{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T07:40:14Z","timestamp":1777794014816,"version":"3.51.4"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hip fractures frequently necessitate hospitalization, especially among patients aged 75 and above who might concurrently suffer from aortic stenosis (AS). This study focuses on postoperative outcomes, potential determinants of morbidity and mortality, as well as evolving trends in patients with AS undergoing surgical repair of hip fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2019 was conducted. Hip fracture cases were identified, and a subgroup with AS was isolated using the ICD-9 and ICD-10 diagnostic codes. We compared baseline characteristics, postoperative in-hospital outcomes and trends in mortality and morbidity between patients with and without AS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From the dataset, 2,834,919 patients with hip fracture were identified on weighted analysis. Of these, 94,270 (3.3%) were found to have concurrent AS. The AS cohort was characterized by higher mean age and elevated burden of cardiovascular comorbidities, such as coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias. Postoperative mortality following hip fracture surgery was greater in the AS groups compared to non-AS group (3.3% vs 1.57%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Risk factors such as congestive heart failure (OR, 2.3[CI, 2.1\u20132.6]), age above 85\u00a0years (OR, 3.2[CI, 2.2\u20134.7]), cardiac arrhythmias (OR, 2.4[CI, 2.2\u20132.6]), end-stage renal disease (OR, 3.4[CI, 2.7\u20134.1]), malnutrition (OR, 2.3[CI, 2.1\u20132.7]) and AS (OR, 1.2[CI, 1.08\u20131.5] were associated with increased adjusted odds of postoperative mortality. AS was linked to higher adjusted odds of postoperative mortality (OR, 1.2 [CI, 1.1\u20131.5]) and complications such as acute myocardial infarction (OR, 1.2 [CI, 1.01\u20131.4]), cardiogenic shock (OR, 2.0[CI, 1.4\u20132.9]) and acute renal failure (OR, 1.1[CI, 1.02\u20131.2]). While hospital stay duration was comparable in both groups (average 5\u00a0days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in patients with AS and hip fracture significantly increased mortality, hospital stay, and cost. A notable decline in postoperative in-hospital mortality was observed in both groups from 2008\u20132019 though the rate of major in-hospital complications rose.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AS significantly influences postoperative in-hospital mortality and complication rates in hip fracture patients. While a reduction in postoperative mortality was observed in both AS and non-AS cohorts, the incidence of major in-hospital complications increased across both groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-023-03584-2","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:24:24Z","timestamp":1698971064000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: a nationwide inpatient sample analysis"],"prefix":"10.1186","volume":"23","author":[{"given":"Shahzad","family":"Hassan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waqas","family":"Anwar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivani","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Iftikhar","family":"Hanif","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdallah","family":"Kamouh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander J.","family":"Blood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"issue":"14","key":"3584_CR1","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1001\/jama.2009.1462","volume":"302","author":"CA Brauer","year":"2009","unstructured":"Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302(14):1573\u20139.","journal-title":"JAMA"},{"issue":"1","key":"3584_CR2","doi-asserted-by":"publisher","first-page":"15","DOI":"10.4103\/0019-5413.73656","volume":"45","author":"DK Dhanwal","year":"2011","unstructured":"Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: worldwide geographic variation. Indian J Orthop. 2011;45(1):15\u201322.","journal-title":"Indian J Orthop"},{"issue":"5","key":"3584_CR3","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/PL00004148","volume":"7","author":"B Gullberg","year":"1997","unstructured":"Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407\u201313.","journal-title":"Osteoporos Int"},{"issue":"4","key":"3584_CR4","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1359\/JBMR.040109","volume":"19","author":"KP Chang","year":"2004","unstructured":"Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo osteoporosis epidemiology study. J Bone Miner Res Off J Am Soc Bone Miner Res. 2004;19(4):532\u20136.","journal-title":"J Bone Miner Res Off J Am Soc Bone Miner Res"},{"key":"3584_CR5","doi-asserted-by":"publisher","first-page":"215145932092958","DOI":"10.1177\/2151459320929581","volume":"11","author":"EA Remily","year":"2020","unstructured":"Remily EA, Mohamed NS, Wilkie WA, Mahajan AK, Patel NG, Andrews TJ, et al. Hip fracture trends in America between 2009 and 2016. Geriatr Orthop Surg Rehabil. 2020;11:2151459320929581.","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"1","key":"3584_CR6","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13018-015-0332-3","volume":"11","author":"KJ Sullivan","year":"2016","unstructured":"Sullivan KJ, Husak LE, Altebarmakian M, Brox WT. Demographic factors in hip fracture incidence and mortality rates in California, 2000\u20132011. J Orthop Surg. 2016;11(1):4.","journal-title":"J Orthop Surg"},{"issue":"6","key":"3584_CR7","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/BF01623184","volume":"2","author":"C Cooper","year":"1992","unstructured":"Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 1992;2(6):285\u20139.","journal-title":"Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA"},{"issue":"15","key":"3584_CR8","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.1001\/jama.2009.1463","volume":"302","author":"U Sennerby","year":"2009","unstructured":"Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, et al. Cardiovascular diseases and risk of hip fracture. JAMA. 2009;302(15):1666\u201373.","journal-title":"JAMA"},{"issue":"11","key":"3584_CR9","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/j.jacc.2013.05.015","volume":"62","author":"RLJ Osnabrugge","year":"2013","unstructured":"Osnabrugge RLJ, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62(11):1002\u201312.","journal-title":"J Am Coll Cardiol"},{"issue":"9540","key":"3584_CR10","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","volume":"368","author":"VT Nkomo","year":"2006","unstructured":"Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. The Lancet. 2006;368(9540):1005\u201311.","journal-title":"The Lancet"},{"key":"3584_CR11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/1754-9493-4-16","volume":"4","author":"C Ossendorf","year":"2010","unstructured":"Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4:16.","journal-title":"Patient Saf Surg"},{"issue":"1","key":"3584_CR12","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.amjmed.2003.07.012","volume":"116","author":"MD Kertai","year":"2004","unstructured":"Kertai MD, Bountioukos M, Boersma E, Bax JJ, Thomson IR, Sozzi F, et al. Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery. Am J Med. 2004;116(1):8\u201313.","journal-title":"Am J Med"},{"issue":"2","key":"3584_CR13","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1161\/CIRCOUTCOMES.111.000091","volume":"6","author":"S Agarwal","year":"2013","unstructured":"Agarwal S, Rajamanickam A, Bajaj NS, Griffin BP, Catacutan T, Svensson LG, et al. Impact of aortic stenosis on postoperative outcomes after noncardiac surgeries. Circ Cardiovasc Qual Outcomes. 2013;6(2):193\u2013200.","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"22","key":"3584_CR14","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.1016\/j.jacc.2014.07.944","volume":"64","author":"LA Fleisher","year":"2014","unstructured":"Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC\/AHA guideline on perioperative cardiovascular evaluation and Management of Patients Undergoing Noncardiac Surgery: a report of the American College of Cardiology\/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;64(22):e77-137.","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"3584_CR15","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.archger.2007.05.013","volume":"46","author":"A Adunsky","year":"2008","unstructured":"Adunsky A, Kaplan A, Arad M, Mizrahi EH, Gottlieb S. Aortic stenosis in elderly hip fractured patients. Arch Gerontol Geriatr. 2008;46(3):401\u20138.","journal-title":"Arch Gerontol Geriatr"},{"issue":"2","key":"3584_CR16","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.injury.2015.10.015","volume":"47","author":"A Keswani","year":"2016","unstructured":"Keswani A, Lovy A, Khalid M, Blaufarb I, Moucha C, Forsh D, et al. The effect of aortic stenosis on elderly hip fracture outcomes: a case control study. Injury. 2016;47(2):413\u20138.","journal-title":"Injury"},{"key":"3584_CR17","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.2147\/CIA.S360538","volume":"17","author":"C Rostagno","year":"2022","unstructured":"Rostagno C, Cartei A, Rubbieri G, Ceccofiglio A, Civinini R, Curcio M, et al. Hip fracture surgery in severe aortic stenosis: a study of factors affecting mortality. Clin Interv Aging. 2022;17:1163\u201371.","journal-title":"Clin Interv Aging"},{"issue":"3","key":"3584_CR18","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1159\/000209245","volume":"55","author":"D Leibowitz","year":"2009","unstructured":"Leibowitz D, Rivkin G, Schiffman J, Rott D, Weiss AT, Mattan Y, et al. Effect of severe aortic stenosis on the outcome in elderly patients undergoing repair of hip fracture. Gerontology. 2009;55(3):303\u20136.","journal-title":"Gerontology"},{"key":"3584_CR19","unstructured":"HCUP-US NIS Overview [Internet]. [cited 2022 Aug 15]. Available from: https:\/\/www.hcup-us.ahrq.gov\/nisoverview.jsp"},{"issue":"1","key":"3584_CR20","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","volume":"36","author":"A Elixhauser","year":"1998","unstructured":"Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8.","journal-title":"Med Care"},{"issue":"6","key":"3584_CR21","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1136\/heartjnl-2012-302265","volume":"99","author":"GW Eveborn","year":"2013","unstructured":"Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. The troms\u00f8 study. Heart. 2013;99(6):396\u2013400.","journal-title":"Heart"},{"issue":"2","key":"3584_CR22","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ijcard.2011.02.026","volume":"159","author":"P Faggiano","year":"2012","unstructured":"Faggiano P, Frattini S, Zilioli V, Rossi A, Nistri S, Dini FL, et al. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process. Int J Cardiol. 2012;159(2):94\u20139.","journal-title":"Int J Cardiol."},{"issue":"8","key":"3584_CR23","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1161\/CIRCULATIONAHA.111.087965","volume":"125","author":"SK Kodali","year":"2012","unstructured":"Kodali SK, Moses JW. Coronary artery disease and aortic stenosis in the transcatheter aortic valve replacement era. Circulation. 2012;125(8):975\u20137.","journal-title":"Circulation"},{"issue":"10","key":"3584_CR24","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1161\/01.CIR.100.10.1043","volume":"100","author":"TH Lee","year":"1999","unstructured":"Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043\u20139.","journal-title":"Circulation"},{"key":"3584_CR25","doi-asserted-by":"crossref","unstructured":"G\u00e9n\u00e9reux P, Pibarot P, Redfors B, et al. Staging classification of aortic stenosis based on the extent of cardiac\u00a0damage. Eur Heart J. 2017;38(45):3351\u20138.","DOI":"10.1093\/eurheartj\/ehx381"},{"key":"3584_CR26","doi-asserted-by":"crossref","unstructured":"Cignoni CB, Vuu SKM, Liu H, Clark JM, Watson CD, Ferber LR, et al. Increased mortality in hip fracture patients with aortic stenosis and pulmonary hypertension compared to aortic stenosis alone. Am Surg. 2021;00031348211054525.","DOI":"10.1177\/00031348211054525"},{"issue":"6","key":"3584_CR27","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1111\/imj.14168","volume":"49","author":"D Palamuthusingam","year":"2019","unstructured":"Palamuthusingam D, Johnson DW, Hawley CM, Pascoe E, Sivalingam P, Fahim M. Perioperative outcomes and risk assessment in dialysis patients: current knowledge and future directions. Intern Med J. 2019;49(6):702\u201310.","journal-title":"Intern Med J"},{"issue":"3","key":"3584_CR28","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1007\/s11886-012-0340-4","volume":"15","author":"A Briasoulis","year":"2013","unstructured":"Briasoulis A, Bakris GL. Chronic kidney disease as a coronary artery disease risk equivalent. Curr Cardiol Rep. 2013;15(3):340.","journal-title":"Curr Cardiol Rep"},{"issue":"5","key":"3584_CR29","doi-asserted-by":"publisher","first-page":"S165","DOI":"10.1097\/01.XCS.0000894264.92980.6f","volume":"235","author":"RS Zamanzadeh","year":"2022","unstructured":"Zamanzadeh RS, Aspang JS, Bonsu JM, Maceroli MA, Boissonneault A. Malnutrition is associated with 30-day postoperative complications and increased length of hospital stay in patients with surgically treated acetabular fractures. J Am Coll Surg. 2022;235(5):S165.","journal-title":"J Am Coll Surg."},{"issue":"2","key":"3584_CR30","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.jamcollsurg.2013.02.027","volume":"217","author":"ME Cohen","year":"2013","unstructured":"Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X, et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg. 2013;217(2):336-346.e1.","journal-title":"J Am Coll Surg"},{"issue":"4","key":"3584_CR31","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1161\/CIRCULATIONAHA.110.015701","volume":"124","author":"PK Gupta","year":"2011","unstructured":"Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381\u20137.","journal-title":"Circulation"},{"issue":"39","key":"3584_CR32","doi-asserted-by":"publisher","first-page":"3826","DOI":"10.1093\/eurheartj\/ehac270","volume":"43","author":"S Halvorsen","year":"2022","unstructured":"Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, et al. 2022 ESC guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery: developed by the task force for cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology (ESC) endorsed by the European Society of Anaesthesiology and Intensive Care (ESAIC). Eur Heart J. 2022;43(39):3826\u2013924.","journal-title":"Eur Heart J"},{"issue":"19","key":"3584_CR33","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1016\/j.jacc.2014.02.556","volume":"63","author":"JJ Popma","year":"2014","unstructured":"Popma JJ, Adams DH, Reardon MJ, Yakubov SJ, Kleiman NS, Heimansohn D, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol. 2014;63(19):1972\u201381.","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"3584_CR34","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1007\/s11739-021-02752-6","volume":"16","author":"C Rostagno","year":"2021","unstructured":"Rostagno C, Falchetti G, Rostagno AC, Mattesini A. TAVR in patients with hip fracture and severe aortic stenosis: how and when? Intern Emerg Med. 2021;16(6):1419\u201322.","journal-title":"Intern Emerg Med"},{"issue":"3","key":"3584_CR35","first-page":"483","volume":"87","author":"CG Moran","year":"2005","unstructured":"Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? JBJS. 2005;87(3):483.","journal-title":"JBJS"},{"issue":"20","key":"3584_CR36","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1001\/jama.2017.17606","volume":"318","author":"D Pincus","year":"2017","unstructured":"Pincus D, Ravi B, Wasserstein D, Huang A, Paterson JM, Nathens AB, et al. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA. 2017;318(20):1994\u20132003.","journal-title":"JAMA"},{"issue":"1","key":"3584_CR37","doi-asserted-by":"publisher","first-page":"13933","DOI":"10.1038\/s41598-018-32098-7","volume":"8","author":"T Klestil","year":"2018","unstructured":"Klestil T, R\u00f6der C, Stotter C, Winkler B, Nehrer S, Lutz M, et al. Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep. 2018;8(1):13933.","journal-title":"Sci Rep"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-023-03584-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-023-03584-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-023-03584-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:24:44Z","timestamp":1698971084000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-023-03584-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,3]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3584"],"URL":"https:\/\/doi.org\/10.1186\/s12872-023-03584-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3140228\/v1","asserted-by":"object"}]},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,3]]},"assertion":[{"value":"4 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 November 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"As this analysis was conducted on publicly available deidentified data, it was exempted from ethics committee approval.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Blood receives grant support from Novo Nordisk, Boehringer Ingelheim, and General Electric Healthcare and consulting income from Color Health and Walgreens Health, and equity in Knownwell Inc.  All other authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"535"}}