Academic Teaching Center Research Articles

Enhanced Total Hip Arthroplasty Education Using Augmented Reality: A Survey From a Tertiary Center.

For total hip arthroplasty (THA), a new technology in the evolution of computer-assisted surgery has emerged in the form of augmented reality (AR). We sought to determine the impact of AR on resident and fellow education after implementation at an academic teaching center. The senior author's intraoperative technique allows for the orthopedic trainee to use AR to correct the acetabular component's position after an attempt is made with standard instrumentation. One year after the implementation of this AR method, both resident and fellow trainees were issued an anonymous survey regarding their experience and descriptive statistics were calculated for the results. Sixteen trainees responded to the survey. One hundred percent felt the use of AR improved their understanding of acetabular component placement and improved their intraoperative experience. Sixty-nine percent reported feeling there was a small increase in operative time but 25% reported no increase in operative time when using AR. Seventy-five percent of trainees felt that patients benefited from the technology and would be in favor of AR if they were having a THA. The majority of those surveyed reported a desire to use AR in their practice if it is available. Computer-assisted surgery has demonstrated variable impacts on orthopedic education. After the implementation of AR at an academic teaching center, all trainees reported it improved their intraoperative experience and their understanding of acetabular component placement. Further studies are needed to determine if AR is able to improve a trainee's component placement. [Orthopedics. 2024;47(4):e157-e160.].

Assessing disparities in pancreatic cancer outcomes in African Americans.

612 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes noted in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We evaluated the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and recurrence free survival (RFS) and overall survival based on race were analyzed. Results: The cohort (N=947) consisted of 147 (16%) African Americans (AA) and 775 (82%) Non-Hispanic Whites (NHW). The mean age at diagnosis was 68 years (±10) among AA and 70 years (±11) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI>30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). Eighteen percent (18%) of AA and 17% of NHW had stage II disease, 16% and 12% had stage III and 48% in both had stage IV disease respectively. The treatment modality consisted of chemotherapy (63% in AA vs. 66% in NHW), surgery (25% in AA vs. 26% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 30 (17, 41) months for AA and 26 (16, 40) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in recurrence free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. High mean age, clinical stage II, III and IV, current alcohol use, underweight and BMI>30 and cerebrovascular accident as a comorbidity was associated with worse overall survival when adjusted for other variables. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. We observe there was no difference in treatment initiation among AA and NHW. There was no significant difference in recurrence free survival and overall survival compared to NHW when adjusted for other variables. Future studies incorporating germline mutations, novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.

INNV-15. OPTIMIZING THE ROLE OF THE ADVANCED PRACTICE PROVIDER IN THE MANAGEMENT OF A SINGLE PATIENT INVESTIGATIONAL NEW DRUG (IND)

Abstract BACKGROUND Single patient Investigational New Drug (IND) applications are a way through which experimental therapies may be accessed by patients with cancer especially if a clinical trial is not available. However, initiating and managing a single patient IND is complex. We will outline our approach used at an academic teaching center to leverage the skills and scope of practice of advanced practice providers (APPs) to facilitate successful initiation and monitoring of individual patients who may be receiving an investigational drug under a single patient IND. METHODS We describe a single case of a 52-year-old male with a left thalamic glioblastoma treated with standard of care and monitored off therapy from May 2021 until November 2022. Extended genomic profiling of his tumor at time of biopsy revealed a FGFR3-TACC3 fusion and MGMT promoter methylation, and the decision was made to pursue a single patient IND for anlotinib for use in combination with temozolomide. RESULTS Following permission from the US Food and Drug Administration (FDA) to proceed and IRB chair concurrence, the MD and APP conferred with the investigational and clinical pharmacists regarding procurement and dispensing of the drug, in addition to surveillance and associated toxicities. The APP obtained consent, collected data on monitoring parameters and adverse events, checked for drug interactions with the patient’s routine medications, ordered and reviewed all treatment related MRIs, labs, and EKGs, and coordinated with ophthalmology for baseline and monthly eye exams. Performance of initial and follow-up exams, ongoing toxicity review and management, and care coordination with the local oncology team were completed by the APP. CONCLUSION As first point of contact for the patient and family, the APP plays a key role in glioma research within the multidisciplinary team by providing ongoing symptom management, education, and monitoring for patients receiving investigational drugs.

Assessment of price variation in colorectal cancer screening procedures at US hospitals.

6652 Background: Following the 2021 Hospital Price Transparency Final Rule, US hospitals were mandated to publish their insurer-negotiated prices. We identified factors contributing to price variability of colorectal cancer (CRC) screening procedures across the US. Methods: We compared prices of colonoscopy, flexible sigmoidoscopy, CT colonography, fecal occult blood test, fecal immunochemical test, and Cologuard across U.S. hospitals using the Turquoise dataset (N = 6,378). Psychiatric, rehabilitation, and pediatric hospitals were excluded. Prices in the top and bottom 1% were also excluded to minimize the effect of outliers. Prices were adjusted by the Medicare Geographic Price Index to account for regional variability. We then compared prices across several subgroups, including National Cancer Institute (NCI) designated hospitals, teaching hospitals, and investor owned hospitals. Significance was assessed using the Kruskal-Wallis test. To quantify price variability across insurance plans within a hospital, we defined the within-center-ratio as the 90th percentile rate at a hospital divided by the 10th percentile rate. To quantify variability across hospitals, the across-center-ratio was defined as the 90th percentile median rate across all hospitals divided by the 10th percentile median rate. Results: 1,460 hospitals reported commercial prices for colonoscopy with a median commercial price of $1,867 (IQR: $1,208 - $2,689). For colonoscopy, the within center ratio was 2.5 (IQR: 1.5 – 3.8) and the across-center ratio was 6.2. Prices for other procedures are provided in the table. Compared to non-investor owned hospitals, prices of colonoscopy ($2,082 vs $1,787, P <0.001) and flexible sigmoidoscopy ($2,022 vs $1,289, P <0.001) were significantly higher at investor owned hospitals. Furthermore, across investor classes, hospitals with >5% ownership from private equity firms had the highest median price for both colonoscopy ($2,898), and flexible sigmoidoscopy ($2,697). We did not find significant differences in price by NCI designation, academic teaching center affiliation, overall hospital mortality, overall hospital readmission rate, or urban/rural location. Conclusions: CRC screening procedure prices vary significantly both within and across hospitals. Private equity and other investor owned hospitals had significantly higher prices compared to non-investor owned hospitals. [Table: see text]

Evaluating disparities in pancreatic cancer outcomes in African Americans.

e18657 Background: Pancreatic Adenocarcinoma (PA) is a leading cause of cancer-related death across the world, with poorer outcomes observed in minority populations. The observed variation in outcomes has been attributed to delayed diagnosis, barriers to optimal treatment and health care related disparities. We sought to evaluate the impact of race on clinical presentation and outcomes in pancreatic cancer at a large academic teaching center. Methods: We performed a retrospective review of patients with pancreatic adenocarcinoma diagnosed between January 2016 to December 2021. The demographic characteristics (age, tobacco use, alcohol use, BMI); comorbidities (diabetes, acute/chronic pancreatitis); pathology, treatment (chemotherapy regimen, radiation, surgery) and progression free survival (PFS) based on race were analyzed. Results: The cohort (N = 983) consisted of 154 (16%) African Americans (AA) and 803 (82%) Non-Hispanic Whites (NHW). The median age at diagnosis was 65 years (60, 70) among AA and 71 years (64, 78) in NHW. Thirty-seven (26%) of AA and 104 (14%) of NHW were current smokers; 46 (33%) of AA and 323 (45%) of NHW consumed alcohol regularly. Among AA, 32 (22%) were obese (BMI > 30), compared to 194 (25%) in NHW. Other comorbidities included diabetes (35% in AA vs. 32% in NHW) and acute/chronic pancreatitis (11% among AA vs. 9% among NHW). The treatment modality consisted of chemotherapy (57% in AA vs. 61% in NHW), surgery (26% in AA vs. 27% in NHW) and radiation (10% in AA vs. 12% in NHW). The median time to treatment initiation was 24 (16, 41) months for AA and 34 (20, 56) months for NHW. On univariate analysis, AA race was associated with younger age at diagnosis (p 0.043), higher current tobacco use (p 0.001), lower alcohol use (p 0.012), lower rates of obesity (p 0.024) and higher rate of acute pancreatitis (p 0.037) in pancreatic cancer. On multivariate analysis, race was not associated with difference in progression free survival (12 months in AA vs. 14 months in NHW; p 0.96) when adjusted for age, sex, alcohol use, tobacco use, cancer stage and chemotherapy. Conclusions: Our study revealed that pancreatic cancer in AA was diagnosed at a younger age, associated with active smoking and pancreatitis. Although there was a shorter time to treatment initiation among AA, there was no significant difference in progression free survival compared to NHW when adjusted for other variables. Future studies incorporating novel biomarkers are needed to determine impact of racial health disparities on outcomes in pancreatic cancer.

Implementation of a Whole Food Plant Based Diet in a Food as Prevention Program in a Resource Constrained Environment.

The efficacy of a Whole Food Plant-based (WFPB) diet has been shown in randomized controlled trials in diabetes, cardiovascular disease and obesity. However, it's effectiveness in routine clinical settings is less well documented. This study describes the implementation and outcomes of a "Food as Prevention" program run by a single clinician. Participants were referred to a "Food as Prevention" program run by a single gastroenterologist at an academic teaching center. The program included 5 physician-led discussion and small group educational sessions. Data collected included demographics, weight and biochemical measurements before and after completion of the program. Statistical analysis included paired t-test and Pearson correlation coefficients were used to assess differences before and after WFPB implementation. A total of 17 participants (age 59 years; 59% female) with an average weight of 90.0 kg attended a median of 3 group sessions. Majority of patients had hyperlipidemia (71%) followed by hypertension (47%) and coronary artery disease (35%), fatty liver disease (35%) and diabetes mellitus (29%). Adoption of a WFPB diet led to significant decreases in weight (4.3 kg; p < 0.01), total cholesterol (0.72 mmol/L; p = 0.046), and triglycerides (0.53 mmol/L; p = 0.005) with an increase in high-density lipoprotein (HDL) (0.10 mmol/L; p = 0.01).Conclusions Implementation of the WFPB diet in this novel pilot program led to weight loss and improvement in biochemical markers of disease. Future studies are needed to implement this model on a larger scale.

A deep dive into complete denture outcomes at an academic teaching center.

Journal of Dental EducationEarly View ADVANCING THROUGH INNOVATION A deep dive into complete denture outcomes at an academic teaching center Viyan S. Kadhium DDS, Corresponding Author Viyan S. Kadhium DDS vkadhium@umich.edu orcid.org/0000-0002-4473-9582 School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA Correspondence Viyan S. Kadhium, DDS, School of Dentistry, University of Michigan, 1011 N. University, Ann Arbor, MI 48109, USA. Email: vkadhium@umich.eduSearch for more papers by this authorPranshu Sharma DDS, Pranshu Sharma DDS School of Dentistry, University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this authorDi Xie , Di Xie School of Dentistry, University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this authorRomesh P. Nalliah BDS, MHCM, Romesh P. Nalliah BDS, MHCM School of Dentistry, University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this author Viyan S. Kadhium DDS, Corresponding Author Viyan S. Kadhium DDS vkadhium@umich.edu orcid.org/0000-0002-4473-9582 School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA Correspondence Viyan S. Kadhium, DDS, School of Dentistry, University of Michigan, 1011 N. University, Ann Arbor, MI 48109, USA. Email: vkadhium@umich.eduSearch for more papers by this authorPranshu Sharma DDS, Pranshu Sharma DDS School of Dentistry, University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this authorDi Xie , Di Xie School of Dentistry, University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this authorRomesh P. Nalliah BDS, MHCM, Romesh P. Nalliah BDS, MHCM School of Dentistry, University of Michigan, Ann Arbor, Michigan, USASearch for more papers by this author First published: 29 July 2022 https://doi.org/10.1002/jdd.13067Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Improving sessile serrated adenoma detection rates with high definition colonoscopy: A retrospective study

BACKGROUNDSessile serrated adenomas (SSAs) are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition, concealment by mucous caps, and flat appearance. High definition (HD) colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition (SD) colonoscopes. In the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients, demonstrating the benefit of HD colonoscopy on SSA detection rate (SSADR) may help strengthen the evidence to recommend its use in all settings.AIMTo evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening colonoscopy.METHODSData from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large, academic teaching center were collected. Patients with symptoms of colorectal disease, positive occult blood test, history of colon polyps, cancer, polyposis syndrome, inflammatory bowel disease or family history of colon cancer or polyps were excluded. Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded. Differences in individual endoscopist SSADR, average SSADR, and overall SSADR with SD colonoscopy vs HD colonoscopy were also evaluated for significance.RESULTSA total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 endoscopists. Statistically significant improvements of 2.30% in mean SSADR and 2.53% in overall SSADR were noted with HD colonoscopy (P = 0.00028 and P = 0.00849, respectively). On the individual level, three endoscopists experienced statistically significant benefit with HD colonoscopy (+5.74%, P = 0.0056; +4.50%, P = 0.0278; +4.84%, P = 0.03486).CONCLUSIONOur study suggests that HD colonoscopy statistically significantly improves sessile serrated adenoma detection rate in the screening of average risk patients during screening colonoscopy. By improving the detection and removal of these lesions, adoption of HD colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.

Immediately sequential bilateral cataract surgery: an academic teaching center's experience.

To evaluate the safety and outcomes of immediately sequential bilateral cataract surgery (ISBCS) at a Canadian academic teaching center. Tertiary university teaching hospital of Laval University, Quebec City, Canada. Retrospective cohort study. 2003 consecutive patients (4006 eyes) who underwent ISBCS under topical anesthesia from January 2019 to December 2019 were included. All charts were retrospectively reviewed. Outcome measures included intraoperative and postoperative complications, postoperative uncorrected distance (UCVA) and pinhole (PHVA) visual acuities, and autorefraction measurements. 4006 eyes from 1218 (60.8%) female and 785 (39.2%) male patients with a mean age of 74 ± 8 years had a mean preoperative visual acuity of 0.503 logMAR (Snellen 20/63). The mean axial length was 23.53 ± 1.37 mm. Most eyes had monofocal intraocular lenses (IOLs) implanted (n = 3738, 93.3%) followed by toric (n = 226, 5.6%), multifocal (n = 25, 0.6%), and multifocal toric (n = 17, 0.4%) IOLs. Intraoperative complications included 14 (0.3%) posterior capsule ruptures with 5 (0.1%) requiring sulcus IOL placement, and 7 (0.2%) partial zonulysis, with 3 requiring capsular tension rings (0.07%). There were no cases of endophthalmitis or toxic anterior segment syndrome. Mean 5-week postoperative UCVA was 0.223 (Snellen 20/33), PHVA was 0.153 (Snellen 20/28) with a mean spherical equivalent of -0.21 diopters. ISBCS performed following International Society of Bilateral Cataract Surgeons recommended guidelines is a safe procedure. This cohort of 4006 eyes had very few complications, with none attributable to the surgery being done bilaterally. The UCVA, PHVA, and refractive outcomes were good.

AAOMS Stage 2 and Some Stage 3 Medication-Related Osteonecrosis of the Jaws (MRONJ) Can Be Managed Successfully and Predictably in OMFS Private Practice with Surgical Intervention and Long-term Intravenous Antibiotics

Despite published guidelines, the management of medication-related osteonecrosis of the jaws (MRONJ) remains controversial. Most cases that are resistant to straight forward conservative management are usually referred to an academic teaching center or hospital-based practice. This article will attempt to show that these cases can be managed successfully in private practice on an outpatient basis.

282 A novel approach to teaching B-lynch suture: a multi-center validation of a uterus model

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality. The B-Lynch brace suture is a fertility-sparing surgical method that can treat uterine atony but limited knowledge and confidence hinders its intraoperative application. We led several training sessions to evaluate the effectiveness of simulation-based learning of the B-Lynch brace suture. We conducted a multi-center, prospective cohort study of ob/gyn residents at two academic teaching centers. A suture simulation session was organized using a previously described, cotton-filled stocking model. Several demonstration and training sessions were held at each residency site. Participants completed validated, pre and post-simulation surveys. Self-perceived understanding and confidence in intraoperative performance was assessed using a 5-point Likert scale ranging from a score of 1 for “not confident (or knowledgeable) at all” to a score of 5 for “very confident (or knowledgeable)”. A Wilcoxon matched-pairs signed rank test was used to compare pre and post-simulation scores. Thirty-three participants completed the cotton-filled stocking model training. 23 (70%) of participants had never performed an intraoperative B-Lynch suture. The median score for self-perceived understanding prior to simulation was 3 (range 1-4), which increased to 5 (range 3-5) immediately following the training session. There was a statistically significant improvement in self-perceived understanding of the B-Lynch suture for all participants post-intervention (p<0.001). Similarly, self-perceived confidence increased from a median score of 3 to 5 (p<0.001) following simulation training, even in residents with prior intraoperative experience. The cotton-filled stocking uterus model significantly improved resident self-perceived understanding and confidence in performing an intraoperative B-Lynch suture. Simulation-based learning is an important tool for teaching skills rarely utilized in residency.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

246 An analysis of qualitative themes in yelp reviews of maternal fetal medicine (MFM) practices

To identify qualitative themes distinguishing poorly-rated practices from highly-rated practices offering MFM care. We conducted an IRB-exempt, qualitative analysis of the publically-accessible online review platform Yelp. MFM practices were analyzed in over 30 highly-populated U.S. cities; reviews were only included on practices with 5+ total reviews. Reviews were coded for 14 qualitative themes grouped into either provider-specific or practice-specific areas with both positive and negative variations. Analysis was performed on the frequency of these themes as a function of 1- to 5-star rating. A total of 1008 reviews were analyzed, with 69% being private practices, defined as not associated with an academic teaching center. The average star rating was 3.34 with 50% being 5-star practices and 32% being 1-star practices. The 5-star practices were three times more likely to be private than academic and most often included positive physician-related themes. Conversely, 1-star practices were much more likely to include negative practice-related themes (Table 1). The most common cited reasons for a 1-star rating included negative staff interactions, poor patient-physician communication, and long wait times (Table 2). Provider-related themes are more important in forming a positive patient experience, while practice-related themes are more likely to worsen patient satisfaction. The aggregation of online reviews may allow physicians to identify areas of practice management that can be enhanced to improve satisfaction measures, an increasingly important aspect of health care quality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Is academic department teaching status associated with adverse outcomes after lumbar laminectomy and discectomy for degenerative spine diseases?

BACKGROUND CONTEXTLumbar laminectomy and discectomy surgeries are among the most common procedures performed in the United States, and often take place at academic teaching hospitals, involving the care of resident physicians. While academic institutions are critical for the maturation of the next generation of attending surgeons, concerns have been raised regarding the quality of resident-involved care. There is conflicting evidence regarding the effects of resident participation in teaching hospitals on spine surgery patient outcomes. As the volume of lumbar laminectomy and discectomy increases, it is imperative to determine how academic status impacts clinical and economic outcomes. PURPOSEThe purpose of this study is to determine if lumbar laminectomy and discectomy surgeries for degenerative spine diseases performed at academic teaching centers is associated with more adverse clinical outcomes and increased cost compared to those performed at nonacademic centers. STUDY DESIGN/SETTINGThis study is a multi-center retrospective cohort study using a New York Statewide database. PATIENT SAMPLEWe identified 36,866 patients who met the criteria through the New York Statewide Planning and Research Cooperative System who underwent an elective lumbar laminectomy and/or discectomy in New York State between January 1, 2009 and September 30, 2014. OUTCOME MEASURESThe primary functional outcomes of interest included: length of stay, cost of the index admission; 30-day and 90-day readmission; 30-day, 90-day, and 1-year return to the operating room. METHODSInternational Classification of Diseases, Ninth revision codes were utilized to define patients undergoing a laminectomy and/or discectomy who also had a diagnosis code for a lumbar spine degenerative condition. We excluded patients with a procedural code for lumbar fusion, as well as those with a diagnosis of scoliosis, neoplasm, inflammatory disorder, infection or trauma. Hospital academic status was determined by the Accreditation Council for Graduate Medical Education. Unique encrypted patient identifiers allowed for longitudinal follow-up for readmission and re-operation analyses. We extracted charges billed for each admission and calculated costs through cost-to-charge ratios. Logistic regression models compared teaching and nonteaching hospitals after adjusting for patient demographics and comorbidities. RESULTSCompared to patients at nonteaching hospitals, patients at teaching hospitals were more likely to be younger, male, non-Caucasian, be privately insured and have fewer comorbidities (p<.001). Patients undergoing surgery at teaching hospitals had 10% shorter lengths of stay (2.7 vs. 3.0 days, p<.001), but 21.5% higher costs of admission ($13,693 vs. $11,601 p<.001). Academic institutions had a decreased risk of return to the operating room for revision procedures or irrigation and debridement at 30 days (OR:0.70, 95% confidence interval [CI]: 0.60–0.82, p<.001), 90 days (OR:0.75, 95%CI: 0.66–0.86, p<.001), and 1 year (OR:0.84, 95%CI: 0.77–0.91, p<.001) post index procedure. There was no difference in 30- and 90-day all-cause readmission, or discharge disposition between the two groups. CONCLUSIONSElective lumbar laminectomy and discectomy for degenerative lumbar conditions at teaching hospitals is associated with higher costs, but decreased length of stay and no difference in readmission rates at 30- and 90-days postoperatively compared to nonteaching hospitals. Teaching hospitals had a decreased risk of return to the operating room at 30 days, 90 days and 1 year postoperatively. Our findings might serve as an impetus for other states or regions to compare outcomes at teaching and nonteaching sites.

197. Infective Endocarditis Over a Five-Year Period in an Academic Teaching Center: The Validity of ICD Codes vs. Manual Chart Review

BackgroundOpioid dependence and overdose are at epidemic levels in the United States. Ohio has the third highest rate of opioid-related overdose deaths. Infectious complications of intravenous drug use (IDU) include increased acquisition of hepatitis C, HIV and infective endocarditis. In this study, we aimed to characterize cases of infective endocarditis admitted to our healthcare system over a five-year period. We additionally sought to determine the validity of using ICD codes to identify infective endocarditis cases and IDU.MethodsPatients with ICD-9 or 10 discharge diagnosis codes for infective endocarditis were identified from our institution’s electronic health record. ICD codes pertaining to substance abuse were used to classify patients according to IDU status. Readmissions during the same episode of infective endocarditis were excluded. We compared chart review to ICD code for the identification of infective endocarditis and IDU in a random sample of 296 of 1590 cases.ResultsOf 296 charts reviewed, 133 (44.9%) were excluded because they did not meet criteria for definite infective endocarditis by modified Duke’s criteria or because the episode was a readmission. A total of 163 (55.1%) cases met inclusion criteria, all of whom were seen in consultation by the inpatient Infectious Disease service. Of these, 52 (31.9%) had ICD 9 or 10 codes linked to substance abuse. Following manual chart review, we established that in fact 86 of these 163 cases (52.8%) had evidence of substance abuse.ConclusionMisclassification due to use of ICD codes is a well-established challenge to epidemiological research. However, the extent of misclassification in this analysis was greater than expected. If prior research on IDU and infective endocarditis has relied on medical record data alone without verification through manual chart review, the observed epidemiological trends may not be accurate.Disclosures All authors: No reported disclosures.

The Voices of Young Women with Breast Cancer: Providing Support and Information for Improved Fertility Preservation Discussions.

Purpose: Fertility is a concern for young women with breast cancer. We explore patient experiences with fertility discussions at diagnosis to identify barriers and preferences to patient-centered delivery of care. Methods: A qualitative study was conducted on consecutive, female breast cancer survivors, 39 years of age or younger at diagnosis and within 2 years of diagnosis, who attended routine outpatient follow-up at a large academic teaching center. Interviews lasted 30 minutes and were transcribed verbatim. Thematic analysis was conducted to explore experiences around fertility discussions. Strength of the theme was determined by examining the frequency of a response. Data collection and analysis continued until theoretical saturation was reached. Results: Analysis comprised 50 women with a median age of 34.5 years (range 25-39 years). Thirty-nine women (78%) had completed university education. Thirty-three women (66%) recalled having fertility preservation discussions at diagnosis. The most common themes identified include the following: (i) the requirement for more patient support, (ii) improving information, (iii) integration of patient values, (iv) creating options for patients, (v) financial limitations, and (vi) the need to look beyond the immediate impact. Conclusions: In this contemporary cohort of young adult breast cancer survivors, fertility discussion experiences at diagnosis remain suboptimal. Improved information and a focus on individual patient desires can improve experiences.

Hematology and oncology patient perceptions of inpatient care coordination at an urban academic teaching center.

109 Background: Outpatient doctors increasingly defer inpatient care to hospital-based physicians. At academic medical centers, inpatient care coordination is further complicated by frequent handoffs between resident teams. Breaks in inpatient care continuity may disproportionately affect hematology and oncology patients, given their often complicated longitudinal histories and specialized problems. We sought to understand hematology and oncology patient perceptions of inpatient care coordination at Massachusetts General Hospital (MGH). Methods: Between July 2014 and June 2015, patients admitted to any MGH service were randomly selected to complete a survey about their perception of inpatient care coordination. In total, 1,783 patients responded. Of these, 158 were admitted to hematology or oncology. Hematology and oncology patient responses were compared to all MGH patient responses using chi-squared analysis, with p values less than or equal to 0.05 used as the threshold for statistical significance. Responses reflect the percentage of patients who chose the “top box” option. Results: Compared to all MGH patients, hematology and oncology patients were significantly more likely to recognize a clearly identified doctor responsible for their care while in the hospital (85% vs 74%, p = 0.003) and to perceive the presence of a responding clinician at all times (79% vs 66%, p = 0.001). Hematology/oncology patients were also much more likely to report seeing their longitudinal MGH doctors while admitted (77% vs 57%, p &lt; 0.001). However, despite more frequent in-person visits by outpatient physicians, significantly fewer hematology/oncology patients reported perceiving that their outpatient doctor receives discharge information (47% vs 64%, p = 0.005). Conclusions: MGH hematology and oncology patients reported stronger inpatient care coordination and higher frequency of outpatient physician visits than MGH patients overall. Nevertheless, patients perceived less frequent coordination of discharge information with outpatient physicians. More research is needed to understand whether patient perceptions of care coordination correlates with clinical and utilization outcomes.

Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome

BackgroundTransanal total mesorectal excision (TaTME) has rapidly become an important component of the treatment of rectal cancer surgery. Cohort studies have shown feasibility concerning procedure, specimen quality and morbidity. However, concerns exist about quality of life and ano(neo)rectal function. The aim of this study was to prospectively evaluate quality of life in patients following TaTME for rectal cancer with anastomosis.MethodsConsecutive patients who underwent restorative TaTME surgery for rectal adenocarcinoma in an academic teaching center with tertiary referral function were evaluated. Validated questionnaires were prospectively collected. Quality of life was assessed by the EuroQol 5D (EQ-5D), European Organization for Research and Treatment of Cancer’s QLQ-C30 and QLQ-CR29 and low anterior resection syndrome (LARS) scale. Outcomes of the questionnaires at 1 and 6 months were compared with preoperative (baseline) values.ResultsThirty patients after restorative TaTME for rectal cancer were included. Deterioration for all domains was mainly observed at 1 month after surgery compared to baseline, but most outcomes had returned to baseline at 6 months. Social function and anal pain remained significantly worse at 6 months. Major LARS (score >30) was 33% at 6 months after ileostomy closure. No end colostomies were required.ConclusionsTaTME is associated with acceptable quality of life and functional outcome at 6 months after surgery comparable to published results after conventional laparoscopic low anterior resection.

Stillbirth: a lot done… a lot more to do.

Stillbirth: a lot done… a lot more to do.

Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: a retrospective cohort study.

The aim of the study was to evaluate changes in the operative trends for various types of hysterectomy due to benign indications, between 2001 and 2015, at the 2nd Department of Gynecology, Medical University of Lublin, as compared to the National Health Service (NHS) registry in Poland. A retrospective cohort study was conducted. Data from the Internal Hospital Discharge Registry and Pathological Results Registry have been compared to the NHS database, which has been available nationwide since 2009. The study group included 5629 women who underwent hysterectomy due to benign indications. During the study period, the following number of procedures were performed: total abdominal hysterectomy - 344 (6.11%), total abdominal hysterectomy with bilateral salpingo-oophorectomy - 1760 (31.27%), total vaginal hysterectomy - 563 (10.00%), subtotal abdominal hysterectomy - 2536 (45.05%), and laparoscopically-assisted subtotal hysterectomy (LASH) - 426 (7.57%). The abdominal route, with the preference for subtotal abdominal hysterectomy, was the main approach to hysterectomy. Symptomatic fibroids were the most common indication for the procedure. Comparison of data collected over the last five years revealed a significant difference in the approach to hysterectomy in favor of subtotal abdominal hysterectomy (SAH) and LASH. Less invasive techniques of hysterectomy (LASH, SAH), which are the preferred choice at the 2nd Department of Gynecology (Lublin), are safe and effective options of treating benign conditions. We are of the opinion that these ap-proaches should be offered to patients instead of more radical techniques. Proper training of physicians may influence the decision-making process in favor of minimally invasive techniques.

Identification of a nonsynonymous polymorphism in the SVEP1 gene associated with altered clinical outcomes in septic shock.

Mortality from septic shock is highly heritable. The identification of causal genetic factors is insufficient. To discover key contributors, we first identified nonsynonymous single-nucleotide polymorphisms in conserved genomic regions that are predicted to have significant effects on protein function. We then test the hypothesis that these nonsynonymous single-nucleotide polymorphisms across the genome alter clinical outcome of septic shock. Genetic-association study plus in vitro experiment using primary cells plus in silico analysis using genomic DNA and protein database. Twenty-seven ICUs at academic teaching centers in Canada, Australia, and the United States. Patients with septic shock of European ancestry (n = 520). Patients with septic shock were genotyped for 843 nonsynonymous single-nucleotide polymorphisms in conserved regions of the genome and are predicted to have damaging effects from the protein sequence. The primary outcome variable was 28-day mortality. Secondary outcome variables were organ dysfunction. Productions of adhesion molecules including interleukin-8, growth-regulated oncogene-α, monocyte chemoattractant protein-1, and monocyte chemoattractant protein-3 were measured in human umbilical vein endothelial cells after SVEP1 gene silencing by RNA interference. Patients with septic shock having the SVEP1 C allele of nonsynonymous single-nucleotide polymorphism, SVEP1 c.2080A>C (p. Gln581His, rs10817033), had a significant increase in the hazard of death over the 28 days (hazard ratio, 1.72; 95% CI, 1.31-2.26; p = 9.7 × 10-5) and increased organ dysfunction and needed more organ support (p < 0.05). Silencing SVEP1 significantly increased interleukin-8, growth-regulated oncogene-α, monocyte chemoattractant protein-1, monocyte chemoattractant protein-3 production in human umbilical vein endothelial cells under lipopolysaccharide stimulation (p < 0.01). C allele of SVEP1 c.2080A>C (p. Gln581His) single-nucleotide polymorphism, a non-synonymous single-nucleotide polymorphism in conserved regions and predicted to have damaging effects on protein structure, was associated with increased 28-day mortality and organ dysfunction of septic shock. SVEP1 appears to regulate molecules of the leukocyte adhesion pathway.