eprintid: 10190266 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/19/02/66 datestamp: 2024-04-08 15:13:02 lastmod: 2024-04-08 15:13:02 status_changed: 2024-04-08 15:13:02 type: article metadata_visibility: show sword_depositor: 699 creators_name: Pegram, C creators_name: Diaz-Ordaz, K creators_name: Brodbelt, DC creators_name: Chang, YM creators_name: von Hekkel, AF creators_name: Wu, CH creators_name: Church, DB creators_name: O'Neill, DG title: Target Trial Emulation: Does surgical versus non-surgical management of cranial cruciate ligament rupture in dogs cause different outcomes? ispublished: pub divisions: UCL divisions: B04 divisions: C06 divisions: F61 keywords: Causal inference, Cranial cruciate ligament, VetCompass, dog, electronic patient record, primary-care note: Copyright © 2024 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). abstract: Target trial emulation applies design principles from randomised controlled trials to the analysis of observational data for causal inference and is increasingly used within human epidemiology. Using anonymised veterinary clinical data from the VetCompass Programme, this study applied the target trial emulation framework to determine whether surgical (compared to non-surgical) management for cranial cruciate ligament (CCL) rupture in dogs causes improved short- and long-term lameness and analgesia outcomes. The emulated target trial included dogs diagnosed with CCL rupture between January 1, 2019 and December 31, 2019 within the VetCompass database. Inclusion in the emulated trial required dogs aged ≥ 1.5 and < 12 years, first diagnosed with unilateral CCL rupture during 2019 and with no prior history of contralateral ligament rupture or stifle surgery. Dogs were retrospectively observed to have surgical or non-surgical management. Informed from a directed acyclic graph derived from expert opinion, data on the following variables were collected: age, breed, bodyweight, neuter status, insurance status, non-orthopaedic comorbidities, orthopaedic comorbidities and veterinary group. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding, with weights calculated based on a binary logistic regression exposure model. Censored dogs were accounted for in the IPTW analysis using inverse probability of censoring weighting (IPCW). The IPCWs were combined with IPTWs and used to weight each dog's contribution to binary logistic regression outcome models. Standardized mean differences (SMD) examined the balance of covariate distribution between treatment groups. The emulated trial included 615 surgical CCL rupture cases and 200 non-surgical cases. The risk difference for short-term lameness in surgically managed cases (compared with non-surgically managed cases) was −25.7% (95% confidence interval (CI) −36.7% to −15.9%) and the risk difference for long-term lameness −31.7% (95% CI −37.9% to −18.1%). The study demonstrated the application of the target trial framework to veterinary observational data. The findings show that surgical management causes a reduction in short- and long-term lameness compared with non-surgical management in dogs. date: 2024-05 date_type: published publisher: Elsevier BV official_url: https://doi.org/10.1016/j.prevetmed.2024.106165 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2263873 doi: 10.1016/j.prevetmed.2024.106165 medium: Print-Electronic pii: S0167-5877(24)00051-5 lyricists_name: Diaz Ordaz, Karla lyricists_id: KDIAZ10 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner funding_acknowledgements: [Dogs Trust] full_text_status: public publication: Preventive Veterinary Medicine volume: 226 article_number: 106165 event_location: Netherlands issn: 0167-5877 citation: Pegram, C; Diaz-Ordaz, K; Brodbelt, DC; Chang, YM; von Hekkel, AF; Wu, CH; Church, DB; Pegram, C; Diaz-Ordaz, K; Brodbelt, DC; Chang, YM; von Hekkel, AF; Wu, CH; Church, DB; O'Neill, DG; - view fewer <#> (2024) Target Trial Emulation: Does surgical versus non-surgical management of cranial cruciate ligament rupture in dogs cause different outcomes? Preventive Veterinary Medicine , 226 , Article 106165. 10.1016/j.prevetmed.2024.106165 <https://doi.org/10.1016/j.prevetmed.2024.106165>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10190266/1/1-s2.0-S0167587724000515-main.pdf