Chronic Steroid Use Research Articles

Reduction Mammoplasty in the Pediatric Population: An Analysis of Pediatric NSQIP Data From 2012 to 2019.

Introduction: Reduction mammoplasty is becoming more commonly performed in the pediatric population yet the risk factors for complications have not been well-studied. The purpose of this study was to assess the relationship between preoperative patient characteristics and postoperative complications in a large population of pediatric patients undergoing reduction mammoplasty. Methods: Pediatric patients undergoing reduction mammoplasty were identified within the 2012 to 2019 National Surgical Quality Improvement Program database for cross-sectional study. The predictor variables were age, body mass index (BMI), diabetes, chronic steroid use, time under anesthesia, and operative time, and the primary outcome was a 30-day postoperative surgical site-related complication. Multivariate logistic regression was performed to identify a relationship between predictor variable and primary outcome. Results: A total of 1216 pediatric patients were identified with a mean age of 16.6 years and mean BMI of 30.8 kg/m2. The incidence of overall postoperative complications was 4.6%. Superficial surgical site infection (SSI) was the most common complication (29/1216; 2.4%). BMI was significantly associated with superficial SSI (odds ratio: 1.03, 95% confidence interval: 1.00-1.05, P = .02). Sixteen patients (1.32%) underwent a second operation, most commonly to address hematoma/seroma (7/16; 43.8%). Conclusion: In a large series of patients, pediatric reduction mammoplasty is a safe procedure with a low complication rate. BMI was significantly associated with the incidence of superficial SSIs with the most common cause for reoperation being a hematoma/seroma. This study can help guide the discussion between physicians and patients regarding potential risks associated with pediatric reduction mammoplasty.

Chronic Steroid Use in Patients Undergoing Liver Resection: Does It Affect Outcomes?

Chronic Steroid Use in Patients Undergoing Liver Resection: Does It Affect Outcomes?

Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study.

Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty. The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis. A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p=0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p=0.016), and had chronic steroid use (25.9% vs. 12.9%, p=0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p=0.020) and chronic steroid use (OR: 3.81, p=0.018). This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS. 4 Laryngoscope, 133:1938-1942, 2023.

DISSEMINATED STRONGYLOIDES PRESENTING WITH DIFFUSE ALVEOLAR HEMORRHAGE

DISSEMINATED STRONGYLOIDES PRESENTING WITH DIFFUSE ALVEOLAR HEMORRHAGE

DISSEMINATED NOCARDIOSIS IDENTIFIED BY MATRIX-ASSISTED LASER DESORPTION/IONIZATION/TIME OF FLIGHT (MALDI-TOF0) MASS SPECTROMETRY

DISSEMINATED NOCARDIOSIS IDENTIFIED BY MATRIX-ASSISTED LASER DESORPTION/IONIZATION/TIME OF FLIGHT (MALDI-TOF0) MASS SPECTROMETRY

DISSEMINATED INVASIVE ASPERGILLUS MASQUERADING AS AMIODARONE-INDUCED THYROTOXICOSIS

DISSEMINATED INVASIVE ASPERGILLUS MASQUERADING AS AMIODARONE-INDUCED THYROTOXICOSIS

S2793 Adrenal Crisis in a Patient With Crohn’s Disease: A Legacy of the Corticosteroid Treatment Era

Introduction: Before the era of biologic agents, corticosteroids were the most effective therapy available for inflammatory bowel disease (IBD) as well as other inflammatory and immune-mediated disorders, and treatment often was prolonged. As a result, many patients developed secondary adrenal insufficiency, in which the normal circadian rhythm of cortisol secretion was maintained but a defect in the cortisol response to stress persisted, as was the risk of adrenal crisis in response to severe physiologic stress. As corticosteroids are no longer used chronically in IBD, adrenal crisis has become a rare complication, and many gastroenterologists have no personal experience with it. We recently saw such a case which we are presenting as a reminder of its continued existence. Case Description/Methods: A 73-year-old female with Crohn’s disease diagnosed at the age of 18, complicated by short bowel syndrome and esophageal involvement, who had been steroid dependent for 15 years though stable on ustekinumab and no steroids for more than 8 years, presented to the emergency department with an acute onset of abdominal pain, diarrhea with incontinence, profound weakness, disorientation, and possible syncope, one hour after IV iron sucrose therapy. Initial physical exam was notable for pallor and edema of hands and feet. Laboratory exams showed hemoconcentration, leukocytosis, hyponatremia, plus elevated serum lactate concentration and anion gap. Because of the severity of this response, the possibility of adrenal crisis was raised: serum cortisol was 15.5 ug/dL (nl 6.2-29) despite the stressful situation and the patient responded clinically to 100 mg of hydrocortisone IV. She was discharged within 24 hours and all laboratory abnormalities reversed within 72 hours. Discussion: Adrenal crisis can present with a wide variety of nonspecific symptoms and should be in the differential diagnosis when a patient presents after a significant physiologic stress and has a history of chronic oral corticosteroid use. Electrolyte disturbances are less common in secondary adrenal insufficiency as the zona glomerulosa of the adrenal gland is not affected. Secondary adrenal insufficiency may persist for many years after chronic steroid use and may be permanent. In patients with secondary adrenal insufficiency. Important hints are the patient’s age and GI history, which includes extent of exposure to corticosteroids. Effective diagnosis requires maintaining a high index of suspicion.

S2411 A Case of Esophagitis in a Patient With Poorly Controlled Systemic Lupus Erythematosus

Introduction: Primary Systemic Lupus Erythematosus (SLE) esophagitis is a rare entity that most commonly presents with odynophagia and dysphagia. Though esophageal involvement with SLE is common, it typically manifests as a motility disorder or secondary infectious or pill esophagitis rather than a primary SLE esophagitis. While its underlying pathologic mechanisms may be similar to other manifestations of SLE, SLE esophagitis remains poorly understood. Case Description/Methods: A 33-year-old man with history of juvenile discoid SLE complicated by arthritis, cutaneous involvement, oral ulcers, cerebritis, and 4-limb avascular necrosis secondary to chronic steroid use presented with a week of worsening oral ulcers, new-onset odynophagia, stable diffuse arthralgias, and active discoid lupus with ear and scalp involvement. His oral ulcers were more numerous and painful than was typical for his flares, and he had not previously experienced odynophagia during flares. Esophagogastroduodenoscopy (EGD) revealed diffuse erythematous, exudative, sloughed mucosa throughout the entire esophagus and stomach, while initial pathology revealed nonspecific findings with concern for possible vesiculobullous disorder. The patient was managed with increased immunosuppression for presumed SLE flare and his symptoms improved. Repeat EGD was performed to rule out an autoimmune blistering process, and immunofluorescence demonstrated granular deposits of IgG, IgM, and complement within the epithelial basement membrane, suggestive of SLE as the basis for the esophageal inflammation (Figure). Discussion: SLE esophagitis is an uncommon condition that results from granular deposition of immune complexes in the basement membrane of the esophageal epithelium, representing a form of SLE mucositis in an unusual location. In patients with a history of SLE who present with odynophagia or dysphagia this diagnosis should be considered as a possibility, especially in those with many previous SLE-related complications. Diagnosis requires EGD with biopsy to differentiate between this and more common causes of esophagitis seen in SLE patients. Management of SLE esophagitis should mirror treatment of other SLE flares with appropriate immunosuppressive therapy but warrants follow-up with a gastroenterologist to assess need for future EGD monitoring.Figure 1.: A: Ulcers on palate of mouth; B: Middle third of the esophagus; C: Lower third of the esophagus; D: Antrum of the stomach.

Risk Factors for 30-day Unplanned Readmission following Surgery for Lumbar Degenerative Diseases: A Systematic Review.

Systematic review. Surgical procedures for lumbar degenerative diseases (LDD), which have emerged in the 21-century, are commonly practiced worldwide. Regarding financial burdens and health costs, readmissions within 30days following surgery are inconvenient. We performed a systematic review to integrate real-world evidence and report the current risk factors associated with 30-day readmission following surgery for LDD. The Cochrane Library, Embase, and Medline electronic databases were searched from inception to April 2022 to identify relevant studies reporting risk factors for 30-day readmission following surgery for LDD. Thirty-six studies were included in the review. Potential risk factors were identified in the included studies that reported multivariate analysis results, including age, race, obesity, higher American Society of Anesthesiologists score, anemia, bleeding disorder, chronic pulmonary disease, heart failure, dependent status, depression, diabetes, frailty, malnutrition, chronic steroid use, surgeries with anterior approach, multilevel spinal surgeries, perioperative transfusion, presence of postoperative complications, prolonged operative time, and prolonged length of stay. There are several potential perioperative risk factors associated with unplanned readmission following surgery for LDD. Preoperatively identifying patients that are at increased risk of readmission is critical for achieving the best possible outcomes.

A case study of successful percutaneous coronary intervention in a young adult with chronic graft-versus-host disease with acute coronary syndrome

Introduction: Acute coronary syndrome in pediatric patients with graft-versus-host disease is rare. Case Report: We present an 18-year-old male with graft-versus-host disease referred for chest pain, electrocardiogram abnormalities, and troponin leak. Additional risk factors for acute coronary syndrome included chronic steroid use, elevated triglyceride/low-density lipoprotein (LDL) levels and cannabis use. A catheterization revealed &gt;90% occlusion of the left coronary artery and he underwent successful percutaneous intervention. Conclusion: Given the overall rarity of acute coronary syndrome in pediatric patients, it may go unrecognized and underappreciated as a significant cause of morbidity in those with graft-versus-host disease.

Rapidly progressive dementia by cryptococcal meningitis: A case report

Dementias constitute a group of degenerative diseases that affect different domains within human cognition. While the usual course is chronically progressive, a small group of patients develops a subacute deterioration in months, an entity that is called rapidly progressive dementia. For these patients, an approach based on considering reversible etiologies is mandatory, and its diagnosis must be taken into consideration not only in immunocompromised patients by the human immunodeficiency virus (HIV) but also in patients with other causes of immunosuppression. We report the case of a patient with chronic use of steroids that developed rapidly progressive dementia as the sole manifestation of cryptococcal meningoencephalitis.

Meta-analysis of patient risk factors associated with post-bariatric surgery leak.

Modifiable risk factors such as diabetes, hyperlipidemia, hypertension, obstructive sleep apnea (OSA), chronic kidney disease (CKD), chronic steroid use and smoking, have been shown in observational studies to negatively affect surgical outcomes. The purpose of this study is to identify and determine the effect of modifiable risk factors on post-operative bariatric surgery leak, as pre-operative risk modification has been shown to reduce the impact on complications. Electronic literature searches of MEDLINE, PUBMED, OVID and Cochrane Library databases were performed, including a manual reference check, over the period of 2010 and 2020. 620 articles were screened according to the PRISMA protocol. Twenty articles were included in the meta-analysis of risk factors. Significant risk factors and the associated effect sizes include: 1. Smoking with an overall OR of 1.31 [1.06, 1.61] and an OR of 1.72 [1.44, 2.05] in Sleeve gastrectomy (SG) patient cohorts; 2. Diabetes with an overall OR of 1.23 [1.08, 1.39] and an OR of 1.33 [1.02, 1.73] in Roux-en-Y patient cohorts; 3. Chronic kidney disease with an overall OR of 2.41 [1.62, 3.59] and 4. Steroid use with an overall OR of 1.57 [1.22, 2.02]. Non-significant risk factors include hypertension with an OR of 0.85, 1.83, OSA with an OR of 1.08 [0.83, 1.39] and hyperlipidemia with an OR of 0.80 [0.61, 1.04]. Combined SG and Roux-en-Y patient cohorts with hyperlipidemia have shown a protective effect of 0.78 [0.65, 0.94]. Significant risk factors for leak post bariatric surgery are smoking in all patients and particularly SG patients, diabetes for all patients and particularly Roux-en-Y patients, and CKD and chronic steroid for all patients. Hyperlipidemia in two combined patient cohorts (SG and Roux-en-Y) appears to have a weak protective effect.

Chronic steroid use and readmission following total shoulder arthroplasty.

BackgroundDegenerative arthritis is a major indication for both anatomic and reverse total shoulder arthroplasty (TSA). Degenerative arthritis is an age-related process that can be secondary to mechanical wear or inflammatory or autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus. Management of these diseases can include chronic corticosteroid for their anti-inflammatory and immunosuppressive effects. Given the well-known complications of chronic steroid use on other surgical procedures, investigation into postoperative complications specific to TSA will assist physicians in risk stratification and preoperative planning. The purpose of this study was to investigate the association between chronic preoperative steroid use and postoperative complications following TSA.MethodsThe American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2020. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. Multivariate logistic regression was used to identify postoperative complications associated with chronic preoperative steroid use. Reasons and risk factors for readmission among chronic steroid users were subsequently identified, as well.ResultsA total of 26,669 patients were included in this study: 25,376 (95.2%) were included in the nonsteroid cohort and 1293 (4.8%) were included in the chronic steroid cohort. The postoperative complications that were significantly associated with chronic preoperative steroid use were septic shock (P = .007), urinary tract infection (P = .016), myocardial infarction (P = .022), ventilator >48 hours (P = .028), readmission (P < .001), nonhome discharge (P < .001), and mortality (P = .007). The only postoperative complication independently associated with chronic preoperative steroid use was readmission (odds ratio, 1.36; 95% confidence interval, 1.04-1.79; P = .027).ConclusionPreoperative chronic steroid use is an independent predictor for readmission following TSA. As procedural improvement increases surgical volume for TSA, a better understanding of preoperative risk factors can improve perioperative risk stratification and help to minimize adverse outcomes.

Rare complications of pessary use: A systematic review of case reports.

IntroductionPessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events.MethodsWe performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient‐level data were extracted from case reports to further describe complications on an individual level.ResultsOverall median age of the patients was 82 years (range 62–98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non‐surgical treatment of the complications.ConclusionPessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self‐care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow‐up that is required.

Does Chronic Use of Steroids Affect Outcomes After Liver Resection? Analysis of a National Database

IntroductionWith the increasing age of patients, more patients on chronic preoperative steroids are undergoing liver resections. Our study aimed to assess the relationship between preoperative steroids and outcomes. MethodsWe performed a retrospective review of the 2014–2019 NSQIP database of all patients undergoing liver resections. Propensity score matching was utilized to match the two groups (chronic steroids vs. no steroids) based on demographics, preoperative laboratory data, and operative findings. The primary outcome measure was mortality. ResultsThere were 712 patients in the chronic steroid group and 21,751 in the no steroid group. After propensity score matching; there were 420 patients in both groups. Post-match analysis again demonstrated that patients on chronic steroids were at higher risk of cardiac arrest than those not on steroids (OR 2.01, 95% CI 1.02–2.45, p = 0.04). In addition, rates of organ space wound infection (OR 2.66, CI 1.33–5.38, p = 0.03), superficial wound infection (OR 2.79, CI 1.08–5.41, p = 0.035), renal insufficiency (OR 1.25, CI 1.03–1.62, p = 0.02), postoperative sepsis (OR 1.28, CI 1.08–1.82, p = 0.04), DVT (OR 1.7, CI 1.01–2.82, p = 0.04), and bile leakage (OR 1.75, CI 1.24–3.36, p = 0.04) were also increased in patients on steroids. However, the matched cohorts were similar in postoperative mortality rates (OR 0.11, CI 0.6–1.17, p = 0.72). ConclusionThe study found higher morbidity rates in patients undergoing liver resections on chronic preoperative steroids but no differences in mortality.

Trabeculectomy Efficacy in a Latin American Ophthalmology Training Institution.

AimTo report trabeculectomy efficacy in a Latin American Ophthalmology Training Institution.Materials and methodsRetrospective study between March 2015 and March 2019, Medical records of 77 patients (96 eyes) that underwent trabeculectomy were reviewed. Collected data included glaucoma type, pre- and post-trabeculectomy intraocular pressure (IOP) and glaucoma therapy and assigned surgeon. Data analysis included descriptive statistics, Paired T student double tailed, and Welch-Satterthwaite test.ResultsNinety-six eyes (77 patients) that underwent trabeculectomy were included in the analysis. 44.79% were male and 55.20% female. Median age was 54.04 ± 18.92 years. Median IOP pretrabeculectomy was 27.86 ± 10 mm Hg. More commonly found diagnoses were narrow angle glaucoma (36.46%), primary open-angle glaucoma (18.75%), and secondary to chronic steroid use glaucoma (14.58%). Median IOP reduction from basal IOP at 6 weeks, 6 months, and 12 months after trabeculectomy was 15.87 mm Hg, 14.42 mm Hg and 14.55 mm Hg, respectively, p < 0.05. Cumulative success was 66.66% at 12 months follow-up. General decrease of antiglaucomatous topical therapy was 1.9 ± 1.09 (p > 0.05) eye drops. Trabeculectomy success rate was 69.23% for attendants and 65.71% for residents (p = 0.85).ConclusionTrabeculectomy continues to be a successful and effective therapy to obtain significant and stable IOP decrease. Success trabeculectomy rates are comparable between residents and attendants.How to cite this articleLópez RAG, Castillo NLO. Trabeculectomy Efficacy in a Latin American Ophthalmology Training Institution. J Curr Glaucoma Pract 2022;16(1):17-19.

Impact of Inhaled and Intranasal Corticosteroids Exposure on the Risk of Ocular Hypertension and Glaucoma: A Systematic Review and Meta-Analysis.

PurposeStarting in 2019, the Global Initiative for Asthma recommended the use of inhaled corticosteroids (ICS) as part of reliever combination therapy in patients 12 years of age and older, thus dramatically increasing the population exposure to ICS. ICS and intranasal corticosteroids (INS) are commonly used for a variety of respiratory diseases. Chronic steroid use is a well-known risk factor for elevated intraocular pressure (IOP) and glaucoma regardless of route of administration. This study aimed to determine the reported risk of glaucoma, ocular hypertension (OHT) and IOP elevation associated with ICS and INS use.Materials and MethodsSystematic literature search in MEDLINE, EMBASE, Cochrane, CINAHL, BIOSIS, and Web of Science databases from the date of inception identified studies that assess ocular outcomes related to glaucoma in ICS and INS users. Study selection, risk of bias assessment and data extraction were done independently in duplicate. Meta-analysis assessed glaucoma incidence, OHT incidence and IOP changes in patients using ICS and INS. Study adhered to PRISMA guidelines. Study protocol was registered with PROSPERO: CRD42020190241.ResultsQualitative and quantitative analyses included 65 and 41 studies, respectively. Incidence of glaucoma was not significantly different in either ICS or INS users compared to control over 45,457 person-years of follow-up. Similarly, no significant difference in OHT incidence over 4431 person-years was detected. In studies reporting IOP, a significantly higher IOP was observed (0.69 mmHg) in 857 ICS or INS users compared to 615 controls. However, no significant increase in IOP was observed within ICS or INS users when compared to pre-treatment baseline.ConclusionOverall, use of ICS or INS does not significantly increase the incidence of glaucoma or OHT. However, ICS and INS patients had significantly higher IOPs compared to untreated patients. Awareness of these findings is significant in care of patients with additional risk factors for glaucoma.

Outcome of Prophylactic Postoperative Negative Pressure Wound Treatment in Colorectal Cancer Patients.

Wound infection is a common cause of morbidity in colorectal surgery. We speculated that a prophylactic Negative Pressure Wound Treatment (NPWT) is associated with less postoperative wound complications for colorectal cancer patients who undergo a colectomy. Multivariate analysis was used to investigate the association between NPWT and wound complications for patients with colorectal cancer who underwent a colectomy using data from the National Surgical Quality Improvement Program (NSQIP) database during the 2013 - 2019 period. We investigated 96105 patients who underwent colectomy for colorectal cancer during 2013-2019 within the database. Negative Pressure Wound Treatment was utilized for 270 patients following the principal procedure (.3%). Patients who had NPWT had dirtier wounds, less bowel preparation, more extensive surgery (total colectomy vs partial colectomy), higher stoma creation, and more non-elective operations. Multiple factors were associated with postoperative wound complications such as smoking Adjusted Odd Ratio (AOR:1.27, P < .01), chronic steroid use (AOR: 1.30, P < .01), obesity (AOR: 1.54, P < .01), and serum albumin level less than 3.5g/dL (AOR: 1.29, P < .01). Overall, there was no significant decrease in wound complications using NPWT (AOR: .66, P = .14). However, a sub-group of patients who underwent emergent/urgent operation had a significant lower risk of wound complications using NPWT (AOR: .3, CI: .09-.99, P = .04). Prophylactic NPWT is associated with a decrease in wound complications of patients who underwent an emergent/urgent colectomy for colorectal cancer. However, we could not find any significant decrease in wound complications for elective colorectal procedures for colorectal cancer. Further clinical trials are needed to confirm these study results.

Increasing Utilization of Outpatient Surgery for Inflatable Penile Prosthesis Placement: Contemporary Data from the National Surgical Quality Improvement Program Database

ABSTRACT Introduction The inflatable penile prosthesis (IPP) is the gold-standard surgical treatment for medically refractory erectile dysfunction. Objective The aim of this study is to characterize the differences between inpatient (IP) and outpatient (OP) practice patterns for IPP placement while utilizing the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach. Methods NSQIP database was queried for men undergoing IPP placement between 2009-2019. Patients were classified as either IP (&amp;gt;24 hours) or OP (&amp;lt;24 hours). Baseline demographics, operating time, and complications were compared between the two groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications. Results A total of 456 patients were identified and classified: 185 as IP and 271 as OP. Statistically significant differences were noted in co-morbidities favoring inpatient surgery between the groups including chronic steroid use, chronic obstructive pulmonary disease, congestive heart failure, acute renal failure, end-stage renal disease, and bleeding disorders. Year of surgery was also significant, with a notable increase in outpatient surgery beginning in 2015 (p&amp;lt;0.001). The 30-day complication rates between both groups differed notably for any complication (20.5 IP, 3.3% OP, p&amp;lt; 0.001), any readmission (9.7% IP, 2.2% OP, p &amp;lt;0.001), intraoperative or post-operative transfusion (8.1% IP, 0% OP, p&amp;lt; 0.001), and sepsis (4.1% IP, 0% OP, p&amp;lt;0.001). Operative time was shorter in the OP group (159.10 minutes IP, 133.50 minutes OP, p &amp;lt;.001). Conclusions IPP placement is increasingly utilized as an OP procedure. OP surgery favors patients with few medical co-morbidities and shorter operative times. Beginning in 2015, trends began to shift toward OP procedures. In the era of increasing hospital costs, a shift toward outpatient prosthetic surgery has increased. Disclosure No

Characteristics and Outcomes After Transcatheter Aortic Valve Implantation in Immunocompromised Patients

Immunocompromised (IC) patients are at greater risk of adverse outcomes from cardiac surgery, and less invasive options for treating severe aortic stenosis among IC patients are often sought. However, despite greater preference for transcatheter aortic valve implantation (TAVI) in this population, there are limited data on outcomes in IC patients. Between January 2015 and December 2019, we studied patients with severe aortic stenosis who underwent TAVI. We defined IC status by the presence of active malignancy and receipt of oncologic treatment, post-organ transplantation-associated immunosuppression, human immunodeficiency virus, chronic steroid use (>5mg/day), or active autoimmune disorder, and compared characteristics and outcomes of IC patients with those of non-IC patients. Of 173 patients who underwent TAVI, 56 (32%) were IC, 30 (54%) had active malignancy and underwent active treatment, 19 (34%) were IC without malignancy, and 7 (13%) were both IC and had active malignancy. IC patients, compared with non-IC patients, had similar baseline demographics, Society of Thoracic Surgeons risk scores (median 4.3% vs 4.4%), and overall complications (29% vs 26%). There were 37 deaths (16 IC and 21 non-IC) over a median follow-up of 17months (95% confidence interval [CI] 14 to 20 months), and 1-year survival after TAVI was 84.0% for IC patients and 89.0% for non-IC patients (p=0.51 by log-rank). After adjusting for Society of Thoracic Surgeons risk scores, IC patients had a nonsignificant trend toward greater risk of death compared with non-IC patients (adjusted hazard ratio 1.48, 95% CI 0.77 to 2.84). IC patients had a significantly smaller risk of cardiac-related death (adjusted hazard ratio 0.21, 95% CI 0.05 to 0.98) but a greater risk of noncardiac-related death (adjusted hazard ratio 4.14, 95% CI 1.71 to 10.0) than non-IC patients. In conclusion, IC patients who underwent TAVI have similar complication rates as non-IC patients, with a nonsignificant trend toward greater mortality, specifically related to noncardiac causes.