Utilization Rate Research Articles

Analysis of outcomes in adult deceased donor dual kidney transplantation

Objective: To investigate the efficacy of dual kidney transplantation (DKT) from adult donors. Methods: Clinical data of adult DKT donors and recipients in the Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 2015 to June 2024 were retrospectively analyzed. The patients were followed up until September 2024. The clinical data of donor and recipient, donor kidney, surgical techniques, complications, and follow-up were collected. Transplant renal function and recipient/graft survival rates within 5 years were analyzed. Results: A total of 102 pairs of DKT donors and recipients were included. Among the donors, 83 were male and 19 were female, with age of (57.8±11.1) years and body mass index (BMI) of (23.1±3.2) kg/m². Among the recipients, 95 were male and 7 were female, with age of (42.0±11.0) years and BMI of (22.1±3.1) kg/m². The postoperative hospitalization and follow-up duration [M (Q1, Q3)] for recipients were [20.0 (15.0, 27.0)] days and [30.0 (12.5, 49.0)] months, respectively. China Class Ⅱ donation accounted for 64.7% (66/102) of donor categories. The pre-procurement serum creatinine (Scr) level of donors was [97.0 (66.5, 144.5)] μmol/L, and the hypothermic machine perfusion utilization rate was 52% (53/102). The warm ischemia time was (5.5±1.7) minutes, and the mean cold ischemia time was (8.7±3.8) hours. The Remuzzi scores for the left and right kidneys before transplantation were (4.8±1.3) and (5.1±1.4) scores, respectively. The glomerulosclerosis rates for the left and right kidneys were 34.0%±16.2% and 35.3%±16.7%, respectively. The primary nephropathy was unknown in 80.3% (82/102) of recipients, and IgA nephropathy was diagnosed in 8.8% (9/102) of the recipients. Bilateral kidneys were implanted ipsilaterally in 94.1% (96/102) of recipients, with operative time of (5.3±1.4) hours. Lymphocyte-depleting induction therapy was administered to 74.5% (76/102) of recipients. One recipient experienced primary graft non-function after surgery. The incidences of delayed graft function and rejection were 30.4% (31/102) and 9.8% (10/102), respectively. The overall incidence of surgical complications was 10.8% (11/102). The 1, 3, and 5-year recipient survival rates were 100.0%, 98.3%, and 98.3%, respectively. The 1, 3, and 6-month and 1, 3, and 5-year graft survival rates were 97.1%, 96.1%, 95.0%, and 94.0%, 89.3%, 85.6%, respectively. The recipient's kidney function remains stable for 5 years after transplantation. At 5 years, the recipient median Scr level and mean estimated glomerular filtration rate (eGFR) were 153.0 (120.0, 232.0) μmol/L and (42.1±17.1) ml-1·min-1·(1.73 m²)-1, respectively. Conclusion: Adult donor DKT demonstrates favorable short-term and 5-year clinical efficacy.

Trends in Medicare procedural and reimbursement rates for spinal CSF leak repair (2000-2021).

CSF leaks are a common complication of spinal surgery, occurring in 3%-16% of elective cases and up to 12% of operatively managed traumatic spinal injuries. They can also occur following lumbar puncture. However, there are limited data on utilization and reimbursement trends within Medicare for CSF leak repairs. Characterizing the economic burden and market of spinal CSF leak repair has implications for optimizing effective management strategies. This study evaluates reimbursement and utilization trends for both surgical repair and epidural blood patch (EBP) management of spinal CSF leaks between the years 2000 and 2021. The 2000-2021 provider utilization and payment files from the Centers for Medicare & Medicaid Services was queried to identify all spinal CSF leak repair procedures billed to Medicare part B. For each management strategy, the number of procedures, total charges submitted by providers, and total Medicare reimbursements were extracted. Monetary data were adjusted to 2021 US dollars using changes to the Consumer Price Index. Spearman rank correlation coefficients were used to analyze trends in reimbursement and utilization. From 2000 to 2021, 62,826 open surgical repairs were reported with $37,082,407 paid in reimbursement (45.9% repaired without additional laminectomy, 28.8% with laminectomy, and 25.3% requiring a spinal dural graft). An additional 63,227 EBPs were reported for CSF leak repair with $7,567,776 in reimbursement. Reimbursement for CSF leak repair without laminectomy totaled $15,707,094; repairs with laminectomy, $12,429,690; and use of spinal dural grafts, $8,945,444. Both a significant 162% increase in the utilization of spinal dural grafts (333 to 872, p < 0.001) and a decrease in reimbursement ($671 to $496, p = 0.02) was observed from 2000 to 2021. There was a significant 31% decrease in reimbursement for EBP ($148 to $102, p < 0.001). Significant variability exists in the management strategy and rates of utilization and reimbursement for treating spinal durotomy. Despite increasing utilization of spinal dural grafts, reimbursement has declined between the years 2000 and 2021. Further studies are required to optimize both the cost effectiveness and efficacy of spinal durotomy repair techniques.

Impact of a Nurse Navigator Program on Referral Rates and Use of Fertility Preservation Among Female Cancer Patients: A 14-Year Retrospective Cohort Study.

Given the known detrimental impact of cancer treatment on fertility, fertility preservation (FP) is recommended for reproductive age patients who are newly diagnosed with cancer. However, the rate of referral to fertility specialists remains suboptimal. The objective of this study was to determine the impact of a dedicated Nurse Navigator Program (NNP) on the rate of referrals and utilization of FP services. A retrospective cohort study of all women ≥ 18 years old referred for FP consultation with a known cancer diagnosis from 2007 to 2021 at a single, large academic center was conducted. FP referrals for non-cancer indications were excluded. Descriptive statistics were performed including comparing referrals received per 30 days and FP utilization rates pre-NNP (October 2007-September 2013) to post-NNP (October 2013-December 2021). A total of 176 patients were included pre-NNP and 990 patients post-NNP. Overall, the mean age at the time of referral was 31.5 ± 6.9 years. The referral rates post-NNP were higher among those without prior exposure to chemotherapy/radiation (0.33 pre-NNP vs. 2.75 post-NNP per 30 days, p < 0.01) and lower among those with prior exposure to chemotherapy/radiation (1.26 pre-NNP vs. 0.70 post-NNP per 30 days, p < 0.01). After the launch of a dedicated fertility preservation nurse navigation program at our institution, we observed a higher number of referrals for FP as well as greater use of FP overall. While not the only variable that changed during this period, this program has optimized patient care and clinical workflow at our institution and serves as a model for such improvement.

Cryopreserved sperm among patients with Oligoasthenoteratozoospermia.

This study investigates sperm utilization and disposal patterns in Oligoasthenoteratozoospermia (OAT) patients undergoing long-term sperm storage. OAT is a major contributor to male infertility. Cryopreservation is a common practice as a "fertility insurance" in case of further deterioration until azoospermia. However, long-term storage practices and utilization rates remain unclear. In this retrospective study spanning from October 1993 to December 2021, we examined men diagnosed with OAT who underwent spermatozoa cryopreservation. Data from medical records included utilization and disposal of sperm samples, age and paternity status at initial cryopreservation. We analyzed the data over 10years using Kaplan-Meier curves, compared age and paternity status with the log-rank test. Among 238 patients undergoing semen cryopreservation due to the indication of OAT, 45 utilized sperm for fertility treatments, with a third using all frozen straws and others using only a portion. Sixteen patients used sperm due to azoospermia. Additionally, 54 requested the disposal of all cryopreserved straws. A Kaplan-Meier analysis revealed that after 10years, 25.9% of men used cryopreserved sperm, while 31.2% opted for disposal. Most participants did not use or dispose of preserved sperm. After 10years, no significant differences were observed in usage or disposal based on age or paternity status. Our analysis of sperm utilization in OAT patients undergoing cryopreservation revealed a key finding: nearly half exhibited a "wait-and-see" approach. Unlike other indication for sperm preservation, age and paternity did not significantly influence utilization or disposal decisions. This suggests unique factors drive decision-making in OAT patients, highlighting the need for tailored cryopreservation management strategies.

Racial Disparities in Total Knee and Hip Arthroplasty in a Medically Underserved Community with a Diverse Population.

Previous studies have demonstrated lower total joint arthroplasty utilization rates and worse postoperative outcomes among non-White patients. Our study examined whether these disparities exist in the setting of a diverse population. This retrospective study included patients with a self-reported race who underwent total knee (TKA) or hip (THA) arthroplasty procedures in a racially diverse county. Patients who did not identify as White or Hispanic/Latino were excluded from the study due to small sample sizes. Demographic, intra and postoperative outcome differences were calculated.A multivariate logistic regression was developed to examine the association between patients' race and undesired postoperative outcomes. Five hundred fifty-five patients were included in our study with 490 identifying as non-Hispanic/Latino White (88.8%) and 65 as Hispanic/Latino (11.2%). Hispanic/Latino-identifying patients were significantly younger (61.9 ± 12.79 versus 68.58 ± 9.00years), had lower Charlson Comorbidity Index scores, and were more likely to use non-Medicare/Medicaid insurance. We observed no differences between our cohorts in postoperative adverse events, emergency department visits, and hospital readmissions.Patients' self-identified race was not correlated with undesired postoperative outcomes. Although Hispanic/Latino-identifying patients constitute 50.2% of the county population of our study cohort, they accounted for only 11.2% of the patients in our study. This is noteworthy considering the lack of evidence suggesting a decreased prevalence of osteoarthritis among individuals of different races and ethnicities. Further, the demographic differences we observed suggest an exclusive Hispanic/Latino patient population utilizing TKA or THA procedures. Future studies controlling for risk factors and less invasive treatment options may explain these disparities.

In situ construction of CuBi2O4/Bi4O5Br2 Z-scheme heterojunction with enhanced photocatalytic degradation performance for polyphenolic contaminant in wastewater

Photocatalytic technique is one of the clean and promising routes for wastewater purification. In this work, a different CuBi2O4/Bi4O5Br2 Z-scheme heterojunction were successfully prepared via an in-situ mechanical agitation method. The 10% CuBi2O4/Bi4O5Br2 (10% CBO/BOB) heterojunction showed the highest photocatalytic degradation activity for catechin, and ∼99.8% catechin was degrade within 40 min visible light stimulation, which is (0.0757/min) about 6.2-folds and 8.8-folds to that of Bi4O5Br2 (0.0122/min) and CuBi2O4 (0.0086/min), The pH=7 is the optimal reaction condition for catechin degradation. Besides, The photocatalytic degradation capacity of the 10% CBO/BOB heterojunction displayed the positive and negative relationship to the dosage of catalyst and initial concentration of catechin, respectively. The enhanced photocatalytic activity of CuBi2O4/Bi4O5Br2 Z-scheme heterojunction can be ascribed to the improvement of the charge separation and light utilization rate. The results of ESR and trapping experiments revealed that the ·O2-, h+ and ·OH are the primariy reactive substances for catechin degradation. Additionally, the transfer pathway of the photogenerated charges in the CuBi2O4/Bi4O5Br2 Z-scheme heterojunction as revealed by the ESR, Mott-Schottky curve and UV-Vis diffuse reflectance absorption spectroscopy. This work provide a new idea for designing and preparing the novel Bi4O5Br2-based photocatalyst for TCM wastewater purification.

Hydrophobic modification of cellulose nanofibers/bionic flower-like ZnO synergistically stabilized Pickering emulsion to enhance pesticide deposition.

Environmental issues arising from the low pesticide utilization rate make the development of environmentally friendly and low-cost pesticide carrier systems an urgent problem to be solved. Pickering emulsion systems have shown broad application prospects in pesticide delivery. In this study, dodecenyl succinic anhydride (DDSA) was used to hydrophobically modify cellulose nanofiber (D-CNF), and biomimetic flower-like zinc oxide (ZnO) particles were prepared by precipitation method at room temperature. Then the two functioned synergistically as stabilizers for the Pickering emulsion, which significantly diminished the reliance on conventional surfactants. Turpentine, an essential oil, was used as a solvent for the broad-spectrum herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) and as a part of the oil phase in an emulsion, replacing traditional toxic solvents for pesticide dissolution in the construction of a Pickering emulsion system. ZnO/D-CNF formed a dense layer at the oil-water interface to prevent droplet aggregation. After the Pickering emulsion contacted the leaves, ZnO could be embedded and adhere to leaves due to its morphology, which effectively reduced the splash of the droplets. No matter what the inclination angle was, the droplets could adhere and diffuse on the leaves. This study presents a new idea for creating a simple, eco-friendly, and practical pesticide carrier system.

Polarized electric field induced by piezoelectric effect of ozone micro-nano bubbles/spontaneously polarized ceramic to boost ozonolysis for efficient fruit sterilization.

Ozone (O3) treatment is an environmentally friendly fruit sterilization strategy. However, the low O3 utilization rate and long-term oxidation lead to O3 waste and fruit damage, respectively. Herein, a sterilization system based on the synergy of O3 micro-nano bubbles (OMNB) and spontaneously polarized ceramic (SPC) was developed to piezoelectrically catalyze ozonolysis for efficient fruit sterilization. OMNB/SPC showed excellent sterilizing activity with 7 lg CFU/mL of E. coli and S. aureus inactivation within 20min, together with significantly improved fruit quality in Kyoho grapes preservation. The excellent sterilizing performance of OMNB/SPC is attributed to that the piezoelectric SPC (d33=103.4pm/V) formed a strong polarized electric field and rich reactive oxygen species (ROS) under OMNB collapse resulting in O3 absorption/decomposition. The electric field and rich ROS caused membranes in-situ electroporation and irreversible inactivation to the microorganisms on fruits successively. This system is important for more efficient long-term preservation of fruits.

NO3--N pulse supply caused by biodegradable plastics exacerbates Trifolium repens L. invasion.

The exacerbation of plant invasion by microplastics attracted widespread attention. Pulse resource hypothesis is popular theory to elucidate plant invasion. Our previous work demonstrated biodegradable microplastics (BMPs) could increase the arbuscular mycorrhizal fungi (AMF) colonization rate. Reportedly, AMF can enhance rhizobia colonization. Therefore, we infer the coexistence of BMPs with legumes may lead to an increased colonization of rhizobia with negative feedback regulation of N fixation. This could result in NO3--N pulse supply, thereby exacerbating plant invasion. Subsequently, a 60-day pot experiment was conducted using Trifolium repens L. as invasive plant and Oxalis corniculata L. as native plant, with 1% or 5% wt BMPs. AMF colonization, BMPs degradation, NO3--N content and pulse supply, rhizobia colonization, relative competitive intensity, replacement diagrams and NO3--N utilization were determined. The mechanism was clarified through heat map and structural equation model. The results reveal the greater the NO3--N consumption by BMPs, the more AMF promoted rhizobia colonization in T. repens, thereby the larger the pulse amplitude of NO3--N supply, then, the higher the NO3--N utilization rate of T. repens. It exacerbates T. repens invasion. This study clarifies effects of BMPs on rhizobia's N fixation, and enriches the evidence on mechanism of BMPs exacerbating plant invasion.

The 2024 American Association for Thoracic Surgery expert consensus document: Current standards in donor lung procurement and preservation.

Donor lung procurement and preservation is critical for lung transplantationsuccess. Unfortunately, the large variability in techniques impacts organ utilization rates and transplantation outcomes. Compounding this variation, recent developments in cold static preservation and new technological advances with machine perfusion have increased the complexity of the procedure. The objective of the American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) expert panel was to make evidence-based recommendations for best practices in donor lung procurement and preservationbased on review of the existing literature. The AATS CPSC assembled an expert panel of 16 lung transplantation surgeons from 14 centers who developed a consensus document of recommendations. The panel was divided into 7 subgroups covering (1) intraoperative donor assessment, (2) surgical techniques, (3) ex situ static lung preservation methods, (4) hypothermic preservation, (5) normothermic exvivo lung perfusion (EVLP), (6) donation after circulatory death (DCD) and normothermic regional perfusion, and (7) donor management centers, organ assessment centers, and third-party procurementteams. Following a focused literature review, each subgroup formulated recommendation statements for each subtopic, which were reviewed and further refined using a Delphi process until a 75% consensus was achieved on each final statement by the voting group. The expert panel achieved consensus on 34 recommendations for current best practices in donor lung procurement and preservation both in brain-dead as well as DCD donation. The use of new methods of cold preservation, the role of EVLP, and DCD with and without concomitant heart donation are described in detail. Consistent and best practices in donor lung procurement and preservationare critical to improve both lung transplantation numbers as well as recipient outcomes. The recommendations described here provide guidance forprofessionals involved in the care of patients with end-stage lung disease considered for transplantation.

Improving Evidenced-based Outpatient Order Set Utilization in the Gastrointestinal Division of a Large Pediatric Health System.

Standardization is crucial in improving healthcare outcomes, equity and quality. Clinical decision support tools are key to achieving this goal. At our organization, Epic serves as our electronic health record, and SmartSets are Epic's version of outpatient standardized order sets with embedded clinical decision support tools. In 2022, the utilization of SmartSets in our hospital's gastrointestinal division was only 1.9%, far below our organizational target of 50%. Our group formed a quality improvement (QI) team and chose the model for improvement methodology. The interventions focused on education, buy-in, feedback performance monitoring, and the enhancement and development of new SmartSets. Our primary aim was to increase the utilization rate of SmartSets by gastrointestinal providers from 1.9% to 20%, and our secondary aim was to reduce the time spent by providers on orders by 10% from 3.3 to 2.8 minutes per encounter. Our balancing measure was monitoring safety reports during the study period. SmartSet utilization improved to greater than 20% within 7 months of the project initiation. Three months after implementing SmartSet updates and introducing new SmartSets into production, time spent on orders during clinical encounters decreased from a median of 3.3 to 2.4 minutes per encounter. We appreciated that there was no change in safety reporting during the project timeline. We achieved our goal of improving utilization rates of standardized SmartSets and reducing time spent on orders using a QI methodology. Our achievements underscore the effectiveness of QI methods in enhancing SmartSet utilization and streamlining order processes.

Use of erectile dysfunction treatments after prostate cancer treatment and their perceived impact on men’s sex life: an analysis of patient reported outcome survey data

BackgroundAlthough sexual dysfunction is a common treatment side-effect affecting men’s quality of life, many prostate cancer patients do not receive or seek out treatments for erectile dysfunction (ED). The aims of this study are to investigate the extent and patterns of use of ED treatments and their perceived impact at different times following prostate cancer treatment.MethodsThis retrospective cohort study included all men on the South Australian prostate cancer registry who completed one or more Patient Reported Outcome Measures (PROMs) survey from 2016 to 2023 (n = 5561). Outcomes included self-reported use of ED treatment (oral medications, intra-cavernosal injections (ICI) and vacuum pumps) and their impact men’s sex life at various time points after treatment. The type and timing of ED treatments used was analysed descriptively. Sociodemographic and clinical characteristics associated with utilisation and self-reported satisfaction were examined using multivariable mixed-effects binomial logistic regression.ResultsPost-treatment use of ED treatments did not exceed 43% at any timepoint, with utilisation rates decreasing over time. Oral medications were most frequently used, while vacuum pump and ICI use was limited. Oral medications were more likely to be used at three-months (odds ratio [OR] = 2.48; 95% confidence interval [95%CI] = 1.88–3.27) and six-months (OR = 2.10; 95%CI = 1.63–2.27) than at 12-months post-treatment, and among men from higher socioeconomic areas (OR = 2.41; 95%CI = 1.47–3.93, highest vs. lowest quintile), and following prostatectomy (OR = 4.37; 95%CI = 2.92–6.42), and less likely among older men (OR = 0.08; 95%CI = 0.05–0.13, < 60yrs vs. 70-79yrs). Men were more likely to report an improved sex life with oral medication use at two-years (OR = 3.79; 95%CI = 1.69–8.47) and five-years (OR = 3.07; 95%CI = 1.51–6.25) post-treatment compared with 12-months or if they were socioeconomically advantaged (OR = 3.22; 95%CI = 1.30–7.96, highest vs. lowest quintile).ConclusionsA substantial proportion of Australian men do not access or continue to use ED treatments after prostate cancer treatment, with many users reporting only modest effects on their sex life. There is a need to improve access to and maintenance of ED treatments following prostate cancer treatment.

Patient-provider communication for lonely, socially isolated adults in Medicare.

Older adults experiencing loneliness or social isolation may experience poor patient-provider communication, potentially contributing to suboptimal health care utilization, particularly in mental health care. However, empirical evidence is limited. Thus, this study examined whether there were differences in patient-provider communication and health care utilization between Medicare beneficiaries with and without loneliness and social isolation. This study conducted a cross-sectional study using data from the 2021 Medical Expenditure Panel Survey. Outcomes were patient-provider communication and health care utilization. The primary independent variables were loneliness and social isolation. Regression analysis was conducted to estimate adjusted differences in outcomes between Medicare beneficiaries with and without loneliness and social isolation. The analysis was conducted in September 2024. The sample included 4,433 Medicare beneficiaries. Medicare beneficiaries experiencing loneliness were 4.0 percentage points (95% CI: 1.0-7.1) more likely to report poor patient-provider communication compared to those without loneliness. Similarly, those with social isolation were 2.0 percentage points (1.1-2.9) more likely to report poor communication than those without social isolation. The rates of mental health care utilization were higher among those with loneliness (1.8 [1.0-2.6], 1.5 [0.8-2.2], and 3.1 [1.1-5.1] for social workers, psychologists, and psychiatrists) or social isolation (2.3 [0.6, 4.0] for psychiatrists), but the overall level of mental health care utilization remained relatively low. These findings highlight significant disparities in patient-provider communication among Medicare beneficiaries experiencing loneliness and social isolation. These disparities may partly result from limited engagement with mental health services, which could help address their specific health care needs.

Normothermic Machine Perfusion vs. Static Cold Storage in Liver Transplantation: A Systematic Review and Meta-Analysis.

Normothermic machine perfusion (NMP) represents an alternative to prolong liver preservation and reduce organ discard rates. We performed an updated systematic review and meta-analysis to compare NMP with static cold storage (SCS) in liver transplantation. MEDLINE, Embase, and Cochrane were searched for randomized controlled trials (RCTs) or observational studies. Risk ratios (RR) and mean differences were calculated. p < 0.05 was considered significant. A random-effects model was applied for all outcomes. CRD42023486184. We included 1295 patients from 5 RCTs and 6 observational studies from 2016 to 2023. 592 (45.7%) underwent NMP. A subgroup RCT analysis favored NMP for non-anastomotic strictures (RR 0.4; 95% CI 0.2, 0.9), postreperfusion syndrome (RR 0.4; 95% CI 0.27, 0.56), and early allograft dysfunction (RR 0.6; 95% CI 0.4, 0.9). NMP favored higher organ utilization rates (RR 1.1; 95% CI 1.02, 1.18). No significant differences between NMP and SCS were observed in graft survival or patient survival at 12 months, primary non-function, serious adverse events, overall biliary complications, AST, or bilirubin levels peak within the first 7 days, ICU or hospital length of stay. Our findings suggest that NMP is associated with lower non-anastomotic biliary stricture rates, postreperfusion syndrome, early allograft dysfunction, and higher organ utilization in the RCT subgroup analysis, without increasing adverse events.

The Impact of Racial and Low Socioeconomic Status on the Implementation of Spinal Cord Stimulation for Chronic Pain in the United States.

This study aims to review the societal, economic, and racial factors that impact the usage of spinal cord stimulation for chronic pain. Our working hypothesis is that patients of ethnic minority groups or of lower socioeconomic status (SES) status may have lower implantation rates and usage of spinal cord stimulation (SCS). Our study sourced publications from PubMed, Embase, and Cochrane Library on December 21st, 2023 for SCS for the purposes of pain management. Articles were excluded from the review if the study was not USA based, did not involve SCS for the purpose of pain or did not allow for the subgroup analysis. There were 1028 reports that resulted after the initial search with 184 duplicates which were removed. Six reports met the inclusion and exclusionary criteria and were included in the review. Several trends were able to be extrapolated from the pooled reviews. Orhurhu et al. found that Black and Hispanic minorities had a higher utilization rate of SCSs than their White and Asian counterparts in the inpatient setting. Jones and Missios et al. found that in the outpatient setting, White and privately insured patients were more likely to utilize SCS. Ovrom et al. observed an increased cost associated with Hispanic ethnicity and inpatient SCS utilization. Wondwossen et al. found that in the US military system White patients were more likely to receive SCS earlier in their care than Black patients. Labaran et al. concluded the Southern US completed more SCS implants, particularly in White patients with Medicare insurance. White patients are recipients of SCS earlier and more frequently than minority patients in the outpatient setting. There is mixed evidence regarding inpatient SCS and how household income relates to SCS usage. Insurance type and coverage may be more accurately predictive than simple household income for SCS utilization.

P-969. Antibiotic Prescribing Patterns for Surgical Prophylaxis Before and After an Educational Campaign about Penicillin Allergies

Abstract Background Patients with a documented penicillin allergy often do not receive first-line antibiotics for surgical prophylaxis due to the concern for allergic cross-reactivity between cefazolin and penicillins. Receiving suboptimal antibiotics unnecessarily may contribute to increased risk of adverse drug reactions and undesirable clinical outcomes. This study evaluated the rate of first-line antibiotic regimen utilization for surgical prophylaxis in penicillin allergy-labeled patients before and after a prescriber-facing educational campaign about penicillin allergies.Figure 1.WINK Educational Document Methods This was a single-center retrospective cohort study conducted at a tertiary care community hospital. Education was provided over one month in-person by infectious diseases and surgical services pharmacists to surgeons and anesthesiologists, including review of an educational handout detailing current penicillin allergy label literature, cefazolin side-chain dissimilarity, and when cefazolin should be considered or avoided (Figure 1). This content was also provided to pharmacists and posted to the system intranet. Patients were included if they had a documented penicillin allergy and received an antibiotic during admission for procedural prophylaxis. Patients receiving systemic antibiotics or with an infection within three days of procedure were excluded. The primary outcome was rate of first-line pre-operative antibiotic regimen utilization for surgical prophylaxis pre-education versus post-education. Secondary outcomes included all-cause hospital readmission within 90 days, acute care length of stay, surgical site infection rate, and safety outcomes. This study was approved by the local Institutional Review Board.Table 1.Baseline Patient Characteristics Results 340 patients were included in the study, evenly split into the pre- and post-groups. Patient demographics are shown in Table 1. First-line pre-operative antibiotic regimen utilization occurred in 89 patients in the pre-education group (52.4%), and in 113 patients in the post-education group (66.5%) (P = 0.011). Secondary outcomes are listed in Table 2.Table 2.Results for Secondary Outcomes Conclusion An educational campaign focusing on reasonable use of cefazolin in the setting of a penicillin allergy label may improve use of first-line antibiotics, which may positively influence clinical outcomes. Disclosures Timothy Gauthier, PharmD, BCPS, BCIDP, AbbVie Pharma: Advisor/Consultant|Antimicrobial Therapy, Inc: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Firstline Mobile Health: Advisor/Consultant|Gilead Pharma: Advisor/Consultant|GoodRx: Advisor/Consultant|GSK Pharma: Advisor/Consultant|Melinta Pharma: Advisor/Consultant|Pattern Biosciences: Advisor/Consultant|Pfizer Pharma: Advisor/Consultant|ProCE: Honoraria|WWW.LearnAntibiotics.com: Ownership Interest

372. Impact of Updated 2020 Public Health Service Guidelines on Deceased Organ Donors and Transplant Recipients

Abstract Background New guidelines for assessing solid organ donors and recipients for Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) infection were published by the US Public Health Service (PHS) in 2020 and implemented into Organ Procurement and Transplantation Network (OPTN) policy on 3/1/21. Changes included a shorter risk criteria inclusionary timeframe and the removal of 4 risk criteria. Methods We analyzed OPTN deceased donor and transplant data 2 years pre-(3/1/19-2/28/21) and post-(3/1/21-3/1/23) implementation of the updated guidelines. For Kaplan-Meier survival analyses, the post- cohort included recipients transplanted before 1/1/23 to ensure recipients had at least 1 year follow-up plus a 3-month data lag. Utilization rates, defined as number of organs transplanted divided by number of available organs from donors with at least 1 organ recovered for the purpose of transplant, are shown for thoracic organs. Non-use rates, defined as number of organs recovered for the purpose of transplant but not transplanted divided by the total number of organs recovered for the purpose of transplant, are shown for abdominal organs. Results The proportion of donors considered to have PHS risk factors decreased by approximately 10% post-policy, both overall and by organ type (Fig. 1). There were no major differences pre- to post- in reported donor HIV, HCV or HBV NAT test results (Fig2. ). Post-policy, utilization rates for heart and lung for donors with risk factors were 34.9% and 17.5% respectively, compared to 34.3% and 20.0% pre-policy; while kidney and liver non-use rates for donors with risk factors were 20.3% and 8.2% respectively, compared to 17.2% and 7.9% pre-policy. There was no significant change in 1-year post-transplant patient survival for recipients who received organs from donors with PHS risk factors (Fig. 3). Conclusion Less restrictive PHS guidelines led to fewer donors being classified as having risk factors for disease transmission. Updated guidelines did not significantly affect donor infectious disease test results or post-transplant survival for recipients. Changes in donor organ utilization and non-use may be due to donor pool changes and/or overlapping policy implementations, and further investigation is warranted. Disclosures Lara A. Danziger-Isakov, MD, MPH, Aicuris: clinical research contract, paid to institutio|Ansun BioPharma: clinical research contract, paid to institution|Astellas: Advisor/Consultant|Astellas: clinical research contract, paid to institutio|Merck: clinical research contract, paid to institutio|Pfizer: Grant/Research Support|Takeda: clinical research contract, paid to institutio

P-237. The CLABSI (Central Line Audit by Staff Investigators) Intervention: Reducing Central Line Use in a Medical ICU using Physician-Led Prospective Audit and Feedback of Catheter Necessity

Abstract Background Prompt removal of unnecessary central lines has been associated with reduction in central line associated bloodstream infections (CLABSI). Following the COVID-19 pandemic, sustained increases in central line utilization and CLABSI were seen at our medical ICU (MICU). Here we present a quality improvement intervention of a weekly physician-led audit and feedback to reduce central line utilization. Methods The intervention was conducted in the MICU at a single tertiary-care hospital from June 2023 to February 2024. Once weekly, 2 physicians did an electronic medical record audit of all central lines. Line necessity was defined as requiring one or more of the following: irritant medication use, renal replacement therapy, hemodynamic monitoring, total parenteral nutrition, or inability to obtain peripheral access. Lines for renal replacement therapy (HD lines) were excluded from evaluation as they were medically necessary by definition. Once an unnecessary line was identified, the primary ICU fellow and attending were sent a text message prior to morning rounds to recommend removal. Central line removal rates and patient demographic data were collected from June 2023 to February 2024. Data on central line utilization and CLABSI rates were collected from July 2023 to December 2023 and compared to data from January 2022 to June 2023. Results 365 patients and 447 central lines were reviewed. 49 (11%) central lines were deemed unnecessary and removal recommended, of which 26 (53%) were removed within 24 hours. The central line device utilization ratio (DUR) in line days per patient days decreased by 20%, from 0.48 to 0.38 [p = &amp;lt; 0.0001]. When HD lines were included, we observed a reduction in DUR by 8%, from 0.61 to 0.56 [p = &amp;lt; 0.0001]. The CLABSI National Healthcare Safety Network Standardized Infection Ratio (SIR) pre-implementation was 2.84 and post-implementation was 2.83 [p = 1.00]. Conclusion A physician-led, once weekly prospective audit and feedback of central line necessity led to a substantial decline in central line utilization rates in our medical ICU. There was no observed reduction in CLABSI SIR, however this may be due to the short intervention period and low incidence rate of CLABSI; over time it would be expected that a reduction in central line days would lead to a reduction in CLABSI. Disclosures All Authors: No reported disclosures

368. Impact of Social Determinants of Health (SDOH) on Outcomes of OPAT (Outpatient Parenteral Antimicrobial Therapy)

Abstract Background Complex infections may warrant extended antibiotics traditionally reserved for inpatient settings. OPAT is safe and cost effective, allowing return to regular activities and decreased risk of hospitalization. Understanding of SDOH-sensitive risk parameters and impact on adverse events is needed to guide safety and adherence interventions.Figure 1.Most Common OPAT Antibiotics and Indications in Study Cohort Methods Records of patients treated 7/15-10/31/2023 by URMC OPAT program, exclusive of concurrent Transitions of Care Program, were retrospectively reviewed for race, social vulnerability index, insurance type, substance use, needs insecurity, household composition, and outcomes such as OPAT-related orders errors, intravascular device (IVAD) complications, emergency utilization, organ system adverse events, and clinical outcome. A composite Undesirable OPAT Outcome was derived. The impact of SDOH was assessed by chi-square, univariate and multivariate logistic regression using R v4.3 3, rstatix v0.7.2, and sjPlotv2.8.15.Table 1.Proportion and Rates of Errors, Complications, and OPAT Treatment Outcomes in Study Cohort Results Total 116 patients received 3573 OPAT days for varying indications (Fig 1). High rates of discharge order errors, ED utilization, IVAD complications, adverse events, and composite Undesirable Outcomes were noted (Table 1). Those with public insurance (OR=13.6, CI: 1.95-322) or who used cannabis (OR=5.23 CI: 1.1- 27.2) were more likely to incur a laboratory order error on discharge. Patients of color were more likely to experience IVAD complications (OR=3.61, CI: 1.1-12.6) and multiple organ system adverse events (OR= 6.55, CI: 1.45-34.9). High-risk tobacco use was associated with shortened OPAT duration due to adverse event (OR=28.47, CI: 1.72-1299) (Fig 2). OPAT patients with public insurance were least likely to follow up with the ID clinic (OR=7.65, CI: 1.27-152). Time to ID follow-up correlated with multiple SDOH parameters, with publicly insured and persons of color experiencing significantly longer time to follow-up appointments (Fig 3). Incurring a non-IVAD adverse event correlated to composite undesirable outcome in multivariate analysis.Figure 2.Odds Ratios in Univariate Analysis of OPAT Complications Based on Social Determinants of Health Conclusion Social determinants may be predictors in OPAT-related unwanted events. A dedicated focus of evaluating SDOH as contributing drivers of adverse OPAT outcomes may assist creating interventions to support marginalized patient groups.Figure 3:Time-to-event probability analysis for timing of post-discharge ID clinic follow up among OPAT patients by Insurance Type (3A), Race (3B), and All Patients (3C) Disclosures All Authors: No reported disclosures

P-1678. Post Implementation Analysis of Inpatient Review by Infectious Diseases Pharmacists of Outpatient Parenteral Antimicrobial Therapy (OPAT) Prior to Discharge

Abstract Background The Infectious Diseases Society of America OPAT guidelines recommend all patients should have ID expert review prior to initiation of OPAT. Prior to 2020, no formal OPAT program existed at this hospital system and prescribing was not limited to any specialty. However, in February 2020, the Outpatient Parenteral Antimicrobial Therapy - Inpatient Review (OPAIR) program was created in response to pre-implementation data showing only 16% of patients were discharged on appropriate therapy per IDSA OPAT guidelines. Figure 1. Outpatient Parenteral Antimicrobial Therapy Inpatient Review (OPAIR) program process Methods This retrospective, observational chart review identified patients for data collection if they had pharmacist documentation of OPAIR review during their index hospital stay. Patients were included in the pre-implementation group if prescribed OPAT and admitted between January 1, 2017, and December 31, 2017, in the health system. Patients were included in the post-implementation group if 18 years and older, prescribed OPAT, and admitted between February 2, 2020, to August 1, 2023, at Abbott Northwestern, New Ulm, Owatonna, Faribault, or River Falls Hospitals. Exclusion criteria include OPAT prescribed by an Infectious Disease (ID) provider or prior to index hospitalization. Chi squared tests were performed for all outcomes. Figure 2. Primary outcome of OPAT appropriateness. Appropriateness defined as a composite outcome: appropriate monitoring or follow up​, indication​, antibiotic selection​, antibiotic dose/frequency/duration, and recommended laboratory monitoring. Results There were 101 patients included in the pre and 79 in the post-implementation analysis. Internal Medicine was the most common prescriber in both the pre and post-implementation groups (60% vs 67%). OPAT appropriateness was significantly higher in the post-implementation group than in the pre-implementation group (52% (n=41/79) vs 16% (n=16/101), p&amp;lt; 0.001). The most common cause of inappropriate OPAT prescribing was a lack of monitoring or follow up (n=8/79). Complication rates were similar between pre and post groups (12% vs 18%, p=0.19) as was the 30-day readmission rate (17% vs 23%, p=0.32). Actual cost savings totaled $33,600 and maximum potential cost savings totaled to $214,200. The rates of midline utilization increased by 62% (p&amp;lt; 0.001). Figure 3. Secondary outcome of complication rate. Conclusion The OPAIR program at this health system significantly increased non-ID provider OPAT prescribing appropriateness. These results support the creation of a new workflow and expansion of the OPAIR program. Figure 4. Secondary outcome of cost avoidance. Disclosures All Authors: No reported disclosures