Increased Charlson Comorbidity Index Research Articles

Treatment and Outcomes of Proximal Esophageal Squamous Cell Carcinoma.

This study evaluated the treatment of proximal (cervical or upper thoracic) esophageal squamous cell carcinoma (SCC), for which chemoradiation is the recommended therapy. Treatment and outcomes of patients with cT1-3N0-1M0 proximal esophageal SCC in the National Cancer Database between 2004 and 2016 was evaluated using logistic regression, Kaplan-Meier analysis, and propensity-score matching. Therapy of 2159 patients was chemoradiation (n=1500, 69.5%), no treatment (n=205, 9.5%), surgery (n=203, 9.4%), radiation alone (n=190, 8.8%), and chemotherapy alone (n=61, 2.8%). Factors associated with definitive therapy with either chemoradiation or surgery were younger age, non-Black race, being insured, cervical tumor location, clinical T2 and T3 stage, clinical nodal involvement, and treatment at a research/academic program. Five-year survival was significantly better in patients treated with definitive therapy than patients not treated definitively (34.0% vs. 13.3%, p<0.001). In multivariable survival analysis, receiving definitive therapy (hazard ratio [HR] 0.39, p=0.017) was associated with improved survival, while increasing age, male sex, clinical T3 stage, positive clinical nodal involvement, and increasing Charlson Comorbidity Index were associated with worse survival. Esophagectomy was not associated with improved survival in multivariable analysis of the definitive therapy cohort (HR 0.84, p=0.08) or propensity matched analysis. However, the pathologic complete response was only 33.3% (40/120) for patients who did have an esophagectomy after chemoradiation. This national analysis supports definitive chemoradiation for not only cervical but also proximal thoracic esophageal SCC. Routine surgery does not appear to be necessary but may have a role in patients with residual disease after chemoradiation.

Population-Based Assessment of Determining Predictors for Discharge Disposition in Patients with Bladder Cancer Undergoing Radical Cystectomy.

Simple SummaryOur study analyzed 138,151 radical cystectomy patient encounters to determine which patient and facility characteristics are associated with discharge home and discharge to continued rehabilitation facilities. We used multivariate logistic regression to statistically analyze these datapoints while controlling for other variables. We found that older age, single/widowed marital status, female gender, increased Charlson Comorbidity Index, Medicaid, and Medicare insurance and open surgery are associated with Continued Rehabilitation Facility (CRF) discharge.Objective: To assess predictors of discharge disposition—either home or to a CRF—after undergoing RC for bladder cancer in the United States. Methods: In this retrospective, cohort study, patients were divided into two cohorts: those discharged home and those discharged to CRF. We examined patient, surgical, and hospital characteristics. Multivariable logistic regression models were used to control for selected variables. All statistical tests were two-sided. Patients were derived from the Premier Healthcare Database. International classification of disease (ICD)-9 (<2014), ICD-10 (≥2015), and Current Procedural Terminology (CPT) codes were used to identify patient diagnoses and encounters. The population consisted of 138,151 patients who underwent RC for bladder cancer between 1 January 2000 and 31 December 2019. Results: Of 138,151 patients, 24,922 (18.0%) were admitted to CRFs. Multivariate analysis revealed that older age, single/widowed marital status, female gender, increased Charlson Comorbidity Index, Medicaid, and Medicare insurance are associated with CRF discharge. Rural hospital location, self-pay status, increased annual surgeon case, and robotic surgical approach are associated with home discharge. Conclusions: Several specific patient, surgical, and facility characteristics were identified that may significantly impact discharge disposition after RC for bladder cancer.

Opioid Utility and Hospital Outcomes Among Inpatients Admitted With Osteoarthritis and Spine Disorders.

The aim of the study is to evaluate opioid analgesic utilization and predictors for adverse events during hospitalization and discharge disposition among patients admitted with osteoarthritis or spine disorders. This is a retrospective study of 12,747 adult patients admitted to six private community hospitals from 2017 to 2020. Opioid use during hospitalization and risk factors for hospital-acquired adverse events and nonhome discharge were investigated. The total number of patients using opioids decreased; however, the daily morphine milligram equivalent use for patients on opioids increased from 2017 to 2020. Increased odds of nonhome discharge were associated with older age, Medicaid, Medicare insurance, and increased lengths of stay, increased body mass index, daily morphine milligram equivalent, and electrolyte replacement in the osteoarthritis group. In the spine group, older age, Black race, Medicaid, Medicare, no insurance, increased Charlson Comorbidity Index, lengths of stay, polypharmacy, and heparin use were associated with nonhome discharge. Adverse events were associated with increased age, lengths of stay, Medicare, polypharmacy, antiemetic, and benzodiazepine use in the osteoarthritis group and increased Charlson Comorbidity Index, lengths of stay, and electrolyte replacement in the spine group. Despite the decreasing number of patients using opioids over the years, patients on opioids had an increased daily morphine milligram equivalent over the same period.

New, long-term opioid use after lung cancer surgery is associated with reduced 2-year survival: a retrospective population-based cohort study in South Korea

IntroductionWe aimed to investigate the proportion and associated factors for new long-term opioid use and its long-term effects after lung cancer surgery.MethodsThe South Korean National Health Insurance Database was used...

Refusal of gynecologic cancer surgery is a surgical and oncologic disparity, not an issue of noncompliance (055)

<b>Objectives:</b> To characterize socioeconomic and clinical factors associated with refusal of gynecologic cancer surgery. Secondary objectives were to estimate the effect of the refusal of surgery on overall survival and determine trends in refusal over time. <b>Methods:</b> The National Cancer Database (NCDB) was surveyed for patients with uterine, cervical, or ovarian cancers treated at participating Commission on Cancer sites between 2004 and 2017. Demographic and clinical data were abstracted. Descriptive statistics and Pearson's Chi-square tests were performed. Univariate and multivariate logistic regression analyses were performed to examine the association between variables and refusal of surgery, with the threshold for two-sided significance set at p <0.05. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. To evaluate changes in refusal over time, we performed joinpoint regression analysis using Joinpoint version 4.9.0. <b>Results:</b> Of the 788,164 women with gynecologic cancer included in our analysis, 5875 (0.75%) patients refused surgery recommended by their treating oncologist. In univariate analysis, age, race, Hispanic ethnicity, metropolitan residence, lower median household income, regional high school graduation rate, insurance status, treatment center type, distance to treating hospital, disease site, stage, and increasing Charlson comorbidity index were all associated with refusal of surgery (p<0.05). On multivariate analysis, patients who refused surgery were older at diagnosis (72.4 ± 16.1 vs 60.3 ± 13.1 years, p<0.001) and more likely Black (OR: 1.77, 95% CI: 1.62-1.92). Refusal of surgery was associated with uninsured status (OR: 2.94, 95% CI: 2.49 - 3.46), primary insurance by Medicare (OR: 1.78, 95% CI: 1.62-1.96), or Medicaid (OR: 2.79, 95% CI: 2.46-3.18) and residence in an area in the lowest national tertile of high school graduation (OR: 1.18, 95% CI: 1.05-1.33). Patients who refused surgery had inferior overall survival (1.0 vs 14.0 years, p<0.01), and this difference persisted when stratified by primary disease site. There were significant differences in survival between patients who refused only surgery but not chemotherapy or radiation therapy and those who refused all treatment modalities (5-year OS: 29.4%, 95% CI: 27.5 - 31.2 vs 9.2%, 95% CI: 7.9-10.6). The rate of refusal of surgery decreased from 2004 to 2008 (-4.4% annual percent change, p<0.05) but increased between 2008 and 2017 (+1.4% annual percent change, p<0.05).Fig. 1 <b>Conclusions:</b> Multiple non-clinical social determinants of health are independently associated with refusal of surgery for gynecologic cancer. Given that patients who refuse surgery are more likely to be underserved, marginalized members of society and have lower survival compared to those who do not, refusal of surgery should be considered an example of oncologic and surgical disparity and tackled as such.

Pre-existing and new-onset depression among patients undergoing esophageal cancer surgery: a nationwide cohort study in South Korea.

Esophageal cancer is believed to be related to psychological stress. This study aimed to examine the prevalence and risk factors for new-onset depression after esophageal cancer surgery among patients who had no pre-existing depression. In addition, we examined whether pre-existing depression affected postoperative 1-year mortality. The National Health Insurance Service database in South Korea was used for data extraction in this population-based cohort study. This study included all adult patients diagnosed with esophageal cancer who underwent esophageal surgery between January 1, 2011, and December 31, 2018. A total of 7039 adult patients who underwent esophageal cancer surgery at 95 South Korean hospitals were included in the analyses. Of the total, 608 patients (8.6%) were diagnosed with new-onset depression within 1year after esophageal cancer surgery. Female sex, adjuvant chemotherapy, increased Charlson comorbidity index, pre-existing anxiety disorder, and pre-existing insomnia disorder were potential risk factors for new-onset depression. In multivariable Cox regression analysis, the pre-existing depression group showed a 1.27-fold (hazard ratio: 1.27; 95% confidence interval: 1.08-1.48; P = 0.004) higher risk of 1-year all-cause mortality than those who had no pre-existing depression. In South Korea, 8.6% of patients are newly diagnosed with depression after esophageal cancer surgery, and some potential risk factors have been identified. Moreover, pre-existing depression was associated with increased 1-year all-cause mortality. Patients with esophageal cancer and pre-existing depression may be at high risk, requiring interventions after esophageal cancer surgery.

P21 Textbook outcome following oesophagectomy for cancer: an international cohort study

Abstract Introduction Although textbook outcome (TO) has been proposed as a tool for the assessment of oncological surgical care, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess TO in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. TO was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with TO, and results are presented as odds ratio (OR) and 95% confidence intervals (CI95%). Results Of 2,159 patients with oesophageal cancer, 39.7% achieved a TO. The outcome parameter ‘no major postoperative complication’ had greatest negative impact on a TO for patients with oesophageal cancer, compared to other TO parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of TO. Presence of 24-hour on-call rota for oesophageal surgeons (OR: 2.05, CI95%: 1.30–3.22, p=0.002) and radiology (OR: 1.54, CI95%: 1.05–2.24, p=0.027), total minimally invasive esophagectomies (OR: 1.63, CI95%: 1.27–2.08, p&amp;lt;0.001), and chest anastomosis above azygous (OR: 2.17, CI95%: 1.58–2.98, p&amp;lt;0.001) were independently associated with a significantly increased likelihood of TO. Conclusion TO is achieved in less than 40% of patients having oesophagectomy for cancer. Improvements in centralisation, hospital resources (i.e. daily 24-hour on-call esophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve TO. Understanding how these individual parameters help improve quality of patient care should be the focus of future research.

Long-term opioid use and mortality in patients with chronic non-cancer pain: Ten-year follow-up study in South Korea from 2010 through 2019.

SummaryBackgroundWe aimed to investigate the prevalence and factors associated with long-term opioid use among patients with chronic non-cancer pain (CNCP).MethodsWe extracted data from the National Health Insurance Service (NHIS) database in South Korea. As a nationwide database, the NHIS database contains information regarding all disease diagnoses and prescriptions for any drug and/or procedures. A total of 2.5% of adult patients (≥20 years of age) who were diagnosed with musculoskeletal diseases and CNCP from 2010 to 2019 were selected using a stratified random sampling technique and included in the analysis. Patients who were prescribed opioids continuously for ≥90 days were classified as long-term opioid users.FindingsA total of 19,645,161 patients with CNCP were included in the final analysis. The prevalence of long-term opioid use was 0.47% (95% confidence interval [CI]: 0.46%, 0.48%; 8421/1,808,043) in 2010, which gradually increased to 2.63% (95% CI: 2.61%, 2.66%; 49,846/1,892,913) in 2019. Among the 2010 cohort (n = 1,804,019), in multivariable logistic regression: old age, underlying disability, increased Charlson comorbidity index, use of benzodiazepine or Z-drug, rheumatoid arthritis, osteoarthritis, and low back pain were associated with an increased prevalence of long-term opioid use among patients with CNCP. In a multivariable Cox regression, the 10-year all-cause mortality in long-term opioid users was found to be 1·21-fold (hazard ratio: 1.21, 95% CI: 1.13, 1.31; P<0·001) higher than that in opioid-naive patients with CNCP.InterpretationLong-term opioid use increased in patients with CNCP in South Korea from 2010 to 2019. Certain factors were potential risk factors for long-term opioid use. Moreover, long-term opioid use was associated with increased 10-year all-cause mortality among patients with CNCP.FundingNone.

Epidemiologic study of epidural analgesia for lung cancer surgery from 2011 to 2018 in South Korea: a National Health Insurance Database cohort study.

BackgroundEpidural analgesia is commonly used for pain control during lung cancer surgery. However, the clinical trends in epidural analgesia, associated factors, and their association with clinical outcomes remain controversial. Therefore, we aimed to investigate the trends, associated factors, and their association with the clinical outcomes of epidural analgesia for lung cancer surgery.MethodsThe National Health Insurance Database was used as the data source in a nationwide cohort study. All adult patients who underwent lung cancer surgery between 2011 and 2018 were included. ResultsA total of 60,031 adult patients who underwent surgery for lung cancer were included. Of these, a total of 24,786 patients (41.3%) received epidural analgesia with a mean value of 1.5 days (standard deviation: 2.0 days). Male sex, increased Charlson comorbidity index (CCI), concurrent musculoskeletal disease, and a wider surgical extent were associated with higher odds of epidural analgesia for lung cancer surgery. Compared to open thoracotomy, video-assisted thoracoscopic surgery (VATS) was associated with lower odds of epidural analgesia for lung cancer surgery. Moreover, epidural analgesia was not associated with 30-day mortality, fatal respiratory events, or one-year mortality after lung cancer surgery.ConclusionsFrom 2011 to 2018, 41.3% of patients with lung cancer in South Korea received epidural analgesia for lung cancer surgery. Some factors (male sex, increased CCI, concurrent musculoskeletal disease, wider surgical extent, and VATS) were associated with the use of epidural analgesia in lung cancer surgery. However, epidural analgesia was not associated with clinical outcomes after lung cancer surgery.

Clinical characteristics, hospital course, and disposition of patients with nontraumatic spinal cord injury in a large private health care system in the United States

Objectives: To evaluate the clinical characteristics, hospital courses, outcomes after hospitalization, and factors associated with outcomes in patients with nontraumatic spinal cord injuries (NTSCI). Design: Retrospective analysis. Setting: A large for-profit United States health care system. Participants: 2807 inpatients with NTSCI between 2014 and 2020 were identified using International Classification of Disease codes. Main Outcome Measure: Demographic, clinical characteristics, hospital course, and disposition data collected from electronic health record. Results: The mean age was 57.91 ± 16.41 years with 69.83% being male. Incomplete cervical level injury was the most common injury type, spinal stenosis was the most common diagnostic etiology and central cord syndrome was the most common clinical syndrome. The average length of stay was 9.52 ± 15.8 days, with the subgroup of 1308 (46.6%) patients who were discharged home demonstrating a shorter length of stay (6.42 ± 10.24 days). Falls were the most common hospital-acquired complication (n = 424, 15.11%) and 83 patients deceased. There were increased odds of non-home discharge among patients with the following characteristics: older age, Medicare insurance, non-black racial minority, increased Charlson Comorbidity Index (CCI), intensive care unit (ICU) stay, use of steroid or anticoagulant medications, and hospital-acquired pulmonary complications. Increased in-hospital mortality was observed in those with Medicaid insurance, ICU stay, increased CCI, diagnosis of degenerative spine disease, other unspecified level of injury, and hospital-acquired pulmonary complications. Conclusions: NTSCI in this sample were predominantly incomplete cervical central SCIs. Increased CCI, ICU stay, and hospital-acquired pulmonary complications were associated with poorer outcomes after acute care hospitalization among patients with NTSCI.

PD29-02 RISK OF HYPERTENSION AFTER RENAL TRAUMA

You have accessJournal of UrologyCME1 May 2022PD29-02 RISK OF HYPERTENSION AFTER RENAL TRAUMA Matthew S. Swallow, Odinachi I. Moghalu, Joshua J. Horns, Benjamin J. McCormick, and Jeremy B. Myers Matthew S. SwallowMatthew S. Swallow More articles by this author , Odinachi I. MoghaluOdinachi I. Moghalu More articles by this author , Joshua J. HornsJoshua J. Horns More articles by this author , Benjamin J. McCormickBenjamin J. McCormick More articles by this author , and Jeremy B. MyersJeremy B. Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The risk of hypertension after renal trauma (RT) is not well-defined. Previous studies are limited by small cohorts and/or difficulty in long-term follow up after trauma. We aimed to utilize the Truven Health MarketScan (MS) database to evaluate the risk of hypertension after RT. METHODS: We conducted a retrospective analysis of inpatient records in MS from 2008-2017 for patients with renal and bladder/urethral trauma. Patients with a diagnosis of RT or non-renal lower genitourinary trauma (GUnRT) (bladder/urethral trauma) were identified through ICD-9/10 codes. The development of HTN (also defined by ICD-9/10 codes) was compared between those who experienced RT and a control group of those who experienced GUnRT. Patients were excluded if they experienced both trauma types, had pre-existing HTN, had less than one year of enrollment data prior to trauma, or if they were under 18 years of age. An adjusted analysis included multiple covariates. RESULTS: There were a total of 6,542 RT patients and 5,144 GUnRT patients. The median age was 52 years (IQR 31-65) for RT patients and 49 years (IQR 38-64) for GUnRT patients. Median follow up data was 18 months (IQR 6-38) for RT patients and 21 months (IQR 7-42) for GUnRT patients. A total of 2,232 (34.1%) RT patients developed post-trauma HTN compared to 1,194 (23.2%) GUnRT patients. On multivariate analysis, risk of post-trauma HTN was higher in individuals with RT compared to GUnRT (hazard ratio 1.75, 95% CI 1.63-1.88, p<0.001). Other covariates associated with increased risk of post-trauma HTN included increasing age, female gender, increased Charlson Comorbidity Index, increased inpatient length of stay, and presence of one or more of the following comorbidities: smoking, diabetes, obesity, hyperlipidemia, and alcohol use. Undergoing either an open or minimally invasive kidney procedure was not associated with a higher rate of HTN (hazard ratio 1.095, 95% CI 0.94-1.27, p=0.239). CONCLUSIONS: Patients experiencing renal trauma have an associated higher rate of developing hypertension compared to a control population. Patient age, female gender, and medical history of diabetes, obesity, and hyperlipidemia was also associated with increased risk of post-trauma HTN. Source of Funding: University of Utah Division of Urology © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e504 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew S. Swallow More articles by this author Odinachi I. Moghalu More articles by this author Joshua J. Horns More articles by this author Benjamin J. McCormick More articles by this author Jeremy B. Myers More articles by this author Expand All Advertisement PDF DownloadLoading ...

Incidence and risk factors for mortality in patients treated with combined ceftaroline for Gram-positive infective endocarditis.

Ceftaroline is a fifth-generation cephalosporin and represents an alternative in the treatment of infective endocarditis (IE). The main objective of this study was to describe the incidence of in-hospital and 42-day mortality in patients with IE treated with ceftaroline. An observational retrospective study included adult patients with IE admitted during a 3.5-year period (January 2018-June 2021) and treated with ceftaroline in a single center. All cases were definite or possible IE according to the modified Duke criteria. Seventy cases were analyzed. The mean age was 67.35 ± 16.62 (16-89) and 39 (55.7%) were males. The mean number of days of treatment with ceftaroline was 21.26 ± 16.17 (1-75). Overall mortality at 42days was 30%, 20.7% in the first line, and 36.6% in rescue therapy. Predictors of 42days-mortality were increased Charlson comorbidity index (CCI) (OR of 1.7 per 1 point increment, 95% CI 1.2-2.4, P 0.001), presence of methicillin-resistance (OR 6.8, 95% CI 1.3-36.8, P 0.026) and evidence of septic shock (OR 8.6 95% CI 1.7-44.2, P 0.01). Predictors of 42days of therapeutic failure were the increase in the CCI (OR of 1.6 per 1 point increment, 95% CI 1.3-2.1, P 0.000) and septic shock (OR 4.5 95% CI 1.1-18 P 0.036). Adverse effects were described in 6/70 (8.6%) of the patients, precipitating in 4/70 (5.7%) the definitive withdrawal of the antibiotic. The incidence of in-hospital and 42day-mortality of IE patients treated with ceftaroline remains similar to literature data. Increased CCI, septic shock, and methicillin resistance are associated with poor prognosis.

Risk factors and mortality in elderly patients with severe hyponatremia admitted to the emergency department.

This study was aimed at determining the risk factors associated with mortality in elderly patients with severe hyponatremia admitted to the emergency department. The data of patients aged ≥ 65 years who were admitted to the emergency department and whose serum sodium levels were < 125 mEq/L were retrospectively collected. Mortality was associated with chronic liver disease/cirrhosis (p = 0.036), metastatic tumor (p = 0.007) and solid tumor (p = 0.013) cancers, antiarrhythmic drug use (p = 0.003), potassium-sparing diuretic use (p = 0.044), antineoplastic drug use (p = 0.0029), and dialysis treatment (p = 0.015). The following cutoff values were determined to be predictive of mortality: urea > 63.6 (AUC: 0.771; p = 0.0001), creatinine > 1.39 (AUC: 0.675; p = 0.0003), potassium > 4.64 (AUC: 0.711; p = 0.0001), C-reactive protein > 44 (AUC: 0.765; p = 0.0001), white blood cell count > 12.21 (AUC: 0.688; p = 0.0001), hemoglobin < 11.2 (AUC: 0.611; p = 0.0103), and Charlson comorbidity index > 2 (AUC: 0.739; p = 0.0001). The use of antineoplastic drugs (OR: 4.502; p = 0.010) and increased values of the following were associated with an increased risk of mortality: urea (OR: 1.007; p = 0.024), C-reactive protein (OR: 1.005; p = 0.026), glucose (OR: 1.008; p = 0.001), and Charlson comorbidity index (OR: 1.198; p = 0.025). Malignancy; liver cirrhosis; dialysis treatment; increased Charlson comorbidity index, urea, and C-reactive protein values and the use of antineoplastic drugs are associated with mortality.

Movement Is Life-Optimizing Patient Access to Total Joint Arthroplasty: Mental Health Disparities.

Mental illness affects 20.6% of American adults. The lifetime prevalence of depression and anxiety is 17% and 29%, respectively. In particular, women suffer more from mental illness than men. Racial and ethnic minorities experience disproportionate discrimination, which has been linked to depression, anxiety, and psychological distress. African Americans are more likely to be chronically depressed, have higher levels of impairment and more severe symptoms, and often have challenges accessing treatment. Poor mental health is associated with low socioeconomic status, prolonged hospital stays, psychosis, postoperative anemia, infection, and pulmonary embolism. For total hip and knee arthroplasty, mental health conditions have been linked to higher hospital charges, higher rates of nonroutine discharges, and an increased Charlson Comorbidity Index. Mechanisms to address mental health are varied and range from psychosocial to pharmacologic modalities. Optimization in these vulnerable patients includes appropriate preoperative screening, assessment of support systems, identifying resources, and providing a safe discharge plan.

Outcome and prognosis after adrenal metastasectomy: nationwide study.

BackgroundData regarding adrenal metastasectomy are limited. Here, clinical outcomes, safety, and prognostic factors in patients undergoing adrenal metastasectomy were evaluated in a large nationwide study.MethodsPatients undergoing adrenal metastasectomy between 2000 and 2018 were identified in the Danish National Pathology Registry. Medical records were reviewed to confirm eligibility and to collect clinical data. The primary outcome was overall survival (OS). Cox multivariable regression analyses were? adjusted for baseline factors.ResultsIn total, 435 patients underwent adrenal metastasectomy; the primary cancer origins were renal (n = 195, 45 per cent), lung (n = 121, 28 per cent), colorectal (n = 50, 11 per cent), and other (n = 69, 16 per cent). The median (interquartile range; i.q.r.) age was 66 (59–71) years, and 280 (64 per cent) were men. The 5-year OS was 31 per cent. The 30-day mortality was 1.8 per cent. Complications were more frequent and severe in patients who underwent open surgery compared with laparoscopic surgery (Clavien–Dindo III–V, 31.5 per cent versus 11.8 per cent respectively, P < 0.001). Factors associated with poor survival included non-radical pR2 resection (hazard ratio (HR) 3.57, 95 per cent c.i. 1.96 to 6.48), tumour size more than 50 mm (HR 1.79, 95 per cent c.i. 1.26 to 2.52), lung cancer origin (HR 1.77, 95 per cent c.i. 1.31 to 2.40), open surgical approach (HR 1.33, 95 per cent c.i. 1.04 to 1.71), presence of extra-adrenal metastases (HR 1.31, 95 per cent c.i. 1.01 to 1.71), and increasing Charlson co-morbidity index factors (HR 1.14 per one-point increase, 95 per cent c.i. 1.03 to 1.27).ConclusionAdrenal metastasectomy is safe and may result in long-term survival in a subset of patients. Non-radical resection, large tumour size, lung cancer origin, open approach, presence of extra-adrenal metastases, and co-morbidity were associated with inferior outcomes.

Textbook outcome following oesophagectomy for cancer: international cohort study.

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Delayed-onset Diabetes Mellitus and Cardiorespiratory Morbidity after Acute Pancreatitis Suggests a Need for Individualised Approach to Follow-up

Introduction: Acute pancreatitis (AP) remains a leading cause of hospitalization and has a deleterious impact on long-term mortality and morbidity. Our aim was to identify key risk factors for long-term mortality and new-onset morbidity after AP. Methods: Healthcare data from 13 eHealth registers including in-patient, critical care, community prescribing and death certificate data for all AP patients in Scotland between 1 April 2009 and 31 March 2012 underwent comprehensive record linkage. Actual minimum follow-up was 5 years. Descriptives and survival analysis used Cox’s methods. Results: 2027 AP patients were included. Median age was 56 years; AP was gallstone-related in 46.8% cases. During the 5-year follow-up, 23.2% of the cohort died. Risk factors for death included increased Charlson co-morbidity index (CCI), non-gallstone aetiology, male gender, and age. New-onset respiratory disease was associated with age (HR1.01, p=0.03), non-gallstone aetiology (HR1.37, p=0.2) and CCI (HR1.97, p<0.01) . New-onset cardiac disease was associated with age (HR1.05, p<0.01) and critical care admission during AP (HR1.61, p<0.01). Predictors of new-onset diabetes included male gender (HR1.43, p<0.01), non-gallstone aetiology (HR1.72, p<0.01) and critical care admission (HR2.68, p<0.01). AP patients needing critical care were at highest risk of new-onset diabetes in the first 2 years after AP (HR4.35, p<0.0001), whereas non-gallstone aetiology was a significant risk factor during later follow-up (HR2.39, p<0.0001). Conclusions: This study identifies discrete predictors of new-onset cardiorespiratory morbidity and a differential risk of new diabetes dependent on critical care admission and AP aetiology. Together, these data support an individualised approach to follow-up after AP.

P-OGC86 Textbook Outcome following Oesophagectomy for Oesophageal Cancer: An International Cohort Study

Abstract Background Although textbook outcome (TO) has been proposed as a tool for the assessment of oncological surgical care, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess TO in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. TO was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with TO, and results are presented as odds ratio (OR) and 95% confidence intervals (CI95%). Results This study included 2,159 patients with oesophageal cancer, of whom 39.7% achieved a TO. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a TO for patients with oesophageal cancer, compared to other TO parameters. Multivariable analysis identified male gender, increasing Charlson comorbidity index, and higher AJCC T and N staging to be associated with a significantly lower likelihood of TO. After accounting for these factors, high volume centres (&amp;gt;50 cases/year; OR: 1.36, CI95%: 1.06 - 1.75, p = 0.015), presence of 24-hour on-call rota for oesophageal surgeons (OR: 2.11, CI95%: 1.33 - 3.35, p = 0.001) and radiology (OR: 1.56, CI95%: 1.08 - 2.26, p = 0.019), total minimally invasive esophagectomies (OR: 1.60, CI95%: 1.25 - 2.05, p &amp;lt; 0.001), and chest anastomosis above azygous (OR: 2.17, CI95%: 1.58 - 2.98, p &amp;lt; 0.001) were independently associated with a significantly increased likelihood of TO. Conclusions TO is achieved in less than 40% of patients having oesophagectomy for cancer. Improvements in centralisation, hospital resources (i.e. daily 24-hour on-call esophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve TO. Understanding how these individual parameters help improve quality of patient care should be the focus of future research.

Rates and risk factors associated with 30- and 90-day readmissions and reoperations after spinal fusions for adult lumbar degenerative pathology and spinal deformity.

Analyze state databases to determine variables associated with of short-term readmissions and reoperations following thoracolumbar spine fusions for degenerative pathology and spinal deformity. Retrospective study of State Inpatient Database (2005-13, CA, NE, NY, FL, NC, UT). age > 45years, diagnosis of degenerative spinal deformity, ≥ 3 level posterolateral lumbar spine fusion. revision surgery, cervical fusions, trauma, and cancer. Univariate and step-wise multivariate logistic regression analyses were performed to identify independent variables associated with of 30- and 90-day readmissions and reoperations. 12,641 patients were included. All-cause 30- and 90-day readmission rates were 14.6% and 21.1%, respectively. 90-day readmissions were associated with: age > 80 (OR: 1.42), 8 + level fusions (OR: 1.19), hospital length of stay (LOS) > 7days (OR: 1.43), obesity (OR: 1.29), morbid obesity (OR: 1.66), academic hospital (OR: 1.13), cancer history (OR:1.21), drug abuse (OR: 1.31), increased Charlson Comorbidity index (OR: 1.12), and depression (OR: 1.20). Private insurance (OR: 0.64) and lumbar-only fusions (OR: 0.87) were not associated with 90-day readmissions. All-cause 30- and 90-day reoperation rates were 1.8% and 4.2%, respectively. Variables associated with 90-day reoperations were 8 + level fusions (OR: 1.28), LOS > 7days (OR: 1.43), drug abuse (OR: 1.68), osteoporosis (OR: 1.26), and depression (OR: 1.23). Circumferential fusion (OR: 0.58) and lumbar-only fusions (OR: 0.68) were not associated with 90-day reoperations. 30- and 90-day readmission and reoperation rates in thoracolumbar fusions for adult degenerative pathology and spinal deformity may have been underreported in previously published smaller studies. Identification of modifiable risk factors is important for improving quality of care through preoperative optimization.

Abstract 11540: Charlson Comorbidity Index is an Effective Predictor of Hospital Outcomes in Takotsubo Cardiomyopathy

Introduction: The Charlson Comorbidity Index (CCI) is a recognized predictor of clinical outcomes that has been studied in diverse clinical settings. In this study, we evaluate its utility for prediction of outcomes in Takotsubo cardiomyopathy. Methods: This is a retrospective cohort study using the 2018 Nationwide Inpatient Sample that included patients admitted with a primary diagnosis of Takotsubo syndrome. Outcomes were mortality, length of stay, total hospitalization charges, and cardiogenic shock. Multivariate regression analysis was performed adjusting for patient age, race, gender, severe sepsis, cardiogenic shock, tobacco use, atrial fibrillation, and other relevant comorbidities with a p-value &lt;0.2 in univariate screen. Statistical analysis was performed using Stata 17.0. Results: A total of 7,970 weighted patients were hospitalized with Takotsubo syndrome, with a mean age of 66.5 years. Incidence of primary outcomes was gradually higher with an increasing Charlson Comorbidity Index. On multivariate regression analysis, each one-point increase in Charlson score was associated with 64% increased odds of inpatient mortality (odds ratio 1.64, p= 0.000). The odds of cardiogenic shock was also increased (odds ratio 1.24, p=0.000), as well as the mean length of stay and total hospitalization charges. Conclusions: The Charlson Comorbidity Index is an effective predictor of hospital outcomes in Takotsubo cardiomyopathy.