Ragheed Al-Dulaimi

A Vascular Quality Initiative-Based Frailty Instrument Predicts 9-Month Postoperative Mortality

aortic injury related), and four patients died after 30 days (one related to aortic injury due to an esophageal-aortic fistula; three unrelated). Freedom from all-cause mortality and aortic injury-related mortality at 1 year was 89.3% and 92.8%, respectively. Two cases of stroke occurred within 30 days, and no strokes were reported beyond 30 days. In total, six patients underwent reintervention for thrombus, device compression, residual injury, endoleak, dissection, and pseudoaneurysm. Only one patient underwent surgical conversion (181 days after the procedure) following a failed reintervention for a site-reported proximal type I endoleak. No patient experienced aortic rupture. Among 31 patients with available core laboratory review of computed tomography imaging at 1 year, aortic injury healing (ie, the absence of aortic injury) was confirmed in 96.8% (30/31) of patients and patency was observed in 100% (31/31) of patients. No type I or type III endoleak, component separation, device migration, or device integrity issues have been observed on the basis of core laboratory imaging review to date. Conclusions: Updated outcomes indicate that the Zenith Alpha Thoracic Endovascular Graft continues to perform safely and effectively for the treatment of BTAIs.

Enterocolitis and bowel function in children with Hirschsprung disease and trisomy 21

BACKGROUND/PURPOSE The purpose of this study was to study the effect of trisomy 21 (T21) on enterocolitis rates and bowel function among children with Hirschsprung disease (HD). METHODS A retrospective cohort study of patients with HD treated at our tertiary childrens hospital (2000-2015) and a cohort of patients with HD treated in our pediatric colorectal center (CRC) (2011-2015) were performed. RESULTS 26/207 (13%) patients with HD had T21. 70 (41%) with HD alone were diagnosed with enterocolitis episodes compared to 9 (38%) with HD+T21 (p=0.71). 55/207 patients were managed in the CRC. 11/55 patients (20%) had HD+T21. 25 (58%) with HD had one or more enterocolitis episodes compared to 4 (36%) with HD+T21 (p=0.20). Number of hospitalizations for enterocolitis was similar between all groups. Toilet training was assessed in 32 CRC patients (25 HD, 7 HD+T21). One child with HD+T21 was toilet trained by age 4years versus 12 with HD (p=0.20). Laxative or enema therapy was required for constipation management in 57% HD versus 64% HD+T21. CONCLUSION Enterocolitis rates in children with HD+T21 did not differ from rates in children with HD alone. The majority of patients with CRC follow-up had constipation requiring laxative or enema therapy, which demonstrates the need for consistent postoperative follow-up. LEVEL OF EVIDENCE Retrospective Study - Level II.

Differences in clinical outcomes and cost between complex and simple arterial switches

BACKGROUND This study evaluates the morbidity, mortality, and cost differences between patients who underwent either a simple or a complex arterial switch operation. METHODS A retrospective study of patients undergoing an arterial switch operation at a single institution was performed. Simple cases were defined as patients with d-transposition of the great arteries with usual coronary anatomy or circumflex artery originating from the right with either intact ventricular septum or ventricular septal defect. Complex cases included all other forms of coronary anatomy, aortic coarctation or arch hypoplasia, and Taussig-Bing anomalies. Costs were acquired using an institutional activity-based accounting system. RESULTS A total of 98 patients were identified, 68 patients in the simple group and 30 in the complex group. The mortality rate was 2% for the simple and 7% for the complex group, p=0.23. Major morbidities including cardiac arrest, extracorporeal membrane oxygenation, a major coronary event, surgical or catheter-based re-intervention, stroke, or permanent pacemaker placement, non-cardiac surgical procedures, mediastinitis, and sepsis did not differ between the simple and complex groups (16 versus 27%, p=0.16). The complex group had increased bleeding requiring re-exploration (0 versus 10%, p=0.04). Hospital and ICU length of stay did not differ. Complex patients had higher overall hospital costs (simple

PD34-10 VALUE OF EARLY SURVEILLANCE CYSTOURETHROSCOPY AFTER BULBAR URETHROPLASTY ON RECURRENCE RISK: A TURNS STUDY

80,749 versus complex

Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy with Non-Anesthesia Administered Propofol Sedation

97,387, p=0.01) and higher postoperative costs (simple

Rapid Methods for Routine Frailty Assessment During Vascular Surgery Clinic Visits

60,192 versus complex

Predicting ICU Readmission among Surgical Patients: Development and Validation of a Predictive Nomogram

70,132, p=0.02). The operating room and supplies accounted for the majority of the cost difference. CONCLUSION Complex arterial switches can be safely performed with low rates of morbidity and mortality but at an increased cost.

Postoperative Outcomes Correlate With Frailty Defined Using Vascular Quality Initiative Data

INTRODUCTION AND OBJECTIVES: Urethral stricture disease is common condition with significant quality of life and economic implications. While endoscopic treatment with incision or dilation is the most common treatment approach, guidelines increasingly recommend urethroplasty based on its high success rates. Whether real world, community practice outcomes mirror those of large volume single center institutional series is unknown. For these reasons, we conducted a population-based study of patients treated with urethroplasty and their outcomes. METHODS: We identified male patients who underwent urethroplasty between 2001 and June 2015 based on ICD-9 codes and administrative claims from a large, national US health insurer (ClinformaticsTM Data Mart Database, OptumInsight, Eden Prairie, MN). We assessed utilization of endoscopic treatments (urethrotomy and dilation) prior to and after urethroplasty. We defined urethroplasty failure by any subsequent urethral dilation, urethrotomy, or urethroplasty after initial urethroplasty. We examined factors associated with failure using multivariable logistic regression and Cox proportional hazards models. RESULTS: We identified 1345 patients treated with urethroplasty. Urethroplasty failure occurred in 344 (26%) of patients. Repeat urethroplasty was performed in 139 (40%) of failures (range 28). Increased number of endoscopic treatments prior to first urethroplasty was associated with urethroplasty failure. The mean ( SD) time to failure was 270 42 days. CONCLUSIONS: Our population-based study demonstrated significantly lower success rates for urethroplasty than previously published reports. Strategies to achieve better outcomes for patients with urethral stricture disease include increasing referrals to reconstructive urologic surgeons, and knowledge and technique transfer to community urologists interested in providing this service rather than repeated, low-value endoscopic treatment.