Don’t Throw Your Heart Away: Increased Transparency of Donor Utilization Practices in Transplant Center Report Cards Alters How Center Performance Is Evaluated

Background Publicly available report cards for transplant centers emphasize posttransplant survival and obscure the fact that some centers reject many of the donor organs they are offered (reflecting a conservative donor acceptance strategy), while others accept a broader range of donor offers (reflecting an open donor acceptance strategy). Objective We assessed how the provision of salient information about donor acceptance practices and waitlist survival rates affected evaluation judgments of hospital report cards given by laypeople and medical trainees. Methods We tested 5 different report card formats across 4 online randomized experiments ( n1 = 1,003, n2 = 105, n3 = 123, n4 = 807) in the same hypothetical decision. The primary outcome variable was a binary choice between transplant hospitals (one with an open donor acceptance strategy and the other with a conservative donor acceptance strategy). Results Report cards featuring salient information about donor organ utilization rates (transplant outcomes categorized by quality of donor offers accepted) or overall survival rates (outcomes from both waitlist and transplanted patients) led lay participants (studies 1, 3, and 4) and medical trainees (study 2) to evaluate transplant centers with open donor acceptance strategies more favorably than centers with conservative strategies. Limitations Due to the nature of the decision, a hypothetical scenario was necessary for both ethical and practical reasons. Results may not generalize to transplant clinicians or patients faced with the decision of where to join the transplant waitlist. Conclusions These findings suggest that performance evaluations for transplant centers may vary significantly based not only on what outcome information is presented in report cards but also how the information is displayed.

189 Outcomes in Appendicitis During The COVID-19 Pandemic: A Single Center Report Of 36 Cases

Introduction Surgical management of acute appendicitis(AA) during the first peak of COVID-19 was modified somewhat in order to mitigate concurrent infection. Early in the pandemic an open approach was preferable. The management of AA at a single surgical unit over three months during the COVID-19 outbreak is presented. Method Data on patients diagnosed with AA (3rd March 2020 to 4th May 2020) were analysed. Management strategies, morbidity, length of stay and readmissions were evaluated. Results Median age was 45 years (range 6-75) with a male: female ratio of 2.7:1. The mean white cell count and CRP were 14.7(5.4-25) and 121.6(1- 545), respectively. Appendicectomy (28/36;77.8%) was performed laparoscopically in 23(82.1%) and open in 4(14.3%); 13.9%(5/36) of AA, were managed conservatively. Among the COVID-19 positive patients(5/36), 4 were managed laparoscopically, one needed a laparotomy. Considering COVID-19 positive vs negative/not done status, conversion was seen 50%(2/4) and 5.3%(1/19) respectively. A difference in mean length of stay was noted (positive vs negative/not done = 10.4 days vs 3.43 days). Morbidity was 16.7%(6/36) with a re-admission rate of 11%(4/36). Conclusions Surgical units need to be flexible to modify their management plans as the COVID-19 pandemic evolves. Awaiting USS/CECT, wait and watch policy related delays should be avoided when possible. A higher conversion rate, morbidity and readmission rate were noted in this cohort of patients, potentially the result of more complicated inflammation, as patients may present late owing to apprehensions regarding their safety while attending hospital.

Postmortem Cardiopulmonary Pathology in Patients with COVID-19 Infection: Single-Center Report of 12 Autopsies from Lausanne, Switzerland

We report postmortem cardio-pulmonary findings including detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in formalin-fixed paraffin embedded tissue in 12 patients with COVID-19. The 5 women and 7 men (median age: 73 years; range 35–96) died 6–38 days after onset of symptoms (median: 14.5 days). Eight patients received mechanical ventilation. Ten patients showed diffuse alveolar damage (DAD), 7 as exudative and 3 as proliferative/organizing DAD. One case presented as acute fibrinous and organizing pneumonia. Seven patients (58%) had acute bronchopneumonia, 1/7 without associated DAD and 1/7 with aspergillosis and necrotic bronchitis. Microthrombi were present in 5 patients, only in exudative DAD. Reverse transcriptase quantitative PCR detected high virus amounts in 6 patients (50%) with exudative DAD and symptom-duration ≤14 days, supported by immunohistochemistry and in-situ RNA hybridization (RNAscope). The 6 patients with low viral copy levels were symptomatic for ≥15 days, comprising all cases with organizing DAD, the patient without DAD and one exudative DAD. We show the high prevalence of DAD as a reaction pattern in COVID-19, the high number of overlying acute bronchopneumonia, and high-level pulmonary virus detection limited to patients who died ≤2 weeks after onset of symptoms, correlating with exudative phase of DAD.