J.D. Sammon

93 A nationwide survey of prostate specific antigen based screening and counseling for prostate cancer

Abstract Introduction Controversy surrounds prostate specific antigen screening following the 2012 U.S. Preventive Services Task Force grade D recommendation. There is limited evidence evaluating patterns of prostate specific antigen counseling and patient perceptions of the prostate specific antigen test since 2012. We evaluated the association between prostate cancer screening counseling and patient sociodemographic factors in a nationally representative sample. Methods Using data from the 2013 Health Information National Trends Survey we identified 768 male respondents age 40 to 75 years without a prior prostate cancer diagnosis. Using logistical regression we assessed trends in prostate cancer screening, counseling and prostate specific antigen use. Results Overall 54.1% of respondents reported ever having a prostate specific antigen test. Men undergoing prostate specific antigen testing were more likely to have had a prior cancer diagnosis other than prostate cancer (OR 3.93, 95% CI 1.19–12.94) and to have had at least some college education (OR 11.35, 95% CI 3.29–39.04). Men 40 to 49 years old had decreased odds of undergoing prostate specific antigen testing compared to men 50 to 69 years old (OR 0.20, 95% CI 0.10–0.39). History of cancer (OR 2.50, 95% CI 1.19–5.26) was associated with greater odds of being counseled on the potential adverse effects of prostate cancer treatment. Younger men (age 40 to 49 years) had decreased odds of discussing the prostate specific antigen test with a health care professional (OR 0.32, 95% CI 0.16–0.62) and being informed of the controversy surrounding prostate specific antigen screening (OR 0.35, 95% CI 0.13–0.95). Conclusions We show that certain men receive substantially different prostate specific antigen screening counseling, which may impact shared patient-provider decision making before prostate specific antigen counseling.

436 Predictors of wound dehiscence in a prospective dataset of 2,586 cystectomies

INTRODUCTION AND OBJECTIVES: Wound dehiscence is major complication following radical cystectomy. It is a significant cause of readmission, reopearation and potentially delays lifesaving adjuvant therapies. We sought to investigate the incidence and predictors of wound dehiscence in patients undergoing radical cystectomy. METHODS: 2556 patient records with Current Procedural Terminology (CPT) codes for cystectomy between 2005 and 2012 were extracted from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP). Stratification was made on the basis of the occurrence of postoperative wound dehiscence. This was defined as full disintegrity of the skin and fascial layer. Outcomes of interest included overall complication, mortality, prolonged length of stay and prolonged operative time, the latter two defined as measures above the 75th percentile. Descriptive and logistic regression models were performed to identify predictors of postoperative wound dehiscence. RESULTS: Of 2556 patients analyzed, 74 (2.9%) had a documented wound dehiscence. In multivariable analyses, smoking (OR 2.2 p1⁄4.002), prolonged operative time (OR 1.6;p1⁄40.05) and BMI were associated with increased odds of postoperative wound dehiscences. Female gender was associated with decreased odds of dehiscence (OR 0.4; p1⁄40.022). Elevated preoperative creatinine (>1.2 mg/dl), chronic steroid use and diabetes were not independent predictors. CONCLUSIONS: Our study is the first to identify predictors of wound dehiscence following radical cystectomy in a large multi-institutional prospective cohort. Identifying patients at risk for postoperative wound complications may guide the use preventative measures at the time of surgery. Source of Funding: none

641 Racial disparities in the surgical care of localized prostate cancer

INTRODUCTION AND OBJECTIVES: The Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score predicts prostate cancer (PCa) recurrence based on pathologic information from radical prostatectomy (RP). We independently validated the CAPRA-S in a European, single-institution database. METHODS: The study cohort comprised of 14532 patients treated with radical prostatectomy between January 1992 and August 2012. Prediction of biochemical recurrence (BCR), metastasis and cancer-specific mortality (CSM) by CAPRA-S was assessed by Kaplan-Meier analysis and the c-index. Performance of CAPRA-S in predicting BCR was assessed by calibration plot and decision curve analysis. RESULTS: Median follow up was 48.8 months (IQR 24.6 e 95.9). Biochemical recurrence occurred in 20.3% of men at a median time of 21.2 mo (interquartile range [IQR]: 7.7e44.9). When stratifying patients by CAPRA-S risk groups, biochemical recurrence-free survival estimates at 5 years were 91.4%, 70.4%, and 29.3% for the low, intermediate and high-risk group, respectively. The c-index for CAPRA-S in predicting BCR was 0.80. The cindices for CAPRA-S in predicting metastasis and CSM were 0.85 and 0.88, respectively. 374 men developed metastasis, and 184 men died from PCa. CONCLUSIONS: The postoperative CAPRA-S score was accurate when applied in a European study cohort and predicted biochemical recurrence, metastasis and CSM after RP with c-indices> 0.80. The score can be valuable for decision-making for adjuvant therapy.

235 Morbidity and mortality after benign prostatic hyperplasia surgery: Data from the national surgical quality improvement program

RESULTS: 484 patients had open or laparoscopic UOS, with 200 (41%) classified as high risk for VTE by CRSs. The rates of VTEs and median times to VTE were 6% and 74 days in Group 1, 13% and 44 days in Group 2, 15% and 40 days in Group 3, and 23% and 11 days in Group 4. Adjusted hazard ratios for VTE are shown in Table 1. Group 1 had no VTE’s or fatal pulmonary embolisms in the first 30 days after UOS. Bleeding and lymphocele rates were 0% and 2% in Group 1, 0% and 4% in Group 2, 3% and 3% in Group 3, 0% and 0% in Group 4. Complications were considered Clavien grades II-IIIa. CONCLUSIONS: VTE risk is lowest in patients who receive clinical protocol prophylaxis with EDP. Risk of VTE remains elevated for at least 90 days following UOS. A clinical VTE prevention protocol using perioperative prophylaxis and EDP is effective and safe in reducing VTE risk in UOS patients.

625 Predictors of admission in patients presenting to the emergency department with urinary tract infection

Purpose Previous studies examining the management of urinary tract infections (UTI) showed marked variability in the economical burden of care, with a tenfold increase in costs when patients require admission to the hospital. We sought to examine the patient and emergency department (ED) characteristics associated with hospitalization in patients presenting to the ED with UTI.