Nicolas S. Bodmer

Objectives: To examine, over a 10-year period, changes in the prevalence of complex chronic conditions (CCCs) and in the distribution of underlying chronic health categories within a large Swiss PICU, and to compare patient characteristics and PICU mortality between children with CCCs and those without. Design: Single-center retrospective observational study of two cohorts (2007 vs. 2017). Setting: Large academic tertiary referral PICU. Patients: Overall, 1867 children were included (0–16 years old): 981 admitted between January 1, 2007, and December 31, 2007, and 886 admitted between January 1, 2017, and December 31, 2017. Interventions: None. Measurements and Main Results: The prevalence of children with CCCs increased from 61% in 2007 to 70% in 2017. The most common conditions were cardiovascular (55% in 2007 vs. 52% in 2017), congenital/genetic defects (36% vs. 38%), and neurologic/neuromuscular (25% vs. 34%). The proportion of children with 3 or more chronic conditions rose from 16% to 25%. Children with CCCs had longer PICU stays than children without, with length of stay increasing significantly with the number of CCCs. Most children who died during the two study periods had a chronic condition (2007: 61%; 2017: 66%), with a significant increase in the proportion of deaths following intensive care treatment withdrawal (8% in 2007 vs. 48% in 2017). Conclusions: Over a decade, the proportion of children with CCCs needing PICU care has grown, with trends toward increasing prevalence in the clinically dominant categories of respiratory and hematology, immunodeficiency, and immunology, and the subcategories respiratory malformations , hereditary hemostasis anomalies, and home ventilation , and trends toward higher mortality rates following treatment withdrawal.

Background/Objectives: The objective of this study is to compare nerve-sparing (NS) and non-nerve-sparing (NNS) robot-assisted radical prostatectomy (RARP) techniques used to treat localized prostate cancer. Numerous studies have evaluated the impact of NS techniques on patient-reported outcomes. However, there are unaddressed methodological issues making interpretation of results difficult. Therefore, we performed a comparison of the two techniques, accounting for methodological threats, including patient selection and confounding. Methods: We sampled 120 patients with similar disease burden who underwent RARP by the same surgeon, either with NS (n = 84) or NNS (n = 36) and assessed changes in lower urinary tract (LUT) function and bother, and bowel function/bother using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire and the six-item International Index of Erectile Function (IIEF-6) survey at 6 weeks and 12 months postoperatively. Multivariable linear regression models were used to adjust for differences in age, preoperative PSA levels, pathological tumor stage and Gleason-score of patients receiving either NS or NNS. Results: At 6 weeks postoperatively, the NNS group had a significantly larger decrease in LUT function compared to the NS group (−17.42; 95% Confidence Interval (CI): −31.31, −3.53; p = 0.0145). At 12 months, both groups recovered substantially, and no group differences were observed (p > 0.9). No significant differences were observed between the NS and NNS groups for the EPIC bowel subscores, whereas the IIEF-6 showed borderline significance at 12 months. Conclusions: The results suggest a small impact of NS vs. NNS RARP on important patient-reported outcomes when controlling for tumor biology, surgeon skill, and patient characteristics. These results need to be confirmed by larger studies using similar sampling strategies and design considerations.