Research Spotlight

Gupta, A., C. Kinman, D. T. G. Hobson, K. V. Meriwether, J. T. Gaskins, M. N. Uddin, J. R. Stewart and S. L. Francis (2020). “The Impact of Fluoroscopy During Percutaneous Nerve Evaluation on Subsequent Implantation of a Sacral Neuromodulator Among Women With Pelvic Floor Disorders: A Randomized, Noninferiority Trial.” Neuromodulation May 4. [Epub ahead of print].

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OBJECTIVES: To evaluate whether percutaneous nerve evaluation (PNE) without fluoroscopy is inferior to fluoroscopy use in women undergoing trials of sacral neuromodulation (SNM) for pelvic floor disorders (PFDs). MATERIALS AND METHODS: In an unblinded noninferiority trial, women undergoing PNE were randomized to fluoroscopy or no fluoroscopy. The primary outcome was “success” and defined as implantation of the permanent SNM device within three months of PNE. At an expected 40% success and a 30% noninferiority threshold, 33 participants in each group were needed for 80% power (alpha = 0.05). Univariate analyses and a logistic regression model adjusting for univariate variables associated with the primary outcome were performed. RESULTS: From April 2016 to December 2018, 74 participants underwent PNE of which 36 underwent PNE with fluoroscopy and 38 without. The fluoroscopy group had less baseline mean daily voids compared to the no fluoroscopy group (10.79 +/- 6.48 vs. 16.21 +/- 10.05, p = 0.01). PNE performed without fluoroscopy had similar success (18/38, 47.4%) compared to fluoroscopy (21/36, 58.3%), meeting our noninferiority definition (difference 10.9%, 90% CI -8% to 30%, p = 0.049). In a logistic regression model adjusting for age, Charlson comorbidity index, stage of prolapse, and number of baseline voids per day, trial success was still similar between the two groups (adjOR 1.82, 95% CI 0.52 to 6.94, p = 0.36). CONCLUSIONS: PNE performed without fluoroscopy is noninferior to PNE with fluoroscopy use for the outcome of SNM device implantation within three months among women undergoing therapy for PFDs.

Filardo, G., B. D. Pollock, B. da Graca, T. K. Phan, R. J. Damiano, Jr., G. Ailawadi, V. Thourani and J. R. Edgerton (2020). “Postcoronary Artery Bypass Graft Atrial Fibrillation Event Count and Survival: Differences by Sex.” Ann Thorac Surg 109(5): 1362-1369.

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BACKGROUND: New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with poor outcomes, but data on the effects of its characteristics are lacking and conflicting. We examined the effect number of post-CABG AF events has on long-term mortality risk, and whether this is sex dependent. METHODS: Routinely collected Society of Thoracic Surgeons (STS) data were supplemented with details on new-onset post-CABG AF (detected in-hospital by continuous electrocardiogram/telemetry monitoring) and long-term survival for 9203 consecutive patients with isolated-CABG (2002-2010). With the use of Cox regression, we determined the propensity-adjusted (STS-recognized risk factors) effect of number of AF events on survival, testing for effect modification by sex and controlling for AF duration. RESULTS: AF occurred in 739 women (29.4%) and 2157 men (32.3%) (P < .001). Adjusted results showed 2 or more AF events significantly (P < .001) increased 5-year mortality risk, independently of total AF duration. However, mortality risk differed between the sexes (P < .001): women with 2 AF episodes had the greatest increase (hazard ratio [HR] = 2.98; 95% confidence interval [CI], 1.43-4.83; versus women without AF), followed by women and men with 4 or more AF events (HR = 2.76 [95% CI, 1.27-4.55] and HR = 2.73 [95% CI, 2.30-3.19], respectively). A single post-CABG AF episode was not associated with increased mortality risk. CONCLUSIONS: Both men and women who experienced 2 or more post-CABG AF episodes showed increased risk of 5-year mortality, independent of total AF duration. Although men's risk increased as the number of AF events increased, women's risk peaked at 2 AF events. Future research needs to determine whether this divergence stems from differences in treatment/management or underlying biology.

El Shamy, O., H. Tran, S. Sharma, C. Ronco, M. Narayanan and J. Uribarri (2020). “Telenephrology with Remote Peritoneal Dialysis Monitoring during Coronavirus Disease 19.” Am J Nephrol Apr 28:1-3. [Epub ahead of print].

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While most patients are unable to switch to home dialysis currently, experts expect the COVID-19 pandemic to act as a catalyst for a surge in this modality for the future. The utilization of telehealth rebukes the perception that care is substandard to in-center dialysis and also allays the fear of receiving care without medical oversight. Telenephrology fosters the patient-clinician relationship and allows for substantial medical oversight as clinicians can observe (via video) a patient’s dialysis environment in their home, providing feedback and recommendations. When the curve starts to flatten, social distancing will still need to be maintained. The continued ability to provide clinical staff with detailed, real-time information about PD patients’ treatments and prescriptions protects this vulnerable patient population and healthcare providers from unnecessary potential exposure to COVID-19. (Excerpt from text; no abstract available.)

Edgerton, J. R. (2020). “Commentary: Ptolemy versus Copernicus: The times they are a-changin’.” J Thorac Cardiovasc Surg Apr 6. pii. [Epub ahead of print].

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As we move to patient-centered medicine, outcomes we track must be those meaningful to patients and their families. To do this, we must transition from proceduralists to practicing disease management. (Excerpt from text; no abstract available.)

Doyle, D. J., A. Goyal, P. Bansal and E. H. Garmon (2020). American Society of Anesthesiologists Classification (ASA Class). StatPearls. Treasure Island (FL), StatPearls Publishing.

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The American Society of Anesthesiologists (ASA) physical status classification system was developed to offer clinicians a simple categorization of a patient’s physiological status that can be helpful in predicting operative risk. The ASAPS originated in 1941 and has seen some revisions since that time.