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1. Home-based exercise prehabilitation to improve disease-free survival and return to intended oncologic treatment after cancer surgery in older adults with frailty: a secondary analysis of a randomized trial

Author

McIsaac, Daniel I., Neilipovitz, Nathaniel, Bryson, Gregory L., Gagne, Sylvain, Huang, Allen, Lalu, Manoj, Lavallée, Luke T., Moloo, Husein, Power, Barbara, Scheede-Bergdahl, Celena, van Walraven, Carl, McCartney, Colin J. L., Taljaard, Monica, and Hladkowicz, Emily

Published
2024
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4. Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study

Author

Fernando, Shannon M., Qureshi, Danial, Talarico, Robert, Vigod, Simone N., McIsaac, Daniel I., Sterling, Lee H., van Diepen, Sean, Price, Susanna, Di Santo, Pietro, Kyeremanteng, Kwadwo, Fan, Eddy, Needham, Dale M., Brodie, Daniel, Bienvenu, Oscar Joseph, Combes, Alain, Slutsky, Arthur S., Scales, Damon C., Herridge, Margaret S., Thiele, Holger, Hibbert, Benjamin, Tanuseputro, Peter, and Mathew, Rebecca

Published
2024
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7. Polysomnographic Assessment of Sleep Disturbances in Cancer Development A Historical Multicenter Clinical Cohort Study

Author

Kendzerska, Tetyana, Murray, Brian J, Gershon, Andrea S, Povitz, Marcus, McIsaac, Daniel I, Bryson, Gregory L, Talarico, Robert, Hilton, John, Malhotra, Atul, Leung, Richard S, and Boulos, Mark I

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Clinical Research, Sleep Research, Cancer, Humans, Cohort Studies, Sleep, Polysomnography, Sleep Wake Disorders, Neoplasms, Ontario, cluster analysis, incident cancer, sleep disturbances, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundMany cellular processes are controlled by sleep. Therefore, alterations in sleep might be expected to stress biological systems that could influence malignancy risk.Research questionWhat is the association between polysomnographic measures of sleep disturbances and incident cancer, and what is the validity of cluster analysis in identifying polysomnography phenotypes?Study design and methodsWe conducted a retrospective multicenter cohort study using linked clinical and provincial health administrative data on consecutive adults free of cancer at baseline with polysomnography data collected between 1994 and 2017 in four academic hospitals in Ontario, Canada. Cancer status was derived from registry records. Polysomnography phenotypes were identified by k-means cluster analysis. A combination of validation statistics and distinguishing polysomnographic features was used to select clusters. Cox cause-specific regressions were used to assess the relationship between identified clusters and incident cancer.ResultsAmong 29,907 individuals, 2,514 (8.4%) received a diagnosis of cancer over a median of 8.0 years (interquartile range, 4.2-13.5 years). Five clusters were identified: mild (mildly abnormal polysomnography findings), poor sleep, severe OSA or sleep fragmentation, severe desaturations, and periodic limb movements of sleep (PLMS). The associations between cancer and all clusters compared with the mild cluster were significant while controlling for clinic and year of polysomnography. When additionally controlling for age and sex, the effect remained significant only for PLMS (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.06-1.50) and severe desaturations (aHR, 1.32; 95% CI, 1.04-1.66). Further controlling for confounders, the effect remained significant for PLMS, but was attenuated for severe desaturations.InterpretationIn a large cohort, we confirmed the importance of polysomnographic phenotypes and highlighted the role that PLMS and oxygenation desaturation may play in cancer. Using this study's findings, we also developed an Excel (Microsoft) spreadsheet (polysomnography cluster classifier) that can be used to validate the identified clusters on new data or to identify which cluster a patient belongs to.Trial registryClinicalTrials.gov; Nos.: NCT03383354 and NCT03834792; URL: www.Clinicaltrialsgov.

Published
2023

9. Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial

Author

Khan, James S., Gilron, Ian, Devereaux, P. J., Clarke, Hance, Ayach, Nour, Tomlinson, George, Quan, May Lynn, Ladha, Karim S., Choi, Stephen, Munro, Allana, Brull, Richard, Lim, David W., Avramescu, Sinziana, Richebé, Philippe, Hodgson, Nicole, Paul, James, McIsaac, Daniel I., Derzi, Simone, Zbitnew, Geoff L., Easson, Alexandra M., Siddiqui, Naveed T., Miles, Sarah J., and Karkouti, Keyvan

Published
2024
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17. Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis

Author

Verret, Michael, Le, John B.P., Lalu, Manoj M., Jeffers, Matthew S., McIsaac, Daniel I., Nicholls, Stuart G., Turgeon, Alexis F., Ramchandani, Rashi, Li, Hongda, Hutton, Brian, Zivkovic, Fiona, Graham, Megan, Lê, Maxime, Geist, Allison, Bérubé, Mélanie, O'Hearn, Katie, Gilron, Ian, Poulin, Patricia, Daudt, Helena, Martel, Guillaume, McVicar, Jason, Moloo, Husein, and Fergusson, Dean A.

Published
2024
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18. Resource Utilization and Costs Associated With Cardiogenic Shock Complicating Myocardial Infarction: A Population-Based Cohort Study

Author

Parlow, Simon, Fernando, Shannon M., Pugliese, Michael, Qureshi, Danial, Talarico, Robert, Sterling, Lee H., van Diepen, Sean, Herridge, Margaret S., Price, Susanna, Brodie, Daniel, Fan, Eddy, McIsaac, Daniel I., Di Santo, Pietro, Jung, Richard G., Slutsky, Arthur S., Scales, Damon C., Combes, Alain, Hibbert, Benjamin, Thiele, Holger, Tanuseputro, Peter, and Mathew, Rebecca

Published
2024
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24. Polysomnographic Markers of Obstructive Sleep Apnea Severity and Cancer-related Mortality: A Large Retrospective Multicenter Clinical Cohort Study.

Author

Kendzerska, Tetyana, Gershon, Andrea S, Povitz, Marcus, Boulos, Mark I, Murray, Brian J, McIsaac, Daniel I, Bryson, Gregory L, Talarico, Robert, Hilton, John, Malhotra, Atul, and Leung, Richard S

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Lung, Sleep Research, Prevention, Clinical Research, Cancer, Good Health and Well Being, Adult, Biomarkers, Cohort Studies, Humans, Hypoxia, Incidence, Neoplasms, Ontario, Retrospective Studies, Risk Factors, Severity of Illness Index, Sleep Apnea, Obstructive, Sleep Deprivation, sleep apnea, obstructive, neoplasms, adult, mortality, Cardiovascular medicine and haematology, Clinical sciences
Abstract

Rationale: The evidence for an association between cancer survival and obstructive sleep apnea (OSA) remains underexplored. Objectives: To evaluate an association between markers of OSA severity (respiratory disturbances, hypoxemia, and sleep fragmentation) and cancer-related mortality in individuals with previously diagnosed cancer. Methods: We conducted a multicenter retrospective cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four Canadian academic hospitals and were previously diagnosed with cancer through the Ontario Cancer Registry. Multivariable cause-specific Cox regressions were used to address the research objective. Results: We included 2,222 subjects. Over a median follow-up time of 5.6 years (interquartile range [IQR], 2.7-9.1 years), 261/2,222 (11.7%) individuals with prevalent cancer died from cancer-related causes, which accounted for 44.2% (261/590) of all-cause death. Controlling for age, sex, alcohol use disorder, prior heart failure, chronic obstructive pulmonary disease, hypertension, diabetes, treatment for OSA, clinic site, year of the sleep study, and time since the cancer diagnosis, measures of hypoxemia and sleep fragmentation, but not apnea-hypopnea index, were significantly associated with the cancer-specific mortality: percentage of time spent with arterial oxygen saturation (SaO2)

Published
2022

26. Intraoperative pharmacologic opioid minimisation strategies and patient-centred outcomes after surgery: a scoping review

Author

Verret, Michael, Lam, Nhat H., Lalu, Manoj, Nicholls, Stuart G., Turgeon, Alexis F., McIsaac, Daniel I., Hamtiaux, Myriam, Bao Phuc Le, John, Gilron, Ian, Yang, Lucy, Kaimkhani, Mahrukh, Assi, Alexandre, El-Adem, David, Timm, Makenna, Tai, Peter, Amir, Joelle, Srichandramohan, Sriyathavan, Al-Mazidi, Abdulaziz, Fergusson, Nicholas A., Hutton, Brian, Zivkovic, Fiona, Graham, Megan, Lê, Maxime, Geist, Allison, Bérubé, Mélanie, Poulin, Patricia, Shorr, Risa, Daudt, Helena, Martel, Guillaume, McVicar, Jason, Moloo, Husein, and Fergusson, Dean A.

Published
2024
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29. Association of obstructive sleep apnea and opioids use on adverse health outcomes: A population study of health administrative data.

Author

Kendzerska, Tetyana, Gomes, Tara, Malhotra, Atul, Gershon, Andrea S, Povitz, Marcus, McIsaac, Daniel I, Aaron, Shawn D, Chung, Frances, Bryson, Gregory L, Talarico, Robert, Ahmed, Tahmid, Godbout, Michael, and Tanuseputro, Peter

Subjects
Humans, Sleep Apnea, Obstructive, Opioid-Related Disorders, Analgesics, Opioid, Polysomnography, Retrospective Studies, Adult, Ontario, Health Services, Sleep Research, Clinical Research, Lung, Patient Safety, Good Health and Well Being, General Science & Technology
Abstract

RationaleDespite the high prevalence of obstructive sleep apnea (OSA) and concurrent use of opioid therapy, no large-scale population studies have investigated whether opioid use and pre-existing OSA may interact synergistically to increase the risk of adverse health consequences. To address this knowledge gap, we conducted a retrospective cohort study using provincial health administrative data to evaluate whether the combined presence of opioid use and OSA increases the risk of adverse health consequences, such as mortality, hospitalizations, and emergency department (ED) visits; and if it does, whether this co-occurrence has synergistic clinical relevance.MethodsWe included all adults who underwent a diagnostic sleep study in Ontario, Canada, between 2013 and 2016. Individuals were considered exposed to opioids if they filled a prescription that overlapped with the date of their sleep study (Opioid+). Individuals with at least a 50% probability of having a diagnosis of moderate to severe OSA (OSA+) were identified using a previously externally validated case-ascertainment model. The primary outcome was all-cause mortality; secondary outcomes were all-cause or ischemic heart disease hospitalizations, all-cause ED visits, and motor vehicle collisions (MVC) requiring hospital or ED visit. We used multivariable Cox regression models to compare hazards between four mutually exclusive groups: (1) Opioid+ OSA+; (2) Opioid+ OSA-; (3) Opioid- OSA+, and (4) OSA- Opioid- (reference for comparison). Relative excess risks due to interaction (RERI) were calculated to test for additive interaction.ResultsOf 300,663 adults who underwent a sleep study, 15,713 (5.2%) were considered as Opioid+ and 128,351 (42.7%) as OSA+. Over a median of two years, 6,223 (2.1%) died from any cause. Regardless of OSA status, opioid use at the date of the sleep study was associated with an increased hazard for all-cause mortality with the greatest hazard associated with Opioid+ OSA- (adjusted hazard ratio [aHR]: 1.75, 95% CI 1.57-1.94), but not Opioid+ OSA+ (aHR: 1.14, 95% CI 1.02-1.27) as hypothesized. Regardless of OSA status, opioid use at the date of the sleep study was associated with an increased hazard for all secondary outcomes. Opioid+ OSA+ was associated with the greatest hazards of all-cause hospitalizations (aHR 1.55, 95% CI 1.49-1.61) and MVC (aHR of 1.39; 95% CI 1.09-1.77); however, no statistically significant synergistic effects were observed.ConclusionsAdults referred for sleep disorder assessment who used opioids had a significantly increased hazard of adverse health outcomes than those who did not, regardless of whether they had a high probability of moderate to severe OSA. The use of opioids and OSA was associated with the greatest hazard of all-cause hospitalizations and MVC requiring hospital or ED visit. The interaction of opioids and OSA did not confer a synergistic risk for poor outcomes.

Published
2022

37. Obstructive Sleep Apnea and Incident Cancer: A Large Retrospective Multicenter Clinical Cohort Study

Author

Kendzerska, Tetyana, Povitz, Marcus, Leung, Richard S, Boulos, Mark I, McIsaac, Daniel I, Murray, Brian J, Bryson, Gregory L, Talarico, Robert, Hilton, John F, Malhotra, Atul, and Gershon, Andrea S

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Prevention, Patient Safety, Sleep Research, Clinical Research, Lung, Cancer, Good Health and Well Being, Female, Humans, Incidence, Male, Neoplasms, Ontario, Oxygen Saturation, Registries, Retrospective Studies, Risk Factors, Severity of Illness Index, Sleep Apnea, Obstructive, Medical and Health Sciences, Epidemiology, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundTo examine the association between the severity of obstructive sleep apnea (OSA) and nocturnal hypoxemia with incident cancer.MethodsThis was a multicenter retrospective clinical cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four academic hospitals (Canada) who were free of cancer at baseline. Cancer status was derived from the Ontario Cancer Registry. Cox cause-specific regressions were utilized to address the objective and to calculate the 10-year absolute risk difference (ARD) in the marginal probability of incident cancer and the number needed to harm (NNH).ResultsOf 33,997 individuals considered, 33,711 with no missing OSA severity were included: median age, 50 years; 58% male; and 23% with severe OSA (apnea-hypopnea index >30). Of the 18,458 individuals with information on sleep time spent with oxygen saturation (SaO2) 30% of sleep with SaO2

Published
2021

39. Survival and health care costs after inpatient elective surgery: comparison of patients with and without chronic obstructive pulmonary disease

Author

Sankar, Ashwin, Thorpe, Kevin, McIsaac, Daniel I., Luo, Jin, Wijeysundera, Duminda N., and Gershon, Andrea S.

Subjects
Medical care, Cost of -- Analysis, Lung diseases, Obstructive -- Care and treatment, Surgery, Elective -- Complications and side effects, Health risk assessment -- Methods, Health
Abstract

Background: Chronic obstructive pulmonary disease (COPD) is common among surgical patients, and patients with COPD have higher risk for complications and death within 30 days after surgery. We sought to describe the longer-term postoperative survival and costs of patients with COPD compared with those without COPD within 1 year after inpatient elective surgery. Methods: In this retrospective population-based cohort study, we used linked health administrative databases to identify all patients undergoing inpatient elective surgery in Ontario, Canada, from 2005 to 2019. We ascertained COPD status using validated definitions. We followed participants for 1 year after surgery to evaluate survival and costs to the health system. We quantified the association of COPD with survival (Cox proportional hazards models) and costs (linear regression model with log-transformed costs) with partial adjustment (for sociodemographic factors and procedure type) and full adjustment (also adjusting for comorbidities). We assessed for effect modification by frailty, cancer and procedure type. Results: We included 932 616 patients, of whom 170 482 (18%) had COPD. With respect to association with risk of death, COPD had a partially adjusted hazard ratio (HR) of 1.61 (95% confidence interval [Cl] 1.58-1.64), and a fully adjusted HR of 1.26 (95% Cl 1.24-1.29). With respect to impact on health system costs, COPD was associated with a partially adjusted relative increase of 13.1% (95% CI 12.7%-13.4%), and an increase of 4.6% (95% CI 4.3%-5.0%) with full adjustment. Frailty, cancer and procedure type (such as orthopedic and lower abdominal surgery) modified the association between COPD and outcomes. Interpretation: Patients with COPD have decreased survival and increased costs in the year after surgery. Frailty, cancer and the type of surgical procedure modified associations between COPD and outcomes, and must be considered when risk-stratifying surgical patients with COPD., Contemporary estimates suggest that more than 10% of surgical patients have COPD. (1) Patients with COPD are at increased risk for complications and death within 30 days after surgery; (2-4) [...]

Published
2023
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40. Outpatient Mental Health Follow-up and Recurrent Self-harm and Suicide Among Patients Admitted to the ICU for Self-harm: A Population-based Cohort Study

Author

Fernando, Shannon M., Pugliese, Michael, McIsaac, Daniel I., Qureshi, Danial, Talarico, Robert, Sood, Manish M., Myran, Daniel T., Herridge, Margaret S., Needham, Dale M., Munshi, Laveena, Rochwerg, Bram, Fiest, Kirsten M., Milani, Christina, Kisilewicz, Magdalena, Bienvenu, O. Joseph, Brodie, Daniel, Fan, Eddy, Fowler, Robert A., Ferguson, Niall D., Scales, Damon C., Wunsch, Hannah, Tanuseputro, Peter, and Kyeremanteng, Kwadwo

Published
2023
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45. The Association Between Hospital High-volume Anesthesiology Care and Patient Outcomes for Complex Gastrointestinal Cancer Surgery: A Population-based Study

Author

Hallet, Julie, Jerath, Angela, Perez d’Empaire, Pablo, Eskander, Antoine, Carrier, François M., McIsaac, Daniel I., Turgeon, Alexis F., Idestrup, Chris, Flexman, Alana M., Lorello, Gianni, Darling, Gail, Kidane, Biniam, Kaliwal, Yosuf, Barabash, Victoria, Coburn, Natalie, and Sutradhar, Rinku

Published
2023
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48. Implementation and Adherence-Supporting Strategies to Improve Healthcare Provider Prescription of and Patient Adherence to Guideline-Recommended Cardiovascular Medications for Atherosclerotic Occlusive Disease: Protocol for Two Systematic Reviews and Meta-Analyses of Randomized Trials (Preprint)

Author

Kirkham, Aidan M, primary, Fergusson, Dean A, additional, Presseau, Justin, additional, McIsaac, Daniel I, additional, Shorr, Risa, additional, and Roberts, Derek J, additional

Published
2024
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49. Association between anaesthesia–surgery team sex diversity and major morbidity

Author

Hallet, Julie, primary, Sutradhar, Rinku, additional, Flexman, Alana, additional, McIsaac, Daniel I, additional, Carrier, François M, additional, Turgeon, Alexis F, additional, McCartney, Colin, additional, Chan, Wing C, additional, Coburn, Natalie, additional, Eskander, Antoine, additional, Jerath, Angela, additional, Perez d’Empaire, Pablo, additional, and Lorello, Gianni, additional

Published
2024
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