Identification Of Independent Risk Factors Research Articles

A Novel Risk Stratification System for Ischemic Stroke in Japanese Patients With Non-Valvular Atrial Fibrillation.

Recently, identification of independent risk factors for ischemic stroke in Japanese non-valvular atrial fibrillation (NVAF) patients was made by analyzing the 5 major Japanese registries: J-RHYTHM Registry, Fushimi AF Registry, Shinken Database, Keio interhospital Cardiovascular Studies, and the Hokuriku-Plus AF Registry.Methods and Results:The predictive value of the risk scheme in Japanese NVAF patients was assessed. Of 16,918 patients, 12,289 NVAF patients were analyzed (mean follow up, 649±181 days). Hazard ratios (HRs) of each significant, independent risk factor were determined by using adjusted Cox-hazard proportional analysis. Scoring system for ischemic stroke was created by transforming HR logarithmically and was estimated by c-statistic. During the 21,820 person-years follow up, 241 ischemic stroke events occurred. Significant risk factors were: being elderly (aged 75-84 years [E], HR=1.74), extreme elderly (≥85 years [EE], HR=2.41), having hypertension (H, HR=1.60), previous stroke (S, HR=2.75), type of AF (persistent/permanent) (T, HR=1.59), and low body mass index <18.5 kg/m2(L, HR=1.55) after adjusting for oral anticoagulant treatment. The score was assigned as follows: 1 point to H, E, L, and T, and 2 points to EE and S (HELT-E2S2score). The C-statistic, using this score, was 0.681 (95% confidence interval [CI]=0.647-0.714), which was significantly higher than those using CHADS2(0.647; 95% CI=0.614-0.681, P=0.027 for comparison) and CHA2DS2-VASc scores (0.641; 95% CI=0.608-0.673, P=0.008). The HELT-E2S2score may be useful for identifying Japanese NVAF patients at risk of ischemic stroke.

Incidence, characteristics and risk factors for perioperative cardiac arrest and 30-day-mortality in preterm infants requiring non-cardiac surgery

Study objectiveTo determine 30-day-mortality, incidence and characteristics of perioperative cardiac arrest as well as the respective independent risk factors in preterm infants undergoing non-cardiac surgery. DesignRetrospective observational Follow-up-study. SettingBielefeld University Hospital, a German tertiary care hospital. PatientsPopulation of 229 preterm infants (age < 37th gestational week at the time of surgery) who underwent non-cardiac surgery between 01/2008–12/2018. MeasurementsPrimary endpoint was overall 30-day-mortality. Secondary endpoints were the incidence of perioperative cardiac arrest and identification of independent risk factors. We performed univariate and multivariate analyses and calculated odds ratios (OR) for risk factors associated with these endpoints. Main results30-day-mortality was 10.9% and perioperative mortality 0.9%. Univariate risk factors for 30-day-mortality were perioperative cardiac arrest (OR,12.5;95%CI,3.1 to 50.3), comorbidities of lungs (OR,3.7;95%CI,1.2 to 11.3) and gastrointestinal tract (OR,3.5;95%CI,1.3 to 9.6); sepsis (OR,3.6;95%CI,1.4 to 9.5); surgery between 22:01–7:00 (OR,7.3;95%CI,2.4 to 21.7); emergency (OR,4.5;95%CI,1.6 to 12.4); pre-existing catecholamine therapy (OR,5.0;95%CI,2.1 to 11.9). Multivariate logistic regression indicated that perioperative cardiac arrest (OR,13.9;95%CI,2.7 to 71.3), low body weight (weight < 1000 g: OR,26.0;95%CI,3.2 to 212; 1000-1499 g: OR,10.3; 95%CI,1.1 to 94.9 compared to weight > 2000 g), and time of surgery (OR,5.9;95%CI,1.6 to 21.3) for 22:01–7:00 compared to 7:01–15:00) were the major independent risk factors of mortality. Incidence of perioperative cardiac arrests was 3.9% (9 of 229;95%CI,1.8 to 7.3). Univariate risk factors were congenital anomalies of the airways (OR,4.7;95%CI,1.2 to 20.3), lungs (OR,4.7;95%CI,1.2 to 20.3) and heart (OR,8.0;95%CI,2 to 32.2), pre-existing catecholamine therapy (OR,59.5;95%CI,3.4 to 1039), specifically, continuous infusions of epinephrine (OR,432;95%CI,43.2 to 4318). Conclusions30-day-mortality and the incidence of perioperative cardiac arrest of preterms undergoing non-cardiac surgery were higher than previously reported. The identified independent risk factors may improve interdisciplinary perioperative risk assessment, optimal preoperative stabilization and scheduling of optimal surgical timing.

243. Predictors of inpatient admission in the setting of anterior lumbar interbody fusion

BACKGROUND CONTEXT While the anterior lumbar interbody fusion (ALIF) procedure may be amenable to ambulatory surgery, it has been hypothesized that limitations such as the risk of postoperative ileus and vascular complications has hindered transition to the outpatient setting. Identification of independent risk factors predisposing patients to inpatient stays of greater than 24 hours after ALIF may facilitate better postsurgical outcomes, target modifiable risk factors, and assist developing screening tools to transition appropriate patients to the ambulatory surgery center (ASC) setting. PURPOSE The purpose of this study is to identify the most relevant risk factors that predispose patients to ≥ 24-hour admission following ALIF. STUDY DESIGN/SETTING Retrospective PATIENT SAMPLE A total of 135 patients who underwent single or multilevel ALIF. OUTCOME MEASURES Postoperative complications, postoperative fever, blood transfusion, cardiovascular complications, longer inpatient stay METHODS A prospectively maintained surgical registry was reviewed for patients undergoing single or multi-level ALIF between May 2006 and September 2019. Demographics, preoperative diagnosis, perioperative variables, and postoperative complications were evaluated according to their elevation of relative risk (RR) of an inpatient stay ≥ 24 hours. A Poisson regression model evaluated predictors of inpatient stays ≥ 24 hours. A stepwise backward regression model identified risk factors for inpatient admission of greater than or equal to 24 hours. RESULTS A total of 135 patients underwent single or multilevel ALIF. 53% of the cohort was female and 54.8% was ≤50 years of age. Nine (6.7%) patients were discharged in less than 24 hours and 126 remained admitted for ≥24 hours. The average inpatient stay was two days. The most common postoperative complication was a temperature ≥100.4°F (n=5, 3.8%). Other complications included blood transfusions (n=4, 3.0%) and cardiovascular complications (n=3, 2.2%). Bivariate analysis revealed that having a multilevel procedure on L4L5 and either L3L4 or L5S1 (RR=1.07 or 1.09, p=0.003) had the largest RR elevation for an inpatient stay of ≥ 24 hours. Stepwise multivariate analysis of risk factors revealed foraminal stenosis (RR=0.84, P=0.045), degenerative disc disease (RR=1.25, P=0.028), estimated blood loss >50 mL (RR=1.25, P=0.011), and BMI ≥30 kg/m2 (RR=1.16, p=0.030) to be significant predictors for inpatient stays of ≥24 hours. CONCLUSIONS Our study provides an incidence of demographics, perioperative characteristics, and postoperative complications as they pertain to patients undergoing ALIF. This preliminary investigation identified the most relevant risk factors to be considered before appropriately transitioning ALIF procedures to the ASC. Further studies of preoperative characteristics are needed to elucidate ideal ASC ALIF patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The importance of age: independent risk factor for atrial fibrillation in isolated rheumatic mitral stenosis

Aim: Atrial fibrillation (AF) is frequent in patients with rheumatic mitral stenosis (MS). Numerous factors have been proposed to support the pathogenesis of AF in mitral stenosis. Because of the most leading rhythm for morbidity and mortality, the identification of independent risk factors is very important for the prevention, and treatment of AF. The present study investigated the risk factors for atrial fibrillations with moderate to severe mitral stenosis. Material and Methods: This retrospective study included 307 patients (217 female, 90 male) with isolated moderate to severe rheumatic mitral stenosis. The populations were organized according to the existence of atrial fibrillation. The patients separated into two groups; as Group 1 with atrial fibrillation (188 patients), as Group II without atrial fibrillation (119 patients). A comparison of two groups was made according to age, MVA, MVG, SPAP, left atrium diameter and mean valve score. Results: According to group1 (atrial fibrillation group) and group 2 (no atrial fibrillation), left atrium diameter was 4.60±0.61 vs. 4.73±0.71; respectively, p=0.132, MVA was 1.09±0.18 vs. 1.20±0.85; respectively, p=0.360), MVG was 11.31±3.86 vs. 10.78±3.32; respectively, p=0.251, SPAP was 48.41± 14.83 vs. 47.80±13,45; respectively, p=0.813, and mean mitral valve score was 7.60±1.77 vs. 7.72±1.66; respectively, p=0.613. All of them were similar in both groups. Age was significantly higher in patients with atrial fibrillation (42.45±12.37 vs. 34.77±10.50; p&amp;lt;0.001, respectively) Conclusion: This study presented that the age is an important factor for genesis of AF.

Predictors of inpatient admission in the setting of anterior lumbar interbody fusion: a Minimally Invasive Spine Study Group (MISSG) investigation.

While the anterior lumbar interbody fusion (ALIF) procedure may be amenable to ambulatory surgery, it has been hypothesized that limitations such as the risk of postoperative ileus and vascular complications have hindered transition of this procedure to the outpatient setting. Identification of independent risk factors predisposing patients to inpatient stays of ≥ 24 hours after ALIF may facilitate better postsurgical outcomes, target modifiable risk factors, and assist in the development of screening tools to transition appropriate patients to the ambulatory surgery center (ASC) setting for this procedure. The purpose of this study was to identify the most relevant risk factors that predispose patients to ≥ 24-hour admission following ALIF. A prospectively maintained surgical registry was reviewed for patients undergoing single ALIF between May 2006 and December 2019. Demographics, preoperative diagnosis, perioperative variables, and postoperative complications were evaluated according to their relative risk (RR) elevation for an inpatient stay of ≥ 24 hours. A Poisson regression model was used to evaluate predictors of inpatient stays of ≥ 24 hours. Risk factors for inpatient admission of ≥ 24 hours were identified with a stepwise backward regression model. A total of 111 patients underwent single-level ALIF (50.9% female and 52.6% male, ≤ 50 years old). Eleven (9.5%) patients were discharged in < 24 hours and 116 remained admitted for ≥ 24 hours. The average inpatient stay was > 2 days (53.7 hours). The most common postoperative complications were fever (body temperature ≥ 100.4°F; n = 4, 3.5%) and blood transfusions (n = 4, 3.5%). Bivariate analysis revealed a preoperative diagnosis of retrolisthesis or lateral listhesis to elevate the RR for an inpatient stay of ≥ 24 hours (RR 1.11, p = 0.001, both diagnoses). Stepwise multivariate analysis demonstrated significant predictors for inpatient stays of ≥ 24 hours to be an operation on L4-5, coexisting degenerative disc disease (DDD) with foraminal stenosis, and herniated nucleus pulposus (RR 1.11, 95% CI 1.03-1.20, p = 0.009, all covariates). This study provides data regarding the incidence of demographic and perioperative characteristics and postoperative complications as they pertain to patients undergoing single-level ALIF. This preliminary investigation identified the most relevant risk factors to be considered before appropriately transitioning ALIF procedures to the ASC. Further studies of preoperative characteristics are needed to elucidate ideal ASC ALIF patients.

Complications Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: Incidence, Independent Risk Factors, and Clinical Impact.

This was a retrospective study. The objective of this study was to determine the incidence and risk factors for postoperative complications following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The identification of independent risk factors that predispose patients to postoperative complications following MIS TLIF may allow for improved outcomes and the optimization of modifiable conditions before surgical intervention. Patients undergoing a single-level MIS TLIF were retrospectively reviewed. Demographic information and the presence of baseline medical conditions was recorded for all patients. Postsurgical complications that arose following the MIS TLIF procedure were recorded. The incidence of postoperative complications was tested for association with patient and surgical characteristics using bivariate Poisson regression. Independent risk factors for complications were identified through a backward stepwise regression model. A total of 421 patients who underwent a primary, single-level MIS TLIF procedure were included in our analysis. The most common complication was urinary retention requiring catheterization (n=43, 10.2%), followed by pseudarthrosis (n=37, 8.8%), and then altered mental status (n=11, 2.6%). Multivariate analysis was conducted to determine the independent risk factors predictive of complications. The significant factors were obesity status (relative risk=2.2, P=0.001), the presence of diabetes (relative risk=2.6, P=0.002), and operative duration >105 minutes (relative risk=2.5, P=0.008). The present study provides the incidence of complications following MIS TLIF, as well as risk factors that are predictive of complications that may arise following the procedure. Independent variables for increased complication rates included extended operative duration, obesity, and diabetes status. The identification of these factors may be clinically useful to spine surgeons in terms of preoperative discussion and planning.

2277. Comparison of 30-day Crude Mortality Rates in Patients with Bloodstream Infections (BSIs) Caused by Colistin Susceptible-(ColS-CRKp) vs. Colistin and Carbapenem-Resistant Klebsiella pneumoniae(ColR-CRKp)

BackgroundColistin is a last resort antibiotic against infections with CRKp. Its increased use has led to resistance to this antibiotic.MethodsThis was a single-center, retrospective, cohort study including all CRKp BSIs treated between January 1, 2014 and July 31, 2018. Antibiotic therapy was appropriate if initiated within 5 days from the onset of BSI including at least an active drug with an adequate dosage. Exclusion criteria were missing key data, death < 24 h after inclusion, subsequent episodes in the same patients, pregnancy, polymicrobial BSI, < 18 years of age, no ID consultation, no carbapenemase gene detection by multiplex PCR for blaKPC, blaNDM, blaVIM, blaIMPand blaOXA48. EUCAST breakpoints were used for antibiotic susceptibilities. Colistin MIC was determined by using broth microdilution. FDA criteria were applied for tigecycline susceptibilityResultsAmong 174 CRKp BSIs, 129 met all inclusion criteria. Susceptibility to antibiotics was as follows: colistin (51.9%), tigecycline (67.4%), gentamicine (38.0%), amikacin (43.0%), meropenem (32.6%), ciprofloxacin (18.6%), TMP-SMX (24.0%), ceftazidime (7.8%), cefepime (7.8%).66.1% and 19.4% of the patients received inappropriate therapy in ColR-CRKp and ColS-CRKp groups, respectively (P ≤ 0.001). We incorporated interaction between colistin susceptibility and inappropriate therapy into multivariate logistic regression analysis (MLRA) that was constructed for identification of independent risk factors for 30-day mortality. The variables having P ≤ 0.1 in crude analysis were included in MLRA. After checking correlation between variables by Pearson correlation analysis and multicollinearity analysis, the final model was builded. The results are shown in Table 2.ConclusionColistin resistance and inappropriate therapy were not associated with decreased mortality individually, however their interaction significantly increased 30-day mortality rate (OR: 4.04; 95% CI: 1.62–10.02; P = 0.003).85.5% of ColR-CRKp isolates produced an OXA-48 enzyme which can be inhibited by ceftazidime–avibactam, but not available in our setting, treatment with this agent may have altered the mortality rates. Thus, high rate colistin resistance among CRKp isolates remains as a significant cause of mortality in our setting. Disclosures All authors: No reported disclosures.

Nationwide incidence and risk factors for posttraumatic seizures in children with traumatic brain injury.

OBJECTIVEPosttraumatic seizures (PTSs) are the most common complication following a traumatic brain injury (TBI) and may lead to posttraumatic epilepsy. PTS is well described in the adult literature but has not been studied extensively in children. Here, the authors utilized the largest nationwide registry of pediatric hospitalizations to report the national incidence, risk factors, and outcomes associated with PTS in pediatric TBI.METHODSThe authors queried the Kids' Inpatient Database (KID) using ICD-9-CM codes to identify all patients (age < 21 years) who had a primary diagnosis of TBI (850.xx-854.xx) and a secondary diagnosis of PTS (780.33, 780.39). Parameters of interest included patient demographics, preexisting comorbidities, hospital characteristics, nature of injury (open/closed), injury type (concussion, laceration/contusion, subarachnoid hemorrhage, subdural hematoma, or epidural hematoma), loss of consciousness (LOC), surgical management (Clinical Classification Software code 1 or 2), discharge disposition, in-hospital complications, and in-hospital mortality. The authors utilized the IBM SPSS statistical package (version 24) for univariate comparisons, as well as the identification of independent risk factors for PTS in multivariable analysis (alpha set at < 0.05).RESULTSThe rate of PTS was 6.9% among 124,444 unique patients hospitalized for TBI. The utilization rate of continuous electroencephalography (cEEG) was 0.3% and increased between 2003 (0.1%) and 2012 (0.7%). The most common etiologies of TBI were motor vehicle accident (n = 50,615), accidental fall (n = 30,847), and blunt trauma (n = 13,831). However, the groups with the highest rate of PTS were shaken infant syndrome (41.4%), accidental falls (8.1%), and cycling accidents (7.4%). In multivariable analysis, risk factors for PTS included age 0-5 years (compared with 6-10, 11-15, and 16-20 years), African American race (OR 1.4), ≥ 3 preexisting comorbidities (OR 4.0), shaken infant syndrome (OR 4.4), subdural hematoma (OR 1.6), closed-type injury (OR 2.3), brief LOC (OR 1.4), moderate LOC (OR 1.5), and prolonged LOC with baseline return (OR 1.8). Surgically managed patients were more likely to experience PTS (OR 1.5) unless they were treated within 24 hours of admission (OR 0.8). PTS was associated with an increased likelihood of in-hospital complications (OR 1.7) and adverse (nonroutine) discharge disposition (OR 1.2), but not in-hospital mortality (OR 0.5). The overall utilization rate of cEEG was 1.3% in PTS patients compared with 0.2% in patients without PTS. Continuous EEG monitoring was associated with higher rates of diagnosed PTS (35.4% vs 6.8%; OR 4.9, p < 0.001).CONCLUSIONSPTS is common in children with TBI and is associated with adverse outcomes. Independent risk factors for PTS include younger age (< 5 years), African American race, increased preexisting comorbidity, prolonged LOC, and injury pattern involving cortical exposure to blood products. However, patients who undergo urgent surgical evacuation are less likely to develop PTS.

Post-Operative Infections: Trends in Distribution, Risk Factors, and Clinical and Economic Burdens.

Post-operative infection (POI) is a serious complication in all surgical disciplines and can derail a patient's treatment and recovery course. In this analysis, we examine national trends, risk factors, and costs associated with POI. Using the Nationwide Inpatient Sample (NIS) for the years available for data analysis at the time of this study (2003-2010), we performed a cross-sectional study of adult (≥18 years) inpatients with POI and designated Clinical Classification Software (CCS) procedural class codes for the operations performed. A comparison group was selected randomly from patients with the same CCS codes who underwent the same procedures but did not experience POI. As the NIS represents 20% of U.S. hospital admissions, excess cost and stay were calculated on the basis of the average difference between cost and duration of stay for POI cases and the cost and duration of stay for the comparison group, then extrapolated to estimate the national burden for the remaining 80% of stays nationwide. Sample admissions included 139,652 cases of POI and 941,670 comparison subjects. The POIs were most common in procedures involving the digestive tract (46.5%), cardiovascular system (16.3%), or musculoskeletal system (11.2%). Older age, male gender, high Charlson Comorbidity Index Score (CCIS), and teaching, urban, or large hospitals were independent risk factors for POI in the multivariable model (p < 0.05). A POI was associated with a higher risk of death (odds ratio 2.93; 95% confidence interval 2.82-3.04, p < 0.001). Nationally, we estimate that POI resulted in an annual average of 1.04 million days of excess hospital stay and $2.72 billion excess cost. Identification of independent risk factors suggests areas for quality improvement initiatives. Post-operative infection carries substantial clinical and financial burdens in the United States, and further analysis of the associated costs is needed to identify areas for intervention to reduce this burden.

Peri-operative risk factors for complications of free flaps in traumatic wounds - a cross-sectional study.

Indication of free tissue transfer for limb reconstruction continues to grow, and despite the good results with this treatment option, complications can impair the functional results and cause a raise in health costs, with prolonged hospitalization. Therefore, peri-operative surgical information and comorbidities were described and analyzed, for identification of independent risk factors for complications of free flaps results for traumatic wounds. For our knowledge, intraoperative ischemia time of free flap was not previously studied for post-traumatic limb reconstruction, which could influence results, in these traumatic cases, with the highest rates of complications among microsurgical flap reconstructions. From July 2014 to January 2017, all patients with free flaps for limb reconstruction were consecutively included. Data on personal medical history, intra-operative microsurgical procedure, and laboratory tests were collected and complications analyzed. Descriptive and inferential statistics were performed. Sixty-two free flaps for traumatic limb reconstruction in 60 patients were studied. We observed a higher rate of complications in patients who underwent surgery > sevendays after the trauma, patients with obesity, when used recipient veins from the superficial system for drainage of the flap, and in those in whom the ischemia time of the free flap was higher in univariate analyzes. After logistic regression, the remaining independent risk factors for complications were ischemia time of free flap > two hours and obesity. The presence of thrombocytosis was associated with partial flap loss. The independent risk factors for complications were ischemia time of free flap > two hours and obesity.

Identification of Independent Risk Factors for Complications: A Retrospective Analysis of 163 Fibular Free Flaps for Mandibulofacial Reconstruction

Fibular free flap transfer is a powerful tool available to the reconstructive surgeon when treating oral and maxillofacial defects, but complications still occasionally occur and predictive analysis focusing on this specific flap is limited in terms of risk factors for complication. The purpose of this study was to identify key variables associated with complications in patients undergoing fibular free flap transfer. The data of 163 consecutive patients who underwent fibular free flap surgery at the Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, between 2012 and 2015 were reviewed retrospectively. Patient demographic data, laboratory data, surgical data, and fluid infusion-related data that may have an influence on free flap outcomes were recorded. Univariate and multivariate logistic regression analyses were used to identify relevant risk factors. A total of 163 fibular free flaps were transferred for mandibulofacial reconstruction in 163 patients with a mean age of 50.9years. Postoperative complications developed in 33 (20.2%). Multivariate analysis showed that free flap complications were significantly associated with radiotherapy history (odds ratio [OR], 5.12; P=.001), postoperative anemia (OR, 1.048; P=.041), postoperative hypoalbuminemia (OR, 0.844; P=.002), and prolonged operative time (OR, 1.005; P=.004). Radiotherapy history, decreased postoperative hemoglobin and albumin levels, and prolonged operative time are potential predictors of postoperative complications after fibular free flap reconstruction for mandibulofacial defects.

Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy

BackgroundThe timing of parathyroidectomy in kidney transplant candidates suffering from secondary hyperparathyroidism before versus early or late after transplantation remains controversial. MethodsThe short-term follow-up cohort comprised 66 patients with 1-year post-transplant follow-up, while the long-term follow-up cohort contained 123 patients. Risk-adjusted identification of independent risk factors for compromised renal graft function (KDIGO stage ≥ IV) was performed using multivariable regression analysis adjusted for propensity score logits for parathyroidectomy before versus after renal transplantation. Intra-individual matched-pairs analyses were used to identify significant effects of post-transplant parathyroidectomy on graft function as assessed by estimated glomerular filtration rate (eGFR) and paired t tests. ResultsDonor kidney function KDIGO stage III (P = .030; OR = 5.191, 95% CI: 1.100–24.508), donor blood group 0 (P = .005; OR = 0.176, 95% CI: 0.048–0.642), and post-transplant parathyroidectomy (P = .032; OR = 17.849, 95% CI: 1.086–293.268) were revealed as independent significant risk factors for compromised renal graft function in the short-term follow-up cohort using propensity score risk adjustment while post-transplant parathyroidectomy had no independent influence in the long-term follow-up cohort (P = .651). Parathyroidectomy after renal transplantation compromised graft function early after parathyroidectomy and at last follow-up in all post-transplant parathyroidectomy cases (P ≤ .004). Parathyroidectomy within the first post-transplant year was associated with compromised renal graft function until last follow-up (P = .004), while parathyroidectomy late post-transplant was not. ConclusionParathyroidectomy should be conducted before transplantation or, if this is not possible, preferably after the first post-transplant year.

Identifying independent risk factors for graft loss after primary liver transplantation.

The aim of the study is the identification of independent risk factors for re-transplantation after primary liver transplantation beyond the occurrence of hepatic artery thrombosis. Eight hundred thirty-four adult patients undergoing primary liver transplantation were analyzed. A propensity score was developed using multivariable binary logistic regression with hepatic artery thrombosis as the dependent variable. The logit link function of the propensity score was included into multivariable Cox regression analysis for graft survival to adjust the study population. Graft loss was observed in 134 patients (16.1%). Independent significant risk factors for graft loss were recipient platelet count (p=0.040; HR: 1.002; 95%-CI: 1.000-1.003), preoperative portal vein thrombosis (p=0.032; HR: 1.797; 95%-CI: 1.054-2.925), donor age (p<0.001; HR: 1.026; 95%-CI: 1.012-1.040), percentage of macrovesicular steatosis of the graft (p=0.011; HR: 1.037; 95%-CI: 1.009-1.061), early complications leading to revision surgery (p<0.001; HR: 2.734; 95%-CI: 1.897-3.956), duration of the transplant procedure (p<0.001; HR: 1.005; 95%-CI: 1.003-1.007) as well as transplantation of a split liver graft (p=0.003; HR: 2.637; 95%-CI: 1.420-4.728). The logit of the propensity score did not reach statistical significance in the final multivariable Cox regression model (p=0.111) indicating good adjustment for the occurrence of hepatic artery thrombosis. Liver transplant programs might benefit from regular donor organ biopsies to assess the amount of macrovesicular steatosis. An elevated recipient platelet count can promote reperfusion injury leading to graft loss. A liver graft from an elderly donor should not be split or be transplanted in a recipient with detected portal vein thrombosis.

Children's Hospital-Acquired Thrombosis (CHAT) Registry: A Multi-Institutional Registry for Prospective Identification of Independent Risk Factors

Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) incidence is rising and many centers are instituting pediatric-specific prophylaxis programs despite a lack of evidence-based risk stratification to reduce unnecessary thromboprophylaxis exposure.Objectives: The multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) Registry via Research Electronic Data Capture (REDCap) can identify independent HA-VTE risk factors for prospective validation and creation of a risk-assessment scoring system.Methods: This IRB-approved, retrospective registry reveals HA-VTE risk factors from subjects aged 0-21 years with radiographically-validated VTE ≥ 48 hours after hospital admission, or after central venous line placement, at 5 pediatric hospitals from January 2012 - June 2015. Descriptive statistics summarize demographics, medical comorbidities, characteristics of the VTEs themselves and associated laboratory testing for 555 subjects. Further analyses are currently utilizing matched controls and logistic regression to identify specific odds ratios for independent risk factors.Results: The median time to VTE diagnosis was 9 days with interquartile range (IQR) of 5-18.5 days, 34% of VTE occurred in a critical care unit, and 36.8% of subjects had been hospitalized in the 30 days prior to the index hospitalization. 22.7% of VTE events were incidentally found. VTE distribution was: deep vein thromboses of arms/legs (79.6%), cerebral sinus venous thrombosis (7%), abdominal VTE (5%), pulmonary embolism (4.3%), and other (intra-cardiac and superior vena cava/right atrial junction - 5.5%) with overlap due to some subjects with multiple, separate, concurrent VTE events. Demographic characteristics revealed median age of 3.6 years (IQR: 0.4 - 13.6 years) at VTE diagnosis and slight male predominance (55%). 66.1% of subjects had significant past medical history (Table 1) and 7.2% were immobile at baseline.Evaluation of hospital course revealed a multitude of acquired putative risk factors for HA-VTE (Table 2). 70.8% of VTE were associated with a central venous catheter (CVC). Of CVC-related VTE, 70.5% were in the same vein as CVC, 20.1% were in a vein which previously held a CVC, 10.7% surrounded the CVC tip, 2.5% occurred in a vein where CVC placement was attempted but unsuccessful. 55% of subjects had at least one documented infection during hospitalization, 42% of subjects had surgery, 20.7% had a procedure involving intravascular instrumentation (defined as dialysis, plasmapheresis, cardiac catheterization, stent placement/removal, or coiling procedure), 5% of subjects underwent trauma prior to admission with 82% of trauma classified as "major", and 59.5% of subjects were intubated at some point during their admission. Regarding medications, 31.9% of subjects were on steroids at VTE diagnosis and an additional 13.2% of subjects received steroids in the 30 days prior to VTE diagnosis, 2.2% of subjects were on estrogen with all of these subjects having started estrogen within 6 months prior to VTE diagnosis, 4.1% of subjects received asparaginase prior to VTE, 1.6% of subjects received recombinant factor VIIa prior to VTE, and 0.4% of subjects received prothrombin complex concentrates prior to VTE.Laboratory testing of hospitalized patients revealed 43.2% of patients had a d-dimer level obtained at time of VTE and 96.5% of those patients had an elevated level. 48.3% of patients had at least one thrombophilia lab test ordered. 17.8% of subjects received VTE prophylaxis - 55% of which was pharmacologic anticoagulation.Conclusions: The CHAT registry results demonstrate a slight male predisposition and multiple associated chronic medical illnesses and acquired hospital course co-morbidities, particularly CVCs which were involved in the majority of events. Ongoing work includes incorporating additional institutions to reach a goal of 1000 cases and 2000 controls to identify independent risk factors for the development of a risk-assessment scoring system. Long-term goals include prospective validation of the scoring system to serve as the basis of identifying subjects for a future randomized clinical trial of risk-based prevention strategies. Such a trial would evaluate efficacy, safety, and cost-benefit of thromboprophylaxis in hospitalized children and help inform best practices. [Display omitted] [Display omitted] DisclosuresYoung:Novo Nordisk: Consultancy, Speakers Bureau; Kedrion: Consultancy; Baxter: Consultancy; Biogen: Consultancy, Speakers Bureau.

Identification of independent risk factors for flap failure: A retrospective analysis of 1530 free flaps for breast, head and neck and extremity reconstruction

Reconstructive microsurgery is a powerful method of treating various complex defects. However, flap loss remains a possibility, leading to additional surgery, hospitalisation and costs. Consequently, it is important to know which factors lead to an increased risk of flap failure, so that measures can be undertaken to reduce this risk. Therefore, we analysed our results over a 20-year period to identify risk factors for flap failure after breast, head and neck and extremity reconstruction. The medical files of all patients treated between 1992 and 2012 were reviewed. Patient characteristics, surgical data and post-operative complications were scored, and independent risk factors for flap loss were identified. Reconstruction with a total of 1530 free flaps was performed in 1247 patients. Partial and total flap loss occurred in 5.5% and 4.4% of all free flaps, respectively. In all flaps, signs of compromised flap circulation were a risk factor for flap failure. More specifically, the risk factors for flap failure in breast reconstruction were previous radiotherapy, venous anastomosis revision, gluteal artery perforator (GAP) flap choice and post-operative bleeding. In head and neck reconstruction, pulmonary co-morbidity and anastomosis to the lingual vein or superficial temporal artery were risk factors, whereas a radial forearm flap reduced the risk. In extremity reconstruction, diabetes, prolonged anaesthesia time and post-operative wound infection were risk factors. Independent pre-, intra- and post-operative risk factors for flap failure after microvascular breast, head and neck and extremity reconstruction were identified. These results may be used to improve patient counselling and to adjust treatment algorithms to further reduce the chance of flap failure.

Children's Hospital-Acquired Thrombosis Database (CHAT): A Multi-Institutional Database for Prospective Identification of Independent Risk Factors

Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) incidence is rising but remains relatively low overall, requiring risk stratification to reduce unnecessary thromboprophylaxis exposure. Large sample sizes are needed for prospective epidemiologic risk factor studies, necessitating collaboration.Objectives: We formed the multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) web-based registry via Research Electronic Data Capture (REDCap) to identify independent HA-VTE risk factors for future clinical risk score development.Methods: This IRB-approved, retrospective chart review reveals HA-VTE risk factors from patients aged 0-21 years who developed diagnostically-validated VTE more than 48 hours after hospital admission, or after central venous line placement, at 3 pediatric hospitals from January 2012 - December 2014. We used descriptive statistics to summarize demographics, medical comorbidities and types of any applicable central lines for the initial 373 patients entered into the database, as well as characteristics of the VTEs themselves and associated laboratory testing. Further analysis is currently underway utilizing matched controls and logistic regression to identify specific odds ratios for independent risk factors.Results: The median length of time to VTE diagnosis was 9 with interquartile range (IQR) of day 4-18, 35.3% of VTE occurred in a critical care unit, and 21% were incidentally found. The distribution of VTE included deep vein thromboses (DVT) of the arms/legs (81.1%) followed by cerebral sinus venous thrombosis (7.3%), pulmonary embolism (5.4%), DVT of the abdomen (4%), and intracardiac DVT (4%) with some overlap due to patients with multiple, separate, concurrent VTE events. Demographic characteristics of the initial 373 subjects revealed median age of 3.7 years (IQR of 0.4 years to 13.8 years) at VTE diagnosis and a slight male predominance (57.4%). 62.6% of patients had significant past medical history (Figure 1) and 8% were immobile at baseline.Evaluation of hospital course revealed a multitude of acquired putative risk factors for HA-VTE (Figure 2). 75.7% of VTE were associated with a central venous catheter (CVC). Of CVC-related VTE, 72% were in the same vein as CVC, 20% were in a vein which previously held a CVC, 3.6% surrounded the CVC tip, 2.9% occurred in a vein where CVC placement was attempted but unsuccessful. 59% of patients had at least one documented infection during hospitalization, 48% of patients had surgery, 5.5% of patients underwent trauma prior to admission, and 59.7% (n=221) of patients were intubated at some point during their admission with 86.9% (n=192) of those patients developing VTE after a minimum of 24 hours of mechanical ventilation. Laboratory testing of hospitalized patients revealed 51.2% of patients had a d-dimer level obtained at time of VTE and 97.8% of those patients had an elevated level. 44% of patients had at least one thrombophilia lab test ordered.Conclusions: The initial CHAT database results demonstrate a slight male predisposition and multiple associated chronic medical illnesses and acquired hospital course co-morbidities, particularly CVCs which were involved in three-fourths of VTE events. Ongoing work includes incorporating additional institutions and utilizing control subjects to identify independent risk factors for the development of a risk score model. Long-term goals include prospective validation of the scoring system in a cohort of patients from pediatric centers not involved in development of the risk score with the ultimate plan of using the scoring system to stratify patients for future randomized clinical trials of risk-based prevention strategies to evaluate the safety and efficacy of this approach for reduction of pediatric HA-VTE incidence without unnecessary thromboprophylaxis exposure. [Display omitted] [Display omitted] DisclosuresYoung:Kedrion: Consultancy; Biogen Idec: Consultancy, Honoraria; Novo Nordisk: Consultancy, Honoraria; Bayer: Consultancy; Baxter: Consultancy.

(420) - Identification of Independent Risk Factors for De Novo DSA Development Through Prospective Monitoring

(420) - Identification of Independent Risk Factors for De Novo DSA Development Through Prospective Monitoring

Identification of independent risk factors for restenosis following bare-metal stent implantation: Role of bare-metal stents in the era of drug-eluting stents

In the era of drug-eluting stents (DESs), the ability of clinicians to predict which patients have a low risk of coronary restenosis following bare-metal stent (BMS) implantion is likely to be of benefit. The study population consisted of 2,711 patients who underwent BMS implantation in 3,770 lesions between 1995 and 2004. With clinical and 6 month follow-up angiographic data, we retrospectively sought to identify the independent risk predictors of restenosis, applied a previously proposed prediction model and assessed the characteristics of patients with a low likelihood of coronary restenosis within 6 months of BMS implantation. A 6-month follow-up coronary angiography was performed in 65.0% of the patients who had undergone the BMS implantation and the rate of restenosis was 26.6%. Using multivariate analysis, diabetes [odds ratio (OR), 1.294; 95% confidence interval (CI), 1.094–1.483; P=0.005], current smoking (OR, 1.294; 95% CI, 1.094–1.483; P=0.002), a reference vessel diameter of <3.25 mm (OR, 1.238; 95% CI, 1.021–1.501; P<0.001), a lesion length of >30 mm (OR, 1.645; 95% CI, 1.336–2.026; P<0.001), ostial lesion (OR, 1.858; 95% CI, 1.437–2.402; P<0.001), post-stenting minimal luminal diameter (OR, 0.576; 95% CI, 0.484–0.685; P<0.001) and bifurcation lesion (OR, 1.353; 95% CI, 1.070–1.711; P=0.012) were identified as significant independent predictors of restenosis. However, the accuracy of the prediction obtained with the current model, which used the clinical and angiographic variables correlated with the risk of restenosis, was poor. Various clinical and angiographic independent risk variables were revealed to be correlated with the risk of restenosis following BMS implantation in the present large dataset. Certain groups of patients with a relatively low risk of restenosis may be considered for BMS implantation as an alternative to DESs. However, the prediction models used at present are incomplete and further studies are required.

FRI0182 Non-biologics disease modifying anti-rheumatic drugs (nbdmards) and biologics agents acquisition and adherence among french rheumatoid arthritis patients in real life population: results from a cross-sectional study

BackgroundRecent meta-analysis established that the efficacy of combination therapy with a biological agent is superior to methotrexate for remission (1). Moreover, superiority of combination of anti-TNFa (aTNF) + nbDMARDs over...

Risk factors for periodontal disease

Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.