P-BN41 Does performing percutaneous cholecystostomy in patients at risk of sepsis have better outcomes than patients in sepsis?

Abstract Background Gallstone related diseases account for almost one-third of acute surgical admissions with presentation varying from biliary colic to sepsis. There were various studies evaluating the role of ‘percutaneous cholecystostomy’ (PC) as part of the management in acute cholecystitis under ‘radiological guidance’ (RG). However, limited literature is conducted to evaluate patients’ outcomes based on the indication and optimal timing of cholecystostomy. Therefore, this study was set up to assess the difference in clinical outcome between the patients undergoing cholecystectomy with overt sepsis (OS) and impending sepsis (IS). Methods A retrospective observational study was conducted using a prospective database on patients who underwent PC under RG between 03/2014-03/2021. NICE’s sepsis risk stratification tool was used to divide patients into OS and IS groups. OS group included patients with 1 or > 1 high-risk criteria. IS group included patients with 2 or > 2 moderate to high-risk criteria. The primary outcomes are 30-day mortality and the ‘length of stay’ (LoS) and secondary outcome include post-procedural ‘bile leak’ (BL).Continuous and categorical variables were analysed using Mann-Whitney U and Chi-squared tests respectively. A p-value of < 0.05 was considered to be statistically significant. Results Some 27 patients were included. The median age was 80 (range 61-90).The majority of the patients (77.78%, n = 21) were unfit for surgery, with a Charlson Comorbidity Index ranging of 3 to 12. The median length of hospital stay of the OS and IS groups were 17 and 15 days respectively (p = 0.47).There was no significant difference in bile leak (IS-1/20 vs OS-0/7; p = 0.56) and drain accidents (IS-8/20 vs OS-1/7;p=0.35).Overall two patients in the IS group underwent an uncomplicated interval cholecystectomy. The 30-day mortality rate was significantly higher in OS (IS 0/20 vs OS-4/7; p = 0.00039). Conclusions Percutaneous cholecystostomy is generally safe to be performed irrespective of patients’ co-morbidities and has no significant long-term complications associated with mortality. Early cholecystostomy before overt sepsis results in a reduced 30-day mortality rate and better outcome. Further clinical studies may be required to determine specific patient groups who would benefit from percutaneous cholecystostomy.

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Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

BMJ Open ◽

10.1136/bmjopen-2020-040817 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040817

Author(s):

Patrick O'Byrne ◽

Amanda Vandyk ◽

Lauren Orser ◽

Marlene Haines

Keyword(s):

Public Health ◽

Cohort Study ◽

High Risk ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Secondary Outcome ◽

Bivariate Analysis ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Risk Criteria

ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

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Rethinking the Definition of High Risk in Pediatric Salivary Gland Carcinoma

Otolaryngology ◽

10.1177/01945998211020301 ◽

2021 ◽

pp. 019459982110203

Author(s):

Sahaja Acharya ◽

Rebecca N. Sinard ◽

Gustavo Rangel ◽

Jeffrey C. Rastatter ◽

Anthony Sheyn

Keyword(s):

Salivary Gland ◽

Young Adult ◽

High Risk ◽

Pediatric Patients ◽

Risk Groups ◽

Adjuvant Radiation ◽

Salivary Gland Carcinoma ◽

Risk Criteria ◽

Significant Difference ◽

Gland Carcinoma

Objective Indications for adjuvant radiation in pediatric salivary gland carcinoma rely on high-risk criteria extrapolated from adult data. We sought to determine whether adult-derived high-risk criteria were prognostic in children aged ≤21 years or young adults aged 22 to 39 years. Study Design Cross-sectional analysis of a hospital-based national registry. Setting Patients were identified from the National Cancer Database between 2004 and 2015. Methods High-risk criteria were defined as adenoid cystic histology, intermediate/high grade, T3/T4, positive margins, and/or lymph node involvement. Exact matching was used to adjust for differences in baseline characteristics between pediatric and young adult patients. Results We identified 215 pediatric patients aged ≤21 years, 317 patients aged 22 to 30 years, and 466 patients aged 31 to 39 years. Within the pediatric cohort, there was no significant difference in overall survival (OS) between low- and high-risk groups (5-year OS, 100% vs 98.5%; P = .29). In contrast, within the young adult cohorts, there was a significant difference in OS between low- and high-risk groups in patients aged 22 to 30 years (5-year OS, 100% vs 96.1%; P = .01) and 31 to 39 years (5-year OS, 100% vs 88.5%; P < .001). When high-risk patients were matched 1:1 on high-risk criteria and race, pediatric patients were associated with better OS than those aged 22 to 30 years ( P = .044) and those aged 31 to 39 years ( P = .005). Conclusion Children have excellent OS, irrespective of adult-derived high-risk status. These findings underscore the need to understand how age modifies clinicopathologic risk factors.

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Demographics and Outcomes of Multiple Myeloma Patients Undergoing Modern Modality Treatments Proceeding to ASCT: A Retrospective Study

Blood ◽

10.1182/blood-2021-154070 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4743-4743

Author(s):

Shubham Adroja ◽

Arslan Babar ◽

Muhammad Ali ◽

Gauranga Mahalwar ◽

Taeyeong Ko ◽

...

Keyword(s):

Multiple Myeloma ◽

High Risk ◽

Research Funding ◽

Categorical Variables ◽

Risk Category ◽

Line Treatment ◽

Second Line ◽

Significant Difference ◽

Before And After ◽

Risk Categories

Abstract Introduction: Multiple myeloma accounts for 1% of all cancers and approximately 10% of all hematologic malignancies. With the advent of novel therapies for multiple myeloma and emerging data from randomized trials, there has been a substantial improvement and favorable outcomes in survival. Here, we report demographics and outcomes in a cohort of patients who underwent Autologous Stem Cell Transplant (ASCT) over the past year. Methods: In this retrospective, cohort study, we assessed all MM patients who received ASCT from January 1, 2020, to January 15, 2021, at Cleveland Clinic, and followed until July 31, 2021. Baseline demographics, ECOG performance status, ISS stage, cytogenetic risk category, therapy received before ASCT, maintenance therapy, time to first relapse/progression, time to next treatment (TTNT; 2nd line of treatment onwards) with treatment response (defined per IMWG response criteria) before and after ASCT were obtained by review of electronic medical records. All patients received HDCT Melphalan 140 mg/m2 or 200 mg/m2 prior to ASCT. Continuous variables were presented as median and interquartile range, while categorical variables were presented as numbers and percentages. Categorical variables were compared using the chi-square test. Results: Of 81 MM patients who underwent ASCT, 59% were males, 84% were white, with a median age of 62 (IQR: 57-67) at the time of diagnosis. 42 (52%) and 24 (30%) patients belonged to the standard and high-risk category. Amongst high-risk cytogenetic abnormalities, +1q was the most common (72%) followed by del(17p) (28%). Baseline characteristics of patients are included in Table 1.1. Lenalidomide, bortezomib, and dexamethasone (VRd) regimen was the most common (75%) first-line induction regimen used, followed by Daratumumab-based regimens (20%). 10 (12%) patients required second-line treatment, and 6 (7%) patients required more than 2 lines of treatments prior to transplant. The median time to transplant was 6.5 months. The overall response rate (ORR) prior to transplant was 99% (21% complete (CR), 40% very good partial (VGPR), and 38% partial (PR)). The ORR post-ASCT was 78% (CR 27%, VGPR 37%, PR 14%). There was no significant difference in response between risk categories after transplant (P=0.72). At 1-year follow-up, 10 (12%) patients had relapsed and 7 (9%) patients had progression of the disease. 3 (4%) patients died of progressive MM, one of which had progressed to plasma cell leukemia. Response to treatment before and after the ASCT are summarized in Table 1.2 and Figure 1. The time to second-line treatment among patients with relapse/progression was 7 months [IQR: 3.75-10.25]. Conclusion: Here we report the demographics and outcomes of patients with MM undergoing modern modality treatments and ASCT, at our center over the last year. The median time to transplant was 6.5 months after induction therapy, and the ORR post-ASCT was 78%. No significant difference in response was observed between high and standard risk categories. No transplant-related mortality was observed as well. Figure 1 Figure 1. Disclosures Anwer: Allogene Therapeutics: Research Funding; Janssen pharmaceutical: Honoraria, Research Funding; BMS / Celgene: Honoraria, Research Funding; GlaxoSmithKline: Research Funding.

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Relationship between Hospital Volume and Inpatient Mortality Among Patients Diagnosed with Thrombotic Thrombocytopenic Purpura (TTP) in the United States

Blood ◽

10.1182/blood.v130.suppl_1.675.675 ◽

2017 ◽

Vol 130 (Suppl_1) ◽

pp. 675-675

Author(s):

Smith Giri ◽

Ranjan Pathak ◽

Robert Franklin ◽

Nikolai A. Podoltsev ◽

Scott Huntington ◽

...

Keyword(s):

Mortality Rate ◽

Thrombotic Thrombocytopenic Purpura ◽

Hospital Volume ◽

The United States ◽

Secondary Outcome ◽

P Value ◽

Inpatient Mortality ◽

Thrombocytopenic Purpura ◽

Significant Difference ◽

The Mean

Abstract Introduction: Thrombotic Thrombocytopenic Purpura (TTP) is a hematological emergency with high inpatient mortality that requires prompt diagnosis and treatment. Studies outside the setting of hematologic emergencies have established hospital volume as a factor associated with clinical outcomes. We tested whether hospital volume was associated with important inpatient outcomes among patients with TTP Methods: We utilized the Nationwide Inpatient Sample (NIS) to identify adult patients ≥18 years, diagnosed with TTP using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 446.6 from the years of 2010 to 2013. We only included patients who received therapeutic plasmapheresis (ICD-9-CM procedure code 99.71) during hospitalization to capture active cases of TTP and improve coding accuracy. Using unique hospital identifier, hospital volume was computed and defined as total hospitalizations for TTP per year. Hospital volume was then divided into four quartiles. The primary outcome of interest was inpatient mortality rate, with time to initiation of plasmapheresis as our secondary outcome. Baseline age, gender, race, demographics, insurance payer, hospital region, hospital type (rural versus urban, teaching versus non-teaching), and bed size were collected. All analyses were survey adjusted to account for the complex sampling nature of the database. Appropriate bivariate methods included ANOVA and tests of trend (nptrend). Mixed effects hierarchical logistic regression analysis was used to calculate adjusted odds ratio of in-hospital mortality adjusting for potential confounders at the patient level (age, race, comorbidity, gender, insurance status) and at the hospital level (hospital location, bedsize and teaching status). All p values were two sided and the level of significance was chose was 0.05. Results: A total of 1128 unique hospitalizations for TTP were identified during the study period. The mean age was 46.3 ± 16.6 years, out of which 66% were females (n=754) and 44% were whites (n=458). The overall inpatient mortality rate was 10.9%. The distribution of hospital volume by quartiles was as follows; 1st quartile, Q1 (2 or less hospitalizations of TTP per year), 2nd quartile, Q2 (3-5/year), 3rd quartile, Q3, (6-11/year), 4th quartile, Q4 (12 and above). The mean length of stay was 14.4 ± 11.5 days and the mean cost of hospitalization was $ 177546 ± 7736. Overall there was decreasing trend in inpatient mortality with increasing hospital volumes (14.4% vs 12.8% vs 9.8% vs 6.5% from Q1-Q4 respectively; p trend 0.002). This effect was also retained in multivariate analysis adjusting for potential confounders (aOR 0.50; 95% CI 0.26-0.98; p 0.04) (Table 1). Also there was a decreasing trend in the time to plasmapheresis with increasing hospital volume (3.02 vs 2.48 vs 2.27 vs 2.09 from Q1-Q4 respectively, ANOVA p value 0.04) with post hoc analysis significant difference between 4th versus 1st quartile (Tukey p value 0.04). Conclusion: In this retrospective cohort study using a large US inpatient database, we identified a significant association between hospital volume and inpatient mortality. Furthermore, plasmapheresis was initiated earlier in the hospital course at higher volume hospitals and provides a potential mechanism for the survival improvement. Disclosures Podoltsev: Ariad: Consultancy; Incyte: Consultancy; Alexion: Consultancy; CTI biopharma/Baxalta: Consultancy. Huntington: Janssen: Consultancy; Pharmacyclics: Honoraria; Celgene: Consultancy, Other: Travel. Zeidan: AbbVie, Otsuka, Pfizer, Gilead, Celgene, Ariad, Incyte: Consultancy, Honoraria; Takeda: Speakers Bureau; Otsuka: Consultancy.

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Mortality of acute promyelocytic leukemia in a rural tertiary care center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18529 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18529-e18529

Author(s):

Joseph Vadakara ◽

Prakash Kharel ◽

Prianka Bhattacharya ◽

Erin Vanenkevort ◽

Jesse Manikowski

Keyword(s):

High Risk ◽

Mortality Rate ◽

Acute Promyelocytic Leukemia ◽

Care Center ◽

Tertiary Care ◽

Age Groups ◽

Promyelocytic Leukemia ◽

Early Mortality ◽

Number Of Patients ◽

Significant Difference

e18529 Background: Acute promyelocytic leukemia (APL) has a very good prognosis when diagnosed and treated promptly. Despite the excellent prognosis, early mortality remains high, ranging 17-40%. Geisinger Health System (GHS) has provided treatment for a significant number of APL patients, but mortality of APL at GHS has not been studied. We conducted a study to assess early mortality related to APL in GHS. Methods: Retrospective analysis was performed of patients diagnosed with APL from January 1988 to February 2019, determining the number of patients diagnosed and treated for APL in GHS, overall 30-day mortality rate, stratified by risk group (low, intermediate, high based on presenting white blood cell and platelet counts) and age above or below 55. Results: A total of 61 patients with APL were identified. Average age at diagnosis was 44.77 years (SD = 19.12). The death rates in patients in whom risk data was available was 7%, 9.3% and 11.6% respectively in the low, intermediate and high risk groups respectively. There was no statistically significant difference in the frequency distribution between risk categories for survival, χ2 = 1.03, p = .60. Between age groups, 8.3% of patients under age 55 died, whereas 18.3% of those 55 or older died. Survival between the two age groups was statistically significant, χ2 = 10.92, p = .001. Estimated 30-day overall mortality in the studied population was 16.39%; and 7.69%, 5.56% and 38.46% for the low, intermediate, high-risk patients respectively. Conclusions: Among patients diagnosed with APL in the GHS over the past 30 years, the early mortality rate has been comparable to reported mortality rates in centers around the world. Our study showed a statistically significant higher mortality rate in patients 55 years or older. Further study is planned to assess factors contributing to mortality and outcomes.

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Biceps Tenodesis versus Tenotomy at the Time of Manipulation and Lysis of Adhesions for Adhesive Capsulitis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00389 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0038

Author(s):

Jourdan M. Cancienne ◽

James E. Christensen ◽

David R. Diduch ◽

Stephen F. Brockmeier ◽

Brian C. Werner

Keyword(s):

Outcome Measure ◽

Adhesive Capsulitis ◽

Secondary Outcome ◽

Categorical Variables ◽

Secondary Outcome Measure ◽

Biceps Tenodesis ◽

Biceps Tenotomy ◽

Increased Risk ◽

Significant Difference ◽

Chi Square Analysis

Objectives: Although rare in the treatment of adhesive capsulitis, arthroscopic lysis of adhesions and manipulation under anesthesia (LOA/MUA) may be necessary if the patient fails conservative therapy. Patients at the time of surgery often have biceps tendon, superior labrum anterior to posterior (SLAP) pathology, or other pathology requiring concurrent treatment. Common treatments for these can include biceps tenodesis or tenotomy. Some surgeons believe that concomitant repairs at the time of LOA/MUA can cause increased stiffness post-operatively due to need for immobilization or protection, possibly leading to poorer outcomes and potentially needing further interventions such as repeat injections or repeat LOA/MUA. The goal of this study was to compare patients who underwent LOA/MUA with biceps tenodesis to those who underwent LOA/MUA with biceps tenotomy. We hypothesized that biceps tenodesis at the time of LOA/MUA did not lead to an increased risk for further intervention in the form of post-operative injections for pain or stiffness or repeat LOA/MUA compared to biceps tenotomy. Methods: A retrospective review of consecutive LOA/MUA for adhesive capsulitis performed by 5 surgeons at a single center from 2010-2016 was performed. All included patients were required to have a minimum of 1 year of follow-up, and be a minimum 2 years post-procedure. Exclusion criteria included prior biceps tenodesis, surgery within six months prior to LOA/MUA, prior infection, prior shoulder fracture or fracture fixation, and concomitant rotator cuff repair. Patients without any biceps surgery (tenotomy or tenodesis) were also excluded. The primary outcome measure was a postoperative injection in the ipsilateral shoulder for recurrent adhesive capsulitis, pain or residual stiffness. The secondary outcome measure was a repeat LOA/MUA. Statistical analysis was completed in SPSS using a chi-square analysis for categorical variables and a student’s t-test for continuous variables. Results: Fifty-five patients were included in the study. Thirty-three patients underwent biceps tenotomy, and 22 patients underwent biceps tenodesis at the time of arthroscopic LOA/MUA. The average age in the tenotomy group was 53 years and 47 years in the tenodesis group (p = 0.383). There was no significant difference in the percentage of males in the tenodesis group (59%) versus tenotomy (48%) (p = 0.440). Average body mass index (BMI) was not significantly different between the two groups (p = 0.329). No patients from either group underwent repeat LOA/MUA. Of those patients who received a biceps tenotomy, 39% had an injection for pain or stiffness post-operatively compared to 18% for biceps tenodesis, which was not significant (p=0.17). Table 1 summarizes the outcomes in both groups. Conclusion: Patients who underwent biceps tenodesis with concurrent arthroscopic LOA/MUA for adhesive capsulitis did not have a higher rate of postoperative injections or repeat LOA/MUA compared to patients who underwent biceps tenotomy at the time of LOA/MUA. [Table: see text]

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SWOG S0221: A Phase III Trial Comparing Chemotherapy Schedules in High-Risk Early-Stage Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2014.56.3296 ◽

2015 ◽

Vol 33 (1) ◽

pp. 58-64 ◽

Cited By ~ 53

Author(s):

George T. Budd ◽

William E. Barlow ◽

Halle C.F. Moore ◽

Timothy J. Hobday ◽

James A. Stewart ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Hormone Receptor ◽

Early Stage ◽

Disease Free Survival ◽

Early Stage Breast Cancer ◽

Phase Iii ◽

Secondary Outcome ◽

Original Design ◽

Significant Difference

Purpose To determine the optimal dose and schedule of anthracycline and taxane administration as adjuvant therapy for early-stage breast cancer. Patients and Methods A 2 × 2 factorial design was used to test two hypotheses: (1) that a novel continuous schedule of doxorubicin-cyclophosphamide was superior to six cycles of doxorubicin-cyclophosphamide once every 2 weeks and (2) that paclitaxel once per week was superior to six cycles of paclitaxel once every 2 weeks in patients with node-positive or high-risk node-negative early-stage breast cancer. With 3,250 patients, a disease-free survival (DFS) hazard ratio of 0.82 for each randomization could be detected with 90% power with two-sided α = .05. Overall survival (OS) was a secondary outcome. Results Interim analyses crossed the futility boundaries for demonstrating superiority of both once-per-week regimens and once-every-2-weeks regimens. After a median follow-up of 6 years, a significant interaction developed between the two randomization factors (DFS P = .024; OS P = .010) in the 2,716 patients randomly assigned in the original design, which precluded interpretation of the two factors separately. Comparing all four arms showed a significant difference in OS (P = .040) but not in DFS (P = .11), with all treatments given once every 2 weeks associated with the highest OS. This difference in OS seemed confined to patients with hormone receptor–negative/human epidermal growth factor receptor 2 (HER2) –negative tumors (P = .067), with no differences seen with hormone receptor–positive/HER2-negative (P = .90) or HER2-positive tumors (P = .40). Conclusion Patients achieved a similar DFS with any of these regimens. Subset analysis suggests the hypothesis that once-every-2-weeks dosing may be best for patients with hormone receptor–negative/HER2-negative tumors.

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Postoperative concurrent chemoradiation (CCRT) for non-squamous cell carcinoma (NSCCA) of head and neck.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17582 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17582-e17582

Author(s):

Lucksamon Thamlikitkul ◽

Janjira Petsuksiri ◽

Suthinee Ithimakin

Keyword(s):

High Risk ◽

Head And Neck ◽

Squamous Cell ◽

Disease Free Survival ◽

Primary Site ◽

Stage I ◽

Secondary Outcome ◽

Curative Surgery ◽

Cervical Lymph Nodes ◽

Significant Difference

e17582 Background: Surgery is the mainstay of treatment for resectable non-metastatic NSCCA of head and neck. Postoperative radiation (RT) is delivered to patients (pt) with high risk for recurrence. Unlike the squamous cell counterpart where survival advantage from adding chemotherapy (CMT) as a radio-sensitizer is evident, the benefit of CCRT is uncertain in NSCCA pt. We hypothesized that CCRT would improve disease free survival (DFS), comparing to RT alone. Methods: NSCCA of head and neck pt who underwent curative surgery and RT at Siriraj hospital from 2006 to 2015 were included in this retrospective study. Patients with residual tumor after surgery or neuroendocrine histology were excluded. The primary outcome was DFS. The secondary outcome was overall survival (OS). Results: We included 139 pt, 99 (71.2%) had RT while 40 (28.8%) had CCRT. Baseline characteristics, including age, gender, primary site, histology and radiation dose were similar between 2 groups. Salivary gland was the most common primary site (67.6%). The most common histology was adenoid cystic carcinoma (35.3%), followed by mucoepidermoid carcinoma (25.9%). Patients who received RT alone had earlier stage (Stage I 29.3%, Stage IVa 14.1%), compared to CCRT group (Stage I 7.7%, Stage IVa 38.5%), p = 0.003. High risk features (positive margin, extranodal extension or ≥ 2 cervical lymph nodes metastasis) were found in 42% and 62% of pt with RT and CCRT, respectively (p = 0.03). In CCRT group, 92% of pt received cisplatin every 3 weeks during RT period. With the median follow-up time of 54.9 months, 3-year DFS was 79.4% and 79.5% in RT and CCRT groups, respectively (p = 0.22). There was no significant difference in 3-year OS between RT and CCRT groups (89.2% vs 89.9%, p = 0.76). Among pt with high-risk features (n = 67, 48.2%), 3-year DFS and OS were not significantly different between treatment groups. However, among pt without high-risk features, 3-year DFS in RT group was significantly higher than CCRT group (84.8% vs 79.0%, p = 0.04). Conclusions: This study demonstrates no survival benefit from adding concurrent CMT to RT following curative surgery in NSCCA of head and neck. Moreover, addition of CMT may be detrimental in pt without high-risk features.

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Hemostatic Resuscitation in Peripartum Hysterectomy Pre- and Postmassive Transfusion Protocol Initiation

American Journal of Perinatology ◽

10.1055/s-0037-1599103 ◽

2017 ◽

Vol 34 (09) ◽

pp. 861-866 ◽

Cited By ~ 2

Author(s):

Aaron Poole ◽

Faranak Behnia ◽

Holly Dunn ◽

Shannon Clark ◽

Luis Pacheco ◽

...

Keyword(s):

Blood Product ◽

High Ratio ◽

Secondary Outcome ◽

Categorical Variables ◽

Continuous Variables ◽

Peripartum Hysterectomy ◽

Hemostatic Resuscitation ◽

Estimated Blood Loss ◽

Significant Difference ◽

Product Replacement

Background Massive transfusion protocols (MTPs) have been examined in trauma. The exact ratio of packed red blood cells (PRBC) to other blood replacement components in hemostatic resuscitation in obstetrics has not been well defined. Objective The objective of this study was to evaluate hemostatic resuscitation in peripartum hysterectomy comparing pre- and postinstitution of a MTP. Study Design We conducted a retrospective, descriptive study of women undergoing peripartum hysterectomies from January 2002 to January 2015 who received ≥ 4 units of PRBC. Individuals were grouped into either a pre-MTP institution group or a post-MTP institution group. The post-MTP group was subdivided into those who had the protocol activated (MTP) versus not activated (no MTP). Primary outcomes were estimated blood loss (EBL) and need for blood product replacement. The secondary outcome was a composite of maternal morbidity, including need for mechanical ventilation, venous thromboembolism, pulmonary edema, acute kidney injury, and postpartum infection. A Mann–Whitney U test was used to compare continuous variables, and a chi-squared test was used for categorical variables with significance of p < 0.05. Results Of the 165 women who had a peripartum hysterectomy during the study period, 62 received four units or more of PRBC. No significant differences were noted in EBL or blood product replacement between the pre-MTP (n = 39) and post-MTP (n = 23) groups. Similarly, the MTP (n = 6) and no MTP (n = 17) subgroups showed no significant difference between EBL and overall blood product replacement. Significant differences were seen in transfusion of individual blood products, such as fresh frozen plasma (FFP) (MTP = 4, no MTP = 2; p = 0.02) and platelets (plts) (MTP = 6, no MTP = 0; p = 0.03). The use of high ratio replacement therapy for both plasma and plts was more common in the MTP group (FFP/PRBC ratio [MTP = 0.5, no MTP = 0.3; p = 0.02]; plts/PRBC ratio [MTP = 0.7, no MTP = 0; p = 0.03]). There were no differences in the secondary outcome between pre- and post-MTP or MTP and no MTP. Conclusion Initiation of the MTP did result in an increase in transfusion of FFP and plts intraoperatively. At our institution, the MTP is underutilized, but it appears that providers are more cognizant of the use of high transfusion ratios.

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