Quickshot – Quickshot Clinical Abstracts 2021

  • Abstracts are listed in order of presentation
Abstract Number Abstract Title Presenter
3628 Mode of Initial Enteral Feeding: Decision Making in Critically-Ill Pediatric Patients Maya
3841 Racial Disparity in Liver Transplantation Listing Carpenter
3697 Gastric Electrical Stimulation for Gastroparesis Associated with Dysautonomia and/or Ehlers Danlos Syndrome in Children Wnuk
3694 Gastric Electrical Stimulation for Gastroparesis Associated with Mitochondrial disorders in Children Jenkins
3613 Developing a Multi-disciplinary Pathway for Pediatric Appendicitis: A Comprehensive Quality Improvement Project (Part One: Diagnosis) Calpin
3541 Indications, Resource Utilization, and Outcomes of Initial Transpyloric Versus Gastric Tube Feeding in Critically-Ill Pediatric Patients Thompson
3823 Preterm Neonatal Blood Transfusions Are Associated with Increased Risks of Sepsis and Pulmonary Complications Hawkins
3550 Historical trends in Pediatric post-operative opioid prescribing practices Thompson
3511 Evaluation of Three different Pain Management Algorithms after repair of Pectus Excavatum Thompson
3592 IMAGING GENTLY AND APPROPRIATELY‚ COMPARING ABDOMINAL CT SCANS OBTAINED IN GENERAL EMERGENCY DEPARTMENTS AND A DEDICATED PEDIATRIC EMERGENCY DEPARTMENT Gillies
3430 Applying Pediatric Brain Injury Guidelines at a Level I Adult/Pediatric Safety-Net Trauma Center Schwartz
3715 Pediatric Upper Extremity Firearm Injuries: Who is at Risk and How Do We Prevent Them? Kerekes
3760 Biomarker Evidence of the Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) in Chronic Critical Illness after Surgical Sepsis Darden
3796 Recovery from anemia during six month follow up after severe traumatic injury Kelly
3745 Resolution of Inflammation in Chronic Critical Illness Patients to Address Persistent Inflammation Immunosuppression and Catabolic Syndrome Rapier
3655 Laparoscopic Inguinal Hernia Repair on Antiplatelet or Anticoagulant Therapy Balch
3607 The Efficacy of Routine Radiologic Screening for Anastomotic Leak After Esophagectomy for Esophageal Cancer Kang
3820 Health Disparities in Patients with Pancreatic Neuroendocrine Tumors Riner
3808 Diversity and Inclusion in Pancreatic Cancer Clinical Trials Herremans
3868 Donor Service Area Characteristics Impacting Liver and Kidney Deceased Donor Population Warren
3589 Missing Seats at the Table ‚ The Importance of Intersectionality in Diversity and Inclusion Among Surgical Faculty and Leadership Riner
3718 Clerkship Education in the COVID19 Era: Using Simulation-Based Cases for Supplemental Surgical Education Laconi
3401 The Utility of Peers and Trained Raters in Technical Skill-based Assessments: A Generalizability Theory Study Anderson
3484 Top Factors Influencing Medical Students‚ Choice of Specialty Fu
3481 THE IMPACT OF ATTENDINGS AND RESIDENTS ON MEDICAL STUDENT CAREER CHOICE Hao
3721 Experience with Implementing a Beta-Lactam Therapeutic Drug Monitoring Service in a Burn ICU Mazirka
3398 Lumbar Artery Perforator Flaps: A Systematic Review of Free Tissue Transfers and Anatomical Characteristics Vonu
3478 Characteristics Associated with Salvage of Infected Breast Tissue Expanders Ehanire
3622 Outcomes analysis of textured versus smooth tissue expanders in breast reconstruction: A 5-year retrospective review Carlson
3625 Trends in Plastic Hand Surgery: Evaluation of 182,137 Procedures in the TOPS Database Chopan
3619 Objective comparison of donor site morbidity following full and thoracodorsal nerve preserving split latissimus dorsi flaps Dang
3754 Optimizing Access to Transplantation Through Surgical Downsizing of Donor Lungs Pruitt
3520 Comparison of Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement Falasa
3407 Deep Hypothermic Circulatory Arrest in Open Left Chest Aortic Aneurysm Repair Falasa
3862 Outcomes of EVAR Conversion in Geriatric Patients Treated at A High-Volume Aorta Center Jacobs
3416 Alive and Kicking: Cerebrospinal Fluid Drain Usage in 1016 TEVARs at a Tertiary Aortic Center Spratt
3844 Implications of Re-intervention after Endovascular and Open Bypass Revascularization for Chronic Mesenteric Ischemia Ehresmann

Surgery Day Abstract Submission 2021 : Entry # 3628
ABSTRACT TITLE
Mode of Initial Enteral Feeding: Decision Making in Critically-Ill Pediatric Patients
ABSTRACT BODY
Introduction: Wide practice variation exists when considering enteral feeding options and the decision to proceed with gastric or postpyloric enteral feeding in critically ill infants and children. The purpose of this pilot study is to explore provider decision making in early feeding of critically ill pediatric patients, review the indications for choice of enteral feeding access, and qualitatively explore the role of institutional culture in medical decision making.

Methods: Following IRB approval, in-person structured interviews of attending physicians, trainees, and advanced practice providers were conducted over a two-week period in the pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and pediatric cardiac intensive care unit (PCICU) at our facility. A survey was developed to evaluate practitioner demographics as well as decision-making for feeding access in mock scenarios. The initial survey tool was pretested and adapted for language and context using cognitive interviewing. Descriptive analysis was used for demographics and quantitative responses. Interview transcripts were analyzed using qualitative content analysis to identify common themes and variance in decision making.

Results: A total of 27 interviews were conducted, 26% in the NICU (n=7), 48% in the PICU (n=13) and 26% in the PCICU (n=7). Respondents included 10 attending physicians, 7 fellows, 5 residents, and 5 advanced practice providers. Providers selected gastric feeding as the initial feeding for most scenarios, a median of 7.4 times for 10 scenarios [IQR 6-9]. However, scenarios where at least 1/3 of respondents selected postpyloric feeding included those with patients with neurologic impairment, hypotonia, ductal-dependent congenital heart disease, and severe burns. 85% of respondents (n=22) felt that institutional culture plays a role in their clinical decision making. Some reasons cited for this included lack of evidence, bias from personal experiences, and that trainees base decisions off of their superiors’ past decisions. 50% of participants felt that use of postpyloric tubes as the initial feeding method results in more complications, and situations resulting in a bowel perforation created a strong bias on qualitative interviews. Quantitative responses did not show any statistically significant differences based on practice location or provider type.

Conclusion: Initial feeding tube decisions vary greatly among providers, and many providers feel institutional culture and personal experience play a role in these decisions. Overall, most participants prefer to start patients on gastric feeds first and many feel that postpyloric feeds are started as the initial method of feeding more often than necessary. The development of feeding guidelines may help to decrease variability in enteral access choice.

PRESENTING AUTHOR NAME
Arianne Maya
PRESENTING AUTHOR EMAIL ADDRESS
ammaya@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Robin Petroze MD, MPH

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3841
ABSTRACT TITLE
Racial Disparity in Liver Transplantation Listing
ABSTRACT BODY
Introduction: Previous studies have demonstrated disparities in transplantation for women, non-Caucasians, the uninsured or publicly insured, and rural populations. We sought to correlate transplant center characteristics with patient access to the waiting list and liver transplantation, with the hypothesis that liver transplant centers vary greatly in providing equitable access to the waiting list and liver transplantation.

Methods: Center-specific adult deceased donor liver transplant and waitlist data for the years 2013 to 2018 were obtained from the Scientific Registry of Transplant Recipients. Waitlist race/ethnicity distributions from liver transplant centers performing ≥250 transplants over this period (n=109) were compared with those of their Donor Service Area, as calculated from 5-year US Census Bureau estimates of 2017. Center-specific characteristics correlated with disparities were analyzed using a linear regression model with a log transformed outcome.

Results: Non-Hispanic Blacks (NHBs) are underrepresented in liver transplant listing compared to center Donation Service Area (88/109, 81%), whereas non-Hispanic Whites are overrepresented (65/109, 58%) (p<0.0001). Hispanics were also underrepresented on the waitlist at the majority of transplant centers (68/109, 62%) (p=0.02). While the racial/ethnic distribution of transplantation is more reflective of the waitlist, there is a higher than expected rate of transplantation for NHBs compared to the waitlist. Predictors of disparity in listing include percentage of transplant recipients at the center who had private insurance, racial composition of the Donation Service Area, and the distance recipients had to travel for transplant.

Conclusions: Non-Hispanic Blacks are listed for liver transplantation less than would be expected. Once listed, however, racial disparities in transplantation are greatly diminished. Improvements in access to adequate health insurance appears to be essential to diminishing disparities in access to this life-saving care.

PRESENTING AUTHOR NAME
Anne-Marie Carpenter MD
PRESENTING AUTHOR EMAIL ADDRESS
acarpenter@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 3
SENIOR AUTHOR/MENTOR NAME
Ali Zarrinpar MD, PhD

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Transplant/Hepatopancreatobiliary (non-cancer)


Surgery Day Abstract Submission 2021 : Entry # 3697
ABSTRACT TITLE
Gastric Electrical Stimulation for Gastroparesis Associated with Dysautonomia and/or Ehlers Danlos Syndrome in Children
ABSTRACT BODY
Introduction: Dysautonomia (DA) is a complex condition that can include Ehlers Danlos Syndrome and Gastroparesis (GP) as co-morbidities. GP can cause a significant decrease in quality of life and can make the treatment of other conditions challenging. In cases of GP where other therapies have failed, Gastric Electrical Stimulation (GES) has been shown to be a potentially effective therapy. We hypothesize that GES can help in children with DA and/or EDS associated GP.

Methods: A retrospective analysis of all patients who underwent either temporary or permanent GES implantation was performed and cases where additional diagnoses of DA or EDS were included for this study. The Gastroparesis Cardinal Symptom Index (GCSI) was used at 1, 6-months, and the latest appointment. Additional clinical data were collected, and descriptive statistics used.

Results:
Overall, 275 patients underwent temporary, and 152 permanent GES. Of these, 50 patients were found to have had associated DA or EDS. A majority (88%) were female and 19 of them were noted to have EDS in addition to DA features. At presentation, the mean age was 15.36 years. 41 responded to temporary GES and had permanent GES implanted. Of the 38 patients having the device longer than 1 month, 21 reported substantial improvement in GCSI scores at all visits and continue to have the device with a presentation mean GCSI score of 16.44 and a latest mean GCSI score of 9.95. The mean duration of GES was 4.88 years. During this time 9 patients reported an increase in amount of oral intake, 3 transitioned from tube feeding to oral intake, 2 was able to stop total parenteral nutrition (TPN) and support themselves completely orally, 5 maintained the same route of feeding, 1 needed a feeding tube placed and 1 started TPN to supplement nutrition. Prior to GES these patients at presentation were on an average of 3.29 gastrointestinal medications. After GES these patients took an average of 2.95 gastrointestinal medications. Fourteen patients had initial sustained improvement over an 8-12 month period, but eventually required explantation – 10 due to progression of the disease, while 4 had remission. Three patients were lost to follow-up with all having reported good response to GES at last contact. Thus, with the use of temporary GES for selection, this group of patients all responded to permanent implant. No major complications occurred in this series.

Conclusion: Patients with GP associated with DA or EDS are a challenging group, requiring extensive care. We found GES to be an effective therapy in selected patients after temporary trials. Disease progression with late failure is an issue that requires further study. In patients who respond to GES substantial quality-of-life improvements can be seen, therefore this therapy should be considered early in children with this combination of conditions.

PRESENTING AUTHOR NAME
Madison Wnuk
PRESENTING AUTHOR EMAIL ADDRESS
madison.wnuk@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Saleem Islam

RESEARCH CATEGORY
Case Report
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3694
ABSTRACT TITLE
Gastric Electrical Stimulation for Gastroparesis Associated with Mitochondrial disorders in Children
ABSTRACT BODY
Introduction: Mitochondrial diseases (MD) are a group of conditions that present with multi-organ dysfunction and may lead to mortality. Gastroparesis (GP) with nausea, emesis and inability to tolerate feeds is a frequent part of the disorder, is difficult to treat, and complicates the management of the MD. Gastric Electrical Stimulation (GES) is an effective therapy in other conditions with recalcitrant GP. We hypothesized that GES can also help in children with MD associated GP.

Methods: Retrospective analysis to assess the effectiveness of off-label use of GES in children with MD. A descriptive analysis of this unique series of patients was performed.

Results: Overall, 12 patients with MD and GP were trialed with temporary GES. Of those, 7 responded and had a permanent implant. Responders were overall younger; 2.6 years for responders, versus 5.6 years for patients who did not respond well to temporary GES. Patients with permanent GES had a mean age of 2.6 years, and 3 were male. Five reported improvement in reported symptoms with parental subjective descriptions of GP symptoms at 1-month, and all 7 at 3 and 6-months and beyond. All had weight gain post GES placement, and improvement in route and volume of feedings including improving from tube feeds only to tolerating oral intake in 3 cases. The use of antiemetic medication was reduced in 1 patient, with no patients requiring an increase. Long term (mean follow up 5.7 years), 6 patients continued successfully with GES, with one explanted at 3 years due to progression of disease. Overall the patients that received a permanent implant showed improvement in quality of life by a decrease in GP symptoms, improved feeding method, reduced hospitalizations, or reduction in antiemetic medications needed.

Conclusion: MD associated GP in children can have long term successful treatment with GES. Patient selection with a temporary trial is critical to avoid implant failure. Children with MD and feeding issues due to gastroparesis should be strongly considered for GES, especially at a younger age.

PRESENTING AUTHOR NAME
Phillip Jenkins
PRESENTING AUTHOR EMAIL ADDRESS
phillip.jenkins@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Saleem Islam

RESEARCH CATEGORY
Case Report
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3613
ABSTRACT TITLE
Developing a Multi-disciplinary Pathway for Pediatric Appendicitis: A Comprehensive Quality Improvement Project (Part One: Diagnosis)
ABSTRACT BODY
Introduction:
In the pediatric population, appendicitis is one of the most common causes of acute abdominal pain. The use of clinical practice guidelines for the evaluation of pediatric appendicitis has been shown to decrease CT utilization, while simultaneously improving diagnostic accuracy. We sought to develop an interdisciplinary clinical practice guideline to be used in the radiology and pediatric emergency departments during the evaluation of pediatric patients with possible appendicitis.

Methods:
A survey was developed to assess current processes in place regarding pediatric patients presenting to the emergency department with suspected appendicitis. It also assessed the opinions of providers in the radiology and pediatric emergency departments about these processes and how they could improve. The survey was conducted via Zoom with six targeted focus groups to maintain social distancing. A SWOT (Strengths-Weaknesses-Opportunities-Threats) analysis was performed after each focus group.

Results:
In the radiology department, ten ultrasound technicians and four pediatric radiologists were surveyed. One of the common themes from these focus groups was that many patients are having an ultrasound ordered as the very first part of their workup, instead of having labs drawn first. Also, about half of technicians felt that it would be helpful to use a standardized reporting checklist for appendicitis ultrasounds since it can sometimes be difficult to visualize the appendix. In the emergency department, twelve pediatric emergency medicine physicians were surveyed. All of the physicians felt the largest obstacle to diagnosis is that many of the ultrasounds come back inconclusive with a non-visualized appendix. The physicians unanimously felt that it would be helpful for the ultrasound technicians to utilize a standardized form for reporting their findings during the scan. Using their feedback, a checklist for pediatric appendicitis ultrasounds was developed that will be filled out by the technician performing the scan and included in the radiologist’s report for the emergency physicians. Finally, they expressed their support for implementing a pathway based around a pediatric appendicitis score and having that pathway built into the electronic medical record. The results of the SWOT analysis were used to develop a protocol for the emergency department that involves utilization of a pediatric appendicitis score and a standardized way to report the score in the patient’s chart.

Conclusions:
From talking to providers in both the radiology and pediatric emergency departments, there are numerous opportunities for process improvement when it comes to caring for pediatric patients presenting to the emergency department with possible appendicitis. By implementing a clinical practice guideline, we hope to decrease CT utilization, improve diagnostic accuracy, and improve the patient experience.

PRESENTING AUTHOR NAME
Joseph Calpin M.S.
PRESENTING AUTHOR EMAIL ADDRESS
jcalpin@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Robin Petroze M.D., M.P.H.

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Quality


Surgery Day Abstract Submission 2021 : Entry # 3541
ABSTRACT TITLE
Indications, Resource Utilization, and Outcomes of Initial Transpyloric Versus Gastric Tube Feeding in Critically-Ill Pediatric Patients
ABSTRACT BODY
Background:
Critically-ill pediatric patients often require supplemental enteral nutrition, administered via gastric or transpyloric (TP) routes. Current research establishing a proven advantage of TP versus gastric access in this population is lacking, leading to significant practice variation. We sought to determine indications, resource utilization, and outcomes of initial gastric versus TP feeding at our institution.

Methods:
This study is a retrospective review of pediatric patients admitted to our intensive care units between 2015-2018 who received initial enteral feeds. Patients with gastrostomy tubes, primary gastrointestinal diagnoses or bowel loss, weight <2.5 kg and gestational age <32 weeks were excluded. Data collected included initial mode of enteral feeding, demographics, presenting symptoms, co-morbidities, complications, outcomes, and imaging. Univariate analysis was performed.

Results:
378 patients met inclusion criteria. 34% (n=130) received TP feeds vs 66% (n=248) gastric. Patients started on TP feeds presented with higher initial rates of intubation, pneumonia, and aspiration (p<0.05). Patients required on average 1 x-ray per 6 days on TP tube and 1 x-ray per 14 days on gastric tube (p<0.05). Complication rate (defined as aspirations, pneumonia, perforations, deaths, or other) was 10.8% (n=15) TP vs. 10.1% (n=25) gastric (p=0.725). 45% (n=58) TP vs. 16% (n=39) gastric patients transitioned to a different tube type during their hospital stay (p<0.05). Length of stay was higher in TP patients (65.5 vs 46.8 days) (p<0.05).

Conclusions:
Our study showed no significant difference in complications for patients started on gastric versus transpyloric tube feeds; however, initial TP feeds were associated with greater radiographic burden and length of stay.

PRESENTING AUTHOR NAME
Tyler Thompson
PRESENTING AUTHOR EMAIL ADDRESS
thompson.t@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Robin Petroze

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3823
ABSTRACT TITLE
Preterm Neonatal Blood Transfusions Are Associated with Increased Risks of Sepsis and Pulmonary Complications
ABSTRACT BODY
Introduction: Blood transfusions are associated with significant risks. Although restrictive blood transfusion guidelines have been widely implemented in adult critical care settings, similar implementation has not occurred in neonatal intensive care units (NICUs). Currently, there is conflicting evidence regarding the association between neonatal blood transfusions and poor clinical outcomes. We hypothesize that neonatal blood transfusions are associated with increased risks of sepsis, bronchopulmonary dysplasia (BPD), and complications.

Methods: Following institutional review board approval, a retrospective cohort study was performed for all preterm neonates (< 37 weeks gestational age) transfused over a 1-year period in our NICU. Data were collected including birthweight, gestational age, type and volume of blood products transfused, and outcomes including sepsis, BPD, necrotizing enterocolitis (NEC), time to full enteral feeds, and complications.

Results: 101 patients were included in the study. The patients’ mean gestational age and birthweight were 28.7 weeks and 1213 grams, respectively. The mean number of transfusions administered was 3.7 for packed red blood cells (RBC), 0.8 for platelets, 1.3 for fresh frozen plasma, and 0.2 for cryoprecipitate. 58 patients developed sepsis, 63 had BPD, and 45 developed complications, predominantly pneumonia. On multivariate analysis including gestational age, birthweight, and Apgar score, number of RBC transfusions emerged as a significant independent predictor of sepsis (AUC 0.78), BPD (AUC 0.78), NEC (0.82), time to full enteral feeds (p < 0.0001), and complications (AUC 0.78).

Conclusions: Blood transfusions were independently associated with poor outcomes including sepsis, BPD, NEC, prolonged time to full enteral feeds, and complications, even when considering patient risk factors including gestational age and birthweight. These findings suggest caution with unrestricted use of blood transfusions in neonates. Prospective trials of restrictive neonatal blood transfusion criteria should be undertaken to determine if selectively limiting transfusions can help avoid poor outcomes such as sepsis and BPD.

PRESENTING AUTHOR NAME
Russell Hawkins
PRESENTING AUTHOR EMAIL ADDRESS
russell.hawkins@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 7 or higher
SENIOR AUTHOR/MENTOR NAME
Shawn Larson

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3550
ABSTRACT TITLE
Historical trends in Pediatric post-operative opioid prescribing practices
ABSTRACT BODY
Introduction
Increased public health awareness and legislation at the state and federal level aim to decrease opioid abuse, including affecting post-operative prescription practices. While children are affected by both direct and indirect consequences of the opioid epidemic, uniform protocols for opioid prescribing practices in children undergoing surgical procedures are often lacking. The goal of this study was to evaluate the patterns in the prescription of pain medication following common pediatric surgeries in order to identify targets for quality improvement. We hypothesized that amounts of narcotics prescribed has decreased in the wake of increased awareness, but that practice patterns are widely variable.

Methods
A single-institution retrospective chart review of pediatric patients (<18 years) was conducted. Data were abstracted from 2012-2019 and entered into a RedCap database for appendectomy, umbilical hernia repair, inguinal hernia repair, circumcision, laparoscopic gastrostomy (+/- fundoplication), laparoscopic cholecystectomy, orchiopexy, and abscess or pilonidal drainage. Patients were excluded if discharged from a long-term ICU, hospital discharge >7 days postoperatively, conversion to major laparotomy, or chronic narcotic use. Variables included demographics, medical history, operative course and discharge medications. Univariate and multivariate analysis evaluated trends in opioid prescriptions with subanalyses performed to identify differences by race, gender, or insurance status. A linear regression model was created to model mean total opioid doses by time. Non-linear polynomial modeling with a 5-knot restricted cubic spine fit was developed to best show the change in prescription patterns over time.

Results
1865 cases met inclusion criteria. The mean age was 9.3, and patients were predominantly male (61.5%), white (66.6%), and insured by Medicaid (63.9%). Average post-op stay was 1.5 days and 1157 total patients were prescribed an opioid on discharge. The mean number of opioids prescribed (defined as total number of doses) decreased over time from 24 in 2012 to 2 in 2019 (p<0.001). All subcategories decreased, with hernia repairs showing the least amount of change. When controlling for other factors, time and procedure were both significantly associated with opioid dose (p<.0001). Time analysis showed a decrease in opioid prescribing from 2012-2014, plateau until 2017, and further decrease until 2019.

Conclusions
Opioid prescriptions for post-operative patients decreased over time despite no pediatric-specific opioid prescribing protocols. This may be due to advocacy, awareness, or legislation, and the influence of these factors on prescribing practice requires further investigation.

PRESENTING AUTHOR NAME
Grace Thompson
PRESENTING AUTHOR EMAIL ADDRESS
gracerthompson@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Robin Petroze MD, MPH

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3511
ABSTRACT TITLE
Evaluation of Three different Pain Management Algorithms after repair of Pectus Excavatum
ABSTRACT BODY
Introduction
Pectus Excavatum is a deformity of the chest wall characterized by sternal depression that can lead to cardiac compression and requires surgery in severe cases. Minimally invasive repair (MIRPE) allows complete correction, however post-operative pain can be prohibitive. This study aims to better understand the pain control outcomes with different analgesic regimens.

Methods
All patients at UF Health Shands Hospital who underwent Pectus Excavatum repair between 1/1/2011 and 12/31/2019 were included. Data regarding patient history of disease, intraoperative course, and post-operative course and outcomes were collected from the charts creating a database which was analyzed as a whole as well as after creation of cohorts based on type of analgesia used (Epidural, sub-pleural Elastomeric pump, and thoracic intercostal nerve cryoablation). Hospital length of stay and total narcotic use measured as oral morphine equivalents were measured as a proxy for pain control. The three groups were compared to each other using appropriate statistical tests (ANOVA, students t test, Mann Whitney U test), and a p value of less than 0.05 was considered significant.

Results
A total of 58 cases had surgical repair during the study period. The overall mean age was 17.9, with 77.6% male and 86.2% Caucasian. The average Haller index (depth of deformity) overall was 4.7 and the mean duration of symptoms 14.1 years. Analgesia was achieved in 29 by a thoracic epidural, 18 underwent cryoablation and 11 had Elastomeric Pumps placed. There were no differences in age, gender, severity of the deformity, insurance status, or number of bars used for repair between the three groups. The operation was significantly longer for either the cryoablation or pump groups compared to epidural (p=0.001). Epidural cases had a 4.4 day length of stay (Median 4), while cryoablation had 3.7 days (Median 3) and pump 3.9 days (Median 4)(p=0.005 comparing epidural and cryoablation median LOS). Both the epidural and pump patients had an average 2.2 days spent in the ICU, compared to 0.4 days for cryoablation (p<0.0002). When comparing the total narcotic use during the hospital stay, we noted 454.3 mg, 725.4 mg, and 246.2 mg morphine equivalents for epidural, pump, and cryoablation cases respectively, which were significantly different (p<0.002).

Conclusions
These data suggest that cryoablation may be the most effective mechanism for controlling pain after MIRPE when measured by the hospital length of stay as well as morphine equivalent narcotic use. This likely translates to a cost saving for cryoablation as well, despite the longer operative time. Further multicenter trials would be beneficial to understand the role of these analgesic techniques.

PRESENTING AUTHOR NAME
Grace Thompson
PRESENTING AUTHOR EMAIL ADDRESS
gracerthompson@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Saleem Islam

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3592
ABSTRACT TITLE
IMAGING GENTLY AND APPROPRIATELY—COMPARING ABDOMINAL CT SCANS OBTAINED IN GENERAL EMERGENCY DEPARTMENTS AND A DEDICATED PEDIATRIC EMERGENCY DEPARTMENT
ABSTRACT BODY

Introduction
CT imaging has become more commonly used in children presenting to emergency departments. The ‘Image Gently’ campaign emphasizes justification of each study performed in children and balancing radiation dose and study quality. Previous studies have noted substantially higher radiation dosing in general emergency departments when compared with dedicated pediatric emergency departments. The purpose of this report is to assess the radiologic dosing and contrast usage of CT scans performed in general emergency departments (GEDs) and a dedicated pediatric emergency department (PED).

Materials and Methods
A retrospective observational study was performed investigating patients aged 0 to 18 years who presents to the emergency department with abdominal pain and/or trauma and underwent an abdominal CT scan between 2013 and 2016. Demographic, clinical, radiologic and outcome data were collected and analyzed. Radiologic data included milliampere seconds (mAs), kilovoltage peak (kVp), total body computed tomography dose index (CTDI) and total body dose length product (DLP).

Results
A total of 171 patients presented to the emergency department during the study period with abdominal pain and/or trauma and underwent an abdominal CT scan. 121 of patients had the scan performed at GEDs. The mean patient age was lower for scans at GEDs. There was an equivalent number of females in both groups and no significant difference in insurance demographics. kVp was significantly higher in GED scans. The other radiologic data were similar between emergency departments. Significantly fewer patients had intravenous contrast used at GEDs while the use of enteral contrast administration was equivalent.

Conclusions
There remains room for improvement in the radiation dosing in CT scans obtained in GEDs in the study referral area. Directed education regarding the use of intravenous contrast and ALARA criteria would be helpful feedback. Ongoing research is needed to both reduce the number and improve the radiologic appropriateness of CT scans in children.

PRESENTING AUTHOR NAME
Gwendolyn Gillies MD
PRESENTING AUTHOR EMAIL ADDRESS
gwendolyn.gillies@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 2
SENIOR AUTHOR/MENTOR NAME
Saleem Islam MD, MPH

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Pediatric Surgery


Surgery Day Abstract Submission 2021 : Entry # 3430
ABSTRACT TITLE
Applying Pediatric Brain Injury Guidelines at a Level I Adult/Pediatric Safety-Net Trauma Center
ABSTRACT BODY
Introduction: Pediatric brain injuries are common, but current management of patients with mild traumatic intracranial hemorrhage (T-ICH) is sub-optimal, often including unnecessary repeat head CT (RHCT) and neurosurgical consultation (NSC). Brain Injury Guidelines (BIG) have previously been developed to standardize the management of TBI, and recent work suggests they may be applied to children. The aim of this study was to apply BIG to a low-risk pediatric TBI population to further determine whether the framework can be safely applied to children in a way that reduces overutilization of RHCTs and NSC.

Methods: A retrospective chart review of a Level 1 Adult and Pediatric Trauma Center’s pediatric registry over four years was performed. BIG was applied to these patients to evaluate the utility of RHCT and need for neurosurgical intervention (NSG-I) in those meeting BIG-1 criteria. Those with minor skull fracture (mSFx) who otherwise met BIG-1 criteria were also included.

Results: Thirty-two patients with low-risk T-ICH met criteria for review. RHCT was performed in 8 patients, with only 2 being prompted by clinical neurologic change/deterioration. NSC occurred in 24 of the cases. Ultimately, no patient identified by BIG1 ± mSFx required NSG-I.

Conclusions: Application of BIG criteria to children with mild T-ICH appears capable of reducing RHCT and NSC safely. Additionally, those with mSFx that otherwise fulfill BIG-1 criteria can be managed similarly by acute care surgeons. Further prospective studies should evaluate the application of BIG-1 in larger patient populations to support the generalizability of these findings.

PRESENTING AUTHOR NAME
Jamie Schwartz
PRESENTING AUTHOR EMAIL ADDRESS
jschwartz@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Brian Yorkgitis

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Acute Care/Trauma/Sepsis


Surgery Day Abstract Submission 2021 : Entry # 3715
ABSTRACT TITLE
Pediatric Upper Extremity Firearm Injuries: Who is at Risk and How Do We Prevent Them?
ABSTRACT BODY
Introduction: Pediatric upper extremity (UE) firearm injuries present challenges for physicians due to limited available literature that investigates risk factors and recurring mechanisms specific to the UE. This study evaluates pediatric patients treated for UE firearm injuries in order to identify vulnerable populations based on demographic and geographic factors. Through elucidating potential trends, we hope to inform treatment algorithm development and distribute information aimed at prevention.

Patients and Methods: A 20-year, retrospective review was conducted of pediatric patients treated for UE firearm injuries. Demographics, injury circumstances, treatment methods, and outcomes were collected. Patients >18 years of age, injuries unrelated to a firearm, and non-upper extremity injuries were excluded. Collected data were compared to statewide population information using the 2010 census. Analysis included descriptive statistics, Fisher’s exact tests, and chi-square tests.

Results: A total of 180 patients were included. One hundred fifty-three (85%) of these were males, and twenty-seven (15%) were females. Females were more likely victims of assault compared to males (p=0.03), and males were more likely injured due to accidental discharge (p=0.0001). The most commonly affected race/ethnicity was White – not Hispanic or Latino (48%). Sixty-three percent of patients were early adolescents (12-17 years), and the hand was the most frequent location of injury (N=56; 31%). These were more likely to be accidental compared to more proximal injuries (p=0.003). Finger (N=36; 20%) and upper arm (N=24; 13.3%) injuries were the next most common locations affected. Air rifles (non-powder) were the most common firearm type (N=101; 56%). Pistols were implicated in 47 cases (26%), rifles in 17 cases (9%), and shotguns in 10 cases (6%). Ninety-nine patients (55%) had procedures in the operating room, 22 in the emergency department (12%), and 3 (2%) in a clinic setting. Fifty-six did not require a procedure (31%). The most frequent procedure was foreign body removal (N=99; 55%).

Conclusions: Risk factors such as male sex, white race/ethnicity, and adolescent age were attributed to increased risk for injury. Common mechanisms included accidental discharge, assault, and self-inflicted injury. Implications of these findings include future development of firearm safety materials targeting at-risk communities and development of upper extremity-specific treatment algorithms for providers.

PRESENTING AUTHOR NAME
David Kerekes
PRESENTING AUTHOR EMAIL ADDRESS
david.kerekes@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 3
SENIOR AUTHOR/MENTOR NAME
Ellen Satteson

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Burns/Plastic Surgery


Surgery Day Abstract Submission 2021 : Entry # 3760
ABSTRACT TITLE
Biomarker Evidence of the Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) in Chronic Critical Illness after Surgical Sepsis
ABSTRACT BODY
Background: While early deaths after surgical ICU sepsis have decreased and most survivors rapidly recover (RAP), over 1/3rd develop the adverse clinical trajectory of CCI. However, the underlying pathobiology of its dismal long-term outcomes remains unclear. Our main objective was to analyze serial biomarkers of the persistent inflammation, immunosuppression and catabolism syndrome (PICS) to gain insight into the pathobiology of chronic critical illness (CCI) after surgical sepsis.

Methods: PICS biomarkers over 14 days from 124 CCI and 225 RAP sepsis survivors were analyzed to determine associations and prediction models for 1) CCI ( >14 ICU days with organ dysfunction) and 2) dismal 1-year outcomes (Zubrod 4/5 performance scores). Clinical prediction models were created using PIRO variables (predisposition, insult, response and organ dysfunction). Biomarkers were then added to determine if they strengthened predictions.

Results: CCI (versus RAP) and Zubrod 4/5 (versus Zubrod 0-3) cohorts had greater elevations in biomarkers of inflammation (IL-6, IL-8, IP-10, MCP1), immunosuppression (IL-10, sPDL-1), stress metabolism (CRP, GLP-1), and angiogenesis (Ang-2, VEGF, Flt1, SDF) at most time-points . Clinical models predicted CCI on day 4 (AUC= 0.89) and 1 year Zubrod 4/5 on day 7 (AUC=0.80). IL-10 and IP-10 on day 4 minimally improved prediction of CCI (AUC=0.90). However, IL-10, IL-6, IL-8, MCP-1, IP-10, Ang-2, GLP-1, sPDL-1 and SDF on day 7 substantially improved the prediction of Zubrod 4/5 status (AUC=0.88).

Conclusions: Persistent elevations of PICS biomarkers in the CCI and Zubrod 4/5 cohorts and their improved prediction of Zubrod 4/5 validate that PICS plays a role in CCI pathobiology.

PRESENTING AUTHOR NAME
Dijoia Darden
PRESENTING AUTHOR EMAIL ADDRESS
dijoia.darden@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Other
SENIOR AUTHOR/MENTOR NAME
Frederick Moore

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Acute Care/Trauma/Sepsis


Surgery Day Abstract Submission 2021 : Entry # 3796
ABSTRACT TITLE
Recovery from anemia during six month follow up after severe traumatic injury
ABSTRACT BODY
Introduction:
Following severe traumatic injury, anemia initially occurs due to acute blood loss but remains persistent following prolonged critical illness. Anemia is a common complication, yet the timing and extent of hemoglobin recovery has not been described following trauma. This study sought to describe the prevalence of anemia after severe traumatic injury, then characterize the trajectory of anemia recovery after severe trauma.

Methods:
A single-institution prospective cohort study enrolled 90 trauma patients with an injury severity score (ISS) of 15 or more plus hemorrhagic shock and a pelvic, hip, or femur fracture. CBC and plasma samples were obtained on day of surgery and again at day 14, and one, three, and six months after enrollment. Mild anemia was defined as hemoglobin between 10.0 to <12.0 g/dL in females and between 10.0 to <13.5 g/dL in males, moderate anemia was defined as hemoglobin 8.0 to <10.0 g/dL, and severe anemia defined as hemoglobin < 8.0 g/dL. Patients were classified as still anemic at 3- and 6-month endpoints if hemoglobin < 13.5 g/dL in males or < 12.0 g/dL in females. Trends in hemoglobin over time across recovery groups and correlations between anemia recovery and clinical parameters were detected using a correlation matrix and unpaired two-tailed t-tests followed by simple logistic regression in GraphPad Prism v9.0. Data presented as median (interquartile range).

Results:
Of the 90 patients included in the study, 59% were male. The median age was 44 years (33-58 years). Admission hemoglobin was 11.5 g/dL (10.2-13.2 g/dL). Hemoglobin at discharge was 9.5 g/dL (8.8-10.3 g/dL), with 98% having anemia. Of these, 34% had mild anemia, 55% had moderate anemia, and 11% had severe anemia. Overall prevalence of anemia was 87% at one month, 41% at three months, and 35% at six months. Age over 45 years (OR 0.286, [CI 0.072,0.960], p = 0.0425) and receiving one or more blood transfusions were both negatively associated with anemia recovery at three months (OR 0.134, CI [0.023,0.692], p = 0.017). Development of an infectious complication during hospitalization was negatively associated with anemia recovery at six months (OR 0.141, [CI 0.017,0.927], p = 0.0415). There were no statistically significant associations identified between anemia recovery and sex, ISS, hospital length of stay, ICU admission, ICU length of stay, admission hemoglobin, blood loss, or number of surgeries.

Conclusions:
Anemia is common after severe trauma and was present in nearly all patients at discharge from the hospital. Despite a younger injured patient demographic, more than a third of patients were still anemic at six months after discharge. The use of blood transfusions and the presence of infectious complications were associated with lack of anemia recovery at six months. Further studies are warranted to evaluate those trauma patients with persistent anemia who may benefit from targeted anemia management strategies.

PRESENTING AUTHOR NAME
Lauren Kelly
PRESENTING AUTHOR EMAIL ADDRESS
lauren.kelly@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 4
SENIOR AUTHOR/MENTOR NAME
Alicia Mohr

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Acute Care/Trauma/Sepsis


Surgery Day Abstract Submission 2021 : Entry # 3745
ABSTRACT TITLE
Resolution of Inflammation in Chronic Critical Illness Patients to Address Persistent Inflammation Immunosuppression and Catabolic Syndrome
ABSTRACT BODY
Introduction: Multiple organ failure (MOF) after sepsis has plagued intensive care units (ICUs) for the past 40 years. With recent ICU advances, early sepsis mortality is low (~5%) and most MOF patients survive their ICU stay. Unfortunately, many sepsis survivors are now progressing into chronic critical illness (CCI) with a new MOF phenotype called the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome (PICS). There are no effective interventions for CCI-PICS and long-term outcomes for this growing epidemic is dismal. We are now faced with a growing epidemic of CCI-PICS in sepsis survivors who suffer from a persistent cycle of low-grade inflammation. We are not interested in preventing sepsis inflammation, but rather promoting resolution to prevent progression into CCI-PICS.

Specialized pro-resolving mediators (SPMs) are the by-products of enzymatic conversion of Omega-3, Poly-Unsaturated Fatty Acids (PUFAs). We now know that SPMs, more specifically resolvins, are endogenous mediators that promote resolution of persistent inflammation that characterizes CCI-PICS as opposed to Rapid Recovery (RAP = those that were discharged out of ICU <14days with no organ dysfunction).

Methods: Retrospective data review of 56 CCI patients double crossed through logistic regression matching for age, sex, Charleson Comorbidity Index to identify correlation of gene expression. Nanostring gene array performed by the Moldawer and Moore lab was performed by standard operating procedures.

Results: 56 CCI patients compared to 112 RAP generated leukotriene (LT) and resolvin scores. With statistical significance the LT score was less in the RAP group after 14 days. A significantly higher CCI resolvin score suggests elevated ongoing genomic expression.

Conclusion: We hypothesize that in CCI-PICS patients, compared to patients who experience RAP, will have low gene expression. Corroborating with our hypothesis we identified that inflammatory lipid mediators were higher in the CCI cohort which is identical to the post hoc analysis of the Glue Grant study. This depicts that our CCI cohort is similar to the complicated cohort in the Glue Grant study. However, our resolvin score depicted a contrary illustration of the genomic array. As our CCI cohort has much higher gene expression for the SPM biosynthetic pathway compred to the RAP cohort. Our belief is that, ultimately this is a feedback mechanism, and that the CCI cohort was either lacking the substrate (EPA and DHA), the enzymatic pathway, or dysfunction in the receptor. This will importantly provide the preliminary data to support ongoing studies into the potential role of using SPMs as a therapeutic intervention to prevent CCI-PICS progression in sepsis survivors.

PRESENTING AUTHOR NAME
Hutson Rapier
PRESENTING AUTHOR EMAIL ADDRESS
rapieh@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Martin Rosenthal

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Acute Care/Trauma/Sepsis


Surgery Day Abstract Submission 2021 : Entry # 3655
ABSTRACT TITLE
Laparoscopic Inguinal Hernia Repair on Antiplatelet or Anticoagulant Therapy
ABSTRACT BODY
Introduction: Laparoscopic inguinal hernia repair (IHR) is associated with wide dissection and carries a risk of extraperitoneal hematoma. This risk may be elevated in patients receiving antiplatelet (APT) or anticoagulation therapy (ACT). As the population ages, the proportion of these patients is increasing. This study aims to assess the safety of laparoscopic versus open IHR in patients on APT and/or ACT.

Methods: We conducted a retrospective cohort study using the Vizient Clinical Database to evaluate all outpatient IHR in patients on APT/ACT from 2017-2019 using CPT codes. Logistic regression was used to assess for differences in surgical outcomes in patients on APT/ACT undergoing laparoscopic or open IHR while controlling for patient characteristics.

Results: A total of 142,052 IHR patients were identified. Of those, 21,547 (15%) were on APT/ACT. 41% of IHR were done laparoscopically. Mean age was 69 ± 11years and 93% were male. 19% of hernias were bilateral and 75% of these were repaired laparoscopically. After adjustment for confounding factors, postoperative hematoma was less likely with laparoscopic IHR (0.1%) compared to open (0.2%) (odds ratio = 0.3, 95% CI 0.1-0.7). There was no difference in transfusion rates, length of stay, 30-day unplanned operation, or 30-day readmission.

Conclusion: Patients on APT/ACT represent a significant proportion of IHR patients. With regards to bleeding related complications in this group, laparoscopic IHR appears to be safe.

PRESENTING AUTHOR NAME
Jeremy Balch
PRESENTING AUTHOR EMAIL ADDRESS
jeremy.balch@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 2
SENIOR AUTHOR/MENTOR NAME
Mazen Al-Mansour

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
General Surgery


Surgery Day Abstract Submission 2021 : Entry # 3607
ABSTRACT TITLE
The Efficacy of Routine Radiologic Screening for Anastomotic Leak After Esophagectomy for Esophageal Cancer
ABSTRACT BODY
Introduction: Anastomotic leaks (AL) are a major source of post-esophagectomy morbidity and patients are often initially asymptomatic. Debate exists on timing and utility of imaging to detect AL post-esophagectomy. We sought to evaluate the efficacy and timing of radiographic AL evaluation in esophageal cancer patients post-esophagectomy.

Methods: A retrospective database of esophageal cancer patients who underwent esophagectomy at a single institution from 2004-2020 was used to determine the utilization, timing, and sensitivity of radiologic testing for AL post-esophagectomy.

Results: Seventy-six patients were identified of which 37 (49%) had a cervical anastomosis. Sixty-four (84%) underwent 72 “asymptomatic radiographic leak tests” (ARLT), 8 of which had 2 different tests, including: 41 fluoroscopic esophagrams (57%), 18 CT-esophagrams (25%), and 13 upper GI studies (18%). Sixteen patients (21%) developed clinical signs of AL (hemodynamic instability, leukocytosis) and underwent “symptomatic radiographic leak tests” (SRLT) with fluoroscopic esophagram (n=9, 12%) or CT-esophagram (n=7, 9%). ARLT and SRLT were positive in 3/64 (5%) and 16/16 (100%) patients, respectively, for 18 total ALs (24%). Among the 16 SRLT(+) patients, 1 was also ARLT(+), 12 were initially ARLT(-), and 3 were not evaluated by ARLT. The median postoperative day for ARLT and SRLT was 4.5 (IQR 4.0-5.0) and 9.0 days (IQR 6.0-13.0), respectively. The sensitivity and specificity of ARLT for detecting AL were 13.3% and 98.0%, respectively.

Conclusions: Based on the low ARLT sensitivity, routine use of imaging to detect asymptomatic ALs post-esophagectomy may be limited. Symptomatic ALs often present in a delayed fashion, even after initial negative imaging.

PRESENTING AUTHOR NAME
Hansol Kang
PRESENTING AUTHOR EMAIL ADDRESS
hansolkang@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Ryan M. Thomas

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Oncology


Surgery Day Abstract Submission 2021 : Entry # 3820
ABSTRACT TITLE
Health Disparities in Patients with Pancreatic Neuroendocrine Tumors
ABSTRACT BODY
Introduction: Pancreatic neuroendocrine tumors (PNETs) represent a rare form of pancreatic cancer. Racial/ethnic disparities have been documented in pancreatic ductal adenocarcinoma, but health disparities have not been well described in patients with PNETs.

Methods: A retrospective review of patients with PNETs in the National Cancer Database was performed for the years 2004-2014. 16,605 patients with PNETs and available vital status were identified. Survival was compared by race/ethnicity and socioeconomic status using Kaplan-Meier methods and Cox regression.

Results: There were no significant differences in survival in Non-Hispanic, White; Hispanic, White; or Non-Hispanic, Black patients on univariate analysis. Kaplan-Meier analysis showed that patients from communities with lower median household income and education level had worse survival (p<0.001). Patients age <65 without insurance, similarly, had worse survival (p<0.001). Multivariable modeling found no association between race/ethnicity and risk of mortality (p=0.37). Lower median household income and lower education level were associated with increased mortality (p<0.001).

Conclusions: Unlike most other malignancies, race/ethnicity is not associated with survival differences in patients with PNETs. Patients with lower socioeconomic status had worse survival. The presence of identifiable health disparities in patients with PNETs represents a target for intervention and opportunity to improve survival in patients with this malignancy.

PRESENTING AUTHOR NAME
Patrick Underwood
PRESENTING AUTHOR EMAIL ADDRESS
patrick.underwood@sugery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 5
SENIOR AUTHOR/MENTOR NAME
Jose Trevino

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Oncology


Surgery Day Abstract Submission 2021 : Entry # 3808
ABSTRACT TITLE
Diversity and Inclusion in Pancreatic Cancer Clinical Trials
ABSTRACT BODY
Introduction: Disparities in pancreatic cancer incidence, treatment and mortality disproportionally affect racial and ethnic minority populations. These disparities may be explained in part by differing tumor biology, thus underrepresentation in clinical trials may compromise assessment of safety and therapeutic efficacy. This study investigates the reporting of demographic data and racial, ethnic and gender diversity of PC clinical trial participants.

Methods: A cross-sectional database analysis of ClinicalTrials.gov was performed of pancreatic cancer clinical trials conducted from 2005-2020. Data were cross-referenced with formally-linked publications and PubMed.gov for secondary verification. Trials including other cancer types, pancreatic diseases and those performed outside to US were excluded. Primary outcomes were the proportion of clinical trials reporting demographic data as well as the racial, ethnic and gender breakdown of each trial. Representation was determined through the enrollment fraction (EF), calculated by dividing the proportion of trial participants by the proportion of incident pancreatic cancer cases by subgroup. Wilcoxon rank sum tests were used to determine whether the distribution of EF ratios among all subgroup trials significantly differed from 1.

Results: Two-hundred seven pancreatic cancer clinical trials consisting of 8,429 pooled participants were included from 2005 to 2020. Participant gender was consistently (99%) reported, whereas race and ethnicity were reported in 49.3% and 34.7% of trials, respectively. Black (8.2%, EF=0.43, p=0.002), Asian/Pacific Islander (2.4%, EF=0, p=<0.0001), American Indian/Alaskan Native (0.3%, EF=0, p=<0.0001) and Hispanic (6%, EF=0.47, p=<0.0001) participants were significantly underrepresented compared to White (84.7%, EF=1.05, p=0.002) participants. Female participants (45.2%, EF=0.93, p=.001) were also significantly underrepresented. This underrepresentation spanned across clinical trial phases and sponsor types. Despite demographic data reporting improvements over time, pancreatic cancer clinical trial diversity remained unchanged.

Conclusion: Though reporting of demographic data has improved over the last decade, non-White, Hispanic and female patients with pancreatic cancer remain underrepresented in pancreatic cancer clinical trials relative to the burden of disease in those populations. A better understanding of biologic responses in racial and ethnic minority populations, through their inclusion in clinical trials, is critical to reducing healthcare disparities, improving patient outcomes and advancing scientific knowledge.

PRESENTING AUTHOR NAME
Kelly Herremans
PRESENTING AUTHOR EMAIL ADDRESS
kelly.herremans@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 4
SENIOR AUTHOR/MENTOR NAME
Jose Trevino

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Oncology


Surgery Day Abstract Submission 2021 : Entry # 3868
ABSTRACT TITLE
Donor Service Area Characteristics Impacting Liver and Kidney Deceased Donor Population
ABSTRACT BODY
Introduction: While there is ample evidence of racial and ethnic disparities in access to listing, being transplanted, and post-transplant outcomes in liver and kidney transplantation, there has not been much investigation into the race/ethnicity of deceased donors. Organ Procurement Organizations (OPOs) are tasked with providing access to allografts from their constituents within a donor service area (DSA). Although there are some reports of lower donation rates in non-White populations, DSA specific factors affecting this have not been adequately examined.
Methods: DSA specific adult liver and kidney head trauma deceased donor (HTDD) data were obtained from the Scientific Registry of Transplant Recipient files between January 2013 and December 2018. DSA specific head trauma eligible donor pool (HTED) was obtained from inpatient head injury deaths calculated through CDC WONDER multiple cause of death files from 2013 to 2018.Race/ethnicity distributions from each DSAs HTDD pool (n=57) were compared to the race/ethnicity distributions of each DSA’s head trauma eligible donor pool (HTED). DSA population demographics were calculated from 2017 5-year estimate US Census data. DSA-specific characteristics were correlated with differences for Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic populations through logistic regression and scatterplots. Statistical analyses were conducted using SAS 9.4.
Results: NHB HTDDs were consistently lower at a majority of programs compared to their respective HTEDs of their DSA (liver 37/57 65%) (kidney 33/57 58%), while Hispanic HTDDs were higher at a vast majority of programs (liver 50/57 87%) (kidney 47/57 82%). Predictors for programs with high Hispanic HTDDs were poverty (p = 0.0346) and under high school education (p = 0.0462) in kidney and in liver public (p = 0.0348) and private insurance (p = 0.0485).
Conclusions: In this study we explore racial and ethnic disparities in kidney and liver donation in the head trauma deceased donor pool. The findings suggest a lower-than-expected utilization of Non-Hispanic Black head trauma deceased donors and a higher-than-expected utilization of Hispanic head trauma deceased donors in a majority of the DSAs. Analysis is underway to explore and better understand the impact of additional factors associated with these disparities in each DSA and to find potential ways to mitigate them.

PRESENTING AUTHOR NAME
Curtis Warren
PRESENTING AUTHOR EMAIL ADDRESS
cwarren1@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Other
SENIOR AUTHOR/MENTOR NAME
Ali Zarrinpar

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Transplant/Hepatopancreatobiliary (non-cancer)


Surgery Day Abstract Submission 2021 : Entry # 3589
ABSTRACT TITLE
Missing Seats at the Table – The Importance of Intersectionality in Diversity and Inclusion Among Surgical Faculty and Leadership
ABSTRACT BODY
Introduction: Diversity in academic surgery is lacking, particularly among positions of leadership. Attention has been drawn to the leaky pipeline in surgery for women and underrepresented in medicine (URiM) racial/ethnic groups separately, leaving a paucity of information on how the trajectory may differ between male and female URiM faculty. Intersectionality, which describes the phenomenon whereby multiple identities collide, leading to interdependent systems of discrimination or bias, may be an important factor in diversity and inclusion among surgical faculty. We hypothesize that although surgical faculty are becoming more diverse, the trajectory of male and female racial/ethnic minority representation differs, particularly among leadership positions.
Methods: This cross-sectional and longitudinal analysis assessed US surgical faculty census data obtained from the Association of American Medical Colleges’ faculty roster in the Faculty Administrative Management Online User System (FAMOUS) database. Surgical faculty members captured in census data from December 31, 2013 to December 31, 2019 were included in the analysis. Faculty were identified from the surgery category of the faculty roster, which includes general surgeons and subspecialists, neurosurgeons and urologists. Gender and race/ethnicity were obtained for surgical faculty stratified by rank. Descriptive statistics with annual percent change in representation are reported based on faculty rank.
Results: A total of 15,653 US surgical faculty, including 3,876 women (24.8%), were included in the data set for 2019. Female racial/ethnic minority faculty experienced an increase in representation at instructor, assistant and associate professorship appointments, with a more favorable trajectory than racial/ethnic minority males across nearly all ranks. White faculty maintain most leadership positions as full professors (3105 of 3997 [77.7%]) and chairs (294 of 380 [77.4%]). The greatest magnitude of underrepresentation along the surgical pipeline has been among Black (106 of 3997 [2.7%]) and Hispanic/Latinx (176 of 3997 [4.4%]) full professors. Among full professors, while Black and Hispanic/Latinx males had modest increases in representation (annual percent change 0.07% and 0.10%, respectively), Black female representation remained constant (annual percent change 0.00004%) and Hispanic/Latinx female representation decreased (annual percent change, -0.16%). Overall Hispanic/Latinx (20 of 380 [5.3%]) and Black (13 of 380 [3.4%]) representation as chairs has not changed, with only 1 Black and 1 Hispanic/Latinx woman ascending to chair from 2013 to 2019.
Conclusion: A dispiritingly small number of minority faculty ascend to leadership positions in academic surgery. Intersectionality may leave female members of racial/ethnic minority groups more disadvantaged than their male colleagues in achieving leadership positions. These findings highlight the urgency to diversify surgical leadership.

PRESENTING AUTHOR NAME
Andrea Riner
PRESENTING AUTHOR EMAIL ADDRESS
andrea.riner@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 4
SENIOR AUTHOR/MENTOR NAME
Jose Trevino

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
General Surgery


Surgery Day Abstract Submission 2021 : Entry # 3718
ABSTRACT TITLE
Clerkship Education in the COVID19 Era: Using Simulation-Based Cases for Supplemental Surgical Education
ABSTRACT BODY
Introduction
The COVID19 pandemic created a unique challenge for medical student education. Medical students were obligated to transfer a significant portion of their surgery clerkship to virtual learning. Their clinical education potentially suffers from decreased exposure to surgical patients and their management. Simulation-based scenarios are a validated method to increase medical student exposure to common surgical cases, improving knowledge of clinical presentation, diagnostics, and management. We supplemented our surgery clerkship curriculum with high yield simulation scenarios to demonstrate non-inferior medical education compared to the pre-pandemic curriculum despite current reduced clinical time and increased educational restrictions.

Methods
Medical students participated in a half day simulation event during the second week of their surgery clerkship. The students were divided into socially distanced groups and put through a series of simulation scenarios. The students were divided into 4 groups, allowing two groups to engage in parallel simulations while the other two groups watched remotely with a facilitator, switching after each case. The students observed/participated in two trauma scenarios and four acute abdominal pain scenarios, for a total of 6 scenarios.
NBME shelf scores serve as the most standardized way to evaluate medical student surgical knowledge compared to their peers that took the rotation prior to the pandemic. All medical students are required to take the surgical shelf exam, allowing for comparison of percentile performance based off the national average. This reduces bias based by directly comparing the medical students to their peers at other institutions, who were also impacted by pandemic restrictions.
Results
NBME shelf exam scores were collected from the past five years of the surgery clerkship, amounting to 17 rotations consisting of 395 total learners prior to simulation implementation. At the time of submission, data from 4 rotations with 89 total learners was available. The mean percentile score pre-simulation was 62.4 (±4.45, 95% CI) compared to the simulation group mean 69.5 (±8.61, 95% CI).
As we remain in the same academic year, NBME data and comparison results are forthcoming. Performance metrics on the rest of the medical student class may help to further declare the significance of simulation on surgical education. Anecdotally, medical students report high satisfaction with the simulation activity, improved clinical confidence, and commonly request an expanded version of it with more frequent sessions.

Conclusion
The use of simulated surgical patient cases as a method of educational supplementation does not show inferiority compared to traditional clinical education. Preliminary results show potential improvement on nationalized standardized test after implementation of a simulation curriculum but more data is required to make further conclusions that meet stat significance.

PRESENTING AUTHOR NAME
Nicholas Laconi
PRESENTING AUTHOR EMAIL ADDRESS
Nicholas.Laconi@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 4
SENIOR AUTHOR/MENTOR NAME
Saleem Islam

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Medical Education


Surgery Day Abstract Submission 2021 : Entry # 3401
ABSTRACT TITLE
The Utility of Peers and Trained Raters in Technical Skill-based Assessments: A Generalizability Theory Study
ABSTRACT BODY
Introduction:
The gold standard for evaluation of resident procedural competence is that of validated assessments from faculty surgeons. A provision of adequate trainee assessments is challenged by a shortage of faculty due to increased clinical and administrative responsibilities. We hypothesized that with a well-constructed assessment instrument and training, there would be minimal differences in procedural assessments made by near-peer resident raters (RR), faculty raters (FR), and trained raters (TR).

Methods:
This study was conducted within a private academic institution, using the creation of intestinal anastomoses as the procedural model. De-identified videos of residents performing hand-sewn (HA) and stapled (SA) anastomoses were distributed to blinded reviewers of 3 types (untrained to the assessment [UTA] RR, UTA FR, and trained to assessment raters). Intra-class correlation (ICC) of RR, FR and TR assessments was determined for each procedure. A fully-crossed design was used to examine the internal structure validity in a generalizability study. A Decision study was performed to make projections on the number of raters needed for a g-coefficient >0.70.

Results:
Twenty-nine videos were reviewed (15 HA and 14 SA) by a total of 9 video reviewers (4 RR, 2 FR, and 3 TR). HA ICC values were 0.84(Confidence Interval [CI]:0.81–0.87) for RR, 0.89(CI:0.86-0.92) for FR, and 0.88(CI:0.86-0.90) for TR. SA ICC values were 0.77(CI:0.72-0.80) for RR, 0.79(CI:0.75-0.83) for FR, and 0.86(CI:0.83-0.88) for TR. The g-coefficient was RR=0.72, FR=0.85, and TR=0.77 for HA; and RR=0.33, FR=0.38, and TR=0.4 for SA. The D-study indicated that at least 2 raters of any type were needed for HA and >11 FR for SA.

Conclusions:
Faculty without training have high assessment agreement. Peers for surgical skills assessment is an option for formative evaluation without training. Training to assessment tools should be performed for any assessment, formative or summative, for the optimal evaluation of procedural competence.

PRESENTING AUTHOR NAME
Tiffany Anderson
PRESENTING AUTHOR EMAIL ADDRESS
Tiffany.anderson@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 7 or higher
SENIOR AUTHOR/MENTOR NAME
Yoon Soo Park

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Medical Education


Surgery Day Abstract Submission 2021 : Entry # 3484
ABSTRACT TITLE
Top Factors Influencing Medical Students’ Choice of Specialty
ABSTRACT BODY
Introduction: The selection of career specialty by medical students is multifactorial. Their choice is influenced by the accumulation of all the experiences during students’ medical education, as well as personal preferences. The purpose of this study was to identify significant factors, and to what extent, they contribute to medical students’ career choices, specifically when deciding on surgery as a career. And, if students changed their specialty choice from initial entry into medical school, we sought to find out what influenced the change.
Methods: We conducted a cross-sectional, observational, survey-based study that was exempt by our IRB. A 14-question survey was developed using a modified Delphi technique. This anonymous and voluntary survey was piloted and distributed using Qualtrics to rising fourth year medical students and new graduates at our institution. Survey respondents were posed multiple questions regarding their demographics, background, and the influences of various factors on their career choice. There was an optional free-response portion at the end of the survey. Descriptive statistics were performed on demographics and background information. Likert responses were evaluated through non-parametric analysis (α=0.05).
Results: We had a 24% (69/282) response rate, with respondents having a median age of 26 years. 57% of respondents were female. 39% (27/69) chose to pursue a surgical specialty as defined by the American College of Surgeons; 13% (9/69) chose general surgery. The most influential factors for students whose specialty choice changed during medical school were attending influences (63%), residents (59%), patient interaction(s) (57%), and clarifying specialty misconception(s) (43%). For students who chose surgical specialties, attending (82%) and resident (77%) influences were particularly impactful; all students choosing general surgery cited the influence of residents. For those pursuing general surgery or any surgical specialties, identifying a role model and perceived personality fit with attending and residents were significantly more important than involvement in a research project, training length, and presence of individuals with similar gender identity, family/social demands, race/ethnicity, or financial burdens (p<0.0001). Length of training was significantly less important to respondents pursuing a career in general surgery or any surgical specialties (p<0.05).
Conclusions: Interactions with attending and resident role models and perceived personality fit in the specialty are key drivers in medical students’ specialty choice, particularly for general surgery. Study limitations include sample size bias, respondent bias, question order bias and selection bias, since only students from our institution were surveyed. These results can provide program directors and medical educators with areas to target, in order to enhance future student experiences and recruitment efforts.

PRESENTING AUTHOR NAME
Shengyi Fu
PRESENTING AUTHOR EMAIL ADDRESS
shengyifu@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Janice Taylor MD, MEd, FACS, FAAP

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Medical Education


Surgery Day Abstract Submission 2021 : Entry # 3481
ABSTRACT TITLE
THE IMPACT OF ATTENDINGS AND RESIDENTS ON MEDICAL STUDENT CAREER CHOICE
ABSTRACT BODY
Introduction
The selection of career choice by medical students is influenced by many factors. Experiences during clinical rotations are key to decision-making. During rotations, students receive mentoring and supervision from attending and resident physicians, both of whom may profoundly influence the students’ perception of a specialty. Previous studies demonstrated the influence of attendings and residents on medical students’ career choices, but their respective influence is not yet established. We aimed to determine the extent to which attendings and residents influence medical students’ career choices, specifically regarding general surgery and surgical specialties.

Methods
An IRB-exempt 14-question survey was created using a modified Delphi technique, and piloted prior to distribution. This anonymous, voluntary, web-based survey was sent to rising fourth year medical students and new graduates at our institution. In addition to demographic information, respondents identified differences in the influence of attendings and residents on their career choice. Descriptive statistics were performed on demographics; 5-point Likert responses underwent non-parametric analyses (α = 0.05).

Results
The response rate was 21% (60/282). 57% were female. 43% (26/60) chose a surgical specialty (general surgery (GS), OB/GYN, plastics, orthopedics, neurosurgery, ophthalmology, urology, ENT); 9 students are pursuing GS. Residents and attendings combined had the greatest influence on all career selections (48%), followed by residents-only (28%) and attendings-only (23%); the trend persisted for surgical specialties. Residents were rated to be more supportive and approachable, more encouraging of students to pursue their specialty, involved students more, provided better feedback, and set fairer expectations compared to attendings. Attendings were rated to explain difficult concepts more clearly and had greater knowledge (p < 0.005). Attending (62%) and resident (57%) influence was cited by respondents who chose a different specialty than they intended to pursue when entering medical school. Attending (88%) and resident (100%) influence was cited amongst those changing their intended career to GS, as well as clarified misconceptions of the field (50%). Respondents pursuing GS rated residents more enthusiastic than attendings. GS attendings received more positive ratings for explaining difficult concepts, compared to other attendings.

Conclusions
This study demonstrates that while both attendings and residents are key influencers of medical student career choices, residents hold greater overall influence. Students choosing a career in general surgery and surgical specialties viewed the mentoring skills of residents in higher regard. These findings provide clinical educators with valuable insights to improve student experiences and career recruitment, and to drive institutional culture change regarding the clinical education of students.

PRESENTING AUTHOR NAME
Kevin Hao
PRESENTING AUTHOR EMAIL ADDRESS
khao2016@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Janice Taylor

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Medical Education


Surgery Day Abstract Submission 2021 : Entry # 3721
ABSTRACT TITLE
Experience with Implementing a Beta-Lactam Therapeutic Drug Monitoring Service in a Burn ICU
ABSTRACT BODY
Introduction: Physiologic and metabolic changes from thermal injury complicate pharmacokinetics and make it difficult to predict response to a standard dose of antibiotics. Therapeutic drug monitoring (TDM) has been proposed as a tool to prevent subtherapeutic dosing of antibiotic therapy. Available studies have demonstrated TDM to significantly change empiric daily dosage but there continues to be scarcity of data on TDM in the unique burn patient population. Methods: We conducted a retrospective chart review of BICU patients who received beta-lactam TDM from 2016 to 2019. Inclusion criteria were age ≥18yr, thermal injury, TDM and receiving cefepime, piperacillin/tazobactam, or meropenem for ≥48 hours. Between Feb2016 and Jul2017, our BICU utilized selective TDM to guide therapy with initiation based on pharmacist’s clinical judgement, failure of treatment response, burn size, fluid shifts, polypharmacy, and suspected risk for sub-therapeutic concentrations. From Oct2018 until Jul2019, TDM was expanded to all BICU patients on beta-lactams. Serum concentrations were quantified at the Infectious Disease Pharmacokinetics Laboratory at the University of Florida. The primary endpoint was the achievement therapeutic concentrations, defined as targets of trough-to-MIC ratio [Cmin/MIC] ≥1 and ≥4. Secondary endpoints were clinical cure, culture clearance, new resistance, length of stay (LOS) and 30d mortality. Data was analyzed using JMP® Pro v15.0 (SAS, Inc., Cary, NC) and presented as median and interquartile ranges (IQR’s), compared with Mann-Whitney U test, or counts and percentages, compared with Chi square test. A p-value <0.5 was considered statistically significant. Results: The selective TDM group included 19 patients with 80% men, 43yr median age and 77kg median weight. The median percent burn, LOS, SOFA, and APACHE scores were 22%, 34d, 4, and 12, respectively. The universal TDM group reviewed 23 patients, with 67% men, 57yr median age and 82kg median weight. The median percent burn, LOS, SOFA, and APACHE scores were 25%, 26d, 4, and 18, respectively. In both groups, skin and lung were the most common primary infection sources, with Pseudomonas aeruginosa as the most common species. Patients in the universal cohort were older, with higher APACHE scores. The MIC was reported in 24 and 22 infection episodes for the selective and universal TDM groups, respectively. In the universal TDM cohort there were less days to start TDM (p<0.0001), and more frequent TDM measurements and beta-lactam dose adjustments. More patients in the universal TDM group achieved the PK/PD target of Cmin/MIC ≥1. Positive clinical outcome was reported in 77% and microbial eradication in 82% of all patients. All clinical outcomes were similar between the groups. Conclusions: The implementation of beta-lactam TDM protocol minimized the time to performing TDM, increased the probability of appropriate target attainment, and individualized beta-lactam therapy in BICU patients.

PRESENTING AUTHOR NAME
Pavel Mazirka MD
PRESENTING AUTHOR EMAIL ADDRESS
pavel.mazirka@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 1
SENIOR AUTHOR/MENTOR NAME
Josh Carson MD

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Acute Care/Trauma/Sepsis


Surgery Day Abstract Submission 2021 : Entry # 3398
ABSTRACT TITLE
Lumbar Artery Perforator Flaps: A Systematic Review of Free Tissue Transfers and Anatomical Characteristics
ABSTRACT BODY
Background
The lumbar artery perforator (LAP) flap has gained popularity as a versatile flap in reconstructive surgery; however, few studies have analyzed salient characteristics of this flap. We set out to provide a comprehensive appraisal of free tissue transfers of LAP flaps with specific attention to anatomic features and clinical outcomes.
Methods
Using PRISMA guidelines, we identified clinical, radiographic, and cadaveric studies of LAP flaps and assessed outcomes, complications, and anatomic parameters, such as pedicle length, diameter, location, and course.
Results
A total of 130 articles were initially reviewed of which 16 met final inclusion criteria. 10 studies were primarily concerned with anatomic characteristics and most clinical studies related to breast reconstruction. Partial and total flap loss was estimated at 4% and 11%, respectively. Acute complications related to hematoma (2.9%), arterial thrombus (7.1%), and venous thrombus (18.7%). Donor-site seromas were frequently encountered in breast reconstruction with an incidence of 17-78%.
Conclusion
The LAP flap has demonstrated favorable outcomes in various reconstructive scenarios. The caudal perforators generally offer more pedicle length, greater pedicle diameter, septocutaneous course and may be better suited for flap design. For breast reconstruction, the LAP flap is a useful alternative to abdominal-based flaps, and special attention should be given to methods that minimize seroma formation at the donor-site.

PRESENTING AUTHOR NAME
Peter Vonu
PRESENTING AUTHOR EMAIL ADDRESS
pvonu@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 1
SENIOR AUTHOR/MENTOR NAME
Mark Leyngold

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Burns/Plastic Surgery


Surgery Day Abstract Submission 2021 : Entry # 3478
ABSTRACT TITLE
Characteristics Associated with Salvage of Infected Breast Tissue Expanders
ABSTRACT BODY
Introduction: Breast tissue expander (TE) infections are a vexing problem, leading to delays in definitive reconstruction, poor aesthetic outcomes, and psychological impacts. We sought to determine factors and treatment algorithms associated with successful salvage of infected TE salvage.

Methods: A retrospective review of 174 patients undergoing 281 immediate TE-based breast reconstructions was performed, evaluating potential risk factors for infection. Postoperative antibiotic prophylaxis, onset of infection, microorganisms cultured, use of acellular dermal matrix, mastectomy type/indication, and empiric antimicrobial selection were compared between successful and failed TE salvage.

Results: Fifty-five TE infections (19.6%) occurred in 48 patients. Seventeen (30.9%) were salvaged with antibiotics while 38 (69.1%) required explantation. Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa were the most common microorganisms. TE salvage was less likely among patients who received postoperative antibiotics (OR 0.088, 95% CI 0.0090-0.8593) or had MRSA on culture (p 0.04). Successful salvage was associated with no postoperative antibiotic prophylaxis or antibiotics other than sulfamethoxazole/trimethoprim (23.5% vs 2.6%, p = 0.027). All patients with salvaged TEs completed definitive reconstruction compared to 47.4% among those requiring explantation. Explantation was also associated with delayed definitive reconstruction (p=0.007).

Conclusions: Successful TE salvage was associated with microorganisms other than MRSA whereas postoperative prophylactic antibiotic therapy, particularly TMP-SMX, was associated with a higher rate of explantation. This raises the possibility that antibiotic induced selection of more virulent microorganisms increases risk of failure to salvage tissue expanders. Patients requiring explantation should be counseled regarding definitive reconstruction delay, averaging over a year after explantation.

PRESENTING AUTHOR NAME
Tosan Ehanire
PRESENTING AUTHOR EMAIL ADDRESS
tosan.ehanire@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 6
SENIOR AUTHOR/MENTOR NAME
Bruce Mast

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Burns/Plastic Surgery


Surgery Day Abstract Submission 2021 : Entry # 3622
ABSTRACT TITLE
Outcomes analysis of textured versus smooth tissue expanders in breast reconstruction: A 5-year retrospective review
ABSTRACT BODY
Introduction: Due to concerns regarding the association of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) with textured implants, the use of smooth devices in breast reconstruction, including tissue expanders (TE), has been increasing. Currently there is a paucity of literature evaluating the safety of using smooth TEs in breast reconstruction. This study seeks to compare the safety and outcomes associated with smooth TEs compared to textured TEs in implant-based breast reconstruction.

Methods: A single-institution retrospective review of 394 TE-based breast reconstructions (147 smooth and 247 textured) performed between 2015-2019 was conducted. Patient demographics, co-morbidities, treatment characteristics, complications, and surgical outcomes were evaluated. Data was analyzed using Fisher exact and t-tests.

Results: Patients in whom smooth TEs were used for implant-based breast reconstruction were found to have a higher rate of mastectomy flap necrosis (p = 0.044). No statistically significant difference between the two groups was identified in comparison of patient demographics or other complication rates, including rates of hematoma, seroma, wound dehiscence, delayed wound healing, infection, TE malposition, nipple necrosis, reoperation, readmission, and explantation. Average follow-up was 20.85 months. No cases of BIA-ALCL occurred in either group.

Conclusion: Despite a slightly higher rate of mastectomy flap necrosis with smooth TEs, this study found a similar safety profile in the use of smooth TEs compared to textured TEs in implant-based breast reconstruction along with the additional potential advantage of decreasing the risk of developing BIA-ALCL.

PRESENTING AUTHOR NAME
Jacob Carlson
PRESENTING AUTHOR EMAIL ADDRESS
jacob.carlson@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 7 or higher
SENIOR AUTHOR/MENTOR NAME
Mark Leyngold

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Burns/Plastic Surgery


Surgery Day Abstract Submission 2021 : Entry # 3625
ABSTRACT TITLE
Trends in Plastic Hand Surgery: Evaluation of 182,137 Procedures in the TOPS Database
ABSTRACT BODY
Introduction: Despite making up 20-25% of hand surgeons with subspecialty certification in the field, little data exists characterizing the clinical practice of hand surgery among plastic surgeons. This study sought to evaluate hand surgery cases in the national Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database.

Methods: All hand procedures logged in the TOPS database between 2002 and 2016 were identified by CPT code and/or “upper extremity” anatomic classification. Trends in the total number and types of procedures, facility type, admission type, modes and providers of anesthesia, and patient demographics were reviewed.

Results: A total of 182,137 hand procedures performed on 82,811 patients were logged during the 15-year period reviewed. Sixty-eight percent of procedures were classified as involving soft tissue only, and 22.7% involved only bone and/or joint. The most common procedure categories included: wound closure/coverage (15.8%), debridement/drainage (15.3%), nerve (13.2%), tendon (12.9%), and fracture/dislocation (12.9%). This category breakdown remained relatively stable over time.
Evaluation of longitudinal trends identified an increase over time in procedures performed in the ambulatory and office-based settings and the use of local anesthetic, as well as a transition from the procedural surgeon providing anesthesia to the use of anesthesiologists and nurse anesthetists. The average patient ASA increased from 1.27 to 1.83.

Conclusions: Plastic surgeons play an important role in the field of hand surgery, performing a large breadth of procedure types, which has remained stable over time. The trends in facility type and anesthesia characteristics have, however, varied.

PRESENTING AUTHOR NAME
Mustafa Chopan
PRESENTING AUTHOR EMAIL ADDRESS
mustafa.chopan@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 4
SENIOR AUTHOR/MENTOR NAME
Ellen Satteson

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Burns/Plastic Surgery


Surgery Day Abstract Submission 2021 : Entry # 3619
ABSTRACT TITLE
Objective comparison of donor site morbidity following full and thoracodorsal nerve preserving split latissimus dorsi flaps
ABSTRACT BODY
Introduction:
The latissimus dorsi (LD) flap is a workhorse for reconstruction. However, flap harvest has been variably reported to result in donor site morbidity. The aim of this study was
to compare donor site morbidity following harvest of a split LD flap, preserving the anterior branch of the thoracodorsal nerve, and a traditional nerve sacrificing full LD
flap.

Methods:
Patients who underwent split or full latissimus dorsi flaps between July 2017 and August 2020 at a single center were recalled for assessment. Donor site morbidity in
the shoulder was evaluated through the Disabilities of the Arm, Shoulder, and Hand (DASH) score, Shoulder Pain and Disability Index (SPADI), and American Shoulder
and Elbow Surgeons (ASES) questionnaires. Medical Research Council (MRC) strength grading was also performed.

Results:
A total of 22 patients were recalled in the split LD cohort and 22 patients in the full LD cohort. Patient reported outcomes as assessed through DASH, SPADI and ASES
scores revealed statistically greater ( p <0.05) donor site morbidity associated with the traditional compared to split LD flap. Seven patients in the full LD cohort had less
than MRC grade 5 power at the shoulder while all patients in the split LD cohort demonstrated full power at the shoulder.

Conclusions:
Traditional full LD flaps were found to result in greater donor site morbidity compared to thoracodorsal nerve preserving split LD flaps. Split LD flaps may be beneficial in
preserving donor site function and strength.

PRESENTING AUTHOR NAME
Jonathan Dang
PRESENTING AUTHOR EMAIL ADDRESS
jonathan.dang@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 6
SENIOR AUTHOR/MENTOR NAME
Harvey Chim

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Burns/Plastic Surgery


Surgery Day Abstract Submission 2021 : Entry # 3754
ABSTRACT TITLE
Optimizing Access to Transplantation Through Surgical Downsizing of Donor Lungs
ABSTRACT BODY
Introduction: Due to donor/recipient size matching challenges, lung transplant candidates height may pose a significant disadvantage for receiving a transplant, resulting in longer wait times and increased waitlist mortality. We hypothesize that a proactive approach focused on donor lung size reduction improves access to transplantation with equivalent post-operative outcomes.

Methods: We retrospectively reviewed our experience with transplant candidates listed from Jan 2010 to May 2019. Since January 2016, our program considers surgical downsizing of donor lungs via non-anatomical reduction or lobar transplantation whenever LAS prioritization recommends matching to a shorter stature candidate and downsizing is anatomically feasible. We compared this cohort of patients (recent era) to those from our early era in which size reduction was not proactively performed (Jan 2010- Dec 2015). We excluded pediatric, redo and multiorgan transplants. Our primary endpoint was waitlist mortality or removal due to clinical deterioration. Secondary endpoints were time to transplant and post-operative outcomes.

Results: We included 410 patients with 226 in the early era and 184 in the recent era. Age (mean 54.46 vs 57.87) and LAS (mean 44.73 vs 44.18) were comparable between both groups. Donor characteristics were similar between periods. The number of patients with surgically downsized grafts was significantly higher in the current period compared to the early period (n=62; 34.4% vs n=20; 8.9%; p<0.0001). There was a significant decrease in poor outcomes on the waitlist during the recent period when compared to the early period (2.17% vs 32.48%; p<0.0001). Similarly, wait times were significantly shorter (median 25 days vs 132 days). In the recent period, 30 day mortality, ICU LOS and overall survival were similar between recipients of surgically downsized vs whole lung transplant recipients.

Conclusion: Removal of size restrictions through proactive surgical downsizing improved access to transplantation. Despite more technically demanding, this change in practice has not impacted postoperative outcomes. The significant decreases in waitlist mortality and wait times suggest that this approach is able to address a significant disparity in our field.

PRESENTING AUTHOR NAME
Eric Pruitt
PRESENTING AUTHOR EMAIL ADDRESS
Eric.pruitt@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 5
SENIOR AUTHOR/MENTOR NAME
Thiago Machuca

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Thoracic/Cardiac


Surgery Day Abstract Submission 2021 : Entry # 3784
ABSTRACT TITLE
Lobar Lung Transplantation Outcomes At A High Volume Single Center
ABSTRACT BODY
Objectives: Lung transplant candidates can often have a size mismatch with potential donor candidates limiting their donor pool. Performing a lobar lung transplant is an option to downsize donor lungs, but there is a fear of patient complications with this approach. We sought to determine if our lobar transplant patients had similar outcomes to our non-lobar transplants.
Methods: The study included all patients receiving a double lung transplant from 12/2015 to 11/2019 excluding redo, pediatric, and other lung volume reduction surgery. Our primary endpoints were 30 day and 1 year mortality with secondary endpoints including percent predicted FEV1 at 1, 3, and 6 months and time on ventilator.
Results: The study included 132 non-lobar double lung transplants and 21 lobar double lung transplants. The patient groups had similar characteristics except the lobar transplants had a shorter height (average 163 vs 170 cm; p = 0.004) and decreased predicted TLC (5.35 vs 6.15 L; p = 0.005). Lobar transplants had a higher use of intraoperative ECMO (100% vs 76%; p = 0.008) and post-operative ECMO (38% vs 14%; p = 0.011). No difference was found in the primary endpoints of 30 day mortality (0% vs 2%; p = 1) and 1 year mortality (5% vs 5%; p = 1). The percent predicted FEV1 was decreased in lobar transplants at 3 months (average 66.5 vs 79.2; p =0.004) and 6 months (average 70.8 vs 80.5; p = 0.049). The postoperative time on the ventilator was increased in lobar transplants (median 23 vs 17 hours; p = 0.044). Our lobar transplants did have 3 incidences of bronchial anastomotic strictures which all resolved after balloon dilation.
Conclusion: In this single center retrospective review, the lobar transplant group had equivalent post-transplant survival at 30 days and 1 year. Lobar transplants did have more post-operative time on the ventilator and decreased FEV1 at 3 and 6 months.

PRESENTING AUTHOR NAME
Michael Gerber
PRESENTING AUTHOR EMAIL ADDRESS
Michael.Gerber@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 7 or higher
SENIOR AUTHOR/MENTOR NAME
Tiago Machuca

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Thoracic/Cardiac


Surgery Day Abstract Submission 2021 : Entry # 3520
ABSTRACT TITLE
Comparison of Monitored Anesthesia Care versus General Anesthesia for Transcatheter Aortic Valve Replacement
ABSTRACT BODY
Background: Monitored Anesthesia Care (MAC) has been increasingly used in lieu of general anesthesia (GA) for transcatheter aortic valve replacement (TAVR). We sought to compare outcomes and in-hospital costs between MAC and GA TAVR at one of the highest cardiac volume Veterans Affairs Medical Centers in the United States.
Methods: A single-center retrospective review of 349 patients who underwent TAVR (MAC, n = 244 vs. GA, n = 105) from October 2013 to December 2019 was performed. Propensity matching was utilized, and resulted in 83 matched groups. Baseline patient characteristics, operating room (OR) time, intensive care unit (ICU) length of stay (LOS) and cost, total LOS, hospital cost, total cost, and complication rates were collected.
Results: In the complete TAVR cohort, MAC TAVR was associated with shorter OR time (146 vs. 198 minutes P < .0001), ICU LOS (1.4 vs. 1.8 days, P < 0.0001), total hospital LOS (3.4 vs. 5.4 days, P < .0001), and lower index total cost ($81,3000 vs. $85,400, P = .010). In the propensity matched groups, MAC TAVR patients had shorter OR time (146 vs 196 minutes, p <0.05), reduced ICU LOS (1.2 vs. 1.7, P = .006) and total LOS (3.5 vs. 5.1, P = .001), and decreased 180-day mortality (2.4% vs 12%, p <0.03), but no difference in total hospitalization cost or total cost.
Conclusions: In propensity matched groups, TAVR utilizing MAC is associated with improved OR time efficiency, decreased LOS, and a reduction in 180-mortality, but no significant difference in cost.

PRESENTING AUTHOR NAME
Reed Holmes
PRESENTING AUTHOR EMAIL ADDRESS
henryholmes@ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Medical Student
SENIOR AUTHOR/MENTOR NAME
Eric Jeng MD, MBA

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Thoracic/Cardiac


Surgery Day Abstract Submission 2021 : Entry # 3407
-ABSTRACT TITLE
Deep Hypothermic Circulatory Arrest in Open Left Chest Aortic Aneurysm Repair
ABSTRACT BODY
Introduction:
Deep hypothermic circulatory arrest (DHCA) is often required for patients undergoing repair of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) via left thoracotomy when proximal cross clamping is not feasible or when aneurysmal disease extends into the transverse aortic arch. Historical literature suggests higher complications rates due to the technical complexity of this approach; we examined outcomes with this approach at our center.

Methods:
Between January 2008 to May 2018, eighty-four patients with DTAA or Crawford extent I TAAA underwent open repair. DHCA was employed in 46 of 84 (55%) patients, of which 33 (72%) required repair of distal arch and DTAA, and 13 (28%) required repair of the distal arch and extent I TAAA. Patients who underwent DHCA had more chronic dissections than those in the non-DHCA group (70% vs. 34%, P = < .05).

Results:
Major adverse outcomes for the DHCA group vs. non-DHCA group were as follows: early mortality 3/46 (7%) vs. 4/38 (11%) (P = .70), stroke 3/46 (7%) vs. 1/38 (3%) (P = .62), permanent spinal cord deficit 2/46 (4%) vs. 3/38 (8%) (P = .65), permanent renal failure necessitating dialysis 1/46 (2%) vs. 2/38 (5%) (P = .59). Freedom from major adverse outcomes was 38/46 (83%) vs. 31/38 (82%) for DHCA vs. non-DHCA (P = 1).

Conclusions:
DHCA can be employed via left thoracotomy for combined arch and descending thoracic or extent I thoracoabdominal aortic aneurysm open repair.

PRESENTING AUTHOR NAME
Matheus Falasa
PRESENTING AUTHOR EMAIL ADDRESS
matheus.falasa@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 5
SENIOR AUTHOR/MENTOR NAME
Thomas Beaver

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Thoracic/Cardiac


Surgery Day Abstract Submission 2021 : Entry # 3862
ABSTRACT TITLE
Outcomes of EVAR Conversion in Geriatric Patients Treated at A High-Volume Aorta Center
ABSTRACT BODY
Introduction: Endovascular aortic aneurysm repair(EVAR) is the dominant treatment strategy for infrarenal AAA in geriatric patients. Correspondingly, EVAR failure resulting in subsequent open conversion(EVAR-c) has increased in older patients but there is a paucity of literature focusing on outcomes in this group. The purpose of this analysis was to evaluate our experience with EVAR-c in geriatric patients.

Methods: Retrospective review of all non-mycotic EVAR-c procedures(2002-2019) at a single high-volume academic hospital with a dedicated aorta center(https://www.uf-health-aortic-disease-center) was performed. EVAR-c patients(n=158) were categorized into geriatric(≥80y;n=43) and non-geriatric(<80y;n=115) cohorts. The primary end-point was 30-day mortality. Secondary end-points included complications, readmission, 90-day mortality, re-intervention, and overall survival. Cox regression estimated effect of covariates on mortality risk. Kaplan-Meier methodology estimated survival.

Results: No difference in pre-admission EVAR re-intervention rates was present(42% vs. 42%;p=1) although time to first re-intervention was greater in geriatric patients(41 vs. 15-months;p=.01). Concordantly, time to EVAR-c was longer(61 vs. 39-months;p<.01). No difference in rupture presentation with EVAR-c was evident(14% vs. 10%;p=.58); however, elective repair occurred less frequently(geriatric-42% vs. non-geriatric-59%;p=.07). AAA diameter was significantly larger for elective geriatric EVAR-c(7.8±1.9mm vs. 7.0±1.5mm;p=.02) and type 1a endoleak was the most common indication overall(58%;n=91).
The overall 30-day mortality rate was higher for geriatric patients(age ≥80, 14% vs. age <80, 7%) but was not statistically significant(p=.21). Similarly, a trend towards higher 90-day mortality was identified for geriatric patients(23% vs. 10%;p=.07). However, incidence of any complication(56% vs 49%;p=.48), readmission(12% vs 6%;p=.32), unplanned re-intervention(10% vs 5%;p=0.5) and LOS(11 vs. 9 days;p=.34) was not different. Age ≥80 was not predictive of short-term survival; however, increasing comorbidity number, non-elective admission and renal/mesenteric revascularization increased 1-year mortality risk(Table). One and three year survival was not significantly different(Figure).

Conclusion: Although a non-significant trend in higher peri-operative mortality occurred among geriatric patients, overall outcomes were comparable to younger EVAR-c subjects when treated at a high-volume aortic surgery center. This underscores the importance of appropriate patient selection and modulation of operative complexity when possible to achieve optimal results. Providers caring for geriatric patients with EVAR failure should consider timely elective referral to high-volume aorta centers to reduce resource utilization and frequency of non-elective presentation.

PRESENTING AUTHOR NAME
Chris Jacobs
PRESENTING AUTHOR EMAIL ADDRESS
christopher.jacobs@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 5
SENIOR AUTHOR/MENTOR NAME
Thomas Huber

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Vascular


Surgery Day Abstract Submission 2021 : Entry # 3416
ABSTRACT TITLE
Alive and Kicking: Cerebrospinal Fluid Drain Usage in 1016 TEVARs at a Tertiary Aortic Center
ABSTRACT BODY
Introduction
Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) is associated with permanent neurologic deficit and decreased long-term survival. The use of cerebrospinal fluid drains (CSFD) in TEVAR for SCI prevention is controversial due to perceived risk of CSFD complications. We evaluated the usage patterns and safety of CSFD in TEVAR at a tertiary aortic center.

Methods
Our institutional TEVAR database was reviewed to determine the frequency of CSFD usage and CSFD complications. Complications were categorized as mild (catheter malfunction, CSF leak not requiring intervention, insertion site pain, bloody CSF, urinary retention), moderate (CSF leak requiring intervention, spinal headache), or severe (intracranial hemorrhage [ICH], epidural hematoma [EDH], neurologic deficit). The relationships between CSFD complications and patient comorbidities, timing of CSFD placement, procedure characteristics/ urgency, and survival were analyzed.

Results
1016 TEVAR procedures were performed in 863 patients between October 2011 and March 2020. 399 CSFDs were placed in 399 (39.3%) TEVAR patients by a dedicated anesthesia team per center criteria. The majority of CSFDs (88.2%) were placed pre-implant. Post-implant drains were most commonly placed for new neurologic symptoms (n=28, 7.0%) vs. SCI prophylaxis (n=19, 4.8%). 26 patients (5.9%) suffered 32 CSFD complications. The majority (n=16, 64%) were moderate in severity (spinal headache +/- CSF leak for all). Severe CSFD complications occurred in only 4 patients (0.9% of overall cohort). 3 were confirmed (n=1) or suspected (n=2) EDH; none caused any permanent deficit. The fourth patient had a history of cirrhosis/ thrombocytopenia and was diagnosed with a large ICH on POD1 and died during the same hospitalization.

CSFD complications were not associated with any patient or procedural characteristics, including age/ sex/ comorbidities, left subclavian artery coverage, and elective vs. non-elective procedures. Post-implant CSFD placement for new neurologic symptoms carried significantly increased risk of CSFD complication (OR 4.8 [95% CI 1.42-14.0, P=0.006]) compared to those receiving prophylactic CSFD pre- or post-implant. The long-term survival of the cohort of patients with CSFD complications did not differ from the overall population (Figure).

Conclusions
CSFD placement by a dedicated team resulted in a very low complication rate in our large TEVAR series. Complications were not associated with any patient/ procedural characteristic, including urgency of index procedure. Post-implant CSFD placement for new deficit was associated with greater risk of CSFD complications. Prophylactic CSFD carries minimal risk of severe complications and should be considered for appropriately selected patients, especially those at greater risk for postoperative SCI to avoid the need for emergent CSFD placement.

PRESENTING AUTHOR NAME
John Spratt MD
PRESENTING AUTHOR EMAIL ADDRESS
john.spratt@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 7 or higher
SENIOR AUTHOR/MENTOR NAME
Thomas Beaver MD

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Thoracic/Cardiac


Surgery Day Abstract Submission 2021 : Entry # 3844
ABSTRACT TITLE
Implications of Re-intervention after Endovascular and Open Bypass Revascularization
for Chronic Mesenteric Ischemia
ABSTRACT BODY
Introduction: Endovascular revascularization has increasingly supplanted open mesenteric bypass(OMB) to treat chronic mesenteric ischemia(CMI). Short-term benefits of endovascular intervention are well-described; however, concerns regarding durability and implications of re-intervention on survival remain poorly understood. Little is known about the type, magnitude and subsequent outcomes of re-intervention after endovascular revascularization for CMI. The purpose of this analysis was to review our experience with re-intervention after endovascular revascularization compared to re-intervention after OMB revascularization for CMI.

Methods: A single center retrospective analysis was performed on all CMI patients undergoing OMB or Endo interventions from 2010-2018. Primary end-point was freedom from re-intervention. Secondary end-points included complications after re-intervention and survival. Kaplan-Meier methods were used to estimate freedom from secondary end-points.

Results: 116 CMI patients(OMB-61%[n=71], Endo-39%[n=45]) were reviewed. The two cohorts were similarly matched in demographics and comorbidities. OMB vessels revascularized at index operation were as follows: SMA-16%(n=11), SMA+Celiac-83%(n=59), and SMA+IMA-11%(n=1). Endovascular revascularization included: SMA Stent-49%(n=19), SMA Angioplasty alone-11%(n=5), and SMA+Celiac stenting-40%(n=16).
In the OMB subgroup, 6%(n=4) underwent re-intervention compared to 24%(n=11) in the endovascular cohort(P=0.005). For OMB re-intervention, 3 had open reconstructions(100% emergent;100% developed a complication) while the remaining patient received an endovascular re-intervention(urgent; no complication). Re-intervention after an index Endo procedure resulted in a higher rate of repeat endovascular remediation and elective presentation[6-Endo re-intervention(100%-elective, no complications); 5 converted to OMB(60%-elective;no complications)].
Median survival of OMB patients who underwent re-intervention was significantly lower than Endo patients who did: OMB-11 months vs. Endo-48 months(Wilcoxon rank-sum P=.03). There was no difference in overall survival among all CMI patients; however freedom from any re-intervention was significantly less for Endo patients(log-rank P=.01).

Conclusion: Re-intervention after endovascular revascularization for CMI is significantly different compared to OMB. Specifically, patients are more likely to present electively and undergo a subsequent endovascular procedure. The complexity and magnitude of re-intervention after OMB is underscored by lower long-term survival compared to endovascular patients undergoing re-intervention. Though an ‘endo first’ approach may have lower overall durability and likely mandates different surveillance strategies compared to OMB, the magnitude, perioperative risk and implications of re-intervention on long-term survival appear to support this approach in all anatomically suitable patients.

PRESENTING AUTHOR NAME
Kathleen Ehresmann
PRESENTING AUTHOR EMAIL ADDRESS
kathleen.ehresmann@surgery.ufl.edu
PRESENTING AUTHOR ACADEMIC RANK
Surgery Resident
Post-Graduate Year (PGY) – for Surgery Residents Only
PGY 1
SENIOR AUTHOR/MENTOR NAME
Salvatore Scali

RESEARCH CATEGORY
Clinical/Translational
RESEARCH DISCIPLINE
Vascular


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