Patient-specific Risk Factors Research Articles

The Epidemiology of Carpal Tunnel Revision Over a 1-Year Follow-Up Period

To establish the incidence of revision carpal tunnel surgery within a 1-year postoperative period using a national administrative database. This information has been unknown until this point because of the absence of laterality-specific coding with the International Classification of Diseases, Ninth Edition and earlier coding systems. Data were collected from the Humana insurance database using PearlDiver patient records from 2015 to 2017. Subjects were identified using Current Procedural Terminology and International Classification of Diseases procedure codes related to carpal tunnel diagnosis and release. Codes were used to identify patients who underwent carpal tunnel release (CTR) and had revision CTR within a 1-year follow-up period. Patient demographic characteristics, including age, sex, medical comorbidities, and smoking status, were collected. In addition, multivariable analysis of the risk of a revision procedure within 1 postoperative year was performed to determine independent risk factors, including the surgical approach, associated with revision CTR. Among 4,549 patients who underwent a primary CTR during the study period, 207 patients (4.8%) underwent a revision CTR within 1 year. The average time from the primary CTR to the revision CTR was 135 days (standard deviation, 99.1 days; range, 21-365 days). Primary endoscopic CTR was associated with an increased rate of revision CTR (odds ratio, 1.3; 95% confidence interval, 1.2-1.6). Patient factors associated with a higher likelihood of requiring revision CTR included diabetes mellitus, tobacco use, psychiatric condition, cervical disease, and history of cubital tunnel release. This study identified a rate of revision CTR of 4.8% within the first postoperative year. Both the surgical technique and patient-specific risk factors influence the likelihood of requiring revision surgery. Notably, an endoscopic approach is associated with a higher risk of revision surgery. Prognostic II.

The Nonoperative Instability Severity Index Score: Is It Predictive in a Larger Shoulder Instability Population at Long-Term Follow-Up?

To evaluate the effect of the Nonoperative Instability Severity Index Score (NISIS) criteria on an established US-geographic population-based cohort of patients with anterior shoulder instability. An established geographically based medical record system was used to identify patients <40 years of age with anterior shoulder instability between 1994 and 2016. Medical records were reviewed to obtain patient demographics and instability characteristics. Patient-specific risk factors were individually incorporated into the 10-point NISIS criteria: age (>15 years), bone loss, type of instability (dislocation vs subluxation), type of sport (collision vs noncollision), male sex, and dominant arm involvement. High risk was considered a score of ≥7 points and low risk as <7 points. Failure was defined as either progression to surgery or recurrent instability diagnosed by a consulting physician at any point after initial consultation. The study population consisted of 405 patients with a mean follow-up time of 9.6 ± 5.9 years. Failure was defined as recurrent instability or progression to surgery, and the overall failure rate was 52.8% (214/405). The rate ofrecurrent instability after initial consultation was 34.6% (140/405), and the rate of conversion to surgery was 37.8% (153/405). A total of 264 (65.2%) patients were considered low risk (NISIS < 7), and 141 (34.8%) patients were considered high risk (NISIS ≥ 7). Patients in the high-risk group were more likely to fail nonoperative management than those in the low-risk group (60.3% vs 48.9%; P= .028). The NISIS has been proposed as a potentially useful tool in clinical decision-making regarding the appropriate use of nonoperative treatment in scholastic athletes. When applied to an established US-geographic population-based cohort consisting of competitive and recreational athletes under the age of 40 with longer-term follow-up, the NISIS high-risk cutoff was able to predict overall failure with 60.3% accuracy. III, retrospective observation trial.

45 Risk factors for lower urinary tract injury with laparoscopic sacrocolpopexy

The objective of this study was to identify patient-specific risk factors for lower urinary tract (LUT) injury with laparoscopic sacrocolpopexy (LSCP). This is an age-matched case-control study including patients who underwent LSCP from 2014-2017 in a high volume Urogynecology practice. Patients were excluded if they had abnormal urinary tract anatomy. Risk factors such as race, body mass index (BMI), preoperative pelvic organ prolapse quantification (POP-Q) stage, prior abdominal and/or vaginal surgery, and concurrent procedures were analyzed. Groups were compared using Student’s t-test for independent samples and chi-square tests. Conditional logistic regression was used to estimate odds ratios, and all regression models were conditioned on the matching variable. The model for adjusted odds ratios included all potential risk factors. The prevalence of LUT injury was 2.4% (17 bladder injuries and 1 ureteral injury out of 763 LSCP procedures). These 18 cases were age-matched to 72 controls. History of prior hysterectomy (unadjusted OR 162.41; CI 3.21, 8227; P= 0.011; adjusted OR 19.94, CI 2.48, 160.38; P= 0.005) and lysis of adhesions (unadjusted OR 5.15; CI 0.50, 52.76; P= 0.168; adjusted OR 4.94, CI 1.05, 23.19; P= 0.043) were associated with an increased risk of LUT injury. Concurrent posterior colporrhaphy appeared to have a protective association with LUT injury (unadjusted OR 0.78, CI 0.02, 27.67; P= 0.892; adjusted OR 0.32; CI 0.11, 0.88; P= 0.028). Race, BMI, POP-Q stage, prior abdominal and/or vaginal surgery, as well as concurrent bilateral salpingo-oophorectomy, mid-urethral sling placement, and anterior colporrhaphy were not associated with an increased risk of LUT injury. The prevalence of LUT injury with LSCP is rare, occurring in 2.4% of patients. History of prior hysterectomy significantly increased LUT injury risk. Concurrent lysis of adhesions increased the risk of LUT injury, while posterior colporrhaphy showed a protective effect. Although these two procedures may impact LUT injury risk, the associations are less clear due to the rarity of cases and baseline differences between groups. Based on our findings, the clinician can individualize surgical counseling based on patient-specific risk factors. This may also aid in setting appropriate postoperative patient expectations, including discussion as necessary regarding potential for prolonged catheterization or additional procedures and/or postoperative imaging in the case of LUT injury.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center.

Introduction: Herein we evaluate the incidence of incisional lumbodorsal hernia (ILDH) after retroperitoneal robotic partial nephrectomy (RRPN) and associated patient-specific and tumor-specific risk factors. Furthermore, we aim to evaluate the role of routine lumbodorsal fascial closure for the prevention of ILDH. Methodology: This is a retrospective review of our robotic partial nephrectomy database of all RRPNs performed at Washington University School of Medicine from 2000 to 2020. Postoperative imaging was reviewed for evidence of ILDH. A clinically significant hernia was defined as the protrusion of visceral organ(s) through the lumbodorsal fascia. Patient and tumor characteristics, and fascial closure techniques were analyzed to determine predictors of ILDH. Results: In total, 150 patients underwent RRPN between 2007 and 2020 with an average follow-up of 4.9 (1-37) months. Twelve (8%) ILDHs were identified. Ten (6.7%) patients had herniated retroperitoneal fat whereas 2 (1.3%) patients had herniated colon. All were asymptomatic and managed conservatively. On matched cohort comparison, patients with ILDH had larger tumors than patients without an incisional hernia (3.9 cm vs 2.8 cm, p = 0.029). In general, patient factors were no different between patients with and without ILDH. However, coronary artery disease (CAD) was more prevalent in patients with ILDH (33.3% vs 10.9%, p = 0.028). Patients with ILDH were more likely to have a port site extended for specimen extraction (66.7% vs 38.2%, p = 0.069). Lumbodorsal fascial closure and type of suture material were not associated with prevention of ILDH (p = 0.545, p = 0.637). Conclusion: The radiographic incidence of lumbar incisional hernias after RRPN without routine fascial closure of the extraction incision was 8%. All were asymptomatic and did not require surgical repair. Larger tumor size and CAD were associated with ILDH.

Intraoperative hypotension and complications after vascular surgery: A scoping review

BackgroundIntraoperative hypotension during major surgery is associated with adverse health outcomes. This phenomenon represents a potentially important therapeutic target for vascular surgery patients, who may be uniquely vulnerable to intraoperative hypotension. This review summarizes current evidence regarding the impact of intraoperative hypotension on postoperative complications in patients undergoing vascular surgery, focusing on potentially modifiable procedure- and patient-specific risk factors. MethodsA scoping review of the literature from Embase, MEDLINE, and PubMed databases was conducted from inception to December 2019 to identify articles related to the effects of intraoperative hypotension on patients undergoing vascular surgery. ResultsNinety-two studies met screening criteria; 9 studies met quality and inclusion criteria. Among the 9 studies that defined intraoperative hypotension objectively, there were 9 different definitions. Accordingly, the reported incidence of intraoperative hypotension ranged from 8% to 88% (when defined as a fall in systolic blood pressure of >30 mm Hg or mean arterial pressure <65). The results demonstrated that intraoperative hypotension is an independent risk factor for longer hospital length of stay, myocardial injury, acute kidney injury, postoperative mechanical ventilation, and early mortality. Vascular surgery patients with comorbid conditions that confer increased vulnerability to hypoperfusion and ischemia appear to be susceptible to the adverse effects of intraoperative hypotension. ConclusionThere is no validated, consensus definition of intraoperative hypotension or other hemodynamic parameters associated with increased risk for adverse outcomes. Despite these limitations, the weight of evidence suggests that intraoperative hypotension is common and associated with major postoperative complications in vascular surgery patients.

Risk factors for complications and revision surgery after anatomic and reverse total shoulder arthroplasty.

Complications and revisions following anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty have deleterious effects on patient function and satisfaction. The purpose of this study is to evaluate patient-specific, implant-specific and technique-specific risk factors for intraoperative complications, postoperative complications, and the occurrence of revisions after aTSA and rTSA. A total of 2964 aTSA and 5616 rTSA patients were enrolled in an international database of primary shoulder arthroplasty. Intra- and postoperative complications, as well as revisions, were reported and evaluated. Multivariate analyses were performed to quantify the risk factors associated with complications and revisions. aTSA patients had a significantly higher complication rate (P = .0026) and a significantly higher revision rate (P < .0001) than rTSA patients, but aTSA patients also had a significantly longer average follow-up (P < .0001) than rTSA patients. No difference (P = .2712) in the intraoperative complication rate was observed between aTSA and rTSA patients. Regarding intraoperative complications, female sex (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.17-3.68) and previous shoulder surgery (OR 2.9, 95% CI 1.73-4.90) were identified as significant risk factors. In regard to postoperative complications, younger age (OR 0.987, 95% CI 0.977-0.996), diagnosis of rheumatoid arthritis (OR 1.76, 95% 1.12-2.65), and previous shoulder surgery (OR 1.42, 95% CI 1.16-1.72) were noted to be risks factors. Finally, in regard to revision surgery, younger age (OR 0.964, 95% CI 0.933-0.998), more glenoid retroversion (OR 1.03, 95% CI 1.001-1.058), larger humeral stem size (OR 1.09, 95% CI 1.01-1.19), larger humeral liner thickness or offset (OR 1.50, 95% CI 1.18-1.96), larger glenosphere diameter (OR 1.16, 95% CI 1.07-1.26), and more intraoperative blood loss (OR 1.002, 95% CI 1.001-1.004) were noted to be risk factors. Studying the impact of numerous patient- and implant-specific risk factors and determining their impact on complications and revision shoulder arthroplasty can assist surgeons in counseling patients and guide patient expectations following aTSA or rTSA. Care should be taken in patients with a history of previous shoulder surgery, who are at increased risk of both intra- and postoperative complications.

Identifying risks factors in thoracolumbar anterior fusion surgery through predictive analytics in a nationally representative inpatient sample.

Anterior thoracolumbar (TL) surgical approaches provide more direct trajectories compared to posterior approaches. Proper patient selection is key in identifying populations that may benefit from anterior TL fusion. Here, we utilize predictive analytics to identify risk factors in anterior TL fusion in patients with trauma and deformity. In this retrospective cohort study of patients receiving anterior TL fusion (between and including T12/L1), population-based regression models were developed to identify risk factors using the National Readmission Database 2016-2017. Readmissions were analyzed at 30- and 90-day intervals. Risk factors included hypertension, obesity, malnutrition, smoking, alcohol use, long-term opioid use, and frailty. Multivariate regression models were developed to determine the influence of each risk factor on complication rates. A total of 265 and 375 patients were identified for the scoliosis and burst fracture cohorts, respectively. In patients with scoliosis, alcohol use was found to increase the length of stay (LOS) (p = 0.00061) and all-payer inpatient cost following surgery (p = 0.014), and frailty was found to increase the inpatient LOS (p = 0.0045). In patients with burst fractures, malnutrition was found to increase the LOS (p < 0.0001) and all-payer cost (p < 0.0001), obesity was found to increase the all-payer cost (p = 0.012), and frailty was found to increase the all-payer cost (p = 0.031) and LOS (p < 0.0001). Patient-specific risk factors in anterior TL fusion surgery significantly influence complication rates. An understanding of relevant risk factors before surgery may facilitate preoperative patient selection and postoperative patient triage and risk categorization.

Patient-Specific Risk Factors and Clinical Correlates of Euglycemic Diabetic Ketoacidosis in Patients on Sodium-Glucose Co-Transporter-2 Inhibitors

Background: Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT-2i) association with euglycemic diabetic ketoacidosis (EDKA) has been well reported. The underlying mechanism is mainly enhanced lipolysis and ketone bodies’ reabsorption. They also stimulate the pancreatic alpha cells and inhibit the beta cells, thereby causing an imbalance in glucagon/insulin levels, further contributing to lipolysis and ketogenesis. SGLT-2i were also found to cause EDKA in all types of diabetes, even uncovering undiagnosed Latent Autoimmune Diabetes of the Adult (LADA). Methods: Numerous electronic databases were systematically searched to identify patient-specific risk factors and clinical characteristics of EDKA in patients on SGLT-2i. The patient’s symptoms, clinical profile, laboratory results, and precipitants for EDKA were reviewed. Results: A total of 96 case reports identifying 116 patients with EDKA was fully reviewed. EDKA was twice prevalent in females (66.3%) than males (33.6%); median age was 52.15 ± 13.47, BMI was 29.3 ± 7.0. Among the 116 DKA events in SGLT-2i 92 (79.3%) were associated with Type-2 DM, 15 (12.9%) were Type-1 DM, 8 (6.9%) in LADA. Common symptoms were nausea (48.7%), vomiting (47%), and abdominal pain (28.2%). Canagliflozin was the most common SGLT-2i (40.5%), followed by Empagliflozin (29.3%) and Dapagliflozin (25.9%). The most common precipitant was surgery (17.2%), followed by infection (14.7%), fasting (11.2%), and Keto Diet (9.5%); others being reduced insulin use, alcoholism, and cancer. At presentation, average blood glucose was 196.8 ± 96.5, pH 7.1 ± 0.16, HCO3 8.7 ± 5.7 mmol/L, potassium 4.3 ± 1.03, anion-gap 24.2 ± 6.8 mmol/L, and the average HbA1C was 9.24 ± 2.08. Urine Ketones were positive in 81.89% of patients. 17 patients had pancreatic autoantibodies testing, and 7 were positive (41.2%) for glutamic acid decarboxylase-65 antibodies (anti-GAD-65). As a result, 7 patients were newly diagnosed with LADA who were previously misdiagnosed with type-2 DM. Conclusion: SGLT2i induced EDKA was found to be more predominant in females and type-2 DM. Diabetics should be educated on risk factors and consult physicians before commencing a dietary or exercise change. Physicians should be vigilant in diagnosing EDKA by thoughtful measurement of urine ketones and anti-GAD-65 testing can help diagnose underlying LADA.

Risk factors and clinical outcomes associated with blood culture contamination.

To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014-2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). A 509-bed tertiary-care university hospital. Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01-1.01), black race (aOR, 1.32; 95% CI, 1.15-1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00-1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02-1.33), paralysis (aOR 1.64; 95% CI, 1.26-2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07-1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40-1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30-1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31-2.16). These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

Dopamine Receptor Antagonists for the Prevention and Treatment of Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) are common postoperative adverse events that lead to patient discomfort and dissatisfaction. The incidence of PONV is estimated at 30% for the general surgical population and as high as 80% in high-risk patients.1 Patient-specific risk factors for PONV include female gender, prior history of PONV or motion sickness, nonsmoking status, and younger age, typically defined as younger than 50 years. Procedure-related risk factors include surgery type with higher risk noted for laparoscopic, bariatric, and gynecologic surgery and anesthesia type with higher risk noted for general anesthesia of a long duration or with use of volatile anesthetics or nitrous oxide.

Patient-specific risk factors for positioning injuries.

Patient-specific risk factors for positioning injuries.

Treatment plan quality control using multivariate control charts

Statistical process control tools such as control charts were recommended by the American Association of Physicists in Medicine (AAPM) Task Group 218 for radiotherapy quality assurance. However, the tools needed to analyze multivariate, correlated data that is often encountered in treatment plan quality measures, are lacking. In this study, we develop quality control tools that can model multivariate plan quality measures with correlations and account for patient-specific risk-factors, without adding a significant burden to clinical workflow. A multivariate, quality control chart is developed that includes a risk-adjustment model, Hotelling's T2 statistic, and principal component analysis (PCA). PCA accounts for correlations among a set of organ-at-risk (OAR) dose-volume histogram (DVH) points that serves as proxies for plan quality. Risk-adjustment models estimate the principal components from PCA using a set of patient- and treatment-specific risk factors. The resulting residuals from the risk-adjustment models are used to compute the Hotelling's T2 statistic; the corresponding multivariate control chart is then plotted based on the beta distribution followed by the statistic. Further, the box-cox transformation is used to account for non-normality in DVH points. We investigate the application of the proposed methodology via three multivariate control charts-a conventional chart that ignores risk-adjustment and PCA, a risk-adjusted chart ignoring PCA, and a PCA-based, risk-adjusted chart. These control charts are evaluated on 69 head-and-neck cases. The conventional multivariate control chart fails to account for important patient-specific risk factors, including volumes and cross-sectional areas of the tumor and OARs and distances in-between. This failure leads to a larger number of false alarms. While the multivariate risk-adjusted control chart is able to reduce false alarms, it fails to account for correlations in DVH points. The multivariate PCA-based, risk-adjusted control chart can detect unusual plans after accounting for the correlations. By replanning, improvements are shown on an unusual plan identified by both risk-adjusted methods. The multivariate risk-adjusted control chart developed here enables quality control of plans prior to delivery. This methodology is generic and can be readily applied for other radiotherapy quality assurance protocols, such as gamma analysis pass-rates.

The ABC's of Stroke Prevention: Reduction in Stroke Frequency Following a Quality Improvement Intervention by the Action Learning Network

<h3>Purpose</h3> To assess the frequency of stroke among ventricular assist device patients following a quality improvement bundled intervention (the "ABCs of Stroke Prevention" [ABCs] which focused on Anticoagulation, Blood pressure, and Communication) within the Advanced Cardiac Therapies Improving Outcomes Network (ACTION). The bundle intervention comprised 3 interventions. These were: a document harmonizing how to implement and maintain bivalirudin infusion, a blood pressure management protocol and a daily stroke prevention checklist. <h3>Methods</h3> Baseline stroke outcomes prior to the formation of ACTION (Q3 2014 - Q2 2017) were obtained from Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs). The CVA adverse event definition was used to assess stroke from Pedimacs. Stroke outcomes following implementation of the ABCs were obtained from the ACTION Outcome Registry Q1 2018-9/18/2020. <h3>Results</h3> A total of 693 patients (350 Pedimacs, 343 ACTION) and 887 devices (472 Pedimacs, 415 ACTION) were included. The overall stroke rate decreased following implementation of the ABCs from 14.6% to 10.4% (p=0.03) (Figure 1). The paracorporeal pulsatile pump stroke rate decreased from 30.1% to 8.2% (p<0.001) (Figure 2). <h3>Conclusion</h3> Stroke frequency has decreased following implementation of the ABCs. The most notable reduction has occurred in pulsatile paracorporeal pump patients where the stroke frequency has decreased more than 20%. Follow-up interventions are focused on further improving other device specific stroke outcomes and understanding patient specific risk factors.

Risk factors for postoperative nausea and vomiting after the removal of impacted third molars: a cross-sectional study

BackgroundA better understanding of the risk factors for postoperative nausea and vomiting (PONV) could improve patient outcomes. This study aimed to analyze the risk factors for PONV and its onset after third molar impaction surgery, and to demonstrate the importance of controlling anesthesia-related factors regardless of patient-specific factors.MethodsWe included patients who reported nausea and vomiting within 12 h of extubation. Patients with incomplete data, those who could not communicate, and those with gastrointestinal disorders were excluded. We evaluated patient-specific risk factors, and the use of volatile anesthetics and intraoperative fentanyl anesthetic-related factors. Multiple logistic regression analysis was performed taking patient background factors into account.ResultsIn total, 182 patients who underwent disimpaction of the third molar under general anesthesia between January 2017 and December 2018 at Nagoya Ekisaikai Hospital, were included. Approximately 12.6% (n = 23) patients experienced PONV, with no significant difference in terms of sex, smoking status, age, and body mass index compared to patients without PONV. Multiple logistic regression analysis revealed no interaction between fentanyl and volatile anesthetics. The major risk factor for PONV was the use of volatile anesthetics. Patients in whom anesthesia was maintained by volatile anesthetics were 13.35 times more likely to have PONV than those in whom total intravenous anesthesia was induced (P < 0.001).ConclusionMaintenance of anesthesia with volatile anesthetics is a risk factor for PONV.

Abstract PS7-59: Presence of comorbidities and use of concomitant medications associated with QTC prolongation/torsades de pointes in patients with HR+/HER2- advanced breast cancer

Abstract BACKGROUND: Corrected QT (QTc) prolongation is a cardiac condition that may increase the risk of ventricular arrhythmias, including Torsades de Pointes (TdP), and cardiac-related death. QTc prolongation is a notable concern in oncology as drug-induced QTc prolongation is a documented side effect of several anticancer therapies. Moreover, patient-specific risk factors for QTc prolongation such as increased age and a history of cardiovascular disease/events can be common among patients with metastatic breast cancer, which puts this population at an increased baseline risk for QTc prolongation. Female sex is a risk factor itself. The objective of this study was to characterize the presence of comorbidities and use of concomitant medications associated with QTc prolongation/TdP among patients receiving first-line (1L) treatment for HR+/HER2- locally advanced or metastatic breast cancer (aBC).METHODS: Oncologists in France, Germany, Israel, Italy, Spain and the United States abstracted clinical characteristics and medication data from the medical records of patients, aged ≥18, who received 1L treatment for HR+/HER2- aBC between 10/2019 and 02/2020. The presence of comorbidities (e.g., congestive heart failure, myocardial infarction, history of atrial arrythmias) and utilization of concomitant medications (excluding anti-cancer therapies) with known, possible, or conditional risk for QTc prolongation/TdP were summarized. The list of comorbidity risk factors was compiled from a targeted literature search and clinician review. The list of concomitant medications was obtained from crediblemeds.org.RESULTS: A total of 1164 patients with aBC were sampled across the six countries. Among them, 99% were female and the mean age was 62 years. The majority of patients had metastatic disease (85%); 15% had locally advanced disease. Among those with metastatic disease, 47% had visceral metastasis and 34% had bone-only metastasis. At 1L initiation, 84% of patients had an ECOG score of 0/1. Comorbidities associated with risk of QTc prolongation/TdP were observed in 8% of patients; the most frequently observed were congestive heart failure (3%) and history of myocardial infarction (2%) (Table 1). The proportion of patients who received at least one medication associated with risk of QTc prolongation/TdP was 39%. Overall, 42% of patients had at least one comorbidity or medication associated with risk of QTc prolongation/TdP. CONCLUSIONS: Approximately 2 out of 5 patients receiving 1L treatment for HR+/HER2- aBC had a comorbidity or utilized a concomitant medication that could increase risk of QTc prolongation/TdP. As cardiovascular toxicity is a known side effect associated with several anticancer therapies, the high prevalence of coexisting risk factors among patients receiving 1L treatment underscores the importance of assessing patients’ existing risk when selecting treatments for advanced breast cancer. Table 1. Presence of Comorbidities and Use of Concomitant Medications with known, possible, or conditional risk for QTc prolongation/TdP in Patients Who Received First-Line Therapy for HR+/HER2- Advanced Breast CancerN%Total Patients1164100ComorbiditiesMyocardial infarction202Congestive heart failure323Moderate or severe liver disease3&amp;lt;1History of QT prolongation3&amp;lt;1Bradyarrhythmia3&amp;lt;1History of atrial arrhythmias282History of ventricular arrhythmias1&amp;lt;1Hypo/hyperkalemia81Hypo/Hypercalcemia81Disorders of magnesium metabolism81Disorders of phosphorus metabolism2&amp;lt;1Unstable angina4&amp;lt;1Presence of comorbidity QTc risk factor948Mean (SD) number of conditions per patient1.3 (.4)Received medication considered a risk factor for QTc prolongation45039Presence of QTc risk factor condition or medication49042 Citation Format: Reshma Mahtani, Katie Lewis, Emily Clayton, Matthew Last, Debanjali Mitra, Samantha Kurosky. Presence of comorbidities and use of concomitant medications associated with QTC prolongation/torsades de pointes in patients with HR+/HER2- advanced breast cancer [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 PS7-59.

Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review.

Study Design:Systematic review.Objectives:Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure.Methods:We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm.Results:After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <−2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated.Conclusion:In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.

Functional Outcomes and Postoperative Cerebral Venous Sinus Thrombosis after Translabyrinthine Approach for Vestibular Schwannoma Resection: A Radiographic Demonstration of Anatomic Predictors.

Introduction While regarded as an effective surgical approach to vestibular schwannoma (VS) resection, the translabyrinthine (TL) approach is not without complications. It has been postulated that postoperative cerebral venous sinus thrombosis (pCVST) may occur as a result of injury and manipulation during surgery. Our objective was to identify radiologic, surgical, and patient-specific risk factors that may be associated with pCVST. Methods The Institutional Review Board (IRB) approval was obtained and the medical records of adult patients with VS who underwent TL craniectomy at University Hospitals Cleveland Medical Center between 2009 and 2019 were reviewed. Demographic data, radiographic measurements, and tumor characteristics were collected. Outcomes assessed included pCVST and the modified Rankin score (mRS). Results Sixty-one patients ultimately met inclusion criteria for the study. Ten patients demonstrated radiographic evidence of thrombus. Patients who developed pCVST demonstrated shorter internal auditory canal (IAC) to sinus distance (mean: 22.5 vs. 25.0 mm, p = 0.044) and significantly smaller petrous angles (mean: 26.3 vs. 32.7 degrees, p = 0.0045). Patients with good mRS scores (<3) appeared also to have higher mean petrous angles (32.5 vs. 26.8, p = 0.016). Koos' grading and tumor size, in our study, were not associated with thrombosis. Conclusion More acute petrous angle and shorter IAC to sinus distance are objective anatomic variables associated with pCVST in TL surgical approaches.

Risk factors for deep surgical site infection following posterior instrumented fusion for degenerative diseases in the thoracic and/or lumbar spine: a multicenter, observational cohort study of 2913 consecutive cases

Surgical site infection (SSI) is one of the most devastating complications following spinal instrumented fusion surgeries because it may lead to a significant increase in morbidity, mortality, and poor clinical outcomes. Identifying the risk factors for SSI can help in developing strategies to reduce its occurrence. However, data on the risk factors for SSI in degenerative diseases are limited. This study aimed to identify risk factors for deep SSI following posterior instrumented fusion for degenerative diseases in the thoracic and/or lumbar spine in adult patients. This was a multicenter, observational cohort study conducted at 10 study hospitals between July 2010 and June 2015. The subjects were consecutive adult patients who underwent posterior instrumented fusion surgery for degenerative diseases in the thoracic and/or lumbar spine and developed SSI. Detailed patient-specific and procedure-specific potential risk variables were prospectively recorded using a standardized data collection chart and retrospectively reviewed. Of the 2913 enrolled patients, 35 developed postoperative deep SSI (1.2%). Multivariable regression analysis identified three independent risk factors: male sex (P = 0.002) and American Society of Anesthesiologists (ASA) score of ≥ 3 (P = 0.003) as patient-specific risk factors, and operation including the thoracic spine (P = 0.018) as a procedure-specific risk factor. Thoracic spinal surgery, an ASA score of ≥ 3, and male sex were risk factors for deep SSI after routine thoracolumbar instrumented fusion surgeries for degenerative diseases. Awareness of these risk factors can enable surgeons to develop a more appropriate management plan and provide better patient counseling.

Influence of patient characteristics and immunosuppressant management on mortality in kidney transplant recipients hospitalized with coronavirus disease 2019 (COVID-19).

The influence of patient characteristics and immunosuppression management on COVID‐19 outcomes in kidney transplant recipients (KTRs) remains uncertain. We performed a single‐center, retrospective review of all adult KTRs admitted to the hospital with confirmed COVID‐19 between 03/15/2020 and 05/15/2020. Patients were followed from the date of admission up to 1 month following hospital discharge or study conclusion (06/15/2020). Baseline characteristics, laboratory parameters, and immunosuppression were compared between survivors and patients who died to identify predictors of mortality. 38 KTRs with a mean baseline eGFR of 52.5 ml/min/1.73 m2 were hospitalized during the review period. Maintenance immunosuppression included tacrolimus (84.2%), mycophenolate (89.5%), and corticosteroids (81.6%) in the majority of patients. Eleven patients (28.9%) died during the hospitalization. Older age (OR = 2.05; 1.04‐4.04), peak D‐dimer (OR = 1.20; 1.04‐1.39), and peak white blood cell count (OR = 1.11; 1.02‐1.21) were all associated with mortality among KTRs hospitalized for COVID‐19. Increased mortality was also observed among KTRs with concomitant HIV infection (87.5% vs. 36.1%; p < .01). Conversely, immunosuppression intensity and degree of reduction following COVID‐19 diagnosis were not associated with either survival or acute allograft rejection. Our findings potentially support a strategy of individualization of immunosuppression targets based on patient‐specific risk factors, rather than universal immunosuppression reduction for KTRs at risk from COVID‐19.

Risk of venous thromboembolism in Asian patients with inflammatory bowel disease: a nationwide cohort study

Routine prophylaxis for venous thromboembolism (VTE) in Asian IBD patients has been controversial. We aimed to estimate the risk of VTE of Asian patients at different phases of IBD by incorporating patient-specific risk factors. In this cohort study, we analyzed the National Health Insurance claims data between 2012 and 2016 for the entire Korean population. We calculated incidence rates and hazard ratios for VTE. The overall VTE risk was higher in patients with IBD [adjusted hazard ratio (aHR), 2.06; 95% confidence interval (CI), 1.66–2.55], than in controls. When we compare the risk of VTE by different disease phases, the risk of VTE was the highest during post-operation period after IBD-related bowel surgery (aHR, 39.7; 95% CI 9.87–159.3), followed by during hospitalized periods with flare (aHR, 27.2; 95% CI 14.9–49.65) and during hospitalized periods with non-flare (aHR, 16.23; 95% CI 10.71–24.58). The incidence rate (per 1000 person-years) was 15.26 during hospitalized periods with a flare and 9.83 during hospitalized periods with non-flare. According to age groups, the incidence rate (per 1000 person-years) during hospitalized periods with flare was 14.53 in young patients (20–39 years) and 34.58 in older patients (60–80 years). During hospitalized periods with non-flare, the incidence rate was 3.55 in young patients and 23.61 in older patients. The prophylaxis of VTE for Asian patients with IBD should be recommended in older patients admitted to hospital and be considered in young patients who are hospitalized with a flare.