Short-term Outcomes In Patients Research Articles

3-Year Survival Outcomes of Patients with Enhanced Recovery After Surgery vs. Conventional Care in Laparoscopic Distal Gastrectomy: The GISSG1901 Randomized Clinical Trial.

The efficacy of enhanced recovery after surgery (ERAS) to improve the prognosis of patients who undergo laparoscopic distal gastrectomy (LDG) for gastric cancer is uncertain. This randomized study compared oncological outcomes in LDG after ERAS or conventional care. At present, randomized controlled trials have confirmed that ERAS can improve the short-term clinical outcomes of patients undergoing LDG, but whether it improves survival has not been reported yet. A multicenter, randomized, controlled trial was performed to compare oncological outcomes of ERAS versus conventional care in LDG. Between April 4, 2019, and March 18, 2020, 527 patients with locally advanced lower gastric adenocarcinoma were recruited from 13 centers in China. The primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS). The secondary endpoints were complications, mortality, recovery, time of receiving adjuvant chemotherapy and medical expenses. The full analysis set included 186 cases in the ERAS group and 184 in conventional group, well balanced with respect to patient demographics and baseline characteristics (published before). Postoperative hospital stay and the interval before adjuvant chemotherapy were obviously shorter in the ERAS group compared to conventional group as reported previously and with lower medical expenses. Compared with the conventional group, ERAS group had fewer overall complications (21.0% vs. 30.4%, respectively; P=0.037). The median (IQR) follow-up for all cases was 42.17 (range, 3.12-48.50) months. The 3-year OS and DFS in the ERAS group and conventional group were 86.56% and 80.11% (log-rank P=0.025), 79.57% and 69.57% (log-rank P=0.027), respectively. In a subgroup analysis of stage I and II disease patients, 3-year OS and DFS were similar between the groups (P=0.901; P=0.859 for stage I and P=0.421; P=0.459 for stage II). However, in the stage III disease, the ERAS group exhibited longer 3-year OS and DFS than the conventional group (79.41% vs. 64.47% for OS, log-rank P=0.046; 70.59% vs. 53.95% for DFS, log-rank P=0.046). Patients undergoing ERAS LDG had fewer overall complications, shorter hospital stay, decreased medical expenses, and improved 3-year OS and DFS rates, particularly in cases with stage III gastric cancer.

Overview of perianeurysmal edema following the endovascular management of cerebral aneurysms: A pooled analysis of 48 cases.

Perianeurysmal edema occurring after endovascular treatment for cerebral aneurysms is uncommon compared to surgical clipping. The clinical aspects and the exact explanation are poorly understood. We searched PubMed, Google Scholar, and Web of Science. We used the following keywords: "endovascular management of cerebral aneurysms," "perianeurysmal cerebral edema," "perianeurysmal cerebral edema after endovascular treatment endovascular treatment," "intracranial aneurysms with perianeurysmal edema," and "vessel wall enhancement after endovascular therapy." For each case, demographic, clinicopathological, therapeutic, and follow-up data were gathered and analyzed. Perianeurysmal edema after endovascular treatment has a clear female predilection, with a male: female ratio of 12:29 (25%; 60.41%). The average time from EVT to the onset of edema ranged from 1day to about 8years. The aneurysm dimension ranged from 6.8 to 25mm as the largest size reported. Most patients were asymptomatic (18 [37.5 %]), and headache was the presenting symptom in 10 patients (20.8%). Aneurysmal wall enhancement was reported in 16 (33.3 %) patients with perianeurysmal edema. About 12 patients (25%) developed post-EVT hydrocephalus. The most common coil used was the platinum type (31 [64.58%]). Most of the patients were treated expectantly with follow-up (17 [35.41 %]), while steroids were used only in 14 (29.16%) patients. Most of the patients have their edema resolved (29 [60.41%]) or stable (9 [37.5%]). There is growing evidence supporting the incidence of post-embolization inflammatory reactions involving the vessel wall and the surrounding parenchyma; however, the exact clinical perspectives and the predisposing factors are not fully uncovered. This analysis highlights the possible presentations and short-term outcome of patients presenting with perianeurysmal edema after endovascular management of cerebral aneurysms.

Predictive value analysis of albumin-related inflammatory markers for short-term outcomes in patients with In-hospital cardiac arrest

ABSTRACT Objective This study investigated the predictive value of albumin-related inflammatory markers for short-term outcomes in in-hospital cardiac arrest (IHCA) patients. Methods A linear mixed model investigated the dynamic changes of markers within 72 hours after return of spontaneous circulation (ROSC). Time-Dependent COX regression explored the predictive value. Mediation analysis quantified the association of markers with organ dysfunctions and adverse outcomes. Results Prognostic Nutritional Index (PNI) and RDW-Albumin Ratio (RAR) slightly changed (p > 0.05). Procalcitonin-Albumin Ratio (PAR1) initially increased and then slowly decreased. Neutrophil-Albumin Ratio (NAR) and Platelet-Albumin Ratio (PAR2) decreased slightly during 24-48 hours (all p＜0.05). PNI (HR = 1.646, 95%CI (1.033,2.623)), PAR1(HR = 1.69, 95%CI (1.057,2.701)), RAR (HR = 1.752,95%CI (1.103,2.783)) and NAR (HR = 1.724,95%CI (1.078,2.759)) were independently associated with in-hospital mortality. PNI (PM = 45.64%, 95%CI (17.05%,87.02%)), RAR (PM = 45.07%,95%CI (14.59%,93.70%)) and NAR (PM = 46.23%,95%CI (14.59%,93.70%)) indirectly influenced in-hospital mortality by increasing SOFA (central) scores. PNI (PM = 21.75%, 95%CI(0.67%,67.75%)) may also indirectly influenced outcome by increasing SOFA (renal) scores (all p＜0.05). Conclusions Within 72 hours after ROSC, albumin-related inflammatory markers (PNI, PAR1, RAR, and NAR) were identified as potential predictors of short-term prognosis in IHCA patients. They may mediate the adverse outcomes of patients by causing damages to the central nervous system and renal function.

Best Available Outcomes Evidence Informing Standard of Care

Summary: Although nonoperative management is the mainstay for rib fracture treatment, surgical stabilization of rib fractures is becoming more common. Recently, the number of high-quality studies on management of rib fractures has also increased. The primary purpose of this review is to analyze the currently available prospective randomized studies on the management of rib fractures. In addition, we will summarize both short-term and long-term outcomes of patients with rib fractures.

Etiology, clinical profile and short-term outcome of patients undergoing pericardiocentesis at tertiary cardiac care center.

Etiology, clinical profile and short-term outcome of patients undergoing pericardiocentesis at tertiary cardiac care center.

The Effect of Preoperative Smoking Status on Carotid Endarterectomy Outcomes in Asymptomatic Patients

The current medical landscape lacks comprehensive data regarding the impact of preoperative smoking status on both short and long-term outcomes for patients undergoing Carotid Endarterectomy (CEA). This study seeks to elucidate the influence of smoking cessation on in-hospital and long-term outcomes in this patient population. Data were collected from the Vascular Quality Initiative (VQI) for all asymptomatic patients who underwent CEA from 2016 to 2023. Outcomes were compared across three different smoking status groups: never smoke (NS), current smoker (CS), and quit >30 days ago (Q30). Our primary outcomes included: in-hospital stroke, death, and MI. Secondary outcomes included 1-year and 3-year death. We used inverse probability of treatment weighting (IPTW) to balance the following preoperative factors: age, gender, race, ethnicity, BMI, diabetes, CAD, prior CHF, renal dysfunction, COPD, HTN, prior CABG/PCI, prior CEA/CAS, degree of stenosis, urgency, anesthesia type, and medications. The final analysis included 85,237 CEA cases with 22,343 (26.2%) NS, 41,731 (49.0%) Q30, and 21,163 (24.8%) CS. Notably, NS tended to be older and more likely to be female. On the other hand, patients who Q30 were more likely to have comorbidities including: obesity, CAD, prior CHF, CKD, as well as prior procedures. Patients who are CS were more likely to have COPD and stenosis >80%. After IPTW, we found no statistical difference for in-hospital stroke, death, MI outcomes across the three groups. However, the long-term outcomes revealed Q30 and CS compared to NS had higher odds of 1-year death (OR= 1.4 [95% CI: 1.2-1.5] P<0.001; OR= 1.4 [95% CI: 1.2-1.6] P<0.001) and 3-year death (OR= 1.5 [95% CI: 1.3-1.6] P<0.001; OR= 1.5 [95% CI: 1.4-1.7] P<0.001), respectively. There was no significant difference in mid-term mortality outcomes between Q30 and CS. In this large national study, we found that smoking status did not emerge as a substantial determinant of adverse short-term outcomes for asymptomatic patients undergoing CEA. However, smoking did adversely affect mid-term mortality in these patients. In light of these findings, our study suggests that delaying CEA for smokers may not be warranted. It is crucial to recognize that the complex relationship between smoking and surgical outcomes requires further exploration and validation through additional prospective studies.

Inferior short-term survivorship and patient outcomes for cementless compared to hybrid fixation with a cemented femoral implant in a novel blade-anchored medial unicompartmental knee arthroplasty design: An analysis of 132 cases

PurposeFor younger, more active patients, a cementless unicompartmental knee arthroplasty (UKA) might be more advantageous than cemented fixation. Therefore, this study aimed to compare implant survivorship and patient-reported outcome measures (PROMs) between cementless and hybrid fixation (cemented femur and cementless tibial fixation) in a novel tibial blade-anchored, medial UKA design. MethodsTwo surgeon’s registries were reviewed for patients who underwent primary cementless or hybrid medial UKA for medial osteoarthritis between 2019 and 2022. Patients were included if implant survivorship and one-year postoperative PROMs (UCLA-activity score, Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), pain (VAS) and satisfaction) were registered. Variables were compared using independent two-sample t-tests or the Chi-square test. Survival rates were determined using the Kaplan-Meier models and compared using the Log-rank test. ResultsA total of 132 knees were included (cementless 58.3%; cemented 41.7%; mean follow-up 3.1 ± 0.6 years). Three-year all-cause revision survival rate was significantly superior for the hybrid fixation (hybrid: 100%; cementless 88.5%[84.7%–92.3%], p = 0.026). However, the difference in three-year conversion rate to total knee arthroplasty (TKA) did not reach statistical significance. The one-year postoperative OKS (hybrid: 42.9 ± 4.8; cementless: 39.8 ± 6.4, p = 0.003) and KOOS-JR (hybrid:81.5 ± 13.7; cementless: 74.4 ± 12.1, p = 0.002) were significantly superior for the hybrid fixation. Three-year conversion rate to TKA and two-year postoperative PROMs did not significantly differ. ConclusionThe cementless medial UKA demonstrated a significantly inferior short-term all-cause survival rate and inferior postoperative one-year OKS and KOOS-JR compared to the hybrid medial UKA design with a cemented femoral component.

Subjective global assessment for nutritional screening and its impact on surgical outcomes: A prospective study in older patients with colorectal cancer

PurposeOur perioperative management center provides preoperative intervention and functional and nutritional assessments for colorectal cancer patients aged over 75 years. This study evaluated the associations of preoperative nutritional status with postoperative outcomes and prognosis in colorectal cancer patients aged 75 years or older.MethodsThis was a prospective, observational study of 71 colorectal cancer patients aged 75 years or older who underwent surgery between July 2020 and September 2022. The Subjective Global Assessment (SGA) was evaluated as a nutritional index. The patients were classified into three groups: SGA-A (well nourished), B (moderately malnourished), and C (severely malnourished), and the correlations with postoperative outcomes and prognosis were examined.ResultsThe median age of the 71 patients (34 males, 37 females) was 78 (75–92) years, and their median body mass index (BMI) was 22.3 (13.4–31.9) kg/m2. Forty-eight patients had colon cancer, and 23 had rectal cancer. On the SGA, 28 patients were SGA-A, 25 SGA-B, and 18 SGA-C. The SGA-B/C group had significantly higher BMI (p < 0.01) and more ICU admissions (p = 0.02). The G8 score was significantly lower (p = 0.03) in the SGA-B/C group, suggesting coexisting functional decline. In terms of postoperative outcomes, the SGA-B/C group had a significantly longer postoperative hospital stay (p = 0.04). The 3-year OS rates for all stages were 100% in the SGA-A group and 49.7% in the SGA-B/C group (p = 0.03), while the 3-year OS rates for patients excluding Stage IV were 100% in the SGA-A group and 68.5% in the SGA-B/C group, not significantly different (p = 0.14). The 3-year RFS rate was 95.5% in the SGA-A group and 65.3% in the SGA-B/C group (p = 0.15).ConclusionThe SGA is a promising nutritional index associated with short-term outcomes in older patients undergoing colorectal cancer surgery. The SGA can be assessed in a few minutes during an outpatient visit, making it useful for routine clinical use.

Morbid obesity is associated with outcomes in patients undergoing vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures: a nationwide inpatient sample analysis

BackgroundOsteoporotic vertebral compression fractures (OVCF) significantly affect older adults, leading to considerable morbidity and healthcare costs. Despite the known health risks of morbid obesity, its impact on surgical outcomes of...

The relationship between composite inflammatory indicators and short-term outcomes in patients with heart failure

BackgroundInflammatory markers are considered reliable indicators for predicting adverse outcomes of cardiovascular disease. However, the prognostic significance of composite inflammatory indicators such as the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and inflammatory prognosis index (IPI), in predicting mortality among heart failure (HF) patients remains unknown. MethodsWe analyzed data from 1981 patients with HF. The composite inflammatory indicators were calculated based on laboratory test. The endpoint of the study was mortality within six months of follow-up. Cox proportional hazards model and restricted cubic spline analysis were used to assess the association between inflammatory markers and outcomes. The incremental predictive value of composite inflammatory indicators was evaluated using C-index, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI). ResultsSII, SIRI, and IPI were linearly associated with the risk of death. Compared to the first tertile, the hazard ratios and 95 % confidence intervals (CIs) for mortality in patients in the third tertile for SII, SIRI, and IPI were 2.32 (1.15–4.67), 3.59 (1.56–8.26), and 4.16 (1.20–14.41), respectively. Incorporating composite inflammatory indicators into the basic model significantly enhanced outcome prediction, with IPI showing the greatest incremental predictive value, as indicated by an increase in C-index (0.042, 95 % CI: 0.004–0.095), a continuous NRI of 0.712 (95 % CI: 0.360–1.063, P < 0.001), and an IDI of 0.010 (95 % CI: 0.001–0.019, P = 0.030). ConclusionsAmong patients with HF, elevated levels of SII, SIRI, and IPI were significantly associated with an increased risk of six-month mortality, with IPI providing the greatest incremental predictive value.

Improving acute care outcome in internal medicine: the role of early stabilization and intermediate care unit.

The progressive reduction of acute care beds will necessitate hospital admission in medical settings solely for acutely ill patients requiring urgent organ support. Early stabilization of the acute condition, potentially through an appropriate treatment unit, may not only improve short-term patient outcomes but also reduce the length of hospital stay. To determine if stabilization of the acute condition in an intermediate care unit (IMCU) is associated with improved patient outcomes and reduced in-hospital stay. A prospective exploratory pilot observational study was conducted at the Department of Internal Medicine of the Alto Vicentino Hospital (Italy), including all patients admitted for non-intensive acute conditions between September and December 2022. The primary endpoint of the study was stabilization of the acute condition within 72h of admission. Three hundred twenty four patients were enrolled. 73.5% (238/324) of patients achieved stabilization at 72h, compared to 26.5% (86/324) who did not achieve stabilization. Among the variables found to be significant in the multivariate analysis, admission to the IMCU was associated with achieving stabilization within 72h with an odds ratio of 2.28 (95% CI 1.29-4.01, p < 0.004). Meanwhile, for 30-day mortality, patient stabilization was found to be protective with an odds ratio of 0.11 (95% CI 0.04-0.29, p < 0.001). Early stabilization is associated with lower 30-day mortality and shorter lengths of stay. Treatment in an IMCU shows higher rates of 72-h stabilization.

Bowel Colonization With Carbapenem-Resistant Bacteria Is Associated With Short-Term Outcomes in Patients With Acute-On-Chronic Liver Failure.

Bowel colonization with antimicrobial-resistant bacteria has been associated with worse clinical outcomes in patients with cirrhosis; however, it has not been studied in patients with acute-on-chronic liver failure (ACLF). We evaluated whether fecal isolation of carbapenem-resistant gram-negative bacteria (CR-GNB) among patients with ACLF affects short-term outcomes. Patients of APASL-ACLF (n = 339) were screened between June 2020 and December 2021, and 150 were included. Stool cultures were carried out at baseline and every 5 days thereafter until discharge or death. All surviving patients were followed until 60 days after discharge. Mean age was 44.8 (8.8) years, with 86% males and alcohol as etiology in 66%. CR-GNB organisms were isolated from stool in 42% of hospitalized ACLF patients, with E. coli and Klebsiella pneumoniae as the most common species. Patients with CR-GNB fecal carriage were associated with higher CTP, MELD, and DF scores but not with recent antibiotics, proton pump inhibitors, or lactulose use. Extraintestinal infections developed in 59.3% overall, most commonly UTI, pneumonia, and SBP. Infectious complications developed in 57.3% and 19.7% with and without CR-GNB in the stool (RR: 5.5; p < 0.001). Peripheral cultures were positive in 60.7% with infections, with species concordant with the fecal isolates found in 90.7%. Isolation of CR-GNB from stool and high bilirubin were independently associated with both in-hospital mortality and 60-day mortality (p = 0.05). Hospitalized ACLF patients with CR-GNB in the stool have a significantly higher risk of extraintestinal infections, in-hospital mortality, and short-term mortality up to 60 days. [NCT04383106].

Determining Outcomes in Patients With Large Vessel Occlusion and Mild Stroke Who Did or Did Not Receive Thrombolytics and/or Thrombectomy

Objectives: The utility of thrombolysis and/or thrombectomy in patients with mild stroke and large vessel occlusion (LVO) remains inconclusive. This retrospective study compared short-term and long-term outcomes in patients treated with best medical therapy (BMT group) versus with intravenous thrombolytics and/or endovascular thrombectomy (intervention group). Methods: Patients with acute ischemic stroke (AIS), LVO, and National Institutes of Health Stroke Score (NIHSS) ≤5 were included. Data collected includes demographics; hospital length of stay (LOS); modified Rankin scale (mRS) at admission, discharge, and follow-up; hemorrhagic conversion; and disposition. Bivariate analyses were conducted to compare outcomes between groups. Results: Of the 29 patients, 15 were treated with BMT and 14 underwent intervention. Median hospital LOS was slightly longer in the intervention group (6.5 [IQR=4 to 12] vs. 5 [IQR=3 to 5] d, P=0.070). Everyone in the BMT group had a favorable outcome (mRS 0 to 2) at discharge and follow-up, unlike the intervention group’s rate at discharge (100% vs. 71.4%, P=0.042), This gap was closed at follow-up between BMT group (median=33 d, IQR=28 to 48) and intervention group (median=44.5 days, IQR=30 to 48) (100% vs. 85.7%, P=0.224). Hemorrhagic conversion rates were similar between groups. More patients in the BMT group were discharged home (80% vs. 42.9%, P=0.079). Conclusions: Patients with AIS, low NIHSS, and LVO, who received thrombolytics and/or thrombectomy had longer hospital LOS, higher mRS at discharge and follow-up, and were less likely to be discharged home, though these trends were not statistically significant. Our study is limited by a small sample size and these findings should be further explored in larger studies.

Evaluation of short-term functional mobility outcomes in patients with traumatic lower limb amputations: A prospective cohort study in India

BackgroundTraumatic amputation of the lower limb is a significant life-changing event. It is associated with substantial functional disability. ObjectiveTo assess the serial improvement in functional mobility outcomes after the rehabilitation provided to traumatic unilateral lower limb amputee (TULLA) over 6 months of follow-up. MethodsIt is a prospective observational cohort study including 106 TULLA performed in a tertiary care trauma center in North India from January 2021 to December 2021. Patients were followed up at 2 weeks, 3 months and 6 months post-surgery in the focused amputee clinic, where functional mobility care was provided by physical rehabilitation and prosthesis application and patients were evaluated using the Locomotors Capabilities Index (LCI-5) and L-Test of functional mobility. ResultsThere was a significant improvement in LCI-5 and L-Test from discharge to follow-up. The mean overall LCI-5 scores were 14.68 ± 6.56, 28.29 ± 9.04 and 42.77 ± 8.94 at 2 weeks, 3 months and 6 months respectively. The mean L-test for overall individuals with limb loss (N = 100) at discharge, 2 weeks, 3 months and 6 months were 178.41 ± 49.62, 126.98 ± 37.76, 98.39 ± 30.09 and 72.82 ± 21.03 respectively. Further, a subgroup analysis showed a significant improvement in LCI-5 and L-test in individuals with above-knee and below-knee limb loss with prostheses compared to those without prostheses. ConclusionOur multidisciplinary approach helps to improve functional mobility outcomes among TULLA. Focused amputee clinics are the need of the hour to achieve successful functional mobility following amputation.

BN SO39 - Laparoscopic Release of Median Arcuate Ligament Syndrome: A Case Series

Abstract Background Median arcuate ligament syndrome (MALS) is a recognized, but rare condition, which is characterized by compression of the celiac artery and ganglion by median arcuate ligament. The entity often presented with chronic post-prandial abdominal pain, vomiting, and weight loss. These patients often undergo comprehensive investigation prior to diagnosis of MALS. This report presents our experience and short-term outcomes of patients with laparoscopic release of MALS at our center. Method Between 2022-2024, five patients with MALS underwent laparoscopic release at a tertiary HPB center under a single surgeon (TS). Data on patient demographics, presenting symptoms and duration, preoperative diagnostic tests, intraoperative findings and complications, postoperative complications, symptom recurrence and follow-up were prospectively maintained. All patients were discussed at a tertiary Vascular and HPB MDT; MALS was confirmed on US doppler (USD) and CT angiogram (CTA) (fish-hook type configuration of Celiac Truck with post-stenotic dilatation). Results Two male and three female patients, with a median (range) age of 41 (25-70) years, underwent laparoscopic MALS release. The median (range) preoperative symptom duration was 54 (24-67) months, with most common presentation of post-prandial abdominal pain and weight loss. The median (range) BMI was 19.61 (18.30-17.82). The median (range) operative time was 313 (166-330) minutes. One patient required conversion to open due to bleeding from celiac trunk. The median (range) LOS was 7 (4-7) days. No postoperative complications occurred. The median follow-up was 10 months. One patient re-experienced abdominal pain, with no evidence of recurrence on USD and CTA. Conclusion Median Arcuate Ligament Syndrome should be considered as a differential in patients presenting with chronic post-prandial abdominal pain and weight loss. Thorough investigation (USD and CTA) along with discussion at Vascular MDT should be undertaken. Laparoscopic release of MALS is a safe and effective treatment option in this cohort.

MS O04 - OGC Outcomes following gastrectomy for cancer: A 15-Year Retrospective Study examining the impact of regional service centralisation, benchmarking against international standards

Abstract Background Gastrectomy remains the cornerstone of curative treatment for gastric cancer but is associated with significant risks of complications. This study aimed to explore the impact of service centralisation in Greater Manchester on outcomes following gastrectomy for cancer. Outcomes were compared against international benchmarks to evaluate impact of centralisation and identify areas for improvement. Method This was a retrospective study of all patients undergoing gastrectomy (total gastrectomy TG; partial gastrectomy PG) for cancer at a tertiary OG cancer centre between 2007-2022. Patients were allocated to three time periods (2007-2012; 2013-2018; 2018-2022). Regional centralisation took place in August 2018. Outcome selection was guided by a core outcome set for gastrectomy and international benchmarks including the GastroData consortium and the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Results 379 patients undergoing gastrectomy (TG; 201, PG; 172) were included. Median length of stay shortened (p=0.023) and median lymph node yield improved (p&amp;lt;0.001) following centralisation. This was consistent with findings from the DUCA audit. There was no difference in R0 resection rates (p=0.668), surgical reinterventions (p=0.717) or readmissions within 90-days (p=0.428) after centralisation. Whilst post-operative mortality improved (30-day 4.5% versus 0%; 90-day 5.4% versus 1.2%), this was not statistically significant (p=0.09). Conclusion Centralisation of surgical OG cancer services in our region resulted in improved short-term outcomes for patients undergoing gastrectomy. This may reflect a greater emphasis on standardised peri-operative surgical and pathology protocols. These findings were partly consistent with international benchmarks. Further evaluation of the impact on longer-term outcomes is required.

Abstract 4137905: The association between prehospital epinephrine administration and short-term outcomes in patients with shockable out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: a propensity matched analysis

Background: In out-of-hospital cardiac arrest (OHCA) patients with an initial shockable rhythm, epinephrine increases the likelihood of return of spontaneous circulation (ROSC), but its effect on neurological outcome remains uncertain. Epinephrine administered before extracorporeal resuscitation (ECPR), which is a non-pharmacological method to obtain ROSC, may have worsened neurological outcome. Aim: To evaluate the impact of prehospital epinephrine administration on the prognosis of OHCA patients undergoing ECPR. Methods: This is a retrospective analysis of a cohort study from a multicenter, prospective registry of 81234 OHCA patients between 2014 and 2021. After the application of exclusion criteria, 1061 OHCA patients with an initial shockable rhythm and who underwent ECPR were eligible for this study. The primary outcome was favorable neurological outcome at 30 days after the OHCA and the secondary outcome was ROSC during transfer. Patients who did and did not receive prehospital epinephrine were propensity score-matched on the basis of age, gender, witness arrest, bystander-initiated CPR, dispatcher-assisted CPR, advanced airway management, call-to-defibrillation interval, year and district. Results: Among 1061 eligible patients, 442 patients received epinephrine and 619 patients did not. Matching was successful in achieving covariate balance as shown by a standardized difference of &lt;10% for all variables (329 matched pairs). The proportion of patients with prehospital ROSC was significantly higher in those who received prehospital epinephrine than those who did not (36 [8%] vs 31 [5%]; adjusted odds ratio [OR] after propensity score-matching, 1.96 [95% CI 1.05-3.67], p=0.03). The proportion of patients with favorable neurological outcome at 30 days was not significantly lower in those who received prehospital epinephrine than those who did not (34 [8%] vs 78 [13%]; adjusted OR after propensity score-matching, 0.78 [95% CI 0.45-1.37], p=0.39). Conclusion: In patients with shockable OHCA and ECPR, prehospital epinephrine administration was significantly associated with increased ROSC before hospital arrival and not significantly with decreased favorable neurological outcome at 30 days.

Predictors of In-hospital and Short-term Outcomes of Thoracic Endovascular Aortic Repair for Aortic Aneurysm and Aortic Syndrome: A Single-Center Experience

BACKGROUND: Endovascular technique has replaced open repair as primary treatment for different aortic disease indications and was associated with low perioperative mortality and acceptable short-, mid-, and long-term survival. Locally, thoracic endovascular aortic repair (TEVAR) was not widely practiced until year 2017. This study aims to determine the predictors of in-hospital and short-term outcomes of patients who underwent TEVAR for aortic aneurysm and aortic syndrome in a single center and how it compares with local and international data. METHODS: This study is a retrospective analysis of 52 adult patients who underwent TEVAR for the treatment of aortic aneurysm and aortic syndrome. Demographic and clinical data, diagnostic imaging, and procedural details were obtained via inpatient charts at the medical records section and hospital system database archiving. Outcomes at 30 days and 1 year postprocedure were obtained through telephone follow-up after attaining verbal consent. Gathered data were analyzed as to association of different variables with or without the presence of complications. Outcomes reported included in-hospital mortality rate, presence of major adverse events (MAEs), 30-day and 1-year survival rates, and rate of freedom from reintervention. RESULTS: The overall in-hospital mortality was 7.69% (n = 4/52), and complication rate was 32% (n = 20/52), with a survival rate of 92.31% and 87.76% at 30 days and 1 year, respectively. The rates of overall freedom from reintervention were 83.33% and 100% at 30 days and 1 year, respectively. The independent predictors for in-hospital mortality and development of MAEs were increasing weight (odds ratio [OR], 1.0588; 95% confidence interval [CI], 1.003–1.208), preexisting chronic kidney disease (OR, 10.33; 95% CI, 1.1069–96.462), and TEVAR with debranching done as a single procedure (OR, 3.6667; 95% CI, 1.1154–12.054), whereas an estimated glomerular filtration rate of 49.05 ± 19.25 (OR, 0.9402; 95% CI, 0.9019–0.9801) and TEVAR with debranching done as a staged procedure (OR, 0.1624; 95% CI, 0.0321–0.8225) statistically decrease the risk for development of in-hospital mortality and MAEs (P = 0.001 and P = 0.028, respectively). CONCLUSIONS: In this single-center study, indications for TEVAR were fusiform and saccular aneurysm, high-risk intramural hematoma and penetrating aortic ulcer, complicated acute type B dissection, chronic complicated type B dissection with high-risk feature, and aortic rupture. The outcome of this study shows comparable results with other international studies with an acceptable in-hospital mortality rate, complication rate, short-term survival rate, and rate freedom from reintervention at 30 days and 1 year. Increasing weight, preexisting chronic kidney disease, and TEVAR with debranching done as a single setting are independent predictors for developing in-hospital mortality and MAEs, whereas a normal estimated glomerular filtration rate and TEVAR with debranching done as a staged procedure decrease the risk; hence, careful planning and scheduling of procedure among elective and amenable cases could further reduce complication rates of future TEVAR procedures.

QOL-15. PATIENT-REPORTED PHYSICAL HEALTH-RELATED QUALITY OF LIFE PREDICTS SHORT-TERM POSTOPERATIVE OUTCOMES IN A HETEROGENEOUS COHORT OF BRAIN TUMOR PATIENTS

Abstract Patient-reported outcome measures (PROMs) are increasingly used to assess patients’ perioperative health. The PROM Information System 29 (PROMIS-29) is a well-validated global health assessment instrument for patient physical health, though its utility in cranial neurosurgery is unclear. To investigate the utility of preoperative PROMIS-29 physical health (PH) summary scores in predicting postoperative outcomes in brain tumor patients. Adult brain tumor patients undergoing resection at a single institution (January 2018-December 2021) were identified and prospectively received PROMIS-29 surveys during pre-operative visits. PH summary scores were constructed and optimum prediction thresholds for length of stay (LOS), discharge disposition (DD), and 30-day readmission were approximated by finding the Youden index of the associated receiver operating characteristic curves. Bivariate analyses were used to study the distribution of low (z-score≤-1) versus high (z-score&amp;gt;-1) PH scores according to baseline characteristics. Logistic regression models quantified the association between preoperative PH summary scores and post-operative outcomes. A total of 157 brain tumor patients were identified (mean age 55.4±15.4 years; 58.0% female; mean PH score 45.5 + 10.5). Outcomes included prolonged LOS (24.8%), non-routine discharge disposition (37.6%), and 30-day readmission (19.1%). On bivariate analysis, patients with low PH scores were significantly more likely to be diagnosed with a high-grade tumor (69.6% vs 38.85%, p=0.010) and less likely to have elective surgery (34.8% vs 70.9%, p=0.002). Low PH score was associated with prolonged LOS (26.1% vs 22%, p&amp;lt;0.001), nonroutine discharge (73.9% vs 31.3%, p&amp;lt;0.001) and 30-day readmission (43.5% vs 14.9%, p=0.003). In multivariate analysis, low PH scores predicted greater LOS (odds ratio [OR]=6.09, p=0.003), nonroutine discharge (OR=4.25, p=0.020), and 30-day readmission (OR=3.93, p=0.020). The PROMIS-29 PH summary score predicts short-term postoperative outcomes in brain tumor patients and may be incorporated into prospective clinical workflows.

Endoscopic Minimally Invasive Approach Versus Median Sternotomy for Multiple-Valve Surgery: A Propensity-Matched Analysis.

Endoscopic minimally invasive valve surgery is a promising alternative to valve surgery through median sternotomy. Our study compared the short-term outcomes of patients undergoing endoscopic minimally invasive multiple concomitant valve surgeries (MIMVS) with median sternotomy (MS). Demographic, clinical, and procedural data of all consecutive patients who underwent multiple-valve surgeries at two institutions in Germany from March of 2017 to March of 2023 were retrospectively collected. Patients were divided into two groups: MIMVS versus MS and their outcomes were compared before and after propensity score matching. Primary endpoint was the incidence of 30-day mortality. A total of 317 patients were included in the study; 112 patients in each group were matched 1:1. MIMVS was performed on 123 patients. After propensity matching, 30-day mortality rates were 8% for MIMVS versus 12.5% for MS (p = 0.28). Median blood transfusion in the MIMVS group was 0 [0-3] vs 1 [0-4] in the MS group (p = 0.002). MIMVS was associated with similar cardiopulmonary bypass time 105.5 [79.8-124] versus 98 [68.8-130.3] mins and aortic cross clamping times 70 [53-80.3] versus 63.5 [46-90.3] mins (pvalues 0.9 and 0.76, respectively). Median intensive care and inhospital stays were similar between both groups (2 [1-4] vs 2 [1-5] days, p = 0.36, and 12 [8-17] vs 12.5 [9-21] days, p = 0.38). Incidences of intrathoracic bleeding, stroke, and acute kidney injury were similar in both groups. In our experience, endoscopic minimally invasive multiple-valve surgeries through right anterior mini-thoracotomy is as feasible, safe, and effective as medial sternotomy in select patients.