Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients
We hypothesized that cholecystectomy may be riskier for kidney transplant recipients (KTR) given their lifelong immunosuppression, physiologic impact of renal failure, and increased risk of gallstone and biliary disease. Using NIS, we compared mortality, morbidity, length of stay and cost in KTR vs...
Gespeichert in:
| Veröffentlicht in: | The American journal of surgery 2018-10, Vol.216 (4), p.694-698 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 698 |
|---|---|
| container_issue | 4 |
| container_start_page | 694 |
| container_title | The American journal of surgery |
| container_volume | 216 |
| creator | DiBrito, Sandra R. Haugen, Christine E. Holscher, Courtenay M. Olorundare, Israel O. Alimi, Yewande Segev, Dorry L. Garonzik-Wang, Jacqueline |
| description | We hypothesized that cholecystectomy may be riskier for kidney transplant recipients (KTR) given their lifelong immunosuppression, physiologic impact of renal failure, and increased risk of gallstone and biliary disease. Using NIS, we compared mortality, morbidity, length of stay and cost in KTR vs non-KTR following cholecystectomy in the US from 2000 to 2011, adjusting for patient and hospital level factors, including transplant center status. Mortality was higher (OR 2.4), morbidity was higher (OR 1.3), LOS was longer (ratio 1.2), and costs were greater (ratio 1.1) for KTR compared to non-KTR following cholecystectomy. While it is clear that KTR are a high risk group following cholecystectomy, the cause of this increased risk requires further investigation.
•Kidney transplant recipients have higher post-cholecystectomy mortality and morbidity.•Length of stay after cholecystectomy is longer for kidney transplant recipients.•Cost of cholecystectomy is greater for kidney transplant recipients.•Post-cholecystectomy outcomes for KTR are similar regardless of location of care. |
| doi_str_mv | 10.1016/j.amjsurg.2018.07.023 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6177305</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002961018300266</els_id><sourcerecordid>2081542410</sourcerecordid><originalsourceid>FETCH-LOGICAL-c495t-a11da597b82afc1679f0f79db28ef5c1bc4a19854c391a215caab01e154910533</originalsourceid><addsrcrecordid>eNqFUcGO0zAUtBCILYVPAEXiwmFT3rOTOLmAUMUC0kpc4MLFchyndUjsYDsr5e9x1e4KuHCybM-beTNDyEuEHQJWb4ednIaw-MOOAtY74Dug7BHZYM2bHOuaPSYbAKB5UyFckWchDOmKWLCn5IoBVAWnxYb82LtpHo2S0TgbrrNR20M8Zq7PQpTrdSZtlykX4ulFHd2o1RqiVtFNa2Zs9tN0Vq9Z9NKGeZQ2Zl4rMxttY3hOnvRyDPrF5dyS7zcfv-0_57dfP33Zf7jNVdGUMZeInSwb3tZU9gor3vTQ86Zraa37UmGrColNXRaKNSgplkrKFlBjWTQIJWNb8u7MOy_tpDuVtL0cxezNJP0qnDTi7x9rjuLg7kSFnLPEsCVvLgTe_Vp0iGIyQekx-dFuCYJCncRogZCgr_-BDm7xNtkTFLFivGZw2qg8o5R3IXjdPyyDIE7tiUFc2hOn9gRwkdpLc6_-dPIwdV9XArw_A3TK885oL4JKWSvdmZR7FJ0z_5H4Da4ar5s</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2116378303</pqid></control><display><type>article</type><title>Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><source>ProQuest Central UK/Ireland</source><creator>DiBrito, Sandra R. ; Haugen, Christine E. ; Holscher, Courtenay M. ; Olorundare, Israel O. ; Alimi, Yewande ; Segev, Dorry L. ; Garonzik-Wang, Jacqueline</creator><creatorcontrib>DiBrito, Sandra R. ; Haugen, Christine E. ; Holscher, Courtenay M. ; Olorundare, Israel O. ; Alimi, Yewande ; Segev, Dorry L. ; Garonzik-Wang, Jacqueline</creatorcontrib><description>We hypothesized that cholecystectomy may be riskier for kidney transplant recipients (KTR) given their lifelong immunosuppression, physiologic impact of renal failure, and increased risk of gallstone and biliary disease. Using NIS, we compared mortality, morbidity, length of stay and cost in KTR vs non-KTR following cholecystectomy in the US from 2000 to 2011, adjusting for patient and hospital level factors, including transplant center status. Mortality was higher (OR 2.4), morbidity was higher (OR 1.3), LOS was longer (ratio 1.2), and costs were greater (ratio 1.1) for KTR compared to non-KTR following cholecystectomy. While it is clear that KTR are a high risk group following cholecystectomy, the cause of this increased risk requires further investigation.
•Kidney transplant recipients have higher post-cholecystectomy mortality and morbidity.•Length of stay after cholecystectomy is longer for kidney transplant recipients.•Cost of cholecystectomy is greater for kidney transplant recipients.•Post-cholecystectomy outcomes for KTR are similar regardless of location of care.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2018.07.023</identifier><identifier>PMID: 30064724</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; African Americans ; Aged ; Calculi ; Case-Control Studies ; Cholecystectomy ; Cholecystectomy - economics ; Cholecystectomy - mortality ; Codes ; Comorbidity ; Complications ; Cross-Sectional Studies ; Databases, Factual ; Demographics ; Female ; General surgery ; Health risk assessment ; Health risks ; Hospital Costs - statistics & numerical data ; Hospital Mortality ; Hospitals ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney transplants ; Laparoscopy ; Length of Stay - economics ; Length of Stay - statistics & numerical data ; Linear Models ; Male ; Middle Aged ; Morbidity ; Mortality ; Multivariate Analysis ; Outcome Assessment (Health Care) ; Patients ; Postoperative Complications - economics ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Renal failure ; Risk ; Risk Factors ; Statistical analysis ; Studies ; Surgeons ; Surgery ; Transplants & implants ; United States</subject><ispartof>The American journal of surgery, 2018-10, Vol.216 (4), p.694-698</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Oct 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-a11da597b82afc1679f0f79db28ef5c1bc4a19854c391a215caab01e154910533</citedby><cites>FETCH-LOGICAL-c495t-a11da597b82afc1679f0f79db28ef5c1bc4a19854c391a215caab01e154910533</cites><orcidid>0000-0001-5884-2604 ; 0000-0003-4252-7065</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2116378303?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30064724$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DiBrito, Sandra R.</creatorcontrib><creatorcontrib>Haugen, Christine E.</creatorcontrib><creatorcontrib>Holscher, Courtenay M.</creatorcontrib><creatorcontrib>Olorundare, Israel O.</creatorcontrib><creatorcontrib>Alimi, Yewande</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Garonzik-Wang, Jacqueline</creatorcontrib><title>Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>We hypothesized that cholecystectomy may be riskier for kidney transplant recipients (KTR) given their lifelong immunosuppression, physiologic impact of renal failure, and increased risk of gallstone and biliary disease. Using NIS, we compared mortality, morbidity, length of stay and cost in KTR vs non-KTR following cholecystectomy in the US from 2000 to 2011, adjusting for patient and hospital level factors, including transplant center status. Mortality was higher (OR 2.4), morbidity was higher (OR 1.3), LOS was longer (ratio 1.2), and costs were greater (ratio 1.1) for KTR compared to non-KTR following cholecystectomy. While it is clear that KTR are a high risk group following cholecystectomy, the cause of this increased risk requires further investigation.
•Kidney transplant recipients have higher post-cholecystectomy mortality and morbidity.•Length of stay after cholecystectomy is longer for kidney transplant recipients.•Cost of cholecystectomy is greater for kidney transplant recipients.•Post-cholecystectomy outcomes for KTR are similar regardless of location of care.</description><subject>Adult</subject><subject>African Americans</subject><subject>Aged</subject><subject>Calculi</subject><subject>Case-Control Studies</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy - economics</subject><subject>Cholecystectomy - mortality</subject><subject>Codes</subject><subject>Comorbidity</subject><subject>Complications</subject><subject>Cross-Sectional Studies</subject><subject>Databases, Factual</subject><subject>Demographics</subject><subject>Female</subject><subject>General surgery</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Hospital Costs - statistics & numerical data</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Kidney Transplantation</subject><subject>Kidney transplants</subject><subject>Laparoscopy</subject><subject>Length of Stay - economics</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Linear Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patients</subject><subject>Postoperative Complications - economics</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Renal failure</subject><subject>Risk</subject><subject>Risk Factors</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Transplants & implants</subject><subject>United States</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFUcGO0zAUtBCILYVPAEXiwmFT3rOTOLmAUMUC0kpc4MLFchyndUjsYDsr5e9x1e4KuHCybM-beTNDyEuEHQJWb4ednIaw-MOOAtY74Dug7BHZYM2bHOuaPSYbAKB5UyFckWchDOmKWLCn5IoBVAWnxYb82LtpHo2S0TgbrrNR20M8Zq7PQpTrdSZtlykX4ulFHd2o1RqiVtFNa2Zs9tN0Vq9Z9NKGeZQ2Zl4rMxttY3hOnvRyDPrF5dyS7zcfv-0_57dfP33Zf7jNVdGUMZeInSwb3tZU9gor3vTQ86Zraa37UmGrColNXRaKNSgplkrKFlBjWTQIJWNb8u7MOy_tpDuVtL0cxezNJP0qnDTi7x9rjuLg7kSFnLPEsCVvLgTe_Vp0iGIyQekx-dFuCYJCncRogZCgr_-BDm7xNtkTFLFivGZw2qg8o5R3IXjdPyyDIE7tiUFc2hOn9gRwkdpLc6_-dPIwdV9XArw_A3TK885oL4JKWSvdmZR7FJ0z_5H4Da4ar5s</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>DiBrito, Sandra R.</creator><creator>Haugen, Christine E.</creator><creator>Holscher, Courtenay M.</creator><creator>Olorundare, Israel O.</creator><creator>Alimi, Yewande</creator><creator>Segev, Dorry L.</creator><creator>Garonzik-Wang, Jacqueline</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5884-2604</orcidid><orcidid>https://orcid.org/0000-0003-4252-7065</orcidid></search><sort><creationdate>20181001</creationdate><title>Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients</title><author>DiBrito, Sandra R. ; Haugen, Christine E. ; Holscher, Courtenay M. ; Olorundare, Israel O. ; Alimi, Yewande ; Segev, Dorry L. ; Garonzik-Wang, Jacqueline</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-a11da597b82afc1679f0f79db28ef5c1bc4a19854c391a215caab01e154910533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>African Americans</topic><topic>Aged</topic><topic>Calculi</topic><topic>Case-Control Studies</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy - economics</topic><topic>Cholecystectomy - mortality</topic><topic>Codes</topic><topic>Comorbidity</topic><topic>Complications</topic><topic>Cross-Sectional Studies</topic><topic>Databases, Factual</topic><topic>Demographics</topic><topic>Female</topic><topic>General surgery</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Hospital Costs - statistics & numerical data</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Kidney Transplantation</topic><topic>Kidney transplants</topic><topic>Laparoscopy</topic><topic>Length of Stay - economics</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Linear Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Outcome Assessment (Health Care)</topic><topic>Patients</topic><topic>Postoperative Complications - economics</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Renal failure</topic><topic>Risk</topic><topic>Risk Factors</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Transplants & implants</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DiBrito, Sandra R.</creatorcontrib><creatorcontrib>Haugen, Christine E.</creatorcontrib><creatorcontrib>Holscher, Courtenay M.</creatorcontrib><creatorcontrib>Olorundare, Israel O.</creatorcontrib><creatorcontrib>Alimi, Yewande</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Garonzik-Wang, Jacqueline</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DiBrito, Sandra R.</au><au>Haugen, Christine E.</au><au>Holscher, Courtenay M.</au><au>Olorundare, Israel O.</au><au>Alimi, Yewande</au><au>Segev, Dorry L.</au><au>Garonzik-Wang, Jacqueline</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>216</volume><issue>4</issue><spage>694</spage><epage>698</epage><pages>694-698</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>We hypothesized that cholecystectomy may be riskier for kidney transplant recipients (KTR) given their lifelong immunosuppression, physiologic impact of renal failure, and increased risk of gallstone and biliary disease. Using NIS, we compared mortality, morbidity, length of stay and cost in KTR vs non-KTR following cholecystectomy in the US from 2000 to 2011, adjusting for patient and hospital level factors, including transplant center status. Mortality was higher (OR 2.4), morbidity was higher (OR 1.3), LOS was longer (ratio 1.2), and costs were greater (ratio 1.1) for KTR compared to non-KTR following cholecystectomy. While it is clear that KTR are a high risk group following cholecystectomy, the cause of this increased risk requires further investigation.
•Kidney transplant recipients have higher post-cholecystectomy mortality and morbidity.•Length of stay after cholecystectomy is longer for kidney transplant recipients.•Cost of cholecystectomy is greater for kidney transplant recipients.•Post-cholecystectomy outcomes for KTR are similar regardless of location of care.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30064724</pmid><doi>10.1016/j.amjsurg.2018.07.023</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0001-5884-2604</orcidid><orcidid>https://orcid.org/0000-0003-4252-7065</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9610 |
| ispartof | The American journal of surgery, 2018-10, Vol.216 (4), p.694-698 |
| issn | 0002-9610 1879-1883 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6177305 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Adult African Americans Aged Calculi Case-Control Studies Cholecystectomy Cholecystectomy - economics Cholecystectomy - mortality Codes Comorbidity Complications Cross-Sectional Studies Databases, Factual Demographics Female General surgery Health risk assessment Health risks Hospital Costs - statistics & numerical data Hospital Mortality Hospitals Humans Immunosuppression Kidney Transplantation Kidney transplants Laparoscopy Length of Stay - economics Length of Stay - statistics & numerical data Linear Models Male Middle Aged Morbidity Mortality Multivariate Analysis Outcome Assessment (Health Care) Patients Postoperative Complications - economics Postoperative Complications - epidemiology Postoperative Complications - etiology Renal failure Risk Risk Factors Statistical analysis Studies Surgeons Surgery Transplants & implants United States |
| title | Complications, length of stay, and cost of cholecystectomy in kidney transplant recipients |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T00%3A05%3A29IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Complications,%20length%20of%20stay,%20and%20cost%20of%20cholecystectomy%20in%20kidney%20transplant%20recipients&rft.jtitle=The%20American%20journal%20of%20surgery&rft.au=DiBrito,%20Sandra%20R.&rft.date=2018-10-01&rft.volume=216&rft.issue=4&rft.spage=694&rft.epage=698&rft.pages=694-698&rft.issn=0002-9610&rft.eissn=1879-1883&rft_id=info:doi/10.1016/j.amjsurg.2018.07.023&rft_dat=%3Cproquest_pubme%3E2081542410%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2116378303&rft_id=info:pmid/30064724&rft_els_id=S0002961018300266&rfr_iscdi=true |