Charlson Comorbidity Index Research Articles

EP551 - Assessment of Surgical Management for Mild and Moderate Acute Gallstone Pancreatitis in Accordance with AUGIS Guidelines: A Clinical Audit

Abstract Aim Acute Gallstone Pancreatitis (AGSP) presents as a surgical emergency with diverse clinical outcomes. The guidelines from the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) recommend inpatient laparoscopic cholecystectomy (LC) during the index admission or within two weeks for surgically fit patients in cases of mild to moderate AGSP. This study examines the surgical management of AGSP, evaluating adherence to AUGIS guidelines. Methods All patients admitted to a single surgical unit who had MRCP for AGPS from September 2020 to September 2022 were included. Electronic case notes were reviewed for demographics, comorbidities, radiological results, whether they had LC and reasons for not proceeding to LC. Severity of AGSP were graded using CT severity index. Those with severe AGSP were excluded. Results 116 patients were identified; one was excluded. Median age was 59 years (IQR 46-73) and 79 (68.9%) were female. Median length of stay was 5.8 days (IQR 3.7-8.2). 19 (16.5%) patients had inpatient LC, 42 (36.5%) had outpatient LC, 4 (3.5%) patients declined LC, 10 (8.7%) patients were not surgically fit and in 40 (34.8%) patients there was no documentation of why LC not carried out. The median Charlson Comorbidity Index for patients where there was no documentations for not proceeding with LC was 4.5 (IQR 2.3-5.8). Conclusion Our study highlights suboptimal compliance with national guideline. It is essential that patients with AGSP undergo inpatient LC or receive prompt outpatient LC to mitigate the risk of recurrent AGSP. Thorough documentation becomes imperative in cases where LC is not scheduled.

A nomogram for predicting short-term mortality in ICU patients with coexisting chronic obstructive pulmonary disease and congestive heart failure

ObjectiveThis study aimed to develop and validate a nomogram for predicting 28-day and 90-day mortality in intensive care unit (ICU) patients who have chronic obstructive pulmonary disease (COPD) coexisting with congestive heart failure (CHF). MethodsAn extensive analysis was conducted on clinical data from the Medical Information Mart for Intensive Care IV database, covering patients over 18 years old with both COPD and CHF, who were were first-time ICU admissions between 2008 and 2019. The least absolute shrinkage and selection operator (LASSO) regression method was employed to screen clinical features, with the final model being optimized using backward stepwise regression guided by the Akaike Information Criterion (AIC) to construct the nomogram. The predictive model's discrimination and clinical applicability were evaluated via receiver operating characteristic (ROC) curves, calibration curves, the C-index, and decision curve analysi s (DCA). ResultsThis analysis was comprised of a total of 1948 patients. Patients were separated into developing and validation cohorts in a 7:3 ratio, with similar baseline characteristics between the two groups. The ICU mortality rates for the developing and verification cohorts were 20.8 % and 19.5 % at 28 days, respectively, and 29.4 % and 28.3 % at 90 days, respectively. The clinical characteristics retained by the backward stepwise regression include age, weight, systolic blood pressure (SBP), respiratory rate (RR), oxygen saturation (SpO2), red blood cell distribution width (RDW), lactate, partial thrombosis time (PTT), race, marital status, type 2 diabetes mellitus (T2DM), malignant cancer, acute kidney failure (AKF), pneumonia, immunosuppressive drugs, antiplatelet agents, vasoactive agents, acute physiology score III (APS III), Oxford acute severity of illness score (OASIS), and Charlson comorbidity index (CCI). We developed two separate models by assigning weighted scores to each independent risk factor: nomogram A excludes CCI but includes age, T2DM, and malignant cancer, while nomogram B includes only CCI, without age, T2DM, and malignant cancer. Based on the results of the AUC and C-index, this study selected nomogram A, which demonstrated better predictive performance, for subsequent validation. The calibration curve, C-index, and DCA results indicate that nomogram A has good accuracy in predicting short-term mortality and demonstrates better discriminative ability than commonly used clinical scoring systems, making it more suitable for clinical application. ConclusionThe nomogram developed in this study offers an effective assessment of short-term mortality risk for ICU patients with COPD and CHF, proving to be a superior tool for predicting their short-term prognosis.

Comparative analysis of treatment results of craniotomy and external closed drain in patients with chronic subdural hematomas

Aim. To conduct a comparative analysis of the treatment results of the patients with chronic subdural hematoma using two methods: closed external drainage and craniotomy.Materials and methods. The data of 55 patients with chronic subdural hematoma operated in the I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine from 2019 to mid-2023 was analyses retrospectively. Depending on the treatment method, patients were divided into 2 groups: external subdural drains (n = 30, 55.5 %) and evacuation of hematoma via craniotomy (n = 25, 45.5 %). The patients in the groups were comparable in clinical features, radiological characteristics and the Charlson comorbidity index. In the postoperative period, the following were assessed: hematoma thickness and displacement of median structures, occurrence of surgical complications, and mortality.Results. There were no differences between the groupsin the midline shift, the frequency of postoperative complications, reoperation and deaths. The thickness of the hematomas according to the control computed tomography scans of the brain was lower in the craniotomy group, but this did not determine the outcome of treatment. Patients with a Charlson Comorbidity Index value of 4 points or higher were significantly more likely to have an unfavorable outcome. The sensitivity and specificity of the index in predicting an unfavorable outcome was 71.4 and 69.7 %, respectively.Conclusion. There were no differencesin the effectiveness of craniotomy and externalsubdural drains of chronic subdural hematoma. In this regard, it is necessary to give preference to minimally invasive methods of treatment. Assessment of the comorbid status allows predicting an unfavorable outcome of treatment.

A Bayesian model to analyse the association of comorbidities with biosimilar treatment retention in a non-medical switch scenario in patients with inflammatory rheumatic musculoskeletal diseases

ObjectivesTo analyse clinical outcomes of a non-medical switch from originator adalimumab (ADA) to its ABP501 biosimilar (ABP) over 6 months in patients with inflammatory rheumatic musculoskeletal diseases (RMD) in relation to comorbidity as a risk factor for therapy discontinuation.MethodsRMD patients switching from originator ADA to ABP were identified from a large routine database from October 2018 onwards. Documented clinical data at the time of non-medical switching (baseline), and at 3 and 6 months were collected. Comorbidities were represented by the Charlson Comorbidity Index (CCI) at baseline and patients were categorized based on CCI > 0. Differences in the ABP retention rate over 6 months between patients with CCI = 0 and patients with CCI > 0 were analysed using Bayesian exponential regression.ResultsA total of 111 patients with axial spondyloarthritis (n = 68), rheumatoid arthritis (n = 23) and psoriatic arthritis (n = 15), were identified, 74.8% of whom had continued treatment with ABP after 6 months, while a smaller proportion had either switched to another ADA biosimilar (10.8%), switched back to originator ADA (7.2%), switched to a different biologic (3.6%), or dropped out (3.6%). At baseline, a CCI > 0 was found in 38% of patients. Cardiovascular comorbidities (40%) were most prevalent followed by diseases of the skin (33%), the gastrointestinal tract (20%) and the eye (20%). ABP treatment was continued after 6 months in 74% of patients with CCI = 0 and in 76% with CCI > 0. Bayesian analysis showed only a small difference (months) in the APB continuation rate between groups (estimate 0.0012, 95% credible interval (CrI) -0.0337 to 0.0361). Adjusting for age, sex, and disease subtype revealed somewhat shorter retention rates for patients with CCI > 0, but the distribution of the difference included 0 (estimate -0.0689, 95% CrI -0.2246 to 0.0234).ConclusionIn a non-medical switch scenario of RMD patients, there was no evidence for a considerable difference in ABP retention rates over 6 months between comorbidity groups.

Parathyroidectomy and the Development of New Depression Among Adults With Primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with neuropsychiatric symptoms. Although parathyroidectomy has been associated with improvement of preexisting depression among adults with PHPT, the effect of parathyroidectomy on the development of new depression is unknown. To determine the effect of early parathyroidectomy on the incidence of new depression among adults with PHPT compared with nonoperative management. Analyzed data included observational national Veterans Affairs data from adults with a new diagnosis of PHPT from 2000 through 2019 using target trial emulation with cloning, a biostatistical method that uses observational data to emulate a randomized clinical trial. New depression rates were compared between those treated with early parathyroidectomy vs nonoperative management using an extended Cox model with time-varying inverse probability censoring weighting, adjusted for patient demographics, comorbidities, and depression risk factors. Eligible adults with a new biochemical diagnosis of PHPT, excluding those with past depression diagnoses, residing in an assisted living/nursing facility, or with Charlson Comorbidity Index score higher than 4 were included. These data were analyzed January 4, 2023, through June 15, 2023. Early parathyroidectomy (within 1 year of PHPT diagnosis) vs nonoperative management. New depression, including among subgroups according to patient age (65 years or older; younger than 65 years) and baseline serum calcium (11.3 mg/dL or higher; less than 11.3 mg/dL). The study team identified 40 231 adults with PHPT and no history of depression of whom 35896 were male (89%) and the mean (SD) age was 67 (11.3) years. A total of 3294 patients underwent early parathyroidectomy (8.2%). The weighted cumulative incidence of depression was 11% at 5 years and 18% at 10 years among patients who underwent parathyroidectomy, compared with 9% and 18%, respectively, among nonoperative patients. Those treated with early parathyroidectomy experienced no difference in the adjusted rate of new depression compared with nonoperative management (hazard ratio, 1.05; 95% CI, 0.94-1.17). There was also no estimated effect of early parathyroidectomy on new depression in subgroup analyses based on patient age or serum calcium. In this study, there was no difference in the incidence of new depression among adults with PHPT treated with early parathyroidectomy vs nonoperative management, which is relevant to preoperative discussions about the benefits and risks of operative treatment.

A multicenter retrospective study to assess feasibility, safety and efficacy of first-line carboplatin-paclitaxel versus carboplatin monotherapy in a frail, elderly epithelial ovarian cancer population

ObjectiveUnderrepresentation of elderly ovarian cancer patients in clinical trials has led to lack of clarity regarding optimal first-line chemotherapy in this cohort. The Elderly Women with Ovarian Cancer (EWOC)-1 trial...

Higher energy delivery is associated with improved long-term survival among adults with major burn injury: A multicenter, multinational, observational study.

Numerous feeding strategies have been used to mitigate the catabolism of major burn injury. Whether higher energy and/or protein delivery results in better long-term outcomes is unknown. We performed a secondary analysis of data from adults with major burn injuries enrolled in the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury at 54 burn centers in 18 countries. The sample was restricted to those who were mechanically ventilated within 72 hours of injury and for ≥7 days. Our key exposure was adequacy of energy, and protein ([Deliveredi/Prescribedi] × 100) was categorized into three groups each: low, 0% to 50%; moderate, ≥50% to 79%; and high, ≥80%. We also analyzed adequacy using restricted cubic splines. Primary and secondary outcomes included 6-month mortality and functional outcomes (i.e., 36-Item Short-Form Health Survey, Katz Index of Independence in Activities of Daily Living, Lawton Activities of Daily Living scores), respectively. Regression models were adjusted for age, body mass index, Charlson Comorbidity Index, baseline Acute Physiology and Chronic Health Evaluation II and modified Sequential Organ Failure Assessment scores, burn size, energy/protein adequacy, and study site. A total of 493 participants met the cohort restriction criteria; 336 participants were alive at 6 months. 36-Item Short-Form Health Survey, Katz Index of Independence in Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale were completed by 218, 216, and 215 participants, respectively. The mean ± SD age was 48 ± 17 years, and 74% were male. The mean ± SD burn size was 41% ± 18% total body surface area. Participants who received 25% of recommended calories had nearly four times the hazard of death during the 6-month follow-up period than participants who received 100% of prescribed calories (adjusted hazard ratio, 3.89; 95% confidence interval, 1.35-11.20) (p = 0.02). There was no significant association between protein and 6-month mortality or energy/protein delivery and 6-month functional outcomes. There was a positive association between higher doses of energy and 6-month survival. This relationship conflicts somewhat with several energy studies among critically ill and non-burn-injured patients. The lack of consistent evidence on optimal nutrition for critically injured patients, a fundamental component of burn care, suggests potential for a randomized trial of lower versus higher energy to improve long-term outcomes after burn injury. Therapeutic/Care Management; Level III.

A Longitudinal analysis of weight changes before and after total hip arthroplasty: Weight trends, patterns, and predictors.

It is crucial to understand weight trends in patients undergoing total hip arthroplasty (THA). To evaluate preoperative and postoperative weight trends for patients undergoing primary THA and factors associated with clinically significant weight change. A prospective cohort who underwent primary unilateral THA (n= 3,011) at a tertiary healthcare system (January 2016 to December 2019) were included in the study. The primary outcomes were clinically significant weight change (> 5% change in body mass index [BMI]) during the one-year preoperative and one-year postoperative periods. Preoperatively, 66.6% maintained a stable weight, 16.0% gained and 17.4% lost weight, respectively. Postoperatively, 64.0% maintained a stable weight, while 22.6% gained and 13.4% lost weight, respectively. Female sex, Black race, obesity, higher Charlson Comorbidity Index (CCI) scores, and older age were associated with preoperative weight loss. Female sex, obesity, higher CCI scores, and Medicare insurance were associated with postoperative weight loss. Preoperative weight loss was associated with postoperative weight gain (OR = 3.37 [CI: 2.67 to 4.25]; p< 0.001), and preoperative weight gain was associated with postoperative weight loss (OR = 1.74 [CI: 1.30 to 2.3]; p< 0.001). Most patients maintained a stable BMI one-year before and one-year after THA. Several factors are associated with weight loss before and after THA. Preoperative weight changes were associated with a reciprocal rebound in BMI post-operatively.

Burden of illness and treatment attitudes among participants meeting Rome IV criteria for irritable bowel syndrome: A nationwide survey in the United States.

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by abdominal pain and altered bowel habits, with patient-perceived dissatisfaction of treatment symptom control. We assessed disease burden, satisfaction with medication use, and impact on activities, in participants with IBS with constipation (IBS-C) and diarrhea (IBS-D). This study assessed data from a large, United States survey of adults querying demographics, comorbid conditions, quality of life, medication use, satisfaction with symptom control, and work productivity. Participants were grouped into the IBS-C or IBS-D cohort if they met Rome IV criteria, with controls matched 1:1 according to age, sex, race, region, and Charlson Comorbidity Index score. All data were self-reported. Nine hundred and ten participants with IBS-C and 669 with IBS-D were matched to controls. The most reported symptoms were abdominal discomfort for IBS-C and abdominal pain and abdominal discomfort for IBS-D. Among the IBS-C and IBS-D cohorts, 74.2% and 65.9%, respectively, took prescription and/or over-the-counter medication for their symptoms. Respondents were more dissatisfied than satisfied with control of their symptoms. Respondents taking prescription medication(s) with or without over-the-counter medication(s) reported better symptom control than respondents only taking over-the-counter medications (p < 0.001). There was significantly higher mean presenteeism, work productivity loss, and daily activity impairment (p < 0.001 for all) in respondents with IBS compared with controls. This study provides insight into respondents' experiences of IBS symptoms, including the impact on daily activity, as well as satisfaction with control of symptoms and prescription and over-the-counter medications.

Extracorporeal membrane oxygenation support in adult patients: Comparing COVID-19- and non-COVID-19-associated respiratory failure.

Extracorporeal membrane oxygenation (ECMO) is a vital intervention for acute respiratory distress syndrome (ARDS), yet its efficacy with coronavirus disease 2019 (COVID-19) remains unknown. This study compared the long-term mortality rates of patients receiving ECMO for COVID-19 with those experiencing other respiratory disease-associated ARDS. This retrospective cohort study included adults with ARDS receiving ECMO for respiratory disease (COVID-19 and non-COVID-19) based on information collected from the National Health Insurance Service of South Korea from February 1, 2020, to December 31, 2021. The primary outcome was all-cause mortality at 6 months and 1 year post-ECMO initiation. Data from 3094 patients with COVID-19 (N = 1095) and non-COVID-19 respiratory disease-associated ARDS (N = 1999) who received ECMO support were analyzed. Despite a higher Charlson Comorbidity index in the non-COVID group, patients with COVID-19 had higher cumulative mortality rates at 6 months and 1 year post-ECMO initiation compared to those with non-COVID-19 respiratory diseases, after adjusting for confounders. Patients with COVID-19 also experienced longer intensive care unit stays, higher hospitalization costs, longer ECMO and mechanical ventilation durations, and lower intensity coverage. Patients with COVID-19 requiring ECMO showed higher mortality rates, possibly due to its distinct long-lasting and potentially fatal consequences compared to other respiratory illnesses.

Comorbidity, Eating Behaviors and Smartphone Addiction in Italian Nurses' Characteristics.

Evidence suggested how nurses experienced worse lifestyles than the general population by recording deterioration rates in healthy conditions. To assess differences between comorbidity, eating behavior, and smartphone addiction according to sex, Body Mass Index (BMI), age, work experience, shift, alcohol assumption, and physical activity in Italian nurses. An online questionnaire was spread through some professional internet pages. Data included demographic characteristics, the Charlson Comorbidity Index (CCI), the Italian Version of the Dutch Eating Behavior Questionnaire, and the Smartphone Addiction Scale (SAS-SV). A total of 456 nurses were recruited. Significant differences were registered in the smartphone addiction score (p=0.030) and BMI scores and work experience (p=0.001), as underweight participants reported higher scores in the smartphone addiction attitude (2.4714 ± 1.25812) than the other subjects and also participants with the highest number of years in work experience also reported higher smartphone addiction scores (2.8074 ± 1.2022). Significant difference was reported in the CCI scores according to age (p<0.001): subjects aged over 61 years recorded higher scores in the CCI (1.67 ± 1.528) and also according to work experience and CCI scores (p<0.001), as participants employed between 21 and 30 years reported higher scores in the CCI (1.27 ± 1.382) and also to night shift (p=0.037), as participants who worked during the night shift also reported higher scores in the CCI. A significant difference was reported only for restrained eating attitude (p=0.034), as participants who declared to assume alcohol 2-3 times per month recorded higher levels in this eating attitude aspect (32.32 ± 7.181). Female nurses, overweight and obese nurses with low physical activity practice, seemed to spend more time with their smartphones. Healthcare organizations should consider findings to prevent unhealthy lifestyles among nurses, which could negatively influence the whole healthcare system.

Prevalence of Potential Drug Interactions With Direct-Acting Antivirals for COVID-19 Among Hospitalized Patients

PurposeClinicians consider polypharmacy, comorbidities, and other factors including the potential for drug-drug interactions (DDIs) when evaluating therapeutic options for specific clinical diagnoses. Contemporary treatment for coronavirus disease 2019 (COVID-19) includes direct-acting antivirals (DAAs). We sought to characterize patients’ characteristics, comorbidities, and medications received during their hospitalization for COVID-19 and quantify potential DDIs that clinicians consider in selecting appropriate DAAs. MethodsPatients hospitalized with a primary diagnosis of COVID-19 between May 2020 and December 2022 from the PINC AI Healthcare Database were identified. Medications administered during the hospitalization with the potential to cause DDIs with nirmatrelvir/ritonavir, remdesivir, or molnupiravir (per the Emergency Use Authorization factsheet or package insert) were assessed. For DDIs with nirmatrelvir/ritonavir, medications are categorized as “Contraindicated,” “Avoid Concomitant Use,” or “Other DDIs” (includes recommendation for dose modification or clinical and laboratory monitoring). For remdesivir, coadministration with chloroquine phosphate and hydroxychloroquine sulfate was not recommended. For molnupiravir, no drugs are listed as having potential DDIs. In a subset of patients, a multivariable logistic regression model was used to examine the association between documented patient/hospital characteristics and the likelihood of being “Contraindicated” to receive nirmatrelvir/ritonavir. FindingsOf the 788,238 patients hospitalized for COVID-19 in 920 hospitals, 53% were ≥ 65 years old, and 31% had Charlson Comorbidity Index (CCI) ≥ 3. During the study period, about half of the patients received medications categorized as “Contraindicated” (11%) and/or “Avoid Concomitant Use” (41%) with nirmatrelvir/ritonavir. The frequency of administered drugs was higher in those aged ≥ 65 years (68%), CCI ≥ 3 (78%), with high-risk underlying conditions (55%). About 1% of patients received medications that were not recommended to be coadmistered with remdesivir. Among a subset of patients hospitalized for COVID-19 in 2022, those who were older, had higher CCI, high-risk underlying conditions, severe hepatic impairment, Medicare insurance, and hospitalized in larger hospitals were significantly more likely to be categorized as “Contraindicated” when considering nirmatrelvir/ritonavir as a therapeutic option to manage COVID-19. ImplicationsA significant proportion of patients hospitalized for COVID-19 receive medications for other conditions that have the potential to result in DDIs with DAAs; most predominantly with nirmatrelvir/ritonavir, a strong CYP3A enzyme inhibitor, fewer with remdesivir, and none with molnupiravir. Higher age and comorbidity burden were significantly associated with a higher likelihood of receiving medications that are “Contraindicated” with nirmatrelvir/ritonavir. In the evolving COVID-19 era, these findings provide insights into patients hospitalized for COVID-19, and the polypharmacy evaluations that clinicians may encounter when selecting among DAAs to manage COVID-19.

The Use of Tranexamic Acid for Primary Prophylaxis of Heterotopic Ossification Following Total Hip Arthroplasty

BackgroundHeterotopic ossification (HO) is a relatively common complication after total hip arthroplasty (THA) and can range from a radiographic observation only to severely disabling and requiring revision surgery. Prophylaxis is recommended for high-risk patients, though the ideal method and targeted population are open to debate. Tranexamic acid (TXA) is a medication increasingly being used to reduce blood loss associated with orthopaedic surgeries, including THA. MethodsA retrospective review of 357 patients undergoing THA from November 2020 through December 2023 was conducted. The patients were grouped based on whether they received intravenous TXA perioperatively or not, and their propensity score matched 2:1 TXA to no TXA on age, body mass index, sex, Charlson Comorbidity Index, and perioperative celecoxib use. Univariate and multivariate analyses were performed. ResultsAfter propensity score matching, the only significant differences between groups were American Society of Anesthesiologists (ASA) scores and preoperative celecoxib use between groups, as the TXA group had fewer patients who had an ASA of 3 or more (38.9 versus 58.5%, P < 0.001) and more patients who had taken celecoxib preoperatively (16.3 versus 5.9%, P = 0.010). Perioperatively, patients were more likely to undergo THA using the anterior approach (74.5 versus 57.6%, P = 0.002) and were more likely to receive postoperative celecoxib prescriptions (44.8 versus 31.4%, P = 0.021), but there was no difference in other nonsteroidal anti-inflammatory drug (NSAID) usage postoperatively. Postoperatively, patients who received TXA had a lower rate of HO on the last postoperative x-ray (20.1 versus 33.9%, P = 0.007). Multivariable logistic regression, to assess predictors of HO, found that patients who had TXA were 42% less likely to have visible HO (OR [odds ratio] = 0.58, P = 0.047), while holding surgical approach, American Society of Anesthesiologists score, preoperative and postoperative celecoxib use, and postoperative other nonsteroidal anti-inflammatory drug use constant. ConclusionsThe use of TXA in patients undergoing primary THA results in a decreased likelihood ofHO formation on postoperative x-rays.

Robotic and Laparoscopic Adrenalectomy for Pheochromocytoma: An International Multicenter Study

Background and objectiveRobotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients. MethodsData for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed. We analyzed baseline characteristics and postoperative complications at discharge, 90 d, and 1 yr. We conducted propensity score matching (PSM; 1:1 ratio) and multivariable analyses to evaluate outcomes and risk factors for the occurrence of complications and higher Comprehensive Complication Index (CCI). Key findings and limitationsOf 1755 patients, 1613 (91.9%) underwent LA and 142 (8.1%) underwent RA. Estimated blood loss, conversion rate, complication rate, and CCI at discharge, 90 d, and 1 yr were similar between the groups. However, RA was associated with a longer operative time in comparison to LA (100 vs 123 min; p < 0.001), but not after PSM (p = 0.120). Multivariable analysis revealed that Charlson comorbidity index (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.07–1.29; p = 0.001), and tumor size per 1-cm increment (OR 1.13, 95% CI 1.07–1.21; p < 0.001) were independently associated with the incidence of complications, but there was no significant difference in complication rates between the LA and RA groups (OR 1.09, 95% CI 0.63–1.87; p = 0.767). After PSM, RA was associated with a lower rate of severe (grade ≥3a) complications in comparison to LA (p = 0.023). Conclusions and clinical implicationsRA is a safe alternative to LA and yields similar outcomes for patients with pheochromocytoma. RA may be associated with a lower likelihood of severe complications. Further studies are warranted to determine the role of robotic surgery in pheochromocytoma. Patient summaryPheochromocytoma is a rare tumor in the adrenal gland and the gold-standard treatment is surgical removal. We assessed patient outcomes after robot-assisted surgery compared with laparoscopic surgery and found that outcomes are similar, but the rate of severe complications may be lower if a surgical robot is used.

Abstract P123: Gender Difference in the In-hospital Mortality for Hypertensive Heart Disease – United States Population-Based Survey Analysis

Background: Females have steeper increases in blood pressure than males throughout life, thus setting the stage for gender based phenotypic and clinical differences in hypertension related pathologies. We set out to determine the in-hospital mortality for the patients primarily admitted for Hypertensive Heart Disease (HHD) in the United States. Methods: Data was extracted from the National Inpatient Sample (NIS) 2016 - 2020 Database. We used ICD-10 code I11.9 to identify the patients primarily admitted for HHD. Multivariable Logistic regression was used to estimate Odds Ratio (OR) for in-hospital mortality between the two genders. Multivariable Poisson regression model was performed for yearly trends with year as the independent variable and in-hospital mortality as the dependent variable. In-hospital mortality rate trends between the two genders were compared using a group-year interaction term in a multivariable regression analysis with in-hospital mortality event as the dependent variable. All the outcomes were adjusted for age, insurance status, race, Charlson comorbidity index (CCI) and the hospital characteristics (location, bed-size). The analysis was performed on STATA 16 software. Results: We identified 1,877,150 patients with HHD. Mean age of the patient cohort was 70 years, mean CCI was 2.7 and 51% were females. Unadjusted in-hospital mortality rate for males was 1.6% compared to 1.8% for females. When adjusted for cofounders, females had lower risk of in-hospital mortality compared to males (OR: 0.95, 95% CI 0.90 – 0.99). In-hospital mortality rate for either gender did not appreciably change from 2016 – 2020, however, when compared to males the mortality rate for females rose more sharply (Interaction p = 0.038) as shown in Figure 1. Conclusion: In our adjusted population-based survey analysis, short term mortality risk for HHD was lower for females than males, however, during the study period 2016 – 2020 mortality rate for females rose more sharply than for male subjects.

Drugs with Anticholinergic Properties and Association with Hip Fractures in Older Patients: A Danish Nationwide Cohort-Study.

Hip fractures (HFx) resulting from falls are a significant health concern, and drugs with anticholinergic properties (DAP) increase the risk of falls. This study aimed to assess the association between use of DAP at hospital admission and HFx risk in older patients. This nationwide population-based study included all patients ≥65 years admitted to Danish geriatric wards during 2005-2014. Outcome of interest was first HFx within 2-years follow-up. The Anticholinergic Cognitive Burden (ACB) scale quantified DAP use. Cox regression analysis of data from four national registries was adjusted for activities of daily living, age, marital status, admission year, BMI, fracture history, previous admissions, dementia, anti-osteoporotic drugs, and Charlson comorbidity index. 74,589 patients (62.8% female) were included, 45,463 (60.9%) received DAP at index, and 7,861 HFx occurred during follow-up. Cumulative 2-year HFx hazard was highest for ACB=0 (15.3%). Higher ACB-score was not associated with increased HFx risk in univariable nor multivariable analyses. In sensitivity analysis, use of DAP with high anticholinergic burden (≥2) did not alter results. In this high-incidence national cohort, higher ACB-score was not associated with increased HFx risk. Our results call for further research on association between specific DAP and risk of HFx.

Epidemiologic characteristics and risk factors of Clostridioides difficile infection in patients with active tuberculosis in the Republic of Korea: a nationwide population-based study

The relationship between anti-tuberculosis (TB) agents and Clostridioides difficile infection (CDI) remains unclear. This study aimed to investigate the epidemiological characteristics and risk factors for CDI in patients with TB. This nationwide, population-based cohort study was conducted in the Republic of Korea (ROK) between January 2018 and December 2022. Data were extracted from the National Health Insurance Service (NHIS) National Health Information Database. The risk factors for CDI in patients with TB were identified through multivariate logistic regression analysis using a 1:4 greedy matching method based on age and sex. During the study period, CDI developed in 2,901 of the 131,950 patients with TB who were prescribed anti-TB agents. The incidence of CDI in patients with TB has increased annually in the ROK from 12.31/1000 in 2018 to 33.51/1000 in 2022. Oral metronidazole (81.94%) was the most common first-line treatment for CDI. The in-hospital mortality rate of patients with concomitant CDI and tuberculosis was 9.9% compared with 6.9% in those with TB alone (P<0.0001). Multivariate logistic regression analysis found intensive care unit admission, Charlson Comorbidity Index ≥3, antibiotics exposure, standard regimen, multidrug resistant TB, and extrapulmonary TB as significant risk factors for development of CDI in patients with TB. CDI is uncommon in patients with TB, but it results in a significantly increased mortality rate. Patients being treated for TB should be carefully monitored for the development of CDI. Further clinical research is warranted to identify effective interventions for preventing and controlling CDI during TB treatment.

346. ESOPHAGOGASTRIC JUNCTION SIEWERT II TUMORS, A CHALLENGE FOR THE SURGEON: RESULTS OF TRANSHIATAL EXTENDED GASTRECTOMY VS. IVOR LEWIS ESOPHAGECTOMY

Abstract Background Esophagogastric junction (EGJ) Siewert type II tumors pose unique challenges in terms of adequate surgical treatment due to their anatomical location and potential for abdominal and mediastinal lymph node metastasis. The optimal surgical approach for these tumors remains a topic of debate, with options including transhiatal extended gastrectomy or transthoracic esophagectomy. Understanding the different outcomes associated with these surgical interventions is crucial for informed decision-making and patient-tailored management. The aim of this study was to compare the perioperative and oncological outcomes of these two surgical technique to access which could be the treatment of choice for Siewert II type tumours. Methods This study is a retrospective non-randomized cohort study from a single center. We reviewed the data of all the patients who underwent surgery for EGJ Siewert type II tumors between December 2014 and February 2023. The patients were divided into two groups: those who underwent transthoracic esophagectomy were assigned to “TE group” (72 patients) and those who underwent transhiatal extended gastrectomy were assigned to “TEG group” (21 patients). Results Patients in the TEG group were older (p=0.011) and in worst clinical condition (Charlson Comorbidity Index 4.15±1.78 vs. 4.95±1.46, p=0.064). The tumour stage at the diagnosis was more advanced in the TE group (p=0.004), and upfront surgery was infrequent in this group (p&amp;lt;0.001). The average duration of surgery was higher in the TE group (p&amp;lt;0.001). No difference was seen in the tumour length (p=0.924), implying a statistically significant difference in the proximal margin length (p&amp;lt;0.001), and distal margin length (p&amp;lt;0.001), with a R0 resection rate higher in the TE group (93.1% vs. 66.7%, p=0.002). The higher rate of R1 resection in the TEG group was mainly due to proximal margin infiltration. No difference was seen in the number of harvested lymph nodes (p=0.339). Overall postoperative complications rates were similar (p=0.144). No differences were found in the length of ICU stay (p=0.676) and in hospital stay (p=0.075). At a median follow up of 20 months, there were no statistical differences in Overall Survival and Disease-Free Survival at 5 years. Conclusion Our data suggests that transthoracic esophagectomy for EGJ Siewert type II tumors should be the treatment of choice for patients in good clinical condition, but transhiatal extended gastrectomy could be a good choice for patients presenting in worse clinical condition. A multidisciplinary approach is essential for optimal patient care, and the selection of the surgical technique should be based on a thorough evaluation of the patient's condition and tumor characteristics

P189 HYPERTENSION AND OBSTRUCTIVE SLEEP APNOEA SYNDROME IN ADULTS WITH HEART FAILURE IN NIGERIA: CLINICAL CORRELATES AND ASSOCIATION WITH CLINICAL OUTCOMES

Rationale: Heart failure (HF) is a common endpoint for cardiovascular diseases. It is a major cause of morbidity and mortality worldwide. Hypertension is a leading cause of HF; a significant proportion of HF patients also have obstructive sleep apnea syndrome (OSAS) which is known to impact clinical outcomes adversely. The diagnosis of OSAS is often missed due to inadequate clinical diagnosis and diagnostic backup. This study aims to add to the body of evidence thereby improving outcomes in HF patients. Methods: This cross-sectional descriptive study involved 200 consenting adults with HF at Jos University Teaching Hospital, Nigeria. Each participant had relevant medical history, physical examination (including a six-minute walk test distance) and relevant investigations. OSAS was diagnosed using high-risk scores obtained using Berlin and STOP-Bang questionnaires, daytime somnolence was assessed by Epworth questionnaire and quality of life by Minnesota living with HF questionnaire. Comorbidities were assessed using Charlson comorbidity index (CCI)) and hospitalizations in the preceding 12 months documented. Data was analyzed using Stata version 13. Results: Hypertension was the aetiology of HF in 41% of the study population and 62.8% of the subset with OSAS (p=0.001). OSAS was identified in 47% and 45.5% by high-risk scores obtained using Berlin and STOP-Bang questionnaires respectively. Significant daytime somnolence was identified in 56.0% of the study population and 93.6% of those with OSAS, (p&lt;0.001). Those with OSAS had a significant association with hypertension (p=0.001), atrial fibrillation (p&lt;0.001), obesity (p=0.002), higher comorbidity index (p=0.001), HF with preserved ejection pattern (p=0.001) and NYHA ≥3 (p&lt;0.001). OSAS was significantly associated with six-minute WTD ≤ 300m, hospitalizations (p&lt;0.001) and sub-optimal quality of life (p=0.003). Conclusion: Hypertension and OSAS are significantly associated and are common in HF. It is recommended to routinely screen HF patients for OSAS as the diagnosis is often missed with consequent adverse clinical outcomes. This will facilitate prompt diagnosis, enhance management and favourable clinical outcomes in HF patients.

Routine Prescription of Proton Pump Inhibitors in the Perioperative Period is Associated With Decreased Rates of 2-Year Revision Surgery After Total Hip and Knee Arthroplasty

BackgroundProton pump inhibitors (PPIs) are often prescribed in conjunction with nonsteroidal anti-inflammatory drugs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) due to their gastroprotective effects. In animal studies, it has been suggested that PPIs have immunosuppressive effects and impair fracture healing; however, the association between PPI use and adverse events following THA and TKA has not been well-studied. MethodsAn administrative claims database was queried for patients who underwent elective THA from 2010 to 2019. The experimental group consisted of patients who did not have a prior history of gastrointestinal bleeding or gastroesophageal reflux disease and who received a PPI prescription in the perioperative period. A 1:1 propensity score matching was used to create control cohorts of patients who did not have any PPI prescription filled, also matching for age, sex, and the Charlson Comorbidity Index. This same cohort selection and matching procedure was then repeated for patients undergoing elective TKA. In total, 11,450 patients were studied (3,103 TKA + PPI, 2,622 THA + PPI, 3,103 TKA controls, and 2,622 THA controls). The mean age was 64 years (range, 38 to 94), and 57% were women. Significance was considered at P < 0.05. ResultsPerioperative PPI prescription in TKA patients was associated with significantly lower rates of all-cause revision (3.0 versus 4.1%, P < 0.01) and periprosthetic joint infection (1.0 versus 1.8%, P < 0.01). In THA patients, PPI prescription was associated with a lower all-cause revision rate (2.8 versus 4.0%, P = 0.02). No significant differences were found between PPI and non-PPI groups for aseptic loosening, periprosthetic fracture, gastrointestinal bleeding, or surgical site infection in either cohort. ConclusionsPatients receiving routine PPI prescriptions in the perioperative period surrounding TKA and THA have a lower risk of all-cause revision surgery, and perioperative PPI use is associated with a decreased risk of PJI in patients undergoing TKA. As these results conflict with the few previous studies performed on this topic, additional controlled studies are warranted to fully elucidate the relationship between PPI use and adverse events after THA and TKA.