entrepreneurs to the ordinary citizen, who ultimately acts as an inducer of change in society, without the need for financial intermediaries. The discussion around the elements that influence the success of startup financing has revealed that the characteristics of the venture profile have been able to determine the success of the financing. This information applied to the dynamic of resource allocation in this market can generate more financial efficiency for private agents as an investment performance parameter and, for public agents, as an input for monitoring. The logistic regression with marginal effects and a dummy for time fixed effects were used. The time of success analysis was carried out via survival models. The sample covers 99 startup financing campaigns from 2014 to 2017. The study identified that the financial goal, the venture category, advisor participation, the campaign duration, and the type of equity offered to the investor positively affect both the probability and speed of success of the startup financing. Its contribution lies in the use of these findings to formulate strategies geared toward estimating success, which enable an appropriate allocation of financial resources.

scholarly journals Mortality differences by surgical volume among patients with stomach cancer: a threshold for a favorable volume-outcome relationship

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Hyeok Choi ◽  
Seong-Yoon Yang ◽  
Hee-Seung Cho ◽  
Woorim Kim ◽  
Eun-Cheol Park ◽  
...  
Keyword(s):  
Stomach Cancer ◽  
Surgical Volume ◽  
Outcome Relationship ◽  
Volume Outcome

scholarly journals Minimally Invasive Surgery and Surgical Volume-Specific Survival and Perioperative Outcome: Unmet Need for Evidence in Gynecologic Malignancy

2021 ◽  
Vol 10 (20) ◽  
pp. 4787
Author(s):  
Shinya Matsuzaki ◽  
Maximilian Klar ◽  
Erica J. Chang ◽  
Satoko Matsuzaki ◽  
Michihide Maeda ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
High Volume ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Surgical Volume ◽  
Gynecologic Malignancies ◽  
Surgical Morbidity ◽  
Volume Outcome

This study examined the effect of hospital surgical volume on oncologic outcomes in minimally invasive surgery (MIS) for gynecologic malignancies. The objectives were to assess survival outcomes related to hospital surgical volume and to evaluate perioperative outcomes and examine non-gynecologic malignancies. Literature available from the PubMed, Scopus, and the Cochrane Library databases were systematically reviewed. All surgical procedures including gynecologic surgery with hospital surgical volume information were eligible for analysis. Twenty-three studies met the inclusion criteria, and nine gastro-intestinal studies, seven genitourinary studies, four gynecological studies, two hepatobiliary studies, and one thoracic study were reviewed. Of those, 11 showed a positive volume–outcome association for perioperative outcomes. A study on MIS for ovarian cancer reported lower surgical morbidity in high-volume centers. Two studies were on endometrial cancer, of which one showed lower treatment costs in high-volume centers and the other showed no association with perioperative morbidity. Another study examined robotic-assisted radical hysterectomy for cervical cancer and found no volume–outcome association for surgical morbidity. There were no gynecologic studies examining the association between hospital surgical volume and oncologic outcomes in MIS. The volume–outcome association for oncologic outcome in gynecologic MIS is understudied. This lack of evidence calls for further studies to address this knowledge gap.

Volume-outcome Relationship Between Surgical Volume and Mortality in Cardiac Surgery Units in Spain

2008 ◽  
Vol 61 (3) ◽  
pp. 276-282
Author(s):  
Ignacio Díaz de Tuesta ◽  
José Cuenca ◽  
Pedro C. Fresneda ◽  
Manuel Calleja ◽  
Rafael Llorens ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Surgical Volume ◽  
Outcome Relationship ◽  
Volume Outcome
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