Population-based long-term outcomes of open versus endovascular aortic repair of ruptured abdominal aortic aneurysms.

OBJECTIVE: Existing data regarding endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) are conflicting in their findings. The purpose of this paper was to determine the long-term outcomes of EVAR vs open surgical repair (OSR) for treatment of rAAA. METHODS: A population-based retrospective cohort study of all patients 40 years or more that underwent OSR or EVAR of rAAA in Ontario, Canada, from 2003 to 2016 was conducted. Administrative data from the province of Ontario was used as the data source. The propensity for repair approach was calculated using a logistic regression model including all covariates and used for inverse probability of treatment weighting. Cox proportional hazards regression was conducted using the weighted cohort to determine the survival and major adverse cardiovascular event (MACE)-free survival of EVAR relative to OSR for rAAA up to 10 years after repair. RESULTS: A total of 2692 rAAA (261 EVAR [10%] and 2431 OSR [90%]) repairs were recorded from April 1, 2003, to March 31, 2016. Mean follow-up for the entire cohort was 3.4 years (standard deviation [SD], 3.9 years), with a maximum follow-up of 14.0 years. OSR patients were followed for a mean of 3.5 years (SD, 4.0 years) and maximum of 14.0 years, and EVAR patients were followed for a mean of 2.7 years (SD, 2.7 years) and a maximum of 11.4 years. Median survival was 2.7 years overall, and 2.5 and 3.7 years for OSR and EVAR patients, respectively. There were no significant baseline differences between EVAR and OSR patients after inverse probability of treatment weighting. EVAR patients were at lower hazard for all-cause mortality (hazard ratio, 0.49; 95% confidence interval, 0.37-0.65; P < .01), and MACE (hazard ratio, 0.51, 95% confidence interval, 0.40-0.66; P < .01) within 30 days of repair. There were no statistically significant differences between EVAR and OSR in the hazard for all-cause mortality or MACE from 30 days to 5 years, and 5 to 10 years. Despite this, the upfront mortality and MACE benefits of EVAR persisted for more than 4.5 years after repair. CONCLUSIONS: This population-based cohort study using administrative data from Ontario, Canada, demonstrated lower hazards for all-cause mortality and MACE within 30 days of operation in favor of EVAR, but no differences in the mid- or longer-term results. More work is needed to understand and improve the long-term outcomes of ruptured endovascular aortic aneurysm repair and ruptured open surgical repair.

Effect of Culturally Mediated Right-Favoritism on the Direction of Pseudoneglect on Line Bisection Tasks.

Objectives: Arabs have a right-to-left language and engage in favoring of the right side or limb when implementing daily routine practices. The purpose of this research is to explore the effect this cultural attitude might have on pseudoneglect, by comparing with a southeast Asian sample that has a left-to-right language structure. Methods: Participants were from two separate ethnic groups (Arabs and Filipinos), residing in Saudi Arabia, healthy individals 18 years and above were allowed to volunteer in the study. The participants were recruited at King Saud University Medical City and the general community by both convenience and snowball sampling. Social demographic information such as gender, age, years of education, dominant hand, was also documented. The line bisection task (LBT) contained 36 randomly assorted lines of three different lengths placed at five different locations on a white sheet. The percent deviation score (PDS) was used to quantify pseudo-neglect. Tests of statistical significance including t-tests and mixed-effects regression were performed to determine if differences existed among different demographic variables or among line properties, respectively. Results: A total of 256 were enrolled (Arabs 52.3%). The overall PDS mean and standard deviation (SD) was -0.64 (2.87), p = 0.0004, which shows a significant leftward deviation in the entire cohort. PDS was -1.26 (2.68) in Filipinos, and -0.08 (2.94) in Arabs. The difference was statically significant (p < 0.0001). Mixed effects model showed positive changes in the PDS value as the length of the line increased (p < 0.0001) and as the line was more rightward placed (p < 0.0001). However, Filipino participants would still exhibit negative changes in the PDS value in comparison to Arabs (p < 0.0001); There were no significant associations between PDS and other factors such as age, years of education and gender. Conclusion: Differences found here between two distinct ethnic groups support the hypothesis that certain cultural aspects such as language direction and other cultural practices influence direction and degree of pseudo-neglect.