Nonsurgical Cases Research Articles

Outcome of Management of Mandibular Sub condylar Fractures Based on Classification System Using Cone-Beam Computed Tomography.

The purpose of this study is to determine the amount of ramal height shortening and degree of displacement of sub condylar fracture that should be considered for effective management of mandibular sub condylar fractures using cone-beam computed tomography. A prospective study of forty-two patients, who presented with unilateral sub condylar fracture was done. All patients were classified into Class I, II and III based on the degree of displacement of fractured segment and amount of ramal height shortening measured using cone-beam computed tomography. The treatment protocol was closed reduction and maxillomandibular fixation for Class I patients and open reduction and internal fixation for Class II and III patients. Outcomes of treatment were measured postoperatively 2weeks, 1 and 3months clinically. The variables, such as mouth opening, lateral and protrusive movements, deviation, pain and occlusion were studied. Among forty-two patients, twenty had Class I fractures, twelve had Class II fractures and ten had Class III fractures. Overall, no statistically significant differences were found between Class I and Class II groups in terms of functional outcomes and there were statistically significant differences between Class I and III groups. Class I fractures can be considered for closed method and open reduction is recommended for Class II and III fractures. The sample was composed of 42 patients grouped as follows: Class I (n = 20), Class II (n = 12), and Class III (n = 10) for treatment of sub condylar fractures. There were no significant differences between the three groups for the study variables at baseline, except for mouth opening and pain. There was significant difference in mouth opening between Class I and III cases (p 0.001) and insignificant difference in mouth opening in Class I and II cases (p 0.98). Persistent pain was elicited more in surgical Class II and III (n = 5) than non-surgical cases Class I (n = 0) on 3months follow-up. The study emphasises on use of three-dimensional diagnostic modality like cone-beam computed tomography for accurately classifying sub condylar fractures. The results favour closed reduction for mildly displaced Class I cases and surgical management of significantly displaced Class III fractures. The need for open reduction for Class II patients classified using CBCT is negligible assessing risks associated with surgical procedure which is contradictory to our protocol which requires a further comparative evaluation among Class II group.

A Review on Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA) of Pancreatic Lesions.

The morbidity associated with pancreatectomies limits surgical options for high-risk patients with pancreatic neoplasms that warrant resection. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offers a minimally invasive and potentially definitive means to treat pancreatic neuroendocrine tumors and precancerous pancreatic cystic lesions. In addition, EUS-RFA may play a role in the treatment and palliation of non-surgical cases of pancreatic adenocarcinoma. The efficacy of RFA appears to be further enhanced by systemic immunomodulatory effects. Here, we review current studies on the developing role of EUS-RFA in these pancreatic pathologies.

Posterior fossa ischemic infarction: single-center retrospective review of non-surgical and surgical cases.

Cerebellar ischemic stroke (CIS) is a morbid neurological event, with potentially fatal consequences. There is currently no objective standard of care regarding when surgical procedures are required for this entity. We retrospectively reviewed 763 patients with CIS, 247 patients of which had a stroke larger than 1cm in greatest dimension on cranial imaging. In this subgroup, 11% of patients received ventriculostomy, 12% suboccipital craniectomy, and 9% mechanical endovascular thrombectomy. Various clinical and radiographic variables were examined for relationship to surgical procedures, 30-day mortality rate, and modified Rankin scores. The smallest volume of stroke requiring a surgical procedure was 15.5 mL3 (BrainLab Software). Patients receiving surgical procedures had a higher incidence of multi-territory infarctions, hydrocephalus, cistern compression, 4th ventricular compression, as well as younger age, lower admission GCS, higher admission NIHSS, and higher 30-day mortality/disability. Patients deemed to require surgical procedures for CIS have a higher expected morbidity and mortality than those not requiring surgery. Various clinical and radiographic variables, including stroke volume, can be used to guide selection of patients requiring surgery.

Role of C - reactive protein for Assessment for Exploration of Acute Scrotum in Children: A Study was done in a Tertiary Care Hospital

Background: Acute scrotum comprises a long list of differential diagnosis. The patient suffering from an acute scrotal condition requires urgent medical care. It must be evaluated promptly and accurately to make a management plan especially to save the testis from necrosis in torsion. Decision making regarding the plan for exploration is more important than reaching an exact diagnosis. Objectives: To differentiate emergency surgical acute scrotal conditions from non-surgical cases. To establish an early diagnosis of acute scrotum in children. To avoid negative exploration of acute scrotum in many cases. Methods: Sixty four patients of different age groups ranging from neonate to 12 years were underwent surgical exploration under general anesthesia (GA) between January 2016 to December 2019. The study was conducted in the Faculty of Paediatric Surgery in Bangladesh Shishu Hospital & Institute (BSH&I). A total of 72 patients were admitted with acute scrotal pain and/or swelling and evaluated by taking detailed history of presenting complaints, careful physical examinations, different laboratory investigations including serum c-reactive protein (CRP) level and radiology & imaging studies whenever appropriate and available. Results: Out of 72 cases admitted for acute scrotum, serum C - reactive protein (CRP) level estimation was done in all cases and surgical exploration was done in 64 cases. Total sample size was 64. In age incidence majority of patients were >1 year-6 years (37.5%) and >6 years-12 years (34.37%). Majority of patients came with scrotal swelling (100%), pain (93.77%) and fever (65.62%). Majority of patients came after 48 hours of onset of symptoms and exploration was performed within 6 hours to 12 hours. Blood collection was done >48 hours since complaints in majority cases (59.38%). Serum CRP level was negative in majority cases of Torsion testis (TT) and Torsion appendix testis (TAT). Total count of WBC was raised in majority of inflammatory cases ...

Locoregional Approaches in Cholangiocarcinoma Treatment.

Cholangiocarcinoma (CCA) is a rare hepatic malignant tumor with poor prognosis due to late detection and anatomic factors limiting the applicability of surgical resection. Without surgical resection, palliation is the most common approach. In non-surgical cases contained within the liver, locoregional therapies provide the best chance for increased survival and disease control. The most common methods, transarterial chemoembolization and transarterial radioembolization, target tumors by embolizing their blood supply and limiting the tumor's ability to metabolize. Other treatments induce direct damage via thermal ablation to tumor tissue to mediate their anti-tumor efficacy. Recent studies have begun to explore roles for these therapies outside their previous role of palliation. This review will outline the mechanisms of each of these treatments, along with their effects on overall survival, while comparing these to non-locoregional therapies.

Utilising Virtual Clinics and Orthoptists to Aid COVID-19 Service Recovery in Adult Strabismus.

The Sheffield Virtual Adult Strabismus service was already well established and was put to real-time trial during the COVID-19 pandemic. We describe a multi-disciplinary adaptation to offer a safe and effective service delivery. We evaluate the efficacy of a virtual strabismus service during the pandemic to meet clinical demand, streamline patient care, balance care delivery and optimise medical input. Prospective data analysis from the virtual strabismus clinics dated from January 2015 to November 2021. All information was captured at first consultation with comprehensive specialist Orthoptic assessment and imaging; then reviewed by a strabismus consultant for clinical outcome. Management was discussed virtually with patients by the consultant. Pre-COVID (January 2015-March 2020), 1,068 appointments were offered. During COVID (July 2020-November 2021), 442 appointments were offered. Clinical capacity increased to meet demand. Within two months of service re-opening, first appointment mean waiting time reduced below 18 weeks. During COVID, 24.6% of patients were listed for procedures after first visit. Face-to-face medical follow up for non-surgical cases reduced from 47.7% to 16.3%. Virtual strabismus services offer flexible, safe and effective ways to meet fluctuating referral patterns and maximise limited time and resources. Orthoptists are uniquely essential and highly valued keyworkers to conservatively manage non-surgical strabismus. Utilising the skillsets of Allied Health Professionals (AHPs) across the NHS is crucial to sustain ongoing clinical demand and patient care.

PSAT181 Amyloidosis as a Possible Cause of Hypoparathyroidism

Abstract Background Hypoparathyroidism is a relatively uncommon metabolic disorder with an estimated prevalence of 37 per 100,000 person-years in the United States. Postsurgical hypoparathyroidism is the most common etiology and accounts for 75% of the cases. Nonsurgical cases are frequently the result of autoimmune or genetic disorders. Rarely parathyroid gland infiltration, external radiation treatment is also known cause hypoparathyroidism. We present a rare case of hypoparathyroidism associated with amyloidosis. Case 61-year-old female presented for evaluation of hypothyroidism and hypoparathyroidism and significant fatigue. Patient was already treated with levothyroxine as well as calcitriol at the time of presentation for management of these issues without improvement in her fatigue. Further review of prior records showed progressive decline in kidney function and albumin, hypothyroidism in addition to worsening hypocalcemia evidenced on ionized calcium levels over a two year period. This also coincided with the duration of the onset of fatigue. Past medical history was also significant for parathyroid surgery for primary hyperparathyroidism 12 years prior to the onset of symptoms. Patient did not develop hypoparathyroidism after surgery but maintained normal calcium levels until onset of symptoms 2 years ago.Physical exam did not reveal any abnormalities. Labs (when patient was receiving calcitriol) revealed a calcium of 9.5mg/dL (8.4-10.2mg/dL), with albumin 2.3g/dL(3.8-5.3g/dL), ionized calcium 1.27mmol/L(1.14-1.33mmol/L), 25-hydroxy Vitamin D 14ng/mL(>/=30ng/mL), PTH 7pg/mL(15-88pg/mL), Phosphorus 3.4mg/dL(2.4-4.8 mg/dL), Magnesium 2.6mg/dL(1.8-3.0 mg/dL), Creatinine 2.45mg/dL(0.40-0.99 mg/dL), eGFR 21 mL/min/1.73m2. She was trialled off calcitriol to assess for improvement of her PTH, however was noted to have inappropriately normal PTH despite hypocalcemia and was restarted on calcitriol. TPO antibody and 21 hydroxylase antibody levels were not elevated. Due to CKD, She underwent kidney biopsy that revealed lambda light chain amyloidosis. Patient is currently receiving daratumumab and Cyclophosphamide-Bortezomib-Dexamethasone and plans to undergo stem cell transplant in future. Conclusion Notably, the occurrence of amyloidosis with hypothyroidism and infiltrative amyloid goiter is well documented. Although prior case studies have detailed the co-occurrence of hyperparathyroidism and amyloidosis, little is known about the relationship of parathyroid disease and amyloidosis. Due to the temporal association of amyloidosis, hypoparathyroidism, and hypothyroidism, we hypothesize that infiltration of these endocrine glands by amyloid has contributed to the dysfunction. The patient will be monitored for improvement in her parathyroid function as the amyloidosis is treated. Further studies are needed to assess the interplay between the parathyroid and amyloidosis. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Diseases of dogs and cats recorded in the Bangladesh Agricultural University Veterinary Teaching Hospital during 2009−2020

Background: A retrospective study was performed to estimate the occurrence and distribution of diseases or conditions in dogs and cats belonging to the Mymensingh division and the surroundings that were brought to Bangladesh Agricultural University Veterinary Teaching Hospital (BAUVTH) for treatment and management from January 2009 to December 2020. Methods: Data on animal species, age, sex, and reporting time of clinical cases were collected from the case register book of BAUVTH to determine the percentages of various diseases or conditions in dogs and cats using Microsoft Excel (2007). Results: In this study, 2535 small animals (e.g., dogs and cats) with various diseases or conditions were considered. Of the total diseases or conditions, 72.39% and 27.61% belonged to dogs and cats, respectively. From 2009 onwards, there was a progressive trend in the number of cases recorded in these animals. The highest occurrence of diseases was found as cutaneous wounds (18.89%), and the lowest was found as conjunctivitis (0.72%) as well as epistaxis (0.79%) in the animals. In addition, male dogs (49.69%) and female cats (16.94%) showed greater frequencies of various diseases or conditions than the corresponding female dogs (23.35%) and male cats (10.63%). Although the adult dogs (42.67%) were more frequently affected by different diseases or conditions than the younger ones (20.53%), cats (15.65%) up to six months of age were predominantly affected by several diseases or conditions than the older ones (11.94%). Moreover, the diseases or conditions in dogs were observed to be higher in the winter (28.41%) followed by the rainy (23.15%) and summer (20.84%) seasons. Likewise, cat diseases or conditions were more frequently observed in the winter (11.70%) followed by summer (8.99%) and rainy (6.90%) seasons. Furthermore, 48.32% of surgical and 51.68% of non-surgical cases were found in all the animals. Conclusion: Dogs and cats were usually presented with various clinical cases in that particular region. Male dogs and female cats suffered more frequently than female dogs and male cats. Age and seasonal variations may also be responsible for different affections. These findings might be helpful for the development of certain disease control and management strategies for pet animals.

Validation of the Nelson Tool: A Scoring Tool for Nonsurgical Service Admission of Injured Patients.

Trauma performance improvement programs are required by the American College of Surgeons to review all nonsurgical admissions if the annual rate exceeds 10%. These reviews can have varying consistency between reviewers, are time consuming, and the consequent aggregate data are difficult to evaluate for trends. This study set forth to standardize nonsurgical admission review through validation of the Nelson tool, which is a published objective scoring tool to determine the appropriateness of nonsurgical admissions. We hypothesized that implementation of this tool would facilitate earlier identification of events resulting in meaningful intervention and a reduction of inappropriate nonsurgical admissions. The Nelson tool and scoring was integrated into the nonsurgical admission review process. A customized audit filter and report were built in the trauma registry. Data were reviewed with respect to scores and admitting service. Statistical analysis included using analysis of variance and t tests to examine differences between admitting services, χ2 test of independence or Fisher's exact to test the association of categorical variables, and ordinal logistic regression to test the ability of the total Nelson tool to predict appropriateness of admission. Using the Nelson tool, scores resulted in appropriate admission service in over 90% of cases. Implementation of the tool resulted in a decreased performance improvement workload with a 78% reduction in nonsurgical admission cases required to go to secondary level of review. Utilization of a validated scoring tool decreases performance improvement workload without compromising patient safety.

578 Is the Scope of the Physician's Duty to Warn the Patient About the Risks Associated with a Surgery Sufficiently Clear?

Abstract Aim To critically analyze the concepts and cases that led to the seminal rulings in Montgomery and Sidaway Method A medical and legal literature review was performed. Case history was identified and critically analysed to understand the progression of consent law in England. Results The physician's duty to warn the patient about the risk associated with medical intervention has been developed through the cases identified to involve: The process of consent is of chief importance in surgery and yet only a single case (Chester) directly involves consenting during a surgical procedure. Conclusion The definition of material risk is expected to cover a plethora of medical interventions from minor procedures to major surgery. It was generated predominantly from non-surgical cases. The physician's scope to disclose risks to patients is broad and encompasses a skillset that incites core clinical skills of empathy, honesty, and information transfer. It has evolved alongside advances in medical and legal judgement, albeit reactively to cases of inadequate care. With regard to its clarity, one has to consider the acceptable boundary of prescriptivism that both respects patient autonomy and creates a transparent working environment. It can be argued that the current scope is not direct enough for healthcare professionals.

The epidemiology of endodontic complexity in general dental practice: a prevalence study.

Aim To determine the prevalence and the epidemiology of the factors influencing endodontic complexities in general dental practice.Method Eligible cases where endodontic treatment was indicated as a treatment option were collected by a total of 30 general dental practitioners based in the UK. Online-based Endodontic Complexity Assessment Tool (E-CAT) was used to determine the perceived complexity of each case. In total, 22 categories, including patient- and tooth-related factors, were recorded.Results Collectively, 435 non-surgical root canal treatment cases were assessed. Overall, 72% of the root canal treatments encountered in general dental practice were found to be either uncomplicated (Class I) or moderately complicated (Class II) and can be considered within the remit of general dental practitioners. Despite the relatively equal distribution of the assessed teeth, the proportion of extraction as a proposed treatment for posterior teeth was more than double that of anterior teeth.Conclusion The results obtained in this study provide a good resource and databank for researchers, educators, public health commissioners and academic institutions to access a wide range of information concerning the prevalence and distribution of endodontic complexity.

CO103 Length of Stay, Cost, and Outcomes Related to Traumatic Subdural Hematoma in Inpatient Setting in the United States

In the United States, the prevalence of traumatic subdural hematoma (TSDH) continues to increase and currently accounts for 12% to 51.4% of all traumatic brain injuries. Using a nationally representative discharge records of hospitalized patients with TSDH, the study objectives were to estimate the inpatient cost, length of stay (LOS), inpatient mortality rate and complication rate among surgical and non-surgical cases; and to identify the effect of various socio-demographic, clinical and hospital characteristics on complications and inpatient death.

The 'tears' score: A tool for grading and monitoring epiphora.

To test the reliability, validity and utility of the TEARS score, a scale of clinical and patient-reported severity in patients with epiphora, comprising 4 subscales: Times wiping (T), clinical Effects (E), Activity limitation (A), and symptoms of Reflex epiphora (R). The TEARS score was completed by 136 patients with epiphora (78 treated surgically, and 51 non-surgically). Inter-rater reliability was evaluated using Cohen's Kappa and Bland-Altman analysis. 129 (95%) participants were followed up 2-6 months after baseline (non-surgical patients) or 3-6 months post-operatively (surgical patients). For each TEARS subscale, differences in scores were compared. Convergent validity was evaluated by testing correlation between TEARS and both The Lacrimal Symptom Questionnaire (Lac-Q) and The Watery Eye Quality of Life Score (WEQOL). Inter-rater reliability (Cohen's K) ranged from 0.5 for 'A' and 'R' to 0.8 for 'T' and 'E' subscales. Scores were lower post-operatively in surgical patients (p < 0.001). 'R' scores (reflex tearing) were higher in non-surgical cases compared with surgical (p = 0.02) but no difference was observed in other subscales at baseline. TEARS subscale scores were positively correlated with both WEQOL (r = 0.51 to 0.73) and Lac-Q score (r = 0.55 to 0.63). The TEARS score is quickly and easily implemented in a busy clinical setting. It provides an overview of both subjective and objective clinical severity in patients with epiphora, with appropriate reliability, post-operative responsiveness and convergent validity for this purpose and in this setting. It is a valuable template to be used alongside individualised symptomology.

Surgical endodontics under the microscope: principles and practice

The direct operating microscope has completely revolutionized the field of endodontics, leading to increased success in both non-surgical and surgical cases. In low- and middle-income countries, microsurgical endodontics is still a developing field and procedures that fall within this category employ higher magnification. Currently, less than 25% of dentists in developing countries employ any sort of magnification in their practice. Basic concepts, such as microscope positioning and operator's ergonomics, are still confusing to many dentists, novice or experienced alike. This article introduces the benefits and general principles of direct operating microscope use in endodontic microsurgeries. CPD/Clinical Relevance: A better understanding of the use of dental operating microscopes in endodontic microsurgical techniques may facilitate a more efficient workflow.

The Patient Pathway for Men with Chronic Urinary Retention: Treatments, Complications, and Consequences

To explore the treatment options for chronic urinary retention (CUR) in men, including treatment-related complications and consequences. This retrospective cohort study included male patients diagnosed with a non-neurogenic, symptomatic and/or high-risk, CUR >150 mL in a large Dutch non-academic teaching hospital. Data for treatments, complications, and consequences (eg, diagnostics, additional treatments, and hospital contact) were recorded and incidence rate ratios (IRRs) were calculated. We enrolled 177 patients (median age, 77 years; range, 44-94) with a median follow-up of 68 months (range, 1-319) during which they had a median of 8 events (range, 1-51). Most patients initially received a urethral catheter (74%) and some form of catheterization as their final treatment (87%). Compared with non-surgical cases, catheterization was more likely to be stopped after de-obstructive prostate surgery (IRR, 4.18; P < 0.001). Urinary tract infection (IRR, 3.68; P < 0.001) and macroscopic hematuria (IRR, 5.35; P < 0.001) were more common with catheterization, but post-renal problems were more likely in patients with no catheterization (IRR, 25.36; P < 0.001). The lowest chance of complication was with clean intermittent catheterization, and complications were usually managed in outpatient (77%) or emergency (6%) departments, rather than by admission (17%). Most patients require catheterization for CUR, with clean intermittent catheterization preferred due to its comparatively lower complication risk. De-obstructive prostate surgery increases the chance of stopping catheterization and may be considered in suitable cases.

Prognostic factors for spontaneous spinal epidural hematoma: a multicenter case-control study.

To determine the optimal treatment for spontaneous spinal epidural hematoma (SSEH). The aim of this study was to identify factors associated with SSEH. In 62 patients with SSEH, several patient-related parameters were analyzed as candidate factors associated with Frankel grade before treatment or at the last follow-up. These parameters were compared between patients with and without surgery. In addition, multivariate ordinal logistic regression analysis was used to identify factors significantly associated with Frankel's grade before treatment or at the last follow-up. There were significant differences in age, location of the hematoma, and Frankel grade before treatment and at the last follow-up between surgical and nonsurgical cases in all patients, but there were no significant differences in any of these parameters when comparing patients with pre-treatment Frankel grade C. The location of the hematoma was significantly associated with the severity of paralysis before treatment. In surgical cases, the time from onset to surgery and the location of the hematoma was significantly associated with the prognosis. When the time from onset to surgery was evaluated using the criteria of 12, 24, and 48h, 24 and 48h had a significant impact on the prognosis. In the analysis of nonsurgical cases, only the vertical size of the hematoma was significantly associated with prognosis. The time from onset to surgery and the location of the hematoma were prognostic factors in surgical cases, while the vertical size of the hematoma was a prognostic factor in nonsurgical cases.

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing: A single-center study.

BACKGROUNDSince the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, outcomes and management of many diseases have been affected. Acute appendicitis is a common acute abdomen. The incidence rate is 0.05%-0.5%. Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic. People avoided going to the hospital for fear of being infected. Different countries have different epidemic prevention measures that result in different treatment outcomes. The Chinese government also published some temporary measures in order to prevent the outbreak. AIMTo explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODSPatients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed. Cases were grouped according to admission year. The demographic characteristics, present illnesses, medical history, symptoms and signs, comorbidities, blood test results, imaging data, appendix pathology, and treatment details were compared.RESULTSOverall, 74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019, whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020. Fever, thick appendix, nonsurgical management, and uncomplicated appendicitis (simple or supportive appendicitis) were more common in group 2020 (P < 0.05). Among the nonsurgical management cases, the neutrophil percentage, neutrophil-to-lymphocyte ratio, and recurrence rate were higher in group 2020 (P < 0.05). Among surgically managed cases, there were more cases with gastrointestinal symptoms, peritonitis, ascites in the image, and intraoperative adhesion or ascites in group 2020 (P < 0.05). The white blood cell count, time from diagnosis to surgery, surgical time, and intraoperative blood loss were higher in group 2020 (P < 0.05).CONCLUSIONDuring the COVID-19 pandemic, patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment. For patients who underwent surgical management, the operation was delayed and more difficult during the pandemic. Nevertheless, the hospital stay and the incidence of postsurgical complications did not change.

Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience

Guidelines for management of Melody transcatheter pulmonary valve (TPV) infective endocarditis (IE) are lacking. We aimed to identify factors associated with surgical valve removal versus antimicrobial therapy in Melody TPV IE. Multicenter retrospective analysis of all patients receiving Melody TPV from 10/2010 to 3/2019 was performed to identify cases of IE. Surgical explants versus non-surgical cases were compared. Of the 663 Melody TPV implants, there were 66 cases of IE in 59 patients (59/663, 8.8%). 39/66 (59%) were treated with IV antimicrobials and 27/66(41%) underwent valve explantation. 26/59 patients (44%) were treated medically without explantation or recurrence with average follow-up time of 3.5 years (range:1–9). 32% of Streptococcus cases, 53% of MSSA, and all MRSA cases were explanted. 2 of the 4 deaths had MSSA. CART analysis demonstrated two important parameters associated with explantation: a peak echo gradient ≥ 47 mmHg at IE diagnosis(OR 10.6, p < 0.001) and a peak echo gradient increase of > 24 mmHg compared to baseline (OR 6.7, p = 0.01). Rates of explantation varied by institution (27 to 64%). In our multicenter experience, 44% of patients with Melody IE were successfully medically treated without valve explantation or recurrence. The degree of valve stenosis at time of IE diagnosis was strongly associated with explantation. Rates of explantation varied significantly among the institutions.

VALIDATION OF A DYNAMIC RISK CLASSIFICATION SYSTEM FOR IN-HOSPITAL DEATH, BASED ON ELECTRONIC RECORDS OF NON-SURGICAL ADMISSIONS TO GENERAL HOSPITALS

Objective: To develop and validate a risk-classification system for in-hospital death, clinically useful for general hospital adult primarily non-surgical cases.&#x0D; Methods: Admissions for non-surgical conditions at 5 public general hospitals of Minas Gerais were included. Procedures: Build a predictive model for death during admission, using logistic regression; Create a severity index based on the independent effect of the selected variables, and then, validate its ability to predict in-hospital death during index admission; Validate the predictive scale by challenging it with a new dataset.&#x0D; Results: The final multivariate model included seven significant predictive variables: age, gender, diagnostic-related group, hospital of index admission, admission to the ICU, total length of stay, and unplanned surgical procedure. This model presented adequate fit and fair discriminative performance (AUC=0.78). Temporal validation with a new sample also presented an adequate fit, and the discriminative performance was again fair (AUC=0.76).&#x0D; Conclusions: A dynamic and clinically useful risk classification system for in-hospital death of non-surgical admissions has been validated.

P01.02 High Risk Factors and Benefit of Adjuvant Chemotherapy in Surgically Resected Stage IB Non–Small Cell Lung Cancer

Lung cancer remains the leading cause of cancer deaths worldwide. Although Stage IB disease is usually managed with upfront resection, consideration for adjuvant chemotherapy treatment is dependent on the presence or absence of high risk factors. The prognostic value of these factors and survival outcomes for these patients as reported by a national database have not been clearly elucidated. Patients with diagnosed NSCLC Stage IB (pT2aN0) per AJCC 7th edition between 2010 and 2016 from the NCDB were included. Non-surgical cases and cases that received radiotherapy were excluded. Univariate analyses comparing the clinico-demographic and pathologic features of those managed with surgery and observation (obs) versus surgery and adjuvant chemotherapy (CT) was performed. Multivariate analyses identified factors that influence survival and the likelihood of receiving CT. Kaplan-Meier method was performed to compare median OS. A total of 10,669 cases (84.2% obs, 15.8% CT) were identified. The obs cohort were primarily over age 70 (50.4%); those managed with CT were primarily 50-70 years (69.3%). Cases with tumors 4-5cm (OR, 0.388, P<0.0001), pleural invasion (OR, 0.598, P<.0001), and poor tumor differentiation (OR, 0.332, P<.0001) had a decreased likelihood of receiving obs versus CT. Age over 70 (HR, 1.801, P<.0001), Medicare insurance (HR, 1.246, P<.0001), and poor tumor differentiation (HR, 1.741, p<.0001) were adverse predictors of OS for those receiving obs versus CT. Five-year survival was higher for CT (63.6%) versus obs (57.1%), median OS was 88 months versus 75 months (p<0.0001) respectively. Those with moderately differentiated tumors achieved a survival benefit of 23 months when managed with CT (Table 1). Median OS increased by 19 months (65 versus 84 months) for poorly differentiated tumors managed with CT (p<.0001). When visceral pleural invasion was present, median OS was 60 months (obs) and greater than 75 months (CT) (p=0.0006). Cases with tumors 4-5cm in size had a median OS of 88 months when CT was received versus 67 months when managed with obs (p<.0001). Cases managed with lobectomy experienced a survival benefit of 92 months (CT) and 76 months (obs) (p<.0001).Tabled 1Surgery and Observation (reference)Surgery and ChemotherapyOS Benefit (Mos)P-valueMedian OS (Mos)95% CI Lower Limit95% CI Upper LimitMedian OS (Mos)95% CI Lower Limit95% CI Upper LimitOverall7571778883NEa13<.0001No pleural involvement7875839284NE140.0026Visceral Pleural Invasion605671NE75 bNE-0.0006< lobectomy5851655243NE- 60.8810lobectomy7673789287NE16<.00013-4cm7976868774NE80.05894-5cm6762718883NE21<.0001Moderately Diff6966759292NE23<.0001Poorly Diff6560708477NE19<.0001aNE= Not estimate, small sample/sparse data bMedian OS >75 months for CT; Mos=Months CI=Confidence Interval Diff=differentiation Open table in a new tab aNE= Not estimate, small sample/sparse data bMedian OS >75 months for CT; Mos=Months CI=Confidence Interval Diff=differentiation Overall, stage IB (pT2aN0) NSCLCs managed with CT, experienced an increased median OS of 13 months when compared to the obs cohort. Cases with pleural invasion, tumors 4-5cm in size with poor differentiation might experience a survival benefit in excess of 20 months, when CT is given versus obs.