Patient Demographic Variables Research Articles

FREQUENCY OF SQUAMOUS CELL CARCINOMA IN POST BURN PATIENTS

Burn injuries, particularly those leading to chronic scars, can predispose individuals to the development of squamous cell carcinoma (SCC). The risk of malignant transformation increases with burn severity and long-term scarring. Understanding the prevalence of SCC in post-burn patients is crucial for implementing preventive and management strategies. Objective: To assess the frequency of squamous cell carcinoma (SCC) in patients with post-burn scars and evaluate associations between demographic and burn-related factors with the development of SCC. Methods: A prospective descriptive study was conducted on 70 patients with a history of burn injuries and resulting scars. The study was carried out over a defined period at a tertiary care hospital. Patient demographic variables such as age, gender, socioeconomic background, and education level were collected. The severity of burns was categorized as partial-thickness or full-thickness, and the aetiology of burns was classified as thermal, chemical, or electrical. Burn locations were also documented. Histopathological examination of biopsy specimens from suspicious scars confirmed SCC diagnosis. Statistical analysis using chi-square tests was employed to identify associations between categorical variables and SCC occurrence. Results: Of the 70 patients included, 53 were males (75.7%) and 17 females (24.3%), with a mean age of 53.97 ± 4.91 years. Full-thickness burns were observed in 57.1% of the patients, while 42.9% had partial-thickness burns. The most common burn cause was thermal (45.7%), with the lower extremities being the most affected region (57.1%). SCC developed in 8.6% (6 out of 70) of the patients. The latency period for SCC ranged between 28 and 37 years, with an average of 31.5 years. Full-thickness burns were more commonly associated with SCC development compared to partial-thickness burns. Conclusion: The study reported a frequency of 8.6% for squamous cell carcinoma in patients with post-burn scars. Full-thickness burns were associated with a higher risk of SCC development. Long-term surveillance and proactive management of burn scars are critical in preventing malignant transformations.

Comparing Military and Civilian Dentists' Treatment Planning Decisions: A Pilot Study.

Clinical decision-making varies among dentists. However, the literature is limited and narrow in scope regarding the variation between public and private sector dentists. Because both types of dentists' decisions can directly influence military dental readiness, it is important to understand the potential differences in diagnosis, treatment planning, and the delivery of care. The purpose of this pilot study was to compare treatment planning recommendations between civilian and military providers. Patient-level data from the 2018 Recruit Surveillance, a stratified, cross-sectional study of 1,208 randomly selected U.S. Air Force recruits, were used to evaluate treatment planning outcomes for the 2 provider groups (2 civilians; seven military providers). Treatment planning outcomes included type of noninvasive, operative, and oral surgery treatment recommended, temporomandibular disorder referrals, and orthodontic referrals. Patient demographic variables included age, gender, education, race/ethnicity, and military component ("status"). Data were examined both at the tooth level and patient level for statistical significance. Multivariate analyses were performed with statistically significant variables included in each final model for patient-level data. Data were analyzed with logistic regression and Poisson regression (alpha = 0.05). Bivariate logistic regression analyses were performed for tooth-level data. Significant differences were found between military and civilian dentists' treatment planning decisions (P < .05) for both patient-level and tooth-level data. Adjusted for significant bivariate predictors of patient demographics at the patient level, civilian dentists were more likely to refer patients for orthodontic treatment, prescribe remineralization for sound tooth surfaces, incipient caries, and carious teeth, and prescribe direct restorations for teeth with 3 to 5 carious surfaces instead of single crowns compared to military dentists. Additionally, civilian dentists were less likely to prescribe sealants for sound tooth surfaces or carious teeth. No statistically significant difference in treatment planning outcomes was observed between civilian and military dentists for sealants for incipient caries, single crowns, or extraction of third molars. At the tooth level, civilian dentists were more likely to prescribe remineralization for sound tooth surfaces, remineralization instead of sealants for carious surfaces, and extraction of third molars. No statistically significant differences were noted between civilian and military providers for recommending sealant or remineralization for teeth with incipient caries or prescribing a single crown versus placing a direct restoration on posterior teeth with 3 to 5 carious surfaces. Significant differences in treatment planning outcomes between civilian and military providers exist. Civilian providers are more likely to refer patients for orthodontic treatment and prescribe remineralization, direct restorations instead of single crowns, and third molar extractions, while military providers are more likely to prescribe sealants for sound tooth surfaces or carious teeth. Therefore, comparisons of treatment planning outcomes between civilian and military providers warrant further research.

Disparities in lungcancerscreening utilization attwo health systems in the Southeastern USA.

Low-dose computed tomography lung cancer screening is effective for reducing lung cancer mortality. It is critical to understand the lung cancer screening practices for screen-eligible individuals living in Alabama and Georgia where lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low income, and rural populations. Therefore, the purpose of this study is to define sociodemographic and clinical characteristicsof patients who were screened for lung cancer at an Academic Medical Center (AMC) in Alabama and a Safety Net Hospital (SNH) in Georgia. A retrospective cohort study of screen-eligible patients was constructed using electronic health records between 2015 and 2020 seen at an Academic Medical Center (AMC) and a Safety Net Hospital (SNH) separately. Chi-square tests and Student t tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate and multivariate logistic regressions determined significant predictors of lung cancer screening uptake. At the AMC, 67,355 were identified as eligible for LCS and 1,129 were screened. In bivariate analyses, there were several differences between those who were screened and those who were not screened. Screening status in the site at Alabama-those with active tobacco use are significantly more likely to be screened than former smokers (OR: 3.208, p < 0.01). For every 10-unit increase in distance, the odds of screening decreased by about 15% (OR: 0.848, p < 0.01). For every 10-year increase in age, the odds of screening decrease by about 30% (OR: 0.704, p < 0.01). Each additional comorbidity increases the odds of screening by about 7.5% (OR: 1.075, p < 0.01). Those with both private and public insurance have much higher odds of screening compared to those with only private insurance (OR: 5.403, p < 0.01). However, those with only public insurance have lower odds of screening compared to those with private insurance (OR: 0.393, p < 0.01). At the SNH-each additional comorbidity increased the odds of screening by about 11.9% (OR: 1.119, p = 0.01). Notably, those with public insurance have significantly higher odds of being screened compared to those with private insurance (OR: 2.566, p < 0.01). The study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake. Furthermore, disparity was noticed between adults living closer to screening institutions and those who lived farther.

Insight into Predictors of Cytoreduction Score Following Cytoreductive Surgery-Hyperthermic Intraperitoneal Chemotherapy for Gastric Peritoneal Carcinomatosis Improves Patient Selection and Prognostic Outcomes.

Peritoneal metastases due to gastric adenocarcinoma (GCPM) carry a dismal prognosis. A promising treatment strategy is cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), but clear eligibility criteria for GCPM are lacking. We sought to identify factors associated with overall survival (OS) following CRS-HIPEC for GCPM to help optimize patient selection and clinical outcomes. In this single-center retrospective cohort study, we examined CRS-HIPEC outcomes for patients with GCPM between 2001 and 2021. After analyzing patient demographic, clinicopathologic, and perioperative variables, we applied multivariable Cox hazard models to assess factors associated with OS. We then assessed associations between baseline predictors and prognostically important variables using multivariable logistic regression. We analyzed 55 patients with GCPM who underwent CRS-HIPEC. Median age was 54 years and 42% were female. Median peritoneal carcinomatosis index (PCI) was 8, and 75% of patients achieved a cytoreduction completeness score (CC score) of 0. Median progression-free survival (PFS) was 6.9 months, and median OS was 14.1 months. On adjusted analysis, a CC score > 0 (HR 2.3, p = 0.02) was significantly associated with worse OS. A peritoneal carcinomatosis index greater than 13 (OR 52.6, p = 0.001) and fewer lymph nodes (especially < 18) resected with the primary tumor (OR 0.86, p = 0.042) in the metachronous setting were significantly associated with incomplete macroscopic cytoreduction (CC score > 0). We demonstrated that PCI > 13 and primary lymph nodes harvested < 18 in metachronous tumors are associated with CC score > 0, which in turn portends a worse OS. Although these results warrant prospective validation, they provide insight into improved selection of patients with GCPM for CRS-HIPEC.

Establishing an autogenous vascular access program in a Guatemalan comprehensive pediatric nephrology center.

The Guatemalan Foundation for Children with Kidney Diseases collaborated with Bridge of Life, a not-for-profit charitable organization, to establish a vascular access program. We reviewed our experience with graded surgical responsibility and structured didactic training, creating arteriovenous fistulas (AVF) for Guatemalan children. Pediatric vascular access missions were completed from 2015 to 2023 and analyzed retrospectively. Follow-up was completed by the Guatemalan pediatric surgeons, nephrologists, and nursing staff. AVF patency and patient survival were evaluated by Kaplan-Meier life-table analysis with univariate and multivariable association between patient demographic variables by Cox proportional hazards models. Among a total of 153 vascular access operations, there were 139 new patient procedures, forming the study group for this review. The mean age was 13.6years, 42.6% were female, and the mean BMI was 17.3. Radial or ulnar artery-based direct AVFs were established in 100 patients (71.9%) and ten of the 25 transposition procedures. Brachial artery inflow was required in 29 direct AVFs (20.9%). Two patients underwent femoral vein transpositions. Access-related distal ischemia was not encountered. Seven of the AVF patients later required access banding for arm edema; all had previous dialysis catheters (mean = 9, range 4-12). Primary and cumulative patency rates were 84% and 86% at 12months and 64% and 81% at 24months, respectively. The median follow-up was 12months. Overall patient survival was 84% and 67% at 12 and 24months, respectively. There were no deaths related to AVF access. Safe and functional AVFs were established in a teaching environment within a Guatemalan comprehensive pediatric nephrology center.

Artificial Intelligence Machine Learning Algorithms Versus Standard Linear Demographic Analysis in Predicting Implant Size of Anatomic and Reverse Total Shoulder Arthroplasty.

Accurate and precise templating is paramount for anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) to enhance preoperative planning, streamline surgery, and improve implant positioning. We aimed to evaluate the predictive potential of readily available patient demographic data in TSA and RSA implant sizing, independent of implant design. A total of 578 consecutive, primary, noncemented shoulder arthroplasty cases were retrospectively reviewed. Demographic variables and implant characteristics were recorded. Multivariate linear regressions were conducted to predict implant sizes using patient demographic variables. Linear models accurately predict TSA implant sizes within 2 millimeters of humerus stem sizes 75.3% of the time, head diameter 82.1%, head height 82.1%, and RSA glenosphere diameter 77.6% of the time. Linear models predict glenoid implant sizes accurately 68.2% and polyethylene thickness 76.6% of the time and within one size 100% and 95.7% of the time, respectively. Linear models accurately predict shoulder arthroplasty implant sizes from demographic data. No significant statistical differences were observed between linear models and machine learning algorithms, although the analysis was underpowered. Future sufficiently powered studies are required for more robust assessment of machine learning models in predicting primary shoulder arthroplasty implant sizes based on patient demographics.

Efficacy of home healthcare on the management of tracheostomy patients.

To evaluated the home healthcare efficacy in managing tracheostomy patients at King Abdulaziz Medical City under the Ministry of National Guard Health Affairs. Home healthcare is care provided to patients in the convenience of their homes to ensure high-quality care based on healthcare providers' supervision. This retrospective cohort study utilizing a non-probability consecutive sampling technique, including all available tracheal patients with no exclusion criteria, was carried out in Riyadh, Saudi Arabia, between January 2019 and June 2022. The collected data included patient demographic variables and respiratory settings (ventilation type, daily ventilation need, tracheostomy duration, and ventilator settings). The outcomes included mortality rate and therapeutic outcomes of tracheal management. Of the 183 patients in the study, the most common type of respiratory-related infection was pneumonia (53%). Unlike respiratory-related causes, The mortality rate of patients admitted to the intensive care unit that was unrelated to respiratory causes was statistically significant (57%) (p=0.003). The mortality rate of patients who used aerosol tracheal collars (34%) was markedly higher than mechanically ventilated patients (57%) (p=0.004). The mortality rate following discharge from HHC was 40%, and was higher among patients aged >70 years (47%) (p=0.04). Pneumonia was associated with the majority of ventilator-related infections and resulted in hospital readmissions. Ensuring proper practices and caregiver education is crucial to decrease the incidence of ventilator-related infections.

The relationship between demographics and reactions during endoscopy under moderate sedation.

Objective: Upper gastrointestinal (UGI) endoscopic procedures are performed under varying levels of anesthesia, with moderate sedation commonly utilized. However, some patients may exhibit reactions such as coughing, retching, and struggling, potentially affecting procedure quality. This study aims to investigate the relationship between patient characteristics and demographic variables and the occurrence of these reactions during UGI endoscopy under moderate sedation. Materials and Methods: This prospective observational cohort study included patients scheduled for UGI endoscopy under moderate sedation. Patient reactions, including coughing, retching, and struggling, were documented during the procedure. Patients were categorized into two groups based on the presence or absence of reactions, and demographic characteristics were compared between groups. Institutional review board approval was obtained. Results: Between December 2021 and May 2022, 79 patients (44 female, 35 male) were enrolled, with 51.9% experiencing reactions during UGI endoscopy. Coughing was the most common reaction (65%), followed by struggling with the scope (52.5%) and retching (47.5%). Procedure cancellation due to intolerance occurred in 12.2% of cases. No significant differences were observed between groups in terms of demographic variables or medical history. Additionally, no cardiac or pulmonary complications were reported. Conclusion: Moderate sedation appears to be safe and effective for UGI endoscopy, facilitating adequate visualization of the UGI system while ensuring patient comfort. The occurrence of patient reactions during the procedure does not appear to be significantly influenced by demographic or clinical characteristics. Ensuring appropriate sedation levels remains essential for optimizing procedural quality and patient experience.

Unexpected variation in outcomes following total (procto)colectomies for ulcerative colitis in New South Wales, Australia: a population-based 19-year linked-data study.

Total (procto)colectomy for ulcerative colitis (UC) is associated with significant morbidity, which is increased in the emergency setting. This study aimed to evaluate the outcomes following total (procto)colectomies at a population level within New South Wales (NSW), Australia, and identify case mix and hospital factors associated with these outcomes. A retrospective data linkage study of patients undergoing total (procto)colectomy for UC in NSW over a 19-year period (2001-2020) was performed. The primary outcome was 90-day mortality. The influence of hospital level factors (including annual volume) and patient demographic variables on outcomes was assessed using logistic regression. Temporal trends in annual volume and evidence for centralization were assessed. In all, 1418 patients (mean 47.0 years [SD 18.7], 58.7% male) underwent total (procto)colectomy during the study period. The overall 90-day mortality rate was 3.2% (emergency 8.6% and elective 0.8%). After adjusting for confounding, increasing age at total (procto)colectomy, higher comorbidity burden, public health insurance (Medicare) status, emergency operation and living outside a major city were significantly associated with increased mortality. Hospital volume was significantly associated with mortality at a univariate level, but this did not persist on multivariate modelling. Outcomes of UC patients undergoing total (procto)colectomy in NSW Australia are comparable to international experience. Whilst higher mortality rates are observed in low volume and public hospitals, this appears attributable to case mix and acuity rather than surgical volume alone. However, as inflammatory bowel disease surgery is not centralized in Australia, only one NSW hospital performed >10 UC total (procto)colectomies annually. Variation in mortality according to insurance status and across regional/remote areas may indicate inequality in the availability of specialist inflammatory bowel disease treatment, which warrants further research.

The oncology care model and initiation of systemic therapy for cancer.

11031 Background: The CMS Oncology Care Model (OCM) was an episode payment model for patients with cancer receiving systemic therapy (chemotherapy, targeted therapy, immunotherapy, or hormonal therapy) that began in July 2016. Voluntarily participating practices received monthly care coordination payments of $160 per patient per month and were required to deliver enhanced services; they were eligible to share in savings if they achieved quality and spending targets (based on historic spending trended forward; all practices were in one-sided risk arrangements before 2019). Prior research identified savings of $499 per episode (excluding monthly payments) through OCM’s first 5 years, but no overall savings after including incentive payments. One concern about an episode payment model triggered by initiation of systemic therapy is that the financial incentives may prompt an increase in the total number of episodes. We assessed if OCM led to an increase in the likelihood of initiating systemic therapy. Methods: Using Medicare data, we studied care for beneficiaries enrolled in Parts A, B, and D of fee-for-service Medicare with index cancer diagnoses in 2010 through 2019. We assessed initiation of systemic therapy in the one year after the index diagnosis date. We studied two populations: (1) all patients with an index cancer diagnosis and no cancer diagnosis in the preceding two years, suggesting newly diagnosed or newly progressive cancers (incident cohort) and (2) patients with poor prognosis cancers. We used a difference-in-differences (DiD) analysis to assess systemic therapy initiation among patients with index cancer diagnoses who had office visits to medical oncology practices that were participating in OCM, compared with matched comparison practices (on number of patients attributed, number of physicians, number of medical oncologists, and academic affiliation, favoring matches within Hospital Referral Region), before and after OCM’s start in July 2016. Analyses adjusted for patient demographic and clinical variables. Results: Among 742,699 beneficiaries in the incident cancer cohort, 61.9% initiated systemic therapy within 1 year of their index diagnosis. Among 777,951 beneficiaries in the poor prognosis cohort, 58.2% initiated systemic therapy within 1 year of their index diagnosis date. OCM was not associated with the likelihood of initiating systemic therapy in the incident cohort (DID:-0.7 percentage point change, 95% CI:-1.9,0.4, P=0.19) or the poor prognosis cohort (DID:-1.0 percentage point change, 95% CI:-2.1,0.1, P=0.07). Conclusions: Despite financial incentives of episode payment models that may favor greater use of systemic therapy for patients with cancer, OCM did not increase the likelihood of initiating systemic therapy episodes among patients with newly diagnosed/newly progressive cancers or poor prognosis cancers who visited a medical oncology practice.

Release of fibrous web bands between the preaponeurotic fat pad and Levator aponeurosis in subclinical blepharoptosis correction during double-eyelid blepharoplasty.

Double-eyelid blepharoplasty is a popular cosmetic procedure in Asia; however, there are some drawbacks to this procedure for mild blepharoptosis. Enhancing movement of the levator aponeurosis can correct blepharoptosis through the release of fibrous web bands present between the preaponeurotic fat pad and levator aponeurosis. To improve our understanding of the anatomical link between the levator aponeurosis and orbital septum fat and to introduce that the release of the link can provide favorable results in double-eyelid blepharoplasty. We included patients with latent ptosis or subclinical blepharoptosis who underwent double-eyelid blepharoplasty with the release of fibrous web bands between June 2021 and March 2023. Mild ptosis was corrected following complete release of the fibrous bands beneath the preaponeurotic fat pad. Patients were followed up for 4-12 months postoperatively, and surgical outcomes were evaluated. Patient demographic variables and photographs were collected pre- and postoperatively. Patients, surgeons, and laypersons were asked to evaluate the outcomes postoperatively. The Friedman's nonparametric (for repeated measures) two-way analysis of variance was used for statistical analyses. Outcomes were assessed in 45 individuals with an average monitoring period of 6.9 months. There were no cases of incomplete eyelid closure or upper eyelid ectropion. Over 50% of the surgical outcomes were deemed "satisfactory" by each of the three groups in relation to the widening of the eyelid fissure. Most of the examined patients demonstrated favorable long-term results. Fibrous web bands are implicated in subclinical or mild blepharoptosis. The release of fibrous web bands between the preaponeurotic fat pad and levator aponeurosis can provide favorable results in double-eyelid blepharoplasty.

Characterization of patient population receiving bioactive glass bone graft substitute as intraoperative treatment for orthopaedic trauma fractures

BackgroundBioactive glass synthetic bone grafts are used to treat osseous defects in orthopaedic surgery. Characterization of the clinical scenarios associated with bioactive glass use in the context of orthopaedic trauma, are not well established. This study aims to characterize population demographics, operative variables, as well as postoperative variables, for patients who required bone grafting for treatment of traumatic orthopaedic injuries and received a bioactive glass bone substitute intraoperatively. MethodsThe electronic medical record at a large Level I trauma center was queried for fracture patients between January 1st, 2019, and April 30th, 2022. Our retrospective cohort included fracture patients who received Fibergraft Matrix or Fibergraft Putty intraoperatively, and their respective control groups. This study ascertained patient demographic variables, operative variables, and postoperative variables. Differences in categorical variables were tested with Fischer's Exact Tests, while differences in continuous variables were tested with ANOVA. Statistical significance was determined as P < 0.05. If the overall Group model was significant for a given variable, post-hoc Fischer's Exact or Tukey HSD tests were used to assess pairwise significance between individual Group pairs. ResultsA total of four categories across our analysis of demographic, operative, and postoperative variables displayed significant differences amongst subject Groups (P ≤ 0.03). Individual groups were compared such that significant differences between subject groups could be appreciated for a specific variable. FM subjects had greater length of surgery, billable costs, and vitamin D supplementation at the time of surgery compared to FM controls. Similarly, FP subjects had greater length of surgery, billable cost, and implants used intraoperatively compared to FP controls. ConclusionThis analysis revealed Fibergraft patients to have greater length of surgery and billable cost, with respect to their matched controls. These data suggest that Fibergraft patients had more severe orthopaedic fractures compared to matched controls.

Prediction of Short-Term Postoperative Complications Following Open Reduction Internal Fixation of Acute Ankle Fractures

Introduction/Purpose: Acute ankle fractures are a common injury and represent a significant financial burden to the healthcare system. Reimbursement following ankle fractures is complicated by bundled payments within the 90-day global period which do not account for unpredictable complications. Comorbidity indices, such as the American Society of Anesthesiologists (ASA) classification, are often correlated with complications; however, the positive predictive value of these metrics have not been investigated. As insurers continue to transition towards bundled reimbursements, greater attentiveness towards providing efficient care is paramount. The purpose of this investigation is to develop a machine learning (ML) model that is predictive of complications following operative management of acute ankle fractures. This study will also compare ML algorithms to legacy indices to assess the predictive value in predicting complications. Methods: The American College of Surgeons-National Surgical Quality Improvement Program database was queried via Current Procedural Terminology (CPT) from 2015-2018 for open reduction internal fixation (ORIF) cases for ankle fractures, including ORIF of the medial malleolus, posterior malleolus, lateral malleolus, bimalleolar, trimalleolar, syndesmosis. Training and validation sets were created by randomly assigning 80% and 20% of the data set. Included variables were age, body mass index (BMI), operative time, smoking status, comorbidities, diagnosis, and preoperative hematocrit and albumin. Complications included any adverse event, transfusion, surgical site infection, return to the operating room, deep vein thrombosis or pulmonary embolism, pneumonia, urinary tract infection, cerebrovascular accident, cardiac arrest, myocardial infarction. Each ML algorithm was compared with one another and to a baseline model using American Society of Anesthesiologists (ASA) classification. Model strength was evaluated by calculating the area under the curve (AUC) for receiver operating characteristic (ROC) of any adverse event. Results: We identified a total of 28,736 ORIF cases. Mean age and BMI were 32.2 ± 18.6 years, 30.8 ± 7.6 kg/m^2, respectively. The overall incidence of any medical complication was 3.4% (n=975) with surgical site infection (1.3%, n=386) and return to operating room (1.3%, n=367) being the most common. Percentage hematocrit, BMI, operative time, and age were of highest importance in outcome prediction. Logistic regression (AUC: 72%) and gradient boosting (AUC: 72%) ML algorithms outperformed ASA classification (AUC: 69%) for predicting any adverse event following ORIF of ankle fractures. Conclusion: Legacy comorbidity indices are simple metrics that can be easily constructed from patient demographic variables and past medical history. However, the predictive power is limited as they have shown a low positive predictive value for predicting complications. Machine learning algorithms can calculate patient-specific risk for postoperative complications which may adjust perioperative care and site of surgery. These models have the capability to optimize utilization of healthcare resources and minimize excessive expenditure by providing patient-specific care. Receiver Operating Curve-Area under the Curve Analysis for Adverse Events Following ORIF of Ankle Fractures

Race/Ethnicity and Social Determinants of Health and Their Impact on the Timely Receipt of Appropriate Operative Treatment of Colon Cancer.

Rates of appropriate surgical treatment of colon cancer are historically worse in traditionally marginalized populations. We sought to examine which social determinants of health may be associated with longer time to appropriate operative intervention. The National Cancer Databank was queried for this retrospective study. Adult patients (18 to 90years of age) diagnosed between 2004 and 2018 with single or primary, stage III colon cancer were included. Patient demographic variables included age at diagnosis, sex, ethnicity (Hispanic or non-Hispanic), comorbidity score, median household income, education status, rural/urban status, treatment facility type and location, and insurance status. Disease characteristics include stage (stage 3), primary site, surgical margins, tumor size, and number of nodes resected. Reported descriptive statistics include means and 95% confidence intervals for continuous variables and frequency and proportions for categorical variables. Univariate and multivariate analyses were performed. A total of 134,601 individuals diagnosed with stage 3 colon cancer were included. Time to surgery in all cases had a mean of 26.4 ± 19.0 days. Multivariate analysis of time to surgery indicated that receiving surgery at a Community Cancer Program, Charlson-Deyo Score of 0, younger age, and non-Hispanic-White race/ethnicity are associated with decreased time to surgery (P < .001). Patients who receive surgery at a Community Cancer Program, have fewer comorbidities, have lower household income, are younger, and receive surgery within 50 miles of their primary residence are more likely to have timely surgery.

Strategies to reduce rates of severe endothermal heat-induced thrombosis following radiofrequency ablation

ObjectiveEndothermal heat-induced thrombosis (EHIT) is a potential complication of radiofrequency ablation (RFA). Data on effective prophylaxis of EHIT are limited. In 2018, a high-volume, single institution implemented strategies to decrease the incidence of EHIT, including a single periprocedural prophylactic dose of low-molecular-weight heparin to patients with a great saphenous vein (GSV) diameter of ≥8 mm or saphenofemoral junction (SFJ) diameter of ≥10 mm and limiting treatment to one vein per procedure. The size threshold was derived from existing literature. The study objective was to evaluate the effects of these institutional changes on thrombotic complication rates after RFA. MethodsA retrospective cohort control study was conducted using the Vascular Quality Initiative database. Data were collected for patients who underwent RFA with a GSV diameter of ≥8 mm or SFJ diameter of ≥10 mm from January 2015 to July 2022. The clinical end points were thrombotic complications (ie, thrombophlebitis, EHIT, deep vein thrombosis) and bleeding complications. Patient demographic and procedural variables were included in the analysis, and significant variables after univariable logistic regression were included in a multivariable logistic regression. ResultsAfter the policy change, the overall vein center EHIT rate decreased from 2.6% to 1.5%, with a trend toward significance (P = .096). The inclusion criterion of a GSV diameter of ≥8 mm or an SFJ diameter of ≥10 mm yielded 845 patients, of whom 298 were treated before the policy change and 547 after. There was a significant reduction in the rate of EHIT classified as class ≥III (2.34 vs 0.366; P = .020) after the institutional changes. Treatment of two or more veins and an increased vein diameter were associated with an increased risk of EHIT (P = .049 and P < .001, respectively). No significant association was found between periprocedural anticoagulation and all-cause thrombotic complications or EHIT (P = .563 and P = .885, respectively). ConclusionsThe institutional policy changes have led to lower rates of EHIT, with a reduction in severe EHIT rates in patients with an ≥8-mm diameter GSV or a ≥10-mm diameter SFJ treated with RFA. Of the changes implemented, restricting treatment to one vein was associated with a reduction in severe EHIT. No association was found with periprocedural low-molecular-weight heparin, although a type 2 error might have occurred. Alternative strategies to prevent thrombotic complications should be explored, such as increasing the dosage and duration of periprocedural anticoagulation, antiplatelet use, and nonpharmacologic strategies.

The Impact of Cardiac Arrhythmias on Total Knee Arthroplasty Outcomes

BackgroundCardiac comorbidities are common in patients undergoing total knee arthroplasty (TKA). While there is an abundance of research showing an association between cardiac abnormalities and poor postoperative outcomes, relatively little is published on specific pathologies. The aim of this study was to assess the impact of cardiac arrhythmias on postoperative outcomes in the setting of TKA. MethodsThis retrospective cohort study included all patients undergoing TKA from a national database, from 2016 to 2019. Patients who had cardiac arrhythmias were identified via International Classification of Diseases, Tenth Revision, and Clinical Modification/Procedure Coding System codes and served as the cohort of interest. Multivariate regression was performed to compare postoperative outcomes. Gamma regression was performed to assess length of stay and total charges, while negative binomial regression was used to assess 30-day readmission and reoperation. Patient demographic variables and comorbidities, measured via the Elixhauser comorbidity index, were controlled in our regression analysis. Out of a total of 1,906,670 patients, 224,434 (11.76%) had a diagnosed arrhythmia and were included in our analyses. ResultsThose who had arrhythmias had greater odds of both medical (odds ratio [OR] 1.52; P < .001) and surgical complications (OR 2.27; P < .001). They also had greater readmission (OR 2.49; P < .001) and reoperation (OR 1.93; P < .001) within 30 days, longer hospital stays (OR 1.07; P < .001), and greater total charges (OR 1.02; P < .001). ConclusionsCardiac arrhythmia is a common comorbidity in the TKA population and is associated with worse postoperative outcomes. Patients who had arrhythmias had greater odds of both medical and surgical complications requiring readmission or reoperation. Study DesignLevel III; Retrospective Cohort Study.

Intraoperative application and early experience with novel high-resolution, high-channel-count thin-film electrodes for human microelectrocorticography.

The study objective was to evaluate intraoperative experience with newly developed high-spatial-resolution microelectrode grids composed of poly(3,4-ethylenedioxythiophene) with polystyrene sulfonate (PEDOT:PSS), and those composed of platinum nanorods (PtNRs). A cohort of patients who underwent craniotomy for pathological tissue resection and who had high-spatial-resolution microelectrode grids placed intraoperatively were evaluated. Patient demographic and baseline clinical variables as well as relevant microelectrode grid characteristic data were collected. The primary and secondary outcome measures of interest were successful microelectrode grid utilization with usable resting-state or task-related data, and grid-related adverse intraoperative events and/or grid dysfunction. Included in the analysis were 89 cases of patients who underwent a craniotomy for resection of neoplasms (n = 58) or epileptogenic tissue (n = 31). These cases accounted for 94 grids: 58 PEDOT:PSS and 36 PtNR grids. Of these 94 grids, 86 were functional and used successfully to obtain cortical recordings from 82 patients. The mean cortical grid recording duration was 15.3 ± 1.15 minutes. Most recordings in patients were obtained during experimental tasks (n = 52, 58.4%), involving language and sensorimotor testing paradigms, or were obtained passively during resting state (n = 32, 36.0%). There were no intraoperative adverse events related to grid placement. However, there were instances of PtNR grid dysfunction (n = 8) related to damage incurred by suboptimal preoperative sterilization (n = 7) and improper handling (n = 1); intraoperative recordings were not performed. Vaporized peroxide sterilization was the most optimal sterilization method for PtNR grids, providing a significantly greater number of usable channels poststerilization than did steam-based sterilization techniques (median 905.0 [IQR 650.8-935.5] vs 356.0 [IQR 18.0-597.8], p = 0.0031). High-spatial-resolution microelectrode grids can be readily incorporated into appropriately selected craniotomy cases for clinical and research purposes. Grids are reliable when preoperative handling and sterilization considerations are accounted for. Future investigations should compare the diagnostic utility of these high-resolution grids to commercially available counterparts and assess whether diagnostic discrepancies relate to clinical outcomes.

A214 AGE, SEX AND POSITION INFLUENCE UPPER ESOPHAGEAL SPHINCTER PRESSURES

Abstract Background Upper esophageal sphincter (UES) function may be evaluated using high resolution manometry (HRM) to measure manometric parameters specific to the UES. The UES parameters are not well established however there is evidence suggesting a relationship between the UES parameters and esophageal motility disorders as well as UES parameters and symptoms including dysphagia, globus sensation and reflux. The Esophageal Symptom Questionnaire (ESQ-30) is a validated tool in the assessment of esophageal symptoms and measures the frequency and severity of dysphagia, reflux and globus through three separate sub-scales (ESQ-D, ESQ-R, ESQ-G respectively). Aims We aimed to identify the relationship between UES manometric variables and patient demographic variables (age, sex) as well as patient symptoms including broad categories of globus sensation, dysphagia and reflux. Methods Retrospective analysis of consecutive reports from HRM studies performed between October 2021 – March 2023 who provided consent for inclusion in the motility databank and completed ESQ-30 questionnaires. All values expressed as median (IQR: 25-75-centile). Values were compared with the non-parametric Mann-Whitney U test. Relationships between manometric diagnosis, UES pressures and symptomatology were explored. Results 681 patients underwent esophageal manometry and completed the ESQ-30 questionnaire. These patients were 442 (65%) female (mean age 54.6 +/- 14.8 years). Over the study period, 318 patients underwent esophageal HRM in the upright position and were diagnosed according to CCv3 and 361 patients underwent HRM in the supine position and were diagnosed by CCv4 manometric criteria. UES mean basal pressure was significantly higher in females than males (64.6 [42.3-89.1] vs 68.4 [48.4-96.1], p = .015) as well as in the supine position (77.5 [55.9-101.0] vs. 56.0 [38.7-80.3]. UES mean basal pressure was negatively correlated with age (R2 -.28 p ampersand:003C .001). In terms of esophageal symptomatology, dysphagia scores (ESQ-D) were negatively correlated with UES mean basal pressure (R2 -.15, p ampersand:003C .001). Conclusions Age, sex and position may influence UES manometric pressures. The finding of higher UES pressures in the supine position may reflect a mechanism for decreasing proximal reflux. The decreased UES basal pressure with age is possibly related to changes in the integrity of the neuromuscular system. Having a better understanding of the poorly understood normal UES dynamics and how this changes in motility disorders may allow us to more specifically target areas for treatment. Funding Agencies None

Evaluating Independent Double Checks in the Pediatric Intensive Care Unit: A Human Factors Engineering Approach.

The goal of this human factors engineering-led improvement initiative was to examine whether the independent double check (IDC) during administration of high alert medications afforded improved patient safety when compared with a single check process. The initiative was completed at a 24-bed pediatric intensive care unit and included all patients who were on the unit and received a medication historically requiring an IDC. The total review examined 37,968 high-risk medications administrations to 4417 pediatric intensive care unit patients over a 40-month period. The following 5 measures were reviewed: (1) rates of reported medication administration events involving IDC medications; (2) hospital length of stay; (3) patient mortality; (4) nurses' favorability toward single checking; and (5) nursing time spent on administration of IDC medications. The rate of reported medication administration events involving IDC medications was not significantly different across the groups (95% confidence interval, 0.02%-0.08%; P = 0.4939). The intervention also did not significantly alter mortality ( P = 0.8784) or length of stay ( P = 0.4763) even after controlling for the patient demographic variables. Nursing favorability for single checking increased from 59% of nurses in favor during the double check phase, to 94% by the end of the single check phase. Each double check took an average of 9.7 minutes, and a single check took an average of 1.94 minutes. Our results suggest that performing independent double checks on high-risk medications administered in a pediatric ICU setting afforded no impact on reported medication events compared with single checking.

Patient Portal Use Among Family Caregivers of Individuals With Dementia and Cancer: Regression Analysis From the National Study of Caregiving.

Family caregivers are often inexperienced and require information from clinic visits to effectively provide care for patients. Despite reported deficiencies, 68% of health systems facilitate sharing information with family caregivers through the patient portal. The patient portal is especially critical in the context of serious illnesses, like advanced cancer and dementia, where caregiving is intense and informational needs change over the trajectory of disease progression. The objective of our study was to analyze a large, nationally representative sample of family caregivers from the National Study of Caregiving (NSOC) to determine individual characteristics and demographic factors associated with patient portal use among family caregivers of persons living with dementia and those living with cancer. We conducted a secondary data analysis using data from the 2020 NSOC sample of family caregivers linked to National Health and Aging Trends Study. Weighted regression analysis by condition (ie, dementia or cancer) was used to examine associations between family caregiver use of the patient portal and demographic variables, including age, race or ethnicity, gender, employment status, caregiver health, education, and religiosity. A total of 462 participants (representing 4,589,844 weighted responses) were included in our analysis. In the fully adjusted regression model for caregivers of persons living with dementia, Hispanic ethnicity was associated with higher odds of patient portal use (OR: 2.81, 95% CI 1.05-7.57; P=.04), whereas qualification lower than a college degree was associated with lower odds of patient portal use by family caregiver (OR 0.36, 95% CI 0.18-0.71; P<.001. In the fully adjusted regression model for caregivers of persons living with cancer, no variables were found to be statistically significantly associated with patient portal use at the .05 level. In our analysis of NSOC survey data, we found differences between how dementia and cancer caregivers access the patient portal. As the patient portal is a common method of connecting caregivers with information from clinic visits, future research should focus on understanding how the portal is used by the groups we have identified, and why.