Risk Factor For Worse Outcomes Research Articles

Abstract 16776: Recurrent Admission of Acute Decompensated Heart Failure Among Patients With and Without PAD and Its Significance in the CKD Population: The ARIC Cohort Study

Introduction: Peripheral artery disease (PAD) and chronic kidney disease (CKD) are common comorbidities in patients with heart failure (HF). Importantly, CKD is associated with a greater risk of incident PAD and is a known risk factor for worse outcomes in HF patients. However, it is unclear whether the concomitant existence of PAD and CKD increases the risk of recurrent hospitalization for acute decompensated heart failure (ADHF). Methods: Since 2005, the Atherosclerosis Risk in Communities (ARIC) study has conducted hospital surveillance of ADHF with events verified by physician review. Demographics, comorbidities, laboratory data, and medications were abstracted from medical record by trained personnel. Hazard ratios of ADHF readmissions were analyzed using repeat-events Cox regression. Models were adjusted for age, race, sex, year and hospital of admission, coronary artery disease (CAD), COPD, and diabetes mellitus. CKD was defined by glomerular filtration rate [GFR] ≤60 mL/min/1.73m 2 . Results: From 2005-2018, there were 1049 index hospitalizations for ADHF (mean age 77 years, 66% white) with measured creatinine, who were discharged alive. Of these, 155 (15%) had a diagnosis of PAD and 66% had CKD stage 3a or worse (GFR ≤60 mL/min/1.73m 2 ). Patients with PAD had a greater prevalence of smoking, CAD, myocardial infarction, and stroke. The 1-year ADHF readmission rate tended to be higher in patients with PAD, irrespective of CKD stage, compared to those without PAD ( Figure 1 ). After adjustments, PAD was associated with greater hazards of 1-year ADHF readmissions, both in patients with CKD stage 3a or worse (HR, 1.71; 95% CI: 1.25 - 2.32) and without CKD (HR, 1.84; 95% CI: 1.07-3.15). Conclusion: Patients with ADHF and concomitant PAD have a higher prevalence of cardiovascular comorbidities and higher likelihood of 1-year ADHF readmission, irrespective of the CKD status. Focused strategies to prevent ADHF readmission in this high-risk group are warranted.

Abstract 12729: Leadless Pacemaker Insertion is Safe in Nonagenarians

Introduction: Increased age is associated with increased frailty and often worse postoperative outcomes. We aim to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population. Methods: We queried the National Readmission Database years 2017-2020 for patients who underwent LPM insertion with the ICD10 code 02HK3NZ. Patients with age 90 or more were included in the nonagenarians group. Patient comorbidities were queried through the appropriate ICD 10 codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities. Results: At baseline, nonagenarians had a higher prevalence of hypertension, history of stroke, A fib./A. flutter, dementia and hypothyroidism. The control group had more of diabetes, coronary disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse and chronic liver disease (Table 1). Compared to controls, nonagenarians were found to have shorter length of stay (-2.486 days, p <0.001), lower rate of mortality (aOR 0.696, p 0.0187), lower rates of postprocedural cardiac arrest (aOR 0.301, p 0.0267), mechanical ventilation (aOR 0.378, p <0.001), and vasopressor use (aOR 0.583, p 0.001). Nonagenarians were only found to have increased risk of pericardial complications (tamponade, pericardiocentesis, hemopericardium) (aOR 1.596, p 0.0151). There was no significant difference in 30-day readmissions (aOR 0.97, p 0.696), postoperative bleed (aOR 0.84, p 0.072), or stroke (aOR 0.586, p 0.112). Conclusions: Our study demonstrates LPM insertion is safe in the very elderly population. However this is likely a demonstration of survivorship bias as patients in the nonagenarians group had overall less comorbidities. Even though our analysis adjusted for comorbidities, there are always unknown confounders which cannot be accounted for. Age itself does not seem to be a risk factor for worse outcomes in this population.

Lenalidomide Maintenance in Multiple Myeloma: A Retrospective, Nationwide, Real-World Study

Introduction: Lenalidomide maintenance (LM) has shown progression-free (PFS) and overall survival (OS) benefit in clinical trials and is the recommended standard of care in patients with newly diagnosed multiple myeloma (MM) after high-dose melphalan and autologous stem cell transplantation (HDM-ASCT). In Denmark, LM has been approved for all patients treated with HDM-ASCT since June 2019 and is publicly funded. That LM was made available nationwide simultaneous across all regions creates a unique opportunity to study the real-world use pattern, efficacy, and adverse effects of LM in an unselected, population-based cohort without referral bias. Methods: Patients with newly diagnosed MM treated with their first HDM-ASCT between June 2019 and March 2022 were included and followed until data cut-off in June 2023. To compare outcomes, a historical pre-LM cohort from the Danish MM Registry, consisting of MM patients treated with HDM-ASCT between June 2015 and June 2019, was used. Baseline clinical characteristics were acquired from the Danish MM Registry. To avoid the risk of guarantee-time bias, several strategies were applied. Early discontinuation of LM was studied using landmark analysis at 6 months after initiation of LM. For comparison with the pre-LM cohort, survival time was calculated from date of ASCT to progression or death for PFS and death of any cause for OS. Cox proportional hazards regression was used to calculate hazard ratios. Multivariate adjustment was made for age and sex as well as known risk factors for worse outcome: ISS and high-risk cytogenetics. Results: Lenalidomide maintenance cohort: Among 364 patients treated with HDM-ASCT after June 2019, 22.3% received consolidation therapy, and 3.7% underwent tandem HDM-ASCT. During follow-up, 297 patients (81.6%) initiated maintenance therapy, with 277 (76.1%) receiving LM. Overall, 145 patients (52.3%) discontinued LM most commonly due to toxicity 75 (51.7%), with fatigue (30.7%), cytopenia (25.3%), and neuropathy (17.3%) being the main reasons. During follow up, 119 (32.7%) patients had an event of progressive disease or death and 38 died. Only 1 death was related to Covid-19. To study the impact of early discontinuation of LM on clinical outcomes a 6-month landmark analysis was conducted. Early discontinuation did not negatively impact PFS, HR 0.92 (95% CI: 0.50, 1.70) or OS, HR 1.12 (0.25, 5.12). Results were similar in a 12-month landmark analysis. Comparison to the pre-lenalidomide maintenance cohort: A cohort of 364 multiple myeloma patients treated before the introduction of lenalidomide maintenance was used as comparison (pre-LM cohort). In that we take advantage of the randomness in being treated for MM in the years before and after the approval of lenalidomide. As the inclusion to either cohort was solely defined by the date of HDM-ASCT baseline characteristics were well balanced as expected with a median age of 61.1 vs 61.8 in the LM cohort and pre-LM cohort, respectively. By chance the dates of inclusion resulted in equal numbers of participants in both cohorts. We confirmed that lenalidomide maintenance was not routinely used before the approval in June 2019 by reviewing the electronic records of all patients treated with HDM-ASCT between January and June 2019. Of these, only 3 (7%) received LM, and in each case, LM was initiated just prior to approval. The LM cohort had similar PFS, HR 0.82 (0.65, 1.04), and OS HR 1.22 (0.78, 1.89) compared to the pre-LM cohort in unadjusted analysis, Figure 1. Results were similar after multivariate adjustment. The 3-year PFS and OS rates in the LM cohort were 61% (95 CI: 55%, 67%) and 86% (95 CI: 82%, 91%), respectively, while the pre-LM cohort had a 3-year PFS of 55% (50%, 60%) and a 3-year OS of 89% (86%, 93%). Conclusion: In this study encompassing all Danish patients with MM treated with HDM-ASCT since the introduction LM, we found that LM was initiated in approximately three out of four patients. One third of patients treated with LM discontinued this treatment within the first year, mainly due to toxicity. Early discontinuation of LM was not associated with worse clinical outcomes. When comparing post-transplantation PFS and OS in two cohorts of patients treated before and after the approval of LM, respectively, we found no differences.

COVID-19 and Diabetes Mellitus: Mutual Interplay of Two Diseases.

Currently, when the world is fighting against the rapidly spreading pandemic of COVID-19, the silent epidemic of diabetes should not be set aside. In comparison, while COVID- 19 led to about 6 million deaths in 2021, diabetes caused 6.7 million deaths in the same year. Diabetes mellitus is a serious risk factor for worse outcomes in COVID-19 patients. Moreover, it seems that there is a bidirectional relationship between pre-existing diabetes pandemic and the rapidly spreading COVID-19 pandemic. In this article, we summarize mechanisms by which SARS-CoV-2 infects the host cell and discuss the bidirectional relationship between diabetes and COVID-19. We also focus on clinical variables in which diabetic patients differ from non-diabetic patients and which could have promising predictive value for the course and outcome of diabetic COVID-19 patients' therapy management.

Randomised controlled trial of a behavioural intervention to reduce exposure to PM2.5 in patients with COPD

BackgroundFine particulate matter (PM2.5) is a well-known risk factor for worse outcomes of chronic obstructive pulmonary disease (COPD). However, evidence-based guidance on effective personal behavioural strategies to minimise the effects of PM2.5 is limited. This study aimed to assess the effectiveness of a behavioural intervention in reducing PM2.5 exposure and improving clinical outcomes in patients with COPD. Materials and MethodsParticipants were 1:1 randomised, and the intervention group received a behavioural intervention consisting of five activities, while the control group received usual care. The participants were followed up for 9 months. The primary outcomes were differences in the score of St. George’s Respiratory Questionnaire for patients with COPD (SGRQ-C) and COPD assessment test (CAT) from baseline. ResultsA total of 106 participants were enrolled and 102 completed the study. At the end of the study, the intervention group showed significant improvements in the primary outcomes compared to the control group, with a group difference of −5.9 in the reduction of total SGRQ-C (−3.4 vs. 2.5; p = 0.049) and −3.8 in the CAT score (−1.2 vs. 2.7; p = 0.001). Participants with good adherence to the intervention demonstrated a greater extent of improvement in CAT score and lower PM2.5 levels compared to those who had poor adherence or were in the control group. Regular checking of air quality forecasts was significantly associated with a reduction in CAT scores among all the intervention activities. ConclusionIndividual-level behavioural interventions can be an effective strategy for mitigating the health hazards associated with PM2.5.ClinicalTrials.gov Identifier: NCT04878367.

FRI043 The Double Pandemic Effect Of Obesity And COVID-19 Among United States Adult Hospitalizations: Outlining Hospitalization Outcomes Of A Synergistic Catastrophe

Abstract Disclosure: H. Shaka: None. A. Ilelaboye: None. E. Krishnaraju: None. M. Dasgupta: None. A. Shaka: None. P. Kanemo: None. Introduction: The COVID-19 pandemic exacerbated significant health disparities among adults in the US. Obesity has been on the rise in the US for decades and has been described as a pandemic. Morbid obesity (MO) is a known risk factor for worse outcomes for viral pneumonia including SARS-CoV-2. This study outlined the national impact of the COVID-19 pandemic on the ongoing obesity pandemic and assessed possible healthcare disparities in this population. Methods: The study obtained data from the US National Inpatient Sample from 2016 - 2020. This provides a nationally representative estimate of all US hospitalizations for each calendar year. We assessed rates of MO hospitalizations per 1000 adult hospitalizations yearly. We compared outcomes between 2019 and 2020 to evaluate the COVID-19 pandemic's effect on this population. Outcomes were also stratified by sex, race, and median household income. Results: From 2016 to 2020, hospitalizations involving adults with MO increased by 61%. While national hospitalizations dropped by about 9% in 2020, those involving adults with MO increased by 7.1% compared with 2019 adjusted for age, race, sex, and comorbidity index. In 2020, hospitalized adults with MO had a lower mean age and a higher proportion of men compared to 2019. There was no significant difference in the race, income and comorbidity index distribution of the patients in 2020 compared to 2019. Among adults with MO who died during hospitalization in 2020, about 1 in 5 had COVID-19 as the reason for admission. The mortality rate in all adults with MO increased from 1.5 to 2.7%. This represented an 84.5% higher odds of mortality compared to 2019. Stratification showed that there was an 80.0 vs 88.9% higher mortality in females vs males. Mortality in Hispanics increased by 169.7%, compared to 111.7% in Blacks and 66.8% in Whites. Patients in the lowest income quartile had an increase of 97.2 vs 61.7% in the highest income quartile. There were also significant regional variations in the increase in mortality among hospitalizations with MO. Year on year, total hospitalization charges in the studied population increased by $10 billion to over $156 billion, adjusted for inflation. The year 2020 also saw an overall increase in the length of hospitalizations for adults with MO. Discussion/conclusion: This study provides evidence that at the national level, patients with MO were significantly impacted by the COVID-19 pandemic. This contributed to significant healthcare costs. We recommend a national approach and response to the obesity pandemic as people with morbid obesity are projected to make up to 30% of the US population by 2030. We also highlighted significant racial and economic disparities in the outcomes of these patients. Although the reasons for such disparities are likely multifactorial, this adds to a growing body of evidence of disparities in healthcare across various health conditions. Presentation: Friday, June 16, 2023

THU541 Impact Of Gender On Treatment Decisions And Outcome In Patients With Neuroendocrine Neoplasms

Abstract Disclosure: J. Beck: None. A. Siebenhüner: None. D. Wild: None. E.R. Christ: None. J. Refardt: None. Introduction/Background: Gender differences affect the treatment of several diseases in both male and female patients. However, the influence of gender on treatment decisions and outcome in neuroendocrine neoplasms (NENs) has scarcely been investigated. Aims: Comparison of tumor characteristics, treatment decisions and outcome of patients with NENs, stratified by gender. Material and Methods: Retrospective analysis of the SwissNET cohort involving NENs of gastroenteropancreatic, pulmonal or unknown origin from 07/14 – 09/21. Site of origin, tumor grading, time to first treatment, choice of treatment and overall survival was assessed. Results: 2329 patients were included in the analysis with 54% being male and 46% female patients. No significant difference in site of origin, tumor grading and staging was found between male and female patients. There was also no difference in time of symptoms onset until diagnosis and first treatment intervention. Surgery was performed in 66.3% of male and 71% of the female patients, p=0.016. Meanwhile, male patients received more often PRRT (22% vs 19.3%, p=0.007) and chemotherapy (15.9% vs 12.7%, p=0.032). Despite the similar tumor characteristics, the median overall survival of male patients was significantly lower compared to female patients (Male: 124.8 months, Female: 158.5 months, p<0.001). Interestingly, this difference was most pronounced in patients with lung NENs (Male: 142 months, Female: not reached) and cancer of unknown origin (Male: 18.5 months, Female: 35 months). Conclusions: Male gender seems to be a risk factor for worse outcome, specifically for lung NENs and NENs of unknown origin. The underlying mechanisms of these findings remain to be established. Presentation: Thursday, June 15, 2023

THU322 Lower HbA1c Is Associated With Lower In-Hospital Mortality In Patients With COVID-19

Abstract Disclosure: M. Tsikala Vafea: None. M. Stefanovic-Racic: None. Introduction/Aim: Diabetes has been proven to be a risk factor for worse outcomes in patients with COVID-19. Several studies have shown that poor glycemic control during hospitalization with COVID-19 is associated with higher mortality. However, the association between a long-term glycemic control and outcomes has yet to be clarified, with some studies reporting no association. The aim of this study is to determine the association between glycosylated hemoglobin (HbA1c) and in-hospital mortality in patients with COVID-19. Methods: Pubmed, Embase and Web of Science databases were searched until 11/15/2022, for studies examining the association between HbA1c level and mortality in hospitalized patients with COVID-19. A random-effects meta-analysis was performed. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed using funnel plots. Results: Among 4,142 results, 22 studies were included in the final analysis with a total of 11,998 patients. In the primary analysis, in studies comparing outcomes in patients using HbA1c as a dichotomous variable using specific cutoff values, lower Hba1c was associated with lower in-hospital mortality [odds ratio (OR) 0.52, 95% confidence interval (CI) 0.37-0.72]. Heterogeneity was substantial (I2 78%). When only patients with diabetes were included in the analysis, the association remained statistically significant (OR 0.70, 95% CI 0.51-0.98). In the subgroup analysis, the association remained statistically significant in studies using as cutoff the HbA1c value of 6.5% (OR 0.34, 95% CI 0.15-0.77) and 7% (OR 0.54, 95% CI 0.32-0.90). The association did not remain statistically significant with greater HbA1c cutoff values; 7.5% (OR 1.09, 95% CI 0.91-1.30) and >= 8% (OR 0.78, 95% CI 0.33-1.82). In the secondary analysis, in studies using HbA1C as a continuous variable, HbA1c level did not have a statistically significant association with in-hospital mortality, either in univariate (OR 0.97, 95% CI 0.92-1.03) or multivariate analyses (adjusted OR 1.00, 95% CI 1.00-1.01). Conclusion: A better glycemic control prior to hospitalization, as reflected by lower HbA1c, is associated with lower in-hospital mortality in patients with COVID-19. Presentation: Thursday, June 15, 2023

Factors Associated with Therapeutic Outcomes in the Treatment of Nontraumatic Acute Upper Limb Ischemia at a Tertiary Care Center in South India: A Prospective Analysis

Abstract Background: The outcomes of acute upper extremity ischemia (AUEI) demonstrated lower rates of limb loss (0%–3.1%) and mortality (~6%) compared to acute lower extremity ischemia. However, AUEI still is a challenge for a vascular surgeon as delays in diagnosis and treatment are likely to result in severe functional disability, even in the absence of overt tissue loss. Objectives: The objectives of this study are to determine the association of factors affecting the clinical outcomes of acute upper limb ischemia treatment. Methodology: A single-center prospective observational study was done between July 2021 and July 2023 on patients with AUEI who came to our emergency medicine department at a tertiary care center in South India. The demography, risk factors, duration of ischemia, time from onset of complaints, and primary intervention chosen were recorded. Functional improvement on subsequent follow-up intervals was analyzed to describe the surgical outcome. Results: Of 53 patients with AUEI, 31 (58.5%) had atrial fibrillation. In 81.1% of patients, thrombosis was the primary cause of acute limb ischemia. Most patients belonged to the 2A Rutherford classification (47.2%), followed by 2B (26.4%). Regardless of the severity of ischemia, the patients (n = 10) who arrived after 36 h had a higher rate of amputation (5; 50%). Lower levels of preoperative serum lactate dehydrogenase and serum glutamic-oxaloacetic transaminase were associated with better postoperative outcomes (P = 0.007) and lesser amputation rates (P = 0.017). Lower grades of ischemia, prompt intervention, and early consultation were all linked to better postoperative functional outcomes (P = 0.026). Conclusion: At our facility, AUEI due to cardiac or noncardiac emboli, thrombosis, or both was a significant cause of inhospital morbidity. An important risk factor for worse outcomes was hypertension. The availability of appropriate interventional care, and the timing of presentation after the onset of symptoms are thus significant modifiable factors in lowering the rates of amputation.

COVID-19 and diabetes

Almost immediately after the emergence of the SARS-CoV-2 coronavirus, it was observed that people with chronic diseases, including diabetes, presented an increased risk of hospitalization and mortality. Diabetes can increase the risk of COVID-associated mortality by more than six times. The hypothesis of a bidirectional relationship between COVID-19 and diabetes assumes that diabetes is a risk factor for worse outcomes of COVID-19 treatment and that coronavirus infection is a predisposing factor for newly diagnosed diabetes or hyperglycemic emergencies. New diagnoses or exacerbations of existing diabetes are associated with direct damage to the pancreas or the body's response to chronic inflammation, and ACE receptors play a large role in this pathomechanism. Restrictions implemented in many countries have resulted in poorer control and underdiagnosis of diabetes. In this review, we summarize the impact of acute COVID-19 on people with diabetes, discuss how presentation and epidemiology changed during the pandemic, and consider the broader impact of the pandemic on patients and healthcare delivery.

Perioperative extracorporeal membrane oxygenation support for pulmonary endarterectomy: A 17-year experience from the UK national cohort

Pulmonary endarterectomy (PEA) is the guideline-recommended treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, some patients develop severe cardiopulmonary compromise before surgery, intraoperatively, or early postoperatively. This may result from advanced CTEPH, reperfusion pulmonary edema, massive endobronchial bleeding, or right ventricular (RV) failure secondary to residual pulmonary hypertension. Conventional cardiorespiratory support is ineffective when these complications are severe. Since 2005, we used extracorporeal membrane oxygenation (ECMO) as a rescue therapy for this group. We review our experience with ECMO support in these patients. This study was a retrospective analysis of patients who received perioperative ECMO for PEA from a single national center from August 2005 to July 2022. Data were prospectively collected. One hundred and ten patients (4.7%) had extreme cardiorespiratory compromise requiring perioperative ECMO. Nine were established on ECMO before PEA. Of those who received ECMO postoperatively, 39 were for refractory reperfusion lung injury, 20 for RV failure, 31 for endobronchial bleeding, and the remaining 11 were for "other" reasons, such as cardiopulmonary resuscitation following late tamponade and aspiration pneumonitis. Sixty-two (56.4%) were successfully weaned from ECMO. Fifty-seven patients left the hospital alive, giving a salvage rate of 51.8%. Distal disease (Jamieson Type III) and significant residual pulmonary hypertension were also predictors of mortality on ECMO support. Overall, 5- and 10-year survival in patients who were discharged alive following ECMO support was 73.9% (SE: 6.1%) and 58.2% (SE: 9.5%), respectively. Perioperative ECMO support has an appropriate role as rescue therapy for this group. Over 50% survived to hospital discharge. These patients had satisfactory longer-term survival.

The association of comorbid depression with mortality and amputation risk in patients with chronic limb-threatening ischemia

ObjectiveThere is increasing evidence that depression is a risk factor for worse outcomes in patients with peripheral artery disease. The association of depression in patients with chronic limb-threatening ischemia (CLTI) is not well described, nor is the impact of medical treatment for depression in this patient population. The objective of this study was to investigate the prevalence of depression in patients with CLTI, its association on major amputation and all-cause mortality, and whether medical antidepressant treatment is associated with improvement in these outcomes in patients with depression. MethodsA retrospective review of all adult patients (≥18 years old) diagnosed with CLTI from January 1, 2007, to December 31, 2018, at a single academic medical center was performed. Collected data included patient demographics, comorbidities, and diagnosis of depression within 6 months of initial CLTI diagnosis. We also collected data on use of antidepressant medications. Outcomes evaluated were need for major lower extremity amputation and all-cause mortality. Multivariable logistic regression models estimated the adjusted effects of comorbid depression and antidepressant medication use on major amputation and all-cause mortality. Kaplan-Meier survival curves illustrated the probabilities of survival and limb salvage over time, stratified by diagnosis of comorbid depression. Multivariable Cox proportional hazards models estimated the adjusted effects of comorbid depression on time to major amputation and all-cause mortality, and the adjusted effect of antidepressant treatment on time to all-cause mortality. ResultsA total of 2987 patients with CLTI were identified. Mean age was 68.6 years (standard deviation, 12.9 years); 56.5% were male, and 43.5% were female. Comorbid depression within 6 months of CLTI diagnosis was present in 7.1% of the cohort (212 patients). In multivariable analysis, comorbid depression was associated with a 68% increase in the odds of major amputation (adjusted odds ratio [aOR], 1.68; 95% confidence interval [CI], 1.19-2.37; P < .01), a 164% increase in the odds of all-cause mortality among patients not taking antidepressants (aOR, 2.64; 95% CI, 1.31-5.32; P = .03), and only a 6% increase in the odds of all-cause mortality among patients taking antidepressants (aOR, 1.06; 95% CI, 0.72-1.55; P = .99). The effect of comorbid depression on mortality varied significantly by whether or not the patient was taking an antidepressant medication (P = .02). ConclusionsComorbid depression in the patient population with CLTI is associated with a worse prognosis for major lower extremity amputation overall, and a worse prognosis for all-cause mortality among patients not taking an antidepressant. Furthermore, antidepressant treatment in the presence of comorbid depression in this patient population is associated with an improvement in the odds of all-cause mortality, illustrating the potential importance of medical management of depression.

Outcomes of emergency colorectal surgery in elderly population.

To assess the outcomes of emergency colorectal surgeries in elderly patients over the age of 65 years. This is a retrospective chart review study. We studied 99 patients over the age of 65 years and 142 patients younger than 65 years who underwent emergency colorectal surgery at our institute. In this study, patient demographics, operative results, length of hospital stay, and survival were analyzed. Emergency colorectal surgery was performed on a total of 145 men and 96 women. Patients over the age of 65 years were found to have a significantly greater proportion of pulmonary, cardiac, and endocrine comorbidities (27.3%, 84.8%, and 65.7%, respectively). The mean length of hospital stay was 26.0±32.1 days in the group of elderly patients and 17.8±22.0 days in the group of patients under the age of 65. The length of postoperative hospital stay was significantly greater in the group of elderly patients with a p-value (0.00). The length of hospital stay in the intensive care unit was 8.86±17.1 days, which was longer in the group of elderly patients, while it was 3.65±11.4 days for the group of younger patients. However, after logistic regression, the difference in the length of post-operative hospital and intensive care unit stays between elderly and non-elderly patients was not statistically significant in elderly patients. Our study suggests that the elderly population are associated with longer hospital stay and higher rates of postoperative pulmonary and cardiovascular complications compared to those under the age of 65. However, after logistic regression, age by itself was not found to be an independent risk factor for worse outcome indicating that patient comorbidities as a whole increase the risk of worse outcomes. Therefore, the care of elderly patients undergoing emergency colorectal surgery should be individualized based on several factors rather than age alone.

537 Epidemiology of Elderly Burn Injuries – A Five Decade Single Center Retrospective Review

Abstract Introduction Age has long been known to be an independent risk factor for worse outcomes in burn patients. In comparison to younger patients, geriatric patients have higher morbidity and mortality. As the median age of the US population has increased, we have seen a greater proportion of elderly burn patients at our burn unit over the last five decades. Methods Retrospective chart review was performed for all burn patients admitted to our burn unit between 2000 and 2019. Demographics and outcomes data was collected for geriatric patients (age 65 and older). This was compared to historic data available for our burn unit between 1972 to 2000. Results Between 2000 to 2019, our burn unit admitted a total of 5881 burn patients of all ages. There were 652 (11%) geriatric patients admitted. The proportion of geriatric patients admitted statistically significantly increased over that period. Meanwhile, length of stay and mortality statistically significantly decreased in the 2000-2019 time period compared to the previous period. The main mechanism of burn injury was flame exposure. Compared to data on geriatric burn patients from 1972 to 2000, mortality has decreased substantially. In the 1970s mortality was 77% compared to 21% in the past decade. The mortality rate increased significantly with age, TBSA and inhalation injury over both time periods. Conclusions Though lagging behind younger age groups, overall survival and outcomes are improving in elderly burn patient due to advances in critical care and surgical burn management. Acknowledging the unique characteristics of this group of patients, such as impaired healing and multiple comorbidities, allows for improved outcomes. Applicability of Research to Practice Burn centers should notice and prepare for an increasing trend in elderly burn patient admission.

Impact of newly diagnosed extramedullary myeloma on outcome after first autograft followed by maintenance: A CMWP-EBMT study.

No adequate data exist on the impact of multiple myeloma (MM) with extramedullary disease (EMD) after autograft and maintenance therapy. We identified 808 patients with newly diagnosed MM who received first autograft, of whom 107 had EMD (83 paraskeletal and 24 organ involvement), and who had been reported to the EBMT registry December 2018. Distribution according to type of involvement was similar between the treatment groups (p = .69). For EMD, 46 (40%) received thalidomide, 59 (51%) lenalidomide, and 11 (10%) bortezomib. The median follow-up from maintenance start was 44 months. Three-year progression-free survival (PFS) was 52% (48%-57%) for no EMD, 56% (44%-69%) for paraskeletal involvement, and 45% (22%-68%) for organ involvement (p = .146). Early PFS (within first year) appeared to be significantly worse for organ involvement (hazard ratio, 3.40), while no significant influence was found after first year from maintenance start. Three-year overall survival (OS) was 81% (77%-84%), 88% (80%-96%), and 68% (47%-89%; p = .064), respectively. With thalidomide as reference, lenalidomide was significantly associated with better PFS and OS, whereas bortezomib appeared to improve outcome specifically in EMD. Lenalidomide maintenance is standard of care for MM without EMD, whereas extramedullary organ involvement remains a significant risk factor for worse outcome, especially for early events after maintenance start.

Hypovitaminosis C in Surgical Patients: an Under-recognized but Modifiable Risk Factor for Worse Outcomes? A Single-Institution Prospective Study

Hypovitaminosis C in Surgical Patients: an Under-recognized but Modifiable Risk Factor for Worse Outcomes? A Single-Institution Prospective Study

Prior Concussion History and Clinical Recovery After Sport-Related Concussion in High School Athletes.

Clinical recovery after sport-related concussion varies as a function of pre-injury and acute factors. Whether, or the extent to which, concussion history is associated with clinical outcome after sport-related concussion is uncertain, because research has produced mixed findings. The present study aimed to assess whether a history of previous concussions was associated with prolonged clinical recovery after a subsequent sport-related concussion. The sample comprised 780 adolescent student athletes (mean age = 16.3, standard deviation = 1.3 years; 56.8% boys, 43.2% girls) whose school participated in the Maine Concussion Management Initiative (MCMI). Survival analyses were used to compare recovery times among adolescents with a history of 0, 1, or ≥2 previous concussions after a subsequent sport-related concussion. The two primary outcomes of interest were the number of days to return to school and sports. There were no statistically significant differences in total time to return to school and sports, or the proportion of adolescents who returned to school and sports at most intervals (e.g., 7, 14, 28 days), between those with 0, 1, or ≥2 previous concussions. A greater proportion of adolescents, however, with a history of ≥2 previous concussions remained out of sports at 28 days compared with those with no previous concussions (23.5% vs. 12.7%; odds ratio [OR] = 2.10, 95% confidence interval [CI] 1.18-3.73). Having sustained prior concussions was not associated with time to return to school after a subsequent sport-related concussion. A greater proportion of adolescents, however, with two or more previous concussions experienced a prolonged return to sports. Further research is warranted to identify risk factors for worse outcomes among the subset of adolescents with a history of multiple previous concussions who experience prolonged recoveries.

Risk factors for outcome and mortality in hospitalized geriatric patients with SARS-CoV-2 infection : Data from a hospital of maximum care during in the period of the second corona wave 2020/2021 in Germany

From autumn 2020 until spring 2021 Germany experienced the second wave of SARS-CoV‑2 infections. As in the previous wave, the older population in nursing homes was hard hit by this infection because of the lack of available vaccines. Due to the multimorbidity in this susceptible group the mortality was high. Retrospectively collected patient data of geriatric patients treated from 1 October 2020 to 31 March 2021 due to proven SARS-CoV‑2 infection were evaluated concerning the duration of symptoms, hospital stay, and laboratory results. The results are presented descriptively and significance tests were performed with t‑test and log-rank test to reveal some risk factors for a worse outcome. A total of 168patients aged from 65 to 97years were included, with amean mortality rate of 28% and was highest in the age group over 90 years old. Most patients died within the first 10days of hospitalization. Intensive care treatment prolonged the hospital stay by 6days, but the average survival time became equal at the end. Risk factors for worse outcome and the need of intensive care treatment were neutrophilia, lymphopenia, high levels of ferritin and high D‑dimer levels on the day of admission. Age, short duration of symptoms and pre-existing dementia, administration of neuroleptic drugs and antidepressants increased the risk of death.

Obesity is a risk factor for worse asthma exacerbation outcomes in the United States

Obesity is an important risk factor for the development of asthma and increased asthma morbidity. Large epidemiological studies addressing the impact of obesity on near-fatal asthma events are lacking. Here we determine if obesity is a risk factor for worse outcomes in asthma patients with an exacerbation.

P747 The impact of COVID-19 on patients with Inflammatory Bowel Disease: A population-based study using artificial intelligence

Abstract Background Coronavirus disease 2019 (COVID-19) has been a pandemic that is still very prevalent. Patients with Inflammatory Bowel Disease (IBD) represent a special population considering their already altered immune system and their exposure to several immunosuppressive therapies. We pretend to study the impact of COVID-19 on IBD patients in our community, Castilla-La Mancha (a region in central Spain). Methods Retrospective observational study using an artificial intelligence with natural language processing capability, the SAVANA manager, we analyzed data from 1 808 010 patients with Electronic Medical Records (EMR) within the public health system of Castilla-La Mancha from March 1st 2020 to January 1st 2021. Data on demographic characteristics, hospitalization, ICU admission and mortality were collected. We compared COVID outcomes between IBD and non-IBD patients. We compared COVID outcomes in IBD patients according to their treatment (comparing each treatment group to those IBD patients with no treatment); we considered: immunomodulators (azathioprine, mercaptopurine, methotrexate), antiTNF alone or combined with immunomodulator, vedolizumab, ustekinumab and tofacitinib; mesalazine and corticosteroids were not analyzed. Results 2 243 patients with IBD suffered COVID-19, compared to COVID-19 cases without IBD there were less females, they suffered more arterial hypertension, diabetes mellitus, dyslipidemia, obesity, or tabacco use (TABLE 1). And yet, despite these being proven risk factors for worse outcomes for COVID-19, no differences were appreciated in hospitalization rate, ICU admission, or mortality between those with or without IBD (TABLE 2). COVID-19 was more frequent in IBD patients (32.59 vs 13.28%). Comparing IBD patients with COVID-19 according to their treatments (TABLE 3), vedolizumab is the only treatment with a higher risk for COVID-19 infection, however the hospitalization risk for vedolizumab is lower than for those without it. Immunomodulators do also have a lower hospitalization risk both alone or in combination with antiTNF, no differences were found for antiTNF monotherapy, ustekinumab or tofacitinib. ICU rate and mortality are no different between treatments, except for tofacitinib (0.00% ICU rate, 10.00% mortality), however the small number of patients using this treatment may bias this result. Conclusion COVID-19 in IBD patients is no different in hospitalization, ICU admission or mortality compared to non-IBD population. IBD patients exposed to immunomodulators and vedolizumab have less hospitalization risk than those not exposed, no differences were found for antiTNF alone or ustekinumab. The impact of tofacitinib in COVID outcomes requires further investigation.