Independent Predictors Of Need Research Articles

The Effect of Preeclampsia on Adverse Maternal Outcomes in Women With Placental Abruption at a Large Urban Hospital in Tennessee From 2019 to 2022 [ID 2683655

INTRODUCTION: Placental abruption is associated with increased pregnancy-related morbidity and mortality. Few studies have explored the effect of individual risk factors for placental abruption on outcomes. Our study evaluates the association of preeclampsia and maternal morbidity in patients with placental abruption. METHODS: We conducted a retrospective case–control study to evaluate the association of preeclampsia with adverse maternal outcomes in the setting of placental abruption. Univariate analyses were used to determine the relationship between preeclampsia and known adverse maternal outcomes of placental abruption. Multivariate logistic regression was then used to evaluate the relationship between preeclampsia and each significantly associated outcome, adjusting for factors including body mass index, gestational age, mode of delivery, race, trauma, diabetes, placental location, cocaine and tobacco use, prior cesarean sections, year of delivery, and parity. Significance was assessed at an alpha of 0.05. RESULTS: Of 147 singleton pregnancies complicated by placental abruption from 2019 to 2022, 37 (25.2%) were complicated by preeclampsia. No significant differences were found between groups in incidence of acute kidney injury, disseminated intracellular coagulation, cesarean delivery, fetal demise, preterm birth, or low birth weight. On adjusted multivariable regression, we found preeclampsia increased the odds of maternal transfusion requirement (adjusted odds ratio [aOR] 3.55; 95% CI: 1.2, 10.4) and postoperative hospital stay greater than 2 days (aOR 4.05; 95% CI: 1.5, 11.2). CONCLUSION: Preeclampsia was an independent predictor of need for blood transfusion and increased duration of hospital stay in patients with placental abruption. Recognition of preeclampsia as an independent risk factor for these outcomes may allow medical optimization, increased preparedness, and lead to decreased pregnancy-related morbidity.

MP47-05 SUTURELESS OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY: INDICATION, FEASIBILITY AND FUNCTIONAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP47-05 SUTURELESS OFF-CLAMP ROBOT-ASSISTED PARTIAL NEPHRECTOMY: INDICATION, FEASIBILITY AND FUNCTIONAL OUTCOMES Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Manuela Costantini, Simone D'annunzio, Mariaconsiglia Ferriero, Leonardo Misuraca, Andrea Iannuzzi, Alberto Ragusa, Rocco Papalia, Salvatore Guaglianone, and Giuseppe Simone Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Manuela CostantiniManuela Costantini More articles by this author , Simone D'annunzioSimone D'annunzio More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Andrea IannuzziAndrea Iannuzzi More articles by this author , Alberto RagusaAlberto Ragusa More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimizing renal function loss during robot-assisted partial nephrectomy (RAPN) is a primary surgical outcome. There are few reports about sutureless RAPN and this procedure has intrinsic selection bias, being renorraphy a mandatory step to manage major bleeding sources and unintended urinary tract violation. The aim of this study was to describe predictors of performing renorraphy, and to compare perioperative and functional outcomes between sutureless and conventional renorraphy RAPN. METHODS: Our single center IRB approved renal cancer database was queried for “RAPN” and “renorraphy””. After a standardization process, all consecutive patients treated between Jan 2020 and May 2022 underwent off-clamp RAPN with a sutureless intent. Renal stump coagulation was used to control bleeding sources after RAPN. Intraoperative evidences of urinary tract violation was the only indication to perform renorraphy. Baseline and postoperative outcomes were collected. Continuous and categorical variables were compared using Mann-Whitney and Chi-Square tests. Logistic regression analysis was performed to identify predictors of renorraphy. Kaplan-Meier (KM) analysis and the log-rank test were performed to compare probabilities of developing newly onset chronic kidney disease (CKD) stage≥3 between cohorts. RESULTS: Out of 269 patients included, sutureless approach was successully completed in 246 patients. Both cohorts were homogeneous for baseline features except for PADUA score (p=0.028). No differences occurred postoperatively (Table 1). On multivariable analysis, nearness to collecting system ≤4mm was the only independent predictor of need for renorraphy (p=0.008 - Table 2). Overall, 108 patients had a renal tumor nearness ≤4mm to collecting system and sutureless intent failure probability was 16%. At KM analysis, performing renorraphy did not impact on probabilities of developning CKD stage ≥3 (2yrs: sutureless: 16.3%±2.9 vs renorraphy: 19.0%±10.5; p=0.71). CONCLUSIONS: Nearness to urinary collecting system predicts probability of performing renorraphy, which had negligible impact on perioperative and early functional outcomes. Safety, feasibility and functional outcomes of sutureless RAPN were confirmed, even if larger cohorts and randomized controlled trials are needed to obtain stronger evidences. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e644 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Manuela Costantini More articles by this author Simone D'annunzio More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Andrea Iannuzzi More articles by this author Alberto Ragusa More articles by this author Rocco Papalia More articles by this author Salvatore Guaglianone More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors for lower extremity vascular complications in adult patients on veno-arterial extracorporeal membrane oxygenation

ObjectiveUtilization of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has increased significantly over the last decade. Prior studies have reported worse mortality for patients with vascular complications on VA-ECMO; however, these were limited by small sample size. The purpose of this study is to investigate predictive risk factors for vascular complications in VA-ECMO patients and their potential impact on mortality. MethodsPatients who underwent peripheral VA-ECMO from January 2011 to December 2021 were identified. Primary outcomes were lower extremity vascular complications and in-hospital mortality. Multivariate stepwise logistic regression models were used to identify predictors of vascular complications and in-hospital mortality. ResultsA total of 605 VA-ECMO patients (25% female) were identified. The mean age was 56.3 ± 13 years, and 56 (10.4%) were black. In-hospital mortality was 63.8% (n = 386), and VA-ECMO ipsilateral vascular complications occurred in 72 patients (11.9%). Vascular surgical interventions (thromboembolectomy, fasciotomies, amputation, and surgical management of cannula bleeding) were required in 30 patients (41.7%). Same-side arterial and venous cannulas, cannula size, and absence of distal perfusion cannula did not increase risk of vascular complication. Multivariate analysis identified age (odds ratio, 0.948; 95% confidence interval, 0.909-0.988; P = .0116) and pre-existing peripheral arterial disease (odds ratio, 3.489; 95% confidence inteval, 1.146-10.624; P = .0278) as independent predictors of need for vascular surgery interventions. The mortality rate of patients who developed vascular complications was not significantly different compared with the mortality rate of those who did not develop vascular complications (61% vs 64%; P = .92). ConclusionsThis study represents one of the largest series to date of lower extremity vascular outcomes in patients undergoing VA-ECMO. Our results confirm the high mortality rate associated with VA-ECMO; however, vascular complications did not represent a risk factor for mortality as previously reported. Same-sided VA-ECMO cannulas, cannula size, and the presence or absence of distal perfusion cannula did not predict vascular complications. Increasing age and presence of peripheral arterial disease are independent predictors of need for vascular surgery intervention in patients on VA-ECMO.

Predicting need for intervention in acute necrotizing pancreatitis following discharge- A single center experience in 525 patients

Background and aimsThe clinical course of necrotizing pancreatitis (NP) is variable and unpredictable, with some patients managed conservatively, but a significant proportion become symptomatic and needing intervention for drainage and/or necrosectomy. The aim of this study was to identify patients based on baseline clinical and imaging metrics who will likely need intervention and therefore closer follow-up. MethodsAll NP patients managed in our institution between 2010 and 2019 were identified from a prospective database and those who did not undergo intervention during initial hospitalization were followed longitudinally post discharge until clinical and imaging resolution of necrosis. Patients were categorized into a conservative arm or intervention arm (endoscopic/percutaneous/surgical drainage and/or necrosectomy) for criteria defined according to IAP/APA guidelines. Clinical and imaging characteristics during initial presentation were analyzed between the two groups to identify independent predictors for eventual intervention using multivariable logistic regression. A nomogram was designed based on factors that were significant as defined by P value < 0.05. ResultsAmong 525 patients, 340 who did not meet criteria for intervention during initial admission were included for study and followed for an average 7.4 ± 11.3 months. 140 were managed conservatively and 200 needed intervention (168 within 6 months and 32 after 6 months). Independent predictors of need for eventual intervention were white race [OR 3.43 (1.11–10.62)], transferred status [OR 3.37 (1.81–6.27)], and need for TPN [OR 6.86 (1.63–28.9)], necrotic collection greater than 6 cm [OR 8.66 (4.10–18.32)] and necrotic collection with greater than 75% encapsulation [OR 41.3 (8.29–205.5)]. A prediction model incorporating these factors demonstrated an area under the curve of 0.88. ConclusionsMajority of NP patients do not need intervention during initial admission but may require drainage/necrosectomy mostly in the first 6 months following discharge. Need for subsequent intervention can be accurately predicted by a combination of clinical and imaging features on index admission.

Risk of Postoperative Stiffness Following Multiligamentous Knee Injury Surgery Is Not Affected by Obesity: A Multicenter Study

The purpose of this study was to examine the relationship between obesity and postoperative stiffness following surgical management of multiligamentous knee injuries (MLKIs) using a large two-center cohort, by both 1) using binary cutoffs at various body mass indexes (BMIs) and 2) a linear regression model. 190 consecutive patients who underwent surgical management of MLKIs between January 2001 and March 2020 were reviewed at two level 1 academic trauma centers. Patient demographics, surgical characteristics, and manipulation under anesthesia (MUA)/lysis of adhesions (LOA) were reviewed. Patients were stratified by obesity grades: grade 1 (BMI 30 to <35) grade 2 (BMI 35 to <40); grade 3 (BMI >40), and compared with a nonobese comparison group with BMI <30. Multivariate logistic regressions were performed, including the covariates of age, gender, BMI, acute versus chronic injury, external fixator, vascular injury, knee dislocation, and Schenck Classification. Fisher's exact test was used to compare rate of MUA between grades of obesity. Analyses were performed with R. Statistical significance was set at P < .05. The mean BMI of the cohort was 29.2 kg/m2. The mean overall follow-up was 27.2 ± 7.2 months (range: 14-142 months). There were 55 (29.1%) MUA procedures observed at a mean 3.77 ± 2.18 months (range: 1.8-9.7 months) after final MLKI surgery. No significant difference was found in BMI of patients who underwent a MUA compared to patients who did not (30.2 vs 28.8; P= .67). There was no significant difference in rate or time to MUA following MLKI surgery between groups, with logistic regression demonstrating no significance (P= .144). Use of external fixation at the index surgery (OR= 3.3 [95% CI: 2.2, 4.7; P < .0001]) and vascular injury (OR= 6.2 [95% CI: 1.8, 24.5; P= .005]) were found to be independent predictors for need for MUA. No difference in risk for postoperative stiffness requiring MUA following surgery for MLKI was found based on BMI. At all BMI levels, there were no significant increase in need for postoperative MUA, suggesting at minimum a neutralizing effect of obesity on postoperative stiffness. In addition, patients with external fixator use and vascular injury at index surgery were found to be at significantly higher risk for postoperative stiffness requiring MUA following surgery for MLKI. Surgeons should be aware of the risk factors for arthrofibrosis when proceeding with surgical repair or reconstruction of two or more ligaments of the knee. III, multicenter retrospective cohort study.

Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19.

Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65–5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.

Routine laboratory test to assess the need of respiratory support in acute bronchiolitis

Accurate and readily available biomarkers to predict the clinical course of bronchiolitis would enable enhanced decision-making in this setting. We explored the relationship of several biochemical parameters available at the pediatric emergency care setting with the need of advanced respiratory support (ARS): continuous positive airway pressure (CPAP), biphasic positive airway pressure (BiPAP), or invasive mechanical ventilation (MV) in bronchiolitis. Single-center, prospective, observational, including infants aged less than 12 months diagnosed with acute bronchiolitis at the Pediatric Emergency Department. Determination of plasmatic values of several laboratory tests was performed at the time of hospital admission. Multivariate logistic analysis identified independent predictors for need of ARS. From October 1, 2018to May 1, 2020, we recruited 149 infants (58% males; median age of 1 [0.5-2.5]month). Thirty-seven (25%) cases required ARS. After adjusting by age, bacterial superinfection, and comorbidities in the multivariate analysis, only higher levels of glycemia (p = 0.001),C-reactive protein (CRP)(p = 0.028), CRP/albuminratio (p = 0.032), and NT-proBNP (p = 0.001) remained independently associated with ARS. These biomarkers reached moderate prediction accuracy with area under the curve of receiver operator curve curves ranging from 0.701 to 0.830 (p = 0.001). All they presented relatively high specificity (0.75-0.84) and negative predictive values (0.77-0.89) with low sensitivity and positive predictive values. They also correlated significantly with length of stay hospitalization (p = 0.001). Increased plasmatic levels of CRP, CRP/albumin ratio, glycemia, and NT-proBNP at hospital admission are associated with the need for ARS in infants with acute bronchiolitis.

Factors determining blood transfusion in patients undergoing off pump coronary artery bypass graft (OPCABG) surgery: A prospective cross-sectional study

Cardiovascular disease, especially coronary heart disease is increasing to a great extent globally and in India. Off pump Coronary artery bypass graft is one of the surgical modalities in the treatment of Coronary artery heart disease. Blood/ blood component transfusion is one of the essential roles during/immediate postoperative period of off pump coronary artery bypass graft surgery. Though there are few benefits due to blood transfusion, the demerits outweigh the merits of blood transfusion. Hence identification of predisposing factors for need of blood /blood component transfusions will enhance us to understand the indications and the ways to minimize it.To determine the predisposing factors that influence the need for blood transfusion during off pump coronary artery bypass graft and to measure their strength of association.This cross-sectional study was done in a tertiary care cardiac center in India between March and September 2016 on 196 patients. The participants were from both sexes, aged between 40-70 years, undergoing elective or emergency OPCABG under general anaesthesia. Information on Demographic data and comorbid illnesses were elicited. Vitals and other hemodynamic parameters were recorded during preoperative, intra operative and post operative periods. Total amount of anticoagulant (heparin) used, activated clotting time (ACT) after 3 minutes of anticoagulation, total duration of graft harvest (time from start of first graft harvesting to end of last graft harvest), total number of grafts taken, total duration for anastamoses (time from start of anastamosis to end of last graft anastamosis), total blood loss and total amount of blood transfused were noted.The intra-operative factors included total intra-operative heparin used, total protamine used, total number of grafts used for anastamoses, total duration of graft anastamoses, total duration of surgery, total duration of anaesthesia, total intra-operative blood loss and insertion of IABP intra-operatively. The post operative factors included total amount of postoperative blood loss and post operative insertion of IABP. Multivariate analysis of significant factors showed male gender, preoperative anaemia and total duration of surgery were independent predictors of need of blood and blood product transfusion.Prior identification of risk factors and correction of them if applicable would help to assess and manage preoperatively and also thereby reduce the need for blood transfusions and help in managing optimal utilization of resources.

OP21 Predictive value of Milan Ultrasound Criteria in Ulcerative Colitis: A prospective observational cohort study

Abstract Background Endoscopic remission is associated with better outcomes in ulcerative colitis (UC). However, colonoscopy (CS) is invasive and poorly tolerated by patients. Recently, we developed and externally validated non-invasive ultrasonography based criteria [Milan ultrasound criteria (MUC)] to assess and grade endoscopic activity in UC. We also confirmed that a MUC score &amp;gt; 6.2 is a valid cut-off to discriminate endoscopic activity, defined by a Mayo endoscopic subscore &amp;gt; 2. Aim of this study was to assess the predictive role of MUC on disease course in a prospective cohort of UC patients. Methods UC consecutive patients were followed for at least 12 months after performing baseline bowel US. UC-related outcomes, including need of treatment escalation (defined as the need of corticosteroids or change/optimization of immunosuppressants), hospitalization and surgery, were assessed at 1 year by logistic regression analysis, and were analyzed after long term follow-up (5 years) using Kaplan-Meier survival analysis. Fig. 1A and 1B. Kaplan–Meier curves for the cumulative probability of hospitalization and surgery in patients with Milan ultrasound criteria (MUC) &amp;lt; 6.2 (solid line) or MUC &amp;gt; 6.2 (dotted line). (p= 0.046; p= 0.023; respectively). Fig. 1C and 1D. Kaplan–Meier curves for the cumulative probability of hospitalization and surgery in patients with Mayo endoscopic subscore 0–1 (solid line) or 2–3 (dotted line). (p= 0.035; p= 0.071; respectively). Results 87 UC consecutive patients were included in the study, 31 (36%) were in endoscopic remission (Mayo endoscopic subscore 0–1) and 56 (64%) in endoscopic activity (Mayo endoscopic subscore 2–3). MUC and Mayo endoscopic subscore significantly correlated at baseline (Spearman’s rank correlations [rho]= 0.642; 95% confidence interval (CI) 0.499 to 0.751; p &amp;lt; 0.001). The multivariable analysis identified as independent predictors of need of treatment escalation throughout the 12-month period as being: MUC &amp;gt; 6.2 (OR: 5.95, 95% CI: 1.32–26.76, p &amp;lt; 0.020) and a partial Mayo score (PMS) &amp;gt; 2 (OR: 26.88, 95% CI: 5.01–144.07, p &amp;lt; 0.001). Kaplan-Meier survival analysis of long-term follow up demonstrated a lower cumulative probability of need for surgery and hospitalization in patients with MUC &amp;lt; 6.2 compared to MUC &amp;gt; 6.2 (Fig. 1A and 1B), as well as in patients with a Mayo endoscopic subscore of &amp;lt; 1 compared to Mayo endoscopic subscore of 2–3 (Fig. 1C and 1D). Conclusion MUC is a novel non invasive tool that predicts the course of UC in the short and long term follow-up.

Bony Edema and Clinical Examination Findings Predict the Need for Distal Clavicle Excision at the Time of Shoulder Arthroscopy.

Background: Deciding to perform a distal clavicle excision for acromioclavicular joint arthritis, especially in conjunction with other arthroscopic shoulder procedures, is challenging for surgeons. Studies have reported mixed results on the value of magnetic resonance imaging (MRI) in decision making. Purpose: We sought to correlate MRI findings with clinical symptoms and the surgeon's decision to perform a distal clavicle excision. Methods: We compared MRI, clinical examination, and MRI findings of 200 patients who underwent distal clavicle excision for symptomatic acromioclavicular joint arthritis with 200 patients who underwent arthroscopic shoulder procedures for other reasons. Univariate statistics were used to determine correlations between physical examination findings, MRI findings, and the decision to perform distal clavicle excision. A binary logistic regression model was used to determine independent predictors of need for distal clavicle excision. Results: There was no difference in mean age, sex, and race between groups. Advanced acromioclavicular joint osteoarthritis was strongly correlated with positive physical examination findings. Bony edema correlated strongly with tenderness at the acromioclavicular joint but not pain with cross-body adduction testing. There was no association between higher MRI grade of osteoarthritis and the need for distal clavicle excision. Regression analysis identified both physical examination findings and bony edema on MRI as independent predictors of the need for distal clavicle excision. Conclusion: In the setting of positive clinical examination findings and bony edema of the distal clavicle, surgeons should feel reassured that distal clavicle excision is likely indicated.

Left Ventricular Unloading With an IABP in Patients Undergoing Ventricular Tachycardia Ablation With ECMO Support

The authors investigated the preprocedural predictors of postprocedural intra-aortic balloon pump (IABP) need in patients undergoing transcatheter ventricular tachycardia (VT) ablation on venoarterial (VA) extracorporeal membrane oxygenation (ECMO). Observational study. Hybrid operating room and intensive care unit of a teaching hospital. Participants were 121 consecutive patients with unstable VT undergoing transcatheter ablation with VA-ECMO. In patients with postprocedural echocardiographic, radiographic, or hemodynamic signs of increased left ventricle afterload, an IABP was positioned. Patients in the IABP group were more frequently on angiotensin-converting enzyme inhibitors (58% v 37%; p = 0.03) and had lower median baseline ejection fraction (25% v 28% p = 0.05), larger end-diastolic diameter (69.7 mm ± 13.0 v 65.7 mm ± 11.3; p = 0.03), and more frequent ischemic etiology as the reason for dilated cardiomyopathy (76% v 47%; p = 0.04,) when compared with patients not requiring IABP. Postoperatively, the IABP group required longer mechanical ventilation (24 hours [20-56.5] v 23 hours [15-28]; p = 0.003), intensive care unit stay (78 hours [46-174] v 48 hours [24-72]; p < 0.001), and continuous renal replacement therapy (13.3% v 1.3%; p = 0.006). By multivariate analysis, end-diastolic diameter (odds ratio [OR]:1.08; confidence interval [CI]: 1.00-1.16; p = 0.049), ischemic dilated cardiomyopathy (OR: 8.40; CI: 2.15-32.88; p = 0.002), and more-than-moderate mitral regurgitation (OR: 4.83; CI: 1.22-19.22; p = 0.025) were independent predictors of need for IABP. The need for an IABP to unload the left ventricle can be predicted by ventricular size, medium-severe mitral valvular defect, and ischemic etiology of the dilated cardiomyopathy.

2. Median Income is Associated with Need for Mechanical Ventilation in COVID-19

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic unmasked the devastating impact of social and health disparities on communities of color. Black race, body mass index (BMI), and presence of comorbidities have been associated with increased severity of disease and need for mechanical ventilation (MV). We examined socioeconomic variables including social support, highest level of education, median income, housing, food insecurity, and employment status, and poverty rate to determine their impact on the need for MV.MethodsRetrospective cohort study of 2,038 adult patients with positive SARS-CoV2 test admitted to four large hospitals within the Henry Ford Health System from March 12-April 24 and followed until May 27, 2020. Collected data included patient demographics, employment status, health insurance status, and comorbidities via Charlson Comorbidity Index (CCI). Census tracts were obtained from patient addresses and used to obtain socioeconomic data from the 2018 American Community Survey and the Food Access Research Atlas. The primary outcome assessed was frequency of MV. Univariate and multivariate analysis was performed on prehospital variables to identify independent predictors for mechanical ventilation.ResultsPatients who required MV were significantly more likely to be male (p=0.0006), black race (p=0.012), and have higher CCI (p< 0.0001) and BMI (p< 0.0001). Using census tract data, patients who required MV lived in neighborhoods with lower median income (p< 0.0001), educational attainment (p< 0.0001), and higher levels of food insecurity (p=0.0007). Multivariate analysis revealed male sex, high BMI, CCI, and lower median income to be independent predictors of need for MV. The remaining results are summarized in Tables 1 and 2.Table 1 Table 2 ConclusionThis study demonstrates the significant impact of socioeconomic status on frequency of MV in COVID-19 patients. Healthcare providers must be aware of disparities in order to address the systematic inequities that harm vulnerable populations.DisclosuresMarcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

Need for Vitreous Surgeries in Proliferative Diabetic Retinopathy in 10-Year Follow-Up: India Retinal Disease Study Group Report No. 2

Introduction: To report the 10-year rate of vitrectomies and the associated factors in people with proliferative diabetic retinopathy (PDR) from a multicentric cohort of people with diabetes mellitus. Methods: Ten centres in India with established vitreoretinal (VR) services for over 10 years were invited to provide long-term data on PDR. People with Type 1 or 2 diabetes with a clinical diagnosis of active PDR in 1 or both eyes were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, and diabetic retinopathy status in both eyes. Available follow-up data included the numbers of panretinal photocoagulation (PRP) sessions, cataract surgery, treatment of diabetic macular oedema, use of anti-vascular endothelial growth factor (VEGF) therapy, vitrectomy with or without retinal surgeries over 10 years. Results: Over 10 years, 89% needed supplemental PRP after initial complete PRP. One-third required retinal surgery, 16% needed intravitreal injection. Men (74.5%) had significant higher risk for vitreous (VR) surgery. Of the group with low-risk PDR, 56.8% did not require VR surgery, p < 0.001. Of the patients who underwent cataract surgery and had intravitreal anti-VEGF injections, 78.5 and 28.2% needed subsequent vitreous (VR) surgery, p = 0.006 and <0.0001, respectively. Independent predictors of need for vitreoretinal surgery included those who underwent cataract surgery and those with poor baseline visual acuity (logMAR). Eyes at lower risk for VR surgery included the eyes previously treated with PRP and low-risk PDR at baseline. Conclusion: Despite initial “complete” PRP, one-third of our study cohort needed vitrectomies over 10 years, highlighting that these patients require regular follow-up for a long period of time.

Development and Validation of Scoring System to Predict Secondary Amputations in Free Flap Reconstruction.

Background:Need for amputation is a potential complication when limb salvage is attempted. The present study aimed to develop a risk assessment tool to predict the risk of future amputation when counseling patients about their reconstructive options.Methods:All patients undergoing a free flap lower extremity soft tissue reconstruction by the senior author from 2005 to 2019 were retrospectively identified. Patient’s demographics, comorbidities, and technical aspects of the operation were extracted. Logistic regressions were used to create a predictive scoring system for future amputation.Results:A total of 277 patients were identified. Of these patients, two-thirds (183) were used to derive the scoring system and one-third (94) were used to validate the score. In total, 25 of 183 patients (14%) underwent an amputation. A stepwise forward logistic regression identified age > 55 years, smoking, acute wound, aggressive fluid resuscitation intra-operatively, inability to use a superficial vein for drainage, and inability to use the posterior tibialis artery for anastomosis as independent predictors of need for future amputations. The beta co-efficients were used to create the scoring system, and the patients were categorized into mild, moderate, and severe risk based on their cumulative score. The validity of the scoring system was verified by using the one-third validation cohort.Conclusions:In patients undergoing free flap reconstruction of the lower extremity, the need for future amputation is 14%. The use of a scoring system can guide the surgeon’s and patient’s decision regarding limb salvage.

Presentation, surgical intervention, and long-term survival in patients with Marfan syndrome

ObjectivePatients with Marfan syndrome (MFS) often present with acute catastrophic aortic events at a young age and have a shortened life span. This study examines the impact of presentation and demographics on late survival in patients with MFS. MethodsAdults with confirmed MFS in our thoracic aortic center dataset were identified and statistical analysis performed to identify the incidence and predictors of aortic interventions and late mortality. ResultsWe identified 301 patients with a MFS initial diagnosis at age 17 years (interquartile range, 4-30 years) with presentation into our thoracic aortic center at 21 years (interquartile range, 8-34 years). The average follow-up in our center was 10 ± 10 years. Clinical features were 41% male, 86% white race, coronary artery disease 28%, hypertension 40%, peripheral vascular disease 19%, and anti-impulse agent in 51% (β-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, calcium channel blocker). Distribution of operative aortic pathology was isolated to the ascending aorta (70%) and descending aorta (8%). One hundred seventy-eight patients (59%) required primary aortic surgery (36% emergent). Primary procedures were cardiac (aortic valve/root) in nature in 94%. Seventy-four patients (42%) required multiple aortic procedures at a mean of 9.2 ± 6.9 years, involving the thoracoabdominal aorta in 65%, thoracic aorta in 37%, and abdominal aorta in 21%. Patients who required multiple aortic procedures were more likely (P < .05) to have coronary artery disease (50% vs 30%), and peripheral vascular disease (43% vs 18%). Multiple aortic procedures were also more likely (P < .05) in patients who developed de novo distal dissection (14% vs 0%), had prior dissection (47% vs 18%), or unknown MFS at the time of the initial procedure (27% vs 63%). Multivariable analysis identified prior dissection as an independent predictor of need for emergent surgery (odds ratio, 13.20; 95% confidence interval, 4.64-37.30; P < .05), as well as additional aortic surgery (odds ratio, 4.42; 95% confidence interval, 1.87-10.50; P < .05). Kaplan-Meier analysis showed similar 10-year survival with or without aortic interventions (82% with vs 89% without; P = .08). Late survival was decreased in patients undergoing emergent initial procedures (66% vs 89%; P < .01), as well as those undergoing multiple operations (74% vs 86%; P = .03). ConclusionsThese data indicate that, in the modern era, the mode of presentation and need for multiple procedures have a detrimental impact on late survival. Additionally, the presence of acute or chronic dissection predicts the need for additional aortic procedures during follow-up.

Predicting the need for tracheostomy in trauma patients without severe head injury

BackgroundEarly tracheostomy is recommended in patients with severe traumatic brain injury (TBI); however, predicting the timing of tracheostomy in trauma patients without severe TBI can be challenging. MethodsA one year retrospective analysis of all trauma patients who were admitted to intensive Care Unit for > 7 days was performed, using the ACS-TQIP database. Univariate and Multivariate regression analyses were performed to assess the appropriate weight of each factor in determining the eventual need for early tracheostomy. ResultsA total of 21,663 trauma patients who met inclusion and exclusion criteria were identified. Overall, tracheostomy was performed in 18.3% of patients. On multivariate regression analysis age >70, flail chest, major operative intervention, ventilator days >5 days and underlying COPD were independently associated with need of tracheostomy. Based on these data, we developed a scoring system to predict risk for requiring tracheostomy. ConclusionAge >70, presence of flail chest, need for major operative intervention, ventilator days >5 and underlying COPD are independent predictors of need for tracheostomy in trauma patients without severe TBI.

Predicting poor outcomes and the need for surgical treatment in neonates with meconium peritonitis.

The objective of this study is to determine factors associated with poor outcomes and the need for surgical treatment in neonates with meconium peritonitis (MP). We evaluated the association between prenatal ultrasound features, maternal characteristics, and the likelihood of surgery, mortality, and serious morbidity in 49 neonates with a prenatal diagnosis of MP, who were born in Guangzhou Women and Children's Medical Center between January 2011 and December 2016. Thirty of 49 neonates (61.2%) required surgical treatment, and 17 (34.7%) had a poor outcome. Independent predictors of need for surgical treatment were polyhydramnios, maternal intrahepatic cholestasis of pregnancy (associated with lower risk), and persistence of peritoneal fluid. The model correctly predicted 70.0% of the neonates who required surgery (at a 10% false-positive rate; area under the curve [AUC]: 0.86 [95% CI, 0.75-0.97]). For poor outcomes, independent predictors were low gestational age at birth, persistence of peritoneal fluid, and polyhydramnios. For the latter, the model only achieved a detection rate of 52.9% (10% false-positive rate, AUC: 0.82 [95% CI, 0.70-0.94]). A combination of prenatal ultrasound features and maternal characteristics correctly predicted 70.0% the need for neonatal surgery. Prediction of poor outcome-based prenatal ultrasound features and gestational age did not perform well.

Long-term Reoperation Rate for Cubital Tunnel Syndrome: Subcutaneous Transposition Versus In Situ Decompression

Background: The purpose of this study was to compare the long-term revision rate of in situ ulnar nerve decompression with anterior subcutaneous transposition surgery for idiopathic cubital tunnel syndrome. Methods: This retrospective, multicenter, cohort study compared patients who underwent ulnar nerve surgery with a minimum 5 years of follow-up. The primary outcome studied was the need for revision cubital tunnel surgery. In total, there were 132 cases corresponding to 119 patients. The cohorts were matched for age and comorbidity. Results: The long-term reoperation rate for in situ decompression was 25% compared with 12% for anterior subcutaneous transposition. Seventy-eight percent of revisions of in situ decompression were performed within the first 3 years. Younger age and female sex were identified as independent predictors of need for revision. Conclusions: In the long-term follow-up, in situ decompression is seen to have a statistically significant higher reoperation rate compared with subcutaneous transposition.

Prognostic Value of Longitudinal Strain Measured by Velocity Vector Imaging, in Asymptomatic Severe Aortic Stenosis with Preserved Ejection

Background: Longitudinal systolic strain (LSS) abnormalitiess have been described in patients with preserved ejection fraction(EF). The prognostic value of LSS in asymptomatic severe aortic stenosis (AoS) is under discussion.Objetive: The aim of this study was to assess whether LSS assessment using velocity vector imaging (VVI) predicts theprogression and indication of aortic valve replacement (AVR) in asymptomatic patients with severe AoS and preserved EF.Methods: The study included patients with severe AoS and preserved EF who were considered asymptomatic and withoutinitial indication for AVR. They underwent two, three and four-chamber echocardiography that evaluated LSS of each segmentand global longitudinal strain (GLS) by VVI, as well as NT-proBNP assessment. The primary endpoint was need for AVR.Results: A total of 57 patients with mean age 69±8 years, 49% women, were included in the study. After two years of follow-up,13 patients (22.8%) required AVR. This group had lower GLS (-15.5±3.4 vs.-18.9±3.1, p=0.03) and two-chamber LSS (-12.8±5.5vs.-16.3±5.6, p=0.04). In univariate analysis, GLS, NT-proBNP and the E/e’ ratio were predictors of the endpoint, while inthe multivariate analysis, only GLS was an independent predictor of need for AVR (HR: 1.28 (95% CI 1.04-1.58), p=0.01).Conclusions: Global longitudinal strain measured by VVI was an independent predictor of need for AVR

A novel grading system for the prediction of the need for cerebrospinal fluid drainage following posterior fossa tumor surgery.

Prophylactic placement of an external ventricular drain (EVD) is often performed prior to resection of a posterior fossa tumor (PFT); however, there is no general consensus regarding the indications. The purpose of this study was to establish a novel grading system for the prediction of required CSF drainage due to symptomatic elevated intracranial pressure (ICP) after resection of a PFT to identify patients who require an EVD. The authors performed a retrospective analysis of data from a prospective database. All patients who had undergone resection of a PFT between 2012 and 2017 at the University Hospital, Goethe University Frankfurt, were identified and data from their cases were analyzed. PFTs were categorized as intraparenchymal (iPFT) or extraparenchymal (ePFT). Prior to resection, patients underwent EVD placement, prophylactic burr hole placement, or neither. The authors assessed the amount of CSF drainage (if applicable), rate of EVD placement at a later time point, and complication rate and screened for factors associated with CSF drainage. By applying those factors, they established a grading system to predict the necessity of CSF drainage for elevated ICP. A total of 197 patients met the inclusion criteria. Of these 197, 70.6% received an EVD, 15.7% underwent prophylactic burr hole placement, and 29.4% required temporary CSF drainage. In the prophylactic burr hole group, 1 of 32 patients (3.1%) required EVD placement at a later time. Independent predictors for postoperative need for CSF drainage due to symptomatic intracranial hypertension in patients with iPFTs were preoperative hydrocephalus (OR 2.9) and periventricular CSF capping (OR 2.9), whereas semi-sitting surgical position (OR 0.2) and total resection (OR 0.3) were protective factors. For patients with ePFTs, petroclival/midline tumor location (OR 12.2/OR 5.7), perilesional edema (OR 10.0), and preoperative hydrocephalus (OR 4.0) were independent predictors of need for CSF drainage. According to our grading system, CSF drainage after resection of iPFT or ePFT, respectively, was required in 16.7% and 5.1% of patients with a score of 0, in 21.1% and 12.5% of patients with a score of 1, in 47.1% and 26.3% of patients with a score of 2, and in 100% and 76.5% of patients with a score ≥ 3 (p < 0.0001). The rate of relevant EVD complications was 4.3%, and 10.1% of patients were shunt-dependent at 3-month follow-up. This novel grading system for the prediction of need for CSF drainage following resection of PFT might be of help in deciding in favor of or against prophylactic EVD placement.