Statistical Difference In Rate Research Articles

Autism and immigration, is there a link? Results from a Manitoba Study

Abstract Objectives To examine a possible association between parental immigration and autism spectrum disorder (ASD) in Manitoba, Canada. Methods Electronic medical records of children diagnosed with ASD between 2016 and 2021 at Manitoba’s only publicly funded referral site for ASD evaluation in children ≤6 years of age were reviewed. Children born in or outside of Canada whose parents/guardians (one or both) were foreign-born were identified to have ‘immigrant’ parents. The proportion of Manitoba’s immigrant population (including non-permanent residents) was obtained from 2016 to 2021 Census data and compared to the proportion of children diagnosed with ASD who had immigrant parent(s). Descriptive statistics were used to compare the characteristics of children with ASD born to immigrants versus non-immigrant parents. Results Among 1858 children diagnosed with ASD during the study period, 669 (36%) had immigrant parents. This proportion was greater than the proportion of immigrants (and non-permanent residents) living in Manitoba in 2016: 243,835/1,278,365 (19%, P < 0.001) and 2021: 291,910/1,342,153 (21.7%, P < 0.001). Those with immigrant parents had a lower rate of family history of ASD (16.3% versus 33.3% P < 0.001), and associated neurologic comorbidities (4.2% versus 6.4% P: 0.047). There were no statistical differences in rates of preterm birth (15.5% versus 12.36 P: 0.152) or use of Autism Diagnostic Observation Schedule-2 in diagnostic approach (30.3% versus 33% P: 0.321) between groups. Conclusions There is an over-representation of immigrant families among young children diagnosed with ASD in Manitoba. Further studies are needed to understand mechanisms that may play a role in this association.

Outcomes for active surveillance are similar for men with favourable risk ISUP-2 to those with ISUP-1 prostate cancer: A pair matched cohort study

Objective: To compare medium-term outcomes of active surveillance (AS) for men with favourable risk International Society for Urologic Pathology (ISUP)-2 prostate cancer (PCa) to a pair matched group of men with ISUP-1 PCa. Methods: This was a retrospective analysis of prospectively collected data from a single institution clinical outcomes registry, using propensity score matching. Men enrolled on AS with favourable risk ISUP-2 PCa with minimum 5-year follow-up were 1:2 propensity score matched to men with ISUP-1 disease. We assessed rates of progression to treatment, metastatic disease, adverse surgical pathology and overall survival. Results: Fifty-five ISUP-2 patients were matched to 105 ISUP-1 patients by propensity score. Median follow-up was 81 months (interquartile range (IQR), 61–109 months). Fifty-seven per cent in the ISUP-1 group progressed to treatment versus 58% in the ISUP-2 group (KM log rank p = 0.24). Estimated 1-, 2- and 5-year progression free survival rates were 93%, 60% and 33% for ISUP-1 patients and 94%, 63% and 16% for ISUP-2 patients, respectively. No patient from either group died of PCa. There was no statistical difference in rates of adverse pathology or metastatic disease between ISUP-2 and ISUP-1 patients on AS. Conclusion: AS for carefully selected men with favourable risk ISUP-2 disease appears safe, with similar oncologic outcomes to men with ISUP-1 disease. Level of evidence: Level 2b.

Safety outcomes and patient convenience in outpatient parotidectomy

BackgroundParotidectomies have historically been performed on an inpatient basis despite being well-tolerated surgeries with minimal postoperative wound care and low rates of complications at high-volume institutions. Past studies have supported the safety of outpatient surgery for parotidectomy but have been limited to superficial parotidectomy and have not addressed the patient experience surrounding the surgical intervention such as pre-operative and post-operative care and communication. PurposeThis study assesses the impact of outpatient superficial, deep, and partial parotid surgery on various parameters including surgical safety, distance traveled for care, utilization of telehealth, and patient-initiated communication. Materials and methodsRetrospective study from January 2020 to October 2021. Patients undergoing superficial lobe, deep lobe, and partial parotidectomies for benign and malignant pathologies were divided into inpatient and outpatient cohorts. A multivariable model examined the relationship between admission status and surgical complications, adjusted for age, sex, and tumor size. Results159 patients total, 94 outpatient and 65 inpatients. No statistical difference in rates of surgical complications with the exception of salivary leak. There was an increased rate of salivary leak reported in the inpatient group (OR 5.4, 95 % CI 1.6 to 18.0, p = 0.01). Mean patient travel distance of 354 miles one-way. Post-operatively, 76 % were evaluated via video visit. Following discharge, >55 % of patients initiated communication with the surgical team, which was not statistically different between the groups. ConclusionsOutpatient parotidectomy is safe and can be more convenient, but telehealth communication must be balanced with rigorous attention to patient education.

Overview of Rate and Risk Factors of Surgical Site Infection in a Tertiary Hospital in Liberia: A Prospective Cohort Study.

Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.

PREDICTING CARE-RECIPIENTS’ WELLBEING BASED ON SPOUSAL CAREGIVERS’ CO-OCCURRING STRESSORS AND RESOURCES

Abstract Besides caregivers, care-recipients’ health outcomes can be impacted by caregiving as well. The aim of the current study is to explore whether care-recipients’ longitudinal health outcomes differ by caregivers’ profiles characterized by the co-occurring and relative intensities of caregiving stressors and resources. Data from Round 5 and Round 7 of National Study of Caregiving and Round 5 to Round 8 of the linked National Health and Aging Trends Study are utilized. After multiple imputation, sample characteristics are described and compared among the 639 unique care-recipients by caregivers’ latent classes. Generalized estimating equations (GEE) with first-order autoregressive covariance are estimated to examine the differences in care recipients’ health outcomes at baseline and rates of change across groups. The average self-rated health at baseline is 2.73 (SD=1.02), and the average baseline depressive symptoms are 2.65 (SD=2.76). GEE results indicate that compared to care-recipients cared by low-stress low-support spousal caregivers, those cared by medium-stress high-support and high-stress medium-support partners score 0.20 and 0.35 unit lower in self-rated health at baseline, respectively, and those cared by high-stress medium-support caregivers on average score 1.21 unit higher in depressive symptoms at baseline. No statistical differences in rate of change are detected for both self-rated health and depressive symptoms across groups. Despite different levels of health at baseline, our research does not find care-recipients’ rates of change in health different across groups over one-year. Future studies are needed to further explore the longer-term differences in rates of change and to better understand the caregiving dyads.

941. Clinical Outcomes of Vancomycin Area-Under-the-Curve Monitoring: A Quasi-Experimental Study Interim Analysis

Abstract Background The 2020 Infectious Diseases Society of America vancomycin guidelines recommend the use of area-under-the-curve (AUC) monitoring instead of trough concentration monitoring. These guidelines changed due to evidence showing decreased rates of nephrotoxicity and lack of correlation between vancomycin troughs and patient treatment outcomes. Two common methodologies of calculating AUC exist in clinical practice, including two level kinetic calculations and Bayesian software programs. Previous studies used two levels for calculating the AUC. The purpose of this study is to evaluate if the same reduction in acute kidney injury (AKI) is achieved while using a Bayesian software program. Methods This retrospective quasi-experiment was performed at two sites within the same health system. The primary objective of this study was to assess the rate of AKI, as defined by the Acute Kidney Injury Network (AKIN) criteria, between patients receiving vancomycin dosed by trough monitoring as compared to AUC monitoring. Secondary objectives include mean daily dose of vancomycin, number of vancomycin levels, and severity of AKI. Patients were included in the study if they were 18 years or older, with at least one vancomycin concentration drawn. Patients were excluded if they had a baseline serum creatine greater than 2 mg/dL, received renal replacement therapy of any type, or received > 1 doses of vancomycin prior to admission. After screening for inclusion criteria, patients were matched 1:1 based on APACHE II score and vancomycin indication. Results One hundred and thirty patients met inclusion criteria at the interim analysis. Overall, baseline characteristics were similar between groups. No statistical difference was detected regarding the rate of acute kidney injury between the vancomycin trough group and AUC group (12% vs 14% p=0.971). The mean total daily doses of vancomycin were 1642 mg per day in the AUC group and 1838 mg per day in the trough group (p=0.08). Conclusion No statistical difference in rates of AKI were detected at the interim analysis, likely due to small sample size. Further data collection is ongoing to meet power and full results will be presented. Disclosures All Authors: No reported disclosures.

Subsequent Surgery Up to 10 Years After Osteochondral Allograft and Osteochondral Autograft: An Analysis of More Than 2000 Patients.

Osteochondral allograft transplant (OCA) and osteochondral autograft transfer (OAT) replace damaged cartilage with a plug of bone and overlying articular cartilage; however, limited research is available regarding the survival of these osteoarticular grafting procedures. We hypothesized that patients who underwent OCA would have a higher rate of subsequent surgery over the course of 5 years compared with patients who underwent OAT. Cohort study; Level of evidence, 3. The PearlDiver Mariner administrative database was used to identify patients 10 to 59 years old who had undergone OCA or OAT between 2010 and 2018. All included patients were assessed for subsequent knee surgeries, defined by the occurrence of a subsequent osteochondral procedure (OCA or OAT) or any type of knee arthroplasty for the duration of the time they were included in the data set (maximum of 10 years). Analyses were performed for the total population and those with allograft versus autograft (compared using the Fisher exact test). The 5-year Kaplan-Meier survival curves for operation-free survival were compared using a Mantel-Cox log-rank test. In total, 2598 patients were identified: 1631 patients who underwent OCA (34.5 ± 12.1 years old; 51.6% female) and 967 patients who underwent OAT (32.1 ± 12.9 years old; 51.0% female). Both groups had similarly high rates of subsequent knee surgeries (23.9% vs 21.9%, respectively; P = .249), with no statistical differences in rates of subsequent surgery between groups. Kaplan-Meier survival curves comparing operation-free survival at 5 years indicated no significant difference between the groups (OCA, 88.0% vs OAT, 89.5%; P = .235). Both osteochondral grafting procedures carried a relatively high rate of secondary surgery, which increased with time. The 5-year survival analysis revealed similarly high rates of subsequent surgery.

Autoimmune Hematological Toxicities of Immune Checkpoint Inhibitors: A Real-World Pharmacovigilance Database Analysis

BACKGROUND: Autoimmune hematological toxicities are rarely reported from the use of checkpoint inhibitors. However, there have been several cases of autoimmune hemolytic anemia, immune thrombocytopenia, hemophagocytic lymphohistiocytosis (HLH), and immune mediated cytopenias that have been reported in patients who were treated with checkpoint inhibitors. We performed a retrospective analysis of data of adverse effects of drugs that has been made available to public by the FDA. METHODS: The FDA has made data on adverse effects of various treatments available to the public through the FDA Adverse Events Reports System (FAERS) public dashboard. We investigated the autoimmune hematological toxicities of various checkpoint inhibitor therapies available at FAERS for the years 2020-2022. RESULTS: We reviewed the reported side effects of PD-1 inhibitors (pembrolizumab, nivolumab, cemiplimab, dostarlimab), PDL-1 inhibitors (atezolizumab, avelumab, durvalumab), and CTLA-4 inhibitors (ipilimumab) from FAERS. A total of 5,195 hematological toxicities from immunotherapies were reported from 2020-2022. Out of those, 483 (9.3%) were autoimmune hematological toxicities. The most common autoimmune complications were autoimmune hemolytic anemia (21.9%), immune thrombocytopenia (36%), autoimmune neutropenia (4.1%), HLH (36.2%) and thrombotic/idiopathic thrombocytopenic purpura (ITP/TTP) (1.8%). Nivolumab had the highest incidence of autoimmune hematological events out of all immune checkpoint inhibitors. Since cemiplimab and dostaralimab are relatively newly being utilized for treatment, there has not been much reported data. CONCLUSIONS: Out of the reported cases of hematological adverse reaction to check point inhibitor, 9.3% were autoimmune toxicities. There was no statistical difference in rate of autoimmune toxicities caused by PD1, PDL1 or CTLA 4 inhibitors. As utilization of newer immune checkpoint inhibitors increase, we would need to re-evaluate incidence of autoimmune hematological adverse reactions. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Comparison of rates of vaginal brachytherapy vs. external beam radiation post-hysterectomy for endometrial cancer patients in rural vs. urban settings (459)

<b>Objectives:</b> The GOG-99 trial published in 2004 demonstrated that patients with high-intermediate risk endometrial cancer benefit from adjuvant external beam radiation therapy (EBRT) post-hysterectomy to decrease the risk of recurrence. The PORTEC-2 trial was then published in 2010, which was an open-label, non-inferiority randomized control trial that compared vaginal brachytherapy (VBT) to EBRT for patients with high-intermediate risk endometrial cancer. This trial demonstrated non-inferiority of VBT compared to EBRT with no significant difference in vaginal or locoregional recurrence, overall survival, and disease-free survival. However, it did show a significant decrease in grade 1-2 gastrointestinal toxicities in the VBT group. VBT is now the standard of care given its decreased toxicity but is also notably less time-consuming for patients. Our objective was to identify if there was a difference in the administration of VBT versus EBRT for endometrial cancer patients post-hysterectomy in rural versus urban locations. <b>Methods:</b> This is a retrospective cohort study based on the SEER 18 dataset of the US National Cancer Institute. Women with localized endometrial cancer post-hysterectomy were included in this study. The SEER dataset defines a localized tumor as a tumor confined to the organ of origin without extending beyond the primary organ. Data were collected from 2011 to 2018, given that PORTEC-2 was published in 2010. Urban versus rural population was defined by the rural-urban continuum codes. Women were excluded if they received both VBT and EBRT or if a rural-urban continuum code was not provided. Statistical analysis was completed with relative risk and confidence interval calculation. <b>Results:</b> In total, 10,840 women were included. There were 9813 women identified in metropolitan counties; 22% (<i>n</i>=2136) received EBRT post-hysterectomy for localized endometrial cancer, whereas 78% underwent VBT. There were 1027 women identified in nonmetropolitan counties, 22% (<i>n</i>=230) received EBRT and 78% (<i>n</i>=797) received VBT. When comparing metropolitan versus nonmetropolitan counties, there was no statistical difference between rates of EBRT versus VBT, with a relative risk of 1.16 (95% CI: 0.91-1.16, p=0.64). There were 125 women identified in completely rural counties, 21% (<i>n</i>=26) received EBRT and 79% (<i>n</i>=99) received VBT. There was no statistical difference in rates of radiation therapy between completely rural and metropolitan counties, with a relative risk of 0.95 (95% CI: 0.67-1.34, p=0.77). <b>Conclusions:</b> Living in a nonmetropolitan county or even a completely rural county was not associated with a difference in receiving EBRT versus VBT in patients with localized endometrial cancer status post-hysterectomy compared to rates in metropolitan counties. It could be inferred that even though rural counties may have fewer medical resources, patients are still receiving the standard of care in regard to radiation therapy for endometrial cancer.

Comparative Outcomes of Standard Perioperative Eye Drops, Intravitreal Triamcinolone Acetonide-Moxifloxacin, and Intracameral Dexamethasone-Moxifloxacin-Ketorolac in Cataract Surgery.

Background Since the advent of cataract surgery, topical eye drops have been the mainstay of postoperative prophylaxis and treatment. Due to factors such as high expenses and poor patient compliance, there has been a growing interest and acceptance of “dropless” or “less drops” alternatives. The purpose of this study is to compare the effectiveness of intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac to a standard eye drop regimen in controlling postoperative inflammation, corneal edema, and intraocular pressure (IOP) among cataract patients. Methods A retrospective longitudinal comparative study among 619 consecutive eyes receiving either a standard eye drop regimen, intraoperative triamcinolone acetonide-moxifloxacin, or dexamethasone-moxifloxacin-ketorolac was performed between October 2016 and December 2020. Primary endpoints at postoperative day one (POD1), week one (POW1), and month one (POM1) included corneal edema, anterior chamber inflammation (ACI), and IOP. Results Throughout the postoperative time points, there were no significant differences in corneal edema between intravitreal triamcinolone acetonide-moxifloxacin versus the standard eye drop therapy (OR [95% CI]: 1.09 [0.82, 1.45], P=0.54) and intracameral dexamethasone-moxifloxacin-ketorolac versus the standard eye drop treatment (OR [95% CI]: 1.22 [0.89, 1.67], P=0.22). The postoperative ACI severity was lower in the dexamethasone-moxifloxacin-ketorolac group than in the triamcinolone acetonide-moxifloxacin group by 35% on postoperative day 1 (P=0.01). The differences at subsequent postoperative time points were not statistically significant (P=0.27 and P=1.00 for POW1 and POM1, respectively). IOP at POM1 follow-up visit was statistically significantly higher for the triamcinolone acetonide-moxifloxacin group (mean (±SD): 15.64 (4.26)) than the dexamethasone-moxifloxacin-ketorolac (mean (±SD): 14.16 (4.02)) (P < 0.01). There was no statistical difference in rates of CME (P=0.16), and there were no cases of endophthalmitis. Conclusions Intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac demonstrate similar levels of efficacy to a standard eye drop regimen after cataract surgery. This study reinforces them as viable alternatives to traditional postoperative drops.

The Effect of State-Level Prescription Opioid Legislation on Patient Outcomes After Lumbar Tubular Microdecompression.

In the United States, a statewide legislation titled the Strengthen Opioid Misuse Prevention (STOP) Act was enacted in 2017 to limit prescription opioid use and reduce dependence. The impact of state legislation curbing opioid prescription on outcomes after spine surgery is unknown. Case series. Data from consecutive patients undergoing lumbar tubular microdecompression for symptomatic lumbar spine stenosis from June 2016 to June 2019 were retrospectively analyzed. Cases between June 2016 and December 2017 represent the group before the STOP act (pre-STOP), while cases between January 2018 and June 2019 represent the group after legislation enactment (post-STOP). Preoperative and postoperative patient functional scores including the EuroQol-Five Dimensions Index, Oswestry Disability Index (ODI), and the visual analog scale (VAS) for back and leg pain were compared between both groups. The meaningful clinically important difference (MCID) was calculated for each score and was compared between both groups as well. A total of 147 patients met inclusion criteria, with 86 in the pre-STOP group and 61 in the post-STOP group. Analysis of postoperative scores demonstrated statistically lower VAS leg pain score averages in the post-STOP group (P < 0.05). Higher trends in achieving MCID among the post-STOP group were observed; however, the differences between both groups were not statistically significant (P > 0.05 for all). Additionally, there were no statistical differences in rates of unplanned pain-related clinic visits and emergency department (ED) visits, as well as no differences in the number of pain-related calls within 90 days after surgery between both groups. The enactment of state legislation to curb the prescribing of opioids for postoperative pain did not negatively affect the rate of achieving clinically meaningful outcomes among patients undergoing lumbar tubular microdecompression for spinal stenosis. Additionally, decreasing the amount of opioids prescribed for postoperative pain does not increase the number of unplanned clinic or ED visits due to pain within 90 days after surgery.

Efficacy of Topical Silver Nitrate for Control of Post-tonsillectomy Hemorrhage.

ObjectiveManagement of patients with post-tonsillectomy hemorrhage (PTH) is not well defined but may include observation, topical bedside treatments, or return to the operating room. Data on the use and efficacy of silver nitrate as a topical bedside agent for the management of PTH remain unexplored. Our primary objective was to assess the efficacy of silver nitrate in reducing the need for operative control of PTH.MethodsSingle-institution retrospective chart review included patients aged 5-18 years who presented with tonsillar bleeding within 30 days of tonsillectomy. Patients undergoing observation or bedside silver nitrate cautery were compared based on clinical characteristics and experience of the physician performing the procedure. The outcome of interest was rebleeding requiring operative control. Sample characteristics according to treatment modality were described using Fisher’s exact tests and ANOVA.ResultsOf the patients eligible for inclusion, 29 (20%) were observed and 70 (48.3%) were treated with topical silver nitrate. Age was the only statistically significant clinical difference among treatment groups. The silver nitrate group had more patients who underwent operative control of PTH compared to the observation group (p = 0.004). When comparing the need for operative control between the observation group and patients who had initial success with silver nitrate, there was no difference (p = 0.29). No differences were found in the rate of bleeding requiring operative control when comparing experience of the physician performing the procedure (p = 0.20).ConclusionMore patients who underwent silver nitrate cautery required PTH control in the operating room compared to the observation group. This may be due to patient selection as our results also suggest that there is no statistical difference in rates of operative control of PTH when comparing initial successful treatment with topical silver nitrate to observation. Age is likely a factor that was used by physicians in this study to decide the initial management of PTH. Provider experience does not appear to affect rebleeding rates. Future studies are necessary to evaluate the clinical impact of silver nitrate in the context of PTH and will benefit from more robust sample sizes and enhanced diversity in the sample group.

Rates of Ischemia Amongst Asymptomatic Patients with High Coronary Artery Calcium Scores

CACS may be used to recommend lifestyle changes or other treatment recommendations to reduce the risk of heart disease. The incidence of asymptomatic ischemia in patients with elevated CACS is poorly defined. Furthermore, the CACS cut-off above which it is clinically important and cost effective to look for and diagnose ischemia is also not well defined. The purpose of this study is to better define the incidence of asymptomatic ischemia in Parkview Heart Institute (PHI) patients with elevated CACS, including an examination of demographic data that may also influence the rate of ischemia. 118 Patients who were screened for CAD, received CACS ≥ 400, and subsequently had stress testing or invasive coronary angiogram within 6 months were admitted into the study. Through statistical analysis it was determined there was no statistical difference in rates of ischemia between patients with CACS of 400-999 and those &gt;1000. However, due to a small sample size this study will be continued to strengthen its results and investigate if demographics play a role in rates of ischemia.

IDENTIFICATION OF TORCH PATHOGENS IN CONGENITAL CATARACT PATIENTS VISITING ARMED FORCES INSTITUTE OF OPHTHALMOLOGY

Objective: To assess the rate of positivity of Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex (TORCH) pathogens in patients suffering from congenital cataract in Pakistan.&#x0D; Study Design: Cross sectional comparative study.&#x0D; Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2017 to Mar 2018.&#x0D; Methodology: Cataract group included sixty children already diagnosed with congenital cataract and control group included 60 children not suffering from congenital cataract. Serum samples of all children were collected to test against IgG and IgM antibodies of Toxoplasma gondii, Rubella, Cytomegalo, Herpes simplex pathogens using enzyme linked immune essay (ELISA) technique. Data were analyzed observe in difference between unilateral and bilateral cataract and between cataract and control group.&#x0D; Results: Out of 60 children in cataract group, 29 were tested positive for Toxoplasma gondii, Rubella, Cytomegalo (CMV), Herpes simplex infections. CMV IgG antibodies were identified in 21 (35%) children followed by Rubella IgG 13 (21.7%), Toxoplasmosis IgG 8 (13.3%), CMV IgM 7 (11.7%), HSV I IgG 5 (8.3%), HSV II IgG 2 (3.3%) and HSV I IgM 1 (1.7%) antibodies. None of the children was positive for Toxoplasmosis, Rubella and HSV II IgM antibodies. There was no statistical difference in rate of positivity of Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex pathogens between unilateral and bilateral cataract and between cataract and control group.&#x0D; Conclusion: Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex pathogens are an important cause of congenital cataract with Cytomegalovirus and Rubella virus being most common respectively. In order to prevent paediatric complications, we need........

S1284 Expanding the Use of ERCP in Pediatrics: A National Database Analysis of Demographics and Complication Rates

Introduction: Despite increasing ERCP usage, there remains a paucity of information regarding demographic differences and complication rates in pediatric populations, with published evidence only encompassing small sample sizes or lacking head-to-head comparisons. This study aims to aid in risk assessment in pediatric ERCP candidates by utilizing a national pediatric database with a large sample to assess how ERCP demographics affect complication rates. Methods: The KID is a sample of pediatric discharges from community hospitals in states participating in the Healthcare Cost and Utilization Project (HCUP). Demographic information, hospital region, hospitalization duration, and mortality information were provided by the database for individual hospitalizations. ICD-10 codes were also used to determine the hospitalization indication, and subsequently coded ERCP indicated a repeat ERCP within the hospitalization. ERCP complication rate was ascertained via complication codes (K91.89, K91.81). All statistical analysis was performed using SAS 9.4. Results: This analysis captured a large Hispanic population, specifically in the South and West regions (Table 1). Procedure complications were seen in 5.4% of hospitalizations with mortality observed in less than 0.2%. Of pediatric patients with documented ERCP during the hospitalization, 30.0% required a repeat ERCP during the same hospitalization. Repeat ERCP was not associated with increased rate of complication. Calculus of the gallbladder, acute, and chronic cholecystitis were more likely to occur in the female group (Figure 1), though there was no difference in complication between genders (p = 0.3). A higher percentage of hospitalized patients in the age 10-17 age group were female (52.7% vs 72.2%, p < 0.01) and Hispanic (22.7% vs 33.4%, p < 0.01) compared to the age 0-9 group. Age 0-5 was associated with a lower routine home discharge rate and a longer length of stay (Table 2). Complications also occurred at a higher rate in this age group, though the difference was not statistically significant. Conclusion: ERCP is a safe procedure for pediatric populations with relatively low complication rates and exceedingly rare associated mortality. We found significant differences in the procedure indications between pediatric age groups, races, and genders. Though no statistical difference was found in complication rates between groups, age < 5 yo and male gender were associated with longer lengths of stay and decreased likelihood of routine home discharge.Figure: Table 1.: Over 6 million hospitalizations were included in the overall sample, and we restricted to live births with at least one ERCP, giving n=4484 for ages 0 to 20 and n=1934 for ages 0 to 17. A large percentage of the captured patients came from the older age groups, indicating that this is an uncommon procedure in patients age < 10. A high percentage of hospitalized patients in the age 10-17 age group were female (52.7% vs 72.2%, p < 0.001) and Hispanic (22.7% vs 33.4%, p < 0.001) compared to the age 0-9 group. Differences in admission primary diagnosis between genders are also depicted. Females had statistically higher rates of calculus of the gallbladder/bile duct (p = 0.03) and chronic cholecystitis (p = 0.02). Males had higher rates of traumatic injury (p < 0.001), obstruction of the bile duct (p < 0.001), cholangitis (p = 0.002), and primary sclerosing cholangitis (p = 0.02).Table 2.: ERCP Age Group Comparison. A large percentage of the dataset if comprised of patients age >10, indicating that this is an uncommonly performed procedure in younger age groups. The common primary diagnoses for age 10 were more often Hispanic. There was no statistical difference in rates of repeat procedure or complication between age groups. The HCUP database prohibits reporting patient counts < 10.

Gluteal compartment syndrome: A systematic review and meta-analysis

IntroductionGluteal compartment syndrome is a rare but devastating condition with limited characterization in the literature. The purpose of our systematic review, case series, and meta-analysis is to synthesize the current literature and provide recommendations on how to prevent gluteal compartment syndrome, identify at-risk patients, and avoid delays in diagnosis and treatment. MethodsInternational Classification of Disease codes were used to identify patients at our institution. PubMed, MEDLINE, and the Cochrane Library were searched to identify case reports between 1972 and March 1st, 2018. Cases were analyzed based on demographics, etiology, presentation, symptoms, diagnosis, treatment, and outcomes. Results139 cases – 13 from our institution and 126 previously published – were included. The most common etiologies were postoperative (41%), prolonged immobilization secondary to substance abuse or loss of consciousness (35%) and trauma (19%). 89% were male, mean age was 45 years (range, 16-74), and mean body mass index was 41 kg/m2. Rhabdomyolysis and sciatic neuropathy were identified in 94% and 74% of patients, respectively. Fasciotomy was performed in 80% of patients. Overall, 93% of patients survived. However, 41% of patients suffered prolonged neurologic dysfunction. In patients with an initial neurologic deficit, there was a higher rate of permanent neurological deficit in patients treated medically than those treated surgically (12/14 vs 29/61, p=0.0153), but no statistical difference in mortality (0/14 vs 4/61, p=1). In patients without initial neurologic deficit, there were no statistical differences in rates of permanent neurological deficit (0/7 vs 2/20, p=1) or mortality (0/7 vs 3/20, p=0.545) between those receiving medical or surgical treatment. DiscussionGluteal compartment syndrome is an orthopaedic emergency that may be more prevalent and associated with higher morbidity and mortality than previously recognized. Risk factors may include prolonged surgical duration, immobilization secondary to substance abuse, and pelvic trauma. Intraoperative precautions and postoperative surveillance are recommended in obese patients undergoing prolonged procedures. Fasciotomies improve neurologic outcomes in patients presenting with an initial neurologic deficit. In patients who are neurologically intact on presentation, medical management with neurologic function surveillance may be the optimal initial treatment. Fasciotomies do not impact mortality. Additionally, a treatment algorithm is provided.

PD28-09 SAFETY AND FEASIBILITY OF SAME-DAY DISCHARGE FOLLOWING SINGLE-PORT ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety I (PD28)1 Sep 2021PD28-09 SAFETY AND FEASIBILITY OF SAME-DAY DISCHARGE FOLLOWING SINGLE-PORT ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY Carrie Ronstrom, Joel Vetter, Julia Sheets, Vicky Peck, Sherb Figenshau, and Eric Kim Carrie RonstromCarrie Ronstrom More articles by this author , Joel VetterJoel Vetter More articles by this author , Julia SheetsJulia Sheets More articles by this author , Vicky PeckVicky Peck More articles by this author , Sherb FigenshauSherb Figenshau More articles by this author , and Eric KimEric Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002029.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have demonstrated the safety of same-day discharge (SDD) following robotic prostatectomy using the multiport robot. At our institution, the da Vinci Single-Port (SP) robot was first used for a robotic prostatectomy in November 2019 and has since been used routinely for prostatectomies. Given the coronavirus pandemic and increased hospital capacity, SDD has become desired. This study was developed to determine safety and feasibility of SDD following SP robotic prostatectomy. METHODS: Patient data was collected from January 2020 to December 2020. SDD was offered to patients starting March 2020. Criteria for SDD included: patients had to obtain surgeon approval, have a caregiver stay overnight the first night after surgery, had to ambulate, tolerate oral intake, and have pain controlled on oral medications. Following discharge, patients who underwent SP robotic prostatectomy received a telephone survey regarding outcomes and opinions regarding SDD. Patient medical records were reviewed to evaluate readmissions and complications. RESULTS: Fifty-one patients were included in the study, 15 of whom underwent SDD. In total there were 8 readmissions and emergency department (ED) visits, four occurred in the SDD group and four in the standard discharge group. Table 1 includes details on visit reasons and timing post-operatively. There was no statistical difference in rate of ED visits, or readmissions within 7-days, 30-days or 90-days between the two groups (p value 0.34, 1.00, 1.00, 0.14 respectively). The only readmission/ED visit that may have been avoided with standard discharge was for kinked catheter on post-operative day (POD) 0. On follow up survey, all patients who discharged same day, except the patient with POD 0 complication, endorsed that SDD remained the right choice for them in retrospect. CONCLUSIONS: SDD following SP robotic prostatectomy appears to be feasible and safe without significant increase in readmissions or ED visits. When offered to patients who met criteria, greater than 90% who underwent SDD felt it remained the correct decision for them in hindsight. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e523-e524 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carrie Ronstrom More articles by this author Joel Vetter More articles by this author Julia Sheets More articles by this author Vicky Peck More articles by this author Sherb Figenshau More articles by this author Eric Kim More articles by this author Expand All Advertisement Loading ...

Analysis of Delivery in Singleton Pregnancies Achieved by In Vitro Fertilization

BACKGROUND: Birth after IVF is increasingly observed in modern obstetrics, so knowledge of its features is of paramount importance for clinical practice. &#x0D; AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of cesarean section rate, operative vaginal birth rate, induction of labor, manual removal of the placenta in vaginal births, severe PPH and need for blood transfusion after delivery.&#x0D; &#x0D; MATERIAL AND METHODS: We conducted a retrospective study at "Maichin Dom" University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies &#x0D; &#x0D; RESULTS: We found a significantly higher rate of cesarean sections in IVF compared to spontaneous pregnancies [OR 1.73; 95% CI 1.4-2.14; p&lt;0.001]. Vaginal delivery after IVF is associated with a higher incidence of operative vaginal delivery than spontaneous pregnancies [OR 2.27; 95% CI 1.14 - 4.52; p=0.018]. No statistical differences in rates of labor induction and manual removal of the placenta between two groups were estimated (p&gt;0.05). Severe PPH and blood transfusions were three times higher in patients after IVF undergoing a cesarean section than in those with spontaneous singleton pregnancies [OR 3.0; 95% CI 1.11 - 8.11; p=0.018].&#x0D; &#x0D; CONCLUSION: IVF singleton pregnancies are associated with a higher risk of cesarean section as well as some obstetric complications. Obstetricians should treat these pregnancies with caution in order to reduce cesarean section rate and improve the outcome.

Is a \u2018guideline-compliant\u2019 primary cesarean delivery associated with a modified risk for maternal and neonatal morbidity?: a clinical evaluation of the 2014 ACOG/SMFM obstetric care consensus statement

BackgroundIt is currently unknown whether primary CDs performed in compliance with the 2014 ACOG/SMFM Obstetric Care Consensus Statement guidelines (“guideline-compliant”) are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the guidelines (“guideline-noncompliant”). Our primary objective was to determine if a guideline-compliant primary CD is associated with a modified risk for maternal or neonatal morbidity, when compared to guideline-noncompliant primary CD.MethodsA retrospective cohort study of all primary CDs at one tertiary referral center in the calendar year following publication of the Consensus Statement. Logistic regression was performed to calculate the risk of adverse maternal and neonatal outcomes for guideline-compliant primary CDs, when compared to guideline-noncompliant and guideline-not addressed, and when adjusted for maternal age, BMI, hypertension, gestational age at delivery, insurance carrier, and provider practice.ResultsEight hundred twenty-seven primary CDs were included during the study period, of which 34.8, 26.0, and 39.2% were guideline compliant, guideline-noncompliant, and guideline-not addressed. No statistically significant differences in the frequency of adverse maternal outcomes across these three groups were observed with the exception of maternal ICU admission, which was significantly associated with a guideline-not addressed primary CD (p = 0.0002). No statistical difference in rates of NICU admissions, 5 min APGAR < 5, or umbilical artery cord pH < 7 were observed between guideline-compliant and guideline-noncompliant primary CDs.ConclusionWomen undergoing guideline-compliant primary CDs were not significantly more likely to experience a maternal or neonatal morbidity when compared to guideline-noncompliant primary CDs.

Clinical characteristics and outcomes of cancer patients with chronic kidney disease and coronavirus disease 2019.

e18815 Background: Coronavirus disease 2019 (COVID-19) has been associated with higher risk of acute kidney injury (AKI) and mortality rate in cancer patients. The prevalence of CKD in cancer patients is close to 20-30% however there has been limited data about cancer patients with CKD and COVID-19 infection. The aim of this study is to evaluate the clinical characteristics and outcomes of this patient population at a tertiary cancer center. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR 15-59 ml/min/1.73m2 calculated by chronic kidney disease epidemiology collaboration equation. The baseline GFR and creatinine values used the most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined as an absolute change of creatinine ≥0.3 mg/dl above the baseline after the positive COVID-19 test. Results: Out of 790 patients with COVID-19,19.6% had underlying CKD. Among these, 86.5% and 46.5% had history of hypertension and diabetes mellitus, respectively. 77.3% had a solid malignancy and 87.3% of them had metastatic disease. 67.7% were asymptomatic, 14.2% required ICU admission, 10.3% required invasive ventilation support, and 11.6% died within 90 days of the COVID-19 test. AKI developed within the first 30 days in 61.3% and 8.4% required renal replacement therapy. AKI was more prevalent in patients who were hospitalized (84.2% vs. 31.7%, p&lt; 0.001), had concurrent pneumonia (63.3% vs. 36.8%, p&lt; 0.002), required critical care (68.3% vs. 15.8% , p&lt; 0.001), and were on ventilation support (16.8% vs. 0%, p=0.002). There was no significant statistical difference in rates of diabetes (52.6% vs. 36.7%, P of 0.076), tumor staging (metastasis; 95.1% vs. non metastatic 82.6%, p&lt; 0.2) , readmission rate (52.6% vs. 43.3%, p=0.336), and death rate at 30 days (9.5% vs. 3.3%, p=0.205) between the two groups. Conclusions: The overall mortality rate of cancer patients with CKD and positive COVID-19 test was relatively high and close to 1.7 times the rate of patients with no CKD at our tertiary cancer center. AKI is a common complication in CKD patients with concurrent pneumonia and requiring ventilation support, and was associated with increased morality at 90 days.