K.R. Ghani

1019 Robotic kidney transplantation with regional hypothermia: Evolution of a novel procedure utilizing the IDEAL guidelines (IDEAL Phase 0 and 1)

Background: Surgical innovation is essential for progress of surgical science, but its implementation comes with potential harms during the learning phase. The Balliol Collaboration has recommended a set of guidelines (Innovation, Development, Exploration, Assessment, Long-term study [IDEAL]) that permit innovation while minimizing complications. Objective: To utilize the IDEAL model of surgical innovation in the development of a novel surgical technique, robotic kidney transplantation (RKT) with regional hypothermia, and describe the process of discovery and development. Design, setting, and participants: Phase 0 (simulation) studies included the establishment of techniques for pelvic cooling, graft placement in a robotic prostatectomymodel, and simulation of the RKT procedure in a cadaveric model. Phase 1 (innovation) studies began in January 2013 and involved treatment of a highly selective small group of patients (n = 7), using the principles utilized in the phase 0 studies, at a tertiary referral center. Intervention: IDEAL model implementation in the development of RKT with regional hypothermia. Outcome measurements and statistical analysis: For phase 0 studies, the outcomes evaluated included pelvic and body temperature measurements, and technical feasibility assessment. The primary outcome during phase 1 was post-transplant graft function. Other outcomes measured were operative and ischemic times, perioperative complications, and intracorporeal graft surface temperature. Results and limitations: Phase 0 (simulation phase): Pelvic cooling to 15–20C was achieved reproducibly. Using the surgical approach developed for robotic radical prostatectomy, vascular and ureterovesical anastomoses could be done without redocking the robot. Phase 1 (innovation phase): All patients underwent live-donor RKT in the lithotomy position. All grafts functioned immediately. Mean console, anastomotic, and warm ischemia times were 154 min, 29 min, and 2 min, respectively. One patient was re-explored on postoperative day 1. Conclusions: Adherence to the IDEAL guidelines put forth by the Balliol Collaboration provided a practical framework for the establishment of a novel surgical procedure, RKT with regional hypothermia, without exposing the initial patients to unacceptable risk. Patient summary: The IDEALmodel allows safe introduction of new surgical techniques without compromising patient outcomes. soc # 2013 European As

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.