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At least 19 recordsLinked to original sources
PubMed1995

Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis.

We used actuarial methods to study outcome after temporal lobectomy in 135 consecutive patients classified into subgroups according to preoperative MRI findings. Sixty months after surgery, 69% of patients with foreign tissue lesions, 50% with hippocampal sclerosis, and 21% with normal MRIs had no postoperative seizures. An eventual seizure-free state of 2 years or more, whether the patient was seizure-free since surgery or not, was achieved by 80% of patients with foreign tissue lesions, 62% of those with hippocampal sclerosis, and 36% of those with normal MRIs. Outcome was worse in those with normal MRIs than in the other two groups. Early postoperative seizures with later remission (the "running down" phenomenon) occurred in all groups. Late seizure recurrence was present only in the hippocampal sclerosis group. These data show that preoperative MRI is a useful predictor of outcome and that actuarial analysis provides insight into different longitudinal patterns of outcome in MRI subgroups. This information can now be used in preoperative counseling.

Actuarial Analysis↗
PubMed1982

Closed mitral valvotomy: actuarial analysis of results in 654 patients over 12 years and analysis of preoperative predictors of long-term survival.

The records of 654 patients with mitral stenosis who underwent closed mitral valvotomy over a 12-year period were submitted to actuarial analysis. This revealed a low (2.97%) operative mortality. At 12 years, the overall cumulative proportion surviving was 78%; 47% of patients survived without reoperation. The usual clinical indicators of suitability for closed valvotomy were successful in predicting improved survival. The surgeon's assessment of the suitability of the valve correlated well with outcome. Valvotomy during pregnancy was associated with a good long-term outlook. The presence of pulmonary hypertension and atrial fibrillation did not alter survival significantly. Sex ane age were not associated with adverse prognosis. We conclude that closed mitral valvotomy still has a place in the management of mobile mitral stenosis, particularly in areas where there is a high incidence of rheumatic heart disease and a large number of young patients have mobile mitral stenosis.

Actuarial Analysis↗
PubMed1988

Early and late results of coronary artery bypass after failed angioplasty. Actuarial analysis of late cardiac events and comparison with initially successful angioplasty.

We reviewed the results of early (less than 24 hours) coronary artery bypass after unsuccessful percutaneous coronary artery angioplasty in 146 patients treated between October 1979 and July 1986. Overall operative mortality was 2.7%, and risk was significantly increased among patients with hemodynamic instability and new occlusion or further narrowing of the dilated vessel (3.8 versus 0%, p less than 0.05). Actuarial analysis was used to compute the rates of cardiac events during the follow-up interval, and event rates were also estimated in a comparison group of 776 patients who had successful first-time PTCA during the same time period. At a follow-up interval of 5 years, the cumulative risks of recurrence of angina and need for an additional procedure (bypass or angioplasty) were significantly (p less than 0.05) lower for patients who had undergone bypass than for those who had successful angioplasty (angina 21% versus 56%, PTCA 2% versus 21%, CAB 6% versus 16%). Cumulative risks of myocardial infarction and death were 4% versus 9% and 6% versus 9% in the two groups. The differences between late outcomes in the bypass and angioplasty groups persisted when patients were stratified into cohorts with single-vessel and multivessel disease, and the highest late event rate occurred in patients in the angioplasty group who had incomplete revascularization. The difference in late events after bypass or angioplasty was greatest during the first year. These late data should be considered when the mode of revascularization (bypass or angioplasty) is selected for symptomatic patients, especially those with multivessel disease.

Actuarial Analysis↗
PubMed1991

Actuarial analysis of the occurrence of remissions following thymectomy for myasthenia gravis in 400 patients.

The role of thymectomy in the treatment of myasthenia gravis (MG) was analysed in 400 patients affected with generalised MG operated on between 1974-83, and prospectively followed up for five years after surgery. The occurrence of stable remission (SR) (that is, complete clinical drug-free remission that remains stable for all the subsequent follow up) was the endpoint of survival analyses and the distribution of SR time (SRT, that is, the interval from thymectomy to the occurrence of SR) was assessed by actuarial and Cox multivariate analyses. SRT distribution after surgery showed a slow progressive increase of cumulative SR rate that could both be ascribed to a delayed effect of thymectomy as well as reflect the natural history of MG, itself characterised by an increasing probability of spontaneous remission with time. SRT distribution was similar after stratification for all variables studied except when patients without thymoma were stratified for the need for immunosuppressive treatment in addition to thymectomy. Patients without thymoma who did not require additional immunosuppressive therapy (n = 130) had the highest SR rate occurring in the two years after thymectomy, and differed from patients treated with immunosuppressive drugs who showed the highest SR rate five years after surgery. Actuarial analysis has therefore identified a subgroup of patients where SR, occurring in the first years after surgery, is more likely to be ascribed to thymectomy than merely reflect the natural course of the disease.

Actuarial Analysis↗
PubMed1989

Single-stage surgery for cholesteatoma: an actuarial analysis.

Single-stage surgery was used for 215 operations for cholesteatoma. The results were analyzed using months at risk (actuarial) statistics. The methods of data collection and of creating a life-table for cholesteatoma follow-up are described. Ninety-one canal-down procedures are compared with 124 canal-up procedures as to the recidivism rate as well as hearing results. The actuarial tables showed a 45% cumulative success rate for canal-up procedures versus a 90% rate for canal-down operations. The successful canal-up procedures demonstrated slightly better hearing results, however. These success rates seemed to be comparable to those using planned staged surgery. It was concluded that, if single-stage canal-up procedures were used with larger mastoids and canal-down procedures with smaller mastoids, 80% of patients could be controlled without either residual or recurrent disease appearing. For the others, it was felt safe to wait for the disease to reappear rather than to do planned two-stage procedures for all patients. It was further urged that actuarial statistics be employed when reporting the results of surgery for cholesteatoma.

Actuarial Analysis↗
PubMed1998

Are we selecting the right patients for treatment of localized prostate cancer? Results of an actuarial analysis.

OBJECTIVES: To determine our accuracy in selecting patients with at least a 10-year life expectancy for aggressive treatment of localized prostate cancer. METHODS: The medical records of 261 consecutive patients who underwent radical retropubic prostatectomy were submitted to the actuarial division of American General Life and Accident Insurance Company (AGLA) for estimation of life expectancy, excluding the diagnosis of prostate cancer. Survival curves were generated from predicted individual survivals. In patients with less than a 10-year life expectancy, AGLA provided us with the basis for assigning suboptimal survival rates. RESULTS: The mean life expectancy for the group was 15.2 years. Two hundred ten men (80%) were projected to have a life expectancy of more than 10 years, including 27 of 55 (49%) and 4 of 8 (50%) men who were older than or equal to 70 and 75 years of age, respectively. Coronary artery disease and diabetes mellitus were the most common coexisting medical conditions that adversely affected risk as single disease entities. CONCLUSIONS: Although clinicians do not estimate life expectancy with the scientific exactitude of an actuary, the ability to assess the patient in person and assimilate pertinent medical information in a less rigid format yields similar results. Selection of men for definitive treatment of localized prostate cancer should be based on the inherent aggressiveness of the disease and the health of the individual and should not be limited by specific age cutoffs. Populations of men undergoing radical prostatectomy are younger and healthier than those in reported series of watchful waiting for prostate cancer.

Actuarial Analysis↗
PubMed1999

Actual versus actuarial analysis for cardiac valve complications: the problem of competing risks.

Methods for analyzing rates of events such as heart valve failure following surgery are important for comparing different techniques and devices; however, in patients undergoing major surgery, other risks such as mortality compete with the risk of heart valve failure to determine each patient's final outcome. When multiple, mutually exclusive endpoints are possible, a situation known to statisticians as a competing risks problem arises. No single statistical technique that is currently available provides an entirely satisfactory solution to this problem. We argue that in order for valve failure incidences to be useful clinically, the overall patient outcome milieu from which these failures arise must be considered. In this article, we review recent work in the area of competing-risks analysis as it pertains to heart valve surgery outcome.

Actuarial Analysis↗
PubMed1986

Actuarial analysis of reoperation in patients undergoing open mitral commissurotomy for mitral stenosis.

Reoperation is one of the most seriously problematical events in postoperative follow-up of patients undergoing open mitral commissurotomy (OMC) for mitral stenosis. In 217 patients with pure mitral stenosis, even when associated with severe subvalvular changes, the actuarial rate of freedom from reoperation was 94% 12 years after OMC. In contrast, in 85 patients with MS combined with regurgitation, the rate was 66%. In postoperative management of patients undergoing OMC, it is mandatory to know preoperative anatomical findings of the stenosed mitral valve.

Actuarial Analysis↗
PubMed1989

Actuarial analysis of a uniform and reliable preservation method for viable heart valve allografts.

CryoLife has developed a method for cryopreserving allograft heart valves for transplantation. Since 1984, 6,907 valves have been processed and 4,216 transplanted. Documentation was available on 2,647 transplants, 11 of which were removed for structural deterioration and 13, for nonstructural deterioration. At the end of 35 months, actuarial survival was 99.17% and the estimated freedom from reoperation, 97.16%. There have been no reports of thromboembolism or valve-related death.

Actuarial Analysis↗
PubMed1987

Fundoplication and pediatric esophageal manometry: actuarial analysis over 7 years.

Sixty-one children and infants who had significant gastroesophageal reflux and associated complications underwent 73 surgical procedures to control the reflux. In order to evaluate the procedure, several esophageal manograms were obtained from each patient, before, during, and after the operation. Delayed follow-up reports were also obtained from follow-up visits, letter and telephone contact, in order to assess how the patient had progressed. The results were evaluated by actuarial analytic methods. Ninety-four percent of the patients remained alive over the 7-year follow-up period. At the completion of the seventh year, 62% of these patients (actuarially calculated) remained event free. All events occurred within 18 months of surgery. One patient could not be traced at long-term follow-up, which was therefore 92% complete. The 7-year actuarial probability of failure of the fundoplication at this institution is 24% when performed using this technique in these patients. These findings support that manometric calibration of the antireflux procedure tends to give uniform results in pediatric patients, but, compared with other published series has not proved to be superior to procedures that employ only a rubber bougie in the esophagus as an obdurator to prevent a repair that will be too tight.

Actuarial Analysis↗
PubMed1999

Concordance rate for type II diabetes mellitus in monozygotic twins: actuarial analysis.

To determine the concordance rate for Type II (non-insulin-dependent) diabetes mellitus in monozygotic twin pairs, initially ascertained discordant for diabetes, we carried out a prospective study on 44 non-diabetic subjects, each of whom had a sibling twin with diabetes (21 men, 23 women, median age 55 years, interquartile range 47-65). The subjects were referred as discordant for Type II diabetes. The twin pairs were part of the British Diabetic Twin Study and ascertained between May 1968 and January 1998. These subjects underwent an OGTT at time of referral and periodically thereafter. The mean follow-up was 8 years (range 0-18 years) and data were collected until January 1996. The percentage of twins who developed Type II diabetes was assessed by standard actuarial life-table methods and the pairwise concordance rate, that is the proportion of concordant pairs over the sum of concordant and discordant pairs, was calculated. The observed rates of concordance for Type II diabetes at 1, 5, 10, and 15 years follow-up were 17, 33, 57, and 76%, respectively. The concordance rate for any abnormality of glucose metabolism (either Type II diabetes or impaired glucose tolerance) at 15 years follow-up was 96%. The concordance rate for Type II diabetes in monozygotic twins is very high even in twins initially ascertained discordant for diabetes.

Actuarial Analysis↗
PubMed1979

Determinants of survival after Kasai's operation for biliary atresia using actuarial analysis.

Survival after Kasai's operation for "noncorrectable" biliary atresia is influenced by (1) age, (2) large bile ducts, and (3) concentration of the bile bilirubin. Critical values are: age less than 10.5 wk, any evidence of a large bile duct, and a bile bilirubin concentration greater than 8.8 mg/100 ml. Using these 3 factors, a predictive model is able to identify a favorable group with an 89% expected 4 yr survival.

Actuarial Analysis↗
PubMed1998

[10-year actuarial analysis of a cohort of 156 total hip prostheses of a cemented polished aluminum/polyethylene alloy].

PURPOSE OF THE STUDY: From 1983 to 1986, 156 alumina/polyethylene combination hip arthroplasties (131 patients) were performed at the Henri Mondor Hospital. Before 1983, the stainless-steel/polyethylene combination was performed. In this follow-up study, the outcome of the first 156 consecutive alumine-polyethylene combination hip arthroplasties were analyzed with clinical and radiological features. The comparison of the two combinations was analyzed. A survival analysis was performed over a ten years interval. MATERIAL AND METHODS: The femoral component of the prosthesis was made of Titanium alloy (TiA16V4). The femoral head was made of dense alumina (A1203). The head diameter was 32 mm. The socket was made of ultra-high-molecular-weight polyethylene (UHMWPE). Fixation of head to stem was obtained through conical sleeving. We used a posterolateral approach, and a cemented THA without pressurization. At last follow-up evaluation, 90 patients were reviewed, 9 patients were interviewed by phone. Three patients were dead and 20 patients were lost for follow-up evaluation, in the first year. Nine failures were reoperated. The major cause of failure was septic complication of the THA (8). The average age of patients at arthroplasty was 58.1 year. The clinical evaluation was performed with the Merle d'Aubigné, Postel scoring system. The radiographs of 117 hips out of the 156 were available for this evaluation. Radiolucents, failures and wear were analyzed. RESULTS: There was a 5 per cent rate (8 hips) of deep infection due for two hips to the underlying pathology. Ten (6.5 per cent) of the 156 hips had had an episode of dislocation at last follow-up. Eighty-nine per cent of the hips were rated excellent, very good, and good; 9.3 per cent were rated fair: and 1.7 per cent were rated poor. The radiographs of the socket revealed 54 per cent of bone-cement radiolucent and three failures at last follow-up. The radiographs of the stem revealed 29 per cent of bone-cement radiolucent and one failure at last follow-up. There was no revision of the femoral stem. Survival analysis (aseptic failures) depicted 93.45 per cent durability of the arthroplasty at 10 years. The survival analysis for the socket alone, using the same criteria for failure, demonstrated 94.53 per cent survival success at 10 years, and 98.91 per cent for the stem component. The comparison of the two combinations gave us a survival analysis for the socket alone, using aseptic failure as criteria, 79.84 per cent for stainless-steel/polyethylene combination at 8 years, and 97.63 per cent for alumina/polyethylene at the same time. CONCLUSION: The alumina/polyethylene combination with a 32 mm head diameter gave better results than the stainless-steel/polyethylene combinations. The improvement was noted on the acetabular component.

Actuarial Analysis↗
PubMed1988

Actuarial analysis of late results after closed mitral valvotomy.

The long-term results of closed mitral valvotomy performed between 1978 and 1985 in 198 patients with noncalcific mitral stenosis were analyzed. Follow-up data were available on 185 patients (93%); 1 patient died in the postoperative period, and 12 foreign patients were lost to follow-up. At the 4-year and 8-year intervals, 91% and 80% of patients, respectively, were event free (not in need of further operative procedures). By multivariate analysis, the factor preoperative mild mitral regurgitation showed a tendency to influence the event-free period. By univariate analysis, postoperative mitral regurgitation significantly reduced the event-free period. Twenty-one patients subsequently underwent mitral valve replacement; 8 for mitral regurgitation, 10 for mitral stenosis, and 3 for mixed mitral regurgitation and stenosis. By multivariate analysis, the reason for reoperation significantly influenced the length of the event-free period. The patients with mitral regurgitation required mitral valve replacement sooner than those with mitral stenosis. Advanced age, sex, previous valvotomy, preoperative New York Heart Association Functional Class, low mitral valve leaflet excursion, and pulmonary hypertension had no influence on the long-term result.

Actuarial Analysis↗
PubMed1984

Actuarial analysis of the risk of undergoing repeat cardiac valve replacement.

One thousand five hundred ninety-eight patients who underwent cardiac valve replacement were reviewed. One hundred fifty-two patients (10 percent) required a second valve replacement. The indications for repeat valve replacement were prosthetic valve dysfunction in 53 patients (35 percent), development of a new valvular lesion in 46 patients (30 percent), simple closure of a perivalvular leak in 14 patients (9 percent), change of the valve poppet in 13 patients (8 percent), severe hemolysis or emboli in 21 patients (14 percent), and prosthetic valve endocarditis in 5 patients (3 percent). The mean preoperative New York Health Association functional class improved from 3 to 1.5 in the nonreoperated patients and from 2.9 to 1.8 in patients who underwent a second valve replacement. Similarly, the mean cardiac index improved from 2.5 to 2.9 and from 2.5 to 2.8 in nonreoperated and reoperated patients, respectively. The operative mortality rate was 14 percent in the nonreoperated patients and 16 percent at second operation in the reoperated patients. Using actuarial techniques, the risk of repeat valve replacement was 1 to 4 percent per year. Long-term survival was compared between groups. Using actuarial techniques, the estimated survival rates at 1, 5, and 10 years were 89 percent, 69 percent, and 52 percent, respectively in nonreoperated patients and 87 percent, 60 percent, and 37 percent in reoperated patients. This study has documented the excellent improvement in functional and hemodynamic state after second cardiac valve replacement. The operative mortality and long-term survival rates were similar to those of the nonreoperated patients. Patients having repeat cardiac valve replacement can expect good improvement in length and quality of life.

Actuarial Analysis↗