United States

Background
After undergoing major surgery, 7-15% of patients experience postoperative complications, with a mortality rate of up to 5%. Since the total number of major surgeries continues to increase, improving postoperative outcomes has become a priority for advancing patient health and reducing medical costs. One method to reduce complications and length of hospital stay is by increasing preoperative cardiovascular fitness (CVF). Increased CVF may allow an individual to better tolerate other physical stresses, such as major surgery. This study aims to explore how preoperative CVF, self-reported by patients as the Exercise Vital Sign (EVS), relates to postoperative outcomes in patients undergoing mixed-major abdominal surgeries (ventral hernia repair, cholecystectomy, appendectomy, and colonic resection). It is hypothesized that patients who report higher levels of preoperative cardiovascular exercise will experience fewer postoperative complications compared to lower levels of reported preoperative cardiovascular exercise.

Methods
Data was gathered from 14254 de-identified patients who underwent major abdominal surgeries using data from a major hospital system. Exercise Vital Sign was evaluated at three thresholds: 0, 75, and 150 minutes of cardiovascular exercise per week. Postoperative outcomes, including complications (hematoma, abscess, infection, and internal bleeding), emergency department visits, critical care admissions, infusion therapy, and general health management, were identified via CPT codes. A multinomial logistic regression was performed. Comorbidities (cancer, diabetes, obesity, and hypertension) and length of stay were controlled for. 

Results
The results show a significant association between increased exercise and lower predicted probabilities of life-threatening CPT categories, particularly as weekly exercise increased from 0 to 75 minutes in patients with one or less comorbidities. Higher risk patients, those with multiple comorbidities, showed the greatest benefit as weekly exercise increased from 75 to 150 minutes per week with the risk of complication dropping from 0.11 at 75 minutes to nearly 0 at 150 minutes. All patient profiles showed a shift away from life-threatening care towards preventive care.

Conclusion
Modest levels of exercise were significantly associated with a sharp reduction in life-threatening postoperative outcomes across all patient profiles. Most patients benefitted by achieving 75 minutes of cardiovascular exercise per week; moreover, higher risk patients had additional benefits of achieving 150 minutes of cardiovascular exercise per week. Thus, preoperative exercise counseling could be an effective, low-cost intervention to reduce postoperative complications. Future policies could incentivize physical activity promotion as part of surgical quality improvement initiatives and integration of collecting exercise data in routine healthcare visits.


AMA Research Challenge 2025 

Understanding the Association between Preoperative Exercise Level and Post-Operative Outcomes of Mixed-Major Abdominal Surgery

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ISTRC 2021 - International Sarcopenia Translational Research Conference

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Background
Acinetobacter baumannii is an opportunistic nosocomial pathogen of concern due to its increasing pan-drug resistance and growing recognition in its involvement in necrotizing fasciitis (NF), a severe soft tissue infection with high morbidity if left untreated. Some NF associated strains of A. baumannii (NFAb) exhibit an ability to survive within human macrophages. However, the macrophage response to intracellular infection by these strains is not well understood. Understanding the macrophage transcriptional response to NFAb infection may help us uncover new immune evasion mechanisms and inform future therapies.

Methods
Human monocyte-derived THP-1 macrophages were infected with two NFAb strains (NFAb1 and NFAb2) or the reference strain ATCC 19606T at a MOI of 100. After 2 hours of infection and 2 hours of colistin protection assay, intracellular bacteria were quantified and total macrophage RNA was collected and subjected to RNA-sequencing (RNA-seq). Differential gene expression analysis was performed using the DESeq2 package in R and gene ontology analysis was used to evaluate enriched immune pathways.

Results
RNA-seq identified distinct transcriptional signatures in response to infection with NFAb strains compared to the reference strain. Pro-inflammatory genes like TNF, CCL4 and IL1B were upregulated in response to NFAb infection, indicating heightened immune activation. Genes related to immune regulation and signaling like CX3CR1 and GPRIN3 were downregulated across all strains. This may indicate disruption of communication pathways. Genes involved in microtubule associated proteins and intracellular trafficking were upregulated as well, suggesting a role for macrophage phagocytosis in intracellular bacterial infection.

Conclusion
This study sheds light on the transcriptional responses of human macrophages to A. baumannii infection, especially in the context of NF. Responses to NFAb strains were characterized by altered signaling regulation and increased inflammation, suggesting NFAb strains may survive intracellularly by triggering and modulating host immune pathways. Understanding of these mechanisms may provide us with novel targets for future therapeutic interventions against multidrug resistant A. baumannii infections.

Evaluation of Innate Immune Transcriptional Responses in the Context of Intracellular Infection by Necrotizing Fasciitis-associated Acinetobacter baumannii

Background
Immunotherapy has revolutionized cancer treatment, with FDA approvals and NCCN guidelines
incorporating immune checkpoint inhibitors across over 20 malignancies. Despite its growing
use and preference over chemotherapy, data on immunotherapy-related complications leading to
hospital readmissions remain limited. No large retrospective cohort study has yet addressed this
gap
Methods
We conducted a retrospective cohort study using the 2022 Nationwide Readmissions Database
(NRD). Index admissions involving inpatient immunotherapy were identified using ICD-10 code
Z51.12, and 90-day all-cause readmissions were tracked. Survey-weighted logistic, linear, and
Cox proportional hazards models were used to compare baseline characteristics and identify
predictors of 90-day readmission
Results
A total of 2,394 weighted admissions met criteria as index immunotherapy admissions, with a
90-day readmission rate of 41.06% (95% CI: 36.7–47.2%). There were 983 weighted 90-day
readmissions. Mean index LOS was 10.1 days, with a cumulative LOS of 24,222 days. The
average total hospital charge for index admissions was $692,011, and the mean cost was
$161,506, yielding a total cost burden of ~$379 million. Among readmitted patients (n ≈ 961
weighted), mean LOS was 8.7 days (8,510 total days), with a mean cost of $114,195 and
cumulative cost burden of ~$110 million.
© 2025 American Medical Association. All rights reserved.
Primary payer distribution differed between groups (p = 0.0002): Medicare was most common
among index admissions (51.7%), while Medicaid was more prevalent in readmissions (16.1%
vs. 7.1%). Most care occurred in urban teaching hospitals (95.3% vs. 98.0%). Discharge
disposition varied slightly (p = 0.047), with most patients discharged home; transfers and home
health use were more common in readmissions.Multivariable Cox regression identified the
following significant predictors of 90-day readmission: younger age (HR=0.983, p=0.000), self-
pay status (HR=2.82), Addison’s disease (HR=4.58), hyperthyroidism (HR=5.59), Crohn’s
disease (HR=7.13), COPD (HR=2.00), and others.Top non-cancer, non-chemotherapy
readmission diagnoses included neutropenia (79.1), sepsis (55.1), immune effector therapy
complications (32.5), COVID-19 (32.1), infusion complications (23.4), anemia of chronic
disease (21.8), ABO incompatibility (10.4), AKI (9.0), transplant complications (8.6), and
bacteremia (8.4)
Conclusion
Inpatient immunotherapy is associated with a high 90-day readmission rate and substantial
healthcare costs. Readmission risk is influenced by insurance type and specific comorbidities,
offering targets for intervention to reduce preventable hospitalizations in this expanding
population

Healthcare Utilization and Predictors of Readmission After Immunotherapy in a National Cohort


Background:
Pulsed-field ablation (PFA) for atrial fibrillation (AF) offers several advantages compared to thermal ablation, however direct comparisons of patient-reported outcomes after PFA and radiofrequency ablation (RFA) are limited. This study aimed to assess patient experience following PFA or RFA in AF ablation performed under general anesthesia.

Methods:
A retrospective study across a single integrated health system was conducted on consecutive patients who underwent PFA or RFA for AF under general anesthesia from March 2024-December 2024. Data were collected from electronic medical records. Primary endpoints included postprocedural pain complaints and scores, need for post-procedure analgesic medication, and frequency of emergency department (ED) visits for procedure-related concerns.

Results:
Two hundred patients (100 PFA and 100 RFA) were analyzed (age 73.2 ±9.2y, 38% female). Patients undergoing RFA had a significantly higher rate of ED visits compared to those who underwent PFA (17% vs. 6%, p <.05). The most common complaints prompting RFA ED visits were shortness of breath (29% of RFA ED visits), palpitations (23% of RFA ED visits), dizziness (18% of RFA ED visits), and other (30% of RFA ED visits). There were no statistically significant differences in postprocedural pain scores (RFA 1.70 vs. PFA 1.57, p = 0.61), requests for analgesic medications in the recovery area (RFA 36% vs. PFA 27%, p = 0.26), nor encounters made to the care team within 4 weeks following the procedure (RFA 57% vs. PFA 44%, p = 0.20).

Conclusion:
In this retrospective study, patients undergoing PFA for AF under general anesthesia experienced fewer ED visits for procedure-related issues compared to those undergoing RFA. While these clinical endpoints potentially suggest improved procedural recovery with PFA compared to RFA, larger prospective studies using patient-reported outcome measures are warranted.

Patient Experience Following Pulsed Field Ablation Compared to Radiofrequency Ablation for Atrial Fibrillation

Impact of Treatment Modality on Local Recurrence for Immunosuppressed Patients with cSCC

Background
Prior literature has established that the immune system plays a significant role in the
development and progression of non-melanoma skin cancers (NMSC), with studies
demonstrating that immunosuppressed patients experience increased rates of local tumor recurrence, tumor metastasis, and mortality post-treatment of cutaneous squamous cell carcinoma (cSCC) compared to non-immunosuppressed patients. The worsened clinical outcomes in immunocompromised patients with cSCC necessitates further investigation into optimal treatment approaches for this population to reduce tumor morbidity and mortality. For this project, we evaluated the impact of host immunosuppression on clinical outcomes for patients with cSCC undergoing electrodessication and curettage (EDC), Mohs micrographic surgery (Mohs), and wide local excision (WLE).

Methods
We studied a retrospective cohort (n=1693) to assess differences in two-year local recurrence (LR) risk. Within the group, 163 (9.6%) were immunocompromised. Tumors (n = 2322) included 288 (12.4%) from immunosuppressed patients, 972 (41.8%) on the head, 1337 (57.6%) welldifferentiated, and 28 (1.2%) with perineural invasion. Most tumors were treated with EDC (1121, 48.3%), followed by Mohs (667, 28.7%), and WLE (534, 23.0%). Multivariable Fine and Gray sub distribution hazard regression models were used to compare local recurrence by immunosuppression status and treatment type, adjusted for high-risk tumor locations, perineural invasion, sex, age, tumor diameter, keratoacanthoma status, and tumor differentiation.

Results
Immunosuppressed patients had higher LR compared to immunocompetent controls with 3% recurrence in immunocompetent patients and 9% recurrence in the immunosuppressed cohort. For immunocompetent patients, Mohs treatment resulted in 1% LR, WLE in 3%, and EDC in 4%. For immunocompromised patients, Mohs treatment resulted in 7% LR, WLE in 6%, and EDC in 11%. Of note, the subgroup analysis for LR following WLE in immunosuppressed patients was the only group to not be statistically significant.

Conclusion
Given the higher likelihood of tumor recurrence among the immunosuppressed population, investigation into optimal treatment strategy to reduce such risk is important. Odds of tumor recurrence, after adjusting for baseline differences in tumor and patient factors, indicate Mohs and WLE may be effective treatment options for immunosuppressed patients with cutaneous squamous cell carcinoma while suggesting that EDC may not be an appropriate treatment modality.

Impact of Treatment Modality on Local Recurrence for Immunosuppressed Patients with cSCC

Abstract Title
Improving Chronic Pain Management among Older Adults through Primary Care Innovation – A Patient-Centered Goal Approach 
Background
Opioid-related deaths among Oklahomans aged 65 and older increased by 61%, from 7.4 to 11.9 deaths per 100,000 between 2017-2019 and 2020-2022. To improve non-cancer chronic pain and opioid management among older adults, the Oklahoma Primary Healthcare Improvement Cooperative implemented a multi-faceted, person-centered, scalable chronic pain management program in 31 Oklahoma primary care practices from January 2022 to September 2023, using a 3-stage, modified stepped-wedge design (Reducing Inappropriate Opioid Use in Seniors in Oklahoma (RISE-OK) Study). As part of the quality improvement intervention, participants set personalized goals related to chronic pain management, and goal achievement was measured as a secondary outcome. This study aimed to assess how effectively older adults involved in a primary care–based intervention achieve their personalized pain management goals to improve chronic pain and reduce opioid use.
Methods
Of the 270 enrolled participants (≥ 60 years), 267 set goals for pain management. Participants were asked how chronic pain impacted their daily lives and what they hoped to achieve with pain management. Participants also identified barriers to achieving their goals and created action plans to address these barriers. Two investigators independently qualitatively coded participant goals, barriers, and action plans, categorizing them into themes; any differences in coding were resolved through group consensus. Most participants rated their goal attainment between 3 and 12 months, depending on their wave, using a 3-category scale.
Results
Participants had an average age of 70 years, were 62% female, and 81% white, non-Hispanic. Most primary care practices (57%) were small, with 1-5 clinicians, and located in rural communities (53%). Participant goals prioritized physical activity (36%), obtaining a specific health care service (12%), doing recreational activities (e.g., travel, hobbies, attending events) (12%), controlling other symptoms (e.g., fatigue, constipation, insomnia) (9%), and reducing medications (7%). Other goals included performing self-care activities (6%), continuing to work (5%), and socializing with family/friends (3%). 24% of participants attained their goals as expected, 22% attained their goals better than expected, and 53% did not attain their goals.
Conclusion
Older adults set diverse personalized goals for chronic pain management, prioritized mobility and meaningful life activities, and nearly half met their goals. Implementing patient-centered goal setting in chronic pain care encourages clinicians to align treatment recommendations with what matters most to patients, potentially improving adherence to care and functional and quality of life outcomes for older adults with chronic pain.




Improving Chronic Pain Management among Older Adults through Primary Care Innovation – A Patient-Centered Goal Approach


Background
This study examines the extent to which preoperative osteoporosis predicts dysphagia after cervical spine surgery. Osteoporosis has been associated with increased surgical risk and poorer outcomes in spine procedures, but its relationship with postoperative swallowing difficulties remains underexplored.

Methods
A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical surgery were categorized based on preoperative osteoporosis, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Mixed-effects logistic regressions were performed to assess the impact of preoperative osteoporosis on the incidence of dysphagia.

Results
Of the 2,001 patients that met inclusion criteria, 110 (5.5%) reported preoperative osteoporosis. Patients experiencing preoperative osteoporosis demonstrated a higher incidence of dysphagia at baseline (29% vs. 15%, p<0.001), 1 month (69% vs. 55%, p=0.032), and 12 months follow up (38% vs. 25%, p=0.014) but not at 3 months follow up (30% vs. 29%, p=0.7). Additionally, patients with preoperative osteoporosis experienced significantly more severe dysphagia at baseline (3.864 ± 7.422 vs. 1.678 ± 4.875, p=<0.001), 1 month (8.516 ± 8.602 vs. 6.246 ± 7.682, p=0.032), and 12 months (4.338 ± 7.296 vs. 2.537 ± 5.061, p=0.014). Further stratification revealed that preoperative osteoporosis did not impact incidence of dysphasia in patients without baseline dysphasia at 1 month (p=0.2), 3 months (p>0.9), or 12 months (p=0.14). Multivariable analyses with baseline dysphagia as a fixed effect demonstrated that osteoporosis is not an independent predictor of postoperative dysphagia at 1 month (OR=1.58, p=0.2), 3 months (OR=0.61, p=0.095), or 12 months (OR=1.05, p=0.9). Exclusion of the patient subset with baseline dysphasia reflected similar results in post-hoc multivariable analyses.

Conclusion
While patients with osteoporosis have higher rates of postoperative dysphagia at baseline, 1-month, and 12-month follow-up, preoperative osteoporosis did not independently predict dysphasia following cervical surgery. The increased rate of postoperative dysphagia in patients with preoperative osteoporosis may be attributed to comorbid conditions (coronary artery disease, chronic pulmonary disease, etc.) more prevalent in osteoporosis patients. Neurosurgeons may benefit from knowing this information to guide preoperative patient decision-making to undergo surgery in patients with osteoporosis.


The Impact of Preoperative Osteoporosis on Postoperative Dysphagia Following Cervical Spine Surgery

Background
Degenerative Vitreous Syndrome (DVS) is a well-documented, age-related condition characterized by vitreous liquefaction and collagen aggregation, leading to the development of symptomatic floaters that project shadows onto the retina and cause dynamic entoptic disturbances. Although Snellen visual acuity is typically preserved, an increasing body of evidence indicates that floaters, especially when central, can significantly impair functional vision. Despite this, DVS is often dismissed as benign and untreatable, even though OCT and ultrasound demonstrate posterior vitreous opacities. While observation and YAG vitreolysis are options, pars plana vitrectomy (PPV) is a definitive method for floater removal. Advances in small-gauge vitrectomy has resulted in improved safety profiles and shorter recovery times. Still, data on outcomes and patient satisfaction remains sparse. This study evaluates the safety, efficacy, and patient-reported results of small-gauge PPV for symptomatic DVS.
Methods
We conducted a retrospective case series involving 53 eyes treated with 25-gauge PPV by the same vitreoretinal surgeon. By design, the study focused on evaluating surgical outcomes in patients selected based on functional impairment attributable to vitreoretinal pathology. All procedures employed high-speed vitrectomy, triamcinolone-assisted vitreous visualization, complete posterior vitreous removal, and fluid-air exchange to optimize vitreous clearance and reduce residual collagen debris. Preoperative counseling emphasized the risks, benefits, and shared decision-making. Postoperative outcomes included anatomic assessments, complication tracking, and structured interviews regarding visual improvement and satisfaction.
Results
Among the 53 eyes treated, 91% (48/53) had preoperative posterior vitreous detachment (PVD), with the remainder undergoing intraoperative induction. Fifteen percent (8/53) of cases were combined with cataract extraction and intraocular lens implantation. No cases of retinal tear, detachment, endophthalmitis, or hypotony occurred. Postoperative epiretinal membranes (ERM) developed in 5.6% (3/53) of eyes, two of which required surgical peeling. Mean follow-up was 4.8 months. At final evaluation, 98.2% (52/53) of patients reported complete resolution of floaters; one patient noted a mild residual floater. Patient satisfaction was consistently high, with many describing restored “continuously clear vision” and expressing interest in surgery for the fellow eye.
Conclusion
Small-gauge vitrectomy is a safe and highly effective intervention for patients suffering from symptomatic floaters due to DVS. With careful surgical technique, patient-centered evaluation, and shared decision-making, PPV can offer dramatic improvements in visual function with minimal risk. These findings challenge traditional clinical reluctance to offer vitrectomy for floaters and underscore the need for more comprehensive assessment tools to better capture the true impact of DVS on patients and guide appropriate treatment options.


Evidence on the Safety, Efficacy, and Patient Satisfaction of Pars Plana Vitrectomy for Symptomatic Floaters in Degenerative Vitreous Syndrome


Abstract Title: Barriers to Breast Cancer Screening Adherence Among African American Women in Michigan 
Author’s: Miranda Goodson B.S., Whitney Bowyer B.S., Anna Lundh B.S., Dr. Laura Benjamins M.D. 

Background 
African American (AA) women have lower adherence to breast cancer screening guidelines, which may contribute to delayed diagnoses and reduced survival rates. The importance of examining studies focused on the experiences of Black women within urban healthcare networks is essential to understanding the links between demographics, socioeconomic status (SES), and breast cancer outcomes. 

Methods 
A systematic literature search was conducted using Ovid Medline. The search string included terms such as “Black or African American,” “Breast Neoplasms,” and “Treatment Outcomes.” Inclusion criteria for the articles focused on studies published from 2014 to 2024 and included cohort studies, case-control studies, and other observational studies. The search yielded 24 articles which were reviewed and assessed for racial disparities and treatment outcomes within this population. 

Results 
Six articles reviewed the prevalence of triple-negative breast cancer, finding that AA women are affected at higher rates. Five articles highlighted SES disadvantages leading to worse health outcomes by limiting access to preventative care services and delaying diagnosis. The historical discrimination of AA patients in healthcare has also fostered hesitation towards seeking these services. Differences in lived experiences contributed largely to lower-quality care. Five studies examined implicit bias and mistrust in the physician-patient relationship, contributing to a compounded delay in diagnosis. The studies reported that physicians with high implicit bias often conducted shorter visits and were less engaged with AA patients. This can extend to decisions regarding preventative care, leading to fewer referrals for genetic and critical screenings compared to other patients. 

Conclusion 
This initial review highlighted how health disparities impact breast cancer screening, treatment and survival rates among Black women. In the next research phase, the attitudes toward mammogram screening will be explored by directly surveying patients. 



Barriers to Breast Cancer Screening Adherence Among African American Women in Michigan

Asthma is a chronic respiratory condition characterized by difficulty breathing, wheezing, and coughing. According to the United States Centers for Disease Control and Prevention (CDC), around 6 million children in the US have asthma. The asthma hospitalization rate for pediatric patients has been shown to be significantly higher in certain racial/ethnic groups. Socio-environmental factors play a role in the perpetuation of healthcare disparities and inequities across racial groups. Despite global clinical advances in asthma management and exacerbation prevention, asthma disproportionately affects Black and Hispanic/Latino children as compared to their White peers. This study aimed to examine racial and ethnic disparities in pediatric asthma hospital admissions and readmissions

We conducted a retrospective analysis using electronic medical record data from Loma Linda University Children’s Hospital (LLUCH). Variables examined included admission and discharge dates, date of birth, sex, and race/ethnicity. The target population was pediatric patients admitted to LLUCH in 2023 with a diagnosis of moderate persistent or severe persistent asthma. Patients were assigned to one of three racial/ethnic groups: Black, White, or Latino. Outcome variables were (1) asthma hospital admissions and (2) asthma readmissions. We conducted statistical analysis by calculating summary statistics and examining differences across racial/ethnic groups using chi-square analysis.

Out of 140 total admissions, 40 were Black, 80 were Latino, and 20 were White. When comparing the proportion of admissions to the expected proportion based on regional demographics, pairwise chi-square analyses revealed significantly higher asthma admission rates among Black children compared to White and Latino children (p < 0.01), and among Latino children compared to White children (p < 0.01). There was also a significantly higher asthma readmission rate among Black children compared to White children (p = 0.03), and among Latino children compared to White children (p = 0.05), with no significant difference between Black and Latino children (p = 0.32)

This study demonstrated continued disparities in pediatric asthma care. Our findings demonstrate that Black and Latino children have significantly more asthma admissions and readmissions as compared to White children. Speculative reasoning for why these racial/ethnic inequities exist include provider biases and limited geographical access to providers for follow-up. Limitations of this study include the small sample size within a single hospital system and that chance of misclassification of race/ethnicity, both of which could introduce bias into the results. Future steps include a QI project to promote asthma follow-up of Black and Latino patients with primary care providers and/or specialists 


Breathless Disparities: Exploring Racial Differences in Pediatric Asthma Admissions

Title
Comparative Effects of Statins and Fibrates on the Onset of Diabetic Retinopathy in Type 2 Diabetes

Background
Diabetic retinopathy (DR) is a common complication of type 2 diabetes mellitus (T2DM) and a leading cause of vision loss in working-age adults. Management often requires invasive, costly procedures to preserve vision and while lipid-lowering drugs (LLDs), particularly statins and fibrates, have shown promise in slowing DR progression, their role in disease onset remains unclear. This study evaluated the association between statin or fibrate therapy and DR onset to assess their prophylactic potential. 
Methods
This retrospective cohort study used de-identified electronic health records from 152 healthcare organizations via the TriNetX Global Network. Patients with T2DM and no prior ocular complications, diagnosed at least 10 years prior, were assigned to fibrate-only (n = 7,004) or statin-only (n = 463,588) cohorts. Drug exposure required two records: one within 6 months and one at least 1 year after diagnosis. After propensity score matching on demographic characteristics, retinal vascular and non-diabetic retinopathy conditions, and serum HDL, LDL, triglycerides, and HbA1c, each cohort included 6,691 patients. Outcomes included diagnosis of nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), or need for antiVEGF injections or retinal laser. Patients with outcomes prior to cohort entry were excluded.

Results
Fibrate therapy was associated with lower risk of DR across all stages: 55.1% reduction in mild NPDR (RR = 0.449; 95% CI: 0.359, 0.561; p < 0.001), 68.7% in moderate (RR = 0.313; 95% CI: 0.202, 0.486; p < 0.001), 65.3% in severe (RR = 0.357; 95% CI: 0.174, 0.735; p < 0.004), and 67.6% in PDR (RR = 0.324; 95% CI: 0.203, 0.517; p < 0.001). Onset was also delayed: mild (log-rank x2 = 25.238; p < 0.001), moderate (log-rank x2 = 17.419; p < 0.001), severe (log-rank x2 = 5.140; p < 0.024), and PDR (log-rank x2 = 15.125; p < 0.001).
Fibrate users had a 66.7% reduced risk of retinal laser (RR = 0.333; 95% CI: 0.212, 0.524; p < 0.001) and longer time-to-event (log-rank x2 = 14.372; p < 0.001). No difference was found in antiVEGF injection risk. 

Conclusion
Fibrate therapy was associated with reduced risk and delayed onset of DR in patients with T2DM compared to statin therapy. These findings support a potential role for fibrates in DR prophylaxis.


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