Significant Differences In Patient Characteristics Research Articles

A retrospective analysis of immune checkpoint inhibitors in patients with preexisting organ dysfunction.

There are limited to no data regarding the use of immune checkpoint inhibitors (ICIs) in patients who have preexisting organ dysfunction because these patients are frequently excluded from clinical trials. The authors' objective was to evaluate the effects of ICIs in patients with chronic kidney disease (CKD), cirrhosis, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF). Data were obtained retrospectively for patients older than 18 years with solid organ malignancies who received at least one dose of an ICI between January 1, 2015, and January 1, 2021, and had either CKD (n=90), cirrhosis (n=20), COPD (n=142), or CHF (n=82) before ICI initiation at the authors' institution. Descriptive statistics were used to summarize patient characteristics, treatment characteristics, immune-related adverse events (IrAEs), and outcomes. An independent samples t-test or the Wilcoxon rank-sum test was used to assess differences in continuous variables; the χ2 test or the Fisher exact test was used to assess differences in categorical variables between patients with and without IrAEs. Progression-free survival (PFS) was assessed using Kaplan-Meier curves, and the log-rank test was used to assess differences in PFS. In all four cohorts, there were no statistically significant differences in patient characteristics, treatment characteristics, or outcomes, such as the number of hospitalizations and PFS, among those who experienced IrAEs compared with those who did not. In the CKD cohort, patients with IrAEs were significantly less likely to die than those without IrAEs (52% vs. 81% [p=.009] for all patients; 53% vs. 83% [p=.008] for patients with stage II/III disease who received no definitive local treatment and patients with stage IV disease); this difference was not observed in the cirrhosis, COPD, or CHF cohorts. There was no statistically significant difference in the number of heart failure and COPD exacerbations during the receipt of ICIs in the CHF and COPD cohorts, respectively. The incidence and time to onset of IrAEs in this study appeared to be similar to those reported previously in clinical trials that excluded patients with significant comorbidities. The current results demonstrate that ICIs are well tolerated by patients who have preexisting organ dysfunction.

Classification of l-DOPA pharmacokinetics shapes and creating a predictive model

BackgroundIt is known that the pharmacokinetics (PK) of levodopa (LD) varies considerably. Difference in PK shapes is expected to affect drug efficacy and development of dyskinesia. In this study, the authors aimed to explore correlations between PK series data of LD and clinical characteristics and dyskinesia in patients with Parkinson's disease (PD). MethodsWe studied 270 PD patients who underwent PK assessment after administration of LD/carbidopa (100/10 mg) in non-compartmental analysis. The patients were grouped according to similarities in time series data of blood LD concentration. Each group was analyzed with respect to clinical characteristics and PK parameters. We created a model to predict PK patterns based on these findings. ResultsPD patients were divided into three groups by clustering analysis: blood LD concentration of the patients in Groups 1 (n = 129), 3 (n = 44) and 2 (n = 97) rose rapidly, relatively slowly and at an intermediate rate, respectively. There were no statistically significant differences in patient characteristics except age among the three groups (one-way ANOVA). Multivariate analysis showed that frequency of dyskinesias in Group 1 was significantly higher than that in Group 2. We successfully created a PK pattern prediction model based on body weight and blood LD concentration at 15 and 30 min after administration. ConclusionsThe PK series data of LD was classified into three patterns. The rapid absorption was associated with dyskinesias. Patients’ PK patterns were successfully predicted based on their body weight and two-point LD concentration.

Application of a New Retraction Method in Laparoscopic Gastrectomy for Gastric Cancer.

Better exposition is important for lymph node dissection in the suprapancreatic region and lesser curvature region of the stomach, and digestive tract reconstruction, especially without excellent assistants. We developed a new laparoscopic retraction method with the use of two internal retractors (TIRs) punctured along with suture. Clinicopathological data, surgical data, and postoperative outcomes were assessed. Of the 143 patients included, 51 underwent surgery with the double-sling suture method and 92 underwent surgery with the TIRs method. Laparoscopic radical gastrectomy was successfully performed in all patients. There were no significant differences in patient characteristics or preoperative data in the 2 groups. The operative time was significantly shorter in the TIR group, but the amount of bleeding did not differ. No retraction-related complications both in clipped tissue and liver occurred in all patients. Our new retraction technique provided an optimal surgical field and make surgery lower requirements for assistants.

Implementation of a Rapid Multiplex Polymerase Chain Reaction Pneumonia Panel and Subsequent Antibiotic De-escalation.

Net effects of implementation of a multiplex polymerase chain reaction (PCR) pneumonia panel (PNP) on antimicrobial stewardship are thus far unknown. This retrospective study evaluated the real-world impact of the PNP on time to antibiotic de-escalation in critically ill patients treated for pneumonia at an academic medical center. This retrospective, quasi-experimental study included adult intensive care unit (ICU) patients with respiratory culture results from 1 May to 15 August 2019 (pre-PNP group) and adult ICU patients with PNP results from 1 May to 15 August 2020 (PNP group) at Nebraska Medical Center. Patients were excluded for the following reasons: any preceding positive coronavirus disease 2019 PCR test, lack of antibiotic receipt, or non-respiratory tract infection indications for antibiotics. The primary outcome was time to discontinuation of anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy. Secondary outcomes included time to discontinuation of antipseudomonal therapy, frequency of early discontinuation for atypical coverage, and overall duration (in days) of antibiotic therapy for pneumonia. Sixty-six patients in the pre-PNP group and 58 in the PNP group were included. There were significant differences in patient characteristics between groups. The median time to anti-MRSA agent discontinuation was 49.1 hours in the pre-PNP and 41.8 hours in the PNP group (P = .28). The median time to discontinuation of antipseudomonal agents was 134.4 hours in the pre-PNP versus 98.1 hours in the PNP group (P = .47). Other outcomes were numerically but not significantly improved in our sample. This early look at implementation of a multiplex PNP did not demonstrate a statistically significant difference in antibiotic use but lays the groundwork to further evaluate a significant real-world impact on antibiotic de-escalation in ICU patients treated for pneumonia.

The association of female sex with management and mortality in patients with Staphylococcus aureus bacteraemia

ObjectivesThe association of biological female sex with outcome in patients with Staphylococcus aureus bacteraemia remains unresolved. The aim of this study was to determine the independent association of female sex with management and mortality in patients with S. aureus bacteraemia. MethodsThis is a post hoc analysis of prospectively collected data from the S. aureus Bacteraemia Group Prospective Cohort Study. Adult patients with monomicrobial S. aureus bacteraemia at Duke University Medical Center were enrolled from 1994 to 2020. Univariable and multivariable Cox regression analyses were performed to assess differences in management and mortality between females and males. ResultsAmong 3384 patients with S. aureus bacteraemia, 1431 (42%) were women. Women were, as compared with men, more often Black (581/1431 [41%] vs. 620/1953 [32%], p < 0.001), haemodialysis dependent (309/1424 [22%] vs. 334/1940 [17%], p 0.001) and more likely to be infected with methicillin-resistant S. aureus (MRSA) (697/1410 [49%] MRSA in women vs. 840/1925 [44%] MRSA in men, p 0.001). Women received shorter durations of antimicrobial treatment (median 24 [interquartile range 14–42] vs. 28 [interquartile range 14–45] days, p 0.005), and were less likely to undergo transesophageal echocardiography as compared with men (495/1430 [35%] vs. 802/1952 [41%], p < 0.001). Despite these differences, female sex was not associated with 90-day mortality in either univariable (388/1431 [27%] in women vs. 491/1953 [25%] in men, p 0.204) or multivariable analysis (adjusted hazard ratio for women 0.98 [95% CI, 0.85–1.13]). DiscussionDespite significant differences in patient characteristics, disease characteristics, and management, women and men with S. aureus bacteraemia have a similar mortality risk.

Comparison of oncological outcomes between sentinel lymph node biopsy and complete lymphadenectomy for endometrial cancer.

Sentinel lymph node (SLN) mapping allows node-negative patients to be spared from the surgical comorbidities associated with total lymphadenectomy. This study aimed to evaluate the oncological outcomes of SLN biopsy versus complete lymph node dissection in patients with early-stage endometrial carcinoma. Retrospective analyses were performed in patients with pathologically confirmed endometrioid endometrial carcinoma, who underwent minimally invasive surgical staging with SLN biopsy or complete lymph node dissection at Yonsei Cancer Center between 2015 and 2019. A total of 301 patients were included in this study. Eighty-two patients underwent SLN biopsy, while 219 underwent complete lymph node dissection. There were no significant differences in patient characteristics between the two groups. In terms of operative characteristics, the SLN biopsy-only group had a significantly shorter surgical duration (p < 0.001) than the lymphadenectomy group. The mean follow-up period was 41.4 months. There were no differences in progression-free survival (PFS) and overall survival (OS) between the two groups (SLN biopsy vs. complete lymph node dissection; p = 0.798 and 0.301, respectively). Multivariate analysis revealed that SLN biopsy was not an independent prognostic factor for PFS or OS. Our results showed that SLN biopsy provided oncological outcomes similar to those of lymphadenectomy.

Oxidized Regenerated Cellulose versus Polyglycolic Acid for Pleural Coverage in Pneumothorax Surgery.

Objectives: Although surgical intervention for spontaneous pneumothorax (SP) reduces the recurrence rate, thoracoscopic surgery is associated with greater postoperative recurrence rates than open thoracotomy. A polyglycolic acid (PGA) sheet or oxidized regenerated cellulose (ORC) mesh can therefore be used for additional coverage after thoracoscopic surgery, and this study compared the clinical impacts of these two materials. Methods: From 2018 to 2020, 262 thoracoscopic surgeries for primary SP were performed, of which 125 patients were enrolled in this study, and 48 and 77 patients received ORC and PGA coverage, respectively. The clinical characteristics and surgical procedures were reviewed, and the recurrence rates were compared. To obtain more comprehensive evidence, we performed a literature review and meta-analysis comparing ORC and PGA coverage. Results: There were no significant differences in patient characteristics between the two groups. Operating time was slightly shorter in the ORC group than in the PGA group (p = 0.008). The pneumothorax recurrence rate was similar in both groups (PGA: 10.4%, ORC: 6.2%, p = 0.529), but the recurrence-free interval was significantly longer (p = 0.036) in the ORC (262 days) than in the PGA (48.5 days) group. The literature review identified three relevant studies, and the meta-analysis revealed no difference in pneumothorax recurrence rate between the two coverage materials. Conclusions: The two visceral pleural coverage materials, PGA and ORC, did not show significant differences in postoperative pneumothorax recurrence. Therefore, if applied appropriately, the choice of material between ORC and PGA for thoracoscopic pneumothorax surgery does not have a significant impact on the clinical outcome.

The Edmonton frail scale is a tool to evaluate the effectiveness of cardiac rehabilitation in frail older patients after open cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Together with the aging population, the part of older frail patients after cardiac surgery is increasing in cardiac rehabilitation (CR) settings. Frailty detection is crucial for choosing appropriate training programs, but according to the literature, there is not enough evidence on what tools should be used to detect frailty and evaluate its dynamics during CR. Purpose To evaluate the effectiveness of CR for older frail patients after open heart surgery using the Edmonton frail scale. Methods A prospective, randomized controlled clinical trial. Inclusion criteria: all patients were admitted to CR after open heart surgery, ≥ 65 years old, within 6-minute walking distance (6-MWD) ≥150 m, Edmonton frailt scale (EFS) score ≥ 4, patient’s agreement to participate in the study. Patients (N=100, 73,3±5,1 years, 17,1±7,4 days post-surgery, 62,0% male)) were randomly allocated for gender assigned (1:1 ration) to intervention or control groups (IG n=50, CG n=50). Both groups participated in exercise training during inpatient-CR. After completing the 20-day rehabilitation program, the intervention group (IG) participated in home-based exercise training that lasted 12 weeks. The home-based exercise training program included four different types of exercise: aerobic endurance training (5/week, 20–60 min) including walking, stair climbing, and cycling of moderate to high intensity; sensomotoric training (3/week, 15 min) including exercises on postural control, dynamic balance, and coordination of moderate to high intensity; resistance training (3/week, 20–25 min) including 4 – 8 exercises at moderate intensity, involving main muscle groups of the legs; flexibility training (3/week, 10–15 min) including isolated type flexibility exercises at low to moderate intensity. Participants of IG were monitored by phone calls every two weeks and the CG were assigned to usual care. Patients were assessed before (T1) and after 20-days inpatient CR (T2) and 12 weeks after completion of CR (T3). Patients' frailty was evaluated between groups and over time by the Edmonton frail scale (frail ≥ 6, prefrail 4-5, robust 0-3). SPSS 22 was used for statistical analysis. The Mann-Whitney U and chi-squared tests were applied to compute p-values for the differences between the groups and periods. Results There were no significant differences in patient characteristics between the groups except that in CG there were more women (p=0,013). As a result of inpatient-CR and home-based exercise training program prevalence of frailty decreased in both groups, but no statistical significance between the groups was observed. (Table 1). Conclusions EFS is a suitable tool to detect frailty and evaluate its dynamic during short-term CR (after 20 days) and medium-term (after 12 weeks) home-based CR programs. The results are encouraging, but probably because of the small sample size and short monitoring time, no significant differences were found between the groups.

Lung Abscess and Pyothorax in Critically Ill COVID-19 Patients: A Single-Center Retrospective Study.

The mortality rate of patients with COVID-19 pneumonia requiring mechanical ventilation remains high. This study determined the percentage and characteristics of patients who developed lung abscesses or pyothorax and their mortality rates among adult patients with COVID-19 admitted to the ICU who required mechanical ventilation. Of the 64 patients with COVID-19 assessed, 30 (47%) developed ventilator-associated pneumonia (VAP), of whom 6 (20%) developed pyothorax or lung abscess. There were no statistically significant differences in patient characteristics, treatment after ICU admission, or outcomes between those with and without these complications, except for age. VAP complicated by Lung abscess or pyothorax was caused by a single organism, with Staphylococcus aureus (n = 4) and Klebsiella species (n = 2) being the primary causative agents. Occur infrequently in patients with COVID-19 requiring mechanical ventilation. Large-scale studies are required to elucidate their effects on clinical outcomes.

Trends in the Use of Second-Generation Androgen Receptor Axis Inhibitors for Metastatic Hormone-Sensitive Prostate Cancer and Clinical Factors Predicting Biological Recurrence.

The advent of second-generation androgen receptor axis-targeted agents (ARATs) has revolutionized the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). Biochemical recurrence-free survival (BRFS) was used to compare the efficacy of each ARAT. This multicenter retrospective study included 581 patients with newly diagnosed mHSPC who received first-line hormone therapy. The characteristics of patients treated with different ARATs were compared as well as changes in the usage of each drug over time. For BRFS, the apalutamide (Apa) and enzalutamide (Enza) groups, as well as the abiraterone acetate (Abi) and Apa/Enza groups, were compared. In addition, multivariate analysis was performed to determine predictive factors for biochemical recurrence (BCR). The use of second-generation ARATs tended to increase after May 2020. No significant difference in BRFS was found between patients receiving Apa and Enza (p = 0.490) and those receiving Abi or Apa/Enza (p = 0.906). Multivariate analysis revealed that the neutrophil-to-lymphocyte ratio (NLR) ≥ 2.76 and PSA ≥ 0.550 ng/mL were independent predictors of BCR. There were no significant differences in patient characteristics or BRFS in patients with mHSPC receiving different ARATs as first-line treatment. NLR and PSA may be prognostic factors following the first-line treatment of patients with mHSPC.

Omission of Pelvic Examination Before Gender-Affirming Hysterectomy and Vaginectomy.

Surgeons may be performing pelvic examinations on transgender patients before gender-affirming pelvic surgery (hysterectomy and vaginectomy) without a clinically significant indication. A retrospective cohort study was conducted at a single-institution academic referral center comparing 30-day perioperative outcomes of all 62 gender-affirming pelvic surgeries, including hysterectomy alone, hysterectomy with vaginectomy, and vaginectomy alone, between April 2018 and March 2022. More than half (53.2%, n=33) of the 62 patients did not have an in-office, preoperative, internal pelvic examination within 1 year of gender-affirming surgery. There were no significant differences in patient characteristics nor 30-day perioperative outcomes between the examined and examination-omitted groups, suggesting that omission of a preoperative pelvic examination is probably safe before gender-affirming hysterectomy and vaginectomy, minimizing barriers to gender-affirming surgical care.

Long-term Progression-free Survival With Pemetrexed Plus Bevacizumab in NSCLC Patients.

Pemetrexed (PEM) and bevacizumab (BEV) are commonly used in combination as second or subsequent line regimens and maintenance therapy after platinum + PEM + BEV therapy for advanced non-small cell lung cancer (NSCLC). Median progression-free survival (PFS) for PEM + BEV has been reported to be less than six months in both clinical trials and clinical practice, but in clinical practice, we found that some patients demonstrate long-term PFS. Furthermore, there is a paucity of clinical practice data on whether long-term administration of PEM + BEV causes renal dysfunction. This study aimed to clarify these aspects in clinical practice. A retrospective review of patients with advanced NSCLC treated with PEM + BEV between September 2011 and June 2022 at four hospitals was conducted. Long-term PFS in PEM + BEV therapy was defined as ≥12 months. During the study period, 109 patients received PEM + BEV treatment. Of them, 42 (38.5%) achieved long-term PFS ≥12 months. No significant differences in patient characteristics were found between patients with PFS ≥12 months and <12 months, except for 'relapse after resection'. Univariate and multivariate analysis showed that the favorable factor for PFS was 'relapse after resection'. With regard to influence on renal function of PEM + BEV therapy, no significant difference was found before and after PEM+BEV therapy between these two groups. NSCLC patients commonly achieved long-term PFS with PEM + BEV therapy with no observed effects on renal function.

PO-01-041 COMPARISON OF DIFFERENT POWER SETTINGS (40W VS 50W) IN HIGH-POWER SHORT-DURATION RADIOFREQUENCY ABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION: ACUTE AND LONG-TERM CLINICAL OUTCOMES

The REAL-AF registry is a prospective multi-center registry designed to obtain real-world clinical experience of atrial fibrillation (AF) ablations. While pulmonary vein isolation (PVI) can be performed successfully with various power settings, there has been a recent surge of interest in delivering higher power short duration (HPSD) lesions using 40W-50W through the irrigated tip ablation catheters. However, the ideal power setting to deliver HPSD lesions is unknown. Compare the procedural characteristics, safety and long-term all-atrial arrhythmia recurrence between patients undergoing HPSD radiofrequency ablation either using 40W or 50W. We analyzed the data derived from subjects in the Real-AF registry from January 2018 through May 2021. The patients enrolled underwent a first-time catheter ablation for paroxysmal AF with a minimum follow-up of 12 months. The sample of patients was dichotomized in procedures using either HPSD 50 W or HPSD 40 W of power, with a target ablation index (AI) in the anterior wall of 500-550 and posterior wall of 400 for both groups. We used unadjusted bivariate analyses to explore the relationship between power delivery, patient characteristics and procedural and 12-month clinical outcomes. A total of 385 patients were included in the analyses. There were no significant differences in patient characteristics between groups (Table 1). The HPSD 50W group had significantly shorter RF time (18.69 vs. 29.21, p<0.001) and procedural time (77.72 vs. 99.98, p<0.01) when compared to the LPLD group. There were no statistically significant differences between HPSD 50 W and HPSD 40W for first-pass PVI and no clinically significant differences in the target ablation index between the groups. When looking at all -atrial arrhythmia recurrence documented post-blanking period at 12 months, there was no statistically significant relationship (p=0.925) between groups. There was no statistically significant relationship between immediate procedural complications, pericarditis, or complications at 12 months post-ablation (p>0.05). The esophageal temperature measurements were not different between groups. HPSD is a safe and effective way of performing radiofrequency ablation of AF. HPSD using 50W was associated with shorter RF ablation and procedural times when compared to HPSD 40W without increase in complications HPSD 50W and HPSD 40W had similar acute and long-term success rates.

Outcomes of HLA-mismatched HSCT with TCRαβ/CD19 depletion or post-transplant cyclophosphamide in patients with inborn errors of immunity – an EBMT inborn errors working party analysis

HLA-mismatched donor HSCT is an increasingly utilized approach for patients with inborn errors of immunity (IEI) lacking a matched donor, thanks to the development of in-vivo T-cell depletion with post-transplant cyclophosphamide (PTCY) or in-vitro TCRαβ/CD19 depletion (TCRab). Our study analyzed the outcome with these approaches in patients with IEI. Pediatric patients who received a first HSCT between 2011 and 2019 from haploidentical related or ≤9/10 HLA-mismatched unrelated (MMUD) donors were included in this retrospective study.We included 296 patients, 139 with PTCY and 157 with TCRab, who received HSCT at a median age of 1.4 years (0.1–19.6) from haploidentical donors (n = 282) or MMUD (n = 14). There were significant differences in patient characteristics: PTCY recipients had a higher rate of pre-HSCT infections (p = 0.002), and organ damage (p < 0.001), had lower performance scores (0.008), and were transplanted more recently (p = 0.001). Owing to the approach, there was a higher proportion with busulfan-based conditioning and multi-drug GVHD prophylaxis, and a lower proportion with serotherapy in the PTCY group; and lower CD34+ but higher CD3+ numbers were infused to PTCY recipients (all p < 0.001). Neutrophil and platelet engraftment occurred significantly earlier after TCRab depletion (p < 0.001). Acute GVHD°III-IV occurred in 10.3% of patients, more frequently after PTCY (p = 0.022), while 14.3% of patients required secondary cellular therapy (boost, DLI, 2nd HSCT), more frequently after TCRab (p = 0.026). Adenoviremia was more frequent (p = 0.012) and veno-occlusive disease (p = 0.015), acute kidney injury (p = 0.028), autoimmune cytopenia (p = 0.032), and pulmonary complications (p = 0.011) less frequent after TCRab. Overall survival at 3 years was 81% (95%CI: 75–88%) and 70% (63–78%; p = 0.001) after TCRab and PTCY, respectively, while event free survival (graft failure, extensive chronic GVHD) was 69% (62–77%) and 63% (55–71%), respectively. In univariate analysis, use of PTCY, conditioning other than busulfan or treosulfan, pre HSCT organ damage, preHSCT infections and number of preHSCT morbidities correlated negatively with overall survival.This study of HLA-mismatched HSCT in IEI demonstrated better overall but not event-free survival after TCRab, but patients with PTCY had significantly higher rates of preHSCT risk factors. We conclude that both approaches are feasible and efficacious in patients with IEI lacking an HLA-matched donor.

D-14 | Atrial Septal Interventions During and After Hybrid Stage I Palliation

Hybrid stage I palliation (HS1P) is an alternative approach for single ventricle (SV) patients, particularly those with high-risk factors. Unlike surgical stage I palliation where atrial septectomy is standardly performed, the approach to atrial septal intervention (ASI) during HS1P is patient dependent. In this study, we aimed to describe the frequency of interventions on the atrial septum both at the time of the HS1P and during the interstage period and to determine factors associated with a need for ASI post-HS1P. A retrospective study was performed in all SV patients who underwent HS1P at our center in the past 12 years. Initial and subsequent interventions on the atrial septum were collected through either surgical Norwood or Comprehensive stage II. Patient factors, atrial septal characteristics by echo, and type of atrial septal intervention were also collected and compared to identify risk factors for ASI intervention post-HS1P. Of 50 SV patients included, about half of the patients (26/50) required an ASI post-HS1P; 23 (46%) had an ASI performed at the time of HS1P, and 7 (27%) of these patients required a subsequent ASI. Of the 27 patients who did not undergo an initial ASI, 19 (70%) required a subsequent ASI. Compared to static and cutting balloon septoplasty, balloon atrial septostomy and atrial septal stent placement were associated with a decreased risk of need for ASI post-HS1P (both p<0.05). There were no significant differences in patient characteristics, hospital course, or overall outcomes between patients who required ASI post-HS1P vs. those who did not. Atrial septal intervention after HS1P is common but has little impact on patient outcomes through the next stage of palliation. Although no patient or anatomic factors were identified risk factors for atrial septal intervention post-HS1P (besides having an intact atrial septum), intervention with either balloon atrial septostomy or atrial septal stent placement was associated with a lower need for atrial septal reintervention and therefore may be the preferred approach when anatomically feasible.

Prediction of survival after lung transplantation at one year (SALTO cohort) using information available at different key time-points.

Lung transplantation is the final treatment option for end-stage lung disease. In this study, we evaluated the individual risk of 1-year mortality at each stage of the lung transplantation process. This was a retrospective analysis of patients undergoing bilateral lung transplantation between January 2014 and December 2019 in three French academic centers. Patients were randomly divided into development and validation cohorts. Three multivariable logistic regression models of 1-year mortality were applied (A) at recipient registration, (B) the graft allocation, and (C) after surgery. The 1-year mortality was predicted for individual patients assigned to three risk groups at time points A-C. The study population consisted of 478 patients with a mean (SD) age of 49.0 (14.3) years. The 1-year mortality rate was 23.0%. There were no significant differences in patient characteristics between the development (n = 319) and validation (n = 159) cohorts. The models analyzed recipient, donor, and intraoperative variables. The discriminatory power (area under the receiver operating characteristic curve) was 0.67 (0.62-0.73), 0.70 (0.63-0.77), and 0.82 (0.77-0.88), respectively, in the development cohort, 0.74 (0.64-0.85), 0.76 (0.66-0.86) and 0.87 (0.79 - 0.95), respectively, in the validation cohort. Survival rates were significantly different among the low- (< 15%), intermediate- (15%-45%), and high-risk (> 45%) groups in both cohorts. Risk prediction models allow estimation of the 1-year mortality risk of individual patients during the lung transplantation process. These models may help caregivers identify high-risk patients at times A-C, and reduce the risk at subsequent time-points.

MP77-13 OUTPATIENT VERSUS INPATIENT ROBOTIC ASSISTED RADICAL PROSTATECTOMY: COMPLICATIONS, TIME DRIVEN ACTIVITIES BASED COSTING AND PATIENT SATISFACTION

You have accessJournal of UrologyCME1 Apr 2023MP77-13 OUTPATIENT VERSUS INPATIENT ROBOTIC ASSISTED RADICAL PROSTATECTOMY: COMPLICATIONS, TIME DRIVEN ACTIVITIES BASED COSTING AND PATIENT SATISFACTION Emily Cheng, Aaron Laviana, Spyridon Basourakos, Sofia Gereta, Alec Zhu, Leonardo Borregales, Xiangmei Gu, Miko Yu, Chunmei Mckernan, Siwen Xie, Christopher Barbieri, Douglas Scherr, and Jim Hu Emily ChengEmily Cheng More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Sofia GeretaSofia Gereta More articles by this author , Alec ZhuAlec Zhu More articles by this author , Leonardo BorregalesLeonardo Borregales More articles by this author , Xiangmei GuXiangmei Gu More articles by this author , Miko YuMiko Yu More articles by this author , Chunmei MckernanChunmei Mckernan More articles by this author , Siwen XieSiwen Xie More articles by this author , Christopher BarbieriChristopher Barbieri More articles by this author , Douglas ScherrDouglas Scherr More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical prostatectomy lengths of stay decreased with ketorolac analgesia and adoption of robotic assisted radical prostatectomy (RARP). During the COVID-19 pandemic, the transition to outpatient RARP freed up critically needed hospital beds. The healthcare cost reduction afforded by the shift to outpatient RARP and its effect on patient satisfaction has yet to be explored. We compared healthcare costs, patient satisfaction and complications for outpatient vs. inpatient RARP. METHODS: We identified and compared a series of consecutive RARP performed as outpatient vs. inpatient and determined the capacity cost rate for every resource, including personnel, equipment, and space. After the lifting of hospital restrictions, men were given the option of inpatient vs. outpatient RARP. We also administered a validated Patient Satisfaction Outcome Questionnaire (PSOQ) post-operatively and compared median scores in perceived outcomes and satisfaction. A time-driven activity-based costing (TDABC) analysis was applied to compare the total costs of care for RARP performed. Finally, we captured complications within 30 days of surgery using the Clavien-Dindo classification. We used multivariable regression to adjust for age, race, BMI, and ASA classification to assess the impact of outpatient vs. inpatient RARP on complications. RESULTS: There were no significant differences in patient characteristics for outpatient (n=145) vs. inpatient (n=80) RARP. When given the choice, 86.6% of men elected for outpatient vs. inpatient RARP. Outpatient RARP netted a $1387 (13.5%) cost reduction compared to inpatient RARP. There were no significant differences in outpatient vs. inpatient median satisfaction survey scores or complications within 30 days (11.0% vs. 11.3%, p=0.961). CONCLUSIONS: Outpatient RARP can be safely performed, with similar outcomes and compared to inpatient RARP. Outpatient RARP has significantly lower costs compared to inpatient RARP while maintaining similar patient satisfaction outcomes. Source of Funding: Jim C. Hu receives research support from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. Jim C. Hu also receives salary support from NIH R01 CA241758, R01 CA259173, R01 CA273031, PCORI CER-2019C1-15682 and CER-2019C2-17372 and a Prostate Cancer Foundation Challenge Award. The remaining authors report no further disclosures related to this work © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1107 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily Cheng More articles by this author Aaron Laviana More articles by this author Spyridon Basourakos More articles by this author Sofia Gereta More articles by this author Alec Zhu More articles by this author Leonardo Borregales More articles by this author Xiangmei Gu More articles by this author Miko Yu More articles by this author Chunmei Mckernan More articles by this author Siwen Xie More articles by this author Christopher Barbieri More articles by this author Douglas Scherr More articles by this author Jim Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

Associations With Virtual Visit Use Among Patients Receiving Radiation Therapy

The objective of this study was to test for patient characteristics associated with virtual versus office visits among radiation oncology patients. Using the electronic health record, we extracted encounter data and corresponding patient information for the 6 months before and 6 months of COVID-19-enabled virtual visits (October 1, 2019, to March 22, 2020 vs March 23, 2020, to September 1, 2020) at a National Cancer Institute-Designated Cancer Center. Encounters during COVID-19 were categorized as in-person or virtual visits. We compared patient demographic variables including race, age, sex, marital status, preferred language, insurance status, and tumor type during the pre-COVID-19 period as a baseline versus during the COVID-19 period. Multivariable analyses examined associations between these variables and virtual visit use. We analyzed 4974 total encounters (2287 before COVID-19 and 2687 during COVID-19) for 3960 unique patients. All (100%) pre-COVID-19 encounters were in-person. During COVID-19, 21% of encounters were via virtual visits. There were no differences identified in pre- versus during-COVID-19 patient characteristics. However, we found significant differences in patient characteristics for in-person versus virtual encounters during COVID-19. On multivariable analysis, virtual visit use was less common among patients who were Black versus White (odds ratio [OR], 0.75; 95% CI, 0.57-0.99; P=.044) and not married versus married (OR, 0.76; 95% CI, 0.59-0.98; P=.037). Patients with head and neck (OR, 0.63; 95% CI, 0.41-0.97; P=.034), breast (OR, 0.36; 95% CI, 0.21-0.62; P ≤ .001), gastrointestinal/abdominal (OR, 0.31; 95% CI, 0.15-0.63; P=.001), or hematologic malignancy (OR, 0.20; 95% CI, 0.04-0.95; P=.043) diagnoses were less likely to be scheduled for virtual visits relative to patients with genitourinary malignancy. No Spanish-speaking patients engaged in a virtual visit. We did not identify differences in the insurance status or sex of patients scheduled for virtual visits. We found significant differences in virtual visit use by patient sociodemographic and clinical characteristics. Further investigation into implications of differential virtual visit use including social and structural determinants and subsequent clinical outcomes is indicated.

Indication Criteria of Hysteroscopic Surgery for Secondary Infertility due to Symptomatic Cesarean Scar Defect Based on Clinical Outcomes: A Retrospective Cohort Study

Hysteroscopic surgery criteria for patients with cesarean scar defect (CSD) are unclear. Therefore, this study aimed to explore the indication of hysteroscopic surgery for secondary infertility owing to CSD. Retrospective cohort study. Single university hospital. Seventy patients with secondary infertility owing to symptomatic CSD who underwent hysteroscopic surgery under laparoscopy between July 2014 and February 2022 were included. Clinical data, including basic patient information, preoperative residual myometrial thickness (RMT), and postoperative pregnancy status, were collected from medical records. Patients were divided into postoperative pregnancy and nonpregnancy groups. A receiver operating characteristic curve was drawn, and the optimal cutoff value was calculated based on the area under the curve to predict pregnancy after hysteroscopic surgery. No complications were observed in any cases. Among the 70 patients, 49 patients (70%) became pregnant after hysteroscopic surgery. There was no significant difference in patient characteristics between the pregnancy and nonpregnancy groups. In the receiver operating characteristic curve analysis for patients aged <38 years, the value of the area under the curve was 0.77 (sensitivity, 0.83; specificity, 0.78) when optimal cutoff of RMT was 2.2 mm. There was a significant difference in preoperative RMT between the pregnancy and nonpregnancy groups (3.3 mm and 1.7 mm, respectively) in patients aged <38 years. For RMT ≥2.2 mm, hysteroscopic surgery was reasonable for secondary infertility owing to symptomatic CSD, particularly in patients aged <38 years.

Comparison of structural occipital and iliac bone grafts for instrumented atlantoaxial fusions in pediatric patients: Radiologic research and clinical outcomes.

Structural autografts harvested from the iliac bone have been used in atlantoaxial fusion; they have been the gold standard for years. However, emerging occipital bone grafts have the advantage of avoiding donor-site morbidity and complications. Thus, we compared the clinical outcomes of structural autografts from the occipital bone or iliac crest and discussed the clinical significance of occipital bone grafts in pediatric patients. Pediatric patients who underwent posterior fusion using occipital bone grafts (OBG) or iliac bone grafts (IBG) between 2017 and 2021 were included in this study. Data on clinical outcomes, including operation time, estimated blood loss, length of hospitalization, complications, fusion rate, and fusion time, were collected and analyzed. Additionally, 300 pediatric patients who underwent cranial computed tomography scans were included in the bone thickness evaluation procedure. The central and edge thicknesses of the harvested areas were recorded and analyzed. Thirty-nine patients were included in this study. There were no significant differences in patient characteristics between the OBG and IBG groups. Patients in both groups achieved a 100% fusion rate; however, the fusion time in the OBG group was significantly longer than that in the IBG group. Estimated blood loss, operation time, and length of hospitalization were significantly lower in the OBG group than those in the IBG group. The surgery-related complication rate was lower, but not significantly, in the OBG group than that in the IBG group. For occipital bone thickness evaluation, a significant difference in the central part of the harvesting area was found between the young and old groups, with no significant sex differences. The use of OBG for atlantoaxial fusion is acceptable for pediatric patients with atlantoaxial dislocation, avoiding donor-site morbidity and complications.