Kevin Lewis

Donor-site Morbidity of Medial and Lateral Thigh-based Flaps: A Comparative Study

Background: Free and pedicled medial and lateral thigh-based flaps are common reconstructive procedures. However, there have been no comparative studies of morbidity between medial and lateral donor sites. Methods: We conducted an Enterprise Data Warehouse-based review of all the senior authors’ (R.D.G., G.A.D., and M.S.A.) thigh-based free and pedicled flaps. Patient demographic data, donor-site complications, drain duration, and number of postoperative visits were collected and compared. Complications were also compared between fasciocutaneous flaps and muscle or myocutaneous flaps, and skin grafted donor sites. Results: We analyzed 352 flap donor sites, with 155 medial and 197 lateral. Two hundred seventeen (217) flaps were pedicled. Flap types included 127 gracilis, 27 rectus femoris, 134 anterolateral thigh, and 36 vastus lateralis-only flaps. There were no significant differences in complications between medial (17.4%) and lateral thigh (21.3%) donor sites, although lateral thigh flaps had a mean of 1 additional postoperative visit. Rates of wound dehiscence/healing issues were significantly higher in both gracilis myocutaneous flaps (25.9%) and flaps requiring a skin grafted donor site (31.2%). Postoperative therapeutic anticoagulation was the only significant risk factor for a donor-site complication. Flap complications resulted in increased drain duration and postoperative office visits. Conclusions: Donor-site morbidity is similar in both lateral and medial thigh-based flaps. The inclusion of muscle in the flap from either donor site does not seem to increase complications, but the inclusion of a skin paddle with gracilis muscle, or a skin grafted lateral thigh donor site, results in increased wound healing complications.

Comparison of Efficacy and Complications Among Various Spacer Grafts in the Treatment of Lower Eyelid Retraction: A Systematic Review

Background: Lower eyelid retraction is a difficult problem to treat, but it is a prevalent condition and a common complication of blepharoplasty. The use of spacer grafts to increase eyelid height and improve symptoms has been described for a long time, but the optimal choice of spacer graft material is unknown. Objectives: The authors reviewed the currently available evidence to determine the best available spacer graft material in terms of efficacy and complications. Methods: A systematic review of all available literature published between 1985 and the present was performed using the Pubmed, Ovid MEDLINE, and Cochrane library databases. Inclusion criteria were that the studies contain original content assessing the treatment of lower eyelid retraction in humans using a spacer graft and provide quantitative outcomes data. Results: One hundred and twelve articles were reviewed following an initial screen using titles, and 19 articles were chosen for inclusion in this systematic review. Analysis of these articles revealed no spacer graft material that is clearly superior to others. Conclusions: Due to a lack of high quality evidence, this review did not reveal one spacer graft material that is clearly superior to others. However, a narrative summary of the available evidence reveals unique sets of advantages and disadvantages associated with the various materials currently available. Further research in the form of well‐designed studies will be necessary to further clarify advantages of certain spacer graft materials over others. Level of Evidence: 3 Figure. No caption available.

The timing and frequency of infectious complications after radical cystectomy: an opportunity for rescue antibiotic treatment

Introduction: We evaluated the timing, frequency and antibiotic sensitivity of post-radical cystectomy urinary tract infections to guide an infection reduction initiative. Methods: A combined review was performed of all patients undergoing radical cystectomy in the 2011 to 2013 American College of Surgeons NSQIP® database and 100 consecutive patients from our institution. We evaluated the rates and timing of postoperative urinary tract infection and sepsis as well as associations with hospital readmissions. Specific culture data and treatment interventions were assessed and an institution specific urinary tract infection antibiogram was created. Results: Among the 3,495 patients identified in the NSQIP database the 30-day rates of urinary tract infection and sepsis were 9.5% and 9.4%, respectively, and median days to urinary tract infection and sepsis were 15 and 13. Median length of stay after radical cystectomy was 10.4 days. Overall 61.5% of urinary tract infections and 52.1% of sepsis episodes occurred after discharge home. At our institution the rates of urinary tract infection and sepsis were 15% and 9%, and occurred at a median of 14 and 18 days, respectively. The 30-day readmission rate was 21%, with 10 readmissions for infections including 7 for urinary tract infection and 5 for bacteremia. We identified 9 patients with positive urine or blood cultures for yeast requiring antifungal therapy. Of the urinary tract infections 88% were sensitive to oral agents and 79% were sensitive to nitrofurantoin or ciprofloxacin. Conclusions: The timing of urinary tract infections/sepsis after radical cystectomy is predictable on the national and institutional level. At our hospital, cultured organisms are likely to respond to well tolerated oral therapies. This information can be used to implement an outpatient antibiotic protocol to prevent infectious complications after radical cystectomy.

MP35-13 VASECTOMY AND THE GENDER GAP: SHIFTING DEMOGRAPHICS OF THE UROLOGIC WORKFORCE

multiple comparison analysis, sperm concentration (p1⁄40.042) and progressive motility (p1⁄40.03) were significantly lower in heavy smokers; similarly, DFI values were significantly higher in Group 3 patients than in no smokers (p1⁄40.025). At multivariable analyses, FSH (OR 1.1, p1⁄40.02) and being heavy smokers (OR 4.1, p1⁄40.006) were independent predictors for pathologic DFI score after accounting for age, BMI and CCI. Similarly, being heavy smokers achieved independent predictor status for pathologic sperm count (OR 2.7, p1⁄40.047) and pathologic total progressive motility (OR 6.3, p1⁄40.002), after accounting for the same variables. CONCLUSIONS: The routine assessment of DFI is getting increasing clinical relevance. Heavy cigarette smoking emerged as the most detrimental factor impacting on the DFI rate, along with an impaired sperm concentration and progressive motility.

MP35-12 SURGICAL TREATMENT OF MALE FACTOR INFERTILITY: DOES INSURANCE COVERAGE MATTER?

multiple comparison analysis, sperm concentration (p1⁄40.042) and progressive motility (p1⁄40.03) were significantly lower in heavy smokers; similarly, DFI values were significantly higher in Group 3 patients than in no smokers (p1⁄40.025). At multivariable analyses, FSH (OR 1.1, p1⁄40.02) and being heavy smokers (OR 4.1, p1⁄40.006) were independent predictors for pathologic DFI score after accounting for age, BMI and CCI. Similarly, being heavy smokers achieved independent predictor status for pathologic sperm count (OR 2.7, p1⁄40.047) and pathologic total progressive motility (OR 6.3, p1⁄40.002), after accounting for the same variables. CONCLUSIONS: The routine assessment of DFI is getting increasing clinical relevance. Heavy cigarette smoking emerged as the most detrimental factor impacting on the DFI rate, along with an impaired sperm concentration and progressive motility.

MP69-19 THE IMPACT OF RACE ON PERCEPTIONS OF ANXIETY AFTER LOCAL THERAPY FOR PROSTATE CANCER

line), and urbanization (percent county pop. living in an urban area) categories to set national quintile cut points. SEER county incidence data were matched with their corresponding national education, poverty, and urbanization quintiles. The highest, middle, and lowest quintiles were compared over time using incidence rate ratio (IRR) and between quintiles by absolute disparity (AD; highest and lowest quintile range difference) and relative disparity (RD; highest and lowest quintile range ratio). Analysis was performed to 95% confidence intervals (CI) using the Tiwari et al. method. RESULTS: Counties with highest education, economic, and urbanization levels had the highest prostate cancer incidence, 112.7, 108.7, and 108.1 per 100,000 respectively in 2013. Counties with the lowest education, economic, and urbanization levels had the lowest prostate cancer incidence, 97.9, 104.0, 97.2 per 100,000 respectively in 2013. The AD demonstrated a convergence in incidence rate between highest and lowest quintiles. From 2008-2013 the percentage change in absolute disparity declined -39.2%, -34.3%, -46.2%, for education, economic, and urbanization categories respectively. IRR declined equally across all quintiles within each category ranging 0.69-0.71. Equivalent IRRs among quintiles indicates decline in incidence was homogenous across counties and not weighted to county educational, poverty, or urbanization level. CONCLUSIONS: Incidence rate is positively correlated with higher county education, wealth, and urbanization levels. The incidence absolutely converged between highest, middle, and lowest education, poverty and urbanization quintiles in all categories after USPSTF recommendations, relative disparity remained unchanged. Statistically equivalent IRRs suggest prostate cancer incidence has declined uniformly among counties of varying education, poverty, and urbanization levels between 2008 and 2013.

Abstract 61: Intraoperative Nerve Blocks for Tissue Expander Breast Reconstruction: Results of a Prospective, Double-Blind, Randomized, Placebo-controlled Trial

METHODS: A prospective, randomized, double-blinded, placebo–controlled, clinical trial was conducted in which patients undergoing immediate tissue expander/implant based breast reconstruction were randomized to either: 1) intraoperative intercostal and pectoral nerve blocks with 0.25 % bupivacaine with 1:200,000 epinephrine and 4 mg dexamethasone or 2) sham nerve blocks with normal saline. The surgeon, patient and researchers collecting postoperative data were blind to group allocation. Quality of recovery (QoR 40), pain score, and opioid use in the postoperative period were compared between groups using the Mann-Whitney’s U test. Fisher’s exact test was used between categorical variables.