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At least 37 records · Page 2Linked to original sources

Importance of graft configuration in outcome of endoluminal aortic aneurysm repair: a 5-year analysis by the life table method.

AIM: The aim of this study was to determine the influence of graft configuration on the outcome of endoluminal repair of abdominal aortic aneurysm (AAA). METHODS: The 5-year study period extended from May 1992 to May 1997 and included analysis of patients undergoing endoluminal AAA repair in the first 4.5-year period with a minimum follow-up period of 6 months. Between May 1992 and November 1996 136 patients underwent endoluminal AAA repair. Two patients who had endoluminal repair of anastomotic AAA and six patients who had secondary endoluminal repair of AAA were excluded, leaving 128 patients in the study group. There were 117 males and 11 females with a mean age for the group of 71 years. The configuration of the grafts was tubular aortic (T) (n = 50), tapered aortoiliac/femoral (AI) (n = 24) and bifurcated (B) (n = 54). Patient characteristics and co-morbidities were similar in the three groups. The procedures were performed in the operating room under radiographic control. Follow-up was complete and consisted of regular physical examination and contrast enhanced computed tomography. Outcome measures were perioperative mortality rate, need for conversion to open repair, presence of early and late endoleaks, successful exclusion of AAA from the circulation, and survival. Data were analysed by the life table method. RESULTS: There was no significant difference in perioperative mortality for T (4%), AI (4%) and B (5.5%) configuration of endograft. Outcome for T, AI, and B configurations was respectively: primary conversion (%) 8, 12, 13; early endoleaks (n =) 5, 0, 1; late endoleaks (n =) 7, 0, 1. The overall incidence of failed procedures throughout the study period was higher in tube grafts compared with non-tube (aortoiliac and bifurcated) grafts (p < 0.05). Kaplan-Meier curves demonstrated a success probability at 40 months of 50% for tube grafts and 80% for non-tube grafts. However, a comparison of the time to procedure failure between tube versus non-tube after adjusting for competing risks (death without prior graft failure) was non-significant (p = 0.14). CONCLUSIONS: The poor mid-term outcome for tube prostheses requires a reassessment of the criteria for selecting this configuration. It would be unwise to abandon the use of tube prostheses entirely in endoluminal repair. With increasing information on mid and long-term outcome of endoluminal AAA repair it is likely that there will be an increasing acceptance of treating smaller AAA while they are still suitable for treatment by the endoluminal method and most likely with tube grafts. A tightening of the criteria for using tube prostheses would seem sensible. In particular, the minimum length of distal neck required for endoluminal tube graft repair should be increased to the 2-2.5 cm range.

Aged↗

Estimating the age-at-onset function using life-table methods.

In the analysis of dominantly inherited diseases, the age-at-onset function is often estimated from the observed age-at-onset distribution of cases. This estimate is confounded with the age distribution of the population from which the cases were sampled and is accurate only if there are no competing causes of death. In this paper, we present a straightforward method for calculating a more accurate age-at-onset function under etiologic heterogeneity. We use the life-table approach and survival analysis methods. This method is illustrated using data on first-degree relatives of probands from two sets of families with high cancer incidence: one with breast/ovarian cancer and the other with colon cancer. A comparison of the estimated age-at-onset function obtained by the two methods is presented. In both cases, colon cancer as well as breast/ovarian cancer, the estimates of onset probabilities based on proportion of cases, are consistently higher than those obtained by the life-table method. For breast/ovarian cancer, this difference is not as striking as it is in the case of colon cancer; nevertheless, the method using proportion of cases tends to give a lower estimate of the age-at-onset function (higher probability of being affected at lower age) than the life-table approach.

Actuarial Analysis↗

Long-term results of trabeculectomy in the Japanese: an analysis by life-table method.

The records of a total of 427 eyes with various types of glaucoma treated by trabeculectomy were compiled from 10 institutions. The follow-up periods of these cases were from 3 months to 5 years. Simple statistics gave an overall success rate of 75% in controlling the intraocular pressure (IOP) below 21 mmHg. In 344 eyes followed more than 1 year, the IOP distribution showed that the IOP was between 14 and 19 mmHg in 47% of th 10 institutions. The follow-up periods of these cases were from 3 months to 5 years. Simple statistics gave an overall success rate of 75% in controlling the intraocular pressure (IOP) below 21 mmHg. In 344 eyes followed more than 1 year, the IOP distribution showed that the IOP was between 14 and 19 mmHg in 47% of th 10 institutions. The follow-up periods of these cases were from 3 months to 5 years. Simple statistics gave an overall success rate of 75% in controlling the intraocular pressure (IOP) below 21 mmHg. In 344 eyes followed more than 1 year, the IOP distribution showed that the IOP was between 14 and 19 mmHg in 47% of the eyes, and in only 2.3% was the IOP lower than 10 mmHg. The probability of failure, i.e. the mean IOP being higher than 20 mmHg for more than 3 months, was calculated by a life-table method, which takes diversity in the follow-up period into account. An analysis of the cumulative failure probability by Weibull distribution function showed that the time course of failure in the IOP control is of an early failure type; the majority of failure occurred within one year. The final failure probability after the follow-up period of 5 years was 0.42 in primary open-angle glaucoma and 0.48 in primary angle-closure glaucoma, but it was 0.65 in congenital glaucoma. It was shown that the failure probability after the first trabeculectomy is lower in the older age group than in the younger age group. The second trabeculectomy on the same eye showed a higher failure probability than the first intervention.

Actuarial Analysis↗

Robustness of life table methods in large populations--a study by computer simulation.

The robustness of the product life table estimator of the survival function was studied for large populations under perturbations in the age distribution, changing levels of mortality and changing patterns of fertility. A macrosimulation system, based on a class of stochastic population models called generalised age-dependent branching processes, was used to carry out the numerical investigations. Aside from drastic perturbations in the age distribution and changes in levels of mortality, the product life table estimator of the survival function was found to be robust in large populations, under a variety of conditions.

Age Factors↗

The uses and abuses of life-table methods in vascular surgery.

This paper details the calculations involved in a life-table analysis and appraises the current use of this technique in vascular research. We suggest that the presentation of patency curves should be standardized and recommend that: curves are presented as step rather than continuous graphs; the number of patients remaining in a study are shown at intervals along patency curves; the length of time for which a curve is claimed to hold is more rigorously defined; an attempt is made to increase, where possible, the frequency of patient review, particularly in the immediate postoperative period; ways of increasing the total sample size (e.g. multicentre studies) are investigated. We also recommend that a set of definitive guidelines on the presentation of graft patency data acceptable to all the major vascular journals be sought.

Actuarial Analysis↗

A modified life table method to study congenital genetic disorders: an application in sickle cell anemia.

A modified life table procedure is introduced designed to study the survival of patients with congenital genetic disorders with the endpoint defined by a complication or death. It uses the ages of the patients as the time axis as in "population' or "current' life tables, and it allows patients to enter and exit the study as in survival life tables. The procedure uses the exact length of time that each patient is observed in the study to determine the conditional probabilities of developing the complication. The proposed procedure is especially helpful in studying recurrent complications or events that occur frequently. The proposed life table procedure is demonstrated in the study of the conditional probability of developing a sickle cell crisis in 509 patients with sickle cell anemia (SS) with different number of prior crises. The demonstration is intended to illustrate the use of the proposed method and not to investigate the clinical severity of sickle cell anemia. It was found that the risk of crisis was to investigate the clinical severity of sickle cell anemia. It was found that the risk of crisis was positively related to the number of prior crises in SS patients (P less than 0.001). This trend was significant in the first three decades of life.

Actuarial Analysis↗

Life table methods for quantitative impact assessments in chronic mortality.

Quantitative health impact assessments of chronic mortality, where the impacts are expected to be observed over a number of years, are complicated by the link between death rates and surviving populations. A general calculation framework for quantitative impact assessment is presented, based on standard life table calculation methods, which permits consistent future projections of impacts on mortality from changes in death rates. Implemented as a series of linked spreadsheets, the framework offers complete flexibility in the sex specific, age specific, and year specific patterns of baseline mortality death rates; in the predicted impacts upon these; in the weights or values placed on gains in life; and in the summary measures of impact. Impacts can be differential by cause of death. Some examples are given of predictions of the impacts of reductions in chronic mortality in the populations of England and Wales and of Scotland.

Adolescent↗

Analysis of underlying and multiple-cause mortality data: the life table methods.

The stochastic compartment model concepts are employed to analyse and construct complete and abbreviated total mortality life tables, multiple-decrement life tables for a disease, under the underlying and pattern-of-failure definitions of mortality risk, cause-elimination life tables, cause-elimination effects on saved population through the gain in life expectancy as a consequence of eliminating the mortality risk, cause-delay life tables designed to translate the clinically observed increase in survival time as the population gain in life expectancy that would occur if a treatment protocol was made available to the general population and life tables for disease dependency in multiple-cause data.

Actuarial Analysis↗

Life-table methods for detecting age-risk factor interactions in long-term follow-up studies.

Methodological investigation has suggested that age-risk factor interactions should be more evident in age of experience life tables than in follow-up time tables due to the mixing of ages of experience over follow-up time in groups defined by age at initial examination. To illustrate the two approaches, age modification of the effect of total cholesterol on ischemic heart disease mortality in two long-term follow-up studies was investigated. Follow-up time life table analysis of 116 deaths over 20 years in one study was more consistent with a uniform relative risk due to cholesterol, while age of experience life table analysis was more consistent with a monotonic negative age interaction. In a second follow-up study (160 deaths over 24 years), there was no evidence of a monotonic negative age-cholesterol interaction by either method. It was concluded that age-specific life table analysis should be used when age-risk factor interactions are considered, but that both approaches yield almost identical results in absence of age interaction. The identification of the more appropriate life-table analysis should be ultimately guided by the nature of the age or time phenomena of scientific interest.

Actuarial Analysis↗

Providing more up-to-date estimates of patient survival: a comparison of standard survival analysis with period analysis using life-table methods and proportional hazards models.

OBJECTIVE: Standard survival methods can yield out-of-date estimates of long-term survival. Period analysis, based on life-table methodology, provides more up-to-date survival estimates by exploring survival during a restricted recent period of interest. It excludes the short-term survival of patients recruited at the start of the study. We use statistical models to further develop the method of period analysis, providing more up-to-date estimates of survival and the ability to explore differences in survival by covariates and adjust for case mix. METHODS: We use cancer registry data for colorectal cancer in Leicestershire, UK, to illustrate the use of Cox proportional hazards (CPH) models to estimate period and standard survival. We compare these estimates with those obtained using life-table methodology. RESULTS: Period estimates were slightly higher than the standard estimates as they reflect recent improvements in short-term survival. The results for period analysis using the life-table approach and using CPH models were similar. However, CPH models allowed further investigation of other risk factors and the ability to control for potential confounding variables. CONCLUSION: Using period survival estimates, more up-to-date information is available to clinicians and others with an interest in monitoring survival. Period CHP models offer all the advantages of statistical modeling, and are straightforward to fit in standard statistical packages.

Colorectal Neoplasms↗