Institutional Outcomes Research Articles

Mechanical thrombectomy of inferior vena cava filter-associated caval thrombosis using FlowTriever and ClotTriever systems

ObjectiveChronically indwelling inferior vena cava filters (IVCFs) can have multiple adverse sequelae, including IVCF-associated thrombosis. The Inari ClotTriever and FlowTriever mechanical and aspiration thrombectomy systems (Inari Medical) can be used for acute caval thrombosis associated with IVCFs if appropriate proximal IVCF protection is used intraprocedurally. The present study reports a single institution's outcomes after ClotTriever and FlowTriever thrombectomy of acute IVCF-associated iliocaval thrombus. MethodsA retrospective review was conducted of all patients who underwent ClotTriever or FlowTriever thrombectomy for IVCF-associated caval thrombosis. The patient demographics, clinical characteristics, and postprocedural outcomes of a 15-patient cohort were compiled and described. ResultsA total of 15 patients were identified as presenting with acute IVCF-associated caval thrombosis and having undergone intervention with either the ClotTriever or FlowTriever system from 2019 to 2022. Of the 15 patients in the cohort, 3 (20%) had presented with a threatened extremity (phlegmasia cerulea dolens), and 12 had presented with severe, debilitating, but non–limb-threatening, lower extremity edema. The preprocedural clot burden was significant and involved the cava, iliac veins, and femoropopliteal veins in 7 of 15 patients (47%) in the cohort. The procedure was technically successful in 11 patients (73.33%). Resolution of acute symptoms was noted in 100% of the technically successful procedures. The 30-day mortality rate was 13% (2 of 15 patients). One intraprocedural death occurred from pulmonary embolism, and one patient died of malignancy complications. The surviving patients not lost to follow-up experienced stable or improving venous disease, with only one patient presenting with post-phlebitic syndrome. ConclusionsMechanical and aspiration thrombectomy of IVCF-associated thrombus with the FlowTriever and ClotTriever systems have good technical success and resulted in significant improvement in acute symptoms with adequate clot clearance. Proximal embolic protection maneuvers for pulmonary embolism prophylaxis and preexisting filter protection are required intraprocedurally.

Unlocking Undergraduate Student Success: A Study of High-Impact Practices in a Comprehensive and Diverse College

This study examines undergraduate senior students’ participation in high-impact practices (HIPs) and the relationship of that participation with engagement indicators, perceived gains, and overall satisfaction, as well as institutional outcomes of persistence and graduation based on race/ethnicity, first-generation status, and low-income status. Drawing on multiple years of data from 1,482 undergraduate seniors who completed the 2015 through 2019 National Survey of Student Engagement (NSSE) and enrolled in a comprehensive four-year state college, this study indicates that HIP participants reported higher levels of engagement, perceived gains, and overall satisfaction. Participation in HIPs is also positively related to improved persistence or graduation, particularly for racially minoritized students. While overall participation patterns were similar regardless of race/ethnicity or first-generation status, low-income students had higher participation rates in HIPs and participated in more kinds of HIPs as compared to their non-low-income counterparts. Implications of implementing and increasing access to HIPs for enhancing student success in similar institutions are discussed.

Information and communication technology: Examining knowledge, availability, and utilization among nurses in secondary health care facilities in Ondo State, Nigeria

Abstract Background: Globally, information and communication technology (ICT) has been recognized as a pivotal strategy for embracing the evolving healthcare landscape. Despite its substantial role in facilitating information sharing, its adoption remains notably constrained in most developing nations. Objective: This study investigated the knowledge, accessibility, and usage of ICT resources among nurses in secondary healthcare establishments within Ondo State, Nigeria. Materials and Methods: The research employed a survey approach involving the participation of 200 nurses. A structured instrument was created to gather data, ensuring its validity and internal consistency. Both descriptive and inferential analysis of data was done. Hypothesis testing utilized Pearson correlation and Chi-square tests. Results: Most nurses, comprising 127 individuals (61.5%), demonstrated a commendable understanding of ICT within secondary healthcare establishments in Ondo State. Half of the participants (108, 54%) possessed ICT equipment in their respective units, whereas other essential ICT infrastructure was notably absent. Chi-square tests revealed an association between nurses’ age and their level of ICT knowledge (P = 0.10). This study discerned a direct connection between knowledge and utilization, denoted by a strong correlation coefficient of 0.738. Notably, gender substantially correlated with nurses’ ICT proficiency as evidenced by a significant P value of 0.459. Conclusion: The research indicates that rectifying the observed disparities can be achieved by ensuring an adequate supply of ICT resources and offering ongoing training sessions for practicing nurses. This approach will improve healthcare outcomes in secondary healthcare institutions in Ondo State.

Designing a Conceptual Framework to Align Learning Objectives to the Interprofessional Education Collaborative Core Competencies: A Narrative Review

Introduction: Early placement of interprofessional education (IPE) in academic curricula may foster foundational learning to shape student attitudes, knowledge, and skills and better prepare practice-ready clinicians for future team-based collaboration. The purpose of this narrative review was to investigate and analyze the current use of IPE in OT and PT higher education. Methods: Three databases, Academic Search Complete, Cochrane Database of Systematic Reviews, and ERIC, were searched from 2017 to 2022. Inclusion criteria were articles with full text availability, published within the 5 year search time range from the time of the narrative review process, peer reviewed studies, original research, meta-analysis studies, case studies, and review articles. Duplicates were removed, and studies were excluded if related to only clinical or practice-based healthcare delivery, community health service-learning, virtual or telehealth platforms, not applicable to the disciplines of OT and PT, or not available in English. Results: After filtering and screening articles yielded from the literature review, a total of studies (n = 76) provided considerable evidence for contributing to best-practice guidelines in aligning IPE learning with student outcomes and the Interprofessional Education Collaborative Core Competencies. Substantial evidence was found, which resulted in the creation of a conceptual framework to advance IPE health science education and to meet discipline-specific IPE accreditation standards for OT and PT education. The resultant proposed IPE Conceptual Framework provides alignment of course learning objectives, accreditation standards, institutional and programmatic learning outcomes, and IPEC Core Competencies to create authentic IPE learning activities. Conclusions: This study provides a current review for IPE in OT and PT education in the United States and can have application abroad. The findings guided development of a conceptual framework for alignment of IPEC Core Competencies, curricular outcomes, and accreditation standards. Follow-up studies are recommended to validate the utilization of the proposed framework, and then subsequent research inquiry to further assess IPE effectiveness.

Do jihadist terrorist attacks cause changes in institutional trust? A multi‐site natural experiment

AbstractResults from previous research suggest that terrorist attacks lead to relatively short‐term increases in trust in institutions. The explanation for this increase is known as the ‘rally effect’, whereby individuals respond to crises and threats with more positive support for political leaders and institutions. Even though the number of related natural experiments with survey data is increasing, these studies merely represent case studies of single incidents with limited external validity. To advance quasi‐experimental research on the effects of terrorist attacks on institutional trust, we propose a new methodological approach by assessing all jihadist terrorist attacks resulting in at least one civilian death in a European country that take place during the fieldwork of the European Social Survey and combining the results of eight unique natural experiments in five different countries using meta‐analytic and meta‐regression techniques. The results of this ‘multi‐site natural experiment’ indicate that support for the rally‐hypothesis is mixed at best. While some attacks appear to significantly increase at least some measures of institutional trust (e.g., The Netherlands 2004, France 2015, Israel 2012), others seem to have no effect at all (e.g., Germany 2015, France 2018), or even substantially decrease trust in domestic political institutions (Russia 2012). Summary effects from multilevel meta‐analyses are non‐significant for any institutional trust outcome. These results are robust to a large number of robustness tests and alternative specifications. In comparison with previous research, it appears that a lot of the European evidence for the rally‐hypothesis was based on ‘outlier’ case studies like the Charlie Hebdo attack in France, 2015. Accordingly, our results cast doubt on the unrestricted generalisability of rally effects after terrorist attacks to different geographic, political, social or historical contexts.

Can Racial Diversity among Judges Affect Sentencing Outcomes?

How does racial diversity impact institutional outcomes and (in)equality? Discussions about diversity usually focus on how individuals’ identities shape their behavior, but diversity is a group-level characteristic. Scholars must, therefore, consider the relationship between group composition and the individual decisions that shape institutional outcomes. Using felony data from a large U.S. court system, I explore the relationship between racial diversity among the judges comprising a court and individual judges’ decisions. I find that as the percent of Black judges in a courthouse increases white judges are less likely to render incarceration sentences in cases with Black defendants. Increases in racial diversity decrease the Black–white gap in the probability of incarceration by up to 7 percentage points. However, I find no relationship between judge’s racial identities and disparities in their decisions. This study highlights the importance of conceptualizing diversity as a group characteristic and the relationship between institutional context and outcomes.

Endoscopic Mucosal Resection of Non-pedunculated Colorectal Polyps ≥20mm: Outcome in a Self-taught Skills Environment.

Endoscopic mucosal resection (EMR) of non-pedunculated colorectal polyps ≥20mm is technically demanding and should preferentially be performed by specialist endoscopists in referral centres. Little is known about the outcome in institutions establishing this competency. Here, we report the learning curve on 100 consecutive large non-pedunculated polyps resected by a single endoscopist with self-taught acquisition of skills. We analysed data on 100 non-supervised EMR procedures performed at our academic endoscopy centre (2016-2021), representing a single endoscopist's learning curve beginning with the first polyp ≥20 mm. The median polyp size was 30 mm (20-70mm), and 61% of all polyps were ≥30 mm. Predominant polyp morphology was 0-Is (34%) or 0-IIa (47%), and most polyps developed in the ascending colon (36%). In total, 20% of polyps showed high-grade intraepithelial neoplasia, and 8% included pT1 carcinoma. Adenoma recurrence rate after piecemeal resection was 21%. All but one recurrent adenoma were treated endoscopically. Deep mural injury, intra-procedural bleeding and post-procedural bleeding were detected and managed endoscopically in 3%, 21%, and 4% of procedures, respectively. Overall, surgery could be avoided in 91% of all and 98% of non- malignant polyps. Results for the first 50 polyps did not differ from results for the following polyps. Structured training is advisable to acquire advanced EMR skills. Our data show that autonomous acquisition of skills after finishing a training course represents an acceptable alternative with good results in the setting of an open error culture. Continuous review of outcome parameters and complication rate is mandatory during the learning process.

University board composition and institutional outcomes

AbstractNumerous studies examine corporate boards of directors' composition and firm performance. Far less is known about the factors influencing university boards' composition and university outcomes. This paper fills this void by examining the relationship between university board selection processes and constituent representation, board composition in terms of size and demographic composition, and the influence of board composition on institutional outcomes. We find that institutional sector, Carnegie classification, and wealth predict board size, and that institutions with larger boards tend to have more favorable institutional outcomes. Board gender and racial composition is less correlated with outcomes than is board size.

Politicians, officers and political transition: the case of post 2003 Iraq

This study brings the notion of informal institutions developed by Helmke and Levintsky’s research agenda into the body of literature on civil–military relations. While acknowledged by the existing literature, the link between informal political-security connections and political transition remains largely undertheorised. Based on the case of post­-invasion Iraq, I attempt to fill this gap, building a conceptual understanding of politician-officer personal connections and their role in defining political order in post-authoritarian and conflict settings. Data collected through fieldwork across Iraq helped to build a typology of the informal connections (communal ties, patronage ties or ideologies ties) and the institutional outcomes they generate over time after the fall of Saddam Hussein’s regime (ethno-sectarian state, a patronage state and a Shia-centred state). Personal connections have been relevant since the colonial era in Iraq. But the de-institutionalisation of Iraqi politics, accelerated by sanctions and the US-led invasion, make these connections crucially relevant for understanding the country’s political transition since the fall of Saddam Hussein. The common history that brought these individuals together, the political order and the violent transition they shaped is an untold story that this study aims to tell.

The Principal Leadership in Indonesian Islamic School: The Strategy in Shaping the Academic Professionalism

An overview of the current situation of Indonesian Islamic schools may be viewed by examining the areas of management and educational assessment, as well as the schools' amenities and facilities, content, and procedure, as well as the competency of its graduates, teachers, and other educational staff. It has recently come to light that not all Islamic schools in Indonesia can adhere to these standards. This study aims to highlight how principals of Indonesian Islamic Schools promote the academic professionalism of teachers and other educational staff members. In the context of the study of Islamic leadership, it incorporates the idea that the essential leadership talent is instructional leadership. It is associated with the core skillsets of assessment, unity of purpose, diversity, reflection, professional development, curriculum and instruction, instructional leadership, visionary leadership, learning community, organizational management, collaboration, and professionalism. This qualitative research uses a descriptive case study approach to provide a detailed description of the phenomenon under study. Using a purposive sampling technique, data collection involved representatives from public and private Madrasah Aliyah (MA) institutions in Parepare, Indonesia. Our study found the core understanding of academic professionalism emphasizes professional development, social service, competence, and responsibility, requiring the support of a proper institutional outcome plan. It provides evidence that the leadership style of principals influences the academic professionalism of teachers and educational staff, directly contributing to school quality. The excellence of the program and alumni reflects the effectiveness of the leadership of the madrasah principal.

Examining the Impact of Interactive Smart Board Use on Technical Students’ Learning Outcomes in Nigerian Higher Educational Institutions

The study was carried out to determine the impact of Interactive Smart Board (ISB) usage on technical students’ learning outcomes (achievement and motivation). The study adopted a quasi-experimental design and was carried out at First Technical University, Ibadan. The study's population consisted of 276 students enrolled in GST 004, with a sample size of 90. GST 004 was taught using ISB, and a pre-test and post-test were performed. The mean, standard deviation, t-test, and p-value were used to record and interpret the results. A questionnaire was also distributed to assess pupils' motivation. The results showed improved achievement scores and increased levels of motivation by the students who were taught using ISB, compared with those students who use the traditional method only. Results obtained from a pre-test/post-test revealed that students in the experimental group (taught using ISB) had a higher mean achievement score (23.06) and a higher mean gain score (15.27) than the control group (taught using the traditional method; mean achievement score 9.92, mean gain score 7.34). Further results from a motivation questionnaire showed that the experimental group had significantly higher scores than the control group on all three subscales of the questionnaire (Procedural Skills Rating, Interest/Enjoyment, and Perceived Choice), with the highest difference being for the Procedural Skills Rating subscale. The overall motivation score for the experimental group was also much higher than that of the control group. These findings suggest that ISB technologies have the potential to transform educational practices in Nigeria as the country strives to provide students with a quality education that meets the best global standards while also recasting itself as an innovative, efficient, and adaptable economy capable of competing in our modern world.

What contributes to local-level institutional adaptation under climate change? A configurational approach based on evidence from China's Sponge City Program

Unrestrained human industrial and agricultural production activities exacerbate climate change and environmental pollution. Climate change leads to an increase in flood risks and the spread of water and soil pollution, resulting in challenges in urban stormwater management. Institutional adaptation to climate change is vital for realizing effective local urban stormwater management. However, the accumulated knowledge on climate adaptation over the past decade has been concentrated at the technical and economic levels, with limited research on institutional adaptation. The Sponge City Program in China selects 30 pilot cities to promote a novel stormwater management approach that combines the reliability of traditional gray infrastructures made of concrete materials with the adaptability and sustainability of green-blue infrastructures based on natural-based solutions, but the extent of institutional adaptation in this process varies considerably across pilot cities. To explain what drives institutional adaptation, a configurational analysis of pilot cities is conducted using the fuzzy-set qualitative comparative analysis method. Based on data from 628 official reports and 36 interviews, we demonstrate local governments are significant institutional entrepreneurs, and high institutional adaptation occurs with the combined effects of institutional capacity, financial resources, and reputational incentives. There are three types of paths driving institutional adaptation: “strong institutional capacity-strong financial resource-low reputational reserve,” “strong institutional capacity-strong financial resource-high reputational competition,” and “strong institutional capacity-weak financial resource-low reputational reserve.” These three paths account for 72% of the instances of high institutional adaptation outcomes, and 90% of cases share a given configuration of conditions associated with an outcome. Our conclusion advances a theoretical understanding of the drivers of institutional adaptation and provides guidelines for future climate adaptation practices.

The Impact of Prenatal Diagnosis on Clinical Outcomes of Isolated Vascular Rings From a Statewide Paediatric Cardiology Tertiary Service.

Vascular rings, including right aortic arch with aberrant left subclavian artery (RAA-ALSCA), double aortic arch (DAA) and pulmonary artery sling (PAS), are congenital anomalies that may cause airway and oesophageal compression. As prenatal detection has improved, literature comparing clinical outcomes of antenatally versus postnatally diagnosed cases continues to emerge. The aim is to define a statewide tertiary paediatric institution's clinical profile and outcomes of prenatal versus postnatally diagnosed isolated vascular rings. A retrospective single-centre review of isolated RAA-ALSCA, DAA and PAS between 1 January 1999 and 31 December 2020 was conducted. Clinical characteristics, surgical and follow-up information were collected. Antenatal and postnatally diagnosed groups were compared. Out of 123 cases diagnosed with isolated vascular rings, 98 (79.7%) cases had RAA-ALSCA, 21 (17.1%) with DAA, 4 (3.3%) with PAS. The antenatal detection rate was 73.6% in the past decade; 20.3% had a genetic disorder, of which 48% had 22q11.21 microdeletion. Of prenatally diagnosed cases, 31.3% developed symptoms, commonly stridor and dysphagia, at a median age of 2.0 months (IQR 0.0-3.0), compared to a median age of diagnosis for the postnatal cohort of 9 months (IQR 1.0-40.7). Postnatally diagnosed cases were more likely to present with symptoms, primarily respiratory distress, than prenatally diagnosed cases (p=0.006). Fifty-nine (59) cases (50% antenatally diagnosed) required vascular ring division; 6.8% had residual symptoms following surgery. Antenatal diagnosis has improved and leads to better parental awareness and more timely, appropriate intervention. Postnatally diagnosed patients were older, more likely to be symptomatic, underwent more investigations and were commenced on more medications for symptom management prior to diagnosis. One in five cases of isolated vascular ring anomalies carried a genetic diagnosis, which has important implications on prenatal counselling and genetic testing.

Outcomes of the Anterior-Based Muscle-Sparing Approach in Elective Total Hip Arthroplasty in Nonagenarians.

As the population ages, total hip arthroplasty has become more common in elderly patients including patients over the age of 90 years. Efficacy in this age group has been established, though literature regarding safety of total hip arthroplasty in nonagenarians is mixed. The anterior-based muscle-sparing (ABMS) approach, which exploits the intermuscular plane between the tensor fasciae latae and the gluteus medius, has proposed benefits of fast recovery, excellent stability, and reduced bleeding and may be adventitious among elderly, more fragile patients. A total of 38 consecutive nonagenarians undergoing elective, primary total hip arthroplasty via the ABMS approach for any indication from 2013 to 2020 were identified, and information regarding operative outcomes and patient-reported outcomes was gathered from review of medical records and our institutional joint replacement outcomes database. Included patients ranged from 90 to 97 years of age with the majority classified as American Society of Anesthesiologists score 2 (50%) or American Society of Anesthesiologists 3 (47.4%). The mean operative time was 74.6 minutes±13.6 minutes. Of all patients, 5 required a transfusion, 2 patients were readmitted within 90 days, and there were no major complications. The mean hospital length of stay was 2.8 days±0.8 days with 22 patients (57.9%) discharged to a skilled nursing facility. Limited patient-reported outcomes data showed statistically significant improvements in most outcomes scores at 6 months to 1 year postoperatively compared to preoperative scores. The ABMS approach is safe and effective in nonagenarians who may benefit from decreased amounts of bleeding and recovery times associated with the ABMS approach, which is evident from the low complication rates, relatively short hospital lengths of stay, and acceptable transfusion rates compared to previous studies.

Analisis Hubungan Antara Jalur Masuk Universitas dengan Predikat Kelulusan Mahasiswa

There are different characteristics of each entry route, so there will be the potential to achieve a different GPA. There are 3 types of entrance routes for public universities held by LTMPT, namely SNMPTN, SBMPTN, and SMMPTM. The achievement of student learning outcomes in tertiary institutions can be seen through the final results indicated by the GPA. Diploma and undergraduate program students have four graduation predicates, three of which are satisfactory (GPA 2.76-3.00), very satisfactory (GPA 3.01-3.50), and with honors (GPA more than 3.50). The population in this study were all PTN graduates from 2018 to 2022. The sample used in this study was at least 50 PTN graduates from 2018 to 2022 and 150 samples. This research will be tested using the Chi-Square test method. Based on the Chi-Square test on the contingency table related to the relationship between college admissions and student graduation predicates, it can be concluded that there is no relationship between college admissions and student graduation predicates. In addition, the relationship between university admissions and student graduation predicates is related to majors and campus clustering in 2020. Meanwhile, the relationship between university admissions and student graduation predicates has no relationship with gender and domicile.

Impact of institutional case volume on intensive care unit mortality.

The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.

The impact of demographic information on students’ preferable extracurricular activities for English learning

The study aims to explore the potential of extracurricular activities (ECAs) in enhancing English learning among Vietnamese higher education students, given the government’s emphasis on English language reforms. In Southwest Vietnam, a comprehensive survey consisting of 20 questions was carried out among 1,032 students at a higher education establishment. The aim was to ascertain their favored ECAs and to explore how students’ demographic details, particularly their gender, field of study, and academic year, influenced these preferences. Results showed students were fond of ECAs for English learning, with female students expressing a higher preference for participation. Students’ majors and years in university significantly influenced preferences for specific activities, while no significant difference was found in the overall perception of ECAs. The study concludes that understanding students’ preferences and demographic influences can help design more effective ECAs for English learning in Vietnamese higher education institutions. The findings offer insights for developing tailored ECAs to address students’ unique needs and preferences, thereby improving English language learning outcomes in Vietnamese higher education institutions.

Internal carotid artery injury during endoscopic endonasal surgery for skull base pathologies: an institutional incidence, management, and outcome.

Endoscopic endonasal surgery (EES) has become a popular approach to deal with skull base pathologies. The most catastrophic intra-operative complication of EES is internal carotid artery (ICA) injury. We aim to discuss and introduce our institutional experience with ICA injury during EES. A retrospective review of patients who underwent EES from 2013 to 2022 was performed to determine the incidence and outcomes of intraoperative ICA injuries. There were six patients (0.56%) with intraoperative ICA injury in our institution during the last 10 years. Fortunately, there was no morbidity or mortality in our patients with intraoperative ICA injuries. The sites of injury were equally in paraclival, cavernous sinus, and preclinoidal segments of ICA. Primary prevention is the best solution for this condition. Regarding our institutional experience, the best option for primary management just after an injury is packing the surgical site. In cases where packing is not enough for temporary control of bleeding, common carotid artery occlusion should be considered. We have presented our experience and reviewed previous studies regarding different treatments and suggested our intra and post-operative management algorithm.

(334) Robotic Transabdominal Vasovasostomy Following Laparoscopic Vasectomy: A Case Series

Abstract Introduction A small subset of men undergoing laparoscopic hernia repair will request concomitant vasectomy, which is typically performed via resection of a segment of the intra-abdominal vas deferens near the inguinal ring. Some of these men will ultimately desire vasectomy reversal to restore fertility or alleviate post-vasectomy pain syndrome. Traditional scrotal or inguinal microsurgical techniques are clearly not feasible in this situation, and open surgical repair carries significant morbidity. The use of a robotic approach may offer an attractive alternative to improve visualization and facilitate a patent intra-abdominal anastomosis. Objective To demonstrate technical feasibility and report institutional outcomes of robotic-assisted laparoscopic transabdominal vasectomy repair Methods IRB approval was obtained. A retrospective chart review of our institutional experience with this operation was performed. Preoperative, operative, and postoperative data was collected. Results Three cases were identified with a mean patient age of 43 and mean interval of 6 years (range 3-10 years) between vasectomy and reversal attempt. Two men desired restoration of fertility, and one man desired reversal for testicular pain. All patients had previously fathered children, and mean partner age was 30 years. Port placement was similar to standard W-configuration used for robotic prostatectomy. Mean operative time was 319 minutes and estimated blood loss was 27mL. Two men required a modified Prentiss maneuver to re-route the vas deferens to obtain additional length. Indocyanine green was used in one case to confirm vasal perfusion. Bilateral vasovasostomy was completed in all cases with either a modified one-layer anastomosis using 8-0 nylon or a two-layer anastomosis using 10-0 and 9-0 nylon. Both men undergoing fertility restoration had return of sperm in the ejaculate with a mean concentration of 62 million sperm/mL, and the solitary patient with pain had subjective resolution of his pain. Conclusions Robotic transabdominal vasectomy reversal is technically challenging but feasible with an experienced team including a robotic surgeon and andrologist. Outcomes appear to be satisfactory. This technique may be considered for men who have undergone abdominal vasectomy and desire restoration of fertility or treatment of post-vasectomy pain syndrome. Disclosure No

Comparative Analysis of NSQIP National Outcomes and Projected Outcomes versus Our Institutional Outcomes for Robotic Gastrectomy: The Future of Gastric Resection.

The robotic approach has vast applications in surgery; however, the utility of robotic gastrectomy has yet to be clearly defined. This study aimed to compare outcomes following robotic gastrectomy at our institution to the national patient-specific predicted outcomes data provided by the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). We prospectively studied 73 patients who underwent robotic gastrectomy under our care. ACS NSQIP outcomes after gastrectomy and predicted outcomes for our patients were compared with our actual outcomes utilizing students t test and chi-square analysis, where applicable. Data are presented as median (mean ± SD). Patients were 65 (66 ± 10.7) years old with a BMI of 26 (28 ± 6.5) kg/m2. 35 patients had gastric adenocarcinomas and 22 had gastrointestinal stromal tumors Operative duration was 245 (250 ± 114.7) minutes, estimated blood loss was 50 (83 ± 91.6) mL, and there were no conversions to 'open'. 1% of patients experienced superficial surgical site infections compared to the NSQIP predicted rate of 10% (P < .05). Length of stay (LOS) was 5 (6 ± 4.2) days vs NSQIP's predicted LOS of 8 (8 ± 3.2) days (P < .05). Three patients died during their postoperative hospital course (4%), due to multi-system organ failure and cardiac arrest. 1-year, 3-year, and 5-year estimated survival for patients with gastric adenocarcinoma was 76%, 63%, and 63%, respectively. Robotic gastrectomy yields salutary patient outcomes and optimal survival for varying gastric diseases, particularly gastric adenocarcinoma. Our patients experienced shorter hospital stays and reduced complications relative to patients in NSQIP and predicted outcome for our patients. Gastrectomy undertaken robotically is the future of gastric resection.