THE SIGNIFICANCE OF THE STUDY OF THE LIVER FUNCTION TEST WITHIN POST-TRANSPLANT PATIENTS

In recent years, the survival rate of patients after liver transplantation (LT) has improved significantly. However, successful transplantation is directly related to the proper management of the patient after surgery, including considering essential aspects based on the results of laboratory tests. Therefore, it is essential to study the laboratory characteristics to investigate the functional state of the liver. In the present study, we investigated the indicators of liver function in postoperative patients: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin, total bilirubin, gamma-glutamyl transferase (GGT). Venous blood samples were used for investigation. A total of 10 post-transplant patients were studied. Appropriate research methods were used. P<0.05 was considered statistically significant. Overall, our results have shown that intensive examinations of the liver panel in postoperative patients significantly contribute to the proper management of the complicated patient, which directly impacts the final results. Notably, the variability of GGT and ALP may be directly related to the transplanted chronic immune response of the liver and may be used as an early marker for the diagnosis of biliary complications.

A Streamlined Approach to the Solid Organ Transplant Recipient with an Infection

Addressing these three simple questions can assist any physician in making the best-informed decision about diagnostic tests and treatments in regard to a solid organ transplant recipient with an infection. This article serves as a preliminary guide to finding the simplest approach to what is typically a complicated patient and the course of the disease.

Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy

Background Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery. Study design Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors. Results One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created. Conclusion Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement.

764 What Do You Think? The Ethics of Treating the Medically and Socially Complicated Patient

Introduction Medically complicated burn patients also often present with complex social situations which raise difficult ethical questions for the providers caring for them. While the four principles of biomedical ethics, respect for autonomy, nonmaleficence, beneficence, and justice help guide medical decision making, providers are often faced with making recommendations that are ethically uncomfortable for them. Methods At the ABA Annual Meeting in 2019, we presented a poster of a case of a medically, socially, and ethically complicated patient who was treated at our verified burn unit about a decade ago. Embedded in the poster was a QR code and weblink that people could scan to get to a 10-item online survey containing questions regarding decision making in the case. For our regional burn conference in September 2019, we asked the organizers to send an email containing a summary of the case and a link to the survey via email to all of those who had registered two weeks before the conference. A summary of the case follows: 47-year-old male with an 81% TBSA burn from a car accident, currently intubated and sedated and unable to participate in medical decision making. He needs four limb amputations, though his chance of long-term survival is ultimately thought to be less than 10–20%; best case scenario is a vent-dependent life with tetraplegia, likely without prosthetics due to skin graft issues. He has a very complicated family situation. Survey questions included those about whether it was medically appropriate to do or not do the amputations, how that appropriateness should be assessed, the extent to which the patient’s previous expressed wishes matter, who the appropriate surrogate is, and whether and to what extent the medical team’s feelings about the situation matter. Results Twelve people at the ABA annual meeting and 17 people from the regional meeting responded to the survey. Every respondent answered every question. While there were some similar responses, there were also those with significant variation. Of note, at the ABA, 50% of respondents felt the evidence needed to withdraw treatment was the same as that needed to continue treatment; 70% of participants at the regional meeting thought this. 25% of respondents at the ABA thought it was extremely important that a decision be made that allows team members to sleep at night; 17.65% of participants at the regional meeting thought this. Conclusions Burn care providers do not agree on important aspects of decision making for patients who are medically, socially, and ethically complicated. Applicability of Research to Practice Further discussion of decision making in burn care is needed to help increase provider comfort in making recommendations for patients who are medically, socially, and ethically complicated.

It’s Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks

Outpatient parenteral antimicrobial therapy (OPAT) requires patients and caregivers to infuse antimicrobials through venous catheters (VCs) in the home. The objective of this study was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of OPAT. The authors performed 40 semi-structured patient interviews and 20 observations of patients and caregivers performing OPAT-related tasks. Six overall goals were identified: (1) understanding and developing skills in OPAT, (2) receiving supplies, (3) medication administration and VC maintenance, (4) preventing VC harm while performing activities of daily living, (5) managing when hazards lead to failures, and (6) monitoring status. The authors suggest that patients and caregivers use teach-back, take formal OPAT classes, receive visual and verbal instructions, use cognitive aids, learn how to troubleshoot, and receive clear instructions to address areas of uncertainty. Addressing these goals is essential to ensuring the safety of and positive experiences for our patients.