Characteristics Of Risk Factors Research Articles

Characterizing Risk Factors Associated With Recurrent Pleural Effusions in the Lung Transplant Recipients.

Pleural effusions remain a common postoperative complication following lung transplantation, occurring in 10% to 26% of cases. We aimed to explore potential clinical or radiographic features associated with clinically significant post-lung transplant pleural effusions requiring repeat interventions for their management. Lung transplantation recipients who underwent thoracentesis at our institution between June 2012 and October 2022 were reviewed. In total, 77 patients were included. Data were collected via the electronic health record and adjudicated through direct chart review. Patients were stratified by the need for a single thoracentesis (control group) or additional interventions, including serial thoracentesis, pigtail placement, and surgery (composite group). The computed tomography (CT) of the chest before the first thoracentesis was reviewed by a thoracic radiologist who was blinded to patient outcome. Single thoracentesis was used to manage 25 (32.5%) patients, 4 (5.2%) required multiple thoracenteses, 42 (54.5%) required a pigtail catheter, and 6 (7.8%) required decortication for definitive management. In the composite group compared with the control group, who were managed by a single thoracentesis, there was an increased incidence of loculations (36.8% vs. 8%, P=0.01), rounded atelectasis (22.8% vs. 4%, P=0.05), and larger effusion size (P=0.01). The composite group had higher pleural fluid eosinophils (0.33% vs. 0% in control, P = <0.01) and monocytes (14.8% vs. 7.3%, P=0.04) levels. Baseline imaging, such as larger effusion size, loculations and rounded atelectasis, and pleural fluid cell profile with increased eosinophils and monocytes, can potentially identify clinically significant and refractory pleural effusions.

Follow-up Adherence After Teleretinal Screening for Diabetic Retinopathy.

Determine the follow-up rate for patients referred following an abnormal teleretinal imaging (TRI) screening and examine patient characteristics predictive of follow-up nonadherence. A cross-sectional study of patients screened between August 2014 and July 2016 in the Harris Health System (HHS) in Houston, TX. All diabetic patients referred for in-person examination, who had data for all study variables, and who did not have established ophthalmic care in the HHS within the previous 2 years were included. Data collected included TRI findings, clinic location, age, race, gender, hemoglobin A1C (HbA1c), and insulin use. The primary outcome was whether or not a patient attended an in-person follow-up visit. Attendance was the dependent variable in a multivariable logistic regression with the aforementioned exposures used as independent variables. There were 1695 patients included in the study. The follow-up rate (ie, the percentage of patients who went for an in-person examination with an ophthalmologist following a positive screening test and referral) was 54.9%. TRI findings of proliferative diabetic retinopathy (PDR) + referable diabetic macular edema (DME) predicted poorer compliance with follow-up recommendations compared to patients with PDR alone (OR 0.64, 95% CI 0.42-0.99; P=0.046). Age, race, gender, glycemic control, and insulin use did not predict compliance. Age, race, gender, glycemic control, and insulin use were not found to be predictive of follow-up compliance rates; the most severe disease (PDR + DME) predicted noncompliance. Diabetic retinopathy screening programs may consider more aggressive measures in emphasizing compliance in patients with the worst disease as these patients are more likely to miss follow-up appointments. More studies are needed to characterize risk factors for noncompliance.

Surgical Site Infections in Simultaneous Colorectal and Liver Resections for Metastatic Colorectal Adenocarcinoma.

Surgical site infections (SSIs) are a major driver of morbidity after combined liver and colorectal surgery for metastatic colorectal cancer. Available literature is inadequate to characterize risk factors and benchmarks for quality improvement. Consecutive cases of simultaneous liver and colorectal surgery for colorectal adenocarcinoma from November 2013 through September 2022 were reviewed for SSIs per National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) criteria. Univariable and multivariable logistic regression evaluated associations with NSQIP 30-day organ-space SSIs. In 580 procedures, the rate of 30-day organ-space SSIs was 16% (n=94) using NSQIP criteria and 11% (n=64) using NHSN criteria; 4% (n=24) had incisional SSIs by both criteria. Most organ-space SSIs were perihepatic, and a minority were associated with bile (26%) or anastomotic (15%) leak. Independent risk factors for organ-space SSIs included major liver resection, upper abdominal (compared with lower abdominal/pelvic) colorectal procedure, and ostomy reversal. Organ-space SSI rates increased over time by approximately 16% per calendar year (p=0.02) despite a declining rate of major liver resection; incisional SSI rates remained low. Overall, major morbidity was 22%, with 7-day median length of stay (interquartile range 6-9) and 0.3% 90-day mortality. Organ-space SSIs are a significant driver of postoperative morbidity in simultaneous liver and colorectal resections for metastatic colorectal adenocarcinoma. Our findings confirm simultaneous resection remains safe and interventions to mitigate the risk of perihepatic organ-space SSIs in high-risk patients are warranted.

Epidemiology of Early-onset Colorectal Cancer in a Safety-net Hospital System in Texas

Goals: We aimed to characterize risk factors for early versus advanced-stage early-onset colorectal cancer (eoCRC) at our safety-net hospital system. Background: Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Rates of CRC diagnosis in young adults (age below 50) have been rising despite an overall decrease in CRC. CRC in this group is often detected late due to screening historically being for persons 50 years and older. Etiologies for the increase in rates of eoCRC remain unclear, as do the risk factors for advanced-stage, defined as stage III or IV, at presentation. Study: We conducted a retrospective cohort study of 556 adults younger than 50 years of age with an ICD-10 diagnosis of malignant neoplasm of the colon or rectum within a 10-year span. Data collected included demographics, age at diagnosis, time to diagnosis, and cancer stage at diagnosis. Multivariable analysis was used to determine factors associated with advanced-stage CRC. Results: A total of 279 patients met the inclusion criteria. Most were Hispanic (67.03%), followed by non-Hispanic Black (NHB, 24.01%). Most had advanced-stage CRC at diagnosis (85.7%, n=239), despite 67.7% (n=189) being diagnosed within 3 months of symptom onset. When compared with non-Hispanic White (NHW) patients, NHB (OR: 2.02, CI: 0.59-6.96) and Hispanic (OR: 1.68, CI: 0.57-4.95) patients had higher odds of advance-stage CRC, albeit not statistically significant. Conclusions: Most patients were diagnosed with advanced-stage disease. NHB and Hispanic patients had a nonstatistically significant higher odds of presenting at advanced-stage CRC compared with NHW patients. System-wide quality improvement interventions may be needed to screen for eoCRC in safety-net hospital systems.

Abstract 4138350: Candidemia in Patients with Left Ventricular Assist Device-A Case Series

Introduction: Candidemia is rare but associated, have significant morbidity and mortality. Outcomes are not well-characterized in patients with left ventricular assist devices (LVADs). With an increasing number of patients living with LVADs, we sought to characterize risk factors to help optimize outcomes for this high-risk population. Methods: We retrospectively reviewed records of 97 patients who underwent LVAD implant between January 2012 to May 2024 at Indiana University Health, Indianapolis Indiana. Demographic and clinical data were extracted. Candidemia was defined as a positive blood culture with candida species. Result: We identified three patients with candidemia, with an overall attack rate of 3.09%. All patients had a HeartMate III (HM3) at the time of infection. The mean age of patients was 40.3 years (Range 29.0 – 58.0 years) and mean BMI was 35.7 kg/m 2 (Range, 30.0 – 42.0 kg/m 2 ). One patient grew Candida auris and Candida tropicana, the other patient grew Candida auris and the third patient grew Candida globrata. All patients had an automatic implantable cardiac defibrillation, a peripherally inserted central catheter line, and right heart failure. Two patients had driveline infections (one fungal, one bacterial) while one patient developed LVAD endocarditis with a right ventricular outflow tract vegetation. Two patients had persistently positive blood cultures despite treatment with a multi-drug anti-fungal regimen (Flucytosine, Amphotericin B and micafungin) and expired. The third patient initially cleared her blood cultures after treatment with IV micafungin only but was re-admitted with muti-organ failure and expired. Summarily, all patients with candidemia died with a mortality rate of 100%. None of the patients were candidates for heart transplantation. Average survival from the time of diagnosis of candidemia was 5 months (Range 1.0 – 11.0 months). RHF, chronic DL infection and high BMI were associated with candidemia in our series. Conclusion: Candidemia in LVAD patients, while less common than bacterial infections, carry high mortality without cardiac transplantation (100% mortality in our cohort). Its rare occurrence makes it challenging to identify reversible risk factors, leading to poor survival. Multicenter registries are needed to fully elucidate these risk factors and determine effective treatment strategies.

Revision Surgery Following Primary Reconstruction for Hand Syndactyly

Web creep and scar contracture are established complications of syndactyly reconstruction; however, few reports characterize risk factors for revision surgery. The purpose of this investigation was to examine the rate and risk factors of reoperation for congenital hand syndactyly. Patients undergoing syndactyly reconstruction from 2007 to 2021 at a single children's hospital were reviewed. Cases with less than 1 year of follow-up were excluded. Demographic, surgical, and outcomes data were recorded by each web space to account for mixed treatments. In total, 514 web spaces in 231 children were reviewed with a mean follow-up of 6.0 years after primary reconstruction; 66 (12.8%) web spaces in 51 (22.1%) children underwent revision. The most common procedures were web space deepening due to web creep (57.9% of cases) and digital scar contracture release (45.6%); these were augmented in a minority (17.5%) of cases by other aesthetic/functional procedures. Revisions occurred at a median of 1.7 years after primary reconstruction. First web spaces (thumb-index finger) were most frequently reoperated (33.3%). On multivariable analysis, first web space involvement, complete syndactyly, and complications after the primary reconstruction significantly increased odds of revision. Age at primary reconstruction was not a significant predictor. Following revision, 10.5% of cases had recurrent web creep, and 14.0% had recurrent scar contracture. Eight (1.6%) web spaces in seven (3.0%) children required multiple revisions. Approximately 13% of syndactyly reconstructions (22% of patients) require reoperation. Most revisions occur within 4 years of primary reconstruction. Complete syndactyly, complications after the primary reconstruction, and first web space involvement increase the risk of revision; age at primary reconstruction is not a risk factor. Revision outcomes mirror the index procedure, with 10% to 14% of revised web spaces experiencing recurrent web creep or contracture. Therapeutic IV.

Characterizing Risk Factors for the Need for Kidney Replacement Therapy in Children After Discontinuation of Maintenance Dialysis

Characterizing Risk Factors for the Need for Kidney Replacement Therapy in Children After Discontinuation of Maintenance Dialysis

At Home and at Risk: A Study on Pediatric Unintentional Firearm Injuries in the USA

Aim of the studyFirearm injury is the leading cause of death among pediatric patients in the United States. Unintentional firearm injury remains underexplored compared to intentional firearm injury. This study aims to characterize risk factors and demographics associated with pediatric unintentional firearm injury. MethodsRetrospective analysis of pediatric patients (≤18 years) with firearm injuries from 2017-2022 using the ACS National Trauma Databank. Firearm injuries were identified via ICD-10 codes, classified by intent, and place of injury. Analysis involved univariate, multivariate, and regression models to identify factors associated with unintentional injury. ResultsOf the 42,152 pediatric firearm injuries, 17.6% (n = 8043) were unintentional. Predominantly occurring at home (56.2%), these injuries mostly involved Black (45.7%) or White (42.0%) males (82.3%) aged 12-18 (74.1%). Children aged 2-5 experienced a higher number of unintentional injuries than intentional (1,064 vs. 770). Unintentional injuries were less severe (ISS >16: 10.9% vs. 17.3%, p<0.001) and less fatal (6.7% vs. 12.6%, p<0.001) compared to intentional injuries. Children aged 2-5 had higher odds of unintentional injury (OR 1.98, p<0.001), while adolescents aged 12-18 had lower odds (OR 0.32, p<0.001). Injuries at home were associated with higher odds of being unintentional (OR 1.61, p<0.001), while those on streets or roads were more likely intentional (OR 0.34, p<0.001). ConclusionsUnintentional firearm injuries, while less severe and fatal, represent a substantial proportion of pediatric firearm trauma in the U.S. These injuries pose significant risks to younger children, often in domestic settings. Levels of EvidenceIII

Epidemiology and Outcomes of Recurrent C Difficile Infection Among Hematopoietic Cell Transplant Recipients: A Single-center, Retrospective 10-year Study.

There are limited data on the contemporary epidemiology of recurrent Clostridioides difficile infection (CDI) among hematopoietic cell transplant (HCT) recipients. We aimed to determine the incidence, risk factors, and outcomes for recurrent CDI among HCT recipients. We conducted a retrospective study of adult HCT recipients between 2012 and 2021 diagnosed with index CDI between HCT day -7 and +100. Recurrent CDI was defined as new symptoms and a positive test within 12 weeks after treatment for index CDI. Cox proportional hazards models were used to investigate associations between prespecified variables (age, neutropenia, exposure to antibiotics with antianaerobic coverage, cytomegalovirus viremia/disease, and metronidazole monotherapy) and recurrent infection, presented as hazard ratios with 95% confidence intervals (CI). Of 3479 HCT recipients, 416 (12%) had index CDI and were treated with oral vancomycin (31%), metronidazole (41%), oral vancomycin and metronidazole (29%). Of 381 patients eligible for recurrent CDI analysis, 35 had recurrent infection; cumulative incidence was 10% (95% CI, 7-13) at 12 weeks. In the 14 days after recurrence, 2/25 (8%) patients required hospital admission; none died within 30 days. Metronidazole monotherapy for treatment of index CDI was associated with an increased rate of recurrence (adjusted hazard ratio, 2.0; 95% CI, 1.0-4.0; P = .048). Recurrent CDI occurred in 10% of HCT recipients in the early posttransplant period and was associated with use of metronidazole. Further study is needed to characterize risk factors for recurrent CDI among HCT recipients to guide use of agents aimed at preventing recurrence.

Audit of risk factors of drug-sensitive, drug-resistant tuberculosis disease, a case-control study of patients registered under NTEP, Gujarat.

Characterizing risk factors for drug-resistant tuberculosis (TB) is critical to guide targeted interventions in high-burden settings like India. We aimed to identify socioeconomic, lifestyle, and clinical factors associated with drug-sensitive and drug-resistant TB acquisition. A comparative cross-sectional study recruited 350 bacteriologically confirmed TB patients registered under the National Tuberculosis Elimination Program (NTEP) in Gujarat, India, and 300 matched participants without active/past TB. Multinomial logistic regression analyzed risk factors for 200 drug-sensitive and 150 drug-resistant TB cases compared to participants without active or past TB. Key factors independently associated with higher adjusted odds ratios (aOR) of both TB types included low socioeconomic status (SES) (drug-sensitive TB: aOR 1.7, 95% CI 1.2-2.5; drug-resistant TB: aOR 2.2, 95% CI 1.3-3.7), crowding (>5 persons/room) (drug-sensitive TB: aOR 1.6, 95% CI 1.1-2.3; drug-resistant TB: aOR 1.9, 95% CI 1.2-2.9), undernutrition (drug-sensitive TB: aOR 1.6, 95% CI 1.1-2.3; drug-resistant TB: aOR 2.0, 95% CI 1.2-3.2), smoking (drug-sensitive TB: aOR 1.5, 95% CI 1.0-2.3; drug-resistant TB: aOR 1.7, 95% CI 1.1-2.7), and indoor air pollution (drug-sensitive TB: aOR 1.5, 95% CI 1.0-2.2; drug-resistant TB: aOR 1.8, 95% CI 1.2-2.8). Marked social determinants and clinical risks drive heightened susceptibility for both TB types in India, while prior inadequate treatment and nosocomial exposures selectively enable additional drug resistance. Holistic prevention policies jointly targeting transmission, vulnerability, and curative factors are imperative.

P134 CHARACTERIZATION OF RISK FACTORS IN RELATION TO THE INCREASE IN CARDIOVASCULAR RISK

Objective: Identify risk factors and their relationship with 10-year cardiovascular risk evaluated using the modified Framingham scale, in order to promote education and healthy lifestyle habits, generating an impact on the incidence of this disease. Methods: A descriptive study was carried out to characterize risk factors related to a high cardiovascular risk at 10 years, based on a cross-sectional study consisting of information collection with modified Framingham surveys, for risk assessment at 10 years. Results: A total of 3,025 people were surveyed, where the following factors were associated with a high cardiovascular risk: diabetes with 221 people and 6.7% at high risk, obesity with 242 people with 11.2% at high risk, alcohol consumption with 938 people with 15.3% high risk and smoking with 333 people with a high risk of 5.8%. Conclusions: Cardiovascular diseases are the most common non-communicable diseases with considerable morbidity and mortality worldwide, especially in low- and middle-income countries. As a fundamental part of the study, the importance of risk factors and their relationship with high cardiovascular risk in a capital city of Colombia is considered, within these diabetes, obesity, alcohol consumption and tobacco consumption, the alcohol consumption as the risk factor with the biggest impact linked to high cardiovascular risk with 15.3%. On the other hand, a negative impact is evident in the relationship between obesity associated with high cardiovascular risk with 11.2% of the total the obese population, the results of this study demonstrate the association with high cardiovascular risk, revealing alcohol consumption and obesity and how it is related to the increase in cardiovascular risk according to the Framingham scale, revealing the importance of education as a fundamental pillar for the prevention of risk and development of the disease, generating new educational campaigns and studies about the relationship of the factors and their modification with healthy lifestyle habits

Risk factors for prolonged infection and secondary infection in pediatric severe sepsis.

Sepsis causes significant worldwide morbidity and mortality. Inability to clear an infection and secondary infections are known complications in severe sepsis and likely result in worsened outcomes. We sought to characterize risk factors of these complications. We performed a secondary analysis of clinical data from 401 subjects enrolled in the PHENOtyping sepsis-induced Multiple organ failure Study. We examined factors associated with prolonged infection, defined as infection that continued to be identified 7days or more from initial identification, and secondary infection, defined as new infections identified ≥ 3days from presentation. Multivariable adjustment was performed to examine laboratory markers of immune depression, with immunocompromised and immunocompetent subjects analyzed separately. Illness severity, immunocompromised status, invasive procedures, and site of infection were associated with secondary infection and/or prolonged infection. Persistent lymphopenia, defined as an absolute lymphocyte count (ALC) < 1000 cells/µL twice in the first five days, and persistent neutropenia, defined as absolute neutrophil count (ANC) < 1000 cells/µL twice in the first five days, were associated with secondary and prolonged infections. When adjusted in multivariable analysis, persistent lymphopenia remained associated with secondary infection in both immunocompromised (aOR = 14.19, 95% CI [2.69, 262.22] and immunocompetent subjects (aOR = 2.09, 95% CI [1.03, 4.17]). Persistent neutropenia was independently associated with secondary infection in immunocompromised subjects (aOR = 5.34, 95% CI [1.92, 15.84]). Secondary and prolonged infections were associated with worse outcomes, including death. Laboratory markers of immune suppression can be used to predict secondary infection. Lymphopenia is an independent risk factor in immunocompromised and immunocompetent patients for secondary infection.

Hospital Admission for Diabetic Ketoacidosis in Thai Children and Adolescents with Type 1 Diabetes: A National Study during 2015-2019.

To study the national incidence of admission for diabetic ketoacidosis (DKA) in Thai children and adolescents with type 1 diabetes (T1D) and characterize risk factors for DKA admission. Admission records of children and adolescents with T1D during the years 2015-2019 were retrieved from the Thai health coverage system of all schemes. Hospitalization was categorized according to patients' age groups (<1, 1-5, 6-12 and 13-17 years), sex and geographical regions (Bangkok, Central, Northeast, North and South). DKA admission incidence and rate were calculated and compared among subgroups. The annual incidences of T1D and DKA admissions progressively increased over the study period (T1D: 12.0 to 15.0, p<0.001 and DKA: 4.8 to 7.3 per 100,000 child-years, p<0.001). About half of DKA admissions (52%) were recurrent episodes. DKA admission rate was 1.49 admissions/patient. The incidence of DKA admission was greatest in individuals aged 13-17 years (13-17 years: 10.3; 6-12 years: 6.3; 1-5 years: 1.7; and <1 year: 0.6 per 100,000 child-years, p<0.001). DKA admission incidence was greater in females than males (7.6 vs. 4.3 per 100,000 child-years, p<0.001). Among 5 geographical regions, greatest percentage of recurrent DKA (57%), rate of increased annual incidence of DKA admission (3.8 to 7.8 per 100,000 child-years), and DKA admission rate (1.64 admissions/patient) were found in the Northeast region. During the years 2015-2019, rising annual incidences of T1D and DKA admissions among Thai youth were observed. Individuals older than 6 years, being females, and resided in the Northeast region had higher risk for DKA hospitalization.

Impacts of Hospital Acquired Bloodstream Infections in Patients Undergoing Hemodialysis Through a Central Venous Catheter

Background: Hospital acquired infections (HAI) are of interest given their resultant morbidity, mortality, and hospital utilization. Among HAIs, central line associated bloodstream infections result in the highest rates of mortality and additional costs. While all central venous catheters (CVC) carry risk for BSI, long-term catheter use is at increased risk. One population that utilize CVCs for extended durations are those undergoing hemodialysis. While data are available characterizing BSI impacts on outpatient hemodialysis patients, little data exist describing inpatients. The purpose of this study was to characterize the demographics, outcomes, and economics associated with the development of hospital acquired BSI (HA-BSI) in patients undergoing hemodialysis through a CVC (HD-CVC). Methods: All admissions of adult patients in the Premier Healthcare Database with hospital stays including HD-CVC with discharge dates during 2020-2022 were retrospectively evaluated. BSIs were identified by ICD-10 codes and blood culture collection dates. A BSI was deemed hospital acquired if the blood culture date was ≥3 calendar days after admission. Descriptive analyses were undertaken for HA-BSI patients including: baseline demographics, clinical characteristics, and outcomes. Length of stay (LOS), ICU utilization, and estimated costs were evaluated for HAI-BSI and non-BSI populations. Results: 166,394 admissions from 91,448 patients were identified. Of these, 5,722 patients (6.3%) had 5,842 admissions with a HA-BSI. These patients were 58.9% white, 28.3% black, 56.8% male, and 62.9% were aged ≥60years. Patients had considerable comorbidities at baseline with 88.9% having ≥2 Charlson comorbid conditions and 46.9% with ≥6. During the study period, all-cause mortality was 27.8% for HA-BSI patients with 85.5% of deaths occurring while inpatient. Median LOS for patients with HA-BSI was 25 days compared with 6 days for HD-CVC without BSI; patients with HA-BSI were also more likely to require the ICU (65.6% vs. 27.6%). The median ICU LOS was 12 days for HA-BSI versus 34 days for HD-CVC without BSI. Greater intensity of healthcare utilization was reflected in median costs of $402K for HA-BSI, compared with $43K for HD-CVC without BSI. Discussion: We described the characteristics of HD-CVC patients that developed HA-BSI. These patients had many comorbidities and relatively high rates of all-cause in-hospital mortality. Patients were likely to have long LOS, both in-hospital and within the ICU. Collectively, care of these patients was associated with considerable healthcare costs, particularly as compared with HD-CVC patients not developing a HA-BSI. Future studies should characterize risk factors and evaluate potential prevention strategies for this high-risk population.

Poster 349: Tobramycin-Soaked Grafts for the Prevention of Infection Following Anterior Cruciate Ligament Reconstruction: A Retrospective Review of Infection Rate

Objectives: Infection can be a devastating complication of anterior cruciate ligament (ACL) reconstruction. Soaking or wrapping grafts in vancomycin solution has been adopted by many surgeons to prevent infection following ACL reconstruction. Recent meta-analysis demonstrated a significant reduction in the incidence of deep infection in vancomycin-soaked grafts to be 0.09% compared to 0.74% for nontreated grafts.1 Tobramycin may provide an alternative for patients with vancomycin allergies or if vancomycin is not available. The purpose of this study is to evaluate the incidence of deep and superficial infection following ACL reconstruction in young patients with tobramycin-soaked grafts as well as characterize potential risk factors for infection. We hypothesize that tobramycin-soaked grafts result in a low deep infection rate, comparable to that of vancomycin-soaked grafts published in the literature. Methods: A total of 812 consecutive patients under age 20 who underwent ACL reconstruction at an academic medical center between 2010 and 2020 with tobramycin-soaked grafts were identified. Retrospective chart review was performed to identify postsurgical superficial and deep wound infections, as well as other pertinent surgical characteristics. The incidence of infection in this tobramycin wrap cohort was compared to the incidence of infection of vancomycin wraps as published in the literature. Results: Superficial wound infections occurred in 24 patients (2.96%) and 0 deep joint infections were identified in the tobramycin wrap cohort. The incidence of infection was 3.16% in 728 patients who received prophylactic perioperative intravenous Cefazolin and 1.23% infection incidence in 81 patients who received prophylactic perioperative Clindamycin (p = 0.30). In addition, no significant difference in incidence of superficial infection was found with patient age, sex, body mass index, or graft type. Conclusions: Tobramycin-soaked ACL grafts demonstrate a low infection risk comparable to that of vancomycin-soaked ACL grafts. The type of prophylactic IV antibiotic used in this young cohort did not impact the incidence of superficial wound infection. Further work with larger and older cohorts is needed to better characterize risk factors for postoperative infection following ACL reconstruction for all ages and comorbidities.

Clinical Outcomes After Definitive Treatment of Soft Tissue Sarcoma of the Hand: A Retrospective Cohort Study of 109 Patients

The purpose of this study was to provide updated data on oncologic outcomes following definitive surgical treatment of soft tissue sarcoma of the hand in a cohort of 109 patients, as well as to characterize risk factors for poor oncologic and functional outcomes. We analyzed data from 109 consecutive patients who had definitive surgical treatment for soft tissue sarcoma of the hand performed between 1996 and 2019 by a single surgeon at a sarcoma center. Primary outcomes included functional outcome (assessed by Musculoskeletal Tumor Society scores), disease-free survival (DFS), and overall survival (OS). We compiled descriptive data and used a multivariable linear model to identify factors associated with functional outcomes. Kaplan-Meier methods were used to estimate 5- and 10-year DFS and OS. Patients had a median age of 36 years at presentation. Median follow-up was 6.1 years among patients alive at the end of follow-up. The median Musculoskeletal Tumor Society score was 29; functional outcome was worse among patients with high-grade tumors or complications. Among the 107 patients who became disease-free, there were four local recurrences (one with metastasis), six distant recurrences, and one death without recurrence. All local recurrences were deep tumors (two myxofibrosarcoma and two myxoinflammatory fibrosarcoma). Estimated 5- and 10-year DFS rates were 89% (95% confidence interval [CI]: 83% to 96%) and 88% (95% CI: 80% to 95%). There were seven deaths, and the estimated 5- and 10-year OS rates were 95% (95% CI: 90% to 100%) and 92% (95% CI: 84% to 100%). Larger tumor size and higher stage at diagnosis were associated with shorter DFS and OS in univariable analyses; low event rates precluded multivariable analysis of survival. Aggressive disease-specific surgical and multidisciplinary treatment can yield long DFS and OS, and good functional outcomes. However, complications and high-grade tumors are associated with worse functional scores. Prognostic II.

Risk quantification as an epidemiological analysis strategy: Analysis and application to bud rot in oil palm

AbstractBud rot (BR), caused by Phytophthora palmivora, limits growth and development of oil palms in the American continent, particularly in Colombia. Due to the absence of systematic epidemiological analyses and determination of risk factors associated with BR, this study aimed to employ deterministic mathematical models and frequentist and Bayesian statistical methods to quantify the genetic response and edaphoclimatic variables as risk indicators of BR. From 2011 to 2014, the severity of BR in oil palm crops was recorded monthly in two locations: Tumaco (hot spot) and Villavicencio (cold spot), determining the edaphoclimatic variables at each site. Using the area under the disease progress stairs curve, temporal models were applied to determine the rate of disease development (R0) to quantify risk at locality and genotype levels. Subsequently, the observed intensity and severity levels of BR were adjusted to models such as survival curves, Cox proportional hazard risk and transition probabilities, or Markov states, with the aim of quantifying and characterizing risk factors associated with genotype and edaphoclimatic variables at each location. The risk in Tumaco was three times higher than in Villavicencio, and the R0 values were differential by genotype, with Tenera more susceptible than Hybrids. Moreover, the risk of BR increased when periods of 2–3 months occurred with successive instances of precipitation and relative humidity greater than 150 mm/month and 90%, respectively, and when manganese and zinc levels were below optimal. This approach allowed us to characterize epidemiological factors that cause plant diseases, allowing quantification of the risk of BR.

#1623 Risk factors for end-stage kidney disease and death in ANCA-associated vasculitis with glomerulonephritis

Abstract Background and Aims ANCA-associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still carries poor prognosis despite treatment improvement over the last years. Currently, improving assessment of disease activity and severity and defining risk factors for ESKD pose challenges. In this study we aim to determine and characterize risk factors associated with progression to ESKD or death in patients with AAV-GN. Method We retrospectively analysed all AAV-GN cases of our Center. ESKD was considered as a composite outcome of eGFR&amp;lt;15 or dialysis dependency. Biopsies were classified according to Berden's classification (BC), Brix's renal risk score (RRS), Mayo Clinic Chronicity Score (MCCS) and AAV-GN combined score (AAV-GN-CS). Categorical variables were analysed by non-parametric chi-square or fisher's exact test; and continuous variables by Mann-Whitney U test. Cox regression models were applied for death and Kaplan-Meier estimator. Significance value α = 0.05 was considered. Results A total of 74 patients, 56.8% male, 69 years-old median age were included. Of them, 81.2% were MPO, 11.6% PR3 and 7.2% negative. At presentation, 35.3% had alveolar haemorrhage, 13.4% GI and 66.7% constitutional manifestations. At diagnosis, median eGFR was 7.5 mL/min/1.73 m2 (5.0-13.0), proteinuria 2.2g/g (0.45-4.17) and all patients had haematuria. Initial median ANCA titer (ATi) was 100 UI/mL (51-134) and at last follow-up 44 (15-101). 64.2% of all patients required dialysis at presentation. Of these, 14.0% recovered until discharge. We also analyzed biopsies of 57 patients. According to BC, 15.8% were focal, 40.4% crescentic, 26.3% mixed, and 17.5% focal. ESKD risk was medium in 28.3% and high in 69.8%, as determined by RRS; whereas low in 31%, intermediate in 42.3% and high in 19% as per AAV-GN-CS. Induction treatment (IT) used was cyclophosphamide (CYC) in 46.3%, CYC plus rituximab (RTX) in 18.3% and RTX in 3.3%. Only 17 patients (26.2%) were added plasmapheresis (PLEX). Only 28% achieved kidney remission (KRm), 7% relapsed and 68.7% developed ESKD. Of them, 95.5% had eGFR&amp;lt;15 at diagnosis, 30% low C3, 37.5% crescentic pattern, 28.1% mixed and 28.1% sclerotic. 87% of ESKD patients had &amp;lt;25% normal glomeruli (NG), and 87.1% high ESKD risk (RRS). Progression to ESKD was associated with lower eGFR (p &amp;lt; 0.001) and low C3 at diagnosis (p = 0.026), lower %NG (p = 0.004), higher %CG (p = 0.004), higher %IFTA (p = 0.011), worse BC (p = 0.012), higher RRS (p &amp;lt; 0.001) and MCCS categories (p = 0.010), but not with AAV-GN-CS. ATi reduction seems to determine better renal outcome (p = 0.042). No significant differences were seen with IT or maintenance treatment, nor with PLEX addition. No patient treated with RTX, or combined treatment developed ESKD. Mortality was 32.8% and the best predictive model includes age, GI manifestations and KRm (p &amp;lt; 0.001). Age (p = 0.004), lower eGFR at diagnosis (p = 0.016) and GI manifestations (p = 0.003) were predictive of death, while achieving KRm improved survival (p = 0.009). Conclusion Our results reveal that AAV-GN patients have poor kidney outcome when presenting with severe kidney dysfunction, high ANCA titers and low C3 levels. Worse histological scoring is determinant of ESKD. The prediction power of AAV-GN-CS must be demonstrated in large cohorts. RTX effectivity on kidney survival must be further supported. Patient survival is related with younger age at diagnosis, organ systems involved at clinical presentation, and achievement of kidney remission.

Impact of thyroid carcinoma invasion of recurrent laryngeal nerve on cervical lymph node metastasis.

Papillary thyroid carcinoma (PTC) has a favorable prognosis. However, involvement of the recurrent laryngeal nerve (RLN) significantly increases the risk of recurrence. RLN invasion was an important factor in determining the extent of thyroid surgery. The purpose of this study was to compare clinicopathologic features and characterize risk factors of central and lateral lymph node metastasis (LLNM) of RLN invasion in patients with PTC. A retrospective review was conducted of 130 patients with PTCs who had exclusive tumor involvement of the RLN at our institution between January 2014 and February 2019. All patients underwent total thyroidectomy and high-dose radioactive iodine (RAI) therapy. The clinicopathologic factors and prognostic outcomes of the patients with solitary and multiple RLN involvements were compared. Kaplan-Meier method was performed to compare the outcomes of tumor recurrence. Univariate and multivariate logistic regression analyses were used to identify risk factors associated with LLNM. The invasion of the RLN was similar on both sides, with 58.5% on the right, 40.0% on the left, and 1.5% on both sides. Significant differences were observed in tumor size (p < 0.001), lymph node metastasis classification (p = 0.002), RLN resection (p < 0.001), and thyroglobulin (p = 0.010) in the solitary and multiple groups. During the median follow-up of 67 months, 9 (6.9%) patients developed recurrence. There were no statistical differences in recurrence for age, tumor size, gender, multifocality, lymph node metastasis (LNM), and RLN resection. According to receiver operating characteristic (ROC) curve analyses, a cut-off of tumor size > 1.7 cm was identified as the most sensitive and specific predictor of RLN with multiple involvements or LNM invasion. Univariate and multivariate analyses revealed that central lymph node metastasis (CLNM) and RLN invasion by LNM can serve as independent risk factors for LLNM (p = 0.006 and p < 0.001, respectively). Our results indicate that recurrence was comparable in patients with solitary and multiple RLN involvements. Multiple RLN involvement was associated with pathological features such as larger tumors, RLN resection, and LLNM. The presence of LNM invading RLN and multiple nerve involvement increases the risk of intraoperative RLN resection. A higher risk of multiple invasion or LNM invasion should be considered when tumor size > 1.7 cm. The presence of CLNM and RLN invaded by LNM were independent predictors for LLNM, which could aid surgeons in deciding on lateral lymph node dissection.

Impact of Arterial Hypotension During Spinal Anesthesia for Cesarean Delivery on the Newborn at Kouba Hospital

Introduction: Spinal anesthesia is commonly used for cesarean deliveries but can lead to maternal hypotension, a frequent complication that may adversely affect the fetus. The objective of this study was to determine the incidence of post-spinal hypotension for cesarean delivery and identify associated risk factors. Methods: This was a prospective descriptive study conducted at Kouba Hospital over one month. Inclusion criteria were patients admitted for scheduled or emergency cesarean under spinal anesthesia after informed consent, without absolute contraindication to spinal anesthesia, baseline blood pressure ≥100 mmHg, and heart rate ≤100 bpm. Patients were excluded if hypotensive, vagotonic, had pre-existing cardiac disease, or received general anesthesia. All patients received 8 mg 0.5% bupivacaine, 2.5 μg sufentanil, and 100 μg intrathecal morphine with standard monitoring and 250 ml fluid preloading. Hypotension was defined as ≥20% decrease from baseline blood pressure. Data collected included demographics, obstetric history, and anesthetic/surgical details. Analysis was done using EPI Info software. Results: 42 parturients were included, mostly ASA II, with mean BMI 26.5±4.1 kg/m2 and gestational age 37.4±2.1 weeks. 50% had a history of hypotension in previous cesareans, and 68% underwent emergency cesarean. Sensory block reached T4 level on average. Hypotension incidence was 80%, with 40% requiring additional fluids and mean 15±10 mg ephedrine. Despite hypotension, most neonates had satisfactory Apgar scores. High BMI, emergency cesarean, and previous hypotension history were significantly associated with increased hypotension risk. Discussion: The high 80% hypotension incidence aligns with literature reports of 70-90%, likely exacerbated by using isobaric/hypobaric rather than hyperbaric bupivacaine. Identified risk factors were consistent with published data. Prompt management likely prevented major neonatal consequences. Conclusion: Intraoperative hypotension is frequent after spinal anesthesia for cesarean delivery. Guidelines recommend a standardized approach with fluid loading, vasopressors, and lateral tilt positioning to prevent maternal and fetal complications. Larger studies are needed to further characterize risk factors.