Age-adjusted Charlson Comorbidity Score Research Articles

A machine learning-based prediction model pre-operatively for functional recovery after 1-year of hip fracture surgery in older people.

Machine learning (ML) has been widely utilized for constructing high-performance prediction models. This study aimed to develop a preoperative machine learning-based prediction model to identify functional recovery one year after hip fracture surgery. We collected data from 176 elderly hip fracture patients admitted to the Department of Orthopaedics and Oncology at Shenzhen Second People's Hospital between May 2019 and December 2019, who met the inclusion criteria. Patient's functional recovery was monitored for one year after surgery. We selected 26 factors, comprising 12 preoperative indicators, 8 surgical indicators, and 6 postoperative indicators. Eventually, 77 patients were included based on the exclusion criteria. Random allocation divided them into the training set (70%) and test set (30%) for internal validation. The Lasso method was employed to screen prognostic variables. We conducted comparisons among various common machine learning classifiers to determine the best prediction model. Prediction performance was evaluated using the area under the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis. To identify the importance of the predictor variables, we performed the recursive feature elimination (RFE) algorithm based on Shapley Additive Explanations (SHAP) values. The AUCs for the testing dataset were as follows: logistic regression (Logit) model = 0.934, k-nearest neighbors (KNN) model = 0.930, support vector machine (SVM) model = 0.910, Gaussian naive Bayes (GNB) model = 0.926, decision tree (DT) model = 0.730, random forest (RF) model = 0.957, and Extreme Gradient Boosting (XGB) model = 0.902. Among the seven ML-based models tested, the RF model demonstrated the best prediction performance, incorporating four features: postoperative rehabilitation compliance, marital status, age-adjusted Charlson comorbidity score (aCCI), and clinical frailty scale (CFS). We developed a prediction model for the functional recovery following hip fracture surgery in elderly patients after one year, based on the Random Forest (RF) algorithm. This model exhibited superior prediction performance (ROC) compared to other models. The software application is available for use. External validation in a larger patient cohort or diverse hospital settings is necessary to assess the clinical utility of this tool.

Percutaneous Cholecystostomy in Severe Acute Cholecystitis: An Observational Study From a Single Institute.

Background Although percutaneous cholecystostomy (PC) is generally accepted as a bridge to definitive therapy for acute cholecystitis (AC), which remains cholecystectomy, some patients did not undergo cholecystectomy, mainly due to contraindications to surgery. Here, we aimed to investigate the predictors of recurrence and the outcome after PC. Methods This is a retrospective study from a single general hospital at Tunbridge Wells, United Kingdom. One hundred twenty-six patients who presented with AC grade 3 and were initially managed with PC were included. In addition, the proportion of patients who did not undergo subsequent laparoscopic cholecystectomy (LC) and their characteristics were analyzed. Results The mean age of the study cohort was 72 (36-98) years, and the median length of drain insertion was 39.5 days. The majority (52%) presented with severe AC grade 3 with failed medical treatment to control the disease, while 7% had an emphysematous gallbladder. Eighty percent of patients did not develop any further attacks of AC after PC removal. The most common comorbidity was hypertension (35%). The mean age-adjusted Charlson comorbidity score was 3.72. Thirty-six percent (45/126) of the study cohort underwent LC, while the remaining patients did not receive any surgical intervention. Nine percent were deemed unfit for surgery. Forty-one patients (33%) were managed conservatively as they did not have a further attack of cholecystitis after PC removal or had a mild attack managed with antibiotics. In addition, 22% experienced procedural complications, including a blocked stent, pain, and cellulitis around the tube. The 30-day mortality rate of patients who did not undergo LC was 5%. Predictors of interval cholecystectomy were younger age, calculus cholecystitis, low Charslson index score, and uncomplicated and shorter length of hospital stay with PC. Conclusion Most severe AC patients treated initially with PC did not undergo subsequent LC. Therefore, PC in high-surgical-risk patients with AC could be a definitive treatment.

The shift in therapies for the treatment of chronic lymphocytic leukemia (CLL) patients in the US Veterans Health Administration (VHA) from 2013-2018.

e19339 Background: The first novel agent for use in CLL was approved in 2014; however, the extent of novel agent uptake in the VHA is largely unknown. Objective: This study described the pharmacoepidemiology of three novel agents (ibrutinib, idelalisib, venetoclax), and traditional chemotherapies/chemoimmunotherapies (CT/CIT) in the VHA. Methods: This was a retrospective study of 26,879 adults with CLL in the VHA from 10/01/2013 to 5/31/2018. All were followed for at least 6 months. Data were extracted from the VHA electronic health record. Patients came from all 18 Veterans Integrated Service Networks, spanning all 50 states and US territories. Descriptive statistics were used to summarize baseline characteristics, CLL treatments, next therapies, and secondary complications. Results: A total of 3670 patients received at least one of 12 CLL therapies of interest. Patients had a median age of 69 years (47% were 65+ and 26% were 75+), a median age-adjusted Charlson comorbidity score of 6, and 6% had a history of exposure to Agent Orange. Ibrutinib accounted for 89% of the novel agent use. Ibrutinib use across all lines of therapy (LOTs) increased sevenfold over the study period (Table). Venetoclax (42%) and idelalisib (30%) were the most common therapies for the next LOT after ibrutinib. Across all LOTs, traditional CT/CIT use declined steadily over the study period. However, in fiscal year (FY) 2018, there were still 17% of patients receiving CT/CIT. Ibrutinib was the most common therapy for the next LOT in these patients (43–74%). Incidence of diffuse large B cell lymphoma post-index was 2–6 times higher in patients on CT/CIT than those on ibrutinib. Other secondary complications were similar between ibrutinib and CT/CIT. Conclusions: To our knowledge, this is the largest study looking at CLL treatment patterns among VHA patients in the real world. There has been a major shift in the treatment of CLL, with fast adoption of novel agents in the VHA from 2013 to 2018. The impact of this shift on healthcare resource use and cost burden in the VHA will need to be examined. [Table: see text]

Adherence to abiraterone or enzalutamide in elderly metastatic castration-resistant prostate cancer.

To evaluate adherence to abiraterone or enzalutamide for the treatment of metastatic castration-resistant prostate cancer (mCRPC). In an observational prospective cohort study, we monitored patients with mCRPC for their adherence to abiraterone or enzalutamide in the pre- or post-chemotherapy setting. Fifty-eight patients with median age of 76years (range 56-94), age-adjusted Charlson comorbidity score of 10 (range, 4-15), and geriatric G8 score of 14 (range, 6-17) were enrolled. Twenty-two (38%) patients were treated with abiraterone and 36 (62%) with enzalutamide, while forty-two (72%) were in the pre-chemotherapy setting. Forty-seven patients (81%) had a caregiver. Based on the pill counting, a non-adherence rate of 4.8% and 6.2% was observed for the whole period and the first 3months, respectively, without a statistically significant difference between abiraterone and enzalutamide cohorts. A lower non-adherence rate (1.3%) was reported by patients during the whole period, mainly due to a misperception (77%) and forgetfulness (19%). Non-adherence rate to the fulfilling of the clinical diary was 38% for the whole period. Non-adherence in the whole period was related to the radiological response (p = 0.03) and geriatric G8 score (p = 0.005). By the receiver operating characteristic (ROC) curve based on the radiological response, non-adherence cut-off was 1.87% (p = 0.04). By this non-adherence cut-off, the G8 cut-off was 14.75 (p = 0.0003). Non-adherence to abiraterone or enzalutamide for mCRPC may have an impact on disease response and be related to patients' frailty, suggesting their geriatric assessment and clinical interventions to monitor and increase their adherence.

2295. Clinical Characteristics of Achromobacter Xylosoxidans Infections in a Korean Teaching Hospital

Background Achromobacter species are non-fermentous Gram-negative bacilli that are primarily found in contaminated soil or water, but is rare in human. Although their low virulence, Achromobacter xylosoxidans is considered one of the emerging nosocomial agents in immunocompromised patients, including those with hematologic malignancy, diabetes, and renal failure. This organisms can cause pneumonia, catheter-related blood stream infection, urinary tract infection, and meningitis. We investigated the clinical manifestations and outcomes associated with A. xylosoxidans infection in a mid-sized community-based hospital in Korea.MethodsWe retrospectively analyzed all consecutive episodes of A. xylosoxidans in a mid-sized community-based hospital from October 2015 to April 2019.ResultsA total 181 clinical isolates of A. xylosoxidans were obtained from 123 patients. Of these, 117 (95%) had nosocomial infection that mostly received previous antibiotic therapy. A. xylosoxidans was isolated from respiratory tract (68%, 84/123), peritoneal fluid (11%, 13/123), urine (8%, 10/123) and blood (6%, 7/123). Seven cases of A. xylosoxidans bacteremia was associated with intravenous catheter sepsis. Seventy-eight cases (63%) had polymicrobial infection; P. aeruginosa (n = 21) was most commonly coisolates organisms, followed by S. maltophilia (n = 20) and methicillin-resistant S. aureus (n = 15). The main underlying diseases were neurologic disease (41%), diabetes mellitus (36%), and solid cancer (25%). Of these, 53 patients (43%) were categorized as in an immunocompromised state. The in-hospital mortality rate was 23%. Based on multivariate analysis, neurologic disease (hazard ratio [HR]: 1.23, 95% confidence interval [CI]: 0.08–0.67; P = 0.007) and the age-adjusted Charlson comorbidity score (HR: 1.31% CI: 1.038–1.65; P = 0.02) were associated with increased mortality.ConclusionWe concludes that, though rare, A. xylosoxidans could be pathogenic in immunocompromised patients who are in hospital. A. xylosoxidans can cause nosocomial infection and bacteremia is mostly originating from intravenous catheter. The potential impact on the clinical outcome, further investigations are required to delineate the role of A. xylosoxidans. Disclosures All authors: No reported disclosures.

A Single Overnight Stay After Robotic Partial Nephrectomy Does Not Increase Complications.

Objectives: To evaluate the feasibility of postoperative day 1 (POD1) discharge after robotic partial nephrectomy (RPN) and to determine whether a protocol targeting a shorter length of stay (LOS) is associated with any difference in the rate of postoperative complications. Materials and Methods: We reviewed a prospectively maintained, multi-institutional database of patients who underwent RPN from September 2013 to September 2016. Three of the six participating surgeons used a protocol that targeted discharge on POD1, whereas three surgeons did not. Patient characteristics and postoperative complication rates between the two groups were compared. Results: A total of 665 patients were included, 455 of whom were treated by surgeons utilizing a POD1 discharge protocol, whereas 210 were not. The mean LOS for those in the POD1 protocol group was 1.13 days vs 2.02 days in the non-protocol group. Between groups, there were no differences in age (p = 0.098), body mass index (p = 0.164), tumor size (p = 0.502), or R.E.N.A.L. Nephrometry score (p = 0.974), but POD1 discharge protocol patients had higher age-adjusted Charlson comorbidity score (4 vs 2, p = 0.033), were less likely to have a hilar tumor (15.9% vs 23.1%, p = 0.03), and had a larger percent decrease in discharge estimated glomerular filtration rate (-15.9% vs -7.1%, p < 0.001). There were no differences in the rates of overall (p = 0.715), major (p = 0.164), medical (p = 0.089), or surgical complications (p = 0.301) or in complications by the Clavien-Dindo category (p = 0.13). Conclusion: Discharge on POD1 after RPN is feasible, reproducible by different surgeons, and not associated with an increased risk of postoperative complications.

Service use by older very frequent emergency department users: A retrospective cohort study

BackgroundFrequent Emergency Department (ED) attendance is a common occurrence, across all patient age groups. Older frequent users of ED are an at-risk group who often have complex, chronic health needs with many requiring out-of-hospital services to support their care.The aim of this study is to identify the characteristics, outcomes and health service use of older, very frequent emergency department (ED) users. MethodsA retrospective cohort study, at three Australian EDs, comparing first and last ED attendances, by older people (≥65 years) with frequent ED use (≥8 attendances/year). ResultsThere were 1387 ED attendances in 12 months by 115 patients (median=11). The median age-adjusted Charlson comorbidity score increased between attendances (5 vs 6, p<0.001). From first to last visit, hospital stays exceeding 7 days increased (12% vs 20%, p=0.013), while both ED re-attendances within 28 days (58% vs 20%, p≤0.001) and hospital readmissions within 30 days (39% vs 23%, p=0.016) decreased. In-patient mortality was 11% (n=10/88). There was no change in out-of-hospital services in place at both ED attendances (55% vs 61%, p=0.185). ConclusionsOut-of-hospital service use did not change despite frequent ED attendance. Older very frequent ED users had increasing co-morbidities over time and often required hospital admission.

A Matched Analysis on the Prognostic Impact of Race on Survival Endpoints of Women with Early-Stage Endometrial Cancer

Objective: To compare survival endpoints between African American (AA) and non-AA (NAA) women with endometrial carcinoma (EC) stage I–II using a robust matching analysis. Methods and Materials: Patients were matched by stage, grade, adjuvant management (surveillance, vaginal brachytherapy or pelvic radiation treatment), age, and year of hysterectomy. Recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. Results: A total of 758 patients were included. Body mass index and Age-Adjusted Charlson comorbidity index was significantly higher in AA compared to NAA women. There were no significant differences between the AA and NAA groups in regard to 5-year RFS (94 vs. 93%), DSS (96 vs. 98%) or 5-year OS (90 vs. 92%). On multivariate analysis of survival endpoints for the entire study cohort, it was found that race (AA vs. NAA) was not a significant predictor of RFS, DSS, or OS. Grade 3 tumors and the presence of lymphovascular space invasion (LVSI) were the only 2 independent predictors of RFS and DSS, while age-adjusted Charlson comorbidity score, grade 3, stage II and the presence of LVSI were independent predictors of shorter OS. Conclusions: When matched based on the tumor stage, grade, adjuvant treatment, age, and year of surgery, our study suggests that there is no statistically significant difference in any survival endpoints between AA and NAA women with early-stage EC. Based on these data, disparities in outcome likely do not stem from uterine cancer-related causes. The increased comorbidity burden in AA women is likely a factor contributing to the racial disparity in endometrial cancer.

The Prognostic Significance of Race on Survival Endpoints in Women with Early Stage Endometrial Cancer. A Matched Analysis

Disparities in survival endpoints between African American (AA) and non-African American (NAA) women in early stage endometrial carcinoma have been previously reported. We used a robust matching system to compare survival endpoints between these two groups of women in an attempt to identify if race is a significant contributor to racial disparities. AA women and NAA women with stage I - II endometrial carcinoma were matched by stage, grade, adjuvant management (surveillance, vaginal brachytherapy, or pelvic radiation treatment), age, and year of hysterectomy. Recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. A total of 758 patients (218 AA matched to 540 NAA) were included. There were no significant differences between the AA and NAA groups in regards to 5-year RFS (94% vs. 93%, p = 0.68), DSS (96% vs. 98%, p = 0.22) or 5-year OS (90% vs. 92%, p = 0.59). On multivariate analysis of survival endpoints for the entire study cohort, race (AA vs. NAA) was not a significant predictor of RFS, DSS, or OS. Grade 3 tumors and the presence of lymphovascular space invasion (LVSI) were the only two independent predictors of RFS and DSS, while age-adjusted Charlson comorbidity score, grade 3, stage II, and the presence of LVSI were independent predictors of shorter OS. When matched based on tumor stage, grade, adjuvant treatment, age and year of surgery, our study suggests no statistically significant difference in any survival endpoints between AA and NAA women with early stage endometrial carcinoma. Based on these data, reported disparities in outcome likely stem from factors that are not inherently race related and may include higher initial staging due to delay in presentation, lack of access to quality healthcare, and a higher comorbidity burden in the AA population. The results of this study should guide us in our attempt to eliminate racial disparities in outcome.

Prophylactic Ureteral Stenting in Laparoscopic Colectomy: Revisiting Traditional Practice

BackgroundProphylactic placement of ureteral stents is performed during open colectomy to aid in ureteral identification and to enhance detection of injury. The effects of this practice in laparoscopic colectomy are unknown. This study compares outcomes of patients undergoing laparoscopic colectomy with and without prophylactic ureteral stenting. MethodsA retrospective cohort study at a tertiary academic medical center was performed. The primary outcome measure was the incidence of ureteral injury. Secondary outcomes evaluated included mortality, length of stay, procedural duration, and new-onset urinary complication (hematuria, dysuria, and urinary tract infection). ResultsIn 702 consecutive patients undergoing elective laparoscopic colectomy from 2013 to 2016, prophylactic stents were placed in 261 (37%) patients. Two ureteral injuries occurred (0.3%), both in patients who underwent ureteral stent placement (P = 0.07) and were found and repaired intraoperatively. There was no in-hospital mortality. When accounting for age-adjusted Charlson comorbidity score, procedural indication, gender, BMI, and extent of resection, no difference in hospital length of stay (P = 0.79) was noted comparing patients with and without stenting. However, stent placement prolonged operating time (P = 0.03) and increased the risk of new-onset urinary complications (P = 0.04). ConclusionsIn this study, ureteral injuries only occurred in those with stent placement. Prophylactic ureteral stents in laparoscopic colectomy are associated with increased operative time and urologic morbidity. Owing to the low prevalence of ureteral injury in the elective setting and the increased risk of urinary complications, use of prophylactic ureteral stenting should be highly selective.

Does age-adjusted Charlson comorbidity score skew survival endpoints in women with FIGO-stage III endometrial cancer?

Does age-adjusted Charlson comorbidity score skew survival endpoints in women with FIGO-stage III endometrial cancer?

Contemporary surgical outcomes of venous tumour thrombectomy managed with intraoperative Doppler ultrasound for kidney cancer.

Radical nephrectomy (RN) with venous tumour thrombectomy (VTT) carries a significant morbidity and mortality risk. Examination of a contemporary single-institution series permits the development of a management algorithm and an audit its results. We report outcomes following the use of intraoperative colour Doppler ultrasound and our surgical pathway. We retrospectively reviewed the records of all patients who underwent RN with VTT for kidney cancer between January 1, 2013 and October 1, 2016. Surgical complications, postoperative complications (Clavien-Dindo classification ≥3), 90-day readmission rates, and outcomes are reported. Multivariate linear regression, logistic regression, and Cox proportional hazard modelling were used to identify associations. Fifty-eight patients underwent RN with VTT. Of these, 26 (45%) patients had Mayo Clinic level III or IV thrombus and nineteen required venovenous/cardiopulmonary bypass. Three patients required patch grafting. The median length of hospital stay was eight days and there were 20 major complications. The 30-day readmission rate was 21% and the 90-day mortality rate was 8.9%. In multivariate analysis, low serum albumin and age-adjusted Charlson comorbidity score predicted length of stay. Increased intraoperative blood loss was significantly associated with increasing body mass index, serum creatinine, tumour thrombus level, and a history of significant weight loss &gt;9.1kg. Low serum hematocrit predicted 90-day mortality. Intraoperative colour Doppler ultrasound is a useful tool and can facilitate caval preservation. Caval grafting can be avoided in most cases. Venovenous bypass can be avoided in many level III cases. Early therapeutic anticoagulation should be instituted with caution.

Does Age-Adjusted Charlson Comorbidity Score Impact Survival Endpoints in Women with Federation of Gynecology and Obstetrics-Stage III Endometrial Cancer?

Objectives: We sought to evaluate the impact of age-adjusted Charlson comorbidity index (AACCI) score on survival endpoints for women with advanced stage endometrial carcinoma (EC). Methods and Materials: We identified 238 women with stage III EC. AACCI score was calculated and 3 groups were created accordingly; group 1 with a score of 0–2, group 2 with score 3–4, and group 3 with score ≥5. Significant predictors of recurrence-free (RFS), disease-specific (DSS) and overall survival (OS) were analyzed. Results: Median follow-up was 54 months and median age was 65 years. Stage IIIC was the most common stage (69%). The 3 groups were well-balanced except for less utilization of adjuvant chemotherapy in group 3 (p = 0.01). Five-year OS was significantly lower in group 3 compared to groups 1 and 2 (23 vs. 65 and 51%, respectively). Similarly, 5-year RFS was 54, 41, and 33% and DSS was 65, 54, and 35% for groups 1, 2, and 3 respectively. On multivariate analyses, AACCI group 3, cervical stromal involvement, positive peritoneal cytology, and higher tumor grade were predictors for shorter OS. Cervical stromal involvement and higher grade were independent predictors for worse RFS and DSS. Additionally, positive cytology, lymphovascular space invasion, and stage IIIC2 were significantly detrimental for RFS. Conclusions: Our study suggests that comorbidity burden is a strong predictor of worse OS in women with stage III EC. Women with higher AACCI are less likely to receive adjuvant chemotherapy. Comorbidity score can significantly impact survival endpoints for women with advanced EC.

Successful Evidence-Based Treatment of Patients with Advanced Pancreatic Cancer in Community-Based Oncology Group Practices

Background: Randomized clinical trials do not reflect the day-to-day reality of patient care; hence, the treatment of patients with advanced pancreatic cancer in oncology group practices was evaluated. Patients and Methods: All consecutive patients with advanced pancreatic cancer who were treated between 01/2012 and 12/2015 in 4 oncology group practices were analyzed retrospectively using SPSS software. Results: 324 patients with a median age of 70 years (range 32-94 years) were analyzed. The majority were male (56%) and had distant metastases (74%). Chemotherapy was the major modality of treatment (86%) with a median overall survival (OS) of 33.3 weeks (range 1.7-245.4 weeks). Chemotherapy significantly (p < 0.001) improved OS in comparison to best supportive care only (37.6 vs. 13.9 weeks). Patients with locally advanced disease had a better prognosis compared to patients with metastases (median OS 49.6 vs. 30.4 weeks; p < 0.001). An age-adjusted Charlson comorbidity score of ≥ 9 was found to influence the OS significantly (p = 0.004). Conclusion: Chemotherapy remains the main modality of treatment for patients with advanced pancreatic cancer with an OS comparable to prospective randomized trials. The OS of this patient cohort has remained the same over the last 20 years despite advances in treatment modalities.

Age-adjusted Charlson comorbidity score is associated with the risk of empyema in patients with COPD.

Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of pneumonia than the general population due to their impaired lung defense. They also have a higher risk of empyema and more comorbidities than patients without COPD. This study aimed to evaluate the risk of empyema in patients with COPD after adjusting for age and comorbidities using the age-adjusted Charlson comorbidity index (ACCI).Data were retrieved from the National Health Insurance Research Database. COPD patients were defined as inpatients aged >40 years with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for COPD. In total, 558,660 COPD patients were enrolled and separated into 3 groups by ACCI score to represent the severity of comorbidity (≤2, 3–5, and >5). Other comorbidities assessed included autoimmune diseases, gastroesophageal reflux disease, dyslipidemia, chest wall injury, and thoracostomy.Of the 558,660 patients, 36,556 (6.54%) had low ACCI scores (≤2), 208,292 (37.28%) had moderate ACCI scores (3–5), and 313,812 (56.17%) had high ACCI scores (>5). The mean ages of the low, moderate, and high groups were 50.66, 70.62, and 78.05 years, respectively. The hazard ratio (HRs) for empyema were 1.26 (95% confidence interval (CI) = 1.13–1.40) in the moderate ACCI group and 1.55 (95% CI = 1.39–1.72) in the high ACCI group compared with the low ACCI group. The overall incidence of empyema in COPD patients was 2.57 per 1000 person-years.This is the first study to use ACCI scores to analyze the risk of empyema in patients with COPD. Patients with high ACCI scores were older and had more complicated comorbidities, resulting in a higher risk of empyema and poor prognosis. The subgroup analysis indicated that COPD patients with comorbid autoimmune disease, gastroesophageal reflux disease, chest wall injury, or history of thoracostomy did not have a higher risk of empyema than patients without these comorbidities.Empyema is an important issue in patients with COPD and is associated with significant morbidity and mortality. Awareness of the risk factors for empyema, close monitoring, and early intervention may improve patient outcomes and decrease mortality.

Age-not Charlson Co-morbidity Index-predicts for mortality after stereotactic ablative radiotherapy for medically inoperable stage I non-small cell lung cancer

PurposeIn this single institution retrospective study of patients with stage I medically inoperable non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy (SABR) we attempt to model overall survival (OS) using initial prognostic variables with specific attention on the Charlson co-morbidity index (CCI). MethodsBetween 2008 and 2013, 335 patients with medically inoperable stage I NSCLC were treated with SABR or hypofractionated radiotherapy (50–60Gy in at least 5Gy or 4Gy fractions respectively) at our institution. Medical comorbidities and Charlson scores were determined by individual chart review. Patients were stratified into 3 groups based on the CCI score (0–1, 2–3, 4–9) and again based on the age-adjusted Charlson Comorbidity score (aCCI). Cumulative survival for each stratum was determined using the Kaplan-Meier method. Non-significant and confounding variables were identified and discounted from survival modeling. 3 sex stratified Cox regression models were tested: (1) aCCI with age and comorbidity combined; (2) age and CCI; (3) age alone, comorbidity removed. ResultsThe median survival was 4.4years and the median follow up 4.7years. The median CCI and aCCI scores were 2 and 5 respectively. Patients with aCCI 7–12 had an increased hazard of death on univariate analysis HR 2.45 (1.15–5.22 95%CI, p=0.02) and -excluding age as a competing variable- on multivariate analysis HR 2.25 (1.04–4.84 95%CI, p=0.04). Patients with CCI 4-9 had an increased hazard of death on univariate analysis HR 1.57(1.30–2.90) but not on multivariate analysis. On formalized testing – with either continuous or categorical variables- all three survival models yielded similar coefficients of effect. ConclusionWe identify male gender, weight loss greater than 10% and age as independent prognostic factors for patients treated with medically inoperable NSCLC treated with SABR or hypofractionated radiotherapy. Based on our survival models, age alone can be used interchangeably with aCCI or CCI plus age with the same prognostic value. Age is more reliably recorded, less prone to error and therefore a more useful metric than Charlson score in this group of patients.

Towards a core outcome set for cardiac arrest clinical trials (COSCA): An international Delphi survey

fromthemedical records. Co-morbiditieswere assessedprior to the IHCA as ICD-10 codes in medical files according to Age-adjusted Charlson Comorbidity Score (ACCI). Differences in survival was assessed with adjusted Odds Ratio with 95% Confidence Intervals (OR 95% CI) between patients with an ACCI of 0–4 points versus thosewith 5–7 points as well as thosewith≥8 points. Adjustments were done for hospital site, first documented heart rhythm, ECG surveillance, witnessed and place of cardiac arrest. Results: In all, 175 patients suffered an IHCA, out of 41 (23%) survived at least 30 days. Patients with an ACCI of 5–7 points had a minor chance aswell as thosewith ACCI of≥8 points had aminimal chance to survive an IHCA compare to thosewithACCI of 0–4points (AdjustedOR0.10 95%, CI 0.04–0.26 andOR0.04, 95% C.I. 0.03–0.42, respectively). Conclusion: Patients with a moderate or severe burden of co-morbidities have a minor chance to survive an IHCA. This information could be used as a decision-tool during ongoing CPR aswell as it might aid clinicians when planning care and discussion DNAR orders.

It’s never too late: Smoking cessation after stereotactic body radiation therapy for non-small cell lung carcinoma improves overall survival

PurposeAs stereotactic body radiation therapy (SBRT) has emerged as a quick, effective, and well-tolerated treatment for early stage non-small cell lung carcinoma (NSCLC), it can be difficult to convince patients to quit smoking in follow-up. We evaluated whether there was a survival benefit to smoking cessation after SBRT. Methods and materialsPatients with early-stage NSCLC treated from 2004 to 2013 who were still smoking tobacco at the time of SBRT were identified from a prospective institutional review board–approved registry. Peripheral tumors were treated to 54 Gy in 3 fractions and central tumors to 50 Gy in 5 fractions. Patients were reviewed for overall survival (OS) and disease progression. The log-rank and Cox regression tests were used to identify factors predictive of OS. ResultsThirty-two patients (27%) quit smoking after SBRT, and 87 (73%) continued smoking. Median follow-up was 22 months (range, 2–87). On multivariate analysis, smoking status (hazard ratio, 2.1; 95% confidence interval, 1.02-4.2; P = .045), increasing age-adjusted Charlson comorbidity score and larger tumor size were predictive of worse OS. The prior number of cigarette pack-years was not significant (P = .62). In a Kaplan-Meier comparison, smoking cessation after SBRT was associated with improved 2-year OS, 78% versus 69% (P = .014). There was no significant difference in 2-year progression-free survival (75% vs 55%, P = .23) or local control (97% vs 88%, P = .63). ConclusionOS is significantly improved in patients who stop smoking after SBRT for early-stage NSCLC, no matter their previous smoking history. Encouraging smoking cessation should be an important part of every posttreatment visit.

Vaginal Vault High-Dose-Rate Brachytherapy Alone as Adjuvant Treatment of Early-Stage Endometrial Cancer: A Retrospective Study on 119 Patients

(DSS). Age-adjusted Charlson Comorbidity Score (HR 1.2, p Z 0.003), LVSI (HR 3.1, p Z 0.003), and RT (HR 0.43, p Z 0.01) were retained in the multivariate model for OS. Conclusions: Adjuvant RT appears to reduce the risk of local-regional failure and improve OS in this cohort of patients with early stage Type II endometrial cancer. However, distant failure is a challenge for women with type II endometrial cancer. Further investigation into optimal adjuvant systemic therapy in these patients appears justified. Author Disclosure: S. Vance: None. N. Rasool: None. M. Mahan: None. M.A. Elshaikh: None.

MP16-13 RECTAL SWAB CULTURE-DIRECTED ANTIMICROBIAL PROPHYLAXIS FOR PROSTATE BIOPSY IS ASSOCIATED WITH A LOWER RISK OF INFECTIOUS COMPLICATIONS

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 2014MP16-13 RECTAL SWAB CULTURE-DIRECTED ANTIMICROBIAL PROPHYLAXIS FOR PROSTATE BIOPSY IS ASSOCIATED WITH A LOWER RISK OF INFECTIOUS COMPLICATIONS Jessica Dai, Kathleen Hwang, Leonard Mermel, Gyan Pareek, Stephen Schiff, Dragan Golijanin, and Joseph Renzulli Jessica DaiJessica Dai More articles by this author , Kathleen HwangKathleen Hwang More articles by this author , Leonard MermelLeonard Mermel More articles by this author , Gyan PareekGyan Pareek More articles by this author , Stephen SchiffStephen Schiff More articles by this author , Dragan GolijaninDragan Golijanin More articles by this author , and Joseph RenzulliJoseph Renzulli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.586AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of rectal swab cultures to guide antimicrobial prophylaxis for transrectal ultrasound (TRUS)-guided prostate biopsy has been suggested as a way to reduce infectious complications from antibiotic-resistant microorganisms. We assessed the incidence of fluoroquinolone resistance in men undergoing prostate biopsy and evaluated the effect of culture-directed prophylaxis on the risk of infectious complications after prostate biopsy. METHODS All men who received prostate biopsies 2/1/13 – 10/31/13 at our institution were included in an IRB approved retrospective cohort study. At the discretion of the attending physician, patients received either a pre-procedural rectal swab and culture to guide antimicrobial prophylaxis, or routine prophylaxis with a fluoroquinolone antibiotic. Basic patient demographic and clinical information were collected, as well as data on any infectious complications within 30 days of biopsy. Fisher’s exact test and Welch’s t-test were used for statistical analysis. Confounding variables were controlled for with a multivariate logistic regression model. RESULTS 347 patients were included in the study. Of these, 205 patients received a pre-procedure rectal swab culture and 142 did not. Average patient age was 62.6 and 64.4 years, respectively (p=0.04). There was no difference in mean PSA value (p=0.30) or age-adjusted Charlson comorbidity score (p=0.10) between the two groups. 13.1% of rectal cultures demonstrated fluoroquinolone-resistant microorganisms. Infectious complications occurred in 0.9% of the rectal swab group and 2.9% of the control group (p=0.16), which included hospital admissions for bacteremia, pyelonephritis, sepsis, or septic shock. Rectal swab culture-directed antibiotics were associated with a decreased risk for post-biopsy infection (RR 0.17, 95% CI 0.02-1.53). A multivariate logistic regression model demonstrated a decreased risk of infection if a rectal swab culture was done (p=0.11). CONCLUSIONS The incidence of fluoroquinolone resistance is relatively high in our patient population. Overall, infection rates after prostate biopsy are low, with a non-significant reduction in incidence of post-biopsy infection for patients receiving rectal swab-directed antimicrobial prophylaxis. Though not statistically significant, these differences remain clinically significant, given the severity of observed infectious complications. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e158 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jessica Dai More articles by this author Kathleen Hwang More articles by this author Leonard Mermel More articles by this author Gyan Pareek More articles by this author Stephen Schiff More articles by this author Dragan Golijanin More articles by this author Joseph Renzulli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...