Risk of Postoperative Renal Failure in Radical Nephrectomy and Nephroureterectomy: A Validated Risk Prediction Model

<b><i>Introduction:</i></b> The study aimed to construct and validate a risk prediction model for incidence of postoperative renal failure (PORF) following radical nephrectomy and nephroureterectomy. <b><i>Methods:</i></b> The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database years 2005–2014 were used for the derivation cohort. A stepwise multivariate logistic regression analysis was conducted, and the final model was validated with an independent cohort from the ACS-NSQIP database years 2015–2017. <b><i>Results:</i></b> In cohort of 14,519 patients, 296 (2.0%) developed PORF. The final 9-factor model included age, gender, diabetes, hypertension, BMI, preoperative creatinine, hematocrit, platelet count, and surgical approach. Model receiver-operator curve analysis provided a C-statistic of 0.79 (0.77, 0.82; <i>p</i> &#x3c; 0.001), and overall calibration testing <i>R</i>² was 0.99. Model performance in the validation cohort provided a C-statistic of 0.79 (0.76, 0.81; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> PORF is a known risk factor for chronic kidney disease and cardiovascular morbidity, and is a common occurrence after unilateral kidney removal. The authors propose a robust and validated risk prediction model to aid in identification of high-risk patients and optimization of perioperative care.

760. Incidence, Predictors and 30-Day Outcomes of Clostridoides difficile Infection in Patients Undergoing Cystectomy: A Nationwide Analysis Using the ACS-NSQIP Database

Background Clostridoides difficile infection is the second most common healthcare acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the CDC in 2017. CDI continues to remain a major cause of inpatient admission and utilization of healthcare resources. The exact incidence of peri-procedural CDI with cystectomy is unknown, and reported incidence of CDI in literature vary widely Methods We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the ACS National Surgical Quality Improvement Program (NSQIP) to study the incidence, risk factors and 30-day post-surgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk-adjusted, outcomes-based program designed to determine and improve the quality of surgical and post-surgical care. Results The incidence of CDI following cystectomy was 3.6% in our patient cohort. 18.8% of patients developed CDI following hospital discharge. Non-elective surgeries, and complete cystectomy procedures had higher rate of CDI. 48.4% of patients with CDI had a preceding post-operative infection. Post-operative organ space infections (OR 1.95), post-operative renal failure (OR 2.38), post-operative sepsis (OR 2.49) and septic shock (OR 2.33) were independently associated with development of CDI, (all p values &lt; 0.05). Patients who developed post-operative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI (OR 2.29) and had a higher risk of DVT formation (2.48), and were also more likely to have unplanned readmissions (OR 7.8) Conclusion This is the first nationwide study looking at inpatient and 30-day post-operative CDI after cystectomy in the US. A sizable number of patients experience CDIs after cystectomy procedures, and CDI development is associated with an increase in length of stay and unplanned readmissions. This study lends further evidence to the need for continued interventions and initiatives to reduce this burden of post-operative CDI. Disclosures All Authors: No reported disclosures

Trends in Lateral Retinacular Release from 2010 to 2017

Historically, lateral retinacular release (LRR) procedures have been utilized in the treatment of a variety of patellofemoral disorders, including lateral patellar instability. However, in the past decade, there has been an increasing awareness of the importance of the lateral stabilizers in patellar stability, as well as the complications of LRR, such as recurrent medial patellar instability. The purpose of this study was to investigate current trends in LRR procedures from 2010 through 2017 using a large national database. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for arthroscopic LRR procedures (the Current Procedural Terminology [CPT] code, 29873) from 2010 to 2017. The number and incidence of lateral release procedures, both isolated and nonisolated, were analyzed and separated into cohorts for analysis. Age and gender of the LRR cohort was investigated and compared with all other orthopaedic procedures during the same time period in the NSQIP database. In addition, concomitant procedures and associated International Classification of Disease-9th Revision (ICD-9) and ICD-10th Revision (ICD-10) codes were analyzed over time and between LRR groups. From 2010 to 2017, 3,117 arthroscopic LRRs were performed. The incidence for LRR was 481.9 per 100,000 orthopaedic surgeries in 2010 and significantly decreased to 186.9 per 100,000 orthopaedic surgeries in 2017 (p < 0.01). LRR was more commonly performed in females (66%) and 58% of patients were under 44 years of age. In addition, LRR was most commonly performed with a concomitant meniscectomy (36%), synovectomy (19%), or microfracture (13%), and for a diagnosis of pain (22%). The overall incidence of LRR procedures significantly decreased from 2010 to 2017. LRRs were more commonly performed in younger, female patients for a diagnosis of pain with the most common concomitant procedure being meniscectomy, synovectomy, or microfracture.