Non-tertiary Centers Research Articles

One Year Patient Reported Outcomes After Single-Level Lumbar Fusion at Orthopedic Specialty Hospital Compared to Tertiary Referral Center

Lumbar spinal fusion is an increasingly common operation to treat symptoms related to degenerative disorders of the spine including radiculopathy and pain. As the volume of spine surgeries grows, it is becoming increasingly common for procedures to take place in non-tertiary care centers, including orthopaedic specialty hospitals (OSH). While previous research demonstrates that surgical outcomes at an OSH are non-inferior to those at a tertiary referral center (TRC), the implications of this difference on patient-reported outcome measures (PROMs) have not been sufficiently assessed. The objectives of this study were (1) to determine if changes in patient reported outcome measures (PROMs) after elective lumbar spinal fusion surgery differ between patients who undergo surgery at an orthopedic specialty hospital (OSH) and those who undergo surgery at a tertiary referral center (TRC) and (2) to characterize differences in short-term outcomes between hospitals. Retrospective cohort study. Adult patients (≥ 18 years old) who underwent primary, elective single-level posterior lumbar decompression and fusion between January 2014 and December 2021 at a tertiary referral center or an orthopaedic specialty hospital. PROMs: Oswestry Disability Index (ODI), Short-form 12 (SF12) Mental Component Summary (MCS); SF12 Physical Component Summary (PCS); Visual Analogue Back and Leg (VAS Back/Leg) METHODS: PROMs were collected preoperatively, 6 months after surgery, and 1 year after surgery. Six-month and 1-year delta PROM values were calculated by subtracting the preoperative PROM score from the 6-month or 1-year score, respectively. Multivariable linear regression analyses were conducted to assess the independent effect of hospital location on postoperative PROM scores. A total of 288 patients were identified as part of the study cohort including 205 patients who underwent surgery at the tertiary hospital and 83 patients who underwent surgery at the OSH. OSH patients had shorter length of stay (1.57 ± 0.72 vs. 3.28 ± 1.32, p<0.001), however there was no difference in discharge disposition or 90-day readmission rates between hospitals (p>0.05). At 6 months, having surgery at the specialty hospital was associated with higher PCS (estimate = 2.96, confidence interval: 0.21 - 5.71, p=0.035). At 1-year postoperatively, the location of surgery no longer demonstrated significant associations with PROM scores. Preoperative PROM scores demonstrated significant associations with 6-month and 1-year scores for each PROM (p<0.05) except VAS leg at 6 months postoperatively. To our knowledge, this is one of the largest studies investigating PROMs at OSH versus TRCs for single-level lumbar fusions. We demonstrated that at one-year follow-up, there is not a significant difference in PROM improvement between patients who undergo surgery at a TRC and patients who do so at an OSH.

Healthcare professional perspectives following implementation of an infection management care pathway for pediatric patients with cancer: a qualitative study.

The Pediatric Oncology Group of Ontario (POGO) supported an effort to implement infection management care pathways based on clinical practice guidelines, to improve the consistency of infection management in pediatric cancer patients. The objective of this qualitative study was to describe the perspective of healthcare professionals (HCPs) following implementation. Four tertiary pediatric oncology centers in Ontario, Canada, implemented the pathways. We randomly identified three HCPs per group (clinical pharmacists; nurse case managers, educators or practitioners and physician assistants; pediatric oncology fellows; or pediatric oncology staff physicians) per site and invited them to participate in a qualitative interview. One-on-one interviews were conducted remotely, followed by thematic analysis of interview transcripts. A total of 66 invitations were extended and 42 HCPs participated. Identified themes were: (1) implementation approach, (2) access and navigation, (3) engagement, (4) concerns, (5) workplace benefits, (6) reception, and (7) provincial harmonization. HCPs preferred in-person implementation strategies over e-mail communication. They identified teaching/educational utility and benefits to non-oncology departments and non-tertiary centers participating in shared care of patients. Other positive aspects related to evidence-based practice, safety, supporting oncology HCPs, and benefits to patients and families. Concerns included need to ensure users applied clinical judgement and loss of autonomy. Provincial harmonization of practice was viewed positively, although potential logistical and institutional cultural barriers were raised. Following infection management care pathway implementation, HCPs described educational utility and benefits to non-oncology departments, oncology HCPs, patients, and families. Our findings may facilitate future infection management care pathway provincial harmonization.

Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study.

Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room. Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

FUTURE BLOOD PRESSURE PREDICTION ARTIFICIAL INTELLIGENCE PROGRAM: THE DR. ANSWER MEDICAL SOFTWARE

Objective: Current guidelines recommend home blood pressure (HBP) monitoring in patients diagnosis with hypertension and those with white coat hypertension or masked hypertension. Delicate classification of these patients are important because the intensification of antihypertensive drug therapy for patients with white coat uncontrolled hypertension or white coat hypertension may not be needed because cardiovascular risk seems not to be greater. Therefore, its detection is important to avoid overtreatment. Meanwhile patients with masked hypertension or masked uncontrolled hypertension and uncontrolled hypertension need further intensification of antihypertensive treatment. Dr. Answer project consists of 21 artificial intelligence (AI) medical software that cover eight major diseases including hypertension. The main object of Dr. Answer hypertension project is to predict the patients next visit office BP according to the home BP data and provide effective and precise treatment plan. Design and method: 2,057 patients and 156,117 pure HBP data were collected in the Dr. Answer hypertension project. Patients were enrolled in 1 tertiary center (Chonnam National University Hospital) and other 21 non-tertiary centers from January 2022 to September 2022. 1,447 patients and 153,712 were excluded due to insufficient HBP data and follow up loss. Finally 610 patients and 2,405 HBP data were evaluated in the AI program model. Results: Patients were 66.7 ± 14.4 years and proportion of women was 24.1%. and patients enrolled in tertiary center was 73.4%. Mean HBP 8weeks of systolic blood pressure and 4 weeks of diastolic blood pressure data were evaluated in the AI program model. Recurrent Neural Network, Long Short-term Memory, Attention algorism were selected in AI model program. Mean Absolute Error (MAE) and Root Mean Square Error (RMSE) and Accuracy data were used as the AI model parameter. MAE of systolic BP was 3.96 and MAE of diastolic BP was 2.1. Meanwhile, RMSE of systolic BP was 5.81 and RSME of diastolic BP was 2.88. Accuracy data showed 74.1% and 91.4% respectively. Conclusions: Dr. Answer hypertension AI medical software showed promising results for predicting future blood pressure data in hypertension patients. Further advancement in the AI program model would be needed.

Italian Survey on Endoscopic Biliary Drainage Approach in Patients with Surgically Altered Anatomy.

Background and Objectives: Biliary drainage (BD) in patients with surgically altered anatomy (SAA) could be obtained endoscopically with different techniques or with a percutaneous approach. Every endoscopic technique could be challenging and not clearly superior over another. The aim of this survey is to explore which is the standard BD approach in patients with SAA. Materials and Methods: A 34-question online survey was sent to different Italian tertiary and non-tertiary endoscopic centers performing interventional biliopancreatic endoscopy. The core of the survey was focused on the first-line and alternative BD approaches to SAA patients with benign or malignant obstruction. Results: Out of 70 centers, 39 answered the survey (response rate: 56%). Only 48.7% of them declared themselves to be reference centers for endoscopic BD in SAA. The total number of procedures performed per year is usually low, especially in non-tertiary centers; however, they have a low tendency to refer to more experienced centers. In the case of Billroth-II reconstruction, the majority of centers declared that they use a duodenoscope or forward-viewing scope in both benign and malignant diseases as a first approach. However, in the case of failure, the BD approach becomes extremely heterogeneous among centers without any technique prevailing over the others. Interestingly, in the case of Roux-en-Y, a significant proportion of centers declared that they choose the percutaneous approach in both benign (35.1%) and malignant obstruction (32.4%) as a first option. In the case of a previous failed attempt at BD in Roux-en-Y, the subsequent most used approach is the EUS-guided intervention in both benign and malignant indications. Conclusions: This survey shows that the endoscopic BD approach is extremely heterogeneous, especially in patients with Roux-en-Y reconstruction or after ERCP failure in Billroth-II reconstruction. Percutaneous BD is still taken into account by a significant proportion of centers in the case of Roux-en-Y anatomy. The total number of endoscopic BD procedures performed in non-tertiary centers is usually low, but this result does not correspond to an adequate rate of referral to more experienced centers.

Successful Extracorporeal Membrane Oxygenation Implementation at a Non-tertiary Medical Center: A Single-Center Experience.

The inexperience and limited resources at non-tertiary medical centers pose unique challenges to the successful development of an extracorporeal membrane oxygenation (ECMO) program. The current literature does not provide a detailed framework that addresses the unique challenges encountered at these facilities. We outline a proactive approach to developing an ECMO program and provide a retrospective analysis of patient demographics, clinical characteristics, ECMO configuration, duration of ECMO support, major adverse events, and survival to hospital discharge. Data are summarized using mean, median, percentages, standard deviation, and interquartile range. Eleven patients were cannulated between December 2021 to March 2023. The age range of the patients who received ECMO varied significantly, with the youngest being 25 years old and the oldest being 69 years old. The mean age was 38 years old, with a standard deviation of 15.9. Hypertension was the most common co-morbid condition occurring in 64% (n=7) of patients. Only one patient had a major adverse event, and survival to hospital discharge was 73% (n=8). Of the patients that survived hospital discharge, seven patients were discharged home and one to a rehabilitation facility. These findings suggest that the safe implementation of an ECMO program at a non-tertiary hospital with inexperienced staff and limited resources is feasible. Adherence to established guidelines is essential for new programs, especially with regard to patient selection. Furthermore, a proactive approach that emphasizes high-yield training techniques, patient management protocols, and strategies that mitigate adverse events may be the key to achieving survival rates that exceed those of larger academic hospitals.

Tobacco smoking is associated with combined pulmonary fibrosis and emphysema and worse outcomes in interstitial lung disease.

Tobacco smoking is an established cause of pulmonary disease whose contribution to interstitial lung disease (ILD) is incompletely characterized. We hypothesized that compared with nonsmokers, subjects who smoked tobacco would differ in their clinical phenotype and have greater mortality. We performed a retrospective cohort study of tobacco smoking in ILD. We evaluated demographic and clinical characteristics, time to clinically meaningful lung function decline (LFD), and mortality in patients stratified by tobacco smoking status (ever vs. never) within a tertiary center ILD registry (2006-2021) and replicated mortality outcomes across four nontertiary medical centers. Data were analyzed by two-sided t tests, Poisson generalized linear models, and Cox proportional hazard models adjusted for age, sex, forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), ILD subtype, antifibrotic therapy, and hospital center. Of 1,163 study participants, 651 were tobacco smokers. Smokers were more likely to be older, male, have idiopathic pulmonary fibrosis (IPF), coronary artery disease, CT honeycombing and emphysema, higher FVC, and lower DLCO than nonsmokers (P < 0.01). Time to LFD in smokers was shorter (19.7 ± 20 mo vs. 24.8 ± 29 mo; P = 0.038) and survival time was decreased [10.75 (10.08-11.50) yr vs. 20 (18.67-21.25) yr; adjusted mortality HR = 1.50, 95%CI 1.17-1.92; P < 0.0001] compared with nonsmokers. Smokers had 12% greater odds of death for every additional 10 pack yr of smoking (P < 0.0001). Mortality outcomes remained consistent in the nontertiary cohort (HR = 1.51, 95%CI = 1.03-2.23; P = 0.036). Tobacco smokers with ILD have a distinct clinical phenotype strongly associated with the syndrome of combined PF and emphysema, shorter time to LFD, and decreased survival. Smoking prevention may improve ILD outcomes.NEW & NOTEWORTHY Smoking in ILD is associated with combined pulmonary fibrosis and emphysema and worse clinical outcomes.

Interfacility transfer of pediatric trauma patients to higher levels of care: The effect of transfer time and level of receiving trauma center.

Interfacility transfer of pediatric trauma patients to pediatric trauma centers (PTCs) after evaluation in nontertiary centers is associated with improved outcomes. We aimed to assess the outcomes of transferred pediatric patients based on their severity of the injury, transfer time, and level of receiving PTCs. This is a 3-year (2017-2019) analysis of the American College of Surgeons Trauma Quality Improvement Program database. All children (younger than 15 years) who were transferred from other facilities to Level I or II PTC were included and stratified by level of receiving PTCs and injury severity. Outcome measures were in-hospital mortality and major complications. A total of 67,726 transferred pediatric trauma patients were identified, of which 52,755 were transferred to Level I and 14,971 to Level II. The mean ± SD age and median Injury Severity Score were 7 ± 4 years and 4 (1-6), respectively. Eighty-five percent were transported by ground ambulance. The median transfer time for Levels I and II was 93 (70-129) and 90 (66-128) minutes, respectively ( p < 0.001). On multivariable regression, interfacility transfers to Level I PTCs were associated with decreased risk-adjusted odds of in-hospital mortality among the mildly to moderately injured group (adjusted odds ratio, 0.59; p = 0.037) and severely injured group with a transfer time of less than 60 minutes (adjusted odds ratio, 0.27; p = 0.002). Every minute increase in the interfacility transfer time is associated with a 2% increase in risk-adjusted odds of mortality among severely injured pediatric trauma patients. Factors other than the level of receiving PTCs, such as estimated transfer time and severity of injury, should be considered while deciding about transferring pediatric trauma patients to higher levels of care. Therapeutic/Care Management; Level III.

Delivery Outcomes in Non-Tertiary Referral Centers for Women with Congenital Heart Disease

Delivery Outcomes in Non-Tertiary Referral Centers for Women with Congenital Heart Disease

Enhancing utility of interfacility triage guidelines using machine learning: Development of the Geriatric Interfacility Trauma Triage score.

Undertriage of injured older adults to tertiary trauma centers (TTCs) has been demonstrated by many studies. In predominantly rural regions, a majority of trauma patients are initially transported to nontertiary trauma centers (NTCs). Current interfacility triage guidelines do not highlight the hierarchical importance of risk factors nor do they allow for individual risk prediction. We sought to develop a transfer risk score that may simplify secondary triage of injured older adults to TTCs. This was a retrospective prognostic study of injured adults 55 years or older initially transported to an NTC from the scene of injury. The study used data reported to the Oklahoma State Trauma Registry between 2009 and 2019. The outcome of interest was either mortality or serious injury (Injury Severity Score, ≥16) requiring an interventional procedure at the receiving facility. In developing the model, machine-learning techniques including random forests were used to reduce the number of candidate variables recorded at the initial facility. Of the 5,913 injured older adults initially transported to an NTC before subsequent transfer to a TTC, 32.7% (1,696) had the outcome of interest at the TTC. The final prognostic model (area under the curve, 75.4%; 95% confidence interval, 74-76%) included the following top four predictors and weighted scores: airway intervention (10), traffic-related femur fracture (6), spinal cord injury (5), emergency department Glasgow Coma Scale score of ≤13 (5), and hemodynamic support (4). Bias-corrected and sample validation areas under the curve were 74% and 72%, respectively. A risk score of 7 yields a sensitivity of 78% and specificity of 56%. Secondary triage of injured older adults to TTCs could be enhanced by use of a risk score. Our study is the first to develop a risk stratification tool for injured older adults requiring transfer to a higher level of care. Prognostic and Epidemiolgical; Level III.

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

Comparative Performance of Artificial Intelligence Optical Diagnosis Systems for Leaving in Situ Colorectal Polyps

The Influence of Gd-EOB-DTPA on T2 Signal Behavior: An Example from Clinical Routine.

In the literature, it has repeatedly been stated that the introduction of hepatospecific contrast agents in Magnetic Resonance Imaging prolongs the acquisition time due to the hepatobiliary phase, normally acquired 15–20 min after injection. Many efforts have been made to shorten the time-consuming protocols, and it was demonstrated that T2-Weighted Images (T2WI) and Diffusion-Weighted Images (DWI) acquired after Gd-EOB-DTPA show a comparable diagnostic capability to pre-contrast T2WI and DWI in the detection and characterization of hepatic tumors. Therefore, T2WI and DWI are usually acquired after the acquisition of vascular phases, in the dead time until the acquisition of the hepatobiliary phase. Unfortunately, contrast agents, especially Gd-EOB-DTPA, reduce the hydrogen nuclei’s relaxation time and modify signal intensity. We report a case in which, due to these limitations of the acquisition protocol, two hemangiomas showed an inhomogeneous, low signal on T2WI and DWI that was not visible in a follow-up scan a few days later. In conclusion, when liver lesions of unknown nature must be characterized, and there is a lack of previous radiological investigations, it could be useful to acquire pre-contrast T2WI and DWI to avoid diagnostic confusion, especially in non-tertiary centers.

Algorithmic Multimodality Approach to Diagnosis and Treatment of Spinal CSF Leak and Venous Fistula in Patients With Spontaneous Intracranial Hypotension.

Spontaneous intracranial hypotension (SIH) is a disorder of CSF dynamics that causes a complex clinical syndrome and severe disability. SIH is challenging to diagnose because of the variability of its presenting clinical symptoms, the potential for subtle imaging findings to be easily overlooked, and the need for specialized diagnostic testing. Once SIH is suggested by clinical history and/or supported by initial neuroim-aging, many patients may undergo initial nontargeted epidural blood patching with variable and indefinite benefit. However, data suggest that precise localization of the CSF leak or CSF-venous fistula (CVF) can lead to more effective and durable treatment strategies. Leak localization can be achieved using a variety of advanced diagnostic imaging techniques, although these may not be widely performed at nontertiary medical centers, leaving many patients with the potential for inadequate workup or treatment. This review describes imaging techniques including dynamic fluoroscopic and CT myelography as well as delayed MR myelography and treatment options including percutaneous, endovascular, and surgical approaches for SIH. These are summarized by an algorithmic framework for radiologists to approach the workup and treatment of patients with suspected SIH. The importance of a multidisciplinary approach is emphasized.

Survival Outcomes for Patients With T3N0M0 Glottic Cancer of the Larynx Treated With Radiation Alone vs. Chemoradiation

Laryngeal preservation with definitive chemoradiation (CRT) in patients with advanced laryngeal cancer has been established through various prospective randomized trials. However, it is unclear what the optimal treatment approach for patients with T3N0M0 glottic cancer is and whether chemotherapy is needed in conjunction with radiation. We sought to evaluate survival differences in patients with T3N0M0 glottic cancer treated with radiation alone (RT) versus chemoradiation.Patients with T3N0M0 glottic cancer diagnosed from 2004 through 2017 were identified from the National Cancer Database. Patients treated definitively with RT or CRT were selected. Patients receiving adjuvant RT or CRT were excluded. Baseline differences among treatment groups were identified. Overall survival was estimated with the Kaplan-Meier method and reported as median survival (MS). A multivariable cox proportional hazards model was constructed to identify variables associated with survival.A total of 3785 patients were included in the cohort, with 942 (25%) patients who received RT alone and 2843 (75%) who received CRT. With a median follow up of 75.2 months, median survival was significantly longer in patients treated with CRT than in patients treated with RT alone (82 months [m], 95% CI 76-87m vs 29m, 95% CI 25-33m). On multivariable cox model, patient factors associated with decreased overall survival (OS) included omission of chemo (hazard ratio [HR] 1.69, 95% CI 1.52-1.87), age > 70 (HR 1.66, 95% CI 1.15-2.42), comorbidities (HR 1.66, 95% CI 1.15-2.42, and treatment at non-tertiary academic cancer centers (HR 1.24, 95% CI 1.04-1.48). Patients age > 70 and those with multiple comorbidities were significantly less likely to receive chemotherapy (odds ratio [OR] 0.30, 95% CI 0.25-0.37 and OR 0.48 95% CI 0.31-0.76, respectively). When limiting analysis to patients under 70 with no comorbidities, the survival benefit persisted in favor of CRT (MS 113m, 95% CI 102-124m vs. MS 65, 95% CI 47-85m).Optimal treatment for T3N0M0 glottic cancer has not fully been established in prospective clinical trials. This is the first study to evaluate survival outcomes in this group of patients comparing RT to CRT. Median survival appears to be significantly increased with the use of CRT, and this benefit persists when controlling for age and performance status. This study supports the use of definitive CRT for appropriately selected patients with T3N0M0 glottic cancer.

Congenital Diaphragmatic Hernia: Core Review and Novel Updates.

Congenital diaphragmatic hernia (CDH) is a developmental defect in the diaphragm that allows abdominal viscera to herniate into the thoracic cavity. Pulmonary hypoplasia and pulmonary hypertension are consequences of this disease process. The incidence is approximately 2.4-4.1/10,000 births, and survival rate is estimated at 70-90 percent. To avoid potentially devastating delays in care, it is crucial that neonatal nurses and care providers in both tertiary and nontertiary care centers be familiar with the pathogenesis of CDH and the standard of care for initial stabilization of the neonate. Novel fetal and postnatal surgical repair techniques are also described here.

What Helps Us Decide to Adopt an Intervention: Efficacy, Costs, or Both?

What Helps Us Decide to Adopt an Intervention: Efficacy, Costs, or Both?

Computed-Tomography-Structured Reporting in Middle Ear Opacification: Surgical Results and Clinical Considerations From a Large Retrospective Analysis.

Purpose: The aim of the study is to compare the accuracy of unstructured preoperative Computed Tomography (CT) reports from non-tertiary diagnostic centers with intraoperative findings in a large cohort of patients with Chronic Otitis Media (COM) undergone surgery.Methods: From 2012 to 2019, a total number of 301 patients were considered for our purposes. All patients with clinical evidence of COM had preoperative non-contrast high resolution CT scan of the temporal bone in non-tertiary diagnostic centers, performed within 3 months before surgery.Results: The accuracy of CT reports was analyzed in terms of nature, anatomical site, disease extension, bony erosion, vascular structures abnormalities relevant to surgical planning, and Eustachian tube patency. Compared to post-surgical findings, CT reporting critical analysis revealed a tendency to overestimation of bony erosion, coupled to underestimated description of facial canal/lateral semi-circular canal, vascular structures, and Eustachian tube.Conclusion: Discrepancies between CT reports and surgical findings in middle ear opacification can be at least in part due to limited expertise of general radiologists in ENT neuroimaging. To limit this lack of information and the limited accuracy of middle ear structures depiction, here we propose a structured checklist to adopt in the case of a temporal bone CT scan for COM, in order to optimize the communication with surgeons and provide all the crucial information for an accurate surgical planning.

Abstract PS6-47: Breast cancer and COVID-19: Impact of active treatment on severe outcomes

Abstract Background: Several reports have observed that cancer patients who recently underwent chemotherapy or surgery had a higher risk of severe events compared with patients without cancer. Limited data is available on outcomes in specific cancer types, as well as the impact of non-cytotoxic systemic treatment, such as targeted therapy and hormonal therapy on severe outcomes. We aim to identify whether active treatment impacts severe outcomes (rate of hospitalization, ICU admission, intubation, and death) in breast cancer patients. Methods: We conducted a multicenter study in the state of Louisiana, throughout the Ochsner Health System, in both tertiary and non-tertiary centers. Patients must carry a diagnosis of breast cancer, and have a completed SARS-CoV-2 test between March 1st and April 30th, 2020. Chi-squared and Fisher’s exact tests were performed to compare the proportion of patients experiencing severe outcomes between treatment groups. Results: As of April 30, 2020, a total of 70 patients with breast cancer who had a positive SARS-COV-2 test were identified. Median age 64.5, median BMI 30.8, 62.9% (n=44) black, 27.1% (n=19) current/former smokers, HTN (n=52) and DM2 (n=22) were the most common comorbidities, and 12.9% (n=9) of patients had stage IV disease. Of these patients, 58.6% (n=41) were on hormonal treatment, and another 12.9% (n=9) were receiving other forms of systemic therapy (cytotoxic chemotherapy or targeted therapy). In terms of severe outcomes, 32.9% (n=23) of patients required hospitalization, 8.6% (n=6) required ICU admission with 7.1% (n=5) patients requiring intubation, 11.4% (n=8) of patients died. There was not a statistical difference in rate of severe outcomes (rate of hospitalization, ICU admission, intubation, and death) among breast cancer patients receiving active treatment (chemotherapy, targeted therapy, or hormonal therapy) vs those receiving no active treatment. There was also no difference in terms of severe outcomes by race. Conclusion: With an ongoing global COVID-19 pandemic, it is important to identify how the treatment and management of cancer impacts COVID-19 outcomes. This small cohort does not identify active treatment as a risk factor for increased rate of severe outcomes in patients with breast cancer. Further analyses describing impact of specific hormonal and chemotherapy regimens on risk of hospitalization and death will be completed by time of presentation. Citation Format: Karine Tawagi, Jeff Burton, Michael Lunski, Diana Maslov, John Cole. Breast cancer and COVID-19: Impact of active treatment on severe outcomes [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-47.

Multivariate mortality analyses in COVID-19: Comparing patients with cancer and patients without cancer in Louisiana.

This is the largest and only multivariate study evaluating the difference in mortality from coronavirus disease 2019 (COVID-19) between patients with cancer and patients without cancer in the United States. The objective was to assess COVID-19 mortality rates in patients with cancer versus patients without cancer and uncover possible statistically significant characteristics contributing to mortality. This retrospective study analyzed patients with cancer and patients without cancer who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 1 through April 30, 2020. This was a multicenter study in the state of Louisiana throughout the Ochsner Health System in both tertiary and nontertiary centers. Patients older than 18 years were eligible. Three hundred twelve patients with cancer were compared with 4833 patients without cancer. Mortality was found to be higher in the cancer group. Patients of advanced age with cancer had a significant increase in mortality (odds ratio [OR], 5.96; P < .001). Other significant risk factors for increased mortality were male sex (OR, 2.15), a history of chronic kidney disease (OR, 3.84), and obesity (OR, 1.30). In hospitalized patients with cancer, adverse vital signs on admission, decreased absolute lymphocyte counts, thrombocytopenia, elevated creatinine, lactic acidosis, and elevated procalcitonin all seemed to increase the risk of death. Among patients with cancer, active or progressive disease (P < .001) and recent therapy (OR, 2.34; 95% confidence interval, 1.08-5.08) were shown to increase mortality. Patients with cancer have increased mortality in the setting of infection with SARS-CoV-2 in comparison with patients without cancer. Patients with cancer who are 65 years of age or older and those with certain comorbidities have the greatest risk of death. Recent cancer-directed therapy and disease status also seem to play roles in mortality. This is the largest study of patients with cancer versus patients without cancer to date and is the first multivariate analysis study comparing these 2 patient populations. This study confirms the hypothesis that patients with cancer are at increased risk for mortality and that there are multiple characteristics posing the potential to risk-stratify these patients in the setting of a future outbreak.

S0060 Characterization of Diagnostic Patterns of Chronic Pancreatitis Within a Large Health Management Organization

INTRODUCTION: Chronic pancreatitis (CP) is an irreversible and progressive fibro-inflammatory disease of the pancreas causing pain and/or loss of exocrine/endocrine function. It is typically diagnosed with a combination of clinical and imaging criteria including atrophy, ductal dilatation, multiple parenchymal and intraductal calcifications. One of the main challenges in making a diagnosis of CP is the lack of universally agreed gold standard diagnostic criteria. To better understand the diagnostic patterns of this chronic, often disabling illness, we performed a retrospective analysis of 215 patients with CP treated at 9 hospitals of MedStar Health. METHODS: Using ICD 10 codes, we retrieved charts of patients presenting to acute care sites within the MedStar Health system between March 2015 and June 2019. These included emergency room visits and inpatient admissions. The following 7 variables pertaining to diagnosis of CP were manually extracted: 1. How was CP diagnosed? 2. Who made the diagnosis? 3. Demographics including sex, age 4. Length of stay 5. Was a GI consult obtained? 6. Location of care (Tertiary care vs. Non-tertiary care hospital) 7. Presumed etiology. Statistical analysis was performed by ANOVA analysis using GraphPad PRISM for Mac OS (Version 8). RESULTS: We found 215 encounters eligible for retrospective chart review. Average length of stay (in days) was longest when a gastroenterologist made the diagnosis (7.48), followed by the internist (2.02), or when a prior diagnosis was known (1.35). When a gastroenterologist was consulted, the chance of making an accurate diagnosis of CP was highest (53%) vs. when they weren’t consulted (20%). Most patients received a diagnosis of CP at a non-tertiary care center. The specialist making the diagnosis significantly changed the probability of accurate diagnosis (P < 0.0001) by clinical and imaging criteria. CONCLUSION: Most patients with CP are diagnosed at non-tertiary centers within the MedStar Health System. Most of these patients are given a diagnosis based on a prior diagnosis of CP. Accuracy of diagnosis significantly improved when a gastroenterologist was consulted. Non-tertiary centers most commonly made a diagnosis of CP based on inappropriate clinical and imaging criteria. These represent avenues for targeted interventions to standardize the diagnosis of CP across a large health management organization.Table 1.: TablesFigure 1.: Retrospective study design.Figure 2.: Graphs.