Rate Of Surgical Intervention Research Articles

COVID-19 in Pregnancy: A Maternal Compromise

Few studies have reported the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnancy albeit the exact mechanism of maternal compromise requiring escalated management is not known. This case demonstrated how a pregnant woman deteriorated and recovered from COVID-19 after delivery. A 37-year-old lady, G4P3, at 29 weeks gestation presented with reduced fetal movement, fever, chest pain and cough, with a background of gestational diabetes. She was proven positive for COVID-19 and was started on treatment promptly. Initially, she was maintaining her oxygen saturations but later deteriorated despite maximum oxygen therapy. She was escalated to the Intensive Care Unit (ICU) and treated with non-invasive mechanical ventilation requiring up to a FiO2 – 0.7. In view of the patient's best interest, multiple Multidisciplinary Team discussions took place and unanimously decided to proceed with emergency lower segment caesarean section under spinal anaesthesia which was uneventful. She made gradual recovery and was discharged from ICU after 2 weeks. During her admission, she was found to be MRSA positive from her Caesarean section wound and was treated accordingly. Both mother and baby were fit for discharge after 1 month of admission. There is a lack of evidence regarding implications of COVID-19 on pregnancy. Gestational diabetes on top of the physiological immunosuppressed status may put pregnant women in a vulnerable group. Further studies are required to identify factors generating increased rate of surgical intervention, preterm deliveries, and ICU admission in COVID-19 positive pregnancies.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S5

No-Touch Versus Conventional Vein Harvesting Techniques at 12 Months After Coronary Artery Bypass Grafting Surgery: Multicenter Randomized, Controlled Trial.

Vein graft occlusion is deemed a major challenge in coronary artery bypass grafting. Previous studies implied that the no-touch technique for vein graft harvesting could reduce occlusion rate compared with the conventional approach; however, evidence on the clinical benefit and generalizability of the no-touch technique is scare. From April 2017 to June 2019, we randomly assigned 2655 patients undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio to receive no-touch technique or conventional approach for vein harvesting. The primary outcome was vein graft occlusion on computed tomography angiography at 3 months and the secondary outcomes included 12-month vein graft occlusion, recurrence of angina, and major adverse cardiac and cerebrovascular events. The generalized estimate equation model was used to account for the cluster effect of grafts from the same patient. During the follow-up, 2533 (96.0%) participants received computed tomography angiography at 3 months after coronary artery bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch group had significantly lower rates of vein graft occlusion than the conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57 [95% CI, 0.41-0.80]; P<0.001) and 12 months (3.7% versus 6.5%; odds ratio, 0.56 [95% CI, 0.41-0.76]; P<0.001). Recurrence of angina was also less common in the no-touch group at 12 months (2.3% versus 4.1%; odds ratio, 0.55 [95% CI, 0.35-0.85]; P<0.01). Rates of major adverse cardiac and cerebrovascular events were of no significant difference between the 2 groups. The no-touch technique was associated with higher rates of leg wound surgical interventions at 3-month follow-up (10.3% versus 4.3%; odds ratio, 2.55 [95% CI, 1.85-3.52]; P<0.001). Compared with the conventional vein harvesting approach in coronary artery bypass grafting, the no-touch technique significantly reduced the risk of vein graft occlusion and improved patient prognosis. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03126409.

Balloon dilation of the Eustachian tube with a seeker-based device: A registry of 169 patients.

ObjectiveTo collect real‐world data on the safety and effectiveness of balloon dilation of the Eustachian tube using a seeker‐based device in patients with persistent/chronic symptoms of Eustachian tube dysfunction.MethodsA multicenter, prospective, single‐arm registry was conducted from June 2018 through August 2020 at 10 US centers, including tertiary care and private practices. Primary endpoints included mean change from baseline in the 7‐item Eustachian Tube Dysfunction Questionnaire (ETDQ‐7) and the serious related adverse event rate. Secondary endpoints include changes in middle ear assessments, surgical intervention rate, and changes in Sino‐Nasal Outcome Test and Work and Activity Impairment (WPAI) questionnaires.ResultsA total of 169 participants were treated with balloon dilation of the Eustachian tube, with 166 and 154 participants completing the 6‐week and 6‐month follow‐ups, respectively. Repeated measures analysis of the change in ETDQ‐7 scores indicated statistically significant improvement (−2.1; 95% CI −2.40, −1.84; P < .0001) at 6‐month follow‐up. The minimum clinically important difference of improvement was achieved by 85% of participants at 6 months. Four nonserious adverse events were reported. Middle ear functional assessments were improved in the majority of participants with abnormal baseline findings. There were no statistically significant differences in the change from baseline ETDQ‐7 scores between participants who had concurrent procedures and those who did not. WPAI scores demonstrated significant improvement.ConclusionReal‐world evidence supports the clinical studies demonstrating that balloon dilation of the Eustachian tube with a seeker‐based device is a safe and effective procedure to treat ETD symptoms.Level of evidence3

Changes in admissions, and hospitalization outcomes of IBD patients in an Italian tertiary referral center over a 13-year period.

The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center. Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed. Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions. Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

Can preoperative renal mass biopsy change clinical practice and reduce surgical intervention for small renal masses?

IntroductionThe role of renal biopsy prior to surgical intervention for a renal mass remains controversial despite the fact that for all other urological organs except the testicle, biopsy inevitably precedes treatment as is true for all other specialties dealing with solid masses (e.g. thyroid, breast, colon, liver, etc.). Accordingly, we sought to determine the impact of a routine biopsy regimen on the course of patients with cT1a lesions in comparison with a contemporary series of cT1a individuals who went directly to treatment without a preoperative biopsy. MethodsWe analyzed a multi-institutional, prospectively maintained database of patients who underwent an office-based, ultrasound-guided, renal mass biopsy (RMB) for a cT1a renal mass (i.e. ≤4cm in largest dimension). Controls were selected from all patients in the database who had a cT1a renal lesion but did not undergo RMB. Both groups were analyzed for differences in treatment modality and surgical pathology results. ResultsA total of 72 RMB and 73 control patients were analyzed. The groups were similar in regards to their baseline characteristics. Overall RMB diagnostic rate was 75%. Surgical pathology revealed that excision of benign tumors was eight-fold less in the RMB cohort compared to the control group (3% vs. 23%; P < 0.001). Additionally, the rate of active surveillance in the RMB cohort was nearly three times higher at 35% vs. 14% for the controls (P < 0.001). Biopsy was concordant with surgical pathology in 97% of cases for primary histology (i.e. benign vs. malignant), 97% for histologic subtype, and 46% for low (I or II) vs. high (III or IV) grade. On multivariate analysis patients who underwent surgical intervention without preoperative RMB were 6.7 times more likely to have benign histopathology compared to patients who underwent preoperative RMB (OR 6.7, 95% CI = 0.714 – 63.626, P = 0.096). There were no procedural or post-procedural RMB complications. ConclusionsFor patients with cT1a lesions, the implementation of routine office-based RMB led to a significant decrease in the rate of surgical intervention for benign tumors. This practice also resulted in a higher rate of active surveillance for the management of renal cortical neoplasms with benign histopathology compared to a control group.

Classification, outcomes, and management of misdeployed stents during EUS-guided gastroenterostomy

Stent misdeployment (SM) has hindered the dissemination of EUS-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction (GOO) management. We aimed to provide a classification system for SM during EUS-GE and study clinical outcomes and management accordingly. This is a retrospective study involving 16 tertiary care centers (8 in the United States, 8 in Europe) from March 2015 to December 2020. Patients who developed SM during EUS-GE for GOO were included. We propose classifying SM into 4 types. The primary outcome was rate and severity of SM (per American Society for Gastrointestinal Endoscopy lexicon), whereas secondary outcomes were clinical outcomes and management of dislodgement according to the SM classification type, in addition to salvage management of GOO after SM. From 467 EUS-GEs performed for GOO during the study period, SM occurred in 46 patients (9.85%). Most SMs (73.2%) occurred during the first 13 EUS-GE cases by the performing operators. SM was graded as mild (n= 28, 60.9%), moderate (n= 11, 23.9%), severe (n= 6, 13.0%), or fatal (n= 1, 2.2%), with 5 patients (10.9%) requiring surgical intervention. Type I SM was the most common (n= 29, 63.1%), followed by type II (n= 14, 30.4%), type IV (n= 2, 4.3%), and type III (n= 1, 2.2%). Type I SM was more frequently rated as mild compared with type II SM (75.9% vs 42.9%, P= .04) despite an equivalent rate of surgical repair (10.3% vs 7.1%, P= .7). Overall, 4 patients (8.7%) required an intensive care unit stay (median, 2.5 days). The median length of stay was 4 days after SM. Although SM is not infrequent during EUS-GE, most are type I, mild/moderate in severity, and can be managed endoscopically with a surgical intervention rate of approximately 11%.

The Role of Biomarkers in Surgery for Ulcerative Colitis: A Review.

Ulcerative colitis (UC) is an inflammatory condition that generally affects the rectum and extends proximally into the colon in a continuous, distal-to-proximal pattern. Surgical resection (total proctocolectomy) is the only cure for UC and is often necessary in managing complicated or refractory disease. However, recent advances in biologically targeted therapies have resulted in improved disease control, and surgery is required in only a fraction of cases. This ever-increasing array of options for medical management has added complexity to surgical decision-making. In some circumstances, the added time required to ensure failure of medical therapy can delay colectomy in patients who will ultimately need it. Indeed, many patients with severe disease undergo trials of multiple medical therapies prior to considering surgery. In severe cases of UC, continued medical management has been associated with a delay to surgical intervention and higher rates of morbidity and mortality. Biomarkers represent a burgeoning field of research, particularly in inflammatory bowel disease and cancer. This review seeks to highlight the different possible settings for surgery in UC and the role various biomarkers might play in each.

Palliative Care Needs in Breast Cancer Patients Entering Inpatient Hospice in Western Kenya

ContextBreast cancer in Kenya is associated with a high mortality due to late stage disease at presentation and limited access to specialty care. ObjectivesTo understand the symptom burden in breast cancer patients entering hospice in Western Kenya and utilize the data to meet the growing need for palliative care and hospice services. MethodsWe conducted a quality improvement exercise to assess the needs of Kenyan women admitted to inpatient hospice with the diagnosis of breast cancer. A retrospective chart review was undertaken to collect and collate demographic, physical and symptom data from a standardized admission form and the medical record. ResultsBetween 2011–2019, 62 women with breast cancer were admitted for care. The median age was 50.0 years (range 23–86) and the median time from diagnosis to admission one year (range 0–4). Only 20% had received surgical treatment for breast cancer. Pain was the predominant symptom on admission (98%) and breast wounds were the most common physical finding. Approximately 50% voiced worry, depression, and stress with <10% voicing spiritual distress. The mean length of stay was 42.6 days (median 10, range 1–1185). While over 70% died in hospice, 27% were discharged home. ConclusionsThe low rate of surgical intervention leads to painful breast wounds that were a major factor for many women seeking hospice admission. The findings challenge our team to maintain expertise in pain and wound management but to also include breast cancer awareness in our rural outreach services.

Indirect Area Estimates of Disease Prevalence: Bayesian Evidence Synthesis with an Application to Coronary Heart Disease

Risks for many chronic diseases (coronary heart disease, can cer, mental illness, diabetes, asthma, etc) are strongly linked both to socio economic and ethnic group and so prevalence varies considerably between areas. Variations in prevalence are important in assessing health care needs and in comparing health care provision (e.g. of surgical intervention rates) to health need. This paper focuses on estimating prevalence of coronary heart disease and uses a Bayesian approach to synthesise information of dif ferent types to make indirect prevalence estimates for geographic units where prevalence data are not otherwise available. One source is information on prevalence risk gradients from national health survey data; such data typ ically provide only regional identifiers (for confidentiality reasons) and so gradients by age, sex, ethnicity, broad region, and socio-economic status may be obtained by regression methods. Often a series of health surveys is available and one may consider pooling strength over surveys by using information on prevalence gradients from earlier surveys (e.g. via a power prior approach). The second source of information is population totals by age, sex, ethnicity, etc from censuses or intercensal population estimates, to which survey based prevalence rates are applied. The other potential data source is information on area mortality, since for heart disease and some other major chronic diseases there is a positive correlation over areas be tween prevalence of disease and mortality from that disease. A case study considers the development of estimates of coronary heart disease prevalence in 354 English areas using (a) data from the Health Surveys for England for 2003 and 1999 (b) population data from the 2001 UK Census, and (c) area mortality data for 2003.

PREVALENCE AND CLINICAL FEATURES OF BILATERAL OSTEOCHONDRITIS DISSECANS (OCD) OF THE KNEE IN PEDIATRIC AND ADOLESCENT PATIENTS PRESENTING WITH UNILATERAL SYMPTOMS

Background:Osteochondritis dissecans(OCD) is an idiopathic condition primarily involving the subchondral bone with secondary articular cartilage changes, commonly occurring in the knee. The true prevalence of bilateral OCD in patients presenting with unilateral OCD symptoms is unknown.Hypothesis/Purpose:The goals of this study are to determine the prevalence and characteristics of bilateral OCD in patients with unilateral symptoms and compare to those with unilateral disease.Methods:An electronic medical record database was queried from 2003-2016 to identify and retrospectively review patients 18 years or younger presenting to a single pediatric institution with a diagnosis of OCD of the knee and strictly unilateral knee pain. Contralateral knee imaging of the asymptomatic knee within one year of initial presentation was required. Lesion characteristics were evaluated on both x-ray and magnetic resonance imaging(MRI) assessing size, location, and Hefti staging. Treatment(both surgical and non-operative) and outcomes were recorded. Patients with unilateral OCD were compared with those with bilateral disease using appropriate statistical analyses.Results:Eighty consecutive patients, 63 males(79%) and 17 females(21%), average age of 13.1 years old (range:8-18), were included. 71% of symptomatic lesions were located on the medial femoral condyle and 14% on the lateral femoral condyle with 20 lesions(25%) deemed stable on MRI evaluation. A positive correlation was found between increasing lesion size and severity of MRI/Hefti grade(Figure-1). Twelve patients(15%) were found to have bilateral OCD on contralateral imaging, with five of the contralateral lesions(42%) considered stable on MRI. There was no significant difference in skeletal maturity between patients with bilateral vs. unilateral disease. Fifty-two patients(77%) with unilateral disease underwent surgical intervention, while 9(75%) of those with bilateral disease underwent a surgical procedure on either knee. In patients discovered to have an asymptomatic contralateral lesion, 67% ultimately underwent surgical intervention on the contralateral knee. Comparing patients with unilateral and bilateral disease, no statistical differences were found in terms of patient demographics or lesion characteristics.Conclusion:In patients presenting with unilateral OCD symptoms, there was a 15% prevalence of bilateral disease. There was no difference in age, sex, physeal status or lesion characteristics between patients with unilateral vs. bilateral OCD lesions, and we found no difference in rates of surgical intervention. A consistent relationship between lesion size and Hefti classification was appreciated. Given the prevalence of asymptomatic contralateral lesions and required intervention, our study supports the recommendation for bilateral radiologic knee evaluation for pediatric and adolescent patients presenting with unilateral knee OCD.Figure 1.Association between size (via volumetric analysis on magnetic resonance imaging [MRI]) of osteochondritis dissecans (OCD) lesions of the knee and Hefti classification

Conservative Treatment for Giant Lumbar Disc Herniation: Clinical Study in 409 Cases

There have been several recent reports of lumbar disc herniation (LDH) resorption; however, large sample studies are lacking, and the mechanism(s) underlying this phenomenon is unclear. To explore the feasibility and clinical outcomes of conservative treatment for giant LDH and to analyze the factors affecting the resorption of giant LDH. Observational study and original research. This work was performed at a University Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine. From January 2008 to December 2019, 409 patients with giant LDH who initially underwent nonsurgical treatment in our hospital were followed for 1-12 years to analyze the rate of surgical intervention, calculate the rate of resorption of protrusions, and the rate of excellent clinical outcomes. Eighty-nine of the 409 patients (21.76%) underwent surgery, while the remaining 320 patients (78.24%) constituted the non-surgical treatment group. The Japanese Orthopaedic Association (JOA) score in the 320 patients changed from 10.22 ± 3.84 points to 24.88 ± 5.69 points after treatment, and the rate of excellent outcomes was 84.06%. Among the 320 patients in the non-surgical treatment group, the protrusion percentage decreased from 70.08±30.95% to 31.67 ± 24.42%. One-hundred and eighty-nine patients (59.06%) had > 30% resorption of protrusions, and 81 patients (25.31%) had a significant resorption of protrusions of > 50%. Among 189 patients with resorption, the shortest resorption interval was 1 month, and the longest was 8 years, with 77 patients (40.74%) showing resorption within 6 months, 51 (26.98%) within 6-12 months, and 61 patients (32.28%) after 12 months. The main limitations are that all patients were from the same site, and there was a lack of multicenter randomized controlled trials with which to compare data. Patients with giant LDH are less likely to develop progressive nerve injury and cauda equina syndrome if their clinical symptoms improve after treatment. As long as there is no progressive nerve injury or cauda equina syndrome, conservative treatment is preferred for giant disc herniation. Resorption is more likely with greater disc protrusions in the spinal canal. A ring enhancement bull's eye sign) around a protruding disc on enhanced magnetic resonance imaging is an important indicator of straightforward resorption.

A Seventeen-Year Descriptive Study of Infective Endocarditis Features at a Tertiary, Teaching Hospital.

IntroductionInfective endocarditis (IE) is a microbial infection affecting the endothelial lining of the heart chambers and valves. Despite advances in diagnostic methods and management, IE still carries high levels of morbidity and mortality. There are no comprehensive data describing incidence, risk factors, and outcomes of IE in Saudi Arabia.Our study aims to describe the epidemiological and clinical characteristics and outcomes of adult patients with IE treated in a tertiary, Teaching Hospital.MethodsThis is a descriptive, retrospective review of charts (between January 2003 and June 2019) conducted at King Abdulaziz University Hospital. We included all patients 16 years and older with a definitive diagnosis of IE based on Duke Criteria. We collected the following information: demographics, risk factors, comorbidities, microbial type, antibiotic choice, complications, laboratory data, echocardiography data, and mortality.ResultsWe found a total of 60 adult patients with definitive diagnoses of IE: 55% of them were males, and the mean age was 48.71 ± 18.3 years. Hypertension was the most common comorbidity, affecting 23 patients (38.3%), followed by end-stage renal disease (ESRD) in 20 patients (33.3%) and diabetes in 17 (28.3%). Staphylococcus aureus was the most common organism (25%), and vancomycin was the most prescribed antibiotic. Fifty-eight patients were treated medically (96.5%). Furthermore, 88% of the patients had vegetations, detected by echocardiography, and the majority had single-valve involvement. Sepsis was the most common complication, and the mortality rate was 36.7%.ConclusionThere was a small number of definitive IE cases over a 17-years span in our institution. Surprisingly, a higher mortality rate was found among our patients and a lower surgical intervention rate in comparison with the literature. Though we acknowledge the limitations of a retrospective, chart review study, we can speculate that the high mortality rate may be in part related to a higher number of virulent organisms, delayed presentation, and lack of prompt surgical intervention.

ABO blood groups do not predict progression of traumatic intracranial hemorrhage

ABO blood groups are associated with genetically predisposed variations in von Willebrand factor (VWF) resulting in higher risks of thrombotic events in non-O blood types and bleeding complications in blood type O. The role of ABO blood groups in progression of traumatic intracranial hemorrhage (TICH) is unknown. Given statistically lower VWF levels in blood type O in the general population, we hypothesized that blood type O patients have a higher risk of such progression. A retrospective review of adult trauma patients with isolated TICH admitted to a Level 1 trauma center over eight years was conducted. Patients were categorized with blood type O and non-O (types A, B, AB) delineation. The primary outcome was radiological progression of TICH during the first 24 h. Secondary outcomes included surgical intervention after follow-up computed tomography (CT), complications, days on mechanical ventilation (DMV), intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. Of 949 patients, 432 (45.5%) had blood type O. When comparing O and non-O groups, no significant differences were found in gender, age, race, admission vital signs, Glasgow Coma Scale, coagulation profile, TICH type, or Injury Severity Score. No difference in TICH progression was found between O and non-O groups: 73 (17%) vs 80 (15%), respectively, p = 0.55. Blood type O mortality was 12 (3% vs. 23 (4%), p = 0.174). Rate of TICH surgical intervention after follow-up CT, DMV, complications, and ICU and hospital LOS did not differ. No association between ABO blood types and radiological progression of TICH was identified.

Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients

PurposeInfections of the deep neck, although becoming scarcer due to the widespread use of antibiotics, still represent a dangerous and possibly deadly disease, especially when descending into the mediastinum. Due to the different specialities involved in the treatment and the heterogenous presentation of the disease, therapeutic standard is still controversial. This study analyzes treatment and outcome in these patients based on a large retrospective review and proposes a therapeutic algorithm.MethodsThe cases of 218 adult patients treated with deep neck abscesses over a 10-year period at a tertiary university hospital were analyzed retrospectively. Clinical, radiological, microbiological and laboratory findings were compared between patients with and without mediastinal involvement.ResultsForty-five patients (20.64%) presented with abscess formation descending into the mediastinum. Those patients had significantly (all items p < 0.0001) higher rates of surgical interventions (4.27 vs. 1.11) and tracheotomies (82% vs. 3.4%), higher markers of inflammation (CRP 26.09 vs. 10.41 mg/dl), required more CT-scans (3.58 vs. 0.85), longer hospitalization (39.78 vs 9.79 days) and more frequently needed a change in antibiotic therapy (44.44% vs. 6.40%). Multi-resistant pathogens were found in 6.67% vs. 1.16%. Overall mortality rate was low with 1.83%.ConclusionDespite of the high percentage of mediastinal involvement in the present patient collective, the proposed therapeutic algorithm resulted in a low mortality rate. Frequent CT-scans, regular planned surgical revisions with local drainage and lavage, as well as an early tracheotomy seem to be most beneficial regarding the outcome.

Morbidity and Mortality Trends of Pancreatitis: An Observational Study.

Background: Pancreatitis accounts for more than $2.5 billion of healthcare costs and remains the most common gastrointestinal (GI) admission. Few contemporary studies have assessed temporal trends of incidence, complications, management, and outcomes for acute pancreatitis in hospitalized patients at the national level. Methods: We used data from one of the largest hospital-based databases available in the United States, the Healthcare Cost and Utilization Project's (HCUP) State Inpatient Database, from 10 states between 2008 and 2015. We included patients with a diagnosis of acute pancreatitis (ICD-9 CM 577.0). Patient- and hospital-level data were used to estimate incidence and inpatient mortality rates. Results: From 80,736,256 hospitalizations, 929,914 (1.15%) cases of acute pancreatitis were identified, 186,226 (20.2%) of which were caused by gallbladder disease). The median age was 53 years (interquartile range [IQR], 41-67) and 50.8% were men. In-hospital mortality was 2.5% and crude mortality rates declined from 2.9% to 2.0% over the study period. Admission year remained significant after adjusting for patient demographics and comorbidities (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.89-0.90; p < 0.001). Gallbladder disease was associated with decreased odds of mortality (OR, 0.60; 95% CI, 0.57-0.62). Median length of stay was four days (IQR, 2-7) and decreased over time. The rates of surgical and endoscopic interventions were highest in 2011 (peak incidence of 16.1% and 9.5%, respectively) and have been decreasing since. Surgical providers were, on average, more likely than medical providers to perform surgery in both those with and without gallbladder disease etiology (gallbladder disease OR, 7.11; 95% CI, 5.46-9.25; non-gallbladder disease OR, 20.50; 95% CI, 16.81-25.01), endoscopy (gallbladder disease OR, 1.22; 95% CI, 0.87-1.72; non-gallbladder disease OR, 1.60; 95% CI, 1.18-2.16), or both (gallbladder disease OR, 7.00; 95% CI, 5.22-9.37; non-gallbladder disease OR, 8.85; 95% CI, 5.61-13.96). Conclusions: The incidence of pancreatitis, from 2008 to 2015, has increased whereas inpatient mortality (i.e., case fatality) has decreased. Understanding temporal trends in outcomes and management along with provider, hospital, and regional variation can better identify areas for future research and collaboration in managing these patients.

Outcomes of Pediatric Fistulising Perianal Crohn's Disease.

Perianal disease is reported more widely in pediatric Crohn patients than in the past, and has been stated as an independent modifier of the disease behavior. In this study, we aimed to analyze the clinical characteristics and outcomes of fistulising perianal Crohn's disease (fpCD) in the pediatric age group. A total number of 149 children with an established diagnosis of inflammatory bowel disease who have been diagnosed before 18 years of age and followed in our tertiary center were revised. Clinical, endoscopic, laboratory, and radiologic data of 50 patients with CD, who had at least 18 months follow-up data, were compiled. Of 50 patients, 26 (52%) were diagnosed as fpCD (38% at onset). More than half of the patients without any notable external orifices around the perianal area were diagnosed as fpCD by an magnetic resonance imaging (MRI). Pediatric fpCD patients had a higher disease activity score and platelet count, lower serum albumin level, and a higher rate of granuloma in the biopsy samples, compared with non-fistulising patients. A considerably high rate of surgical interventions (i.e., seton placement 46% and abscess drainage 15%) was performed in combination with infliximab. Fistulising perianal Crohn's disease seems to be more common than previously reported in the pediatric age group. A severe course of the disease might serve as a warning for the development of fpCD. A careful physical examination and use of perianal MRI with a high index of suspicion may increase the likelihood of fistula detection, hence may change the treatment strategy.

Presentation of Infectious Keratitis to ED during COVID-19 Lockdown.

Objectives To compare presentation of infectious keratitis during COVID-19 lockdown with previous years, assess relative severity, and compare outcomes between COVID-19 and pre-COVID-19 era groups. Methods Acute presentations of infectious keratitis during a strict government-mandated COVID-19 lockdown period were analysed retrospectively (March–May 2020). Data were compared with the same periods in 2018-2019. The clinical notes of patients undergoing corneal scrapes were reviewed, and data were collected on treatment, culture growth, surgical interventions, visual outcomes, admission rates, and risk factors. Results There were 37% fewer presentations of infectious keratitis to the ED in 2020 (N = 29, 47, and 45, respectively). Risk factor profiles and microbial data were similar across all periods. Admission rates and use of fortified antibiotics were lower in 2020. COVID-19 era cases recovered less vision (LogMAR 0.26, 0.67, and 0.45, respectively; p = 0.04) and were more likely to require surgical intervention (10%, 4%, and 2%, respectively; OR 3.4 (CI 0.7–17.9, p = 0.1)). Conclusion A concerning fall in presentations of infectious keratitis to ED during the pandemic lockdown was observed. Though societal behaviour changed during the lockdown, our data suggest it is unlikely that the incidence of infectious keratitis fell significantly. It is unclear how and where these patients were treated. We postulate that lower levels of visual recovery and higher rates of surgical intervention may have been caused by delays in accessing care. To minimise avoidable ocular morbidity as COVID-19 resurges, we must communicate clearly with patients and health professionals on how to access available emergency eye care services.

Effects of easing shelter-in-place restrictions and the lingering COVID-19 pandemic on orthopaedic trauma at a community level 2 trauma center.

Objectives:Evaluate the effect of easing “shelter-in-place” restrictions and coronavirus-2019 (COVID-19) cases on orthopaedic trauma encounters (OTEs) at a community level II trauma center.Methods:A retrospective analysis was conducted of OTEs from March-June of 2016 to 2020. Injuries were classified by high or low severity. Admission and surgical intervention rates were also compared year to year. Data were statistically analyzed and compared with external data for traffic counts near the hospital and COVID-19 cases in Michigan as well as a timeline for enacting and easing of shelter-in-place orders in the state of Michigan.Results:There was no difference in the number of OTEs May to June, 2020 compared with the average of those same months 2016 to 2019. March to June, 2020 showed no change in proportion of injury severity, admissions, or surgical interventions when compared with the average of March-June, 2016 to 2019, although the overall quantity of each was decreased in March and April. A significant negative correlation was found between the daily number of COVID-19 cases in Michigan and OTEs.Conclusions:The quantity of OTEs normalized to pre-COVID-19 levels in May and June of 2020 compared with 2016 to 2019 despite a previously documented 45.1% drop in March and April. A negative correlation was noted between the number of reported Michigan COVID-19 cases and volume of OTEs. There were no significant changes noted to admission rates or rates of surgical intervention on OTEs throughout the time period studied.

COVID-19 pandemisinin ürolojik konsültasyonlara ve ürolojik cerrahiye akut etkisi

Objective: Coronavirus disease (COVID-19) has greatly affected the clinical functioning of all sub-specialties, including urology. Clinicians have also been affected by this sudden chaotic process to a certain extent. In this study, we aimed to evaluate the effect of pandemic period on urological consultations and urological surgery in the acute phase of our country. Material and Methods: This retrospective study was designed after the approval of our hospital’s local ethics committee (decision number dated 22.07.2020: 2020/0458) was obtained. In the first 4 weeks after the first case in our country, the data of the patients who were consulted to the Urology clinic from the emergency service and other clinics in our hospital, which is a tertiary healthcare facility (Group 1), and patients in the same period of 2019 (group 2) were retrospectively collected. The demographic characteristics of the patients, specific triage evaluations for the pandemic, reasons for consultation and results were analyzed in detail. Results: Of the total 377 patients, 123 (32.6%) were in Group 1, and 254 (67.4%) were in Group 2. While there was a similar distribution in the number of weekly consultations in group 2, a statistically significant decrease was observed in the second and third weeks in Group 1 and an increase in the fourth week (p = 0.025). Ninety-three patients (75.6%) in Group 1 and 180 patients (70.9%) in Group 2 were consulted from the emergency service (p = 0.116). The two most common reasons for consultation were urinary infections and urolithiasis in Group 1; urolithiasis and hematuria in Group 2 (p = 0.027). While the rate of urological surgical intervention was 24.4% in Group 1; it was 37.8% in Group 2 (p = 0.010). Conclusion: The difficulty of the COVID-19 outbreak for clinicians has been to strike a balance between providing the most appropriate treatment while avoiding contamination for themselves and their patients. This balance in urology practice has emerged as a decrease in the rate of consultations resulting in surgery. Keywords: consultation, coronavirus, COVID-19, pandemic, urological surgery

DOP38 An observational study to evaluate the burden of illness in patients with Crohn’s Disease with and without perianal fistulas in the USA

Abstract Background Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can lead to complications such as perianal fistulas (PAFs). This study compared disease burden, experiences and health-related quality of life between patients who have CD with PAFs (CPF) and those who have CD without PAFs (non-PAF CD). Methods This cross-sectional, observational study was conducted in three cohorts of US patients aged 18–89 years with self-reported physician-diagnosed CD: (1) non-PAF CD; (2) CPF without PAF-related surgery; and (3) CPF with PAF-related surgery. Data on medical and surgical interventions, CD-specific symptoms and Fecal Incontinence Quality of Life (FIQL) were collected via a web-enabled questionnaire. Statistical comparisons were assessed at the 0.05 level. Results The mean (standard deviation) age of patients in cohorts 1 (n = 300), 2 (n = 51) and 3 (n = 52) was 47 (16.4), 40 (12.2) and 39 (13.1) years, respectively. In patients with CPF (cohort 2 + 3), 59 (57%) reported multiple fistulas and 48 (47%) reported fistula recurrence/persistence. Compared with cohort 1 (non-PAF CD), more patients with CPF reported currently receiving biologic treatment or immunomodulators for CD (58% vs 43% and 23% vs 15%, respectively; both p = 0.01). More patients with CPF also reported undergoing ≥ 1 CD-related surgery and experiencing ≥ 1 failures of CD-related surgery (79% and 20%, respectively) versus cohort 1 (53% and 9%, respectively; both p &amp;lt; 0.001). In cohort 3, 63% of patients had ≥ 3 PAF-related surgeries, and in those receiving seton placement (n = 37), 8% reported placement failure. Post-surgical/seton placement complications were common; the most frequently reported were worsening of pain and swelling around the anus (33%) and fever/infection (29%). CD-specific symptom frequency and severity results indicated a high symptom burden across cohorts; fatigue was reported with the highest frequency and severity. Faecal incontinence (FI) and leakage-related symptoms affected greater proportions of patients in cohorts 2 and 3, often with greater severity and frequency, compared with cohort 1 (Fig.1). Across all cohorts, 58% of patients (cohort 1/2/3, n = 158/35/40) reported experiencing FI and completed the FIQL questionnaire: cohorts 2 and 3 reported lower (worse) FIQL scores across domains than cohort 1 (Fig.2). Conclusion The burden of illness in patients with CPF is substantial, with medical and surgical intervention rates, and symptom severity and frequency greater than for those with non-PAF CD. Higher disease burden, including FI, was noted in patients with CPF compared with the non-PAF CD cohort. An unmet need remains for improved management and outcomes of CPF. Sponsor: Takeda Pharmaceuticals USA, Inc.