Doug Brunk

SAN DIEGO – Reoperations after the Ross procedure remain rare, at 11%, results from a long-term single-center study showed.

The main reason for reoperation appears to be autograft dilatation, Dr. Francis Juthier reported at the annual meeting of the Society of Thoracic Surgeons.

"A major drawback of the Ross operation is a progressive dilatation of the neo–sinuses of Valsalva in patients who undergo root replacement," said Dr. Juthier, a cardiovascular surgeon at the Centre Hospitalier Régional Universitaire de Lille (France). "Cryopreserved pulmonary homograft is also subject to structural failure."

In an effort to better understand the need for reoperation after the Ross procedure, Dr. Juthier and his associates studied 336 adult and pediatric patients who underwent the procedure at the hospital between March 1992 and February 2010. The mean age of patients was 29 years, and the mean follow-up period was 6.2 years.

Of the 336 patients, 38 (11%) required reoperation. The chief cause of reoperation was autograft dilatation in 23 cases, which occurred an average of 9.6 years after the original Ross procedure. All of these patients initially had a complete aortic root replacement. The subsequent procedures included a mechanical Bentall intervention in 19 cases, valve-sparing surgery in 3 cases, and insertion of a stentless bioprosthesis in 1 case.

The second most common cause for reoperation was autograft regurgitation, which occurred in nine patients at an average of 2.6 years after the Ross procedure. All of these patients underwent mechanical aortic valve replacement.

The third most common cause for reoperation was infective endocarditis, which occurred in three cases at an average of 3.8 years after the Ross procedure. The subsequent procedures included aortic and pulmonary valve replacement.

Dr. Juthier also reported that two patients required reoperation because of a proximal autograft anastomosis dehiscence (pericardial patch repair), and one required removal of a left intra-atrial mass.

No perioperative deaths occurred, and all-cause early mortality was 3.3%. Overall survival was 93% at 10 and 15 years, whereas freedom from reoperation or reintervention was 87% at 10 years and 77% at 15 years.

Freedom from autograft explantation was 89% at 10 years and 83% at 5 years, whereas freedom from homograft explantation was 98% at 10 years and 93% at 15 years.

Univariate predictors for reoperation resulting from autograft dilatation were autograft regurgitation (hazard ratio, 3.23), aortic annulus diameter of greater than 1.35 cm/m2 (HR, 3.83), and autograft diameter (HR, 1.2 per mm).

The current policy at the university’s hospital, Dr. Juthier said, is to perform a modified Ross procedure with the autograft included in a Valsalva Gelweave Dacron tube in adult patients who have an aortic annulus that measures 20 mm or greater in diameter.

Dr. Juthier said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Reoperations after the Ross procedure remain rare, at 11%, results from a long-term single-center study showed.

The main reason for reoperation appears to be autograft dilatation, Dr. Francis Juthier reported at the annual meeting of the Society of Thoracic Surgeons.

"A major drawback of the Ross operation is a progressive dilatation of the neo–sinuses of Valsalva in patients who undergo root replacement," said Dr. Juthier, a cardiovascular surgeon at the Centre Hospitalier Régional Universitaire de Lille (France). "Cryopreserved pulmonary homograft is also subject to structural failure."

In an effort to better understand the need for reoperation after the Ross procedure, Dr. Juthier and his associates studied 336 adult and pediatric patients who underwent the procedure at the hospital between March 1992 and February 2010. The mean age of patients was 29 years, and the mean follow-up period was 6.2 years.

Of the 336 patients, 38 (11%) required reoperation. The chief cause of reoperation was autograft dilatation in 23 cases, which occurred an average of 9.6 years after the original Ross procedure. All of these patients initially had a complete aortic root replacement. The subsequent procedures included a mechanical Bentall intervention in 19 cases, valve-sparing surgery in 3 cases, and insertion of a stentless bioprosthesis in 1 case.

The second most common cause for reoperation was autograft regurgitation, which occurred in nine patients at an average of 2.6 years after the Ross procedure. All of these patients underwent mechanical aortic valve replacement.

The third most common cause for reoperation was infective endocarditis, which occurred in three cases at an average of 3.8 years after the Ross procedure. The subsequent procedures included aortic and pulmonary valve replacement.

Dr. Juthier also reported that two patients required reoperation because of a proximal autograft anastomosis dehiscence (pericardial patch repair), and one required removal of a left intra-atrial mass.

No perioperative deaths occurred, and all-cause early mortality was 3.3%. Overall survival was 93% at 10 and 15 years, whereas freedom from reoperation or reintervention was 87% at 10 years and 77% at 15 years.

Freedom from autograft explantation was 89% at 10 years and 83% at 5 years, whereas freedom from homograft explantation was 98% at 10 years and 93% at 15 years.

Univariate predictors for reoperation resulting from autograft dilatation were autograft regurgitation (hazard ratio, 3.23), aortic annulus diameter of greater than 1.35 cm/m2 (HR, 3.83), and autograft diameter (HR, 1.2 per mm).

The current policy at the university’s hospital, Dr. Juthier said, is to perform a modified Ross procedure with the autograft included in a Valsalva Gelweave Dacron tube in adult patients who have an aortic annulus that measures 20 mm or greater in diameter.

Dr. Juthier said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Reoperations after the Ross procedure remain rare, at 11%, results from a long-term single-center study showed.

The main reason for reoperation appears to be autograft dilatation, Dr. Francis Juthier reported at the annual meeting of the Society of Thoracic Surgeons.

"A major drawback of the Ross operation is a progressive dilatation of the neo–sinuses of Valsalva in patients who undergo root replacement," said Dr. Juthier, a cardiovascular surgeon at the Centre Hospitalier Régional Universitaire de Lille (France). "Cryopreserved pulmonary homograft is also subject to structural failure."

In an effort to better understand the need for reoperation after the Ross procedure, Dr. Juthier and his associates studied 336 adult and pediatric patients who underwent the procedure at the hospital between March 1992 and February 2010. The mean age of patients was 29 years, and the mean follow-up period was 6.2 years.

Of the 336 patients, 38 (11%) required reoperation. The chief cause of reoperation was autograft dilatation in 23 cases, which occurred an average of 9.6 years after the original Ross procedure. All of these patients initially had a complete aortic root replacement. The subsequent procedures included a mechanical Bentall intervention in 19 cases, valve-sparing surgery in 3 cases, and insertion of a stentless bioprosthesis in 1 case.

The second most common cause for reoperation was autograft regurgitation, which occurred in nine patients at an average of 2.6 years after the Ross procedure. All of these patients underwent mechanical aortic valve replacement.

The third most common cause for reoperation was infective endocarditis, which occurred in three cases at an average of 3.8 years after the Ross procedure. The subsequent procedures included aortic and pulmonary valve replacement.

Dr. Juthier also reported that two patients required reoperation because of a proximal autograft anastomosis dehiscence (pericardial patch repair), and one required removal of a left intra-atrial mass.

No perioperative deaths occurred, and all-cause early mortality was 3.3%. Overall survival was 93% at 10 and 15 years, whereas freedom from reoperation or reintervention was 87% at 10 years and 77% at 15 years.

Freedom from autograft explantation was 89% at 10 years and 83% at 5 years, whereas freedom from homograft explantation was 98% at 10 years and 93% at 15 years.

Univariate predictors for reoperation resulting from autograft dilatation were autograft regurgitation (hazard ratio, 3.23), aortic annulus diameter of greater than 1.35 cm/m2 (HR, 3.83), and autograft diameter (HR, 1.2 per mm).

The current policy at the university’s hospital, Dr. Juthier said, is to perform a modified Ross procedure with the autograft included in a Valsalva Gelweave Dacron tube in adult patients who have an aortic annulus that measures 20 mm or greater in diameter.

Dr. Juthier said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Reoperations after the Ross procedure remain rare, at 11%, results from a long-term single-center study showed.

The main reason for reoperation appears to be autograft dilatation, Dr. Francis Juthier reported at the annual meeting of the Society of Thoracic Surgeons.

"A major drawback of the Ross operation is a progressive dilatation of the neo–sinuses of Valsalva in patients who undergo root replacement," said Dr. Juthier, a cardiovascular surgeon at the Centre Hospitalier Régional Universitaire de Lille (France). "Cryopreserved pulmonary homograft is also subject to structural failure."

In an effort to better understand the need for reoperation after the Ross procedure, Dr. Juthier and his associates studied 336 adult and pediatric patients who underwent the procedure at the hospital between March 1992 and February 2010. The mean age of patients was 29 years, and the mean follow-up period was 6.2 years.

Of the 336 patients, 38 (11%) required reoperation. The chief cause of reoperation was autograft dilatation in 23 cases, which occurred an average of 9.6 years after the original Ross procedure. All of these patients initially had a complete aortic root replacement. The subsequent procedures included a mechanical Bentall intervention in 19 cases, valve-sparing surgery in 3 cases, and insertion of a stentless bioprosthesis in 1 case.

The second most common cause for reoperation was autograft regurgitation, which occurred in nine patients at an average of 2.6 years after the Ross procedure. All of these patients underwent mechanical aortic valve replacement.

The third most common cause for reoperation was infective endocarditis, which occurred in three cases at an average of 3.8 years after the Ross procedure. The subsequent procedures included aortic and pulmonary valve replacement.

Dr. Juthier also reported that two patients required reoperation because of a proximal autograft anastomosis dehiscence (pericardial patch repair), and one required removal of a left intra-atrial mass.

No perioperative deaths occurred, and all-cause early mortality was 3.3%. Overall survival was 93% at 10 and 15 years, whereas freedom from reoperation or reintervention was 87% at 10 years and 77% at 15 years.

Freedom from autograft explantation was 89% at 10 years and 83% at 5 years, whereas freedom from homograft explantation was 98% at 10 years and 93% at 15 years.

Univariate predictors for reoperation resulting from autograft dilatation were autograft regurgitation (hazard ratio, 3.23), aortic annulus diameter of greater than 1.35 cm/m2 (HR, 3.83), and autograft diameter (HR, 1.2 per mm).

The current policy at the university’s hospital, Dr. Juthier said, is to perform a modified Ross procedure with the autograft included in a Valsalva Gelweave Dacron tube in adult patients who have an aortic annulus that measures 20 mm or greater in diameter.

Dr. Juthier said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Reoperations after the Ross procedure remain rare, at 11%, results from a long-term single-center study showed.

The main reason for reoperation appears to be autograft dilatation, Dr. Francis Juthier reported at the annual meeting of the Society of Thoracic Surgeons.

"A major drawback of the Ross operation is a progressive dilatation of the neo–sinuses of Valsalva in patients who undergo root replacement," said Dr. Juthier, a cardiovascular surgeon at the Centre Hospitalier Régional Universitaire de Lille (France). "Cryopreserved pulmonary homograft is also subject to structural failure."

In an effort to better understand the need for reoperation after the Ross procedure, Dr. Juthier and his associates studied 336 adult and pediatric patients who underwent the procedure at the hospital between March 1992 and February 2010. The mean age of patients was 29 years, and the mean follow-up period was 6.2 years.

Of the 336 patients, 38 (11%) required reoperation. The chief cause of reoperation was autograft dilatation in 23 cases, which occurred an average of 9.6 years after the original Ross procedure. All of these patients initially had a complete aortic root replacement. The subsequent procedures included a mechanical Bentall intervention in 19 cases, valve-sparing surgery in 3 cases, and insertion of a stentless bioprosthesis in 1 case.

The second most common cause for reoperation was autograft regurgitation, which occurred in nine patients at an average of 2.6 years after the Ross procedure. All of these patients underwent mechanical aortic valve replacement.

The third most common cause for reoperation was infective endocarditis, which occurred in three cases at an average of 3.8 years after the Ross procedure. The subsequent procedures included aortic and pulmonary valve replacement.

Dr. Juthier also reported that two patients required reoperation because of a proximal autograft anastomosis dehiscence (pericardial patch repair), and one required removal of a left intra-atrial mass.

No perioperative deaths occurred, and all-cause early mortality was 3.3%. Overall survival was 93% at 10 and 15 years, whereas freedom from reoperation or reintervention was 87% at 10 years and 77% at 15 years.

Freedom from autograft explantation was 89% at 10 years and 83% at 5 years, whereas freedom from homograft explantation was 98% at 10 years and 93% at 15 years.

Univariate predictors for reoperation resulting from autograft dilatation were autograft regurgitation (hazard ratio, 3.23), aortic annulus diameter of greater than 1.35 cm/m2 (HR, 3.83), and autograft diameter (HR, 1.2 per mm).

The current policy at the university’s hospital, Dr. Juthier said, is to perform a modified Ross procedure with the autograft included in a Valsalva Gelweave Dacron tube in adult patients who have an aortic annulus that measures 20 mm or greater in diameter.

Dr. Juthier said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Reoperations after the Ross procedure remain rare, at 11%, results from a long-term single-center study showed.

The main reason for reoperation appears to be autograft dilatation, Dr. Francis Juthier reported at the annual meeting of the Society of Thoracic Surgeons.

"A major drawback of the Ross operation is a progressive dilatation of the neo–sinuses of Valsalva in patients who undergo root replacement," said Dr. Juthier, a cardiovascular surgeon at the Centre Hospitalier Régional Universitaire de Lille (France). "Cryopreserved pulmonary homograft is also subject to structural failure."

In an effort to better understand the need for reoperation after the Ross procedure, Dr. Juthier and his associates studied 336 adult and pediatric patients who underwent the procedure at the hospital between March 1992 and February 2010. The mean age of patients was 29 years, and the mean follow-up period was 6.2 years.

Of the 336 patients, 38 (11%) required reoperation. The chief cause of reoperation was autograft dilatation in 23 cases, which occurred an average of 9.6 years after the original Ross procedure. All of these patients initially had a complete aortic root replacement. The subsequent procedures included a mechanical Bentall intervention in 19 cases, valve-sparing surgery in 3 cases, and insertion of a stentless bioprosthesis in 1 case.

The second most common cause for reoperation was autograft regurgitation, which occurred in nine patients at an average of 2.6 years after the Ross procedure. All of these patients underwent mechanical aortic valve replacement.

The third most common cause for reoperation was infective endocarditis, which occurred in three cases at an average of 3.8 years after the Ross procedure. The subsequent procedures included aortic and pulmonary valve replacement.

Dr. Juthier also reported that two patients required reoperation because of a proximal autograft anastomosis dehiscence (pericardial patch repair), and one required removal of a left intra-atrial mass.

No perioperative deaths occurred, and all-cause early mortality was 3.3%. Overall survival was 93% at 10 and 15 years, whereas freedom from reoperation or reintervention was 87% at 10 years and 77% at 15 years.

Freedom from autograft explantation was 89% at 10 years and 83% at 5 years, whereas freedom from homograft explantation was 98% at 10 years and 93% at 15 years.

Univariate predictors for reoperation resulting from autograft dilatation were autograft regurgitation (hazard ratio, 3.23), aortic annulus diameter of greater than 1.35 cm/m2 (HR, 3.83), and autograft diameter (HR, 1.2 per mm).

The current policy at the university’s hospital, Dr. Juthier said, is to perform a modified Ross procedure with the autograft included in a Valsalva Gelweave Dacron tube in adult patients who have an aortic annulus that measures 20 mm or greater in diameter.

Dr. Juthier said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients younger than age 60 who undergo aortic valve replacement may have a worse rate of survival with a pericardial bioprosthesis as opposed to a mechanical aortic valve replacement, results from a single-center study showed.

"There is insufficient evidence to recommend bioprosthetic valves other than in exceptional situations for patients who require AVR [aortic valve replacement] and are younger than age 60," Dr. Alberto Weber said at the annual meeting of the Society of Thoracic Surgeons. "A prospective strict randomization between valve types only, in isolated AVR, and a longer continued echocardiographic analysis of the prosthetic valve areas would help to clarify this conflict," said.

Current American College of Cardiology/American Heart Association guidelines recommend a bioprosthesis (BP) for AVR in patients of any age who will not take warfarin or who have major medical contraindications to warfarin therapy. "In the past decade, there has been a shift toward bioprosthetic use, to the detriment of mechanical valves, but the data on survival are conflicting," said Dr. Weber, a cardiovascular surgeon at Bern (Switzerland) University Hospital.

He and his associates compared overall survival, cardiac-related mortality, and structural valve deterioration in 110 patients who underwent AVR with the Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards) and 110 patients who underwent AVR with a bileaflet mechanical prosthetic (MP) valve (either St. Jude Medical or ATS) at Bern Hospital between 2000 and 2009. All patients were younger than age 60.

The only statistically significant baseline differences between the two groups were age (a mean of 51 years for BP patients vs. 50 years for MP patients) and the need for acute aortic dissection (1.8% vs. 10.9%, respectively).

During the first 30 days of follow-up, the researchers observed a trend toward more interventions for pericardial effusion or bleeding in the MP group, compared with the BP group, but this did not reach significance. There was also a trend toward more atrial fibrillation in the BP group.

During a mean follow-up of 33 months, 13 patients in the BP group died (11.8%), compared with 3 in the MP group (2.7%), a significant difference. After adjusting for potential confounders in multivariate analysis, the researchers determined that patients in the BP group were five times more likely to die, compared with patients in the MP group.

Overall, "most patients died from cardiac-related causes based on medical records," Dr. Weber said. "There was no autopsy data, unfortunately, and one patient in the MP group committed suicide."

The two groups were similar in the rate of bleeding, stroke, reoperation, and endocarditis, but there were significantly more cases of atrial fibrillation in the BP group than in the MP group (12 vs. 2, respectively).

Echocardiography results at 22 months suggested an early onset of structural valve deterioration in the BP group, leading to accelerated occurrence of moderate prosthesis-patient mismatch. "The groups were similar in ventricular remodeling and left ventricular ejection fraction, but results of the effective orifice area index demonstrated that the BP group showed worse results," Dr. Weber said.

Results from a questionnaire that patients filled out postoperatively indicated that 81% had a preference for valve type before surgery, 57% of patients in the BP group were on aspirin, 14% of patients in the BP group were on warfarin, and 96% of patients in the MP group were on warfarin.

Dr. Weber acknowledged certain limitations of the study, including its relatively short follow-up period and the fact that no autopsy data were available. "We wonder if surgeons preferred a biological AVR in patients who looked somewhat sicker," he said. "It could also be that more physically active patients prefer a bioprosthesis."

While survival might be impaired with a bioprosthetic valve as opposed to a mechanical one, he described the rates of morbidity and mortality observed in the BP group as "very acceptable. They were actually comparable with the literature. In fact, the good news is the excellent results of mechanical prostheses in these young patients. This is remarkable."

Dr. Weber said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients younger than age 60 who undergo aortic valve replacement may have a worse rate of survival with a pericardial bioprosthesis as opposed to a mechanical aortic valve replacement, results from a single-center study showed.

"There is insufficient evidence to recommend bioprosthetic valves other than in exceptional situations for patients who require AVR [aortic valve replacement] and are younger than age 60," Dr. Alberto Weber said at the annual meeting of the Society of Thoracic Surgeons. "A prospective strict randomization between valve types only, in isolated AVR, and a longer continued echocardiographic analysis of the prosthetic valve areas would help to clarify this conflict," said.

Current American College of Cardiology/American Heart Association guidelines recommend a bioprosthesis (BP) for AVR in patients of any age who will not take warfarin or who have major medical contraindications to warfarin therapy. "In the past decade, there has been a shift toward bioprosthetic use, to the detriment of mechanical valves, but the data on survival are conflicting," said Dr. Weber, a cardiovascular surgeon at Bern (Switzerland) University Hospital.

He and his associates compared overall survival, cardiac-related mortality, and structural valve deterioration in 110 patients who underwent AVR with the Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards) and 110 patients who underwent AVR with a bileaflet mechanical prosthetic (MP) valve (either St. Jude Medical or ATS) at Bern Hospital between 2000 and 2009. All patients were younger than age 60.

The only statistically significant baseline differences between the two groups were age (a mean of 51 years for BP patients vs. 50 years for MP patients) and the need for acute aortic dissection (1.8% vs. 10.9%, respectively).

During the first 30 days of follow-up, the researchers observed a trend toward more interventions for pericardial effusion or bleeding in the MP group, compared with the BP group, but this did not reach significance. There was also a trend toward more atrial fibrillation in the BP group.

During a mean follow-up of 33 months, 13 patients in the BP group died (11.8%), compared with 3 in the MP group (2.7%), a significant difference. After adjusting for potential confounders in multivariate analysis, the researchers determined that patients in the BP group were five times more likely to die, compared with patients in the MP group.

Overall, "most patients died from cardiac-related causes based on medical records," Dr. Weber said. "There was no autopsy data, unfortunately, and one patient in the MP group committed suicide."

The two groups were similar in the rate of bleeding, stroke, reoperation, and endocarditis, but there were significantly more cases of atrial fibrillation in the BP group than in the MP group (12 vs. 2, respectively).

Echocardiography results at 22 months suggested an early onset of structural valve deterioration in the BP group, leading to accelerated occurrence of moderate prosthesis-patient mismatch. "The groups were similar in ventricular remodeling and left ventricular ejection fraction, but results of the effective orifice area index demonstrated that the BP group showed worse results," Dr. Weber said.

Results from a questionnaire that patients filled out postoperatively indicated that 81% had a preference for valve type before surgery, 57% of patients in the BP group were on aspirin, 14% of patients in the BP group were on warfarin, and 96% of patients in the MP group were on warfarin.

Dr. Weber acknowledged certain limitations of the study, including its relatively short follow-up period and the fact that no autopsy data were available. "We wonder if surgeons preferred a biological AVR in patients who looked somewhat sicker," he said. "It could also be that more physically active patients prefer a bioprosthesis."

While survival might be impaired with a bioprosthetic valve as opposed to a mechanical one, he described the rates of morbidity and mortality observed in the BP group as "very acceptable. They were actually comparable with the literature. In fact, the good news is the excellent results of mechanical prostheses in these young patients. This is remarkable."

Dr. Weber said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients younger than age 60 who undergo aortic valve replacement may have a worse rate of survival with a pericardial bioprosthesis as opposed to a mechanical aortic valve replacement, results from a single-center study showed.

"There is insufficient evidence to recommend bioprosthetic valves other than in exceptional situations for patients who require AVR [aortic valve replacement] and are younger than age 60," Dr. Alberto Weber said at the annual meeting of the Society of Thoracic Surgeons. "A prospective strict randomization between valve types only, in isolated AVR, and a longer continued echocardiographic analysis of the prosthetic valve areas would help to clarify this conflict," said.

Current American College of Cardiology/American Heart Association guidelines recommend a bioprosthesis (BP) for AVR in patients of any age who will not take warfarin or who have major medical contraindications to warfarin therapy. "In the past decade, there has been a shift toward bioprosthetic use, to the detriment of mechanical valves, but the data on survival are conflicting," said Dr. Weber, a cardiovascular surgeon at Bern (Switzerland) University Hospital.

He and his associates compared overall survival, cardiac-related mortality, and structural valve deterioration in 110 patients who underwent AVR with the Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards) and 110 patients who underwent AVR with a bileaflet mechanical prosthetic (MP) valve (either St. Jude Medical or ATS) at Bern Hospital between 2000 and 2009. All patients were younger than age 60.

The only statistically significant baseline differences between the two groups were age (a mean of 51 years for BP patients vs. 50 years for MP patients) and the need for acute aortic dissection (1.8% vs. 10.9%, respectively).

During the first 30 days of follow-up, the researchers observed a trend toward more interventions for pericardial effusion or bleeding in the MP group, compared with the BP group, but this did not reach significance. There was also a trend toward more atrial fibrillation in the BP group.

During a mean follow-up of 33 months, 13 patients in the BP group died (11.8%), compared with 3 in the MP group (2.7%), a significant difference. After adjusting for potential confounders in multivariate analysis, the researchers determined that patients in the BP group were five times more likely to die, compared with patients in the MP group.

Overall, "most patients died from cardiac-related causes based on medical records," Dr. Weber said. "There was no autopsy data, unfortunately, and one patient in the MP group committed suicide."

The two groups were similar in the rate of bleeding, stroke, reoperation, and endocarditis, but there were significantly more cases of atrial fibrillation in the BP group than in the MP group (12 vs. 2, respectively).

Echocardiography results at 22 months suggested an early onset of structural valve deterioration in the BP group, leading to accelerated occurrence of moderate prosthesis-patient mismatch. "The groups were similar in ventricular remodeling and left ventricular ejection fraction, but results of the effective orifice area index demonstrated that the BP group showed worse results," Dr. Weber said.

Results from a questionnaire that patients filled out postoperatively indicated that 81% had a preference for valve type before surgery, 57% of patients in the BP group were on aspirin, 14% of patients in the BP group were on warfarin, and 96% of patients in the MP group were on warfarin.

Dr. Weber acknowledged certain limitations of the study, including its relatively short follow-up period and the fact that no autopsy data were available. "We wonder if surgeons preferred a biological AVR in patients who looked somewhat sicker," he said. "It could also be that more physically active patients prefer a bioprosthesis."

While survival might be impaired with a bioprosthetic valve as opposed to a mechanical one, he described the rates of morbidity and mortality observed in the BP group as "very acceptable. They were actually comparable with the literature. In fact, the good news is the excellent results of mechanical prostheses in these young patients. This is remarkable."

Dr. Weber said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients younger than age 60 who undergo aortic valve replacement may have a worse rate of survival with a pericardial bioprosthesis as opposed to a mechanical aortic valve replacement, results from a single-center study showed.

"There is insufficient evidence to recommend bioprosthetic valves other than in exceptional situations for patients who require AVR [aortic valve replacement] and are younger than age 60," Dr. Alberto Weber said at the annual meeting of the Society of Thoracic Surgeons. "A prospective strict randomization between valve types only, in isolated AVR, and a longer continued echocardiographic analysis of the prosthetic valve areas would help to clarify this conflict," said.

Current American College of Cardiology/American Heart Association guidelines recommend a bioprosthesis (BP) for AVR in patients of any age who will not take warfarin or who have major medical contraindications to warfarin therapy. "In the past decade, there has been a shift toward bioprosthetic use, to the detriment of mechanical valves, but the data on survival are conflicting," said Dr. Weber, a cardiovascular surgeon at Bern (Switzerland) University Hospital.

He and his associates compared overall survival, cardiac-related mortality, and structural valve deterioration in 110 patients who underwent AVR with the Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards) and 110 patients who underwent AVR with a bileaflet mechanical prosthetic (MP) valve (either St. Jude Medical or ATS) at Bern Hospital between 2000 and 2009. All patients were younger than age 60.

The only statistically significant baseline differences between the two groups were age (a mean of 51 years for BP patients vs. 50 years for MP patients) and the need for acute aortic dissection (1.8% vs. 10.9%, respectively).

During the first 30 days of follow-up, the researchers observed a trend toward more interventions for pericardial effusion or bleeding in the MP group, compared with the BP group, but this did not reach significance. There was also a trend toward more atrial fibrillation in the BP group.

During a mean follow-up of 33 months, 13 patients in the BP group died (11.8%), compared with 3 in the MP group (2.7%), a significant difference. After adjusting for potential confounders in multivariate analysis, the researchers determined that patients in the BP group were five times more likely to die, compared with patients in the MP group.

Overall, "most patients died from cardiac-related causes based on medical records," Dr. Weber said. "There was no autopsy data, unfortunately, and one patient in the MP group committed suicide."

The two groups were similar in the rate of bleeding, stroke, reoperation, and endocarditis, but there were significantly more cases of atrial fibrillation in the BP group than in the MP group (12 vs. 2, respectively).

Echocardiography results at 22 months suggested an early onset of structural valve deterioration in the BP group, leading to accelerated occurrence of moderate prosthesis-patient mismatch. "The groups were similar in ventricular remodeling and left ventricular ejection fraction, but results of the effective orifice area index demonstrated that the BP group showed worse results," Dr. Weber said.

Results from a questionnaire that patients filled out postoperatively indicated that 81% had a preference for valve type before surgery, 57% of patients in the BP group were on aspirin, 14% of patients in the BP group were on warfarin, and 96% of patients in the MP group were on warfarin.

Dr. Weber acknowledged certain limitations of the study, including its relatively short follow-up period and the fact that no autopsy data were available. "We wonder if surgeons preferred a biological AVR in patients who looked somewhat sicker," he said. "It could also be that more physically active patients prefer a bioprosthesis."

While survival might be impaired with a bioprosthetic valve as opposed to a mechanical one, he described the rates of morbidity and mortality observed in the BP group as "very acceptable. They were actually comparable with the literature. In fact, the good news is the excellent results of mechanical prostheses in these young patients. This is remarkable."

Dr. Weber said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients younger than age 60 who undergo aortic valve replacement may have a worse rate of survival with a pericardial bioprosthesis as opposed to a mechanical aortic valve replacement, results from a single-center study showed.

"There is insufficient evidence to recommend bioprosthetic valves other than in exceptional situations for patients who require AVR [aortic valve replacement] and are younger than age 60," Dr. Alberto Weber said at the annual meeting of the Society of Thoracic Surgeons. "A prospective strict randomization between valve types only, in isolated AVR, and a longer continued echocardiographic analysis of the prosthetic valve areas would help to clarify this conflict," said.

Current American College of Cardiology/American Heart Association guidelines recommend a bioprosthesis (BP) for AVR in patients of any age who will not take warfarin or who have major medical contraindications to warfarin therapy. "In the past decade, there has been a shift toward bioprosthetic use, to the detriment of mechanical valves, but the data on survival are conflicting," said Dr. Weber, a cardiovascular surgeon at Bern (Switzerland) University Hospital.

He and his associates compared overall survival, cardiac-related mortality, and structural valve deterioration in 110 patients who underwent AVR with the Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards) and 110 patients who underwent AVR with a bileaflet mechanical prosthetic (MP) valve (either St. Jude Medical or ATS) at Bern Hospital between 2000 and 2009. All patients were younger than age 60.

The only statistically significant baseline differences between the two groups were age (a mean of 51 years for BP patients vs. 50 years for MP patients) and the need for acute aortic dissection (1.8% vs. 10.9%, respectively).

During the first 30 days of follow-up, the researchers observed a trend toward more interventions for pericardial effusion or bleeding in the MP group, compared with the BP group, but this did not reach significance. There was also a trend toward more atrial fibrillation in the BP group.

During a mean follow-up of 33 months, 13 patients in the BP group died (11.8%), compared with 3 in the MP group (2.7%), a significant difference. After adjusting for potential confounders in multivariate analysis, the researchers determined that patients in the BP group were five times more likely to die, compared with patients in the MP group.

Overall, "most patients died from cardiac-related causes based on medical records," Dr. Weber said. "There was no autopsy data, unfortunately, and one patient in the MP group committed suicide."

The two groups were similar in the rate of bleeding, stroke, reoperation, and endocarditis, but there were significantly more cases of atrial fibrillation in the BP group than in the MP group (12 vs. 2, respectively).

Echocardiography results at 22 months suggested an early onset of structural valve deterioration in the BP group, leading to accelerated occurrence of moderate prosthesis-patient mismatch. "The groups were similar in ventricular remodeling and left ventricular ejection fraction, but results of the effective orifice area index demonstrated that the BP group showed worse results," Dr. Weber said.

Results from a questionnaire that patients filled out postoperatively indicated that 81% had a preference for valve type before surgery, 57% of patients in the BP group were on aspirin, 14% of patients in the BP group were on warfarin, and 96% of patients in the MP group were on warfarin.

Dr. Weber acknowledged certain limitations of the study, including its relatively short follow-up period and the fact that no autopsy data were available. "We wonder if surgeons preferred a biological AVR in patients who looked somewhat sicker," he said. "It could also be that more physically active patients prefer a bioprosthesis."

While survival might be impaired with a bioprosthetic valve as opposed to a mechanical one, he described the rates of morbidity and mortality observed in the BP group as "very acceptable. They were actually comparable with the literature. In fact, the good news is the excellent results of mechanical prostheses in these young patients. This is remarkable."

Dr. Weber said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients younger than age 60 who undergo aortic valve replacement may have a worse rate of survival with a pericardial bioprosthesis as opposed to a mechanical aortic valve replacement, results from a single-center study showed.

"There is insufficient evidence to recommend bioprosthetic valves other than in exceptional situations for patients who require AVR [aortic valve replacement] and are younger than age 60," Dr. Alberto Weber said at the annual meeting of the Society of Thoracic Surgeons. "A prospective strict randomization between valve types only, in isolated AVR, and a longer continued echocardiographic analysis of the prosthetic valve areas would help to clarify this conflict," said.

Current American College of Cardiology/American Heart Association guidelines recommend a bioprosthesis (BP) for AVR in patients of any age who will not take warfarin or who have major medical contraindications to warfarin therapy. "In the past decade, there has been a shift toward bioprosthetic use, to the detriment of mechanical valves, but the data on survival are conflicting," said Dr. Weber, a cardiovascular surgeon at Bern (Switzerland) University Hospital.

He and his associates compared overall survival, cardiac-related mortality, and structural valve deterioration in 110 patients who underwent AVR with the Carpentier-Edwards Perimount pericardial bioprosthesis (Edwards) and 110 patients who underwent AVR with a bileaflet mechanical prosthetic (MP) valve (either St. Jude Medical or ATS) at Bern Hospital between 2000 and 2009. All patients were younger than age 60.

The only statistically significant baseline differences between the two groups were age (a mean of 51 years for BP patients vs. 50 years for MP patients) and the need for acute aortic dissection (1.8% vs. 10.9%, respectively).

During the first 30 days of follow-up, the researchers observed a trend toward more interventions for pericardial effusion or bleeding in the MP group, compared with the BP group, but this did not reach significance. There was also a trend toward more atrial fibrillation in the BP group.

During a mean follow-up of 33 months, 13 patients in the BP group died (11.8%), compared with 3 in the MP group (2.7%), a significant difference. After adjusting for potential confounders in multivariate analysis, the researchers determined that patients in the BP group were five times more likely to die, compared with patients in the MP group.

Overall, "most patients died from cardiac-related causes based on medical records," Dr. Weber said. "There was no autopsy data, unfortunately, and one patient in the MP group committed suicide."

The two groups were similar in the rate of bleeding, stroke, reoperation, and endocarditis, but there were significantly more cases of atrial fibrillation in the BP group than in the MP group (12 vs. 2, respectively).

Echocardiography results at 22 months suggested an early onset of structural valve deterioration in the BP group, leading to accelerated occurrence of moderate prosthesis-patient mismatch. "The groups were similar in ventricular remodeling and left ventricular ejection fraction, but results of the effective orifice area index demonstrated that the BP group showed worse results," Dr. Weber said.

Results from a questionnaire that patients filled out postoperatively indicated that 81% had a preference for valve type before surgery, 57% of patients in the BP group were on aspirin, 14% of patients in the BP group were on warfarin, and 96% of patients in the MP group were on warfarin.

Dr. Weber acknowledged certain limitations of the study, including its relatively short follow-up period and the fact that no autopsy data were available. "We wonder if surgeons preferred a biological AVR in patients who looked somewhat sicker," he said. "It could also be that more physically active patients prefer a bioprosthesis."

While survival might be impaired with a bioprosthetic valve as opposed to a mechanical one, he described the rates of morbidity and mortality observed in the BP group as "very acceptable. They were actually comparable with the literature. In fact, the good news is the excellent results of mechanical prostheses in these young patients. This is remarkable."

Dr. Weber said that he had no relevant financial conflicts to disclose.

Erosive progression is arrested in rheumatoid arthritis patients who are treated with adalimumab and methotrexate combination therapy, judging from results of a novel longitudinal study comparing MRI, ultrasonography, CT, and radiography.

However, only MRI was sensitive enough to document repair of individual erosions. Both MRI and ultrasound could detect changes in bone edema, which "was predictive of subsequent erosive progression on CT, both at the individual bone/joint level and also for MRI bone edema at the patient level," reported lead author Dr. Uffe Møller Døhn of the department of rheumatology at the University of Copenhagen in the February 2011 edition of the Annals of the Rheumatic Diseases. "These data emphasize the predictive value of modern imaging, and especially highlight the importance of MRI bone edema for predicting erosive progression."

The findings also offer a different way of thinking about RA’s pathology. In an accompanying editorial, Dr. Fiona McQueen and Dr. Esperanza Naredo said that the study’s findings add to existing evidence suggesting that osteitis is more strongly predictive of bone erosion than is synovitis, which supports "the notion that there is a more direct connection between bone inflammation and bone damage than between synovial inflammation and bone damage" (Ann. Rheum. Dis. 2011;70:241-4). They described synovitis and osteitis as "cousins with a common ancestor, the process that ultimately drives both remaining obscure but possibly sited in the bone marrow."

Dr. Døhn and his associates used MRI, ultrasound, standard radiography, and high-resolution CT images of the wrist and metacarpophalangeal joints 2-5 to study response to adalimumab/methotrexate therapy in 52 RA patients naive to biological agents. All images were obtained before the first dose of adalimumab injection and were repeated after 6 and 12 months of treatment (Ann. Rheum. Dis. 2011;70:252-8).

The median age of patients was 61 years, and 67% were women. From baseline, the researchers did not observe any statistically significant changes in overall bone destruction or repair at 6 or 12 months, but differences were seen when researchers used the smallest-detectable-change cutoff. For example, after 6 and 12 months, the scores of MRI synovitis, grey-scale synovitis, and power Doppler ultrasonography decreased. So did scores as assessed by DAS28 (disease activity score in 28 joints), a health assessment questionnaire, and tender and swollen joint counts.

Study participants with disease progression on CT had higher baseline MRI bone edema scores. In fact, when baseline MRI bone edema was present, the risk ratio for erosive progression in the same bone on CT at 12 months was 3.8. In addition, time-integrated MRI bone edema, power Doppler, and grey-scale synovitis scores were higher in bones and joints with CT progression.

With CT as the reference method, the researchers determined that the sensitivity and specificity for the other imaging modalities were 68% and 92%, respectively, on MRI; 44% and 95% on ultrasonography; and 26% and 98% on radiography.

In their concluding remarks in the editorial, Dr. McQueen and Dr. Naredo emphasized that the reduction of both synovitis and osteitis "is clearly an important therapeutic goal" in treating RA. "The detection and monitoring of synovitis is often more feasible in clinical practice using [ultrasound] than MRI scanning, but the latter does afford the opportunity to detect and monitor bone edema at the same time."

Dr. McQueen is with the department of molecular medicine and pathology at the University of Auckland (New Zealand). Dr. Naredo is with the department of rheumatology at the Hospital Universitario Severo Ochoa in Madrid.

Funding for the study was provided by Abbott Denmark, the Danish Rheumatism Association, and the Aase and Ejner Danielsen Foundation. Dr. Døhn reported no relevant financial conflicts, but many of the study’s coauthors disclosed that they have received consulting fees, speaking fees, or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. McQueen and Dr. Naredo stated that they have no conflicts of interest.

Erosive progression is arrested in rheumatoid arthritis patients who are treated with adalimumab and methotrexate combination therapy, judging from results of a novel longitudinal study comparing MRI, ultrasonography, CT, and radiography.

However, only MRI was sensitive enough to document repair of individual erosions. Both MRI and ultrasound could detect changes in bone edema, which "was predictive of subsequent erosive progression on CT, both at the individual bone/joint level and also for MRI bone edema at the patient level," reported lead author Dr. Uffe Møller Døhn of the department of rheumatology at the University of Copenhagen in the February 2011 edition of the Annals of the Rheumatic Diseases. "These data emphasize the predictive value of modern imaging, and especially highlight the importance of MRI bone edema for predicting erosive progression."

The findings also offer a different way of thinking about RA’s pathology. In an accompanying editorial, Dr. Fiona McQueen and Dr. Esperanza Naredo said that the study’s findings add to existing evidence suggesting that osteitis is more strongly predictive of bone erosion than is synovitis, which supports "the notion that there is a more direct connection between bone inflammation and bone damage than between synovial inflammation and bone damage" (Ann. Rheum. Dis. 2011;70:241-4). They described synovitis and osteitis as "cousins with a common ancestor, the process that ultimately drives both remaining obscure but possibly sited in the bone marrow."

Dr. Døhn and his associates used MRI, ultrasound, standard radiography, and high-resolution CT images of the wrist and metacarpophalangeal joints 2-5 to study response to adalimumab/methotrexate therapy in 52 RA patients naive to biological agents. All images were obtained before the first dose of adalimumab injection and were repeated after 6 and 12 months of treatment (Ann. Rheum. Dis. 2011;70:252-8).

The median age of patients was 61 years, and 67% were women. From baseline, the researchers did not observe any statistically significant changes in overall bone destruction or repair at 6 or 12 months, but differences were seen when researchers used the smallest-detectable-change cutoff. For example, after 6 and 12 months, the scores of MRI synovitis, grey-scale synovitis, and power Doppler ultrasonography decreased. So did scores as assessed by DAS28 (disease activity score in 28 joints), a health assessment questionnaire, and tender and swollen joint counts.

Study participants with disease progression on CT had higher baseline MRI bone edema scores. In fact, when baseline MRI bone edema was present, the risk ratio for erosive progression in the same bone on CT at 12 months was 3.8. In addition, time-integrated MRI bone edema, power Doppler, and grey-scale synovitis scores were higher in bones and joints with CT progression.

With CT as the reference method, the researchers determined that the sensitivity and specificity for the other imaging modalities were 68% and 92%, respectively, on MRI; 44% and 95% on ultrasonography; and 26% and 98% on radiography.

In their concluding remarks in the editorial, Dr. McQueen and Dr. Naredo emphasized that the reduction of both synovitis and osteitis "is clearly an important therapeutic goal" in treating RA. "The detection and monitoring of synovitis is often more feasible in clinical practice using [ultrasound] than MRI scanning, but the latter does afford the opportunity to detect and monitor bone edema at the same time."

Dr. McQueen is with the department of molecular medicine and pathology at the University of Auckland (New Zealand). Dr. Naredo is with the department of rheumatology at the Hospital Universitario Severo Ochoa in Madrid.

Funding for the study was provided by Abbott Denmark, the Danish Rheumatism Association, and the Aase and Ejner Danielsen Foundation. Dr. Døhn reported no relevant financial conflicts, but many of the study’s coauthors disclosed that they have received consulting fees, speaking fees, or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. McQueen and Dr. Naredo stated that they have no conflicts of interest.

Erosive progression is arrested in rheumatoid arthritis patients who are treated with adalimumab and methotrexate combination therapy, judging from results of a novel longitudinal study comparing MRI, ultrasonography, CT, and radiography.

However, only MRI was sensitive enough to document repair of individual erosions. Both MRI and ultrasound could detect changes in bone edema, which "was predictive of subsequent erosive progression on CT, both at the individual bone/joint level and also for MRI bone edema at the patient level," reported lead author Dr. Uffe Møller Døhn of the department of rheumatology at the University of Copenhagen in the February 2011 edition of the Annals of the Rheumatic Diseases. "These data emphasize the predictive value of modern imaging, and especially highlight the importance of MRI bone edema for predicting erosive progression."

The findings also offer a different way of thinking about RA’s pathology. In an accompanying editorial, Dr. Fiona McQueen and Dr. Esperanza Naredo said that the study’s findings add to existing evidence suggesting that osteitis is more strongly predictive of bone erosion than is synovitis, which supports "the notion that there is a more direct connection between bone inflammation and bone damage than between synovial inflammation and bone damage" (Ann. Rheum. Dis. 2011;70:241-4). They described synovitis and osteitis as "cousins with a common ancestor, the process that ultimately drives both remaining obscure but possibly sited in the bone marrow."

Dr. Døhn and his associates used MRI, ultrasound, standard radiography, and high-resolution CT images of the wrist and metacarpophalangeal joints 2-5 to study response to adalimumab/methotrexate therapy in 52 RA patients naive to biological agents. All images were obtained before the first dose of adalimumab injection and were repeated after 6 and 12 months of treatment (Ann. Rheum. Dis. 2011;70:252-8).

The median age of patients was 61 years, and 67% were women. From baseline, the researchers did not observe any statistically significant changes in overall bone destruction or repair at 6 or 12 months, but differences were seen when researchers used the smallest-detectable-change cutoff. For example, after 6 and 12 months, the scores of MRI synovitis, grey-scale synovitis, and power Doppler ultrasonography decreased. So did scores as assessed by DAS28 (disease activity score in 28 joints), a health assessment questionnaire, and tender and swollen joint counts.

Study participants with disease progression on CT had higher baseline MRI bone edema scores. In fact, when baseline MRI bone edema was present, the risk ratio for erosive progression in the same bone on CT at 12 months was 3.8. In addition, time-integrated MRI bone edema, power Doppler, and grey-scale synovitis scores were higher in bones and joints with CT progression.

With CT as the reference method, the researchers determined that the sensitivity and specificity for the other imaging modalities were 68% and 92%, respectively, on MRI; 44% and 95% on ultrasonography; and 26% and 98% on radiography.

In their concluding remarks in the editorial, Dr. McQueen and Dr. Naredo emphasized that the reduction of both synovitis and osteitis "is clearly an important therapeutic goal" in treating RA. "The detection and monitoring of synovitis is often more feasible in clinical practice using [ultrasound] than MRI scanning, but the latter does afford the opportunity to detect and monitor bone edema at the same time."

Dr. McQueen is with the department of molecular medicine and pathology at the University of Auckland (New Zealand). Dr. Naredo is with the department of rheumatology at the Hospital Universitario Severo Ochoa in Madrid.

Funding for the study was provided by Abbott Denmark, the Danish Rheumatism Association, and the Aase and Ejner Danielsen Foundation. Dr. Døhn reported no relevant financial conflicts, but many of the study’s coauthors disclosed that they have received consulting fees, speaking fees, or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. McQueen and Dr. Naredo stated that they have no conflicts of interest.

Erosive progression is arrested in rheumatoid arthritis patients who are treated with adalimumab and methotrexate combination therapy, judging from results of a novel longitudinal study comparing MRI, ultrasonography, CT, and radiography.

However, only MRI was sensitive enough to document repair of individual erosions. Both MRI and ultrasound could detect changes in bone edema, which "was predictive of subsequent erosive progression on CT, both at the individual bone/joint level and also for MRI bone edema at the patient level," reported lead author Dr. Uffe Møller Døhn of the department of rheumatology at the University of Copenhagen in the February 2011 edition of the Annals of the Rheumatic Diseases. "These data emphasize the predictive value of modern imaging, and especially highlight the importance of MRI bone edema for predicting erosive progression."

The findings also offer a different way of thinking about RA’s pathology. In an accompanying editorial, Dr. Fiona McQueen and Dr. Esperanza Naredo said that the study’s findings add to existing evidence suggesting that osteitis is more strongly predictive of bone erosion than is synovitis, which supports "the notion that there is a more direct connection between bone inflammation and bone damage than between synovial inflammation and bone damage" (Ann. Rheum. Dis. 2011;70:241-4). They described synovitis and osteitis as "cousins with a common ancestor, the process that ultimately drives both remaining obscure but possibly sited in the bone marrow."

Dr. Døhn and his associates used MRI, ultrasound, standard radiography, and high-resolution CT images of the wrist and metacarpophalangeal joints 2-5 to study response to adalimumab/methotrexate therapy in 52 RA patients naive to biological agents. All images were obtained before the first dose of adalimumab injection and were repeated after 6 and 12 months of treatment (Ann. Rheum. Dis. 2011;70:252-8).

The median age of patients was 61 years, and 67% were women. From baseline, the researchers did not observe any statistically significant changes in overall bone destruction or repair at 6 or 12 months, but differences were seen when researchers used the smallest-detectable-change cutoff. For example, after 6 and 12 months, the scores of MRI synovitis, grey-scale synovitis, and power Doppler ultrasonography decreased. So did scores as assessed by DAS28 (disease activity score in 28 joints), a health assessment questionnaire, and tender and swollen joint counts.

Study participants with disease progression on CT had higher baseline MRI bone edema scores. In fact, when baseline MRI bone edema was present, the risk ratio for erosive progression in the same bone on CT at 12 months was 3.8. In addition, time-integrated MRI bone edema, power Doppler, and grey-scale synovitis scores were higher in bones and joints with CT progression.

With CT as the reference method, the researchers determined that the sensitivity and specificity for the other imaging modalities were 68% and 92%, respectively, on MRI; 44% and 95% on ultrasonography; and 26% and 98% on radiography.

In their concluding remarks in the editorial, Dr. McQueen and Dr. Naredo emphasized that the reduction of both synovitis and osteitis "is clearly an important therapeutic goal" in treating RA. "The detection and monitoring of synovitis is often more feasible in clinical practice using [ultrasound] than MRI scanning, but the latter does afford the opportunity to detect and monitor bone edema at the same time."

Dr. McQueen is with the department of molecular medicine and pathology at the University of Auckland (New Zealand). Dr. Naredo is with the department of rheumatology at the Hospital Universitario Severo Ochoa in Madrid.

Funding for the study was provided by Abbott Denmark, the Danish Rheumatism Association, and the Aase and Ejner Danielsen Foundation. Dr. Døhn reported no relevant financial conflicts, but many of the study’s coauthors disclosed that they have received consulting fees, speaking fees, or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. McQueen and Dr. Naredo stated that they have no conflicts of interest.

Erosive progression is arrested in rheumatoid arthritis patients who are treated with adalimumab and methotrexate combination therapy, judging from results of a novel longitudinal study comparing MRI, ultrasonography, CT, and radiography.

However, only MRI was sensitive enough to document repair of individual erosions. Both MRI and ultrasound could detect changes in bone edema, which "was predictive of subsequent erosive progression on CT, both at the individual bone/joint level and also for MRI bone edema at the patient level," reported lead author Dr. Uffe Møller Døhn of the department of rheumatology at the University of Copenhagen in the February 2011 edition of the Annals of the Rheumatic Diseases. "These data emphasize the predictive value of modern imaging, and especially highlight the importance of MRI bone edema for predicting erosive progression."

The findings also offer a different way of thinking about RA’s pathology. In an accompanying editorial, Dr. Fiona McQueen and Dr. Esperanza Naredo said that the study’s findings add to existing evidence suggesting that osteitis is more strongly predictive of bone erosion than is synovitis, which supports "the notion that there is a more direct connection between bone inflammation and bone damage than between synovial inflammation and bone damage" (Ann. Rheum. Dis. 2011;70:241-4). They described synovitis and osteitis as "cousins with a common ancestor, the process that ultimately drives both remaining obscure but possibly sited in the bone marrow."

Dr. Døhn and his associates used MRI, ultrasound, standard radiography, and high-resolution CT images of the wrist and metacarpophalangeal joints 2-5 to study response to adalimumab/methotrexate therapy in 52 RA patients naive to biological agents. All images were obtained before the first dose of adalimumab injection and were repeated after 6 and 12 months of treatment (Ann. Rheum. Dis. 2011;70:252-8).

The median age of patients was 61 years, and 67% were women. From baseline, the researchers did not observe any statistically significant changes in overall bone destruction or repair at 6 or 12 months, but differences were seen when researchers used the smallest-detectable-change cutoff. For example, after 6 and 12 months, the scores of MRI synovitis, grey-scale synovitis, and power Doppler ultrasonography decreased. So did scores as assessed by DAS28 (disease activity score in 28 joints), a health assessment questionnaire, and tender and swollen joint counts.

Study participants with disease progression on CT had higher baseline MRI bone edema scores. In fact, when baseline MRI bone edema was present, the risk ratio for erosive progression in the same bone on CT at 12 months was 3.8. In addition, time-integrated MRI bone edema, power Doppler, and grey-scale synovitis scores were higher in bones and joints with CT progression.

With CT as the reference method, the researchers determined that the sensitivity and specificity for the other imaging modalities were 68% and 92%, respectively, on MRI; 44% and 95% on ultrasonography; and 26% and 98% on radiography.

In their concluding remarks in the editorial, Dr. McQueen and Dr. Naredo emphasized that the reduction of both synovitis and osteitis "is clearly an important therapeutic goal" in treating RA. "The detection and monitoring of synovitis is often more feasible in clinical practice using [ultrasound] than MRI scanning, but the latter does afford the opportunity to detect and monitor bone edema at the same time."

Dr. McQueen is with the department of molecular medicine and pathology at the University of Auckland (New Zealand). Dr. Naredo is with the department of rheumatology at the Hospital Universitario Severo Ochoa in Madrid.

Funding for the study was provided by Abbott Denmark, the Danish Rheumatism Association, and the Aase and Ejner Danielsen Foundation. Dr. Døhn reported no relevant financial conflicts, but many of the study’s coauthors disclosed that they have received consulting fees, speaking fees, or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. McQueen and Dr. Naredo stated that they have no conflicts of interest.

Erosive progression is arrested in rheumatoid arthritis patients who are treated with adalimumab and methotrexate combination therapy, judging from results of a novel longitudinal study comparing MRI, ultrasonography, CT, and radiography.

However, only MRI was sensitive enough to document repair of individual erosions. Both MRI and ultrasound could detect changes in bone edema, which "was predictive of subsequent erosive progression on CT, both at the individual bone/joint level and also for MRI bone edema at the patient level," reported lead author Dr. Uffe Møller Døhn of the department of rheumatology at the University of Copenhagen in the February 2011 edition of the Annals of the Rheumatic Diseases. "These data emphasize the predictive value of modern imaging, and especially highlight the importance of MRI bone edema for predicting erosive progression."

The findings also offer a different way of thinking about RA’s pathology. In an accompanying editorial, Dr. Fiona McQueen and Dr. Esperanza Naredo said that the study’s findings add to existing evidence suggesting that osteitis is more strongly predictive of bone erosion than is synovitis, which supports "the notion that there is a more direct connection between bone inflammation and bone damage than between synovial inflammation and bone damage" (Ann. Rheum. Dis. 2011;70:241-4). They described synovitis and osteitis as "cousins with a common ancestor, the process that ultimately drives both remaining obscure but possibly sited in the bone marrow."

Dr. Døhn and his associates used MRI, ultrasound, standard radiography, and high-resolution CT images of the wrist and metacarpophalangeal joints 2-5 to study response to adalimumab/methotrexate therapy in 52 RA patients naive to biological agents. All images were obtained before the first dose of adalimumab injection and were repeated after 6 and 12 months of treatment (Ann. Rheum. Dis. 2011;70:252-8).

The median age of patients was 61 years, and 67% were women. From baseline, the researchers did not observe any statistically significant changes in overall bone destruction or repair at 6 or 12 months, but differences were seen when researchers used the smallest-detectable-change cutoff. For example, after 6 and 12 months, the scores of MRI synovitis, grey-scale synovitis, and power Doppler ultrasonography decreased. So did scores as assessed by DAS28 (disease activity score in 28 joints), a health assessment questionnaire, and tender and swollen joint counts.

Study participants with disease progression on CT had higher baseline MRI bone edema scores. In fact, when baseline MRI bone edema was present, the risk ratio for erosive progression in the same bone on CT at 12 months was 3.8. In addition, time-integrated MRI bone edema, power Doppler, and grey-scale synovitis scores were higher in bones and joints with CT progression.

With CT as the reference method, the researchers determined that the sensitivity and specificity for the other imaging modalities were 68% and 92%, respectively, on MRI; 44% and 95% on ultrasonography; and 26% and 98% on radiography.

In their concluding remarks in the editorial, Dr. McQueen and Dr. Naredo emphasized that the reduction of both synovitis and osteitis "is clearly an important therapeutic goal" in treating RA. "The detection and monitoring of synovitis is often more feasible in clinical practice using [ultrasound] than MRI scanning, but the latter does afford the opportunity to detect and monitor bone edema at the same time."

Dr. McQueen is with the department of molecular medicine and pathology at the University of Auckland (New Zealand). Dr. Naredo is with the department of rheumatology at the Hospital Universitario Severo Ochoa in Madrid.

Funding for the study was provided by Abbott Denmark, the Danish Rheumatism Association, and the Aase and Ejner Danielsen Foundation. Dr. Døhn reported no relevant financial conflicts, but many of the study’s coauthors disclosed that they have received consulting fees, speaking fees, or research grants from Abbott, Centocor, Roche, Schering-Plough, UCB-Nordic, and Wyeth. Dr. McQueen and Dr. Naredo stated that they have no conflicts of interest.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

SAN DIEGO – General surgeons perform the majority of lung resections for cancer in the United States, yet lung cancer resections performed by thoracic surgeons had significantly lower in-hospital mortality rates than did those performed by general surgeons and cardiac surgeons, according to results of a large analysis of national hospital data.

When performing a lung cancer resection, thoracic surgeons performed lymphadenectomy significantly more often than did general surgeons and cardiac surgeons.

"Lymph node status in lung cancer is the main determinant of stage, prognosis, and need for further therapy," Dr. Michelle Ellis said at the annual meeting of the Society of Thoracic Surgeons. "The performance of lymphadenectomy at the time of lung cancer resection can be considered a process measure of quality."

Previously published studies have demonstrated that general surgeons perform the majority of thoracic cases in the United States, while surgeons who specialize in thoracic surgery have lower perioperative morbidity and mortality. "Furthermore, patients who have their lung resection performed by a board-certified cardiothoracic surgeon specializing in general thoracic surgery have longer overall and cancer-specific survival," said Dr. Ellis of Oregon Health and Science University, Portland. "We hypothesized that the completeness of intraoperative oncologic staging at the time of primary lung cancer resection varies by surgeon specialty, and may explain the observed differences in outcome."

To test the hypothesis, Dr. Ellis, with the assistance of Dr. Paul H. Schipper and Dr. John T. Vetto, reviewed 222,233 primary lung cancer cases from the Nationwide Inpatient Sample from 1998 to 2007 who were treated surgically with limited lung resection, lobectomy, or pneumonectomy. The main outcome measure was the presence of lymphadenectomy or mediastinoscopy performed during the same admission.

The researchers divided the surgeons into three main groups based on their case mix of thoracic, cardiac, or other types of surgery. A thoracic surgeon was defined as someone who performed greater than 75% general thoracic surgery operations and less than 10% cardiac operations; a general surgeon was defined as someone who performed fewer than 75% thoracic operations and fewer than 10% cardiac operations, and a cardiac surgeon was defined as someone who performed greater than 10% cardiac operations.

Dr. Ellis reported that lung cancer resections were performed by general surgeons in 62% of cases, by cardiac surgeons in 35% of cases, and by thoracic surgeons in 3% of cases. The median annual case volume was 21 for thoracic surgeons, 23 for cardiac surgeons, and 8 for general surgeons.

In-hospital mortality rates for thoracic, cardiac, and general surgeons were 2.3%, 3.4%, and 4.0%, respectively. This translated into an odds ratio for in-hospital mortality of 1.33 for cases performed by cardiac surgeons and 1.55 for those performed by general surgeons.

Thoracic surgeons performed lymphadenectomy significantly more often than did their counterparts (73% vs. 55% for both cardiac and general surgeons). Thoracic surgeons also performed mediastinoscopy significantly more often (16% vs. 10% by cardiac surgeons and 11% by general surgeons).

Multivariate analysis revealed that patients were significantly less likely to undergo lymphadenectomy if they were in the lowest two quartiles of household income (odds ratio, 0.74); insured by Medicare (OR, 0.93); received their care at a rural hospital (OR, 0.60) or at an urban nonteaching hospital (OR, 0.74); or had their resection performed by a general surgeon (OR, 0.47) or by a cardiac surgeon (OR, 0.47).

"A patient was more than twice as likely to have a lymphadenectomy performed if the lung cancer resection was performed by a thoracic surgeon," Dr. Ellis said.

Next, the researchers assessed the impact of case volume on their multivariate model. They determined that for every doubling of thoracic surgery case volume, there was a significant increase in the likelihood that a lymphadenectomy would be performed (OR, 1.28). On the other hand, for every doubling of general surgery case volume, there was a significant decrease in lymphadenectomy rates (OR, 0.95). Doubling of cardiac surgery case volume did not affect lymphadenectomy rates.

"Lymphadenectomy rates for all surgeon groups did improve over the study period," Dr. Ellis said. "However, despite these improvements, cardiac and general surgeons still have lymphadenectomy rates significantly lower than [those of] cardiac surgeons. The next step is to ensure that all patients receive adequate staging of the mediastinum, possibly through disseminating knowledge, creating centers of excellence, or providing opportunities to learn the skills necessary to perform adequate lung cancer surgery."

She acknowledged certain limitations of the study, including the fact that it contains only single-admission information. "It also has limited cancer-specific data such as stage, and has no mechanism for long-term follow-up," she said. In addition, surgeons are anonymous in the database, so board certification could not be determined.

Dr. Ellis said that she had no relevant financial disclosures to make.

DENVER – Moderate alcohol consumption among renal transplant recipients is inversely associated with posttransplant diabetes and all-cause mortality, results from a large single-center study showed.

The finding contradicts the notion that renal transplant recipients should refrain from alcohol use because of possible interaction with their immunosuppressive drugs, lead investigator Dorien M. Zelle said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

"After renal transplantation, patients have a lot of restrictions," said Ms. Zelle, a PhD candidate at University Medical Center Groningen, The Netherlands. "Doctors advise them not to smoke, and they have to take a lot of medications. We should not advise them against moderate alcohol consumption, because we have shown that nondrinkers are doing worse than moderate drinkers after transplantation."

She went on to note that the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Care of Kidney Transplant Recipients does mention specific alcohol restrictions for kidney transplant patients.

Ms. Zelle and her associates studied 600 renal transplant recipients who visited the medical center’s outpatient clinic between 2001 and 2003 and were at least 1 year post transplant. They filled out self-report questionnaires about their alcohol use and the researchers recorded mortality and graft failure until May 2009. Study participants were classified into one of four groups: abstainers, sporadic drinkers, moderate drinkers (range of 1 unit per week to 3 units per day), and heavy drinkers (4 or more units per day).

At baseline, the mean age of the 600 patients was 51 years and 12% had posttransplant diabetes. Nearly half (288, or 48%) were abstainers, 94 (16%) were sporadic drinkers, 210 (35%) were moderate drinkers, and 8 (1%) were heavy drinkers.

Ms. Zelle reported that during a median follow-up of 7 years, moderate drinkers had a 67% lower risk for diabetes compared with respondents in the other groups (OR = 0.33). In addition, 33 (15.7%) of the moderate drinkers died, compared with 75 (26%) of the abstainers, 23 (24.5%) of the sporadic drinkers, and 2 (25%) of the heavy drinkers.

Univariate Cox regression analysis revealed that moderate drinkers were 44% less likely to die after transplantation compared with respondents in the other groups (HR = 0.56). Adjustment for potential confounders including diabetes and smoking did not change this association.

Ms. Zelle acknowledged certain limitations of the study, including its single center design and the fact that alcohol consumption was measured at a single point in time. "It could be that some patients started drinking more or quit drinking during the course of the study," she said.

Ms. Zelle said that she had no relevant financial disclosures to make.

DENVER – Moderate alcohol consumption among renal transplant recipients is inversely associated with posttransplant diabetes and all-cause mortality, results from a large single-center study showed.

The finding contradicts the notion that renal transplant recipients should refrain from alcohol use because of possible interaction with their immunosuppressive drugs, lead investigator Dorien M. Zelle said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

"After renal transplantation, patients have a lot of restrictions," said Ms. Zelle, a PhD candidate at University Medical Center Groningen, The Netherlands. "Doctors advise them not to smoke, and they have to take a lot of medications. We should not advise them against moderate alcohol consumption, because we have shown that nondrinkers are doing worse than moderate drinkers after transplantation."

She went on to note that the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Care of Kidney Transplant Recipients does mention specific alcohol restrictions for kidney transplant patients.

Ms. Zelle and her associates studied 600 renal transplant recipients who visited the medical center’s outpatient clinic between 2001 and 2003 and were at least 1 year post transplant. They filled out self-report questionnaires about their alcohol use and the researchers recorded mortality and graft failure until May 2009. Study participants were classified into one of four groups: abstainers, sporadic drinkers, moderate drinkers (range of 1 unit per week to 3 units per day), and heavy drinkers (4 or more units per day).

At baseline, the mean age of the 600 patients was 51 years and 12% had posttransplant diabetes. Nearly half (288, or 48%) were abstainers, 94 (16%) were sporadic drinkers, 210 (35%) were moderate drinkers, and 8 (1%) were heavy drinkers.

Ms. Zelle reported that during a median follow-up of 7 years, moderate drinkers had a 67% lower risk for diabetes compared with respondents in the other groups (OR = 0.33). In addition, 33 (15.7%) of the moderate drinkers died, compared with 75 (26%) of the abstainers, 23 (24.5%) of the sporadic drinkers, and 2 (25%) of the heavy drinkers.

Univariate Cox regression analysis revealed that moderate drinkers were 44% less likely to die after transplantation compared with respondents in the other groups (HR = 0.56). Adjustment for potential confounders including diabetes and smoking did not change this association.

Ms. Zelle acknowledged certain limitations of the study, including its single center design and the fact that alcohol consumption was measured at a single point in time. "It could be that some patients started drinking more or quit drinking during the course of the study," she said.

Ms. Zelle said that she had no relevant financial disclosures to make.

DENVER – Moderate alcohol consumption among renal transplant recipients is inversely associated with posttransplant diabetes and all-cause mortality, results from a large single-center study showed.

The finding contradicts the notion that renal transplant recipients should refrain from alcohol use because of possible interaction with their immunosuppressive drugs, lead investigator Dorien M. Zelle said in an interview during a poster session at the annual meeting of the American Society of Nephrology.

"After renal transplantation, patients have a lot of restrictions," said Ms. Zelle, a PhD candidate at University Medical Center Groningen, The Netherlands. "Doctors advise them not to smoke, and they have to take a lot of medications. We should not advise them against moderate alcohol consumption, because we have shown that nondrinkers are doing worse than moderate drinkers after transplantation."

She went on to note that the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Care of Kidney Transplant Recipients does mention specific alcohol restrictions for kidney transplant patients.

Ms. Zelle and her associates studied 600 renal transplant recipients who visited the medical center’s outpatient clinic between 2001 and 2003 and were at least 1 year post transplant. They filled out self-report questionnaires about their alcohol use and the researchers recorded mortality and graft failure until May 2009. Study participants were classified into one of four groups: abstainers, sporadic drinkers, moderate drinkers (range of 1 unit per week to 3 units per day), and heavy drinkers (4 or more units per day).

At baseline, the mean age of the 600 patients was 51 years and 12% had posttransplant diabetes. Nearly half (288, or 48%) were abstainers, 94 (16%) were sporadic drinkers, 210 (35%) were moderate drinkers, and 8 (1%) were heavy drinkers.

Ms. Zelle reported that during a median follow-up of 7 years, moderate drinkers had a 67% lower risk for diabetes compared with respondents in the other groups (OR = 0.33). In addition, 33 (15.7%) of the moderate drinkers died, compared with 75 (26%) of the abstainers, 23 (24.5%) of the sporadic drinkers, and 2 (25%) of the heavy drinkers.

Univariate Cox regression analysis revealed that moderate drinkers were 44% less likely to die after transplantation compared with respondents in the other groups (HR = 0.56). Adjustment for potential confounders including diabetes and smoking did not change this association.

Ms. Zelle acknowledged certain limitations of the study, including its single center design and the fact that alcohol consumption was measured at a single point in time. "It could be that some patients started drinking more or quit drinking during the course of the study," she said.

Ms. Zelle said that she had no relevant financial disclosures to make.