Comorbidity Data Research Articles

Overall survival and causes of death in elderly patients with Hodgkin lymphoma—a Norwegian population‐based case‐control study

Background: Elderly Hodgkin Lymphoma (HL) patients (pts) are poorly characterized and underrepresented in high-quality studies. Populations-based studies with individual disease- and treatment-factors together with causes of death are lacking. Methods: Pts ≥60 years diagnosed with HL between 2000 and 2015 were identified by Cancer Registry of Norway. Hospital and other health-care records were reviewed and pts grouped according to treatment into ineligible (no HL directed treatment), palliative (intended dose intensity <50%) or curative (>50% intended dose intensity of HL regimens or curative radiotherapy only). Pts’ causes of death were obtained from records and compared to The Norwegian Cause of Death Registry providing date and cause of death for pts and cancer-free controls matched 1:10 based on age, sex and place of residency. Overall survival was analyzed by Kaplan-Meier statistics. Cumulative incidence functions were calculated using the Aalen-Johansen estimator and compared using Gray’s test. Risk differences between pts and controls were calculated for each competing event at 2, 5 and 10 years. Results: Of 492 pts, 81 (16.5%) were ineligible for the analysis of treatment outcomes, due to composite lymphoma (n = 51), diagnosis after death (n = 13), severe comorbidity (n = 16) or incomplete patient data (n = 7). 74 (15%) and 337 (68.5%) pts were treated with palliative or curative intent, respectively, most commonly with CHOP. Median overall survival in the ineligible, palliative and curative groups were 0.5 (95% Confidence interval [CI] 0.4–0.6), 0.8 (0.4–1.2) and 9.1 (7.5–10.7) years, respectively. With 359 deaths, the most common cause was HL in all groups, with 30% dying from HL, 8% from treatment-related mortality and 62% from other causes. The risk difference of dying from HL compared to controls increased from 16% (95% CI: 12%–20%) at 2 years to 28% (23%–33%) after 10 years for the curative group, compared to 59% (48%–71%) and 42% (31%–53%) after 10 years in the palliative and ineligible groups, respectively. There was an increased risk of dying from other hematological malignancies, including Non-Hodgkin lymphoma in all groups, but not from other causes of death (Figure 1). Keyword: Hodgkin lymphoma No conflicts of interests pertinent to the abstract.

(160) An Analysis of the Mis-Diagnosis of Peyronie’s Disease (PD) In Men Referred for the Assessment of Penile Deformity

Abstract Introduction PD is diagnosed in the presence of penile deformity combined with a tunical plaque. Clinical experience shows us that some men who believe they have PD actually have congenital penile curvature (CPC), whilst others, especially those with a history of penile trauma, have anxiety about having PD but, in fact, do not. Objective This analysis aimed to define the mis-diagnosis rate of men referred for PD evaluation. Methods Study population consisted of men who (i) presented to a sexual medicine clinic for the evaluation of penile deformity (ii) and/or the presence of a tunical nodule (iii) underwent comprehensive penile examination by a sexual medicine physician with extensive experience in PD and (iv) underwent penile deformity assessment at the time of penile duplex Doppler ultrasound (PDDU). Demographic and comorbidity data were recorded. Multivariable analysis (MVA) was conducted to define predictors of the absence of PD. Results 1942 patients met the inclusion criteria. 79% were MD referred (MDR), the remainder were self-referred (SR). Mean age of the entire cohort was 58±28 years (MDR 64±22y, SR 41±11y, p&amp;lt;0.01). Comorbidities: hypertension 24%, diabetes 11%, dyslipidemia 27%, chronic pelvic pain syndrome (CPPS) 6%, history of radical pelvic surgery (RPS) 24%, history of penile trauma 8%. Overall 14% of patients had no PD plaque identified on examination (MDR 12%, SR 21%). For MDR without PD, majority had CPC (9%), 3% had no deformity, while for SR only 6% had CPC, the remaining 15% had no deformity at PDDU. Results of MVA is presented in the Table. Conclusions Men referred to a tertiary referral center for the evaluation of PD commonly have no PD. Predictors of no PD include: diagnosis of CPPS, history of penile trauma, young age and absence of RPS. Disclosure No

(068) Total Testosterone is Inversely Associated with C-reactive Protein Levels in Men: Findings from the Baltimore Longitudinal Study of Aging

Abstract Introduction Elevated C-Reactive Protein (CRP) and testosterone deficiency are associated with advanced age and chronic inflammatory diseases, such as cancer, obesity, diabetes, and cardiovascular disease. Further, serum CRP has proven to be a robust predictor of major adverse cardiovascular events. Testosterone decreases inflammation through several mechanisms, and testosterone replacement therapy (TRT) has been shown to consistently lower CRP levels in aging, hypogonadal men. While cross-sectional studies have shown an inverse relationship between CRP and total testosterone (TT) levels, mixed findings have been reported when individual components of metabolic syndrome and additional comorbidities are considered. Given that androgens have been implicated in anti-inflammatory pathways, we hypothesize that men with testosterone deficiency will have low CRP levels, independent of added comorbidities. Objective We evaluated the relationship between CRP and TT levels in men from 2004-2018 using the Baltimore Longitudinal Study of Aging. Methods Male participants with a documented serum TT level measured via mass spectroscopy during two separate visits &amp;gt;3 years apart were included in our cohort. CRP, High-Density Lipoprotein (HDL), and Triglyceride levels were collected via blood specimens. Comorbidity data were documented for all participants at each follow-up visit. Patients with serum TT or CRP levels &amp;gt;3 standard deviations from the mean of each respective variable were removed. Men with documented use of any form of TRT or a history of prostate cancer were excluded. Panel regression, a statistical technique implemented to analyze the relationship of a series of independent variables collected in pooled cross-sectional observations over time with a dependent variable, was used for univariable and multivariable modeling of CRP. P-value &amp;lt; 0.05 was considered statistically significant. Results A total of 347 patients (694 visits) met the inclusion criteria of this study. The median age of our sample was 71 years with a follow-up time of 8 years (range: 3-13 years). Participants had a median CRP level of 1.03 mg/dL [0.52, 2.11] and a median TT level of 446 ng/dL [339, 560]. In terms of comorbidities, diabetes was documented most frequently, followed by congestive heart failure (CHF) and cancer (Table 1). On univariable analysis TT, cancer, and HDL were associated with a decline in CRP, while BMI, CHF, Diabetes, and Triglycerides were associated with increased CRP. Age was not associated with CRP (Table 2). On multivariable analysis, we found that increasing TT was associated with a decline in CRP levels, independent of comorbidities (p = 0.022; Table 2). The strengths of our study include having well-documented laboratory values and comorbidity information for patients at multiple visits. However, causal associations cannot be inferred due to the retrospective nature of the data. Conclusions We report that an increase in TT is associated with a decline in CRP levels, after controlling for components of metabolic syndrome and other related comorbidities. This finding is consistent with the anti-inflammatory effects of androgens, which decrease pro-inflammatory mediators and leukotriene biosynthesis. Our study further highlights the benefits of restoring eugonadal testosterone levels in older, hypogonadal men via hormone replacement, potentially lowering CRP levels and reducing cardiovascular risk. Disclosure No

Efficacy of breast reconstruction in elderly women (>60 years) using deep inferior epigastric perforator flaps: A comparative study

The indications for microsurgical breast reconstruction remain debated, particularly concerning the safety of deep inferior epigastric perforator (DIEP) flaps in elderly women. Free tissue transfer still carries a risk of perioperative morbidity and mortality in elderly patients. We conducted this comparative study to clarify this issue. This retrospective cohort study included all unilateral DIEP breast reconstructions performed at a single institution. Patients were divided into two groups based on age: an elderly (60 years or older) and a non-elderly cohort (younger than 60 years). Demographic and comorbidity data were secondary predictor variables. The primary outcomes were complete flap loss, partial flap loss, and the need for flap re-exploration. The secondary outcomes included surgical site occurrences, such as wound healing-related complications, seroma, and others. We included 214 flaps, 177 in the non-elderly and 37 in the elderly cohort. Elderly women had slightly higher comorbidity rates than those of non-elderly women, although these differences were not statistically significant. BMI was significantly lower in elderly women than in non-elderly women. The incidence of total or partial flap loss did not differ significantly between the two cohorts (2.7% vs 1.1%, p = 0.459% and 0.0% vs 5.1%, p = 0.161), nor did the flap re-exploration (8.1% vs 10.1%, p = 0.937). Similarly, postoperative complication rates did not differ significantly between the two groups (45.9% vs 61.8%, p = 0.074). On logistic regression, being elderly was not a risk factor for complete flap loss, nor for any complications. The overall success rate for the non-elderly cohort was 98.7%, whereas that for the elderly cohort was 97.3%. Microsurgical breast reconstruction using DIEP is safe in elderly patients, as it achieves outcomes and complications rates comparable to those observed in a younger population. Patients should not be denied DIEP flaps because of their age alone.

SP28. The Risk Analysis Index Has Superior Frailty Discrimination Than the Modified Frailty Index-5 for Predicting Poor Cranioplasty Outcomes

PURPOSE: Cranioplasty is a common surgical procedure where autologous or synthetic materials are used to repair cranial defects and although considered simple and low-risk, it is surprisingly associated with significant morbidity and mortality. Although increased patient age has been shown to be a predictor of poor postoperative outcomes, no studies have evaluated frailty’s impact on cranioplasty outcomes. This study examined the association between frailty and cranioplasty by comparing effect sizes of the Risk Analysis Index-Administrative (RAI-A), Modified Frailty Index-5 (mFI-5), and increasing patient age on the primary outcome of 30-day mortality and secondary outcomes of non-home discharge rates and postoperative complications, as measured by the Clavien-Dindo (CD) complication classification system: (CD I: surgical site infection, CD II: postoperative bleeding or transfusion(s), CD IIIb: reoperation under general anesthesia, CD IV: sepsis, septic shock, pulmonary embolism, myocardial infraction, ventilator status, 30-day mortality). METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried for all patients undergoing cranioplasty between 2012-2020. Data for baseline demographics, comorbidities, operative characteristics, and postoperative outcomes were evaluated. Statistical analysis was performed on IBM SPSS Statistics ver. 28.0 (IBM Co., Armonk, NY, USA). The discriminatory thresholds of RAI-A, mFI-5, and increasing patient age on 30-day mortality were evaluated using receiver operating characteristics (ROC) curve analysis. The area under the curve (AUC) is represented as a C-statistic with a 95% confidence interval (CI). Two distinct multivariable analyses were conducted for RAI-A and mFI-5 to measure the independent relationships between frailty and outcomes. Covariates controlled for included race, BMI, primary procedure, cranial defect size, and material type. Additionally, the mFI-5 model was age-adjusted, allowing for direct comparison of effect sizes between age and frailty. We excluded age from the model for RAI-A to prevent any collinearity, since age contributes to the total RAI-A score. RESULTS: There were 2,864 included study patients with a median age of 57 years (IQR, 44-67), and a higher proportion of patients were female (57.0%), and white (68.5%). The RAI-A demonstrated better predictive ability for 30-day mortality (C-Statistic: 0.741, 95% CI: 0.678-0.804) compared to mFI-5 (C-Statistic: 0.574, 95% CI: 0.489-0.659) and increasing patient age (C-Statistic: 0.671, 95% CI: 0.610-0.732). On multivariable analyses, RAI-A demonstrated superior independent associations with mortality, NHD, CDII, and CDIII when compared to mFI-5 and increasing patient age. (p<0.05). CONCLUSIONS: The RAI-A demonstrated superior discrimination than the mFI-5 and increasing patient age in predicting poor outcomes following cranioplasty. The high rates of operative morbidity (5.0-36.5%) and mortality (0.4-3.2%) after cranioplasty highlight the importance of being able to predict which patients are at increased risk for poor cranioplasty outcomes, so that shared decision making regarding the potential risk and benefits of treatment can occur. Multivariable Analyses for Postoperative Outcomes

Do Outcomes Differ After Proximal Hamstring Repair for Patients Receiving Workers' Compensation?

Patients with workers' compensation (WC) insurance claims are often shown to experience inferior patient-reported outcomes (PROs) after an orthopaedic surgical intervention compared with patients without WC claims. To compare the postoperative PROs of patients with WC claims (WC patients) versus those without WC claims (non-WC patients) after proximal hamstring repair (PHR). Cohort study; Level of evidence, 3. WC patients who underwent PHR between November 2011 and to September 2020 were propensity score matched at a 1:2 ratio to non-WC patients according to age, sex, and body mass index. Comorbidity data were collected as well as minimum 1-year postoperative PRO scores for the Lower Extremity Functional Scale (LEFS), the Hip Outcome Score (HOS), and the 12-Item Short From Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS). The type of work was characterized according to national WC insurance guidelines as light (maximum 20 lbs [9.1 kg]), medium (maximum 50 lbs [22.7 kg]), or heavy (≥50 lbs) [>/=22.7 kg]. A total of 30 patients (10 WC and 20 non-WC) were included. The work type and baseline demographic characteristics of patients did not differ between groups. There were no significant between-group differences in postoperative PRO scores as measured by the LEFS (P = .488), HOS (P = .233), or SF-12 PCS (P = .521). However, the WC cohort showed inferior SF-12 MCS scores compared with the non-WC group (49.28 ± 9.97 vs 54.26 ± 9.69, respectively; P = .032). The WC status was also associated with an increased time needed for patients to return to full-duty work capacity (21 ± 9 vs 9 ± 8 weeks; P = .005). Our findings suggest that WC and non-WC patients who undergo PHR have comparable outcomes. Differences in SF-12 MCS scores and return to work time for full-duty capacity warrant further investigation.

The State of Pediatric Retinal Detachment Surgery in the United States: a Nationwide Aggregated Health Record Analysis.

In this study, we aim to identify the demographics of retinal detachment in children in the United States, and to report the treatment modalities chosen by vitreoretinal surgeons, and associated outcomes. This was a multicenter cohort analysis of the Vestrum Health LLC Database (Naperville, Illinois). Children (1-17 years) with rhegmatogenous retinal detachment (RRD), as identified by ICD10 and CPT codes, between January 2015 and August 2021. Demographic, comorbidity, visual acuity, and treatment modality data were analyzed. A total of 168,152 RRDs were identified, of which 2200 (1.3%) were 1-17 years old. Mean age was 12.7 years, and 821 (37%) were female. The prevalence of RRD increased with age (P =0.009). Associated co-morbidities included myopia (17.3%), ocular trauma (7.5%), and history of prematurity (5.7%). Laser retinopexy alone was used as the initial treatment modality in 19%, primary vitrectomy in 23%, primary scleral buckle in 25%, and vitrectomy with scleral buckle in 33%. The single surgery success rate for all procedures was 73.3%. Of the incisional surgical modalities, primary scleral buckling had the best single surgery success rate (79.0%) compared to vitrectomy alone (64.5%) and vitrectomy with scleral buckle (67.2%) (p < 0.001 and p = 0.004, respectively). Younger age resulted in worse SSSR overall (coefficient = 0.151, R2 = 0.746, p = 0.027). Rhegmatogenous retinal detachments in children increased with age. Myopia, trauma, and history of retinopathy of prematurity were common risk factors. Treatment techniques varied, but primary scleral buckling had the best anatomic and visual outcomes.

КЛИНИКО-АНАМНЕСТИЧЕСКИЕ ДАННЫЕ БЕРЕМЕННЫХ С РАЗНЫМ ТЕЧЕНИЕМ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

Pregnant women infected with SARS-CoV-2 are considered as a risk group for the development of severe complications and an unfavorable outcome of a new coronavirus infection. At the same time, various non-gestational factors may be an additional unfavorable background that determines the course of this disease in pregnant women. The purpose of the study was to evaluate the clinical and anamnestic data of pregnant women with different course of a new coronavirus infection. Material and research methods. A retrospective analysis of the history and comorbidity data of 360 pregnant women infected with SARS-CoV-2 was carried out. The features of the reproductive history and ex-tragenital pathology of pregnant women with different course of Coronavirus Disease 2019 (COVID-19) were revealed. The standard collection of anamnesis and clinical examination was carried out, which is required to fill in the medical records of an outpatient and inpatient patient. Statistical pro-cessing of the obtained results was carried out using Microsoft Excel 2010 and Statistica (version 6.0). Research results. It has been established that among pregnant women with a severe course of this dis-ease, patients who use nicotine-containing products and have such concomitant somatic pathologies as diabetes mellitus, obesity, hypothyroidism, iron deficiency anemia, chronic arterial hypertension and varicose veins are significantly more common. Unfavorable factors of the reproductive history in-clude: abortion, non-developing pregnancy, preeclampsia. Conclusion. To predict the course of a new coronavirus disease in the gestational period, it is necessary to take into account the listed clinical and anamnestic data of the patient.

48. MICRO - The Microsurgical Index for Complication Risk and Outcomes

PURPOSE: Free tissue transfer (FTT) is determined by a multitude of factors. However, no tool exists to quantify risk for complications following FTT. This study developed the Microsurgical Index for Complication Risk and Outcomes (MICRO) to address this. METHODS: Patients were queried from the 2003-2015 MarketScan Databases with CPT codes for FTT requiring microsurgical anastomosis. ICD9 codes were used to query comorbidity and 90-day postoperative complication data for each patient. The Charlson and Elixhauser Comorbidity Indexes were constructed for each patient. The MICRO was then constructed with forward stepwise selection from Elixhauser comorbidities and domain expert input. Indexes were used as covariates in multivariate logistic regression models with patient age, sex, and flap tissue type to predict complications following FTT. The area under the receiver operating curve (AUC) and five-fold cross validated classification accuracy were determined. RESULTS: 5,595 patients were included. The final MICRO consists of seven variables (Charlson - nineteen; Elixhauser - thirty). It had the highest AUC (0.60) and accuracy (60.4%) when predicting complications. CONCLUSION: The MICRO outperforms available comorbidity indexes at predicting complications following FTT with far fewer variables. Future studies could augment the MICRO with surgeon, donor-site, and recipient-site data to create a sharper risk tool for the plastic surgeon.

Vaccination and Factors Related to the Clinical Outcome of COVID-19 in Healthcare Workers-A Romanian Front-Line Hospital's Experience.

The study aims to describe the frequency of COVID-19 in healthcare workers (HCWs) in a designated hospital for COVID-19 treatment in Bucharest, Romania, and to explore COVID-19 vaccination and other factors associated with the clinical outcome. We actively surveyed all HCWs from 26 February 2020 to 31 December 2021. Cases were laboratory-confirmed with RT-PCR or rapid test antigen. Epidemiological, demographic, clinical outcomes, vaccination status, and co-morbidities data were collected. Data were analyzed using Microsoft Excel, SPSS, and MedCalc. A total of 490 cases of COVID-19 in HCWs were diagnosed. The comparison groups were related to the severity of the clinical outcome: the non-severe group (279, 64.65%) included mild and asymptomatic cases, and the potentially severe group included moderate and severe cases. Significant differences between groups were registered for high-risk departments (p = 0.0003), exposure to COVID-19 patients (p = 0.0003, vaccination (p = 0.0003), and the presence of co-morbidities (p < 0.0001). Age, obesity, anemia, and exposure to COVID-19 patients predicted the severity of the clinical outcomes (χ2 (4, n = 425) = 65.69, p < 0.001). The strongest predictors were anemia and obesity (OR 5.82 and 4.94, respectively). In HCWs, mild COVID-19 cases were more frequent than severe cases. Vaccination history, exposure, and individual risk influenced the clinical outcome suggesting that measures to protect HCWs and occupational medicine are important for pandemic preparedness.

491 Anticholinergic cognitive burden score in a cohort of nursing home patients; an observational study.

Abstract Introduction Anticholinergic medications are commonly prescribed to older patients, particularly nursing home patients. Anticholinergic burden caused by these medications increases the risk of cognitive impairment, falls, delirium and increased mortality in this patient cohort. There are several published tools available to assess the impact of anticholinergic burden on patient negative outcomes (e.g. falls, cognitive impairment, hospitalisation, mortality). The Anticholinergic Cognitive Burden (ACB) scale is a validated tool which calculates a patient’s total anticholinergic medication score, to allow an estimation of cognitive burden (1). Aim The aim of this study was to describe the anticholinergic cognitive burden of medications in a cohort of nursing home patients using the ACB scale. Methods An observational study was conducted which involved screening patients’ pharmacy dispensing records for three nursing homes. All nursing homes which the pharmacy provides services for were sent an information leaflet and invited to participate, three agreed, with Directors of Nursing and General Practitioners providing consent. Medications contributing to Anticholinergic cognitive burden were recorded in Microsoft Excel by the researcher and patients total ACB score was calculated (1). A sample of 20% of patient scores was independently checked by another researcher for accuracy. Patients’ comorbidity data and cognitive function measure (Mini Mental State Examination or Mental Test Score) was recorded from their nursing home records by the researcher. Long-term nursing home patients ≥65-years-old were eligible for inclusion. Descriptive analysis was conducted. Results In total, the medications of 254 patients were assessed using the ACB score (63.4% female, mean age 83.5 ±7.79 -years-old). Of these, 195/254 (76.8%) were prescribed at least one anticholinergic medication. There were 132/254 (51.9%) patients with a total ACB score of ≥3 which is clinically significant and increases the risk of negative outcomes. The three most commonly prescribed anticholinergics were quetiapine (82/254, 32.3%), olanzapine (32/254, 12.6%) and furosemide (31/254, 12.2%). Of the patients with an ACB score ≥3, 58/132 (49.9%) had dementia and 63/132 had hypertension (47.7%). Conclusion This study highlights the high prevalence of anticholinergic medication prescribing in an Irish nursing home population. This is high in comparison with other European and international studies where lower ACB scores in nursing home populations have been recorded (2). The study was limited as it was only conducted in three nursing homes, a larger study may identify different prescribing patterns and ACB scores. Further work in pharmacy practice to include the ACB score as part of patients’ medication reviews is recommended. Collaboration with nursing home prescribers and nurses to increase awareness of anticholinergic medication risks and review is vital. Reductions in ACB scores would reduce the risk of falls, cognitive impairment and harm to these patients.

The effect of autoimmune skin disorders on post-operative outcomes following arthroplasty

IntroductionThe impact of autoimmune skin disorders on post-operative outcomes after TJA is conflicting and studies are limited by small sample sizes. The purpose of this study is to analyze a range of common autoimmune skin disorders and identify whether an increased risk of post-operative complication exists after total joint arthroplasty. MethodsData was collected from NIS database for patients diagnosed with autoimmune skin disorder (psoriasis, lupus, scleroderma, atopic dermatitis) and who underwent total hip arthroplasty (THA), total knee arthroplasty (TKA), or other TJA (shoulder elbow, wrist, ankle) between 2016 and 2019. Demographic, social, and comorbidity data was collected. Multivariate regression analyses were performed to assess the independent influence of autoimmune skin disorder on each post-operative outcome including implant infection, transfusion, revision, length of stay, cost, and mortality. ResultsAmong 55,755 patients with autoimmune skin disease who underwent TJA, psoriasis was associated with increased risk of periprosthetic joint infection following THA (odds ratio 2.44 [1.89–3.15]) and increased risk of transfusion following TKA (odds ratio 1.33 [1.076–1.64]). Similar analyses were performed for systemic lupus erythematosus, atopic dermatitis, and scleroderma, however no statistically significant associations were observed in any of the six collected post-operative outcomes. ConclusionThis study suggests psoriasis is an independent risk factor for poorer post-operative outcomes following total joint arthroplasty, however similar risk was not observed for other autoimmune skin disorders such as lupus, atopic dermatitis, or scleroderma.

MP71-12 AMBULATORY ARTIFICIAL URINARY SPHINCTER AND MALE URETHRAL SLING SURGERY HAVE SIMILAR 30-DAY COMPLICATION, REOPERATION, AND READMISSION RATES: A NATIONAL ANALYSIS, 2016-2019

You have accessJournal of UrologyCME1 Apr 2023MP71-12 AMBULATORY ARTIFICIAL URINARY SPHINCTER AND MALE URETHRAL SLING SURGERY HAVE SIMILAR 30-DAY COMPLICATION, REOPERATION, AND READMISSION RATES: A NATIONAL ANALYSIS, 2016-2019 Krishna Ravivarapu, Micah Levy, Christopher Connors, Daniel Wang, Chih Peng Chin, Evan Garden, Olamide Omidele, Francisca Larenas, and Michael Palese Krishna RavivarapuKrishna Ravivarapu More articles by this author , Micah LevyMicah Levy More articles by this author , Christopher ConnorsChristopher Connors More articles by this author , Daniel WangDaniel Wang More articles by this author , Chih Peng ChinChih Peng Chin More articles by this author , Evan GardenEvan Garden More articles by this author , Olamide OmideleOlamide Omidele More articles by this author , Francisca LarenasFrancisca Larenas More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have compared complication rates following artificial urinary sphincter implantation (AUS) and male urethral sling placement (MUS). To the best of our knowledge, this is the first population-based comparative analysis of ambulatory AUS and MUS. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement database from 2016 to 2019 was used to identify all patients who underwent AUS (CPT 53445) and MUS (CPT 53440). Ambulatory surgery patients were selected based on a total hospital length of stay of zero days. We compared baseline characteristics, complication rates, reoperations, and readmissions between ambulatory AUS and MUS cohorts. Multivariate regression analysis controlling for available demographic and comorbidity data was used to evaluate the relationship between procedure type and adverse events. RESULTS: A total of 963 AUS and 550 MUS surgeries were analyzed. Of these, surgery was performed on an ambulatory basis for 27.7% (n=267) of AUS and 60.5% (n=333) of MUS cases. There were no statistically significant changes in utilization of same-day discharge for AUS (p=0.33) or MUS (p=0.82) from 2016 to 2019. Compared to patients undergoing ambulatory MUS, ambulatory AUS patients were more likely to be over 65 years old (74.7% vs. 64.9%), White race (77.7% vs. 58.9%), hypertensive (63.8% vs. 55.6%), insulin-dependent (9.4% vs. 3.9%), chronic steroid users (5.3% vs. 2.1%), and diagnosed with disseminated cancer (2.3% vs. 0.3%) (all p<0.05). There was no difference in overall 30-day complication rates (3.4% AUS vs. 3.3% MUS, p=0.91). Likewise, there were no significant differences in Clavien-Dindo I/II rates (3.0% AUS vs. 2.4% MUS, p=0.64) or Clavien-Dindo IV rates (0.4% AUS vs. 0.9% MUS, p=0.44). There was no significant difference in 30-day reoperation rates (2.3% AUS vs. 1.8% MUS, p=0.69). There was a trend towards higher rates of 30-day readmission rate for ambulatory AUS at 3.4% versus 1.5% for MUS (p=0.13). However, after controlling for patient demographics and comorbidities on multivariate regression analysis, undergoing ambulatory AUS versus MUS did not confer significantly increased odds of 30-day complication (OR 0.71, 95% CI 0.25-1.97, p=.51), reoperation (OR 1.03, 95% CI 0.30-3.61, p=.96), or readmission (OR 1.75, 95% CI 0.45-6.77, p=.42). CONCLUSIONS: Using a national database, we found no significant differences in 30-day complication, reoperation, or readmission rates between ambulatory AUS and MUS. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1019 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Krishna Ravivarapu More articles by this author Micah Levy More articles by this author Christopher Connors More articles by this author Daniel Wang More articles by this author Chih Peng Chin More articles by this author Evan Garden More articles by this author Olamide Omidele More articles by this author Francisca Larenas More articles by this author Michael Palese More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of Sepsis on Death as Modified by Solid Organ Transplantation.

Patients who have undergone solid organ transplants (SOT) have an increased risk for sepsis compared with the general population. Paradoxically, studies suggest that SOT patients with sepsis may experience better outcomes compared with those without a SOT. However, these analyses used previous definitions of sepsis. It remains unknown whether the more recent definitions of sepsis and modern analytic approaches demonstrate a similar relationship. Using the Weill Cornell-Critical Care Database for Advanced Research, we analyzed granular physiologic, microbiologic, comorbidity, and therapeutic data in patients with and without SOT admitted to intensive care units (ICUs). We used a survival analysis with a targeted minimum loss-based estimation, adjusting for within-group (SOT and non-SOT) potential confounders to ascertain whether the effect of sepsis, defined by sepsis-3, on 28-day mortality was modified by SOT status. We performed additional analyses on restricted populations. We analyzed 28 431 patients: 439 with SOT and sepsis, 281 with SOT without sepsis, 6793 with sepsis and without SOT, and 20 918 with neither. The most common SOT types were kidney (475) and liver (163). Despite a higher severity of illness in both sepsis groups, the adjusted sepsis-attributable effect on 28-day mortality for non-SOT patients was 4.1% (95% confidence interval [CI], 3.8-4.5) and -14.4% (95% CI, -16.8 to -12) for SOT patients. The adjusted SOT effect modification was -18.5% (95% CI, -21.2 to -15.9). The adjusted sepsis-attributable effect for immunocompromised controls was -3.5% (95% CI, -4.5 to -2.6). Across a large database of patients admitted to ICUs, the sepsis-associated 28-day mortality effect was significantly lower in SOT patients compared with controls.

U-shaped association between serum IGF2BP3 and T2DM: A cross-sectional study in Chinese population.

To clarify the expression of N6-methyladenosine (m6 A) modulators involved in the pathogenesis of type 2 diabetes mellitus (T2DM). We further explored the association of serum insulin-like growth factor 2 mRNA-binding proteins 3 (IGF2BP3) levels and odds of T2DM in a high-risk population. The gene expression data set GSE25724 was obtained from the Gene Expression Omnibus, and a cluster heatmap was generated by using the R package ComplexHeatmap. Differential expression analysis for 13 m6 A RNA methylation regulators between nondiabetic controls and T2DM subjects was performed using an unpaired t test. A cross-sectional design, including 393 subjects (131 patients with newly diagnosed T2DM, 131 age- and sex-matched subjects with prediabetes, and 131 healthy controls), was carried out. The associations between serum IGF2BP3 concentrations and T2DM were modeled by restricted cubic spline and logistic regression models. Two upregulated (IGF2BP2 and IGF2BP3) and 5 downregulated (methyltransferase-like 3 [METTL3], alkylation repair homolog protein 1 [ALKBH1], YTH domain family 2 [YTHDF2], YTHDF3, and heterogeneous nuclear ribonucleoprotein [HNRNPC]) m6 A-related genes were found in islet samples of T2DM patients. A U-shaped association existed between serum IGF2BP3 levels and odds of T2DM according to cubic natural spline analysis models, after adjustment for body mass index, waist circumference, diastolic blood pressure, total cholesterol, and triglyeride. Multivariate logistic regression showed that progressively higher odds of T2DM were observed when serum IGF2BP3 levels were below 0.62 ng/mL (odds ratio 3.03 [95% confidence interval 1.23-7.47]) in model 4. Seven significantly altered m6 A RNA methylation genes were identified in T2DM. There was a U-shaped association between serum IGF2BP3 levels and odds of T2DM in the general Chinese adult population. This study provides important evidence for further examination of the role of m6 A RNA methylation, especially serum IGF2BP3 in T2DM risk assessment.

Distance and resources in vulnerable populations: understanding access barriers to outpatient shoulder arthroplasty

BackgroundOutpatient shoulder arthroplasty is advantageous in appropriately selected patients, and tools for performing selection are available. Whether vulnerable populations benefit from outpatient surgery despite being appropriate candidates clinically is unclear. We hypothesized that patient travel distance and resource level impact the ability to complete accelerated care pathways. MethodsA retrospective cohort of patients undergoing anatomic/reverse total shoulder arthroplasty at 2 geographically diverse, high-volume tertiary referral centers was created; 5406 cases were stratified into cohorts based on travel distance (0-49, 50-99, 100-150, and >150 miles). Sociodemographic, median income, and comorbidity data were collected. Short inpatient stay was utilized as a proxy for appropriateness for same-day discharge. Overall length of stay (LOS) and unplanned 90-day readmissions were collected as secondary outcomes. ResultsFour thousand one hundred one patients traveled 0-49 miles, 695 traveled 50-99 miles, 313 traveled 100-149 miles, and 297 traveled >150 miles for shoulder arthroplasty. Few significant differences in sociodemographic/comorbidity burdens were observed between distance cohorts. Increased distance outside of the immediate area (>50 miles) was significantly associated with decreased likelihood of short inpatient stay (P < .001) and increased LOS (P = .027) for Institution #1. For Institution #2, those in the shortest and longest distance groups had the shortest LOS (P = .018). Overall, patients living <50 miles had the highest income levels. A bi-modal income distribution was observed for Institution #1, while income decreased as distance increased for Institution #2. Unplanned 90-day readmission rates were not significantly different for either institution. DiscussionOverall, when examining demographic variables for the entire cohort representing both institutions, patient travel distance to a high-volume tertiary orthopedic center did not appear to be the primary driver for variability in early postoperative outcomes (ie, 90-day readmissions, short stay, LOS). For Institution 1, patients living further from surgery centers underwent short inpatient stay at lower rates relative to those nearby. Importantly, lower resource levels were seen as distance increased for both institutions, potentially limiting the ability to manage same-day discharge without additional assistance despite being clinically appropriate candidates for outpatient arthroplasty. Therefore, providing overnight lodging options and perioperative support for vulnerable populations may minimize disparities in access, while serving as a lower-cost-option.

Bariatric Surgery Is Associated with Alcohol-Related Liver Disease and Psychiatric Disorders Associated with AUD

Background/AimsBariatric surgery can increase the risk of addictive disorders and nutritional deficiencies. The aim of this study was to evaluate the association between bariatric surgery and alcohol use disorder (AUD), alcohol-related liver disease (ALD), and psychiatric disorders associated with AUD. The impact of vitamin D deficiency in these associations was also investigated.MethodsA cross-sectional study was performed using the National Inpatient Sample database and its ICD-9 codes information. Diagnostic and comorbidity data from hospital discharges were obtained from patients with bariatric surgery and other abdominal surgeries between 2005 and 2015. The two groups were then compared for alcohol-related outcomes after propensity-score matching.ResultsThe final study cohort included 537,757 patients with bariatric surgery and 537,757 with other abdominal surgeries. The bariatric surgery group had an increased risk of AUD [odds ratio (OR): 1.90; 95% CI: 1.85–1.95], ALD [OR: 1.29; 95% CI: 1.22–1.37], cirrhosis [OR, 1.39; 95% CI: 1.37–1.42], and psychiatric disorders associated with AUD [OR, 3.59; 95% CI: 3.37–3.84]. Vitamin D deficiency did not impact in the association between bariatric surgery and AUD, ALD, or psychiatric disorders associated with AUD.ConclusionsBariatric surgery is associated with an increased prevalence of AUD, ALD, and psychiatric disorders associated with AUD. These associations appear to be independent from vitamin D deficiency.Graphical

The relationship between serum albumin and prostate-specific antigen: A analysis of the National Health and Nutrition Examination Survey, 2003-2010.

Previous studies have shown that serum albumin is associated with prostate cancer (PCa), but not with prostate-specific antigen (PSA) levels in populations without PCa history. Therefore, we analyzed secondary data provided by the National Health and Nutrition Examination Survey (NHANES) (2003-2010). In total, 5,469 participants were selected from the NHANES database (2003-2010). Serum albumin and PSA levels were serially considered independent and dependent variables, serially. A number of covariates were included in this study, including demographic, dietary, physical examination, and comorbidity data. Using weighted linear regression model and smooth curve fitting, the linear and non-linear relationship between serum albumin and PSA was investigated. After modulating underlying interference factors, the weighted multivariate linear regression analysis revealed that serum albumin did not independently predict PSA levels (β = -0.009 95%CI: -0.020, 0.002). Nevertheless, a non-linear relationship was found between serum albumin and PSA, with a point of 41 g/L. Left of the inflection point, the effect size, 95%CI, and P-value were 0.019 (log2 transformation) (-0.006, 0.043) and 0.1335, respectively. We found a negative association between serum albumin and PSA on the right side of the inflection point, with effect size, 95%CI, and a P-value of -0.022 (log2 transformation) (-0.037, -0.007), 0.0036. In summary, serum albumin and PSA levels are not linearly related. When serum albumin levels exceed 41 g, serum albumin levels are negatively associated with PSA levels.

Fear of COVID-19 among patients with prior SARS-CoV-2 infection: A cross-sectional study in Estonian family practices

Background Fear of coronavirus disease (COVID-19) has been associated with significant health effects. Objectives To assess COVID-19 fear and investigate factors associated with higher fear among COVID-19 survivors over 6 months after infection. Methods Cross-sectional study using multistage sampling (family practices within the highest 5th percentile of numbers of SARS-CoV-2 infected patients and random sample of patients within these practices) performed from March 15 to 17 July 2021. Adult patients with a laboratory-confirmed history of COVID-19 were recruited for a self-administered 79-item questionnaire including demographics, self-rated health, physical activity, COVID-19 characteristics, severity and the fear of COVID-19 Scale (FCV-19S). Comorbidity data were extracted from Estonian Health Insurance Fund. Logistic regression models were used to evaluate factors associated with COVID-19 fear. Results Of 341 participants included, 60% were women, 24.2% were hospitalised due to COVID-19 and 22.2% had long COVID, 143 (42%) participants reported high levels of fear (cut-off FCV-19S >17.8). Higher fear was associated with being female (aOR 2.12, 95% CI 1.14–3.95), age ≥61 years (aOR 3.23, 95% CI 1.28–8.16), two-member-households (aOR 3.70, 95% CI 1.40–9.77) physical inactivity 6 months prior to COVID-19 (aOR 3.53, 95% CI 1.26–9.95), and symptom severity during acute COVID-19. Long COVID was not associated with higher COVID-19 fear (aOR 1.82 95% CI 0.91–3.63). Conclusion Almost half of participants reported COVID-19 fear more than 6 months after infection. Greater fear was associated with sociodemographic factors, physical activity prior to COVID-19 and COVID-19 symptom severity. There is a need to target this population to develop appropriate interventions.

Abstract P1-07-04: Claims-derived comorbidities associations with real-world overall survival (rwOS) among patients with metastatic breast cancer in an electronic health record-claims linked dataset

Abstract Introduction: Comorbid conditions can significantly impact various aspects of cancer care and therefore are often utilized as covariates to control for selection bias in observational studies. Oncology based electronic health record (EHR) data is often used as a source for comorbidity information but may be subject to missingness due to differences in clinician documentation. Utilizing additional data sources, such as health care claims data, may allow for greater capture of comorbidities. This study used a claims data linked to oncology EHR to identify comorbidities and related patient characteristics, as well as the association between a claims-derived comorbidity index and real-world overall survival (rwOS) among outpatient metastatic breast cancer (mBC) patients, to characterize the comorbidities data from this data source. Methods: We selected patients diagnosed with mBC between 2013 and 2021 from a linkage of mBC de-identified EHR-derived Flatiron Health Research Database (FHRD) and Komodo Health claims data. Charlson Comorbidity Index (CCI) were identified based on the presence of a pre-specified International Classification of Diseases (ICD) codes within 12 months preceding cancer diagnosis. To understand comorbidity data within this linkage, patient characteristics were assessed after the study cohort was stratified by the presence of any comorbidity assessed as part of CCI. We calculated the CCI for the study cohort as well as the prevalence of comorbid conditions that are used as part of the CCI. Kaplan-Meier estimates and Cox proportional hazards model were used to estimate median survival time and hazard ratios (HRs) of rwOS among patients with a CCI score of 1 and 2+. Results: The study cohort had 3,213 patients with a median age of 63 [IQR(52, 76)] and 98.7% were female. White patients accounted for 60.1% of the study population while Black and Hispanic/Latino patients accounted for 12.5% and 7.4% of the study cohort, respectively. Patients with comorbidities were older (mean age of 65 vs 61), had a higher (2+) ECOG performance status (PS) score (14.0% vs 9.7%), and were more likely to be Black (16.0% vs 11.0%) or Hispanic/Latino 10.8% vs 6.3%). Twenty percent of the patients had diabetes, 8.2% had peripheral vascular disease, 7.5% had mild liver disease, and 6.3% had congestive heart failure. According to index values, 21.0% of the study cohort had a CCI score of 1, and 18.0% had a score of 2 and above. The median survival times in years for patients with a CCI score of 1 and 2+ were 2.51 [95% CI 2.29,2.81] and 2.05 [95% CI 1.83,2.42], respectively. Based on univariate analysis, patients with a CCI score greater than zero had a higher risk of mortality (CCI 1: HR = 1.25 [95%CI 1.10, 1.41, p&amp;lt; 0.01], CCI 2+: HR = 1.54 [95%CI 1.35, 1.76, p&amp;lt; 0.01]). In the multivariate analysis, adjusted for age, ethnicity/race, and baseline ECOG PS score, the HR for the CCI 1 group was not statistically significant (HR=1.12 [95%CI 0.99, 1.27, p=0.08]). However, the risk of mortality was statistically significant for the CCI 2+ group (HR=1.31 [95%CI 1.14, 1.50], p &amp;lt; 0.01) in the adjusted analysis. Conclusion: Claims data linked to EHR can be used to identify comorbidities and describe patient characteristics. As anticipated, generally, the presence of more comorbid conditions was associated with worse rwOS for patients with mBC. This finding supports use of this linked dataset for similar future studies. Citation Format: Mustafa S. Ascha, Alemseged A. Asfaw, Prakirthi Yerram, Samantha N. Reiss, Sarah D. Brake, Niquelle B. Wadé. Claims-derived comorbidities associations with real-world overall survival (rwOS) among patients with metastatic breast cancer in an electronic health record-claims linked dataset [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-07-04.