Retrospective Database Analysis Research Articles

BS SO06 - Bariatric Surgery is a Safe, Effective and Feasible Option in Super-Super Obese Patients

Abstract Background Bariatric surgery is proven to be feasible and safe in obese and super obese patients (BMI < 60). SSO patients pose greater challenges from technical and medical standpoints. This cohort study aims to assess the safety and feasibility of bariatric surgery in SSO individuals. Method A retrospective analysis of a prospective database was conducted, encompassing 4471 bariatric procedures performed over seven years (January 2016 to December 2023). Fifty patients were classified as SSO (BMI > 65). Key outcome variables examined included length of stay (LOS), intra-operative complications, and 30-day morbidity and mortality rates. We evaluated the Resolution of Obesity Related Morbidity (RORM). Results Sleeve gastrectomy most common procedure (24, 48%), followed by One Anastomosis Gastric Bypass (17, 34%). Six patients underwent Roux-en-Y Bypass (12%), and six others received SADIs (12%). Among these, [24 (48%)] had obstructive sleep apnea (OSA), [14 (28%)] had diabetes mellitus (DM) and [9 (18%)] had hypertension. Average LOS was 2.5 days. No mortality was reported within 30 days with no intra-operative complications. One patient required readmission to the hospital within 30 days after discharge due to vomiting. The report at 6 months was positive. OSA, DM and Hypertension were resolved in [11 (46%), 13 (92%) and 7 (77%)] Conclusion Bariatric surgery should not be dismissed for SSO patients solely due to perceived increased risk based on BMI. Evidence suggests that it can be safely performed on SSO individuals, yielding significant benefits particularly for obesity-related morbidity.

INNV-04. SINGLE INSTITUTION RETROSPECTIVE STUDY TO DETERMINE TIME TO FIRST PROGRESSION IN MGMT METHYLATED GLIOBLASTOMA PATIENTS WHO RECEIVED STANDARD OF CARE

Abstract MGMT methylated glioblastomas respond well to standard of care with temozolomide, have a longer survival as well as increased risk of pseudo-progression as compared to unmethylated patients. Shorter survival in these patients despite effective treatments is due to misdiagnosis of true progression (in cases with pseudo-progression) that leads to overtreatment or discontinuation of effective treatments. There are limited non-invasive diagnostic tools to distinguish true progression from pseudo-progression. Knowing the expected time to first true progression will aid with interpretation of MRI changes and serve as an additional tool to distinguish true from pseudo-progression. OBJECTIVE We sought to define the time to first progression in MGMT methylated glioblastoma patients who were treated with standard of care/Stupp protocol (this has not been previously defined). METHODS We conducted a retrospective analysis of an IRB-approved database at our institution from 2019 to 2022 of all MGMT methylated glioblastoma patients who completed Stupp protocol. Time to first progression (time from initial surgery to first true progression) was determined by treating multidisciplinary team based on radiographic review +/- pathology. Eligible MGMT methylated glioblastoma patients had IDH status determined by NGS and completed standard Stupp protocol after surgery. RESULTS Approximately 30% (27) patients with IDH wild-type glioblastoma were MGMT methylated. 10 patients met eligibility criteria. 50% of MGMT methylated GBM patients had multifocal disease at presentation. Median time to first progression in MGMT methylated GBM who received standard of care was 28 months. 20% patients have not had first progression 3 years after initial surgery. CONCLUSION MRI changes on surveillance scans should be carefully interpreted in the first 28 months. Knowing time to first true progression will aid with management decisions and decrease unnecessary early aggressive interventions in MGMT methylated glioblastoma patients. We will validate these findings in a larger patient population at our institution.

Comparison of efficacy and safety of regorafenib and anti-EGFR targeted therapy in metastatic colorectal cancer: A retrospective study

Aim. To compare the efficacy of regorafenib and the combination of chemotherapy (CT) with anti-EGFR (cetuximab/panitumumab) in the third-line treatment of metastatic colorectal cancer (mCRC). Materials and methods. A retrospective analysis of a prospective database of patients with mCRC from two clinics in the Russian Federation was conducted. Overall survival was considered the primary efficacy criterion. Additional criteria were progression-free survival (PFS), objective effect (OE), and incidence of toxicity. No statistical hypothesis was assumed. Statistical analysis was performed using SPSS (IBM SPPS Statistics v. 20). Results. The database identified 51 patients with morphologically confirmed left-sided mCRC with wild-type RAS and BRAF genes who received more than two lines of antitumor drug therapy from 2010 to 2021, one of which included anti-EGFR antibodies in the third and subsequent lines of treatment. Thirty patients who received regorafenib in the third line and 21 patients who received CT in combination with anti-EGFR in the third line were selected, of which 7 patients had a history of anti-EGFR use, and 14 patients received anti-EGFR for the first time. The median overall survival from the third line initiation date in the CT group in combination with anti-EGFR was numerically higher (21 months, CI 9.0–32.9 months) than in the regorafenib group (10 months, CI 2.4–17.5 months); p=0.1 by log-rank test (Mantel–Cox test); p=0.2 by Breslow–Wilcoxon test; p=0.3 (Tarone–Ware test). PFS was also higher in the anti-EGFR CT group (6 months, CI 3.8–8.2 months) than in the regorafenib group (3 months, CI 1.2–4.7 months); p=0.05 according to Breslow–Wilcoxon test. OE of third-line therapy was reported in 57.1% (n=12) of patients in the CT with anti-EGFR group and significantly less often in the regorafenib group – 10.3% (n=3) of patients (p=0.001). The toxicity of drug therapy of all grades in the regorafenib group was reported in 86.2% (n=25) of patients, while in the CT anti-EGFR group, it was significantly less common – in 52.4% (n=11) of patients (p=0.01). Conclusion. Compared with regorafenib, combining CT with anti-EGFR agents in the third-line treatment of patients with left-sided mCRC with wild-type RAS and BRAF genes is associated with better PFS and the frequency of OE with significantly less toxicity.

Iron Deficiency in Collegiate Athletes Obtaining Preparticipation Hemoglobinopathy Screening in the Upper Midwest.

Iron and other biologically important metals are essential to mitochondrial function but are not routinely evaluated. Their equilibrium is critical to the optimal performance of cells with high metabolic activity such as neurons, cardiomyocytes, and skeletal myocytes. Teenagers are at a high risk of iron deficiency even without anemia. Metal ion imbalances can cause cognitive impairments, muscle weakness, and sudden cardiac death. We aim to assess the current prevalence of iron deficiency among collegiate athletes in the Upper Midwest. Our study is a multicenter, retrospective chart review of outpatient clinics in a regional healthcare system between January 2012 and December 2023, and a national public database between 2017 and March 2020. We reviewed the ferritin concentrations of regional collegiate athletes having preparticipation sport evaluations and nationally in the NHANES database. We identified 643 unique individuals aged 16-21 years with 253 having ferritin screening. Iron deficiency (ferritin <20mcg/L) was present in 24.5% and hypoferritinemia (ferritin <50mcg/L) was present in 66.7% of collegiate athletes. From the NHANES database, 12.7% of active sampled participants aged 16-21 years were iron deficient. Our study findings suggest the need for universal screening for iron deficiency among collegiate athletes given the high prevalence of iron deficiency in both the retrospective chart review and NHANES database analysis. Given the critical role of metal ion homeostasis to optimal mitochondrial function, these findings may warrant the inclusion of ferritin testing in cardiac, neurological, and skeletal muscle evaluations.

Evaluating the Association of Area Deprivation Index (ADI) on Postoperative Outcomes in Pancreatic Adenocarcinoma.

Pancreatic adenocarcinoma (PDAC) is a challenging disease, with outcomes influenced by several factors including socioeconomic status. The area deprivation index (ADI) has been used to understand how neighborhood disadvantages affect healthcare outcomes. Prior research has indicated that a higher ADI, reflective of a greater neighborhood disadvantage, is associated with an increased risk of major complications and unplanned readmission following PDAC resection. This study aimed to extend this investigation to the Northwell Health System in New York and explore the association between neighborhood ADI and surgical outcomes in patients with PDAC. A retrospective analysis of the Northwell Health multicenter pancreatic cancer database from 2014 to 2023 included patients who underwent PDAC resection. The ADI scores were divided into low (1-3), moderate (4-6), and high (7-10), as previously described. Multinomial regression models and Kaplan-Meier log-rank tests were used to compare differences in surgical outcomes between the patients in each ADI group. Out of 314 PDAC patients who underwent resection and had available ADI data, 116 (36.9%) were in the low, 163 (51.9%) in the moderate, and 35 (11.2%) in the high ADI category. The median ADI score was 4 (IQR: 3-5). Adjusted multinomial regression analysis revealed the following disparities: compared to the low ADI group, patients in the moderate ADI group demonstrated a significantly higher risk of diabetes (RR: 1.76, 95% CI 1.06-2.90, p = 0.028); high ADI was associated with a poorer response to neoadjuvant therapy (RR 3.13, 95% CI 1.11-8.82, p = 0.031), higher incidence of microscopic positive margins (RR 1.87, 95% CI 1.11-5.17, p = 0.028), increased severe complications (Clavien-Dindo class III-IV) (RR 1.36, 95% CI 1.04-1.80, p = 0.027), and a higher failure-to-rescue (FTR) rate (RR 1.44, 95% CI 1.12-1.85, p = 0.048). Although readmission and mortality rates at 30 and 90 days did not show significant differences (p > 0.05), the Kaplan-Meier log-rank test indicated a marked disparity in survival probabilities among ADI ranks (p = 0.0025). This study underscores a pronounced survival disparity across ADI categories among PDAC patients, suggesting an association between socioeconomic status and postoperative survival. Consideration of patient ADI may guide tailored healthcare strategies, such as the distribution of navigation and resources, to bridge the gap in survival outcomes and ensure equitable care for all socioeconomic strata.

Gynaecologic oncology referrals to specialist palliative care in a tertiary referral centre: population, characteristics and outcomes

BackgroundThe early integration of a specialist palliative care team is demonstrated to have numerous benefits for patients. These extend beyond end-of-life care to include reducing depressive symptoms, improving quality of...

Association between Lactate dehydrogenase and 28-day all-cause mortality in patients with non-traumatic Intracerebral hemorrhage: A retrospective analysis of the MIMIC-IV database.

Lactate dehydrogenase (LDH), a nonspecific inflammatory biomarker, has been used in the assessment of acute myocardial infarction, acute hepatitis, acute lung injury, and other severe diseases. However, no studies have evaluated the prognostic value of LDH in patients with non-traumatic intracerebral hemorrhage (ICH). This cohort study aims to assess the association between LDH levels and 28-day all-cause mortality in patients with non-traumatic ICH. Data for this retrospective cohort analysis were obtained from the MIMIC-IV (v2.2) database, and the study included patients with non-traumatic ICH as defined by the International Classification of Diseases, 9th and 10th editions. Patients were categorized into four distinct groups based on their LDH levels. The primary outcome of interest was the 28-day mortality rate. To analyze these associations and assess the consistency of interactions, subgroup analyses, Cox regression analysis, Kaplan-Meier (KM) curves, and nonlinear analysis were conducted. A total of 406 patients with non-traumatic ICH were enrolled in the study and were divided into quartiles based on LDH levels. The KM curve indicated that the 28-day all-cause mortality rate of patients in the Q4 group (LDH > 287.25) was significantly higher than in the Q1 (LDH < 194.7) (P < 0.001) and Q2 (194.7 < LDH < 233.0) (P < 0.001) groups, though not significantly different from Q3 (P = 0.140). Multivariate Cox proportional hazards analysis revealed that patients in the highest LDH quartile had a significantly increased risk of mortality compared to those in the lowest quartile across three models: unadjusted [HR, 3.401; 95% CI, 1.719-6.731; P < 0.001], partially adjusted [HR, 2.422; 95% CI, 1.211-4.846; P = 0.012], and fully adjusted [HR, 3.054; 95% CI, 1.522-6.126; P = 0.002]. Restricted cubic spline (RCS) models revealed an L-shaped association between LDH levels and the 28-day all-cause mortality rate, indicating a non-linear relationship (P < 0.001). No significant interactions were observed between LDH levels and other factors in the subgroup analyses (all P for interaction > 0.05). Our findings indicate a significant association between 28-day all-cause mortality and LDH levels in patients with non-traumatic intracerebral hemorrhage. Specifically, patients with elevated LDH levels within the first 24 hours of ICU admission are at a higher risk of mortality.

Predictors and Impact of Ileus on Outcomes After Laparoscopic Right Colectomy: A Case-Control Study.

Ileus is a common complication of major abdominal surgery, including colorectal resection. The present study aimed to assess the predictors of ileus after laparoscopic right colectomy for colon cancer. This study was a retrospective case-control analysis of a prospective IRB-approved database of patients who underwent laparoscopic right colectomy at the Department of Colorectal Surgery, Cleveland Clinic Florida. Patients who developed ileus after right colectomy were compared to patients without ileus to determine the risk factors of ileus. The present study included 270 patients with a mean age of 68.7years. Thirty-six patients (13.3%) experienced ileus after laparoscopic right colectomy. The median duration of ileus was 6 days. Factors associated with ileus were age (71.6 vs 68.2years, P = .158), emergency colectomy (11.1% vs 3.9%, P = .082), extended hemicolectomy (19.4% vs 6.8%, P = .021), green gastrointestinal anastomosis (GIA) 4.8mm staple height cartridge (19% vs 8.1%, P = .114), and longer operative time (177.9 vs 160.4 minutes, P = .157). The only independent predictor of ileus was extended colectomy (OR: 16.7, P = .003). Increased age, emergency surgery, green GIA cartridge, and longer operative times were associated with ileus, yet the only independent predictor of ileus was extended right hemicolectomy.

Incidence of Pneumocystis jirovecii Pneumonia and Prophylaxis-Associated Adverse Events Among Patients with Systemic Lupus Erythematosus.

Pneumocystis jirovecii Pneumonia (PJP) is an opportunistic infection that may affect patients with systemic lupus erythematosus (SLE). The objective of this project was to describe the incidence of PJP among patients with SLE. A retrospective cohort analysis of the TriNetX database. Included patients had ≥2 ICD9- CM/ICD10-CM codes for SLE separated by at least 30 days and were new users of mycophenolate mofetil or cyclophosphamide. The incidence of PJP over the first six months of therapy was calculated; adverse events were assessed using incident rate ratios (IRR) and Cox proportional hazards regressions. A total of 6,017 patients with SLE were identified. Most were female (5,176, 86%) and Black or African American (2,138, 35.5%). Induction medications included mycophenolate mofetil (5,208, 86.6%), cyclophosphamide (505, 8.4%), or both (304, 5.1%); the most common PJP prophylaxis was trimethoprim/sulfamethoxazole (1,126, 18.7%). Five PJP cases were identified over 2,752 person years, one of whom received PJP prophylaxis, for an incidence rate of 1.8 cases per 1000 person years. In adjusted analysis, patients who received prophylaxis had a higher risk of neutropenia (hazard ratio (HR) 2.5, CI 1.4-4.4), leukopenia (HR 1.9, CI 1.3-2.8), nephropathy (HR 1.7, CI 1.4-2.1), and hyperkalemia (HR 1.4, CI 0.9-2.0). PJP rarely affects patients with SLE undergoing therapy with mycophenolate mofetil or cyclophosphamide; prophylaxis against PJP is associated with adverse events. The majority of patients with SLE and PJP had structural lung disease. These data do not support universal prescribing of PJP prophylaxis for patients with SLE without lung disease.

Lung Transplantation After Ex Vivo Lung Perfusion in High-Risk Recipients: A Propensity Matched Analysis of a National Database

PurposeWe report outcomes associated with EVLP lungs in high-risk lung transplant recipients utilizing a national database. MethodsWe performed a retrospective analysis of the UNOS Database (1/1/2018-3/31/2024). High-risk status was defined as mean pulmonary arterial pressure > 35 mmHg, lung retransplantation, or bridge to transplant. In addition to univariable analysis, propensity score matched analysis was performed on predictors of donor and recipient characteristics. ResultsRisk of dying on the waitlist was significantly higher for high-risk candidates (HR: 1.69 [1.51 – 1.89], p < 0.001). Following matching, 203 EVLP cases were matched to 609 standard procurement recipients. The EVLP group was associated with higher rates of postoperative acute kidney injury requiring renal replacement therapy (27% vs 16%, p < 0.001), higher mortality on index admission (13% vs. 8%, p = 0.04), and longer length of stay (29 vs 25 days, p = 0.006). EVLP modality was associated with survival time (p < 0.001) with portable EVLP having significantly shorter survival (2.7 years) relative to standard cases (4.7 years, p < 0.02). A subgroup analysis found that this survival effect was limited to bridge and retransplant recipients. ConclusionsEVLP lungs were associated with higher rates of postoperative AKI and portable EVLP was associated with shorter survival in high-risk lung transplant recipients. However, given the high waitlist mortality in this candidate population, EVLP lungs should still be considered an alternative.

The Burden of Seasonal Influenza and Its Potential Complications Among Older Japanese Adults: A Real-World Database Study.

Seasonal influenza may lead to severe complications, including respiratory and cardiovascular disease, that result in considerable healthcare resource utilization (HCRU) and mortality, particularly in older individuals. This real-world study assessed the burden of influenza and its potential complications in older Japanese adults. This retrospective claims database analysis (April 2015 to June 2019) included insured individuals aged ≥ 60 years at the start of four consecutive influenza seasons in Japan (October 1 to April 30). The primary endpoint was the incidence of influenza-related emergency room (ER) and outpatient visits, the incidence of hospitalizations, the probability of 30-day inpatient mortality, and 60-day medical costs of influenza or its potential complications. Of 8,974,708 individuals (43.2% male, mean ± standard deviation age 73.8 ± 8.9 years), 370,430 (4.13%) were diagnosed with influenza. Overall, 17.18 (95% confidence interval [CI] 16.32-18.04) and 3893.53 (3880.87-3906.19) per 100,000 individuals had influenza-related ER and outpatient visits, respectively, and 181.50 (178.71-184.28) per 100,000 individuals were hospitalized for influenza. The incidence of influenza-related ER visits and hospitalizations for influenza or potential complications and the probability of 30-day inpatient mortality increased with age. Seasonal influenza and its potential complications represent a substantial burden that increases with age in Japanese individuals.

Increased risk of stroke in non-rheumatic valvular disease associated with antiphospholipid syndrome (APS): a US nationwide study 2017-2019

Abstract Introduction Antiphospholipid syndrome (APS) is an autoimmune syndrome characterized by the presence of antiphospholipid autoantibodies, arterial and venous thrombosis, recurrent pregnancy loss and thrombocytopenia. Cardiac manifestations are also common which include coronary artery disease (CAD), non rheumatic valvular heart disorders (NRVHD), myocardial dysfunction, intracardiac thrombi and pulmonary hypertension. Valvular lesions occur likely due to immune complex deposition on the valves, causing fibrosis, calcification and subsequently valvular deformities. Literature review suggests prevalence of NRVHD in APS population is 30% and left sided valves are more involved than right. An increased risk of stroke has also been seen in APS patients with valvular disorders. Purpose Studies report variations in incidence of NRVHD in association with APS. To estimate the prevalence of NRVHD and their correlation with APS, we conducted a retrospective database analysis of hospitalizations across the United States. Additionally we investigated whether this association indicates a increased risk of ischemic stroke in this specific subpopulation. Methods The national inpatient sample (NIS) from 2017-2019 was queried for adult patients (age&amp;gt;18 yrs) admitted with a primary or secondary diagnosis of APS. These patients were stratified for different NRVHD including tricuspid stenosis, tricuspid insufficiency, pulmonary stenosis, pulmonary regurgitation, mitral stenosis, mitral insufficiency (MI), aortic stenosis (AS), and aortic regurgitation. Baseline risk factors and cardiac complications were compared. Multiple regression analysis was performed to study the association of NRVHD with stroke as the primary outcome in the subpopulation of APS hospitalizations. Results A total of 567600 adult patients hospitalized with diagnosis of APS were identified from the NIS 2017-2019 database. Among those, 33,095 had NRVHD with a mean age of 69 years. Of these, prevalence of males was 52.41% compared to females of 47.59%. In the cohort of APS, patients with NRVHD had a higher prevalence of coronary artery disease (43.78% vs 20.41%), diabetes mellitus (30.65% vs 27.56%), prior stroke (10.42% vs 7.78%) than those without valvular disorders. Among the APS population the most prevalent NRVHD were mitral insufficiency (MI), 2.45% and aortic stenosis (AS), 2.13%. In the cohort of NRVHD in APS hospitalizations, the odds of stroke was found to be 1.3 times higher with statistical significance (confidence interval (CI): 1.13-1.48, p &amp;lt;0.001) adjusted for relevant clinical and demographic risk factors such as tobacco abuse, CAD, diabetes mellitus, prior stroke. Conclusion This study shows 6.2% prevalence of NRVHD in APS population, of which MI and AS were common. NRVHD is also associated with higher odds of stroke in APS. Further studies are warranted in identifying the risk of stroke with NRVHD in APS population and emphasizing the need for early detection.

National Trend of Surgical Stabilization of Rib Fractures: Indications, Approaches, and Disparities

IntroductionRib fractures are among the most frequent injuries in trauma. This study aims to assess the current nationwide trends in operative rib fixation and identify predictors of surgical stabilization of rib fractures (SSRFs). MethodsA 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program database was performed. Adult trauma patients who had at least one rib fracture were included. We analyzed data regarding type of SSRF including open and thoracoscopic approaches and its trends. ResultsA total of 780,275 patients were identified, of which 15,339 patients (1.9%) were managed with SSRF. Trends of both open and endoscopic approaches were increasing during the study period. Patients with ≤2 rib fractures had a decreasing rate of SSRF. Flail chest (odds ratio = 13.42, P < 0.001) was the strongest predictor of SSRF. ConclusionsSSRF is gaining popularity in the management of chest trauma. The presence of a flail segment and multiplicity of rib fractures is among the predictors of SSRF.

Concurrent validity of the Single Assessment Numerical Evaluation and hip-specific patient-reported outcome measures.

The Single Assessment Numerical Evalution (SANE) score is a pragmatic alternative to longer patient-reported outcome measures (PROMs). The purpose of this study was to investigate the concurrent validity of the SANE and hip-specific PROMs in a generalized population of patients with hip pain at a single timepoint upon initial visit with an orthopaedic surgeon who is a hip preservation specialist. We hypothesized that SANE would have a strong correlation with the 12-question International Hip Outcome Tool (iHOT)-12, the Hip Outcome Score (HOS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), providing evidence for concurrent validity of the SANE and hip-specific outcome measures in patients with hip pain. This study was a cross-sectional retrospective database analysis at a single timepoint. Data were collected from 2,782 patients at initial evaluation with a hip preservation specialist using the iHOT-12, HOS, HOOS, and SANE. Outcome scores were retrospectively analyzed using Pearson correlation coefficients. Mean raw scores were iHOT-12 67.01 (SD 29.52), HOS 58.42 (SD 26.26), HOOS 86.85 (SD 32.94), and SANE 49.60 (SD 27.92). SANE was moderately correlated with the iHOT-12 (r = -0.4; 95% CI -0.35 to -0.44; p < 0.001), HOS (r = 0.57; 95% CI 0.53 to 0.60; p < 0.001), and HOOS (r = -0.55; 95% CI -0.51 to -0.58; p < 0.001). The iHOT-12 and HOOS were recorded as a lower score, indicating better function, which accounts for the negative r values. This study was the first to investigate the relationship between the SANE and the iHOT-12, HOS, and HOOS in a population of patients with hip pain at the initial evaluation with an orthopaedic surgeon, and found moderate correlation between SANE and the iHOT-12, HOS, and HOOS. The SANE may be a pragmatic alternative for clinical benchmarking in a general population of patients with hip pain. The construct validity of the SANE should be questioned compared to legacy measures whose content validity has been more rigorously investigated.

Clinical Trends and Outcomes in Technology-Assisted Total Hip Arthroplasty.

Background/Objectives: In recent years, there has been a widespread focus on implementing technology in total hip arthroplasty (THA) to further improve precision and outcomes. This study aimed to identify recent trends in the utilization, clinical variables, and rate of adverse events for technology-assisted THA (TA-THA) and compare the outcomes to those of conventional THA. Methods: This retrospective cohort analysis of the ACS-NSQIP database queried data on THA patients (CPT 27130) from 2015 to 2020. Technology assistance was identified with CPT 20985, 0054T, and 0055T. Matched cohorts were created to compare clinical comorbidities and adverse events. Results: This analysis included 219,216 conventional THAs and 2258 cases utilizing TA-THA. The number and percentage of surgeries utilizing technology, as well as the average operative time, consistently rose from 2015 to 2019, with all declining in 2020. Length of stay decreased yearly from 2015 to 2019, with an increase in 2020. There were no significant differences in the incidence of adverse events by year. Matched cohort analysis demonstrated that TA-THA led to longer operative times (102.6 ± 35.6 vs. 91.6 ± 37.4 min, p < 0.001) and a shorter average length of stay (1.6 ± 1.4 vs. 2.0 ± 1.9 days, p < 0.001). Transfusion rates were higher in the TA-THA cohort (6.0% vs. 4.4%, p = 0.013). Conclusions: The usage of TA-THA increased from 2015 to 2019, with declines during 2020. TA-THA led to longer operative times, increased transfusion rates, and no difference in the incidence of adverse events compared to conventional arthroplasty. These findings demonstrate that TA-THA is growing in popularity without a significant improvement in short-term complication rates.

Survival outcomes of patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation in Germany: real-world evidence from an administrative database between 2010 and 2019.

Limited real-world evidence is available for patients with diffuse large B-cell lymphoma (DLBCL) who received an autologous stem cell transplantation (ASCT) in Germany. This study aims to describe the real-world survival outcomes of patients with DLBCL who received ASCT in Germany after diagnosis. This study is a retrospective database analysis covering the period between 2010 and 2019. Unadjusted overall survival (OS) was plotted using the Kaplan-Meier estimator for the overall population and stratified by relapse status. A Cox regression was run to identify factors that influence OS. A total of 112 patients received an ASCT, with the average time from first-line treatment to ASCT being 11.7 months. The median OS estimated by Kaplan-Meier was 83.4 months for the entire cohort. The only variable that significantly reduced the OS was the presence of subsequent treatment after ASCT in a time-dependent model. OS after ASCT for DLBCL patients in Germany is higher than previously reported and may still be considered a valid option for carefully selected patients with relapsed/refractory DLBCL.

The Route to ROSC: Evaluating the Impact of Route and Timing of Epinephrine Administration in Out-of-Hospital Cardiac Arrest Outcomes

Objectives Previous investigations comparing intraosseous (IO) and intravenous (IV) epinephrine delivery in out-of-hospital cardiac arrest (OHCA) suggest that epinephrine is oftentimes more expeditiously administered via the IO route, but this temporal benefit doesn’t always translate to clinical benefit. However, very few studies adequately controlled for indication and resuscitation time biases, making the influence of first epinephrine route on OHCA outcomes unclear. To determine the association between first epinephrine route and return of spontaneous circulation (ROSC) while controlling for resuscitation time bias and other potential confounders. Methods We conducted a retrospective analysis using the 2020 ESO Data Collaborative dataset. Adult patients with a witnessed, non-traumatic OHCA prior to EMS arrival were included. Logistic regression was used to determine the association between medication route and ROSC. Linear regression was then used to calculate the probability of ROSC for each route across all call receipt-to-drug delivery intervals. Using these linear equations, the call receipt-to-drug delivery intervals were calculated that would yield equivalent probabilities of ROSC between the IV and IO routes. Results Data were available for 10,350 patients, of which 27.4% presented with a shockable rhythm, 29.7% received bystander CPR, and 39.6% experienced ROSC. After controlling for confounders, IO epinephrine was associated with decreased likelihood of ROSC (OR = 0.77, p < 0.001). The linear regression models provided differing slope coefficients for ROSC between each route, with the IV route associated with a higher likelihood of ROSC for any given call receipt-to-drug-delivery interval. From these equations, the additional time allowed to establish an IV and administer epinephrine intravenously beyond the time required for IO delivery, yet with an equivalent predicted probability of ROSC via the IO route, was calculated. This additional time interval for intravenous administration declined linearly from 9 min at a call receipt-to-intraosseous epinephrine interval of 4 min to no additional time at a call receipt-to-intraosseous epinephrine interval of 29 min. Conclusions This retrospective analysis of a national EMS database revealed that IO epinephrine was negatively associated with ROSC. Additionally, there appears to be a finite time window during which intravenous epinephrine remains superior to the intraosseous route even if there are brief initial delays in IV drug delivery.

Impact of Hypoalbuminemia on Outcomes Following Hepatic Resection: A NSQIP Retrospective Cohort Analysis of 26,394 Patients

Background/Objectives: Efforts to preoperatively risk stratify and optimize patients before liver resection allow for improvements in postoperative outcomes, with hypoalbuminemia being increasingly researched as a surrogate for nutrition, overall health and functional status. Given the paucity of studies examining the relationship between hypoalbuminemia and liver resection, this study aims to determine the impact of hypoalbuminemia on outcomes following liver resections using a large multicenter database. Methods: The American College of Surgeons–National Surgical Quality Improvement Program (2017–2021) database was used to extract the data of patients who underwent a hepatic resection. Two cohorts were defined; those with hypoalbuminemia (HA; &lt;3.0 g/L) and those with normal albumin levels (≥3.0 g/L). Both baseline characteristics and 30-day postoperative complication rates were compared between the two cohorts. Multivariable logistic regression models were used to assess the independent effect of HA on various outcomes. Area under curve–receiver operating characteristic (AUC-ROC) curves were used to identify optimal albumin thresholds for both serious complications and mortality. Results: We evaluated 26,394 patients who underwent liver resections, with 1347 (5.1%) having preoperative HA. The HA patients were older (62.3 vs. 59.8; p &lt; 0.001) and more likely to be of an ASA class ≥ 4 (13.0% vs. 6.5%; p &lt; 0.001). The patients with HA had significantly more complications such as an increased length of stay, readmission, reoperation, sepsis, surgical site infection, bile leak, and need for transfusion. After controlling for demographics and comorbidities, HA remained a significant independent predictor associated with both 30-day serious complication rates (aOR 2.93 [CI 95% 2.36–3.65, p &lt; 0.001]) and mortality (aOR 2.15 [CI 95% 1.38–3.36, p = 0.001]). The optimal cut-off for albumin with respect to predicting serious complications was 4.0 g/dL (sensitivity 59.1%, specificity 56.8%, AUC-ROC 0.61) and 3.8 g/dL (sensitivity 56.6%, specificity 68.3%, AUC-ROC 0.67) for mortality. Conclusions: In this large, retrospective database analysis, preoperative HA was significantly associated with 30-day morbidity and mortality rates following hepatic resection. Preoperative albumin may serve as a useful marker for risk stratification in conjunction with pre-existing calculators. Future studies evaluating the risk mitigation impact of nutrition and exercise prehabilitation in these patients and its capacity to modify hypoalbuminemia would be beneficial.

Systemic inflammatory markers: Predictors of survival in mucinous appendix cancer patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

IntroductionInflammatory markers have been investigated as predictors of prognosis in various malignancies, but their role in mucinous appendix cancer (MAC) remains controversial. We evaluated the association between complete blood count-derived markers and survival in MAC patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). MethodsWe conducted a retrospective analysis of a single-center database (1998–2023) including newly diagnosed MAC patients who underwent complete (CC-0/1) CRS/HIPEC. Preoperative values of neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelets-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated. For markers strongly associated with survival, we used time-dependent ROC analysis to define cutoffs to predict 5-year overall survival (OS). The Kaplan-Meier method with and Cox regression were employed for survival analysis. ResultsOf 626 CRS/HIPEC cases, 211 were eligible. NLR (p=0.049), dNLR (p=0.049), and MLR (p<0.001) were significantly associated with OS, while PLR was not. MLR demonstrated the strongest prognostic power (AUC=0.682) with the optimal cut-off 0.29. There were no significant differences in age, grade, or peritoneal cancer index (PCI) between patients with MLR<0.29 and MLR≥0.29. Five-year progression-free (PFS) and OS were 72.2 % and 83.2 % for MLR<0.29 and 54.2 % and 66.6 % for MLR≥0.29, respectively. After adjusting for age, PCI, and grade, MLR≥0.29 was associated with worse 3-year PFS (hazard ratio [HR] 1.74, 95 % confidence interval [CI]:1.02–2.97, p=0.044) and 3-year and 5-year OS (HR 1.87, 95 %CI: 1.00–3.47, p=0.049). ConclusionMLR has emerged as an independent predictor of survival in MAC patients undergoing CRS/HIPEC. Along with other prognostic factors, MLR≥0.29 may be potentially used for preoperative risk stratification.

Impact of the COVID-19 pandemic on sexually transmitted infection testing and diagnosis in Lebanon: A retrospective chart review

BackgroundSocial distancing restrictions during the COVID-19 pandemic caused disruptions to sexual health services (SHS) worldwide. During the first year of the pandemic, Lebanon implemented multiple lockdowns during which SHS endured repetitive closures. We explore the impact of the pandemic on SHS delivery and the diagnosis rate of sexually transmitted infections (STIs) among attendees of a large sexual health clinic in Beirut, Lebanon. MethodsThis was a retrospective analysis of the clinic's database, including data on voluntary counseling and testing (VCT) for HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV). We compared the number and types of services provided, and the number and rate of positive VCT diagnoses pre- (Mar 2019–Feb 2020) and post- (Mar 2020–Feb 2021) COVID-19 onset. ResultsMen who have sex with men (MSM) comprised 35 % and 40 % of attendees pre- and post- COVID-19 onset, respectively. Post-COVID-19 onset, a total of 1350 VCT services and 406 medical consultations were provided, an overall 45 % decrease compared with pre-COVID-19 onset. The prevalence pre-COVID-19 onset of HIV, syphilis, HBV, and HCV was 0.8 %, 0.3 %, 0.2 %, and 0.1 %, respectively, and post-COVID-19 onset 1.2 %, 0.7 %, 0.3 %, and 0.3 %, respectively. Post-COVID-19 onset, 1.7 % of patients tested positive for any STI compared with 1.1 % pre-COVID-19 onset (OR: 1.5, 95%CI: 0.8–2.7). Close to 90 % of all positive diagnoses were among MSM. The prevalence of HIV, syphilis, HBV, and HCV among MSM in the total sample was 2.1 %, 1.2 %, 0.4 %, and 0.3 %, respectively. ConclusionCOVID-19 related closures led to substantial reduction in SHS accessibility among clinic attendees. STI positivity rates increased post-COVID-19 onset, although this increase was not statistically significant. Findings suggest that sexual risk behavior was taking place during the pandemic despite the lockdowns and highlight the need to minimize disruptions in provision of SHS during similar crises, particularly to key populations.