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TER N S URGIC A LC O UT ES • SO ND MT ID GR H ES N W SD S• THE SOUTHWESTERN WY NV NE UT CA CO AZ NM MO KS OK AR SURGICAL CONGRESS TX HI OR GANIZED 1948 FINAL PROGRAM 2017 Annual Meeting April 2 – 5, 2017 Hyatt Regency | Maui, HI THANK YOU The Southwestern Surgical Congress would like to thank the following companies for their generous support via Educational Grants: Karl Storz KLS Martin The Southwestern Surgical Congress would like to thank the following organizations for their marketing support of the 2017 Annual Meeting: 3D Systems DePuy Synthes Prytime Medical Devices, Inc. The Southwestern Surgical Congress would like to thank the following companies for their generous support as Exhibitors: 3D Systems American College of Surgeons Bard Davol De Puy Synthes Genentech Halyard Health Integra LifeSciences Karl Storz KLS Martin LifeCell Mallinckrodt Pharmaceuticals Olympus Pacira Pharmaceuticals Prytime Medical Devices, Inc. Star Surgical Stryker Endoscopy Teleflex Torax Medical Inc. TABLE OF CONTENTS 2 Letter from the President 4 Officers, State Councilors & Representatives 6Committees 8 Nonie Lowry Fund 9 Past Presidents & Meeting Locations 13 Educational Objectives 14 CME Credit Information 15 General Information 17 Presidential Address 18 Guest Speakers 24 Awards 26 In Memoriam 27 New Members 29 Schedule at a Glance 37 Scientific Program 75 Scientific Paper Abstracts 123 Quick Shot Abstracts 225 ePoster Abstracts 305 Membership by Location 214Notes See inside back cover for future meetings. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 1 LETTER FROM THE PRESIDENT Dear Members and Guests, Welcome to the 69th annual meeting of the Southwestern Surgical Congress! Clay Cothren Burlew, MD The Program Committee, under the leadership of Dr. Fred Pieracci, has planned an outstanding educational program. There will be 33 podium presentations and 68 quick shot presentations, and 63 ePosters (up from 54 last year!). A new event, the Presidents’ Poster Session with oral presentations, hosted by 12 of the Past Presidents, will take place Sunday afternoon following the Presidential Address. The Postgraduate Courses in Trauma and in Emergency General Surgery will be held on Sunday morning with nationally recognized experts. Additional highlights of the meeting include the Past President’s Panel, the American College of Surgeons’ panel discussions, the Global Opportunities luncheon, mock oral boards for the chief residents, and the invited lectures from Dr. Christine Cocanour, Dr. Rob Todd, and Dr. John Moore. No meeting of the SWSC would be complete without family-oriented activities to complement the educational program. There will be kayaking/snorkeling, hula lessons, the golf tournament, and yoga on the beach. The casual SWSC Reception will be Tuesday evening on the Haloni Kai Lawn. I hope you enjoy your time in Maui. Thank you for your loyalty and support of the SWSC. I look forward to seeing each of you during the meeting. Clay Cothren Burlew, MD President, Southwestern Surgical Congress 2016-2017 2 Southwestern Surgical Congress | 69th Annual Meeting PRESIDENTIAL BIOGRAPHY Clay Cothren Burlew, MD FACS Dr. Burlew grew up in San Antonio, Texas. She is a graduate of Amherst College, earning her degree in Biology magna cum laude. She attended medical school at UT Southwestern Medical School, where she was ranked 1st in her class and was elected to the Alpha Omega Alpha medical honor society. She completed her general surgery residency and Surgical Critical Care fellowship at the University of Colorado. Dr. Burlew joined the faculty at Denver Health Medical Center/University of Colorado to pursue her interest in trauma and critical care. She is a Professor of Surgery and the Director of the Surgical Intensive Care Unit. She is also the Program Director of the Surgical Critical Care Fellowship and the AASTapproved Trauma & Acute Care Surgery Fellowship. Dr. Burlew has been an active surgical investigator, educator, and clinician; she has received multiple awards in each of these areas including the J. Cuthbert Owens Award, the DHMC Award for Academic Excellence, the Bartle Faculty Teaching Award, the Academy of Medical Educator’s award for Excellence in Mentoring, and the 2017 American College of Surgeons Travelling Fellowship to Australia/New Zealand. She serves on national committees for the Western Trauma Association and the American Association for the Surgery of Trauma, and serves as a SESAP author for the American College of Surgeons. She is on the Editorial Board of The Journal of Trauma and Acute Care Surgery, The World Journal of Emergency Surgery, and Trauma Surgery and Acute Care Open, and reviews for an additional 13 journals in an ad hoc capacity. She has authored over 160 peer-reviewed articles and 64 book chapters. She has given over 100 national lectures and scientific presentations. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 3 OFFICERS, STATE COUNCILORS & REPRESENTATIVES EXECUTIVE OFFICERS STATE COUNCILORS PRESIDENT Clay Cothren Burlew Denver, CO ARIZONA Barb Pockaj NEVADA Shawn Tsuda ARKANSAS Anne Mancino NEW MEXICO M. Timothy Nelson CALIFORNIA (SOUTHERN) Nicolas Melo NORTH DAKOTA Randolph Szlabick PRESIDENT-ELECT Daniel Margulies Los Angeles, CA VICE PRESIDENT Courtney Scaife Salt Lake City, UT SECRETARYTREASURER Shanu Kothari La Crosse, WI RECORDER Daniel Vargo Salt Lake City, UT IMMEDIATE PAST PRESIDENT John Potts, III PAST PRESIDENT Ronald Stewart COUNCILORSAT-LARGE Alicia Mangram John Moore HISTORIAN Ronald Stewart 4 CALIFORNIA (NORTHERN) Christine Cocanour COLORADO David Partrick HAWAII Mike Hayashi IDAHO Marcus Torgeson KANSAS Josh Mammen MISSOURI Bryan Troop OKLAHOMA Anthony Howard SOUTH DAKOTA Paul Bjordahl TEXAS (NORTHERN) Justin Regner TEXAS (SOUTHERN) Brian Eastridge UTAH Bartley Pickron WISCONSIN Brandon Grover W YOMING Sara Smith MONTANA Glenn Winslow NEBRASKA Rudy Lackner Southwestern Surgical Congress | 69th Annual Meeting OFFICERS, STATE COUNCILORS & REPRESENTATIVES (continued) CONGRESS REPRESENTATIVES AMERICAN COLLEGE OF SURGEONS - BOARD OF GOVERNORS S. Rob Todd Houston, TX AMERICAN COLLEGE OF SURGEONS - ADVISORY COUNCIL FOR SURGERY Kenric Murayama Honolulu, HI AMERICAN BOARD OF SURGERY REPRESENTATIVE Roxie Albrecht Oklahoma City, OK AJS EDITORIAL ADVISORY BOARD Daniel Vargo Salt Lake City, UT April 2 – 5, 2017 | Hyatt Regency, Maui, HI 5 SWSC COMMITTEES BUDGET AND FINANCE COMMITTEE Dmitry Oleynikov, Chair (2018) Dennis Kim (2019) David Plurad (2018) Tom White (2018) Frank Wright (2018) CONSTITUTION AND BYLAWS COMMITTEE Sharmila Dissanaike; Chair (2019) Mark Savarise (2018) Alicia Mangram (2018) Edward Jones (2019) DEVELOPMENT COMMITTEE James Edney; Chair (2017) Kenric Murayama (2017) Shanu Kothari (2017) John Moore (2017) Dmitry Oleynikov (2017) Michael Truitt (2019) GME COMMITTEE Walt Biffl; Chair (2018) Stephanie Gordy (2018) Nicolas Melo (2018) LOWRY FUND GOVERNING COMMITTEE Kenric Murayama, Chair (2018) Ernie Dunn (2018) Dmitry Oleynikov (2018) David Plurad (2018) Tom White (2018) Frank Wright(2018) Dennis Kim, MD (2019) 6 MEMBERSHIP COMMITTEE Bryan Morse; Chair (2018) Sharmila Dissanaike (2017) Jillian Ciocchetti (2017) Randall Friese (2018) Maria Albuja-Cruz (2018) John Uecker (2019) Stacy Dougherty (2019) Brandon Grover (2019) Nicolas Melo (2019) Sarah Judkins (2019) Susan McLean (2019) Walt Biffl; GME Chair NOMINATING COMMITTEE Ronald Stewart, Chair (2017) John Potts, IIIx (2018) Christine Cocanour (2017) James Davis (2017) PROGRAM COMMITTEE Fredric Pieracci; Chair (2018) Clay Burlew; President (2017) Daniel Vargo; Recorder (2018) Lillian Liao; CME Chair (2018) Barb Pockaj (2017) Richard Frazee (2018) Gail Tominaga (2018) Molly Gross (2019) Jorge DeAmorim Filho (2019) Mike Truitt; past-Chair (2017) Southwestern Surgical Congress | 69th Annual Meeting SWSC COMMITTEES PUBLICATIONS COMMITTEE Daniel Vargo; Chair (2018) Richard Barton (2017) Anees Chagpar (2017) Michael Corneille(2017) Chris DeVirgilio (2019) Ronda Henry-Tillman (2019) Susan McLean (2017) Laura Moore (2017) Rob Todd(2017) Sean Langenfeld (2017) Brijesh Gill (2018) APC COMMITTEE (AD HOC) Tom White; co-Chair Annika Kay; co-Chair Walt Biffl Barbara Eaton Lindsey O’Meara Courtney Scaife Crystal Szczepanski COMMUNICATIONS COMMITTEE (AD HOC) Sean Langenfeld; Chair Eric Campion Laura Harmon Lilian Liao, Anne Mancino Justin Regner Daniel Vargo (continued) MULTICENTER TRIALS COMMITTEE (AD HOC) Clay Cothren Burlew; Chair Michael Truitt; vice-Chair Mark Bailey Annabel Barber Walt Biffl Brandon Bruns Chris Cribari Daniel Dent Sharmila Dissanaike Brian Eastridge Barbara Eaton Richard Frazee Ernest Gonzalez Stephanie Gordy Brandon Grover Laura Harmon Jeff Holloway Sarah Judkins Krista Kaups Shanu Kothari Lillian Liao Anne Mancino Dan Margulies Robert McIntyre Nicolas Melo Laura Moore John Moore Mary Mrdutt Kenric Murayama Paul Nelson Lindsey O’Meara Erik Peltz Fredric Pieracci John Potts, III Justin Regner Liz Scherer Ronald Sing Ronald Stewart Robert Sticca Randolph Szlabick Rob Todd Tom White April 2 – 5, 2017 | Hyatt Regency, Maui, HI 7 SWSC LOWRY FUND SWSC is proud to announce The Lowry Fund honoring Nonie Lowry, past SWSC Director, for her strength, professionalism, and dedication to the Southwestern Surgical Congress. Donations to the Fund will be used for the annual Lowry Award (best paper by a new member), educational grants for medical students and residents, and other educational initiatives to be supported and defined by the Southwestern Surgical Congress. The Lowry Fund Donor Levels are named for the first 6 Presidents of the SWSC. Donations made to the Lowry Fund of the SWSC Foundation are tax deductible. Current lifetime accumulation status based on 2016 year end. LOWRY FUND DONOR LEVELS STUCK LEVEL ($5000 AND UP) ORR LEVEL ($2500 - $4999) Clay Burlew John Potts, III STARRY LEVEL ($1000-$2499) David Antonenko Ernest Dunn Daniel Margulies Kenric Murayama Jon Thompson S. Rob Todd DEBAKEY LEVEL ($500-$999) Roxie Albrecht James Chandler Sharmila Dissanaike James Edney Alicia Mangram Laura Moore Bartley Pickron Chris Raeburn 8 Justin Regner Robert Sticca Michael Truitt GOOD LEVEL ($250-$499) Walter Biffl Paul Bjordahl Eric Campion Mark Cohen Brian Eastridge LP etc Shanu Kothari Rudy Lackner Jeffrey Lee Marjie Malia Joshua Mammen Anne Mancino Nicolas Melo John Moore Bryan Morse John Myers Dmitry Oleynikov David Plurad Courtney Scaife Sara Smith Gail Tominaga PRICE LEVEL (up to $250) Wayne Anderson Maria Allo Karen Borman Christine Cocanour Millard Davis Daniel Dent Stacy Dougherty Richard Frazee William Fry Brandon Grover Sara Hartsaw Edward Jones Jeffry Kashuk Sean Langenfeld Peter Lopez Kelly McMasters Ernest Moore Lindsay O’Meara Barbara Pockaj Melanie Richards John Sherck Ronald Sing R Stephen Smith Harl Stump Gary Timmerman Daniel Vargo Southwestern Surgical Congress | 69th Annual Meeting PAST PRESIDENTS & MEETING LOCATIONS 1949 1958 *Walter Stuck, MD Shamrock Hotel, Houston, Texas *Kenneth C. Sawyer, MD Shamrock Hotel, Houston, Texas 1950 1959 *Thomas G. Orr, MD Shirley Savoy, Denver, Colorado *Lewis M. Overton, MD Brown Palace Hotel, Denver, Colorado 1951 1960 *Leo J. Starry, MD Hotel Jefferson, St. Louis, Missouri *Fred H. Krock, MD Riviera Hotel, Las Vegas, Nevada 1952 1961 *Michael E. DeBakey, MD Baker Hotel, Dallas, Texas *Howard D. Cogswell, MD Chase Park Plaza, St. Louis, Missouri 1953 1962 *Louis P. Good, MD Hotel Utah, Salt Lake City, Utah *Charles M. O’Leary, MD Western Skies Hotel, Albuquerque, New Mexico 1954 *Philip B. Price, MD Skirvin Hotels, Oklahoma City, Oklahoma 1963 1955 1964 *Lawrence P. Engel, MD Hotel Muehlebach, Kansas City, Missouri *Eugene M. Bricker, MD Granada Hotel, San Antonio, Texas *Edgar J. Poth, MD Maria Isable Hotel, Mexico City, Mexico 1965 1956 *Charles R. Rountree, MD Pioneer Hotel, Tucson, Arizona *Wayne C. Bartlett, MD Velda Rose Towers, Hot Springs, Arkansas 1957 1966 *John V. Goode, MD Broadway Hotel, Wichita, Kansas *O. Ernest Grua, MD Flamingo Hotel, Las Vegas, Nevada April 2 – 5, 2017 | Hyatt Regency, Maui, HI 9 PAST PRESIDENTS & MEETING LOCATIONS (continued) 1967 1976 *John A. Growdon, MD Del Webb-Town House, Phoenix, Arizona *John B. Gramlich, MD Hyatt Regency Hotel, Houston, Texas 1977 1968 *Robert B. Howard, MD Brown Palace Hotel, Denver, Colorado 1978 1969 *John H. Clark, MD Sahara Tahoe Hotel, Lake Tahoe, Nevada *Cyril Costello, MD Riviera Hotel, Palm Springs, California 1979 1970 *Jean C. Gladden, MD Sheraton-Dallas Hotel, Dallas, Texas *MacDonald Wood, MD Caesars Palace Hotel, Las Vegas, Nevada 1980 1971 *J. Robert Spencer, MD Caesar’s Palace Hotel, Las Vegas, Nevada Gilbert S. Campbell, MD Broadmoor Hotel, Colorado Springs, Colorado 1972 1981 *John G. Shellito, MD Hilton Inn, Albuquerque, New Mexico *Wallace L. Chambers, MD Hyatt del Monte, Monterey, California 1973 1982 *James B. Growdon, MD Mountain Shadows Hotel, Scottsdale, Arizona *Albert J. Kukral, MD Hotel del Coronado, Coronado, California 1974 1983 *Lawrence H. Wilkinson, MD Del Monte Hyatt House, Monterey, California Livingston Parsons, Jr., MD The Pointe Resort, Phoenix, Arizona 1984 1975 *George H. Mertz, MD Caesars Palace Hotel, Las Vegas, Nevada 10 *Howard T. Robertson, MD Princess Hotel, Acapulco, Mexico *Raymond C. Read, MD The Hyatt Regency, Honolulu & Maui, Hawaii Southwestern Surgical Congress | 69th Annual Meeting PAST PRESIDENTS & MEETING LOCATIONS (continued) 1985 1993 *Claude H. Organ, Jr., MD Caesars Palace Hotel, Las Vegas, Nevada Dominic Albo, Jr., MD Hyatt Regency Monterey, Monterey, California 1986 Ronald C. Elkins, MD Hyatt Regency San Francisco, San Francisco, California 1994 1987 1995 *Joseph L. Kovarik, MD Hotel del Coronado, Coronado, California Robert B. Sawyer, MD Hyatt Regency Hill Country Resort, San Antonio, Texas 1988 1996 Arlo S. Hermreck, MD The Pointe at Squaw Peak, Phoenix, Arizona Carey P. Page, MD Marriott’s Camelback Inn Resort, Scottsdale, Arizona 1989 1997 Frederic C. Chang, MD Hyatt Regency Monterey, Monterey, California James H. Thomas, MD Westin Mission Hills Resort, Rancho Mirage, California 1990 1998 Kent C. Westbrook, MD LaQuinta Golf & Tennis Resort, La Quinta, California Charles H. McCollum, MD Hyatt Regency Hill Country Resort, San Antonio, Texas 1991 1999 William F. Sasser, MD The Mirage, Las Vegas, Nevada Ernest E. Moore, Jr., MD Loews Coronado Bay Resort, Coronado, California 1992 David V. Feliciano, MD Marriott’s Camelback Inn Resort, Scottsdale, Arizona Ernest Poulos, MD The Westin LaPaloma, Tucscon, Arizona 2000 Victor J. Zannis, MD The Broadmoor, Colorado Springs, Colorado April 2 – 5, 2017 | Hyatt Regency, Maui, HI 11 PAST PRESIDENTS & MEETING LOCATIONS (continued) 2001 2009 Nicholas P. Lang, MD Fiesta Americana Coral Beach Resort, Cancun, Mexico Maria D. Allo, MD Hotel del Colorado Coronado, California 2002 2010 James A. Edney, MD Hotel del Coronado, Coronado, California Frederick A. Moore, MD Loews Canyon Resort, Tucson, Arizona 2011 2003 Russell G. Postier, MD Loews Ventana Canyon Resort, Tucson, Arizona 2004 Jon S. Thompson, MD Hyatt Regency Monterey, Monterey, California 2005 Jeffrey R. Saffle, MD Westin La Cantera Resort, San Antonio, Texas 2006 Ernest L. Dunn, MD Kauai Marriott Resort and Beach Club Kauai, Hawaii 2007 Scott R. Petersen, MD Rancho Las Palmas Resort and Spa Rancho Mirage, California 2008 Alan G. Thorson, MD Fairmont Acapulco Princess Acapulco, Mexico 12 Edward Nelson, MD JW Marriott Ihilani, Oahu, Hawaii 2012 Robert C. McIntyre, Jr., MD Terranea Resort, Rancho Palos Verdes, California 2013 David Antonenko, MD, PhD Bacara Resort Santa Barbara, California 2014 Kenric M. Murayama, MD Westin Keirland Resort Scottsdale, Arizona 2015 Ronald Stewart, MD Hyatt Regency Monterey Monterey, California 2016 John Potts, III Hotel del Coronado Coronado, California * Deceased Southwestern Surgical Congress | 69th Annual Meeting EDUCATIONAL OBJECTIVES LEARNING OBJECTIVES: The scientific program of the Annual Meeting of the Southwestern Surgical Congress will provide contemporary information on the management of a broad range of surgical diseases for community surgeons, academic surgeons and the surgeon‐in‐ training. Topic areas discussed will incorporate a comprehensive perspective of surgical practice including abdominal and gastrointestinal surgery, emergency general surgery, trauma / critical care surgery, surgical education, thoracic and vascular surgery, surgical oncology, and breast and endocrine surgery. The intent of the program is to broaden the knowledge base of the audience and enhance the quality of patient care and patient safety. Audience participation and interaction will be encouraged. The content and format of the program have been developed based on evaluations and suggestions of attendees of previous programs of the Southwestern Surgical Congress. At the end of this activity, attendees will / will be able to perform the following: • Develop an understanding of current issues relevant to the advancement of the art and practice of surgery, specifically in the evaluation and management of hernia, breast, endocrine, gastrointestinal, thoracic, vascular, trauma / critical care and emergency / acute care surgical disease. • Discuss the highlighted translational data and evidence based practice with respect to the potential impact on the future of patient care and evolution of surgical best practice. • Implement a strategy to establish new technologies within the context of the individual’s current surgical practice. CME CERTIFICATES AND EVALUATION FORMS Evaluation completion, CME and Self Assessment credit will be completed online. You will receive emailed instructions on how to claim CME online immediately following the conference. DISCLOSURE INFORMATION In compliance with the ACCME Accreditation Criteria, the American College of Surgeons, as the accredited provider of this activity, must ensure that anyone in a position to control the content of the educational activity has disclosed all relevant financial relationships with any commercial interest. All reported conflicts are managed by a designated official to ensure a bias-free presentation. Please see the insert to this program for the complete disclosure list. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 13 EDUCATIONAL OBJECTIVES (continued) CONTINUING MEDICAL EDUCATION CREDIT INFORMATION Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Surgeons and Southwestern Surgical Congress. The American College of Surgeons is accredited by the ACCME to provide continuing medical education for physicians. AMA PRA Category 1 Credits™ - Annual Meeting The American College of Surgeons designates this live activity for a maximum of 21.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Of the AMA PRA Category 1 Credits™ listed above, a maximum of 12.75 credits meet the requirements for Self-Assessment. AMA PRA Category 1 Credits™ - Postgraduate Course: Trauma The American College of Surgeons designates this live activity for a maximum of 3.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Of the AMA PRA Category 1 Credits™ listed above, a maximum of 3.25 credits meet the requirements for Self-Assessment. AMA PRA Category 1 Credits™ - Postgraduate Course: Emergency General Surgery The American College of Surgeons designates this live activity for a maximum of 3.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Of the AMA PRA Category 1 Credits™ listed above, a maximum of 3.25 credits meet the requirements for Self-Assessment. 14 Southwestern Surgical Congress | 69th Annual Meeting GENERAL INFORMATION HOTEL Hyatt Regency Maui 200 Nohea Kai Dr. Lahaina, Maui, HI 96761-1990 REGISTRATION The registration desk hours are as follows (Grand Promenade): Sunday 7:30am – 5:00pm Monday 6:00am – 11:30am Tuesday 6:00am – 5:00pm Wednesday 6:00am – 12:00pm SPOUSE ACTIVITIES Hula Dance Lessons Tuesday, April 4, 2017 1:00pm - 2:00pm Hyatt Regency Maui Cost: $25/person Hula dancing is a graceful art and has many hand movements that signify various emotions. These hand motions can also signify the different aspects of nature like swaying of a tree or swells of an ocean wave. There will be a private instructor to teach you about Maui culture and how to Hula dance. In this private hula class you will be taught 2 dance numbers to recorded music. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 15 GENERAL INFORMATION Yoga on the Beach Monday, April 3, 2017 6:30am– 7:30am Hyatt Regency Maui Cost: $30 per person (continued) Please stop by the registration desk for additional details and registration information Yoga mats and a water station will be provided . Join us in a private yoga class that is designed to revitalize your body physically, mentally and spiritually. This class will focus on basic yoga postures and breathing that increase muscle tone, improve flexibility and concentration, detoxify vital organs and induce a state of deep relaxation. Annual Golf Tournament Monday, April 3, 2017 Shotgun start at 1:00pm Ka’anapali Golf Course Cost: $150 per person Fee includes transportation and greens fees. Join us for an afternoon on the greens. Be sure to register in advance, as we typically have strong interest for golf. Fee includes transportation and green fees. Golfers may opt to purchase a box lunch for an additional $22. Kayak and Snorkel Excursion Monday, April 3, 2017 2:00pm – 4:00pm Cost: $85 per person Location: Hanakao’o Beach Park a.k.a. “Canoe Beach” (Just next to Hyatt Hotel) The Island of Maui is known for its beautiful beaches and incredible watersports in the Pacific Ocean alive with marine life. With its deep reefs with colorful fish, sea turtles and coral formations, Maui is one of Hawaii’s hottest snorkeling and diving destinations. Come join your fellow attendees on a guided paddle and snorkeling adventure! There will be a 15-minute pre-tour briefing that includes a water safety discussion, kayak, snorkel, & paddle talk. Snacks and beverages included Inclusions: Water, snacks, mask, snorkel, fins, life jackets, paddles 16 Southwestern Surgical Congress | 69th Annual Meeting PRESIDENTIAL ADDRESS SURGICAL EDUCATION: LESSONS FROM PARENTHOOD SUNDAY, APRIL 2, 2017 4:30pm – 5:15pm Monarchy 4 Speaker: Clay Cothren Burlew, MD Denver, CO Dr. Burlew grew up in San Antonio, Texas. She is a graduate of Amherst College, earning her degree in Biology magna cum laude. She attended medical school at UT Southwestern Medical School, where she was ranked 1st in her class and was elected to the Alpha Omega Alpha medical honor society. She completed her general surgery residency and Surgical Critical Care fellowship at the University of Colorado. Dr. Burlew joined the faculty at Denver Health Medical Center/University of Colorado to pursue her interest in trauma and critical care. She is a Professor of Surgery and the Director of the Surgical Intensive Care Unit. She is also the Program Director of the Surgical Critical Care Fellowship and the AAST-approved Trauma & Acute Care Surgery Fellowship. Dr. Burlew has been an active surgical investigator, educator, and clinician; she has received multiple awards in each of these areas including the J. Cuthbert Owens Award, the DHMC Award for Academic Excellence, the Bartle Faculty Teaching Award, the Academy of Medical Educator’s award for Excellence in Mentoring, and the 2017 American College of Surgeons Travelling Fellowship to Australia/New Zealand. She serves on national committees for the Western Trauma Association and the American Association for the Surgery of Trauma, and serves as a SESAP author for the American College of Surgeons. She is on the Editorial Board of The Journal of Trauma and Acute Care Surgery, The World Journal of Emergency Surgery, and Trauma Surgery and Acute Care Open, and reviews for an additional 13 journals in an ad hoc capacity. She has authored over 160 peer-reviewed articles and 64 book chapters. She has given over 100 national lectures and scientific presentations. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 17 GUEST SPEAKERS (continued) EDGAR J. POTH MEMORIAL LECTURESHIP INFORMED CONSENT - IT IS MORE THAN JUST A SIGNATURE ON A PIECE OF PAPER TUESDAY, APRIL 4, 2017 8:45am - 9:30am Monarchy 4 Speaker: Christine Cocanour, MD Sacramento, CA Christine S. Cocanour, MD, FACS, FCCM obtained a B.S. in Biology and B.A. in Chemistry from the University of Toledo. She received her MD from the University of Cincinnati College of Medicine. She completed a general surgery residency at Case Western Reserve which included one year as a Dudley P. Allen Research Fellow. Following residency, she completed a Trauma Critical Care fellowship at UTHSCHouston and joined the faculty in 1989. She was promoted to Professor of Surgery in 2005. At UTHSC-Houston, she was the Program Director of the Surgical Critical Care Fellowship and the Medical Director of the Shock Trauma ICU at Memorial Hermann Hospital. In 2006, she moved to Sacramento, California where she joined the faculty of the UC Davis Medical School. At UC Davis, she has continued her interest in Trauma, Emergency General Surgery and Surgical Critical Care as the Program Director for the UC Davis Surgical Critical Care Fellowship and is the Medical Director of the UCDMC Surgical Intensive Care Unit. She recently transitioned to the Associate Program Director for the Surgical Critical Care Fellowship in order to become the Quality and Safety Chair for the Department of Surgery as well as being the Surgery Department NSQIP champion. She recently completed her tenure as the President of the Western Trauma Association in 2015. 18 Southwestern Surgical Congress | 69th Annual Meeting GUEST SPEAKERS (continued) EDGAR J. POTH MEMORIAL LECTURESHIP PAST PRESENTERS 1975 George H. Mertz, MD 1989 Carey P. Page, MD 2003 Kenneth W. Sharp, MD 1976 Frank G. Moody, MD 1990 James H. Tomas, MD 2004 B. Timothy Baxter, MD 1977 Claude H. Organ, Jr., MD 1991 Lawrence W. Way, MD 2005 John F. Eidt, MD 1978 Raymond C. Read, MD 1992 Jon M. Burch, MD 1979 William W. Monafo, MD 1993 Jeffrey R. Saffle, MD 2006 David Antonenko, MD, PhD 1980 George C. Morris, MD 1994 G. Patrick Clagett, MD 1981 Ronald C. Elkins, MD 1995 Jon S. Thompson, MD 1982 MacDonald Wood, MD 1996 Wayne H. Schwesinger, MD 1983 J. Bradley Aust, MD 1984 Ernest E. Moore, Jr., MD 1985 Stephen L. Wangensteen, MD 1986 David V. Feliciano, MD 1987 David Roos, MD 1988 Kent C. Westbrook, MD 2007 Edward W. Nelson, MD 2008 Kenric Murayama, MD 2009 Karen R. Borman, MD 2010 Alden D. Harken, MD 1997 Glenn C. Hunter, MD 2011 Anees Chagpar, MD 1998 Courtney M. Townsend, Jr., MD 2012 Clay Cothren Burlew, MD 1999 James A. Edney, MD 2000 Robert J. Fitzgibbons, MD 2001 Gregorio A. Sicard, MD 2002 Layton F. Rikkers, MD 2013 R. Stephen Smith, MD 2014 Peter Angelos, MD, PhD 2015 J. Patrick Walker, MD 2016 David Mercer, MD April 2 – 5, 2017 | Hyatt Regency, Maui, HI 19 GUEST SPEAKERS (continued) THOMAS G. ORR MEMORIAL LECTURESHIP PLANNING AND PERFORMANCE UNDER STRESS TUESDAY, APRIL 4, 2017 2:45pm – 3:30pm Monarchy 4 Speaker: S. Rob Todd, MD Houston, TX S. Rob Todd received his Bachelor of Business Administration degree in Finance from The University of Texas at Austin in 1992. He then matriculated from Texas Tech University Health Sciences Center School of Medicine with a Doctorate of Medicine in 1996. He remained in the Texas Tech University system where he completed his General Surgery residency in 2001. He followed that with a Fellowship in Trauma and Surgical Critical Care from Oregon Health & Science University in 2003. During fellowship, his research focused on hemorrhagic shock and its’ resuscitation. In August of 2003, he joined The University of Texas Medical School at Houston as an Assistant Professor in the Department of Surgery. His primary clinical responsibilities included trauma surgery, surgical critical care, and emergency general surgery (Acute Care Surgery). In August of 2006, he joined The Methodist Hospital (Houston, Texas) as an Acute Care Surgeon where he was the Medical Director of the Surgical Intensive Care Unit and the Associate Program Director of the Residency in General Surgery. He was an Assistant Professor of Surgery at Weill Cornell Medical College. His research focus was on surgical sepsis and surgical education. In 2011, he was recruited to New York University School of Medicine (New York, New York) as an Acute Care Surgeon where he served as the Chief of Trauma and Emergency Surgery for Bellevue Hospital Center. His research focus was blood product utilization in the surgical population. Dr. Todd was recruited to Baylor College of Medicine (Houston, Texas) in 2014, where he currently serves as Professor of Surgery and Chief of Acute Care Surgery. He is also the Chief of General Surgery and Trauma and the Medical Director of the Trauma Surgical Intensive Care Unit at the Ben Taub Hospital. 20 Southwestern Surgical Congress | 69th Annual Meeting GUEST SPEAKERS (continued) THOMAS G. ORR MEMORIAL LECTURESHIP PAST PRESENTERS 1966 Michael E. DeBakey, MD 1983 G. Rainey Williams, MD 2000 H. Harlan Stone, MD 1967 Edgar J. Poth, MD 1984 Samuel A. Wells, Jr., MD 2001 Russell G. Postier, MD 1968 Stanley R. Friesen, MD 1985 Layton F. Rikkers, MD 2002 Richard J. Andrassy, MD 1969 Philip B. Price, MD 1986 Ronald C. Jones, MD 2003 Keith Lillemoe, MD 1970 Kenneth C. Sawyer, MD 1987 W. Sterling Edwards, MD 2004 Alan Thorson, MD 1971 Merlin K. DuVal, MD 1988 Laurence Y. Cheung, MD 2005 Nathaniel Soper, MD 1972 C. Frederick Kittle, MD 1989 Tom R. DeMeester, MD 2006 Thomas Weber, MD 1973 Erie E. Peacock, MD 1990 Charles M. Balch, MD 2007 Byers W. Shaw, MD 1974 Eugene M. Brickner, MD 1991 Alex G. Little, MD 2008 Shuvo Roy, PhD 1975 William R. Waddell, MD 1992 Donald E. Fry, MD 2009 Mark A. Talamini, MD 1976 Denton A. Cooley, MD 1993 Keith Reemtsma, MD 2010 Barbara Lee Bass, MD 1977 Gilbert S. Campbell, MD 1994 C. James Carrico, MD 2011 John Potts, III, MD 1978 Howard T. Robertson, MD 1995 Frederick L. Grover, MD 2012 David Mercer, MD 1979 Norman M. Rich, MD 1996 Ernest E. Moore, Jr., MD 2013 Alicia Mangram, MD 1980 W. Gerald Rainer, MD 1997 Nicholas P. Lang, MD 2014 Daniel R. Margulies, MD 1981 Arthur C. Beall, Jr., MD 1998 Alden H. Harken, MD 2015 Raul S. Coimbra, MD, PhD 1982 Arlo S. Hermreck, MD 1999 Frederick A. Moore, MD 2016 Donald Lesslie, MD April 2 – 5, 2017 | Hyatt Regency, Maui, HI 21 GUEST SPEAKERS (continued) CLAUDE H. ORGAN, JR. MEMORIAL LECTURESHIP WHY THE VA MATTERS: RESIDENT EDUCATION, RESEARCH AND VETERAN CARE WEDNESDAY, APRIL 5, 2017 8:45am - 9:30am Monarchy 4 Speaker: John Moore, MD Denver, CO Dr. Moore was born in Omaha, NE the third child of Tom and Pat Moore. He attended high school at Creighton Prep Jesuit before moving on to the University of Notre Dame. He returned to Omaha to complete his undergraduate work at Creighton University and medical school at University of Nebraska Medical College. While in his third year of medical school he married the love of his life and high school sweetheart Laura Vita Ancona. At the completion of medical school, they moved to Denver for his surgical residency at Saint Joseph Hospital. He then completed a year of pediatric surgical fellowship before moving on to his professional life. In order he has been employed by Kaiser Permanente, a partner in Surgical Consultants P.C., Program Director of the General Surgical Residency at Saint Joseph Hospital and currently the Assistant Chief of Surgery and Associate Chief of Staff for Academic Affiliates at the Veterans Administration Hospital of Denver. Along the way, he has been blessed with 3 wonderful children, a brand new grandchild as well as a terrible golf swing. Laura and he reside in Greenwood Village enjoying their downsized home, friends and travel. 22 Southwestern Surgical Congress | 69th Annual Meeting GUEST SPEAKERS (continued) CLAUDE H. ORGAN, JR. MEMORIAL LECTURESHIP PAST PRESENTERS 1996 V. Suzanne Klimberg, MD 2007 Glen D. Warden, MD 1997 LaSalle D. Leffall, Jr., MD 2008 Dmitry Oleynikov, MD 1998 Samuel A. Wells, Jr., MD 2009 Mary L. Brandt, MD 1999 Hiram C. Polk, Jr., MD 2000 F. Charles Brunicardi, MD 2001 John B. Cone, MD 2002 Douglas S. Reintgen, MD 2003 Frank Lewis, MD 2004 Philip Schauer, MD 2010 Ernest E. Moore, MD 2011 Ronald M. Stewart, MD 2012 Eugene Foley, MD 2013 Kelly McMasters, MD 2014 Shanu N. Kothari, MD 2015 2015 Roxie M. Albrecht, MD 2016 Terry C. Lairmore, MD 2005 Sean J. Mulvihill, MD 2006 John Hanks, MD April 2 – 5, 2017 | Hyatt Regency, Maui, HI 23 AWARDS JACK A. BARNEY RESIDENT’S AWARD Dr. Jack A. Barney received his medical degree in 1956 from the University of Oklahoma. He completed his surgical residency training at St. Anthony Hospital and the University of Oklahoma Health Science Center before entering private practice in Oklahoma City. Dr. Barney continued in private practice in Oklahoma City and Clinical Assistant Professor of Surgery at the University of Oklahoma. The Barney award is given to the best paper presented by a resident. 1987 Ronald M. Stewart, MD 1997 Evan R. Kokoska, MD 2007 Marcene McVay, MD 1988 T.L. Demmy, MD 1998 Tari King, MD 2008 Jodi Gerdes, MD 1989 Ronald M. Stewart, MD 1999 David G. Affleck, MD 2009 Jennifer Keller, MD 1990 George Orloff , MD 2000 Philip A. Woodworth, MD 2010 Brenda Kopriva, MD 1991 L. Lee Nelson, MD 2001 Elizabeth K. Paulsen, MD 2011 Stephanie Cohen, MD, MS 1992 Phillip M. Brown, MD 2002 Sandra Wong, MD 2012 Paul Bjordahl, MD 1993 Timothy C. Hollingsed, MD 2003 Ketan Desai, MD 2013 Irminne Van Dyken, MD 2004 Joseph A. Davis, MD 2014 Katie Wiggins-Dohlvik, MD 1994 Walter L. Biffl, MD 1995 Daniel R. Meldrum, MD 1996 David A. Partrick, MD 24 2005 Elizabeth Fitzsullivan, MD 2006 Hyong Kim, MD 2015 Abdul Alarhayem, MD 2016 Abdul Alarhayem, MD Southwestern Surgical Congress | 69th Annual Meeting AWARDS BEST POSTER AWARD This award is presented to the highest ranked poster presented at the Southwestern Surgical Congress Annual Meeting. 1996 Abdelkrim Touijer, MD 2008 Candy Arentz, MD 1997 Joseph Huh, MD 2009 Christian Jones, MD 1998 Hedieh Stefanacci, MD 2010 Shuan Brown, MD 1999 Stacy L. Stratmann, MD 2011 Amani Jambhekar, BA, BS 2000 Archana Ganaraj, MD 2012 Gaurav Kaushik, PhD 2001 Erik B. Wilson, MD 2013 Anne Doughtie, MD 2002 Danny Little, MD 2014 Timothy Feldmann, MD 2003 Anees Chagpar, MD 2014 Timothy Feldmann, MD 2004 Shawn St. Peter, MD 2015 Caitlin Gade, MD 2007 Shanu Kothari, MD 2016 Cristine S. Velazco, MD April 2 – 5, 2017 | Hyatt Regency, Maui, HI 25 IN MEMORIAM DEATHS REPORTED 2016 – 2017 As of March, 2017 John C. Baldwin, MD - Lubbock, TX Leroy H. Stahlgren, MD - Denver, CO Denton A. Cooley, MD - Houston, TX Frank Gorden Moody, MD - Houston, TX Henry Laws, MD - Birmingham, AL Please report any known member deaths to the Southwestern Surgical Congress: Southwestern Surgical Congress 2625 W. 51st Terrace Westwood, KS 66205 t: 913-402-7102 [email protected] www.swscongress.org 26 Southwestern Surgical Congress | 69th Annual Meeting 2016 – 2017 NEW MEMBERS ACTIVE FELLOWS Sasha D. Adams, MD Houston, TX Joseph Darryl Amos, MD Dallas, TX Christopher D Carey, MD Oklahoma City, OK Sebastiano Cassaro, MD Visalia, CA Mitchell Jay Cohen, MD Denver, CO Alexander Lorenzo Colonna, MD Salt Lake City, UT Joshua L. Gierman, MD Oklahoma City, OK Tien C. Ko, MD Houston, TX Sumeet K. Mittal, MBBS, MBA Phoenix, AZ Colleen D. Murphy, MD Denver, CO Keith H. Paley, MD Owatonna, MN Alexander Raines, MD Oklahoma City, OK Elizabeth Padgett Scherer, MD, MPH San Antonio, TX Bradley Winston Thomas, MD, FACS Charlotte, NC Irminne Van Dyken, MD, FACS Ewa Beach, HI Justin Lane Green, MD, MS, MBA, PhD Kansas City, KS Derek Brian Wall, MD Skokie, IL Kenneth Scott Helmer, MD Conroe, TX Ryan F. Wicks, MD Oklahoma City, OK Kenneth Michael Jastrow, MD San Angelo, TX Advanced Practice Clinician Jason Michael Johnson, DO Denver, CO Teresa Shyr Jones, MD, MS Denver, CO Peter T. Kennealey, MD Denver, CO Shane Backman, MPAS Salt Lake City, UT Gena Belk Brawley, ACNP-BC Charlotte, NC Kimberli Bruce, ACNP-BC Phoenix, AZ April 2 – 5, 2017 | Hyatt Regency, Maui, HI 27 2016 – 2017 NEW MEMBERS (continued) Barbara Deanna Carey, ACNP Oklahoma City, OK Brittany Anne Gerali, MHS, PA-C, RD Murray, UT Susan Lynn Jackson, RN, FNP, ANCC Denver, CO Edward Rance Wadley, MPAS, PA-C Oklahoma City, OK Sean Tyler Yoder, MSN, AGACNP-BC Dallas, TX Jennifer Lynn Zeller, MSN, CRNP, ANCC Baltimore, MD ASSOCIATE FELLOW Bradley R. Hall, MD Omaha, NE Laura A. Harmon, MD Baltimore, MD Jordan Hoffman, MD, MPH Atlanta, GA 28 Southwestern Surgical Congress | 69th Annual Meeting SCHEDULE AT A GLANCE April 2 – 5, 2017 | Hyatt Regency, Maui, HI 29 SCHEDULE AT A GLANCE SATURDAY, APRIL 1, 2017 30 1:00pm - 2:00pm SWSC Executive Committee Meeting Monarchy 5 2:00pm - 5:00pm SWSC Council Meeting Monarchy 5 5:00pm - 6:00pm Program Directors Meeting Monarchy 5 6:30pm - 7:00pm Lowry Donors Reception Napili Pool Lawn 7:00pm - 8:30pm President’s & Residents Reception Napili Pool Lawn Southwestern Surgical Congress | 69th Annual Meeting SCHEDULE AT A GLANCE (continued) SUNDAY, APRIL 2, 2017 7:30am - 5:00pm SWSC Registration Grand Promenade 8:00am - 12:00pm PostGraduate Course - Emergency General Surgery Monarchy 4 8:00am - 12:00pm PostGraduate Course - Trauma Maui Suite 1-2 1:00pm - 2:30pm Opening Scientific Session I: General Surgery Monarchy 4 2:30pm - 2:45pm Introduction of SWSC New Members Monarchy 4 2:45pm - 3:15pm Afternoon Beverage Break, ePoster & Exhibit Viewing Monarchy 1-3 3:15pm - 4:30pm Scientific Session II: Trauma I Monarchy 4 4:30pm - 5:15pm Presidential Address: “Surgical Education: Lessons from Parenthood” Clay Cothren Burlew, MD Denver, CO Monarchy 4 5:30pm - 6:30pm SWSC Presidents ePoster Session Monarchy 1-3/Foyer 6:30pm - 7:30pm SWSC Welcome & Exhibitor Reception Monarchy 1-3 April 2 – 5, 2017 | Hyatt Regency, Maui, HI 31 SCHEDULE AT A GLANCE (continued) MONDAY, APRIL 3, 2017 32 6:00am - 11:30am SWSC Registration Grand Promenade 6:30am - 8:30am Continental Breakfast Sunset Terrace 6:30pm - 7:30pm SWSC Yoga on the Beach *additional fee applies 6:30am - 8:00am Quick Shot Presentation I: Acute Care Surgery Monarchy 4 6:30am - 8:00am Quick Shot Presentations II: Trauma Maui Suite 1-2 6:30am - 8:00am Quick Shot Presentations III: Surgical Oncology Maui Suite 3-4 8:00am - 11:30am American College of Surgeons Session Monarchy 4 9:30am - 10:00am Morning Beverage Break, ePoster & Exhibit Viewing Monarchy 1-3 11:30am - 12:00pm MCT Committee Meeting Monarchy 4 1:00pm – 6:00pm SWSC Annual Golf Tournament Kaanapali Royal Golf Course *additional fee applies 2:00pm – 4:00pm Kayak and Snorkel Excursion Hanakao’o Beach Park “Canoe Beach” *additional fee applies Southwestern Surgical Congress | 69th Annual Meeting SCHEDULE AT A GLANCE (continued) TUESDAY, APRIL 4, 2017 6:00am - 5:00pm Registration Grand Promenade 6:30am - 9:00am Continental Breakfast Sunset Terrace 6:30am - 7:30am Quick Shot Presentation IV: Critical Care Monarchy 4 6:30am - 7:30am Quick Shot Presentations V: Outcomes/Quality Maui Suite 1-2 6:30am - 7:30am Quick Shot Presentations VI: General Surgery Maui Suite 3-4 7:30am - 8:45am Scientific Session III: Surgical Oncology Monarchy 4 8:45am - 9:30am Edgar J. Poth Memorial Lecture: “Informed Consent It Is More than Just a Signature on a Piece of Paper” Christine Cocanour, MD Sacramento, CA Monarchy 4 9:30am - 10:00am Morning Beverage Break, Poster & Exhibit Viewing Monarchy 1-3/Foyer 10:00am - 11:00am Scientific Session IV: Education/Other Monarchy 4 11:00am - 12:00pm Past Presidents Panel Monarchy 4 12:00pm - 1:30pm Mock Oral Boards Maui Suite 1-2 April 2 – 5, 2017 | Hyatt Regency, Maui, HI 33 SCHEDULE AT A GLANCE (continued) TUESDAY, APRIL 4, 2017 34 12:15pm - 1:30pm Global Opportunities Luncheon *additional fee applies Maui Suite 3-4 1:00pm - 2:00pm Hula Dance Lesson for SWSC Guests Halona Kai Lawn 1:30pm - 2:30pm Scientific Session V: Laparascopy Monarchy 4 2:30pm - 2:45pm Afternoon Beverage Break, ePoster & Exhibit Viewing Monarchy 1-3/Foyer 2:45pm - 3:30pm Thomas G. Orr Memorial Lecture: “Planning and Performance Under Stress” S. Rob Todd, MD Houston, TX Monarchy 4 3:30pm - 4:30pm Scientific Session VI: Trauma II Monarchy 4 4:30pm - 5:00pm SWSC Annual Business Meeting (Members Only) Monarchy 4 5:00pm – 6:00pm SWSC APC Reception Hyatt Residence Club Bar 6:00pm – 9:00pm SWSC Reception Haloni Kai Lawn Southwestern Surgical Congress | 69th Annual Meeting SCHEDULE AT A GLANCE (continued) WEDNESDAY, APRIL 5, 2017 6:00am – 11:30am SWSC Registration Grand Promenade 6:30am - 8:30am Continental Breakfast Sunset Terrace 6:30am - 7:30am Quick Shot Presentations VII: Trauma/General Monarchy 4 6:30am - 7:30am Quick Shot Presentations VIII: Potpourri Maui Suite 1-2 6:30am - 7:30am Quick Shot Presentations IX: Pediatric/Vascular Maui Suite 3-4 7:30am - 8:45am Scientific Session VII: Potpourri Monarchy 4 8:45am - 9:30am Claude H. Organ, Jr. Memorial Lecture John Moore, MD Denver, CO Monarchy 4 9:30am – 10:15am Top 10 Papers in Trauma 2016 Monarchy 4 10:15am – 11:00am Top 10 Papers in General Surgey 2016 Monarchy 4 11:00am - 11:30am Award Presentations & Closing Session Monarchy 4 April 2 – 5, 2017 | Hyatt Regency, Maui, HI 35 36 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGR AM April 2 – 5, 2017 | Hyatt Regency, Maui, HI 37 SCIENTIFIC PROGRAM SATURDAY, APRIL 1, 2017 1:00pm - 2:00pm SWSC Executive Committee Meeting Monarchy 5 2:00pm - 5:00pm SWSC Council Meeting Monarchy 5 5:00pm - 6:00pm Program Directors Meeting Monarchy 5 6:30pm - 7:00pm Lowry Donors Reception Napili Pool Lawn 7:00pm - 8:30pm President’s & Residents Reception Napili Pool Lawn *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 38 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) SUNDAY, APRIL 2, 2017 7:30am - 5:00pm SWSC Registration Grand Promenade 8:00am - 12:00pm PostGraduate Course - Emergency General Surgery Monarchy 4 Moderator: Michael Truitt, MD - Dallas, TX 8:00am - 8:20am Management of Choledocholithiasis Richard Frazee, MD – Temple, TX 8:20am - 8:40am Frailty and Operative Risk Robert C. McIntyre, MD – Denver, CO 8:40am - 9:00am Current Controversies in Ventral Hernia Repair S. Rob Todd, MD – Houston, TX 9:00am - 9:20am Perianal Woes Jeff Johnson, MD – Denver, CO 9:20am - 9:40am Morning Break 9:40am - 10:00am Damage Control Emergency General Surgery Lillian Liao, MD, MPH – San Antonio, TX 10:00am - 10:20am Update on Gastric and Duodenal Ulcer Disease David V. Feliciano, MD – Indianapolis, IN *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 39 SCIENTIFIC PROGRAM (continued) 10:20am - 10:40am Management of Pre-existing Ventral Hernia During EGS Mitch Cohen, MD – Denver, CO 10:40am - 11:00am Morning Break 11:00am - 12:00pm Lab Breakout Sessions Station#1: Virtual Colonoscopy David Antonenko, MD – Grand Forks, ND Station#2: Virtual Bronchoscopy/EBUS Fredric Pieracci, MD, MPH – Denver, CO Station #3: 3D Laparoscopy/Suturing Kenric M. Murayama, MD – Honolulu, HI Dean J. Mikami, MD – Honolulu, HI 8:00am - 12:00pm PostGraduate Course - Trauma Maui Suite 1-2 Moderator: Alicia Mangram, MD – Phoenix, AZ 8:00am - 8:20am Liver Ernest A. Gonzalez, MD – Austin, TX 8:20am - 8:40am Pelvis Clay Burlew, MD – Denver, CO 8:40am - 9:00am REBOA Laura J. Moore, MD – Houston, TX 9:00am - 9:20am Trauma-induced Coagulopathy Ernest E. Moore, MD – Denver, CO *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 40 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 9:20am - 9:40am Morning Break 9:40am - 10:00am Spleen Grace Rozycki, MD, MBA – Indianapolis, IN 10:00am - 10:20am Pediatric Surgery David Partrick, MD MD – Denver, CO 10:20am - 10:40am Thoracic Francis Ali-Osman, MD – Phoenix, AZ 10:40am - 11:00am Morning Break 11:00am - 12:00pm Lab Breakout Sessions Station#1: Vascular Access/REBOA Laura J. Moore, MD – Houston, TX Station#2: Rib Repair Francis Ali-Osman, MD – Phoenix, AZ Station #3: Hemostasis Justin Regner, MD – Temple, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 41 SCIENTIFIC PROGRAM (continued) 1:00pm - 2:30pm Opening Scientific Session I: General Surgery Monarchy 4 Moderators: Fredric Pieracci, MD, MPH - Denver, CO; Sam Finlayson, MD, MPH Salt Lake City, UT 1:00pm - 1:15pm 1. OUTPATIENT LAPAROSCOPIC APPENDECTOMY CAN BE SUCCESSFULLY PERFORMED FOR UNCOMPLICATED APPENDICITIS: A SOUTHWESTERN SURGICAL CONGRESS MULTICENTER TRIAL Presenter: Richard Frazee, MD - Temple, TX Invited Discussant: Kenric Murayama, MD - Honolulu, HI 1:15pm - 1:30pm 2. KEEP CALM AND CARRY ON OPERATING! INVESTIGATING OUTCOMES OF PATIENTS UNDERGOING URGENT LAPAROSCOPIC APPENDECTOMY ON ANTITHROMBOTIC THERAPY Presenter: Michael Truitt, MD - Dallas, TX Invited Discussant: Ronald Stewart, MD - San Antonio, TX 1:30pm - 1:45pm *3. FOLLOW-UP TRENDS AFTER EMERGENCY DEPARTMENT DISCHARGE FOR THE ACUTELY SYMPTOMATIC HERNIA Presenter: Lara Spence, MD - torrance, CA Invited Discussant: Erik Peltz, DO - Denver, CO 1:45pm - 2:00pm *4. DAY VERSUS NIGHT LAPAROSCOPIC CHOLECYSTECTOMY: A COMPARISON OF OUTCOMES AND COST Presenter: Sammy Siada, DO - Fresno, CA Invited Discussant: David B. Adams, MD - Charleston, SC 2:00pm - 2:15pm *5. ADDRESSING THE QUALITY AND COSTS OF CHOLECYSTECTOMY AT A SAFETY NET HOSPITAL Presenter: Roy Won, MD - Torrance, CA Invited Discussant: Krista Kaups MD, MSc - Fresno, CA *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 42 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 2:15pm - 2:30pm 6. ACUTE POST-OPERATIVE DELIRIUM INCREASES LONG TERM MORTALITY IN OLDER SURGICAL PATIENTS Presenter: Eliza Moskowitz, MD - Aurora, CO Invited Discussant: John Harvin, MD - Houston, TX 2:30pm - 2:45pm Introduction of SWSC New Members Monarchy 4 2:45pm - 3:15pm Afternoon Beverage Break, ePoster & Exhibit Viewing Monarchy 1-3 3:15pm - 4:30pm Scientific Session II: Trauma I Monarchy 4 Moderators: Justin Regner, MD - Temple, TX; Laura Moore, MD - Houston, TX 3:15pm - 3:30pm *7. TARGETING RESUSCITATION TO NORMALIZATION OF COAGULATING STATUS: HYPER AND HYPOCOAGUALABILITY AFTER SEVERE INJURY ARE BOTH ASSOCIATED WITH INCREASED MORTALITY Presenter: Hunter Moore, MD - Denver, CO Invited Discussant: Bryan C. Morse MD, MS - Atlanta, GA 3:30pm - 3:45pm 8. IMPACT OF GERIATRIC CONSULTATIONS ON CLINICAL OUTCOMES OF ELDERLY TRAUMA PATIENTS: A RETROSPECTIVE ANALYSIS Presenter: Mustafa Baldawi, MD - Toledo, OH Invited Discussant: Walter Biffl, MD - Honolulu, HI 3:45pm - 4:00pm 9. IS HEAD CT INDICATED AFTER EVERY GROUND LEVEL FALL IN THE ELDERLY? Presenter: Sharmila Dissanaike, MD, FACS - Lubbock, TX Invited Discussant: Amy Kwok, MD, PhD - Fresno, CA *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 43 SCIENTIFIC PROGRAM (continued) 4:00pm - 4:15pm +10. PRETRANSFER CT SCANS ARE FREQUENTLY PERFORMED, BUT RARELY HELPFUL IN RURAL TRAUMA SYSTEMS Presenter: Danielle Thornburg, MS4 - Sioux Falls, SD Invited Discussant: Robert McIntyre, MD - Denver, CO 4:15pm - 4:30pm *11. RETURNING FROM THE ACIDOTIC ABYSS: MORTALITY IN TRAUMA PATIENTS WITH A PH <7.0 Presenter: Samuel Ross, MD, MPH - Charlotte, NC Invited Discussant: David V. Feliciano - Indianapolis, IN 4:30pm - 5:15pm Presidential Address: “Surgical Education: Lessons from Parenthood” Clay Cothren Burlew, MD Denver, CO Monarchy 4 5:30pm - 6:30pm SWSC Presidents ePoster Session Monarchy 1-3/Foyer ePoster Station I: Trauma I Moderators: Robert C. McIntyre, MD - Denver, CO; David V. Feliciano, MD Indianapolis, IN 5:30pm - 5:35pm P 1. TYPE OF CERVICAL SPINE FRACTURE AND VASCULAR INJURY OF THE NECK Presenter: Yuichi Ishida, MD - El Paso, TX 5:35pm - 5:40pm P 2. MASS CASUALTY PLANNING: A SURVEY OF TEN TEXAS TRAUMA CENTERS Presenter: Samuel Long, MD - Austin, TX 5:40pm - 5:45pm P 3. GEOGRAPHIC ANALYSIS OF TRAUMA READMISSIONS IN NORTH TEXAS Presenter: Laura Petrey, MD - Dallas, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 44 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 5:45pm - 5:50pm P 4. SERIOUS INJURY REPORTING SYSTEMS IN CHILDREN PLAYING ORGANIZED SPORTS: A SURVEY OF ALL 50 US STATES Presenter: Pamela Daher, MD - Austin, TX 5:50pm - 5:55pm P 5. INFECTION AFTER PENETRATING BRAIN INJURY -- A DECADE OF ANALYSIS Presenter: Laura Harmon, MD - Baltimore, MD 5:55pm - 6:00pm P 6. THE HIGH COST OF LARGE BORE TUBE THORACOSTOMY FOR TRAUMATIC PNEUMOTHORAX Presenter: William Lyman, MD - Charlotte, NC 6:00pm - 6:05pm P 7. CAN CT IMAGING OF THE CHEST, ABDOMEN, AND PELVIS IDENTIFY ALL VERTEBRAL INJURIES OF THE THORACOLUMBAR SPINE WITHOUT DEDICATED REFORMATTING? Presenter: Jonathan Imran, MD - Dallas, TX 6:05pm - 6:10pm P 8. POST-TRANSFER TUBE THORACOSTOMY PLACEMENT AMONG TRAUMA PATIENTS DIAGNOSED WITH A PNEUMOTHORAX OR HEMOTHORAX: IS IT ASSOCIATED WITH POOR OUTCOMES? Presenter: Cullen McCarthy, MD - Oklahoma City, OK 6:10pm - 6:15pm P 9. PRE-HOSPITAL SPINAL IMMOBILIZATION: NEUROLOGICAL OUTCOMES FOR SPINAL MOTION RESTRICTION VS. SPINAL IMMOBILIZATION Presenter: Aaron Nilhas, MD - Wichita, KS 6:15pm - 6:20pm P 10. RIDE-SHARING PLATFORM TECHNOLOGY’S IMPACT ON DRUNK DRIVING CRASHES AND DEATHS Presenter: Evan Ross, MD - Austin, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 45 SCIENTIFIC PROGRAM (continued) ePoster Station II: Potpourri I Moderators: David Antonenko, MD, PhD - Grand Forks, ND; John Potts, III, MD Chicago, IL 5:30pm - 5:35pm P 12. HAWAII: ISLANDS OF PARADISE- AND PERFORATED DUODENAL ULCERS Presenter: Christina Souther, MD, MPH - Honolulu, HI 5:35pm - 5:40pm P 13. DESTRUCTIVE TORNADOS: A COMPARISON OF TORNADOASSOCIATED INJURIES IN ADULT VERSUS PEDIATRIC PATIENTS FROM A COMBINED TRAUMA CENTER Presenter: Alessandra Landmann, MD - Oklahoma City, OK 5:50pm - 5:55pm P 16. OUTCOMES OF RURAL TRAUMA PATIENTS WHO UNDERGO DAMAGE CONTROL LAPAROTOMY Presenter: Paige Harwell, MD - Wichita, KS 5:55pm - 6:00pm P 17. GLOBAL HEALTH OPPORTUNITIES: DOES INTEREST EQUAL ACTION? Presenter: Eric Wise, MD - Baltimore, MD 6:00pm - 6:05pm P 18. LAPAROSCOPIC APPENDECTOMY IN THE NON-ACUTE APPENDIX: IS IT APPROPRIATE? Presenter: Deidre Wyrick, MD - Little Rock, AR 6:10pm - 6:15pm P 20. EPIDEMIOLOGY PROJECT REVEALS SIGNIFICANTLY LOWER INCIDENCE OF FUNCTIONAL GALLBLADDER DISORDER THAN THE STATE AND NATIONWIDE ADMINISTRATIVE DATABASE Presenter: Mohamed Mohamed, MBBS - Rochester, MN 6:15pm - 6:20pm P 21. PHEOCHROMOCYTOMA: A CASE OF DEVASTATING RESPIRATORY FAILURE WITH ECMO SALVAGE Presenter: L. Ashley Griffin, MD - Madison, MS *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 46 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 6:20pm - 6:25pm P 22. DIRECT PERITONEAL RESUSCITATION IN SEVERE NECROTIZING PANCREATITIS: A STRATEGY FOR PREVENTION OF ABDOMINAL COMPARTMENT SYNDROME? A CASE REPORT Presenter: Amelia Pasley, DO - Baltimore, MD ePoster Station III: Potpourri II Moderators: Edward Nelson, MD - Salt Lake City, UT; Alan G. Thorson, MD Omaha, NE 5:30pm - 5:35pm P 23. ACE INHIBITOR INDUCED INTESTINAL ANGIOEDEMA: A LITTLE KNOWN BUT SIMPLY CORRECTED PROCESS CONFUSED WITH INTESTINAL ISCHEMIA Presenter: Samuel Ross, MD - Charlotte, NC 5:35pm - 5:40pm P 24. GALLBLADDER WALL THICKNESS MEASURED ON ULTRASOUND: IS IT ASSOCIATED WITH OPERATIVE TIME AND SURGICAL PATHOLOGY? Presenter: Shanu Kothari, MD - La Crosse, WI 5:40pm - 5:45pm P 25. SAFETY AND FEASIBILITY OF SEMI-RIGID INCOMPLETE ANNULOPLASTY RING IMPLANTATION FOR FUNCTIONAL MITRAL REGURGITATION Presenter: Patrick Chan, MD - Pittsburgh, PA 5:45pm - 5:50pm P 26. STRAY ENERGY TRANSFER TO REINFORCED ENDOTRACHEAL TUBES DURING NECK SURGERY Presenter: Sarah Hilton, MD - Denver, CO 5:50pm - 5:55pm P 27. THE SENSITIVITY OF 4D MRI IN PREOPERATIVE LOCALIZATION OF PARATHYROID ADENOMA IS INFLUENCED BY THE SIZE OF THE ADENOMA Presenter: Kelvin Memeh, MD - Tucson, AZ *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 47 SCIENTIFIC PROGRAM (continued) 5:55pm - 6:00pm P 28. THE EFFECT OF ARCHITECTURAL DESIGN ON THE INCIDENCE OF HOSPITAL WIDE DELIRIUM Presenter: Aaron Lynn, MD, PhD - Denver, CO 6:00pm - 6:05pm P 29. HERNIA FORMATION FOLLOWING AORTOILIAC INTERVENTIONS Presenter: Sara McKeever, DO - Little Rock, AR 6:05pm - 6:10pm P 30. CARDIAC ARREST SECONDARY TO ACCIDENTAL HYPOTHERMIA: DOES EXTRACORPOREAL BYPASS WORK? Presenter: Julia Coleman, MD, MPH - Aurora, CO 6:10pm - 6:15pm P 31. RADIOGRAPHIC VENTRAL HERNIAS ARE PREVALENT BEFORE AND AFTER ABDOMINAL SURGERY Presenter: Deepa Cherla, MD - Basking Ridge, NJ 6:20pm - 6:25pm P 33. TRENDS IN FEMORAL HERNIA REPAIRS PERFORMED FOR RECURRENCE IN THE UNITED STATES Presenter: Brittany Murphy, MD - Rochester, MN ePoster Station IV: Advanced Laparoscopy Moderators: Kenric Murayama, MD - Honolulu, HI; Ronald Stewart, MD - San Antonio, TX 5:30pm - 5:35pm P 34. ROBOT-ASSISTED DIAPHRAGM PLICATION VIA AN ABDOMINAL APPROACH Presenter: David Hill, MD - Phoenix, AZ 5:40pm - 5:45pm P 36. SPLENIC INJURIES AFTER ERCP Presenter: Mallory J. Yelenich-Huss - Grand Forks, ND *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 48 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 5:50pm - 5:55pm P 38. LAPAROSCOPIC VENTRAL HERNIA AND INGUINAL HERNIA REPAIR USING ONLY TWO 5MM PORTS Presenter: Hugo Bonatti, MD – Schwaz, Austria 5:55pm - 6:00pm P 39. USE OF LIGHTED URETERAL STENTS IN LAPAROSCOPIC COLON SURGERY Presenter: Hugo Bonatti, MD – Schwaz, Austria 6:00pm - 6:05pm P 40. PATIENT OUTCOMES FOLLOWING ROUX-EN-Y GASTRIC BYPASS REVERSAL Presenter: Philip Ernest, MD – Denver, CO 6:05pm - 6:10pm P 41. FEMALE VERSUS MALE MORBIDLY OBESE SURGICAL PATIENTS VARY SIGNIFICANTLY IN PRE-OPERATIVE CLINICAL CHARACTERISTCS: ANALYSIS OF 67,514 BARIATRIC SURGERY WOMEN AND MEN Presenter: Christopher Bashian, DO - Vineland, NJ 6:10pm - 6:15pm P 42. INITIAL EXPERIENCE WITH LAPAROSCOPIC SLEEVE GASTRECTOMY IN A SAFETY NET HOSPITAL SYSTEM Presenter: Irada Ibrahim-zada, MD, PhD - Aurora, CO 6:15pm - 6:20pm P 43. LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY: 3-YEAR OUTCOMES Presenter: Emanuel Nearing II, MD - La Crosse, WI 6:20pm - 6:25pm P 44. INITIAL ROBOTIC EXPERIENCE IN COMBINED RECURRENT UMBILICAL HERNIA AND DIASTASIS RECTI REPAIR Presenter: Daniel Vargo, MD - Salt Lake City, UT *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 49 SCIENTIFIC PROGRAM (continued) ePoster Station V: Outcomes/Quality Moderators: Maria Allo, MD - Los Altos, CA; James Edney, MD - Omaha, NE 5:30pm - 5:35pm P 45. THE EFFECTS OF OPERATING ROOM RESTRUCTURING ON QUALITY OF SURGICAL CARE FOR BENIGN BILIARY DISEASE AT A SAFETY-NET HOSPITAL Presenter: Krislynn Mueck, MD, MPH - Houston, TX 5:40pm - 5:45pm P 47. DECREASING TRANSFERS TO HIGHER LEVEL OF CARE FOLLOWING TRANSFERS OUT OF THE ICU Presenter: Sonja McAllister, RN MSN - La Jolla, CA 5:45pm - 5:50pm P 48. STANDARDIZING HANDOFFS BETWEEN OPERATING ROOM AND SURGICAL INTENSIVE CARE UNIT IMPROVES INFORMATION EXCHANGE Presenter: Dhriti Mukhopadhyay, MD - Temple, TX ePoster Station V: Outcomes/Quality 5:50pm - 5:55pm P 49. A THREE PRONGED APPROACH FOR PRACTICE-BASED LEARNING AND QUALITY OF CARE IMPROVEMENT IN A SURGICAL RESIDENCY PROGRAM Presenter: Kyle Rose, MD - Phoenix, AZ 5:55pm - 6:00pm P 50. HEALTH LITERACY DISPARITIES AMONG TRAUMA PATIENTS: A TARGET OF OPPORTUNITY Presenter: Jonathan Dameworth, Md - Phoenix, AZ 6:00pm - 6:05pm P 51. MANAGING BARRIERS TO RECYCLING IN THE OPERATING ROOM Presenter: Solomon Azouz, MD MSc - Phoenix, AZ 6:05pm - 6:10pm P 52. IMPLEMENTATION OF AN ERAS PROTOCOL FOR COLECTOMY IS ASSOCIATED WITH IMPRESSIVE RESULTS Presenter: Irminne Van Dyken, MD - Kapolei, HI *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 50 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 6:10pm - 6:15pm P 53. IMPACT OF SURGICAL FELLOWSHIPS ON AMERICAN BOARD OF SURGERY PASS RATES FOR GENERAL SURGERY PROGRAMS Presenter: Mohammed Al Fayyadh, M.B.Ch.B. - San Antonio, TX 6:15pm - 6:20pm P 54. CLINICAL CHARACTERISTICS OF SUPER-OBESE FEMALE SURGICAL PATIENTS VARY BY RACE: ANALYSIS OF 1212 BOLD DATABASE PATIENTS Presenter: Michael Davis, DO - Vineland, NJ 6:20pm - 6:25pm P 55. TACKLE TRAUMA 5K RUN/WALK: A CONTEMPORARY AND INNOVATIVE WAY TO INCREASE COMMUNITY AWARENESS AND RAISE FUNDS TO REDUCE THE BURDEN OF TRAUMA Presenter: Alicia Mangram, MD – Phoenix, AZ ePoster Station VI: Trauma II Moderators: Ernest (Gene) Moore, MD - Denver, CO; Ernest L. Dunn, MD - Dallas, TX 5:30pm - 5:35pm P 56. TIMING IS EVERYTHING: OUTCOMES IN TRAUMATIC SUBDURAL HEMATOMAS BASED ON TIME TO OR Presenter: Rachel Caiafa, MD - Fresno, CA 5:35pm - 5:40pm P 57. RELATIONSHIP OF OIL PRICES AND ACTIVITY TO TRAUMA IN NORTHWESTERN NORTH DAKOTA Presenter: Cody Pratt, MD - Grand Forks, ND 5:40pm - 5:45pm P 58. INCIDENCE OF ACUTE KIDNEY INJURY IN SEVERELY INJURED PEDIATRIC TRAUMA PATIENTS IS NOT AFFECTED BY RECEIVING IV CONTRAST Presenter: Paul McGaha, MD - Oklahoma City, OK 5:45pm - 5:50pm P 59. 10 YEAR RETROSPECTIVE REVIEW OF INJURY PATTERNS BETWEEN 4-WHEELERS AND SIDE-BY-SIDE ALL TERRAIN VEHICLES Presenter: Shawn Olson, MD - Grand Forks, ND *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 51 SCIENTIFIC PROGRAM (continued) 5:50pm - 5:55pm P 60. FAILURE OF INTRACRANIAL PRESSURE RESPONSE TO BARBITURATE COMA Presenter: Richard Vasak, MD - Torrance, CA 6:00pm - 6:05pm P 62. CORRELATING GEOGRAPHIC LOCATION WITH INCIDENCE OF MOTOR VEHICLE INDUCED PEDESTRIAN INJURY Presenter: Matthew Bozeman, MD - Louisville, KY 6:10pm - 6:15pm P 64. MANAGEMENT OF MULTIPLE RIB FRACTURES AND FLAIL CHEST WITHOUT OPERATIVE RIB STABILIZATION AND IMPACT ON PATIENT OUTCOMES Presenter: Hanna Park, MD MPH - Colton, CA 6:15pm - 6:20pm P 65. THE FAST EXAM CAN RELIABLY IDENTIFY PATIENTS FOR ZONE III RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA (REBOA) DEPLOYMENT IN LIFE THREATENING PELVIC FRACTURES Presenter: Nicole Townsend, MD, MSCS - Aurora, CO 6:20pm - 6:25pm P 11. HEMOSTATIC MASSIVE TRANSFUSION PROTOCOLS AND TRAUMA LAPAROTOMIES Presenter: Susan McLean, MD - El paso, TX 6:30pm - 7:30pm SWSC Welcome & Exhibitor Reception Monarchy 1-3 *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 52 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) MONDAY, APRIL 3, 2017 6:00am - 11:30am SWSC Registration Grand Promenade 6:30am - 8:30am Continental Breakfast Sunset Terrace 6:30pm - 7:30pm SWSC Yoga on the Beach *additional fee applies 6:30am - 8:00am Quick Shot Presentation I: Acute Care Surgery Monarchy 4 Moderators: Lindsay O’Meara, CRNP - Westminster, MD; Teresa Jones, MD - Denver, CO 6:30am - 6:38am QS 1. MANAGEMENT AND OUTCOMES OF CHOLECYSTECTOMY IN PREGNANCY Presenter: Roy Won, MD - Torrance, CA 6:38am-6:46am QS 2. PREDICTORS OF FAILED TRANSCYSTIC LAPAROSCOPIC COMMON BILE DUCT EXPLORATION: A MULTICENTER INTEGRATED HEALTH SYSTEM EXPERIENCE Presenter: Mohammed Al-Temimi, MD, MPH - Fontana, CA 6:46am-6:54am QS 3. AN ACUTE CARE SURGERY MODEL IS ASSOCIATED WITH DECREASED COSTS AND LENGTH OF STAY AFTER APPENDECTOMY Presenter: Marissa Srour, MD - Los Angeles, CA *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 53 SCIENTIFIC PROGRAM (continued) 6:54am-7:02am QS 4. OUTPATIENT LAPAROSCOPIC APPENDECTOMY MAY BE SAFE FOR NON-PERFORATED GANGRENOUS APPENDICITIS Presenter: Anjali Patel, BA - Temple, TX 7:02am - 7:10am QS 5. EVALUATION OF NEGATIVE PRESSURE WOUND THERAPY TO CLOSED LAPAROTOMY INCISIONS IN ACUTE CARE SURGERY Presenter: Elleson Schurtz, MD - West Fargo, ND 7:10am-7:18am QS 6. A REVISED LRINEC SCORING SYSTEM FOR NECROTIZING FASCIITIS Presenter: Lara Spence, MD - Torrance, CA 7:18am-7:26am QS 7. “A NOT SO FORGOTTEN DISEASE”: A 10 YEAR ASSESSMENT OF PERFORATED GASTRO-DUODENAL ULCER Presenter: Viraj Pandit, MD - Tucson, AZ 7:26am - 7:34am QS 8. A FLIP OF A COIN: THE NATIONWIDE RISK OF MORTALITY AND ADVERSE OUTCOMES FOR ABDOMINAL COMPARTMENT SYNDROME Presenter: Samuel Ross, MD, MPH - Charlotte, NC 7:34am - 7:42am QS 9. POSTOPERATIVE MORTALITY FOR PATIENTS WITH COLONIC VOLVULUS ADVERSELY AFFECTED BY ASSOCIATED COMORBIDITIES Presenter: Kenneth Sirinek, MD, PhD - San Antonio, TX 7:42am - 7:50am QS 10. MANAGEMENT, OUTCOMES, AND COST OF NECROTIZING SOFT TISSUE INFECTIONS AT A COMMUNITY TEACHING HOSPITAL: SHOULD YOU SLASH BEFORE YOU DASH? Presenter: Brandon Grover, DO - La Crosse, WI *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 54 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 7:50am - 7:58am QS 11. EMERGENT CHOLECYSTECTOMY IS SUPERIOR TO PERCUTANEOUS CHOLECYSTOSTOMY TUBE PLACEMENT IN SEVERELY ILL PATIENT WITH EMERGENT CALCULOUS CHOLECYSTITIS Presenter: Bradley Hall, MD - Omaha, NE 6:30am - 8:00am Quick Shot Presentations II: Trauma Maui Suite 1-2 Moderators: Alicia Mangram, MD - Phoenix, AZ; Rifat Latifi, MD - Valhalla, NY 6:30am - 6:38am QS 12. EFFECT OF A CLINICAL PHARMACIST ON THE TRAUMA RESUSCITATION TEAM DURING RAPID SEQUENCE INTUBATIONS: A PROSPECTIVE OBSERVATIONAL STUDY Presenter: Charles Frank, BA - Atlanta, GA 6:38am-6:46am QS 13. GERIATRIC TRAUMA PATIENTS WITH RIB FRACTURES: IS THERE A DIFFERENCE IN OUTCOMES BETWEEN PATIENTS TREATED WITH RIB FIXATION COMPARED TO NON-OPERATIVE MANAGEMENT? Presenter: Francis Ali-Osman, MD - Phoenix, AZ 6:46am-6:54am QS 14. ABDOMINAL SEATBELT SIGN: NO LONGER A REQUIREMENT FOR ADMISSION? Presenter: Tammy Kopelman, MD – Phoenix, AZ 6:54am-7:02am QS 15. NOVEL CLINICAL COAGULOPATHY SCORE IS HIGHLY SENSITIVE FOR MORTALITY RISK SECONDARY TO TRAUMAINDUCED COAGULOPATHY RELATED HEMORRHAGE Presenter: Peter Einersen, MD - Aurora, CO 7:02am - 7:10am QS 16. VITAMIN D DEFICIENCY AND FRACTURE PROFILE IN GERIATRIC TRAUMA PATIENTS: HIPS DON’T LIE! Presenter: Khalid Almahmoud, MD, MPH - Dallas, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 55 SCIENTIFIC PROGRAM (continued) 7:10am-7:18am QS 17. INCIDENCE AND PREDICTORS OF EMERGENCY DEPARTMENT THORACOTOMY PERFORMED OUTSIDE OF TEMPORAL GUIDELINES FOR TRAUMA ARREST Presenter: Fredric Pieracci, MD, MPH - Denver, CO 7:18am-7:26am QS 18. SHOULD INFANTS WITH BLUNT TRAUMATIC BRAIN INJURIES AND INTRACRANIAL HEMORRHAGE HAVE ROUTINE REPEAT IMAGING? Presenter: Patricia Hill, MD - Wichita, KS 7:26am - 7:34am QS 19. DAMAGE CONTROL LAPAROTOMY IS ASSOCIATED WITH INCREASED ABDOMINAL COMPLICATIONS: A MATCHED ANALYSIS Presenter: Mitchell George, MD - Houston, TX 7:34am - 7:42am QS 20. ROUTINE “PAN-SCAN” IS NOT INDICATED IN THE ELDERLY AFTER GROUND LEVEL FALLS Presenter: Sharmila Dissanaike, MD FACS - Lubbock, TX 7:42am - 7:50am QS 21. ACUTE KIDNEY INJURY IN TRAUMA PATIENTS RECEIVING CHLORIDE-RICH VS. CHLORIDE RESTRICTIVE RESUSCITATION Presenter: Eric Glendinning, MD - Wichita, KS 7:50am - 7:58am QS 22. BASE DEFICIT IS SUPERIOR TO LACTATE IN TRAUMA Presenter: James Davis, MD – Fresno, CA *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 56 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 6:30am - 8:00am Quick Shot Presentations III: Surgical Oncology Maui Suite 3-4 Moderators: Charles Scoggins, MD, MBA - Louisville, KY; Joshua Mammen, MD, PhD - Kansas City, KS 6:30am - 6:38am QS 23. MINIMALLY INVASIVE VERSUS OPEN CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY - A COMPARISON OF SHORT TERM OUTCOMES Presenter: Ryan Day, MD - Phoenix, AZ 6:38am-6:46am QS 24. REDUCING VTE EVENT RATES IN COMPLEX ABDOMINAL CANCER SURGERY: A RETROSPECTIVE, SINGLE INSTITUTE COMPARISON OF DEXTRAN VS HEPARIN Presenter: Asish Patel, MD - Omaha, NE 6:46am-6:54am QS 25. FIT TEST FOR COLORECTAL CANCER SCREENING: OUR COMMUNITY EXPERIENCE Presenter: Elisa Furay, MD - Austin, TX 6:54am-7:02am QS 26. SPLENECTOMY IN HEMATOLOGIC DISEASE: DO WE MAKE A DIFFERENCE? Presenter: William Sheaffer, MD - Phoenix, AZ 7:02am - 7:10am QS 27. INFLAMMATORY BREAST CANCER REMAINS A POOR PROGNOSIS: A SINGLE INSTITUTION REVIEW Presenter: Patrick Hangge, MD - Phoenix, AZ 7:10am-7:18am QS 28. SURGICAL OUTCOMES OF LYMPHADENECTOMY IN THE ELDERLY MELANOMA POPULATION Presenter: Tiffany Weidner, MD - Phoenix, AZ *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 57 SCIENTIFIC PROGRAM (continued) 7:26am - 7:34am QS 30. SPECT-CT impacts surgical and radiographical approach in sentinel lymph node biopsy for head and neck melanoma Presenter: Becky Trinh, MD - Aurora, CO 7:34am - 7:42am QS 31. EARLY EXPERIENCE WITH CYTOREDUCTION AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY AT A NEWLY DEVELOPED CENTER FOR PERITONEAL MALIGNANCY: LESSONS LEARNED FROM THE FIRST 50 CASES Presenter: Jeremiah Deneve, DO - Memphis, TN 7:42am - 7:50am QS 32. A NSQIP ANALYSIS OF CRS-HIPEC OUTCOMES COMPARED TO OTHER MAJOR GASTROINTESTINAL SURGERIES Presenter: Richard Sleightholm, BS - Omaha, NE 7:50am - 7:58am QS 33. PERIOPERATIVE OUTCOMES AND SURVIVAL FOLLOWING NEOADJUVANT STEREOTACTIC BODY RADIATION THERAPY VERSUS INTENSITY-MODULATED RADIATION THERAPY IN PANCREATIC ADENOCARCINOMA Presenter: Brandon Chapman, MD - Denver, CO 8:00am - 11:30am American College of Surgeons Session Monarchy 4 Part I 8:00am – 9:30am Moderator: Clay Cothren Burlew, MD, FACS 8:00am – 8:20am Challenges for Future Surgeons J. David Richardson, MD, FACS 8:20am – 8:40am MACRA Update Christian Shalgian *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 58 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 8:40am – 9:00am ACS Role in Resident Education J. David Richardson, MD, FACS 9:00am – 9:30am Q&A Part II 10:00am – 11:30am Moderator: Fredric Pieracci, MD, MPH, FACS 10:00am – 10:20am Is There Such a Thing as “Protected Time”? Ronald Stewart, MD FACS 10:20am – 10:40am Is It Possible to Achieve Work/Life Balance? Kathryn Beauchamp, MD FACS 10:40am – 11:10am Panel: “Hot Topics for the Young Attending” -Tips for Contact Negotiation -Finding the Right First Job -Billing/Coding Panelists: J. David Richardson, MD, FACS Ronald Stewart, MD FACS Kathryn Beauchamp, MD FACS Robert C. McIntyre, MD FACS 11:10am – 11:30am Q&A 9:30am - 10:00am Morning Beverage Break, ePoster & Exhibit Viewing Monarchy 1-3 *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 59 SCIENTIFIC PROGRAM (continued) 11:30am - 12:00pm MCT Committee Meeting Monarchy 4 1:00pm – 6:00pm SWSC Annual Golf Tournament Kaanapali Royal Golf Course *additional fee applies 2:00pm – 4:00pm Kayak and Snorkel Excursion Hanakao’o Beach Park “Canoe Beach” *additional fee applies *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 60 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) TUESDAY, APRIL 4, 2017 6:00am - 5:00pm Registration Grand Promenade 6:30am - 9:00am Continental Breakfast Sunset Terrace 6:30am - 7:30am Quick Shot Presentation IV: Critical Care Monarchy 4 Moderators: Alyssa Chapital MD, PhD - Phoenix, AZ; Liz Scherer MD, MPH - San Antonio, TX 6:30am - 6:38am QS 34. IMPLEMENTATION OF A NURSE-DRIVEN PROTOCOL FOR CATHETER REMOVAL TO DECREASE CATHETER ASSOCIATED URINARY TRACT INFECTION RATE IN A SURGICAL TRAUMA INTENSIVE CARE UNIT Presenter: Anna Tyson, MD, MPH - Charlotte, NC 6:38am-6:46am QS 35. LONG-TERM OUTCOMES OF FALLS IN OCTOGENARIANS TAKING ORAL ANTI-PLATELET AND ANTI-COAGULANT MEDICATIONS Presenter: Chad Hall, MD - Temple, TX 6:46am-6:54am QS 36. MAJOR VENOUS INJURIES AND VTE: WHAT IS THE RISK? Presenter: April Mendoza, MD, MPH - San Francisco, CA 6:54am-7:02am QS 37. ULTRASOUND-GUIDED JUGULAR CENTRAL VENOUS CATHETER INSERTION IN SEVERELY THROMBOCYTOPENIC CANCER PATIENTS IS SAFE WITH OR WITHOUT PLATELET TRANSFUSION Presenter: Zainulabdeen Al Rstum, MD - Houston, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 61 SCIENTIFIC PROGRAM (continued) 7:02am - 7:10am QS 38. COAGULOPATHY OF HEMORRHAGIC SHOCK IN A LETHAL SWINE MODEL: TRANSITION FROM FIBRINOLYSIS TO FIBRINOGEN AND PLATELET DYSFUNCTION Presenter: Gregory Stettler, MD - Aurora, CO 7:10am-7:18am QS 39. HIGHER PAIN SCORES TRIGGER THE INITIAL ONSET OF POSTOPERATIVE DELIRIUM Presenter: Douglas Overbey, MD - Aurora, CO 7:18am-7:26am QS 40. FUTILITY NO MORE: CRITICALLY INJURED TRAUMA PATIENTS WITH SEVERE ACIDOSIS Presenter: Nicole Tapia, MD - Houston, TX 6:30am - 7:30am Quick Shot Presentations V: Outcomes/Quality Maui Suite 1-2 Moderators: David Partrick, MD - Aurora, CO; Peter Kennealey, MD - Denver, CO 6:30am - 6:38am QS 41. AN EFFECTIVE MODEL FOR PROVIDING ACCESS TO SURGICAL CARE TO THE UN- AND UNDER-INSURED Presenter: Samuel Walling, BE - Louisville, KY 6:38am-6:46am QS 42. ELIMINATION OF ROUTINE CHEST X-RAY AFTER IMAGE GUIDED CENTRAL VENOUS ACCESS PORT PLACEMENT IS SAFE AND COST EFFECTIVE Presenter: Austin Cannon, MD - Salt Lake City, UT 6:46am-6:54am QS 43. ACS-NSQIP RISK CALCULATOR ACCURATELY PREDICTS COMPLICATIONS IN VENTRAL HERNIA REPAIRS DESPITE THE LACK OF HERNIA SPECIFIC RISK FACTOR INPUT Presenter: Mary Mrdutt, MD - Temple, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 62 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 6:54am-7:02am QS 44. INSURANCE STATUS IS ASSOCIATED WITH SURVIVAL IN PATIENTS WITH METASTATIC CANCER Presenter: Mariam Ali-Mucheru, MD - PHOENIX, AZ 7:10am-7:18am QS 46. ESTABLISHING A SYSTEM-WIDE ASSESSMENT OF PREOPERATIVE FRAILTY IN ELECTIVE SURGERY Presenter: Mary Mrdutt, MD - Temple, TX 7:18am-7:26am QS 47. RACIAL AND SOCIODEMOGRAPHIC FACTORS ASSOCIATED WITH STAGE AT DIAGNOSIS IN PANCREATIC ADENOCARCINOMA Presenter: Douglas Swords, MD - Salt Lake City, UT 6:30am - 7:30am Quick Shot Presentations VI: General Surgery Maui Suite 3-4 Moderators: Bartley Pickron, MD - Salt Lake City, UT; Sarah Judkins, MD Montrose, CO 6:30am - 6:38am QS 48. SUSPECTED COMMON BILE DUCT STONE DISEASE: CURRENT PRACTICE PATTERNS FOR DIAGNOSIS, MANAGEMENT, AND DEFINITIVE SURGICAL TREATMENT Presenter: Frank Zhao, MD - Honolulu, HI 6:38am-6:46am QS 49. DOES SLUDGE ON ULTRASOUND INDICATE CHOLELITHIASIS: A RETROSPECTIVE REVIEW Presenter: M. Timothy Nelson, MD - Las Vegas, NV 6:54am-7:02am QS 51. IMPACT OF OPERATION TYPE ON UNPLANNED READMISSION FOLLOWING COLORECTAL SURGERY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE Presenter: Reza Fazl Alizadeh, MD - Orange, CA *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 63 SCIENTIFIC PROGRAM (continued) 7:02am - 7:10am QS 52. THE IMPACT OF FALCIFORM PEDICLE WRAP AFTER PANCREATICODUODENECTOMY ON POST OPERA-TIVE PANCREATIC FISTULA Presenter: Young Hong, MD - Louisville, KY 7:10am-7:18am QS 53. READMISSION AFTER PANCREATECTOMY: CAN IT BE PREVENTED? Presenter: Morgan Bonds, MD - Oklahoma City, OK 7:18am-7:26am QS 54. NATIONWIDE TRENDS IN ROBOTIC ANTIREFLUX SURGERY Presenter: Kathleen Coakley, DO - Charlotte, NC 7:30am - 8:45am Scientific Session III: Surgical Oncology Monarchy 4 Moderators: Colleen Murphy, MD - Denver, CO; Rakhshanda Layeequr Rahman MD - Amarillo, TX 7:30am - 7:45am 12. DOES LYMPH NODE STATUS INFLUENCE ADJUVANT THERAPY DECISION-MAKING IN WOMEN 70 YEARS OF AGE OR OLDER WITH CLINICALLY NODE NEGATIVE HORMONE RECEPTOR POSITIVE BREAST CANCER? Presenter: Anees Chagpar, MD, MSc, MPH, MA, MBA - New Haven, CT Invited Discussant: Richard Gray, MD - Phoenix, AZ 7:45am - 8:00am *13. RADIOACTIVE SEED LOCALIZATION FOR BREAST CONSERVATION SURGERY: LOW POSITIVE MARGIN RATE WITH NO LEARNING CURVE- THE NEW GOLD STANDARD? Presenter: Cristine Velazco, MD, MS - Phoenix, AZ Invited Discussant: Jim Edney, MD - Omaha, NE 8:00am - 8:15am *14. THE SUCCESS OF SENTINEL LYMPH NODE BIOPSY AFTER NEOADJUVANT THERAPY: A SINGLE INSTITUTION REVIEW Presenter: James Chang, MD - Phoenix, AZ Invited Discussant: Anne Mancino, MD - Little Rock, AR *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 64 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 8:15am - 8:30am *15. SURGICAL LYMPH NODE EVALUATION IS ASSOCIATED WITH IMPROVED PROGNOSIS IN NODE NEGATIVE SWEAT GLAND CANCER Presenter: Lyndsey Kilgore, MD - Kansas City, KS Invited Discussant: Terry Lairmore, MD - Temple, TX 8:30am - 8:45am *16. RE-EXCISION RATES AFTER BREAST CONSERVING SURGERY FOLLOWING THE 2014 SSO-ASTRO GUIDELINES Presenter: Alicia Heelan Gladden, MD - Aurora, CO Invited Discussant: Edward Nelson, MD - Salt Lake City, UT 8:45am - 9:30am Edgar J. Poth Memorial Lecture: “Informed Consent - It Is More than Just a Signature on a Piece of Paper” Christine Cocanour, MD Sacramento, CA Monarchy 4 9:30am - 10:00am Morning Beverage Break, Poster & Exhibit Viewing Monarchy 1-3/Foyer 10:00am - 11:00am Scientific Session IV: Education/Other Monarchy 4 Moderators: John Russell, MD - Albuquerque, NM; John M. Uecker, MD - Austin, TX 10:00am - 10:15am 17. SOUTHWESTERN SURGICAL CONGRESS JACK BARNEY AWARD COMPETITION PRESENTERS - WHERE ARE THEY NOW? Presenter: Shanu Kothari, MD - La Crosse, WI Invited Discussant: John Potts, III, MD - Chicago, IL 10:15am - 10:30am *18. PHYSICIAN BURNOUT & PTSD IN SURGICAL RESIDENTS: EVERYBODY HURTS. . . SOMETIMES Presenter: Theresa Jackson, MD - Tulsa, OK Invited Discussant: Christian DeVirgilio MD - Torrance, CA *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 65 SCIENTIFIC PROGRAM (continued) 10:30am - 10:45am 19. VENOUS THROMBOEMBOLISM IN COMMON LAPAROSCOPIC ABDOMINAL SURGICAL OPERATIONS Presenter: Reza Fazl Alizadeh, MD - Orange, CA Invited Discussant: Dmitry Oleynikov - Omaha, NE 10:45am - 11:00am 20. PERIOPERATIVE COMPLICATIONS INCREASE THE RISK OF VENOUS THROMBOEMBOLISM FOLLOWING BARIATRIC SURGERY Presenter: Jon Gould, MD - Milwaukee, WI Invited Discussant: Brandon Grover DO - LaCrosse, WI 11:00am - 12:00pm Past Presidents Panel Monarchy 4 Cases will be presented and voted on using an audience response system before discussion by three of our past presidents. Moderator: Daniel Margulies, MD - Los Angeles, CA Panelists: Ernest (Gene) Moore, MD - Denver, CO Kenric M. Murayama, MD - Honolulu, HI John Potts, III, MD - Chicago, IL 12:00pm - 1:30pm Mock Oral Boards Maui Suite 1-2 12:15pm - 1:30pm Global Opportunities Luncheon *additional fee applies Maui Suite 3-4 1:00pm - 2:00pm Hula Dance Lesson for SWSC Guests Halona Kai Lawn *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 66 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 1:30pm - 2:30pm Scientific Session V: Laparascopy Monarchy 4 Moderators: Nicolas Melo, MD - Los Angeles, CA; Susan McLean, MD - El Paso, TX 1:30pm - 1:45pm *21. DOES LAPAROSCOPIC APPENDECTOMY HAS TO BE THIS EXPENSIVE? THE USE OF HEM-O-LOK VERSUS ENDOSTAPLER DEVICES Presenter: Samir Johna, MD, MACM Invited Discussant: Gary Dunn - Oklahoma City, OK 1:45pm - 2:00pm +*22. FULL PATHOLOGICAL REVIEW OF ALL GASTRIC REMNANTS FOLLOWING SLEEVE GASTRECTOMY: IS IT NECESSARY? Presenter: Spencer Hansen, MD - Denver, CO Invited Discussant: Corey McBride, MD - Omaha, NE 2:00pm - 2:15pm *23. LAPAROSCOPIC COMMON BILE DUCT EXPLORATION VERSUS ERCP FOR THE MANAGEMENT OF CHOLEDOCHOLITHIASIS FOUND AT TIME OF LAPAROSCOPIC CHOLECYSTECTOMY: ANALYSIS OF A LARGE INTEGRATED HEALTH CARE SYSTEM DATABASE Presenter: Mohammed Al-Temimi, MD, MPH - Fontana, CA Invited Discussant: Edward Jones, MD - Denver, CO 2:15pm - 2:30pm 24. A NATIONWIDE EVALUATION OF ROBOTIC VENTRAL HERNIA SURGERY Presenter: Kathleen Coakley, DO - Charlotte, NC Invited Discussant: Dean J. Mikami, MD - Honolulu, HI 2:30pm - 2:45pm Afternoon Beverage Break, ePoster & Exhibit Viewing Monarchy 1-3/Foyer *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 67 SCIENTIFIC PROGRAM (continued) 2:45pm - 3:30pm Thomas G. Orr Memorial Lecture: “Planning and Performance Under Stress” S. Rob Todd, MD Houston, TX Monarchy 4 3:30pm - 4:30pm Scientific Session VI: Trauma II Monarchy 4 Moderators: George Lavenson - Lahaina, HI; Michael Corneille, MD - San Antonio, TX 3:30pm - 3:45pm *25. DISPARATE EFFECTS OF CATECHOLAMINES UNDER STRESS CONDITIONS ON ENDOTHELIAL GLYCOCALYX INJURY: AN IN VITRO MODEL Presenter: Jonathan Martin, MD - Detroit, MI Invited Discussant: Mitchell J. Cohen, MD - Denver, CO 3:45pm - 4:00pm *26. REDEFINING THE ABDOMINAL SEATBELT SIGN: ENHANCED CT IMAGING METRICS IMPROVE INJURY PREDICTION Presenter: Michael Johnson, MD - San Antonio, TX Invited Discussant: Stacy Dougherty MD - Brooklyn, NY 4:00pm - 4:15pm *27. NOT EVERY TRAUMA PATIENT WITH A RADIOGRAPHIC HEAD INJURY REQUIRES TRANSFER FOR NEUROSURGICAL EVALUATION: APPLICATION OF THE BRAIN INJURY GUIDELINES TO PATIENTS TRANSFERRED TO A LEVEL 1 TRAUMA CENTER Presenter: Gweniviere Capron, MD - Urbana, IL Invited Discussant: Kathryn Beauchamp, MD - Denver, CO 4:15pm - 4:30pm 28. LOW-GRADE BLUNT HEPATIC INJURY AND BENEFITS OF INTENSIVE CARE UNIT MONITORING Presenter: Jeffrey Perumean, MD - Dallas, TX Invited Discussant: Brian Eastridge, MD - San Antonio, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 68 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 4:30pm - 5:00pm SWSC Annual Business Meeting (Members Only) Monarchy 4 5:00pm – 6:00pm SWSC APC Reception Hyatt Residence Club Bar 6:00pm – 9:00pm SWSC Reception Haloni Kai Lawn *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 69 SCIENTIFIC PROGRAM (continued) WEDNESDAY, APRIL 5, 2017 6:00am – 11:30am SWSC Registration Grand Promenade 6:30am - 8:30am Continental Breakfast Sunset Terrace 6:30am - 7:30am Quick Shot Presentations VII: Trauma/General Monarchy 4 Moderators: Daniel Dent, MD - San Antonio, TX; Eric Campion, MD - Denver, CO 6:30am - 6:38am QS 55. TEN-YEAR TRENDS IN TRAUMATIC INJURY MECHANISMS AND OUTCOMES; A TRAUMA REGISTRY ANALYSIS Presenter: Zhamak Khorgami, MD - Tulsa, OK 6:38am-6:46am QS 56. OPERATING ROOM FIRES REPORTED TO THE FOOD AND DRUG ADMINISTRATION Presenter: Douglas Overbey, MD - Aurora, CO 6:46am-6:54am QS 57. PREPERITONEAL PELVIC PACKING IS EFFECTIVE FOR HEMORRHAGE CONTROL WITH OPEN PELVIC FRACTURES Presenter: Eliza Moskowitz, MD - Aurora, CO 6:54am-7:02am QS 58. ROUGH DAY AT THE BEACH: EPIDEMIOLOGY AND CLINICAL PRESENTATION OF SPINAL CORD INJURY IN HAWAII Presenter: Justin Cheng, - Honolulu, HI 7:02am - 7:10am QS 59. PATHOLOGIC FINDINGS OF THE GALLBLADDER IN PATIENTS UNDERGOING SURGERY FOR BILIARY DYSKINESIA Presenter: HASSAN AHMED, MD, MRCSI - Lubbock, TX *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 70 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 7:10am-7:18am QS 60. SURGICAL EVACUATION OF ACUTE SUBDURAL HEMATOMA IN OCTOGENARIANS: A TEN YEAR EXPERIENCE FROM A SINGLE TRAUMA CENTER Presenter: Michael McGinity, MD - San Antonio, TX 7:18am-7:26am QS 61. END TIDAL CARBON DIOXIDE (ETCO2) BEFORE AND AFTER RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA WITH CLOSED CHEST COMPRESSION (REBOACCC) IS HIGHER COMPARED TO OPEN CHEST CARDIAC MASSAGE WITH AORTIC CROSS-CLAMP (OCCMACC) Presenter: Megan Brenner, MD, MS - Baltimore, MD 6:30am - 7:30am Quick Shot Presentations VIII: Potpourri Maui Suite 1-2 Moderators: Fredric Pieracci, MD-Denver, CO; Michael Truitt, MD-Dallas, TX 6:30am - 6:38am QS 62. HYPERTRIGLYCERIDEMIA INDUCED PANCREATITIS: DOES PLASMAPHERESIS REALLY MAKE A DIFFERENCE? Presenter: Lindsay O’Meara, CRNP - Baltimore, MD 6:38am-6:46am QS 63. THE GREY’S ANATOMY EFFECT: TELEVISION PORTRAYAL OF TRAUMA PATIENTS MAY CULTIVATE UNREALISTIC PATIENT AND FAMILY EXPECTATIONS FOLLOWING INJURY Presenter: Rosemarie Serrone, MD - Phoenix, AZ 6:46am-6:54am QS 64. ADRENALECTOMY IN OCTOGENARIANS: ASSESSMENT OF OUTCOMES Presenter: Stephanie Sims, M.D. - Charlotte, NC 6:54am-7:02am QS 65. CHANGING PRACTICES: THE ADDITION OF A NOVEL SURGICAL APPROACH TO GYNECOMASTIA Presenter: Deidre Wyrick, MD - Little Rock, AR *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 71 SCIENTIFIC PROGRAM (continued) 7:02am - 7:10am QS 66. PROGNOSTIC FACTORS IN CUTANEOUS HEAD AND NECK MELANOMA Presenter: Brandon Chapman, MD - Denver, CO 7:10am-7:18am QS 67. ASSESSING EMERGENCY EXPLORATORY LAPAROTOMIES IN PATIENTS WITH ADVANCED MALIGNANCIES Presenter: Eric Pillado, BS - Los Angeles, CA 6:30am - 7:30am Quick Shot Presentations IX: Pediatric/Vascular Maui Suite 3-4 Moderators: Jeremiah Deneve, DO - Memphis, TN; Danny Chu, MD - Pittsburgh, PA Quick Shot Session IX: Pediatric/Vascular Surgery 6:30am - 6:38am QS 69. 4- HOUR POST-OPERATIVE PTH LEVEL PREDICTS HYPOCALCEMIA AFTER THYROIDECTOMY IN CHILDREN Presenter: Lily Hsieh, MD - Ann Arbor, MI 6:38am-6:46am QS 70. QUICK CAROTID SCAN FOR STROKE PREVENTION Presenter: George Lavenson, MD - Lahaina, HI 6:54am – 7:02am QS 72. COMPARATIVE ANALYSIS OF PEDIATRIC NON-POWDER VS POWDER FIREARM INJURIES Presenter: Michael Johnson, MD – San Antonio, TX 7:02am – 7:10am QS 73. SHORT AND LONG TERM OUTCOMES OF CHILDREN AND ADOLESCENTS WITH PAPILLARY THYROID CARCINOMA Presenter: Bradley Wallace, MD – Aurora, CO 7:10am – 7:18am QS 74. SURGICAL TRAINEE AUTONOMY DURING ARTERIOVENOUS FISTULA CREATION: IS THERE A COST? Presenter: Abraham Korn MD – Torrance, CA *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 72 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PROGRAM (continued) 7:30am - 8:45am Scientific Session VII: Potpourri Monarchy 4 Moderators James Davis, MD - Fresno, CA; Ronald Sing, DO - Charlotte, NC 7:30am - 7:45am 29. OPERATIVE VERSUS NON-OPERATIVE MANAGEMENT IN THE CARE OF PATIENTS WITH COMPLICATED APPENDICITIS Presenter: Thomas Helling, MD - Jackson, MS Invited Discussant: Eric Campion MD - Denver, CO 7:45am - 8:00am 30. HOSPITAL ADMISSION UNNECESSARY FOR SUCCESSFUL UNCOMPLICATED RADIOGRAPHIC REDUCTION OF PEDIATRIC INTUSSUSCEPTION Presenter: Michael Mallicote, MD - Los Angeles, CA, Ronald Sing, DO-Charlotte, NC Invited Discussant: 8:00am - 8:15am *31. RE-OPERATIVE CENTRAL LYMPH NODE DISSECTION FOR INCIDENTAL PAPILLARY THYROID CANCER CAN BE PERFORMED SAFELY Presenter: Chad Hall, MD - Temple, TX Invited Discussant: Maria B. Albuja-Cruz, MD - Denver, CO 8:15am - 8:30am 32. WHAT HAPPENS AFTER A FAILED LIFT FOR ANAL FISTULA? Presenter: Moriah Wright, MD - Omaha, NE Invited Discussant: Bartley Pickron - Salt Lake City, UT 8:30am - 8:45am *33. THE HYPERCOAGULABILITY OF END STAGE RENAL DISEASE: THE ROLE OF FIBRINOGEN Presenter: Geoffrey Nunns, MD - Aurora, CO Invited Discussant: Tam Huynh MD - Houston, TX 8:45am - 9:30am Claude H. Organ, Jr. Memorial Lecture John Moore, MD Denver, CO Monarchy 4 *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award April 2 – 5, 2017 | Hyatt Regency, Maui, HI 73 SCIENTIFIC PROGRAM (continued) 9:30am – 10:15am Top 10 Papers in Trauma 2016 Ernest “Gene” Moore, MD – Denver, CO Monarchy 4 10:15am – 11:00am Top 10 Papers in General Surgey 2016 Walter Biffl, MD – Honolulu, HI Monarchy 4 11:00am - 11:30am Award Presentations & Closing Session Monarchy 4 *Indicates resident paper competing for Jack A. Barney Award +Indicates New Member paper competing for Lowry Award 74 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTR ACTS *Indicates resident paper competing for Jack A. Barney Award. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 75 SCIENTIFIC PAPER ABSTRACTS *Indicates resident paper competing for Jack A. Barney Award. 1. OUTPATIENT LAPAROSCOPIC APPENDECTOMY CAN BE SUCCESSFULLY PERFORMED FOR UNCOMPLICATED APPENDICITIS: A SOUTHWESTERN SURGICAL CONGRESS MULTICENTER TRIAL R Frazee MD, C Cothren Burlew MD, J Regner MD, R McIntyre MD, E Peltz DO, C Cribari MD, J Dunn MD, L Butler MD, P Reckard MD, S Dissanaike MD, K Karimi BS, C Behnfield BS, N Melo MD, D Margulies MD Temple, TX Background: Laparoscopic procedures offer the advantages of less pain, shorter hospitalization, and quicker return to full activities. Because of these advantages, many surgical procedures that formerly required hospitalization are now performed on an outpatient basis, including cholecystectomy, hernia repair, fundoplication, and bariatric procedures. An exception to this trend has been laparoscopic appendectomy, which continues to have a 1-2 day average length of hospitalization. We hypothesize laparoscopic appendectomy can be safely performed as an outpatient procedure. Method: Seven institutions adopted a previously described outpatient laparoscopic appendectomy protocol. Patients with uncomplicated appendicitis were candidates for the protocol. Exclusion criteria included age < 18 years, pregnancy, and gangrenous/ perforated appendicitis. Per protocol, patients were dismissed from the recovery room unless there was a clinical indication for admission. Patient demographics, success with outpatient management, time of dismissal, morbidity, and readmissions were analyzed. Results: During the 1-year study period, 376 patients with a mean age of 35.4 years were included in the protocol including two hundred six men and one hundred seventy women. Seventy-eight patients (21%) had pre-existing comorbidities including cardiac disease (4%), hypertension (13%), diabetes (3%), renal disease (1%), morbid obesity (1%), gastrointestinal (1%), and pulmonary (1%). Of the 376 patients, 299 (80%) successfully completed the protocol and were managed as outpatients. There were no conversions from laparoscopic to open appendectomy. Postoperative morbidity occurred in twelve patients (3%) and included cardiac, pulmonary, surgical site infections, reoperation, and urinary retention. The time of patient dismissals was evenly distributed: 6 a.m.-noon: 22.3%, noon-6 p.m.: 29%, 6 p.m.-midnight: 23.5%, midnight-6 a.m.: 25.3%. Twelve patients (3%) required readmission. Outpatient follow-up occurred in 63% of patients. Conclusion: An outpatient laparoscopic appendectomy protocol was successfully applied at multiple institutions with low morbidity and low readmission rates. Application of this practice nationally could reduce length of stay and decrease overall health care costs for acute appendicitis. 76 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 2. KEEP CALM AND CARRY ON OPERATING! INVESTIGATING OUTCOMES OF PATIENTS UNDERGOING URGENT LAPAROSCOPIC APPENDECTOMY ON ANTITHROMBOTIC THERAPY CP Pearcy MD, K Almahmoud MD, T Jackson MD, C Hartline MD, A Cahill MD, L Spence MD, D Kim MD, O Olatubosun MD, SR Todd MD, EM Campion MD, CC Burlew MD, J Regner MD, R Frazee MD, D Michaels BA, S Dissanaike MD, P Nelson MD, V Agrawal PhD, MS Truitt MD Dallas, TX Background: The literature regarding outcomes in patients on irreversible antithrombotic therapy (IAT) undergoing urgent laparoscopic appendectomy is limited. The aim of this multicenter retrospective study was to examine the impact of prehospital IAT on outcomes in this population. Method: From 2010 to 2014, seven institutions from the SWSC MCT group conducted a retrospective study to evaluate the clinical course of all patients who underwent urgent/emergent laparoscopic appendectomy. Given statistically significant demographic variations between IAT vs. No-IAT, two groups (IAT vs No-IAT) were matched 1:1 based on age and gender. The IAT group was subdivided into IAT-Aspirin only and IAT-Aspirin-Plavix. The IAT-Aspirin-Plavix subgroup was matched 1:1 to controls based on age, gender, and comorbidity profile. The primary outcomes were estimated blood loss (EBL) and transfusion requirement. Secondary outcomes included infections (SSI - Surgical Site Infection, DSI - Deep Space Infection, and OSI - Organ Space Infection), hospital length of stay (HLOS), complications, 30-day readmissions, and mortality. A chi-square or Fisher’s exact test were employed for statistical significance in large or small sample sizes, respectively. A p ≤ 0.05 is considered statistically significant. Results: Out of the 2,903 patients included in the study, 287 IAT patients were identified and matched in a 1:1 ratio to 287 No-IAT controls. In the IAT vs Control group, no significant differences in EBL (p=1.0), transfusion requirement during the preoperative (p=0.5), intraoperative (p=0.3) or postoperative periods (p=0.5), infectious complications (SSI p=1.0, DSI p=1.0, and OSI p=0.1), overall complications (p= 0.3), HLOS (p=0.7), 30-day readmission (p=0.3), or mortality (p=0.1) were noted. Outcomes in the IAT-Aspirin only subgroup vs controls also failed to demonstrate statistical significance. Additionally, in the IAT-Aspirin-Plavix subgroup vs controls, no statistically significant differences in the assessed outcomes were observed. Conclusion: Our results demonstrate no difference in outcomes between the overall IAT group and Controls. Furthermore, analysis of the IAT-Aspirin only and IATAspirin-Plavix subgroups failed to show a significant difference in any outcome. Our analysis suggests that urgent/emergent laparoscopic appendectomy is a safe procedure in patients on IAT therapy. Prehospital use of IAT therapy as an independent factor should not be used to delay laparoscopic appendectomy. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 77 SCIENTIFIC PAPER ABSTRACTS (cont.) *3. FOLLOW-UP TRENDS AFTER EMERGENCY DEPARTMENT DISCHARGE FOR THE ACUTELY SYMPTOMATIC HERNIA Lara Spence MD, Eric Pillado BS, Dennis Kim MD, David Plurad MD Torrance, CA Background: It is felt that patients with acutely symptomatic hernias that present to the Emergency Department (ED) can be discharged with clinic follow-up in the absence of immediate indications for repair. However, little is known about the outcomes after discharge. The purpose of this study was to evaluate the outcomes of patients with symptomatic hernias discharged from the ED to include the percentage that undergo surgery or re-present needing emergency repair. Method: A retrospective analysis of patients discharged from the ED with a symptomatic hernia over a three year period at a safety-net hospital was performed. The patient’s laboratory values, radiological findings, the number of re-presentations to the emergency department, time to being seen in the clinic for the purposes of elective repair, time to surgical repair, operative outcomes, the length of stay, and complications of surgery were analyzed. Results: There were 111 patients who presented with an acutely symptomatic hernia and were discharged with elective follow up. Age ranged from 19-99 years, with a mean age of 49 years. Seventy-five (57.9%) were male, 23 (21%) had a prior repair, and 30 (27%) had a chronically incarcerated hernia. The number of inguinal (45%) and umbilical (43%) hernias were nearly equal. Less than a quarter (24%) of patients were seen in follow up clinic after initial ED discharge. Mean days to this clinic visit was 128 days and patients who were repaired electively waited a mean of 32 days to surgery thereafter. Only 20 (18%) patients overall eventually underwent hernia repair where 43% were emergent. Twenty-five percent of patients bounced back once, 6% bounced back twice and 5% bounced back three times. In patients returning to the ED at least once, 32% required emergency repair where 2 (7%) underwent laparotomy. Of these patients, most (78%) were never seen in their scheduled clinic visit to arrange elective repair. The most common reasons for not undergoing more immediate repair was obesity. Other common reasons were cirrhosis, uncontrolled diabetes, and patient request. Conclusion: In this population, only one quarter of the patients evaluated by a surgeon after initial ED visit for a symptomatic hernia followed up in the clinic and even fewer underwent hernia repair. Half of those that underwent surgery occurred emergently after re-presenting to the ED. Failure of follow up after an ED visit for an acutely symptomatic hernia leaves many patients at risk for needing emergency surgery. Barriers to follow-up must be studied in this population of patients. 78 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) *4. DAY VERSUS NIGHT LAPAROSCOPIC CHOLECYSTECTOMY: A COMPARISON OF OUTCOMES AND COST SS Siada DO, SM Schaetzel MD, AK Chen MD, HD Hoang MD, FG Wilder MD, RC Dirks PhD, JW Davis MD Fresno, CA Background: Acute cholecystitis is a common cause of the acute abdomen making laparoscopic cholecystectomy (LC) one of the most common procedures performed in the United States. Early treatment of acute cholecystitis has been advocated to reduce morbidity, length of stay, and risk of complications. However, recent studies have suggested higher complication and conversion to open rates for nighttime LC and recommend against the practice. We hypothesize that patients undergoing cholecystectomy at night have decreased length of stay and cost with no difference in complication and conversion rates compared with daytime cholecystectomy. Method: A retrospective review, in a 650-bed tertiary-care hospital, of all patients with acute cholecystitis who underwent LC from August 2011 through June 2015 was performed. Patients who underwent elective cholecystectomy, incidental cholecystectomy, a planned open cholecystectomy, had gallstone pancreatitis or choledocholithiasis, and those admitted to the medicine service were excluded. Day was defined as LC that started after 7 am and before 5 pm, and night LC started after 5 pm and before 7 am. Variables that were analyzed included patient age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) class, presence of pre-operative systemic inflammatory response syndrome (SIRS), length of operation, length of stay (LOS), cost of hospitalization, and complications. These variables were compared between patients undergoing day cholecystectomy and night cholecystectomy. Results: During the study period, 1552 patients with a diagnosis of acute cholecystitis who underwent laparoscopic cholecystectomy were analyzed; 867 made up the study population and 685 met exclusion criteria. Of the patients in the study cohort, 647 (75%) had LC during the day and the remainder had LC at night. There was no statistical difference in age, BMI, gender distribution, and presence of SIRS between patients undergoing day and night operations. Patients undergoing night LC were more likely to be ASA class 3 or 4 than the day LC group (37% vs 30%, p = 0.05). Conversion to open rate was higher in the day LC group (9% vs 5%, p = 0.02). Length of stay was shorter in the night group (2.4 vs 2.8 days, p = 0.002) and cost of the hospitalization was lower in the night group ($4244 vs $4513, p = 0.22). Patients without SIRS who underwent night LC had a greater reduction in length of stay (2.1 vs 2.7 days, p = 0.001) and cost of hospitalization ($3911 vs $4342, p = 0.14). There was no statistical difference in the use of cholangiography, length of operation, mortality, and rate of complications between the day and night groups. Conclusion: Performing LC at night has no increased risk of complications, speeds patient care, and decreases length of stay. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 79 SCIENTIFIC PAPER ABSTRACTS 80 Southwestern Surgical Congress | 69th Annual Meeting (cont.) SCIENTIFIC PAPER ABSTRACTS (cont.) *5. ADDRESSING THE QUALITY AND COSTS OF CHOLECYSTECTOMY AT A SAFETY NET HOSPITAL RP Won MD, S Friedlander MPH, SL Lee MD Torrance, CA Background: Safety-net hospitals have limited resources, yet care for a disproportionate share of low-income, uninsured, and otherwise vulnerable patients. Complex, elective surgery at safety-net hospitals has been associated with inferior outcomes and increased costs. However, it is unclear how safety-net burden affects common urgent surgical procedures. The objective of this study was to evaluate the effects of safety-net burden on the outcomes of cholecystectomy. Method: The California State Inpatient Database was queried for all cholecystectomies performed from 2005-2011. The hospitals performing cholecystectomy were then stratified by safety-net burden: low-burden hospitals had the lowest quartile of uninsured/Medicaid patients (0-14%), medium-burden hospitals had the middle two quartiles (15-41%), and high-burden hospitals had the highest quartile (>42%). Hierarchical and multivariate analysis were then performed with primary outcomes including rates of advanced disease (perforation or hydrops), laparoscopy, morbidity, length of hospitalization, and cost. Results: High-burden hospitals treated a higher proportion of minorities (p<0.01) and were the least likely to use laparoscopy (p<0.01). Rates of advanced disease, specifically perforation and hydrops, were similar across all groups, yet high-burden hospitals had the lowest morbidity (p<0.01). Low-burden hospitals had the longest mean length of hospitalization (p<0.01), while high-burden hospitals had the lowest costs (p<0.01). Multivariate analysis failed to show any differences in rates of laparoscopy or advanced disease. However, multivariate analysis confirmed high-burden hospitals had the lowest rates of complications (RR -0.33, 95% CI -0.46, -0.19, p<0.01) and the lowest costs (cost difference -5592, 95% CI -8928, -2256, p<0.01). Length of hospitalization also trended down with increasing safety-net burden (p=0.06). Conclusion: Cholecystectomies at safety-net hospitals were associated with lower morbidity and cost, challenging the stigma that safety-net hospitals have inferior outcomes. Additional research is needed to evaluate how safety-net hospitals achieved these results, as it may help improve all surgical outcomes at under-resourced hospitals. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 81 SCIENTIFIC PAPER ABSTRACTS Lowburden (n = 78) 58.9% Female Race 63.3% Highburden (n = 100) 68.8% p-value < 0.01 White Black Hispanic Insurance 53.8% 4.0% 17.7% 51.6% 2.9% 24.0% 21.6% 5.5% 53.0% < 0.01 < 0.01 < 0.01 Uninsured/Medicaid Private/Medicare Laparoscopy 8.3% 89.6% 87.5% 25.9% 68.4% 89.4% 49.1% 39.9% 86.4% < 0.01 < 0.01 < 0.01 3.2% 3.3% 3.2% 0.99 9.2% 8.0% 6.5% < 0.01 5.6 4.5 4.8 < 0.01 $18,955 $16,363 $15,073 < 0.01 Advanced Disease (perforation or hydrops) Complications Length of Stay (days) Cost (dollars) 82 Mediumburden (n = 179) (cont.) Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 6. ACUTE POST-OPERATIVE DELIRIUM INCREASES LONG TERM MORTALITY IN OLDER SURGICAL PATIENTS Moskowitz EE, Overbey D, Jones T, Jones E, Arcomano T, Moore JT, Robinson TN Denver, CO Background: Post-operative delirium is associated with increased morbidity and mortality up to 1 year in older surgical patients. There is limited data on long term outcomes for elderly patients who have delirium. The purpose of this study was to determine if the presence of postoperative delirium can predict long term mortality in older surgical patients. We hypothesize that post operative delirium attributes to increased mortality over a 5 year period. Method: Patients aged 50 years and older undergoing elective surgery with a planned ICU admission were prospectively enrolled between 2007-2011. Preoperative demographics, Charlson comorbidity index, cognitive function, psychiatric history, and alcoholism screening were recorded. Factors associated with delirium including age, operation type, labs, and medications were also included in the analyses. Post-operative delirium was defined using ICU Confusion Assessment Method (CAM-ICU) Scores. Long term outcomes were obtained via retrospective chart review. Results: One hundred and seventy two patients were enrolled during the five year study period. Mean patient age was 64±8years and the majority were male (96.5%). Seventy five patients experienced delirium during their hospitalization (43.6%). Five year follow-up data was available for 164 patients (95%). Mortality was 58.6% (41/70) in patients with delirium compared to 12.8% (12/94) in patients without delirium (p<0.001). Age, ICU length of stay, Charlson Index, operation type, and delirium were significant on both univariate and multivariable analyses (p<0.05). Five year mortality was 7.35 fold greater for patients who had delirium on multivariate analysis. (See Table 1 for comparison). Conclusion: Post-operative delirium independently predicts a seven fold increase in 5 year mortality. Delirium in the immediate postoperative period has lasting consequences. The identification and prevention of postoperative delirium in elderly patients is critical to long term survival. Delirium n (%) Age (years) Charlson Index ICU length of stay (days) Death at 5 years Alive at 5 years (n=53) (n=111) 41 (74.5) 68.6±8.7 4.7±2.5 7.8±5.5 29 (27.7) 62.3±7.9 2.2±1.7 5.8±5.8 Univariate p Multivariable analysis Multivariable p Odds ratio (95% CI) <0.001 <0.001 <0.001 0.036 7.35 (1.49-36.18) 1.10 (1.02-1.19) 1.55 (1.14-2.13) 1.18 (1.02-1.36) 0.014 0.009 0.006 0.024 Table 1: Univariate and Multivariable analysis of various factors observed in postoperative patients. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 83 SCIENTIFIC PAPER ABSTRACTS (cont.) *7. TARGETING RESUSCITATION TO NORMALIZATION OF COAGULATING STATUS: HYPER AND HYPOCOAGUALABILITY AFTER SEVERE INJURY ARE BOTH ASSOCIATED WITH INCREASED MORTALITY HB Moore MD, EE Moore MD, BR Huebner MD, IN Liras MD, CC Burlew MD, FM Pieracci MD, CE Wade PhD, Sauaia A MD PhD, BA Cotton MD Denver, CO Background: Correcting hypocoagulability has been the primary focus of resuscitation in trauma patients, but the impact of hypercoagulability early after injury is poorly defined. Fibrinolysis shutdown (impaired fibrinolysis) has recently been reported to be the dominant phenotype of altered coagulation following injury. However, fibrinolysis resistance has not been evaluated in the context of additional coagulation factors attributed to hypercoagulability. We hypothesize that the predominant phenotype of postinjury coagulopathy is hypercoagulability, largely attributable to impaired fibrinolysis. Method: Blood samples from 160 healthy volunteers assayed with rapid thrombelastography (R-TEG) were used to identify thresholds of hypo and hypercoagulability (above or below the interquartile range) of Activated clotting time (ACT), angle, maximum amplitude (MA), and lysis at 30 minutes (LY30). These cutoffs were then evaluated in 2,504 severely injured trauma patients from two level 1 trauma centers with blood samples obtained within an hour of injury. The four R-TEG indices were classified as hypocoagulable (hypo), normal, or hypercoagulable (hyper) in all of these patients. Differences in the prevalence of hyper and hypo were contrasted to the distribution of healthy volunteers using the Goodness of Fit test. In-hospital mortality, cause of mortality, and massive transfusion (>10 untits of RBC in 6 hours) were also assessed between composite coagulation status of patients using a Chi Square analysis. Results: The median injury severity score (ISS) of the trauma population was 25 with a mortality rate of 22%. All TEG variables evaluated had a different prevalence compared to the healthy volunteer population (p<0.001 for all table 1). Only 9% of all trauma patients had all 4 TEG indices within the interquartile range of health volunteers (normal), while 41% of patients were hyper, 22% hypo, and 28% had a mix of hyper and hyper. In the hyper group: 47% had a short ACT, 55% had a steep angle, 57% had an elevated MA, and 45% had a low LY30. In the mixed group a low LY30 was prevalent in the majority of patients (65%). The ISS between these cohorts was different with hypo patients having a higher ISS (27 IQR 22-35) than mixed (25 IQR 21-30 p=0.004) and hyper (25 IQR 19-29 p<0.001). The mortality between the groups was significantly different (normal 12%, hyper 19%, mixed 26%, and hypo 30% p<0.001) and after logistic regression controlling for ISS, hypo (p<0.001) and mixed coagulopathy (P<0.001) remained significant predictors of mortality with a trend towards increased mortality with hypercoagulability (p=0.09). Massive transfusion was significantly different between cohorts (p<0.001) with hypocoagulable patients having a 84 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 3-fold increased rate of MT compared to hypercoagulable patients (12% vs 4%). Cause of mortality differed by coagulation status (p<0.001) with 44% (39/88) of hemorrhagic deaths associated with the hypo group, and 55% (17/31) of all multiple-organ deaths associated with the hyper group. Conclusion: The majority of severely injured trauma patients present to the hospital with deranged coagulation detected with R-TEG; the most common pattern being hypercoagulability. These data support the ongoing need for goal directed resuscitation in trauma patients, as empiric ratios of blood products only treat the hypocoagulability aspect of TIC, while neglecting a potentially lethal hypercoagulable component. R-TEG Indices ACT Angle MA LY30 Normal 42% 49% 43% 51% Hypercoagulable 28% 30% 31% 36% Hypocoagulable 30% 21% 25% 13% April 2 – 5, 2017 | Hyatt Regency, Maui, HI p Value <0.001 <0.001 <0.001 <0.001 85 SCIENTIFIC PAPER ABSTRACTS (cont.) 8. IMPACT OF GERIATRIC CONSULTATIONS ON CLINICAL OUTCOMES OF ELDERLY TRAUMA PATIENTS: A RETROSPECTIVE ANALYSIS JP Dugan BS, KM Burns BS, M Baldawi MD, DG Heidt MD Toledo, OH Background: The elderly population accounts for the majority of cases of morbidity and mortality secondary to traumatic injury, despite lower-energy mechanisms of injury and fewer trauma admissions. Comprehensive geriatric wards demonstrate improved clinical outcomes in the elderly hospital patient yet the benefit of inpatient geriatric consultation teams remains unclear, particularly in the setting of trauma. Our center established a mandatory geriatric trauma consultation service (GTCS) in January of 2015. We hypothesized that geriatric patients admitted during the period of mandatory GTCS consultations would have better outcomes across all measures analyzed. Method: We performed a single institution retrospective, non-randomized, pre- and post-intervention analysis of a GTCS after obtaining IRB approval. All patients admitted to the trauma service over 60 from January of 2014 to February 2016 were eligible. Data was abstracted from the institution’s Trauma Service Database and the EMR in order to measure the following outcome variables: mortality, length of stay, complications, ICU admission, disposition status, and readmission within 30 days of hospital release. Results: Among the 1,102 patients over the age of 60 admitted to the trauma service during the study period, 526 (48%) were in the pre-intervention cohort and 576 (52%) were in the post-intervention cohort. There were no significant differences observed in in-hospital mortality (2.9%, n=15 pre- vs. 3.1%, n=18 post-intervention, P=0.79), 30day mortality (3.6%, n=19 pre- vs. 3.6% n=21 post-intervention, P=0.976), mean ICU length of stay (4.6 days, n=98 pre- vs. 5.1 days, n=101 post-intervention, P=0.55), mean total length of stay (4.9 days, n=526 pre- vs. 4.8 days, n=576 post-intervention, P=0.78), or complication rates (8.4%, n=44 pre- vs. 11.8%, n=68 post-intervention, P=0.059). Despite no difference in complication rates, if a single complication was experienced, patients seen after the implementation of the mandatory GTCS were nearly 3 times more likely to experience multiple complications (1%, n=5, pre- vs. 2.6%, n=15, postintervention, P=0.04, OR=2.78). Patients in the GTCS group were more likely to be discharged home (40.7%, n=214 pre- vs. 47.4%, n=273 post-intervention, P=0.025, OR=1.3), but were four times more likely to be readmitted than the pre-GTCS group (1.3%, n=7, pre- vs. 5.2%, n=30 post-intervention, P=0.000, OR=4.07). Conclusion: We found the mandatory geriatric trauma consultation service to be no more beneficial to patient outcomes than management exclusively by the trauma team, and we in fact observed an increase in readmission rates. Multiple complication rates were also higher following implementation of the GTCS. In summary, the additional costs of and increased administrative and documentation burdens imposed by mandatory geriatric consultations did not result in improved patient outcomes. 86 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 9. IS HEAD CT INDICATED AFTER EVERY GROUND LEVEL FALL IN THE ELDERLY? R Sartin BS, C Kim BS, S Dissanaike MD Lubbock, TX Background: The incidence of ground level falls in the elderly is increasing, along with the ageing population in the US. Appropriate evaluation of these patients is a matter of debate, with differing opinions on whether the routine use of advanced imaging such as CT is indicated. We evaluated the clinical utility of routine head computed tomography (CT) in this population. Method: Retrospective review of all patients > 55years who presented to a level 1 trauma center after sustaining a ground level fall between January 2013 and May 2015. Standard evaluation during this time at this institution included a chest radiograph and a head CT scan. Inclusion criteria were GCS 15, hemodynamic stability and having received a head CT scan. Results: 148 positive findings were reported on head CT scans of 437 patients (34%). 94 resulted in a change in clinical management (64% of findings, 21.5% of entire cohort). 19 patients required surgery, 59 had a medication change, 56 required ICU admission and 84 had additional imaging. Risk factors for positive findings were age > 85 years (p<0.03) and presence of a neurologic deficit on admission (p< 0.0001). Patient sex, loss of consciousness at the time of event and history of anticoagulant or antiplatelet medication use did not increase risk of intracranial injury in this cohort. Conclusion: Head CT scan has a high rate of positive findings in elderly patients after a ground level fall, even with a GCS of 15; the incidence of positive findings increased with advancing age. We recommend routine head CT in the elderly presenting after a ground level fall. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 87 SCIENTIFIC PAPER ABSTRACTS (cont.) +10. PRETRANSFER CT SCANS ARE FREQUENTLY PERFORMED, BUT RARELY HELPFUL IN RURAL TRAUMA SYSTEMS DA Thornburg MS4, WE Paulson MD, PM Bjordahl MD Sioux Falls, SD Background: In rural trauma systems, many injured patients are assessed and stabilized at community hospitals prior to transfer to a regional trauma center. Subsequent evaluation often includes additional or repeated radiographic exams. Prior studies have demonstrated that computed tomography (CT) scans are often repeated at the receiving facility primarily due to difficulty in image transfer. The purpose of this study is to evaluate the frequency and potential reasons behind repeat CT imaging following transfer to a rural regional trauma center. Method: Two hundred consecutive adult trauma patients transferred to a rural Level 2 trauma center from September 2014 through June 2015 were retrospectively evaluated. Data considered included CT scans performed at transferring facilities, documentation of the indication for transfer and intervention at the outside facility, level of trauma activation, injury severity score, and repeat CT scans upon arrival to receiving facilities. Repeat imaging was defined as CT scan performed upon arrival at the receiving trauma center for a patient who underwent CT just prior to transfer. The majority of images performed prior to transfer were viewed at the trauma center via the picture archiving and communication system (PACS). The reason for repeating studies was recorded as: (1) incomplete imaging, (2) change in patient condition, (3) inappropriate/inadequate technique, (4) images not available, and (5) unknown/not determined. Results: Three patients were excluded. 197 transferred patients’ records were evaluated. 152 patients (77.2%) underwent CT scan prior to transfer. CT scan findings were the indication for transfer in 88 imaged patients (44.7%). One intervention (0.5%) was performed as a result of CT imaging prior to transport, and resulted in unnecessary iatrogenic injury. 84 patients (55.3%) received repeat CT imaging on at the trauma center. There were no differences in rates of CT imaging based on injury severity, mechanism, or age. The most common reasons for repeat CT scans were incomplete initial imaging and inappropriate technique. Conclusion: Repeat CT imaging in transferred trauma patients is very common. Despite the lack of recommendations to perform CT imaging during initial resuscitation, many trauma patients receive radiographic studies both prior to and after the decision to transfer has been made in the rural community hospitals. Our results suggest that management, aside from transfer decision, is very rarely altered as a result of pre-transfer CT scans. In contrast to prior studies, the transmission of imaging data was of minimal contribution to the rate of repeat CT imaging of transferred patients in this series. The rural trauma system may benefit from improved protocols and communication between providers in the community hospitals and trauma center to provide prompt, efficient and safe care for rural trauma patients that omits evaluations that do not impact care or outcome of this population. 88 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) *11. RETURNING FROM THE ACIDOTIC ABYSS: MORTALITY IN TRAUMA PATIENTS WITH A PH <7.0 SW Ross MD MPH, BW Thomas MD, AB Christmas MD, KW Cunningham MD MPH, RF Sing DO Charlotte, NC Background: Severe acidosis is part of the lethal triad and is a marker for mortality in trauma. Venous blood gas (VBG) is a readily available, rapid lab in the emergency department (ED). Subsequently, VBG is frequently used as an adjunct in the initial trauma evaluation. We hypothesized that a VBG pH of <7.0 on ED presentation would correlate with almost universal mortality in trauma patients. Method: A retrospective analysis was performed on an institutional Level I trauma center registry from 2013 to 2014. Pediatric and adult patients with initial pH ≤7.30 were included in the study. Patients without pH data were excluded. Patients were then divided into two cohorts, <7.0 or≥7.0, and compared with standard bivariate statistics. Hospital mortality was the primary outcome measured. Multivariate analysis controlling for mechanism of injury (MOI), gender, age, injury severity score (ISS), and initial Glasgow Comas Scale (GCS) was performed by pH status for charges, length of stay (LOS), ventilator days, and mortality; p<0.05 set as statistical significance. Results: There were 593 patients included in the analysis: 66 <7.0, 527≥7.0. The majority of MOI were blunt (78.6%) with fewer penetrating (21.4%). Patients in the <7.0 cohort were younger and had lower initial GCS and base deficit; p<0.05. However, they had similar distribution of male sex, Caucasian race, mean ISS (22.7±14.9 vs. 19.2±13.8), and rate of penetrating trauma (16.7 vs. 20.9%); p>0.05. The lower pH cohort was more likely to proceed directly to surgery (31.8 vs. 18.4%) or incur an ED death (16.7 vs. 1.5%), but less likely to be discharged home (18.2 vs. 54.5%); p<0.01. Mortality was 3x higher in the <7.0 pH cohort (62.1 vs. 20.3%; p<0.0001), however there was no threshold for a pH below which there was 100% mortality. Despite higher mortality, the <7.0 group had equivalent ICU LOS (7.2±9.6 vs. 6.0±6.2 days), ventilator days (6.2±10.9 vs. 6.1±8.2 days), hospital LOS (8.8±15.7 vs. 9.0±11.0 days), and hospital charges ($157,943vs. $129,393) as the≥7.0 cohort; p>0.05. On multivariate analysis, pH <7.0 was not associated with increased ICU or hospital LOS, ventilator days, or charges; p>0.05. However, even after controlling for these confounding variables, initial pH was found to be an independent predictor of inpatient mortality at several cut-points (Odds Ratio, 95% CI; p value): <6.7 (12.15, 1.14-129.7; p=0.039), <6.8 (4.83, 1.28-18.21; p=0.020), <6.9 (5.66, 2.28-14.07; p=0.0002), <7.0 (6.33, 3.29-12.19; p<0.0001), <7.1 (3.76, 2.28-6.19; p<0.001). and <7.2 (2.38, 1.42-3.99; p=0.001) Conclusion: Severe acidosis with pH <7.0 is associated with 62.1% mortality in trauma patients, and higher rates of ED death, need for initial emergent surgery, and lower rates of discharge home. However, there was no pH value where patient mortality reached 100%. This data indicates that while patients with severe acidosis are at increased risk for mortality, a pH <7.0 is not synonymous with futility. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 89 SCIENTIFIC PAPER ABSTRACTS (cont.) 12. DOES LYMPH NODE STATUS INFLUENCE ADJUVANT THERAPY DECISION-MAKING IN WOMEN 70 YEARS OF AGE OR OLDER WITH CLINICALLY NODE NEGATIVE HORMONE RECEPTOR POSITIVE BREAST CANCER? AB Chagpar MD, N Horowitz MD, T Sanft MD, L Wilson MD, A Silber MD, B Killelea MD, M Moran MD, M DiGiovanna MD, E Hofstatter MD, G Chung MD, D Lannin MD New Haven, CT Background: In its 2016 “Choosing Wisely” guidelines, the Society of Surgical Oncology made the recommendation that women≥ 70 years of age with clinically lymph node (LN) negative (-), hormone receptor (HR) positive (+) breast cancer should not routinely be staged with a sentinel LN biopsy (SLNB). We sought to understand the implications of such a recommendation in terms of adjuvant therapy decisionmaking. Method: The National Cancer Database (NCDB), which captures data on over 70% of cancer patients, was queried for patients who had clinically LN-, HR+ breast cancer. Statistical analyses were performed to determine the impact of LN evaluation on receipt of adjuvant chemotherapy and radiation therapy. Results: Between 2004 and 2013, there were 193,728 patients in the NCDB who were between the ages of 70 and 90 (median, 77) when they were diagnosed with clinically LN-, HR+ invasive breast cancer. The median tumor size was 14 mm. 154,504 patients (79.8%) had regional LN surgery; of these, the median number of LNs examined was 3 (range; 0-88). 23,126 (15.1%) were found to be LN+; the median number of positive LNs was 1 (range; 1-57). 63.6% of patients had a lumpectomy, 31.4% had a mastectomy, and 4.9% had no surgery for their breast cancer primary. Of the 97,866 patients who had a lumpectomy with LN assessment, there was a significant difference in receipt of radiation therapy between LN- and LN+ patients (73.8% vs. 81.4%, respectively, p<0.001). Post-mastectomy radiation therapy also varied significantly based on LN status (30.3% vs. 5.1% for LN+ vs. LN-, respectively, p<0.001). In addition, patients with LN+ disease were more likely to receive chemotherapy (28.3% vs. 5.5% for LN- patients, p<0.001), and more likely to receive hormonal therapy (83.6% vs. 82.7%, p<0.001). On multivariate analysis, patients who were LN+ remained significantly more likely to receive chemotherapy independent of patient age, race, insurance status, income, tumor size, grade, comorbidities, receipt of hormonal therapy, or region of the country in which patients resided (OR = 5.587; 95% CI: 5.340-5.847, p<0.001). Similarly, on multivariate analysis of patients undergoing a lumpectomy, LN+ patients were significantly more likely to receive radiation therapy, independent of patient age, race, insurance status, income, tumor size, grade, comorbidities, receipt of hormonal therapy, region of the country in which patients resided, or crowfly distance to the nearest radiation facility (OR = 1.388; 95% CI: 1.309-1.472, p<0.001). 90 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) Conclusion: While only 15% of patients who are≥ 70 years of age with clinically LN-, HR+ breast cancer will have positive nodes, and over 80% of them will receive hormonal therapy as part of their treatment regimen, LN status seems to be an important factor in decision-making regarding addition of chemotherapy and/or radiation therapy in these patients. Hence, to avoid SLNB in these patients must be considered in a multidisciplinary context. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 91 SCIENTIFIC PAPER ABSTRACTS (cont.) *13. RADIOACTIVE SEED LOCALIZATION FOR BREAST CONSERVATION SURGERY: LOW POSITIVE MARGIN RATE WITH NO LEARNING CURVETHE NEW GOLD STANDARD? CS Velazco MD, MS, N Wasif MD, MPH, BA Pockaj MD, RJ Gray MD Phoenix, AZ Background: Radioactive seed localization (RSL) is an alternative to wire localization for non-palpable breast lesions. Although most new procedures have a “learning curve”, the skills required for RSL can be mastered easily by breast surgeons. We compared the rate of positive margins (the key outcome of breast lesion localization) at our institution during our early and later experience with RSL for evidence of a learning curve. Method: A retrospective review of RSL procedures at a single institution was performed. To adequately power the study to detect a 3% absolute reduction in positive margin rates inclusion of at least 300 patients was calculated as an adequate sample size. Three surgeons were included in this study. The first 100 cases and up to the last 100 RSL cases for each surgeon were examined. Intraoperative pathologic examination with selective frozen section analysis was used in all cases. Positive margins were defined as ink on tumor. Exclusion criteria included male sex, non-invasive carcinoma and palpable tumors. Statistics were calculated using two-tailed Fisher’s exact test. Results: Total experience with RSL for the three surgeons ranged from 142 to more than 500 cases. The rate of positive margins among the first 100 of each surgeons’ experience with RSL (n=300) was 2.3% and the rate after exceeding 100 RSL procedures or more (n=242) was 3.3% (p=0.62). Individual surgeon’s positive margin rates ranged from 2-5% in the early experience and 2-7% in the later experience (p=NS). When limiting the early experience to the first 50 cases only, the rate of positive margins was 2% (n=150) for the early experience and 4% for the late experience (n=150, p=0.49). Individual surgeon’s rates of positive margins for this division of experience was 2% for all surgeons for the early experience and 2-6% for the late experience. Setting the threshold at the first 10 or the first 20 cases also did not reveal an increase in positive margin rates (0% and 0%, respectively). Conclusion: Radioactive seed localization for breast conservation surgery has a low rate of positive margins even early in a surgeon’s experience. Implementation of RSL can be done with no evidence of a learning curve to achieve a low rate of positive margins. 92 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) *14. THE SUCCESS OF SENTINEL LYMPH NODE BIOPSY AFTER NEOADJUVANT THERAPY: A SINGLE INSTITUTION REVIEW JM Chang MD, HE Kosiorek MS, N Wasif MD MPH, RJ Gray MD, CH Stucky MD, DW Northfelt MD, KS Anderson MD PhD, AE McCullough MD, IT Ocal MD, BA Pockaj MD Phoenix, AZ Background: In 2013, the results of ACOSOG Z1071 demonstrated the efficacy of neoadjuvant therapy in axillary disease. We reviewed a cohort from a tertiary care center to validate these results and examine our experience. Method: From 2002 to 2015 we performed a retrospective review of a prospectively collected database of women with breast cancer who underwent neoadjuvant therapy. Patient factors, tumor factors, and specifically axillary staging procedures and response were analyzed. Neoadjuvant therapy varied per medical oncology discretion. For analysis, patients with stage IV disease, inflammatory breast cancer, and no axillary staging procedure were excluded. Results: Of 289 women, 38 (13%) had inflammatory breast cancer, 82 (28%) had triple negative breast cancer (TNBC), 126 (44%) had ER+HER2- breast cancer and 77(27%) had HER2+ disease. The mean age of patients was 56 years (SD=12). The majority of patients, pre-neoadjuvant therapy, were clinical stage IIA [72 (25%)], IIB [62 (22%)] or IIIA [52 (18%)], respectively). After excluding patients with inflammatory breast cancer, no axillary staging procedures, and stage IV disease, 225 patients were included for analysis. Pre-neoadjuvant therapy, clinical staging was cN0 in 54%, N1 in35%, N2 in 8%, and N3 in3%. Axillary US pre-neoadjuvant therapy was performed in 62% of cases. 30% of these underwent biopsy, of which 80% were positive. Forty-nine patients had planned axillary lymph node dissection (ALND, 22%), 126 had sentinel lymph node biopsy (SLNB) only (56%, and 50 SLNB + completion axillary lymph node dissection (CALND, 22%). In patients undergoing only SLNB, the mean number of lymph nodes resected was 4.2 (SD=3.3) compared to 15.1 (SD=7.0) for patients who underwent a CALND and 16.0 (SD=8.1) for SLNB + CALND. Pathologically positive lymph nodes were found in 30 (63%) cases of patients who underwent a CALND, 19 (17%) SLNB only and 44 (96%) in SLN + CALND. Decisions not to proceed with CALND in those patients who had a positive SLNB were made by the multi-disciplinary team caring for the patient. 31 (15%) who were deemed to be N0 prior to neoadjuvant therapy were found to have axillary disease at definitive surgery, whereas 32 (15%) who had clinical N1, 2, or 3 disease prior to neoadjuvant therapy had no axillary metastases at definitive surgery. The use of SLNB increased significantly over the study period. Prior to 2013, 33% (26/80) underwent planned ALND and 67% (54/80) underwent SLNB or SLNB+ALND compared to 16% (23/145) and 84% (122/145), respectively, after 2013 (p=0.004). April 2 – 5, 2017 | Hyatt Regency, Maui, HI 93 SCIENTIFIC PAPER ABSTRACTS (cont.) There was no significant difference in overall survival or local/regional recurrence between patients who underwent ALND, SLNB, or SLNB+ALND (p=0.41 and p=0.95). A total of 3 axillary recurrences were found: CALND 1, SLNB 1, and 1 SLNB+ CALND. Conclusion: Patients treated with neoadjuvant therapy can be safely selected to undergo axillary staging using SLNB with infrequent axillary recurrences. Until results of pending trials are available to further define the need for ALND, multidisciplinary clinical judgment should guide the decision to pursue CALND with routine ALND in at least the high risk patients (N2, N3, or TNBC). 94 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) *15. SURGICAL LYMPH NODE EVALUATION IS ASSOCIATED WITH IMPROVED PROGNOSIS IN NODE NEGATIVE SWEAT GLAND CANCER L Kilgore MD, G Winter BS, E Spornitz MA, D Subramaniam PhD, GJ Chen PhD, JMV Mammen MD PhD Kansas City, KS Background: Sweat gland malignancies are rare cancers with an incidence of approximately 5 cases per 1 million individuals annually. Surgical lymph node evaluation is commonly used to better stage patients for many malignancies, commonly by sentinel lymph node biopsy. While wide local excision of the primary tumor is commonly performed, a standard of care for the surgical evaluation of lymph nodes for sweat gland malignancies has not been defined. In this study, we sought to determine if patient survival was improved in patients who had wide local excision with surgical nodal evaluation versus wide local excision alone. Method: We queried the National Cancer Database for all cases of sweat gland malignancies from 1999 to 2013. For the further analysis, we included patients who were clinical N0M0 with any T stage who had undergone surgical resection. In addition to descriptive statistics, multivariate Cox-regression survival analysis was performed with a p value < 0.05 denoting significance. Results: A total of 2439 evaluable patients who had surgery were identified in the National Cancer Database that were N0 and M0. 360 patients underwent wide local excision and surgical nodal evaluation and were found to be pathologic N0 (Group 1). 2079 patients underwent wide local excision alone without surgical nodal evaluation (Group 2). The median age of Group 1 patients was 58 years old versus 68 years old in Group 2 patients. On multivariate analysis, younger age, female gender, low grade, lower T stage, and surgical evaluation of lymph nodes were all associated with improved survival with p values less than 0.05. 5 year survival for patients who had surgery with lymph node evaluation alone was 58.2% versus 49.0% for patients who had surgery without lymph node evaluation (p < 0.01). Conclusion: Surgical evaluation of lymph nodes has been shown to be important in order to appropriately stage patients with melanoma, breast cancer, and Merkel cell cancer. In this study, we demonstrate that surgical evaluation of lymph nodes is an independent prognostic factor towards better survival in sweat gland cancer patients who are lymph node negative. Due to the challenge of performing a randomized study in this rare disease, our data supports the routine use of sentinel lymph node biopsy in patients with sweat gland malignancies. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 95 SCIENTIFIC PAPER ABSTRACTS Survival of TXN0MO Sweat Gland Cancers Patients with or without Surgical Lymph Node Evaluation Group 1- Blue Group 2- Green 96 Southwestern Surgical Congress | 69th Annual Meeting (cont.) SCIENTIFIC PAPER ABSTRACTS (cont.) *16. RE-EXCISION RATES AFTER BREAST CONSERVING SURGERY FOLLOWING THE 2014 SSO-ASTRO GUIDELINES AA Heelan Gladden MD, S Sams MD, C Finlayson MD, AL Gleisner MD, N Kounalakis MD, RJ Brown MD, T Chong MD, DW Mathes MD, C Murphy MD Aurora, CO Background: Reported re-excision rates after breast conserving surgery (BCS) are variable due to controversy over the definition of a “positive” margin. The Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) published consensus guidelines in 2014 where “no ink on tumor” was the new margin requirement for invasive breast cancer after BCS. We sought to evaluate whether reexcision rates at our own institution were affected by the 2014 guidelines. Method: All breast cancer patients treated by BCS between January 1, 2010, and March 1, 2016 were identified. We utilized a guideline adoption date of June 1, 2014. Re-excision rates were calculated and tumor characteristics recorded. Margin size was defined as positive (tumor on ink) or close (≤ 2mm). Student’s t-test and Chi-squared were performed where appropriate. Results: During the designated time period, 759 patients underwent BCS, 434 before the guideline adoption date and 325 after. Of the 434 patients who underwent BCS prior to guideline adoption, 60 required re-excision. After guideline adoption, 39 of the 325 patients required re-excision. Overall re-excision rates before and after the guideline adoption date were 13.8% and 12% respectively (p = 0.46). Patient and tumor characteristics were similar between time periods. When stratified by reason for re-excision by tumor type, the distribution of patients requiring re-excision before the guideline adoption date was 20% for invasive carcinoma, 51.7% for DCIS, and 28.3% for both. After the guideline adoption date, the distribution of patients requiring re-excision was 25.6% for invasive carcinoma, 53.8% for DCIS and 25% for both (p= 0.63). When stratified by margin size on initial lumpectomy, the distribution of patients who underwent re-excision for positive margins before guideline adoption was 66.7% for invasive carcinoma, 26% for DCIS, and 82% for both. After guideline adoption, the distribution of patients requiring re-excision for positive margins was 90% for invasive carcinoma, 47% for DCIS, and 85.5% for both. The distribution of patients requiring re-excision for close margins before guideline adoption was 33.3% for invasive carcinoma, 74% for DCIS, and 17% for both. After guideline adoption, the distribution of patients requiring re-excision for close margins was 10% for invasive carcinoma, 52% for DCIS, and 12.5% for both (p= 0.10). Conclusion: Overall re-excision rates at our institution did not significantly decrease after release of 2014 SSO-ASTRO guidelines, even when stratified by tumor type and size of margin. Re-excision rates were highest for DCIS and comprised over half of all re-excisions. The 2014 SSO-ASTRO guidelines had minimal impact on our institution’s re-excision rate as most re-excisions were done for margins containing DCIS, which were not addressed by the new guidelines. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 97 SCIENTIFIC PAPER ABSTRACTS Indication for Reexcision by tumor type Invasive Carcinoma DCIS Both Total 98 Before Guidelines n=12 (20%) n=31 (51.7%) n=17 (28.3%) 60 After Guidelines n=10 (25.6%) n=21 (53.8%) n=8 (20.5%) 39 Southwestern Surgical Congress | 69th Annual Meeting (cont.) p= 0.63 SCIENTIFIC PAPER ABSTRACTS (cont.) 17. SOUTHWESTERN SURGICAL CONGRESS JACK BARNEY AWARD COMPETITION PRESENTERS - WHERE ARE THEY NOW? SN Kothari MD, KJ Kallies MS La Crosse, WI Background: Participation in scholarly activity is required for faculty and residents by the Accreditation Council for Graduate Medical Education. Resident research presentations at regional, national, and international surgical conferences offer a unique opportunity and may encourage presenters to pursue future research endeavors after graduation. The Jack A. Barney award was instituted in 1987 at the Southwestern Surgical Congress (SWSC) to recognize the top-ranked resident paper. Method: The programs from the 2010-2016 SWSC annual meetings were reviewed for all presenters eligible for the Jack Barney award. In addition, all recipients of the Jack Barney award from 1987-2016 were included. A literature search for all publications authored by eligible presenters and recipients was completed. Fellowship, practice location and type were reviewed. Descriptive statistics were applied. Results: There were 109 presentations from 100 unique presenters eligible for the Jack Barney award from 2010-2016, and 28 unique recipients of the award (2 presenters won twice) from 1987-2016. Among the eligible presenters, 95% were residents, 4% fellows, and 1% medical students. There were 9 presenters who had more than one eligible presentation at separate annual meetings. Of the unique presenters eligible for the award, 75% were from University residency programs, 23% were from independent residency programs, and 2% from military programs. Forty-four presenters have completed their surgical training; of whom, 28 (64%) completed fellowships. Thirty-six (82%) presenters currently practice in a community/private practice hospital, 5 (11%) in a university setting, 2 (5%) in a non-U.S. setting, and 1 (2%) in a military hospital. Overall, subsequent scholarly articles were published in the peer-reviewed literature by 41% of presenters. Among the 28 Barney award recipients, 24 (86%) and 4 (14%) represented University and independent residency programs, respectively. Currently, 16 (57%) practice in community/private practice, and 9 (32%) practice in University settings. Three recipients are still in training. Twenty recipients completed fellowships, and 20 (71%) published after residency. Overall, 13 of the 100 (13%) eligible presenters are current SWSC members, and 7 of 28 (25%) award recipients are current SWSC members. Conclusion: The Jack Barney award recognizes scholarly activity among surgery trainees at the SWSC. Subsequent peer-reviewed publications were frequent among eligible presenters and award recipients. Low retention rates of resident presenters as SWSC members provide an opportunity for further recruitment and retention as they have to potential to be future leaders of the SWSC. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 99 SCIENTIFIC PAPER ABSTRACTS (cont.) *18. PHYSICIAN BURNOUT & PTSD IN SURGICAL RESIDENTS: EVERYBODY HURTS. . . SOMETIMES T Jackson MD, B Bankhead-Kendall MD, C Pearcy MD, K Almahmoud MD, J Hunter MD, T Cook, Y Haque, K McLean, J Morgan, V Agrawal PhD, K Taubman MD, MS Truitt MD Dallas, TX Background: The incidence of Posttraumatic Stress Disorder (PTSD) among practicing physicians has been demonstrated to be higher than the general population. Physician Burnout (PBO) is also on the rise. Given the potential overlap of symptoms, we aim to evaluate the incidence of PTSD and PBO among surgery residents. To our knowledge, no previous work has evaluated these two conditions in this cohort. Method: A cross-sectional national survey of surgery residents was conducted. Screening for PTSD and PBO was performed using the Primary Care PTSD Screen (PC-PTSD) and a previously validated abbreviated burnout tool. Three or more positive responses to the PC-PTSD screen were considered positive for PTSD (PTSD+). Causative traumatic factors associated with PTSD were queried. Responses to PBO questions were grouped into low, intermediate and high scores within the categories of depersonalization and emotional burnout. Eleven risk factors for PTSD and PBO were examined including resident demographics and residency characteristics. A chi-square or Fisher’s exact test were employed for statistical significance in large or small sample sizes, respectively. Results: From September to October 2016, 549 surgery residents completed the survey. A positive PTSD screen was noted in 22% of respondents (n=113), and 51% reported symptoms of PTSD. Overall, there were significant differences in the incidence of PTSD by Post-Graduate Year (PGY). PGY2 residents were at highest risk of developing PTSD, followed by PGY4, PGY3, and PGY1 residents respectively. Upper level residents (PGY5, PGY6, and PGY7) exhibited the lowest risk. Overwhelming responsibilities at work (22%), discord between personal and professional life (19%), and criticism or bullying by attendings (13%) were the most frequently cited stressful experiences. No other risk factors were found to be significant. Of respondents, 35% (n=191) were positive for a high degree of PBO (PBO+). The emotional exhaustion and depersonalization subcomponents were positive in 23% (n=125) and 29% (n=157) respectively. Degree of depersonalization increased with PGY (p=0.003). Additionally, a greater proportion of women reported burnout on the emotional exhaustion component (p=0.02). Finally, 37% of all PTSD+ surgery residents were positive for one of the components of PBO as well (p < 0.001). Conclusion: Our data indicate an incidence of 22% and 35% for PTSD and PBO, respectively, among surgery residents. Additionally, we noted a strong association between PTSD+ and PBO+ residents. Given the apparent relationship between PTSD and PBO, screening and coping strategies should be considered. Physician satisfaction has been linked to improved quality of care, cost containment, patient safety, and overall patient satisfaction. As healthcare evolves, the wellness of physicians and residents cannot be overlooked. 100 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 19. VENOUS THROMBOEMBOLISM IN COMMON LAPAROSCOPIC ABDOMINAL SURGICAL OPERATIONS R Fazl Alizadeh MD, S Sujatha-Bhaskar MD, MJ Stamos MD, NT Nguyen MD Orange, CA Background: Venous thromboembolism (VTE) is a substantial postoperative complication with severe consequences following abdominal operations. The natural history of this disease process appears to significantly vary between different surgical procedures. In this review, we intend to examine the incidence and course of VTE among different abdominal surgical operations and assess potential risk factors. Method: The ACS-NSQIP databases were utilized to identify patients who underwent laparoscopic abdominal operations from 2005 to 2014. All the malignant cases were excluded. All the patients with VTE were identified and divided into six groups based on sub-specialty: colorectal, bariatric, gall bladder, esophagus, hernia, and appendiceal resections. Demographic patient data, preoperative risk factors, and postoperative complications were reviewed for each of these six cohorts. Results: 2424 out of 750060 (0.3%) patients diagnosed with VTE during this time period. Of these, 734 out of 65512 (1.1%) were colorectal, 539 out of 153552 (0.4%) were bariatric, 489 out of 239499 (0.2%) were gall bladder, 276 out of 168963 (0.2%) were appendiceal, 215 out of 91122 (0.2%) were hernia repair, and 171out of 31412 (0.5%) were esophageal resections. Patients undergoing colorectal operations had the highest VTE risk and median age of this patient subset was 59. A high incidence of comorbidities was noted as 50.2% of this patient population had an ASA score > 2. Median operative length during colorectal procedures (187 min) was longer in comparison to other abdominal operations. Patients with VTE following colorectal procedure additionally demonstrated highest rates of pulmonary embolism (33.9%), organ space infection (15.9%), and sepsis (14.4%). Length of stay was prolonged in colorectal operations including patients with VTE (13 days ±11.5) and without VTE (6 days ±8) in comparison to other abdominal operations. Conclusion: Laparoscopic colorectal operations demonstrated the highest incidence of VTE when compared against other abdominal operations. A high degree of suspicion for potential VTE should be utilized during the postoperative phase. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 101 SCIENTIFIC PAPER ABSTRACTS (cont.) 20. PERIOPERATIVE COMPLICATIONS INCREASE THE RISK OF VENOUS THROMBOEMBOLISM FOLLOWING BARIATRIC SURGERY KL Simon MD, RM Higgins MD, TL Kindel MD PhD, MC Helm BS, JC Gould MD Milwaukee, WI Background: Morbidly obese patients are at an increased risk of venous thromboembolism (VTE) following surgery. VTE, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), has the potential to result in significant morbidity and mortality. When a patient experiences a clinically significant post-surgical complication, their risk of VTE may suddenly increase. Using a large national database, we sought to determine the relationship between the most common post-bariatric surgery complications (other than VTE) and a subsequent VTE in the first 30 days following bariatric surgery. Method: The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) dataset between 2012-2014 was used to identify patients who underwent primary or revisional bariatric surgery. The cohort included gastric bypass (n=28,268), sleeve gastrectomy (n=30,258), bariatric revision (n=418), and biliopancreatic diversion procedures (n=480). We examined 17 of the most common perioperative complications including: wound dehiscence, surgical site infections, reintubation within 48-hours of surgery, failure to wean from the ventilator, pneumonia, sepsis, septic shock, blood transfusion, cardiac arrest, myocardial infarction, ischemic stroke, reoperation, renal insufficiency, acute renal failure, and urinary tract infection. Multivariate regression analysis was used to determine the effect of post-operative complications on the risk of VTE. Results: Of the 59,424 patients who met inclusion criteria, the overall incidence of VTE was 0.5% (PE 0.2%; DVT 0.3%; n=282). The average time to diagnosis of DVT was 14.3 days, while PE was 12.1 days. 80% of VTE events occurred after discharge, but within the first 30 days after surgery. Patients with a post-operative VTE were more likely to have previously had another major complication during their hospital stay (21.3%; p<0.0001). Average post-operative length of stay in patients later diagnosed with a VTE was 5.12 days, in comparison to 2.15 days for patients who did not have a VTE (p<0.0001). Reoperation increased the risk of VTE 7.6-fold, renal complications 20-fold, cardiac complications 11.9-fold, pulmonary complications 21.7-fold, and SSI 6.2-fold (all p<0.0001). The more complications experienced by an individual patient, the more likely they were to develop a VTE (Figure 1). Furthermore, 30-day mortality increased 13.94 fold following VTE (p<0.0001). Figure 1: Multivariate regression analysis assessing the impact of multiple postoperative complications on the risk of VTE within 30-days of surgery, after controlling for age and sex. Conclusion: Post-operative complications place patients at a significantly increased risk of VTE following bariatric surgery. Once a significant complication has occurred, more aggressive surveillance and preventative protocols should be put in place to address 102 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) this higher risk. Since the majority of VTE events occurred after hospital discharge, studies to screen for lower extremity DVT, extended chemoprophylaxis after discharge, and even considering insertion of inferior vena cava filters in those at highest risk, are strategies that should be considered and may help minimize the incidence and morbidity of these VTE events. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 103 SCIENTIFIC PAPER ABSTRACTS (cont.) *21. DOES LAPAROSCOPIC APPENDECTOMY HAS TO BE THIS EXPENSIVE? THE USE OF HEM-O-LOK VERSUS ENDOSTAPLER DEVICES MA Al-Temimi MD MPH, MA Berglin BA, AF Mousa BA, DJ Tessier MD, Samir Johna MD MACM Fontana, CA Background: Few North American studies evaluated the use of Hem-O-Lok (HOL) clip to secure the appendiceal stump and the mesoappendix during laparoscopic appendectomy (LA). Our study evaluates the safety, efficacy and cost of using the HOL clip in LA. Method: We conducted a prospective cohort study of patients undergoing LA between June and September 2016 at a single institution. Eight surgeons used the HOL clip and twelve used the conventional endostapler during LA. Preoperative characteristics, intraoperative details, and 30-day postoperative outcomes were compared using univariate and multivariate analysis. Propensity score analysis was also used to adjust for preoperative differences between the two groups. Results: HOL clip was used in 45 out of 92 LA. The use of the HOL clip was attempted in two patients, but the clip could not secure the thick stump. The stapler was then used to complete these two procedures. The minimum cost for the endostapler during LA was $273.13 ($101.97 for stapler handle and $171.16 for stapler load) versus $32.14 for the HOL clip. Age (mean+/-standard deviation (sd), 27.97 +/-16.01 vs. 32.1 +/-17.46), body mass index (mean+/-sd, 25.93 +/-5.53 vs. 26.8 +/-6.98), gender (male, 40.4% vs. 40.0%), any preoperative co-morbidity (51% vs. 63%) and resident participation (24.4% vs. 17.0%) were not different between the HOL and endostapler groups (P>0.05); however, perforated appendicitis was more common in the endostapler group than the HOL group (29.8% vs. 11.1%, P=0.027). Operative time (mean+/-sd, 43.3+/- 15.8 min vs. 38.8+/- 20.5 min, P=0.247) and intraoperative blood loss (mean+/-sd, 13.2+/-36.6 ml vs. 7.29 +/-9.1 ml, P=0.290) were not different between the two groups. Drain placement (4.4% vs. 8.5%, p=0.430), return to the hospital (2.2% vs. 10.6%, p=0.102), and longer hospital stay (mean+/-sd; 1.8+/- 1.32 days vs. 2.5 days +/-2.76, p=0.111) were more common in the endostapler group, but did not reach statistical significance. Postoperative complications were more common in the endostapler group (19.2% vs. 2.2%, p=0.009). In multivariate analysis, the HOL clip was associated with a lower complications rate (OR=0.05, 95% CI 0.003-0.744; p=0.030). In propensity score matched cohort with balanced preoperative characteristics including the rate of perforated appendicitis, the HOL group still had lower postoperative complications (15.8% vs. 2.6%). In a subgroup analysis of 77 patients with non-perforated and non-gangrenous appendicitis, postoperative complications were lower in the HOL group but that did not reach statistical significance (6.1% vs. 0%, P=0.114). Conclusion: Use of the HOL clip in LA is safe, effective and less costly than using the endostapler. The HOL clip use might be associated with decreased postoperative complications after LA. 104 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) *+22. FULL PATHOLOGICAL REVIEW OF ALL GASTRIC REMNANTS FOLLOWING SLEEVE GASTRECTOMY: IS IT NECESSARY? SK Hansen MD, BJ Pottorf MD, HW Hollis Jr MD, FA Husain MD Denver, CO Background: Obesity is now emphasized as a major health concern in the United States. Current estimates show that over 50% of adults are overweight or obese; 6% of the population qualifies as morbidly obese based upon body mass index (BMI >40). Obesity has been proven to increase medical co-morbidity and mortality. To date, the most successful treatment for obesity remains bariatric surgical intervention. Sleeve gastrectomy has become a popular choice for the morbidly obese patient. Many institutions across the country send the gastric remnant for full pathologic review. This study attempts to determine if enough pathological abnormalities exist in these remnants to warrant full pathologic evaluation in each instance. Method: Data on patients presenting for elective sleeve gastrectomy between Aug 1, 2011 and June 30, 2014 were collected. All pathology results were reviewed. Any abnormality noted on pathology report was documented. Significant abnormalities (those requiring continued follow up or treatment) were documented separately. All procedures were performed by a fellowship trained surgeon. Results: A total of 385 patients comprised the study population. Full pathologic evaluation, performed by credentialed pathologists, was available for 352 patients (91.4%). One hundred and fifteen (115/352) were noted to have abnormal pathology (32.7%). Chronic gastritis or inflammation was the most common abnormality, noted in 95 (27%) specimens. Other abnormalities were noted in 19 specimens (5.4%). These included: benign polyps, which were identified in 8 (2.3%), and active gastritis or inflammation was noted in 7 (2.0%) specimens. Active H. Pylori infection was also present in 7 (2.0%) specimens. Intestinal metaplasia was identified in only 6 (1.7%) specimens and no dysplasia or frank malignancy was recognized in any specimen. Conclusion: Bariatric surgery remains the gold-standard for the treatment of obesity and its comorbidities. Of the effective surgical options, sleeve gastrectomy has increased in popularity. Many institutions send all gastric remnants for full pathologic analysis at a cost ranging from $500 to $1500 per specimen (in our institution). These data suggest that this practice is not necessary. None of the 352 patients in this retrospective cohort analysis showed pathological findings requiring treatment or continued followup. In an era of exponentially increasing healthcare costs these results suggest that routine pathologic evaluation of the gastric remnant following sleeve gastrectomy is unnecessary, particularly when gross pathology is not noted at initial operation. In high risk or symptomatic patients, preoperative EGD may be warranted if gastric pathology is suspected. In average risk patients, back table examination of the remnant at the time of surgery, with full pathologic review if an abnormality is noted, appears to be both safe and present significant cost savings. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 105 SCIENTIFIC PAPER ABSTRACTS (cont.) *23. LAPAROSCOPIC COMMON BILE DUCT EXPLORATION VERSUS ERCP FOR THE MANAGEMENT OF CHOLEDOCHOLITHIASIS FOUND AT TIME OF LAPAROSCOPIC CHOLECYSTECTOMY: ANALYSIS OF A LARGE INTEGRATED HEALTH CARE SYSTEM DATABASE MA Al-Temimi MD MPH, EB Kim MD, BA Chandrasekaran MD, CN Trujillo MD, VJ Franz MD, SD Johna MD MACM, DJ Santos MD Fontana, CA Background: Endoscopic retrograde cholangiopancreatography (ERCP) after laparoscopic cholecystectomy (LC/ERCP) and laparoscopic common bile duct exploration (LCBDE) are acceptable interventions for the management of choledocholithiasis that is found at time of LC, however, LCBDE can potentially decrease the number of procedures and cost and shorten hospital length of stay. This study will use data from large integrated urban/suburban health care system to compare the safety and effectiveness of LCBDE to LC/ERCP in patients with cholidocholithiasis found at time of LC. Method: All patients with LC and choledocholithiasis found on intraoperative cholangiogram (IOC) with no preoperative ERCP were identified in the Southern California Kaiser Permanente database between January 2005 and September 2015. Those undergoing LCBDE during the study period (N=105) were compared to consequent cases of those undergoing LC/ERCP between September 2014 and September 2015. Failure was defined as the inability to clear the common bile duct on cholangiogram, readmission with retained stones within 1 year, or conversion to open surgery. Success of clearing the common bile duct is the primary outcome of the study. Hospital length of stay, intraoperative events, and postoperative complications were the secondary outcomes. Bivariate and multivariate analysis was used to test the association of type of intervention with the primary and secondary outcomes. Results: During the study period, 5,046 patients had LC with IOC and no preoperative ERCP. Out of 1,372 who had choledocholithiasis on IOC and met our inclusion criteria, 300 patients were included in the study (105 LCBDE, 195 LC/ ERCP). Mean age was 47.5+/-20 years and 74.7% were females. Patients undergoing LCBDE were more likely to have American Society of Anesthesiologists (ASA) class >3 (28.6% vs. 17.4%, p=0.025) and history of roux-en-y gastric bypass (16.2% vs. 0%, P<0.001). LC/ERCP was significantly more effective at clearing the common bile duct than LCBDE (98.9% vs. 89.5%, p = 0.01), however, LCBDE was associated with lower number of procedures per patient (mean+/- standard deviation (sd), 1.1+/-0.4 vs. 2.0+/-0.12, p<0.001). There was no mortality. 30-day postoperative morbidity (6.7% vs. 7.2%), hospital length of stay (mean+/-sd, 3.5+/-2.4 day vs. 3.4+/-2.6 day), readmission to the hospital, return to the operating room, conversion to open surgery and number of retained stones were not different between LCBDE and LC/ERCP (P>0.05). Two patients failed ERCP and underwent open CBD exploration, while 11 patients failed LCBDE and had subsequent ERCP. All patients with roux-en-y gastric bypass had successful LCBDE. Conclusion: LC/ERCP is superior to LCBDE at clearing common bile duct stones in a large integrated health care system, however, LCBDE is an effective alternative when ERCP cannot be used due to roux-en-y gastric bypass. 106 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 24. A NATIONWIDE EVALUATION OF ROBOTIC VENTRAL HERNIA SURGERY KM Coakley DO, SM Sims MD, T Prasad MA, AE Lincourt PhD MBA, VA Augenstein MD, R Sing MD, BT Heniford MD, PD Colavita MD Charlotte, NC Background: Robotic surgery offers technical advantages to traditional laparoscopic surgery, however, this technology comes at greater cost. Our purpose was to examine outcomes of robotic versus laparoscopic surgery using a comprehensive national database. Method: The Nationwide Inpatient Sample, which captures ~20% of US inpatient admissions, was queried from October 2008 (inception of the robotic ICD-9-CM code) to December 2013 for ventral hernias, defined as incisional, umbilical, epigastric, hypogastric, and spigelian. Demographics, morbidity, mortality, and costs were compared between robotic and laparoscopic techniques. Results: From 2008-2013, 149,622 ventral hernia surgeries were identified; 117,028 open, 32,243 laparoscopic, and 351 robotic. Robotic use rose annually with 2013 alone having 168 (47.9%) of all the robotic ventral hernias for the study period. Robotic patients were more likely to be older (59.4 ±14.6 years vs 57.4±14.9 years; p=0.01) and have more chronic conditions (3.8±2.7 vs 3.4±2.6; p=0.007). When comparing robotic and laparoscopic groups, there was no difference between length of stay (3.5±3.6 vs 3.4±2.6, p=0.2). Pneumonia rates were higher in the robotic group (4.3% vs 2.4% p=0.02); however, mortality and other major complications (CHF, renal failure, MI, wound dehiscence, stroke, PE, ARDS, shock) were the same between laparoscopic and robotic ventral hernias. Total charges were increased for the robotic group ($61,274.5 ± $42,666.7 vs $38,715.2 ± $28,533.74; p<0.0001), and robotic technique was more likely to be performed in zip codes with the highest median income,≥$64,000, (28.6% vs 22.9% p=0.014). Robotic ventral hernias were more likely to be performed in urban teaching hospitals (57.3% vs 48.2%; p=0.0007) and regionally the South had the highest rate of robotic utilization (45.0% vs 38.1%, p=0.008). Using multivariate regression, when controlling for age, number of chronic conditions, hospital geographic region, public versus private hospital type, urban versus rural teaching status, and zip code median income, robotic repair remained an independent predictor of increased charges ($42,120± $257.1 vs. $61,458.9± $1431.0; p<0.0001) Conclusion: The first nationwide evaluation of robotic ventral hernia repair demonstrates comparable safety to the laparoscopic technique, with increased cost and regionalization to urban teaching hospitals in areas of higher median income. The results of this nationwide evaluation continue to demonstrate robotics’ higher costs compared with conventional laparoscopy. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 107 SCIENTIFIC PAPER ABSTRACTS (cont.) *25. DISPARATE EFFECTS OF CATECHOLAMINES UNDER STRESS CONDITIONS ON ENDOTHELIAL GLYCOCALYX INJURY: AN IN VITRO MODEL JV Martin MD, LN Diebel MD, DM Liberati MS Detroit, MI Background: Geriatric trauma patients have high circulating norepinephrine (NE) levels but attenuated release of epinephrine (Epi) in response to increasing severity of injury. Sympathoadrenal activation and tissue hypoxia secondary to trauma induce endothelial activation and glycocalyx injury, which are major factors in the pathogenesis of the acute coagulopathy of trauma. Elderly patients also have a greater proclivity to a post injury hyperfibrinolytic phenotype; however the pathogenesis is unknown. To account for these findings, we hypothesized that NE and Epi ± hypoxia have different effects on the endothelial and glycocalyx components of the vascular barrier and were studied in vitro. Method: Confluent human umbilical vein endothelial cells (HUVEC) were treated with varying concentrations of NE or Epi and exposed to hypoxia-reoxygenation (H/R; 5% CO2 95% N2) or standard culture conditions (21% O2, 5% CO2). Cell culture supernatants were obtained and glycocalyx injury indexed by syndecan-1 release and endothelial cell activation/injury determined by soluble thrombomodulin (TM), plasminogen activator inhibitor-1 (PAI-1), and tissue type plasminogen activator (tPA) concentrations (all by ELISA). Results: See table Conclusion: NE ± H/R was associated with significantly greater glycocalyx damage and endothelial activation/injury vs. Epi treatment groups. There were minimal changes in PAI-1 with either NE or Epi ± H/R. However NE ± H/R was associated with significantly higher tPA levels, reflective of a profibrinolytic state. Our study supports the more liberal use of the anti-fibrinolytic agent tranexamic acid in the severely injured elderly patient population. 108 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS April 2 – 5, 2017 | Hyatt Regency, Maui, HI (cont.) 109 SCIENTIFIC PAPER ABSTRACTS (cont.) *26. REDEFINING THE ABDOMINAL SEATBELT SIGN: ENHANCED CT IMAGING METRICS IMPROVE INJURY PREDICTION MC Johnson MD, R Stewart MD, D Jenkins MD, J Myers MD, D Dent MD, L Liao MD, R Cestero MD, S Nicholson MD, M Muir MD, E Scherer MD, C Crane MD, B Eastridge MD San Antonio, TX Background: The abdominal seatbelt sign (ASBS) has an established association with abdominal injury, yet its definition remains ill-defined. The goal of our study was to better characterize abdominal seatbelt sign in the context of seatbelt wear pattern. We hypothesize specific imaging characteristics associated with the ASBS such as location above the pelvic brim and depth of abdominal wall soft tissue injury would better predict underlying injury and need for operative intervention. Method: We performed a retrospective chart review of all motor vehicle crashes (MVC) evaluated at a level one trauma facility from 2010-2015. Inclusion criteria included age >17, MVC mechanism, diagnosis of abdominal wall contusion, and availability of CT imaging. The population was refined by documentation of an “abdominal seat belt sign” in the medical record. Variables collected for the analysis included demographics, intraperitoneal injuries, pelvic fractures, injury severity score, operative procedures and outcomes. CT imaging was reviewed for the presence of a transverse abdominal wall contusion consistent with lap belt use. Contusion location was determined in relation to the anterior superior iliac spine (ASIS). Abdominal wall thickness as well as contusion depth were measured at the contusion level and an abdominal seatbelt sign depth index (ASBSI) was calculated. Results: Sample size for the cohort was 333 subjects, of which 111 had evidence of seatbelt sign on CT imaging and 163 had evidence of seatbelt sign only on exam. Operative need was 7.4% in those with ASBS on CT (CT ASBS) and 2.8% in those with only clinical evidence of ASBS (CL ASBS). CT ASBS above the ASIS was associated with higher incidence of intra-abdominal injuries (33.3% vs 18.5%; p =0.07) and a higher rate of abdominal operations (24.6% vs. 7.4%; p < 0.01) compared to below the ASIS. In contrast, CT ASBS below the ASIS was associated with a higher incidence of pelvic fractures (24.1% vs. 5.3%; p<0.005). Calculation of the associated risk ratios for abdominal exploration noted those with CL ASBS were 1.17 times more likely to need an abdominal operation while those with CT ASBS were 2.12 times more likely to require intervention. Evaluating subjects with CT ASBS above the ASIS, those requiring operative intervention were associated with seatbelt signs higher above the ASIS (5.07 vs 3.21 cm; p- 0.01) and a deeper ASBSI (0.91 vs 0.57; p <0.001). Applying these metrics to predict the need for operative intervention demonstrated that ASBSI was significantly associated with abdominal injury requiring operative intervention (Figure 1). Conclusion: Characteristics of the abdominal wall injury on CT imaging such as location above the ASIS and injury depth index are better predictors of abdominal 110 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) operative need than standard clinical measures. This analysis substantiates a novel diagnostic tool which may have the potential to facilitate clinical diagnosis and management decisions in patients with abdominal seatbelt sign. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 111 SCIENTIFIC PAPER ABSTRACTS (cont.) *27. NOT EVERY TRAUMA PATIENT WITH A RADIOGRAPHIC HEAD INJURY REQUIRES TRANSFER FOR NEUROSURGICAL EVALUATION: APPLICATION OF THE BRAIN INJURY GUIDELINES TO PATIENTS TRANSFERRED TO A LEVEL 1 TRAUMA CENTER G Capron MD, DB Wall MD Urbana, IL Background: Regional trauma protocols and local custom require all patients with radiographically-identified traumatic brain injuries to be transferred to our level 1 trauma center for neurosurgical evaluation. However, few injuries ultimately require neurosurgical intervention. Furthermore, in our rural area, transfer is costly, inconvenient, and potentially risky in inclement weather. Joseph, et al have previously validated within their own institution Brain Injury Guidelines (BIG) to identify patients with head injuries who can be safely managed solely by acute care surgeons. We propose that these guidelines may be useful in helping to determine which patients could safely avoid mandatory transfer to a regional trauma center for neurosurgical evaluation. Method: All patients transferred to our level 1 trauma center with a diagnosis of head injury between January 2012 and December 2013 were identified. Patients without a radiographically-identified intracranial bleed or skull fracture, as well as those with severe non-cranial injuries that mandated transfer, were excluded. The remaining 340 patients were classified as BIG 1 (minor head injury-46 patients), BIG 2 (moderate head injury-59 patients), and BIG 3 (severe head injury and all patients on anticoagulation-235 patients) according to Joseph, et al’s guidelines. Patient characteristics and outcomes were compared. Results: When compared with BIG 3 patients, BIG 1 and 2 patients were significantly younger. BIG 2 patients were more likely to be intoxicated. BIG 1 and 2 patients had a significantly higher GCS, lower Injury Severity Score, and shorter length of hospital stay and ICU stay than BIG 3 patients. BIG 3 patients were significantly more likely to require a neurosurgical procedure and to die. No BIG 1 patients deteriorated or required neurosurgical intervention. One BIG 2 patient required lumbar peritoneal shunt placement for prolonged cerebrospinal fluid leak after basilar skull fracture and another required readmission 9 days after hospital discharge for an enlarged subdural hematoma that was managed nonoperatively. In the BIG 3 group, 28 patients (11.9%) required neurosurgical procedures and 47 (20%) died. Conclusion: The BIG classification proposed by Joseph, et al can help stratify patients for whom transfer is considered. BIG 1 patients have a minimal probability of neurologic deterioration and could potentially be safely observed at their local facility without transfer. In contrast, BIG 3 patients potentially need neurosurgical intervention and should be transferred. BIG 2 patients have a small probability of deterioration or of requiring neurosurgical intervention and the decision to transfer should be individualized. 112 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 28. LOW-GRADE BLUNT HEPATIC INJURY AND BENEFITS OF INTENSIVE CARE UNIT MONITORING JC Perumean MD, M Martinez BS, R Neal BS, J Lee BS, B Wiliams MD, S Wolf MD, H Phelan MD Dallas, TX Background: The standard of care for nonoperative management of blunt hepatic injuries (BHI) is intensive care unit (ICU) observation. It remains unknown if subpopulations of BHI exist which can be safely observed in a non-ICU environment. We sought to determine which low-grade hemodynamically normal BHI at first presentation to the emergency department were associated with any of three interventions indicating ICU observation. Method: We reviewed all BHI admitted to our urban, level 1 trauma center between 01/01/96 and 6/30/14, collecting information on packed red cell (PRC) transfusions, imaging, hepatic angiography, laparotomy, associated injuries, and cause of death. Two groups were created: Group A (hepatic injury grades 1-3 with normal first systolic blood pressure (hemodynamically normal) and Group B (all other BHI). Interventions traditionally undergoing ICU observation were defined as any with the following three criteria: PRC transfusion within the first 24 hours, hepatic angiography, or all-cause laparotomy. Outcomes between Groups and within Group A subgroups were collected. Fischer’s exact was used for categorical data and t-tests for continuous data. Results: Group A (n=838) had a significantly lower ISS, shorter length of stay, fewer units of PRCs transfused, and lower mortality (all p<0.01) than Group B (n=331). Interventions in Group A by grade subgroup are listed in Table 1. Hemodynamically normal low grade injuries had a negative predictive value of 77.42% for any of the three interventions that warranted ICU admission. Sensitivity/specificity of the criteria for ICU admission were 46.53% and 73.49%, respectively. Laparotomy specifically for management of BHI was low in both groups (1.9% in the Grade I/II subgroup and 4.3% in the Grade III subgroup). For patients with isolated BHI (n=156), the sensitivity and specificity of the three interventions was 13% and 90%, while the NPV had a small increase to 81%. Conclusion: Hemodynamic stability at presentation is insufficiently sensitive as a sole criterion for safe admission of Grade I-III BHI to a non-ICU environment. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 113 SCIENTIFIC PAPER ABSTRACTS (cont.) 29. OPERATIVE VERSUS NON-OPERATIVE MANAGEMENT IN THE CARE OF PATIENTS WITH COMPLICATED APPENDICITIS TS Helling MD, DF Soltys MD, S Seals PhD Jackson, MS Background: While there is some evidence that antibiotic therapy alone for uncomplicated appendicitis may be sufficient therapy in a majority of patients, the approach to complicated appendicitis, defined as evidence of perforation, periappendiceal abscess, or phlegmon, is less clear. We have sought to determine whether early surgery or antibiotic therapy would be the preferred treatment for this group of patients Method: All adult patients (> 18 years old) admitted to a university hospital over a five-year period 2009 – 2014 with a diagnosis of appendicitis were reviewed. The majority of patients received a CT scan for diagnosis. The patients were grouped into uncomplicated and complicated presentations. Operative management during the index hospitalization was identified using specific CPT codes. The absence of these codes was presumptive evidence of non-operative management. The patients were stratified into age, gender, ethnicity, and socio-economic status by virtue of income and payer source. Mortality, morbidity, length of hospital stay (LOS), readmission, and hospital charges were used as outcome measures. Analyses utilized univariate and multivariate methodology. Results: Over the study period 611 adult patients were admitted with the diagnosis of appendicitis. Of those 306 patients (50 percent) presented in an uncomplicated manner, and 305 patients (50 percent) were complicated presentations. Complicated presentations were more often seen in older patients (p < 0.001) and in white ethnicity (p = 0.002). Overall, patients who underwent surgery for their appendicitis (complicated or uncomplicated) experienced a lower rate of complications (OR = 0.33, p = 0.0066), and in the complicated groupings, those who were treated non-operatively had significantly more morbidity (OR = 6.94, p = 0.0005). There was a trend, but no statistical significance, towards lower mortality in those patients with complicated presentation who had surgery (OR = 0.23, p = 0.566). Length of hospital stay was significantly longer for complicated patients treated non-operatively (OR = 4.37 versus 2.56, p < 0.0001) and they required more readmissions compared to uncomplicated patients undergoing immediate appendectomy (OR = 6.84, p < 0.0001). By multivariate analysis LOS and rate of hospital readmissions were significantly affected in complicated patients treated operatively compared to those complicated patients treated non-operatively (OR = 4.21 versus 2.33, p < 0.001; OR = 7.19, p < 0.001). Conclusion: From this single center retrospective study it appears that the early, operative treatment of patients presenting with complicated or uncomplicated appendicitis is preferable to non-operative, antibiotic oriented treatment. Moreover, the operative treatment of complicated appendicitis compared to non-operative management reduced morbidity, LOS, and hospital readmission, all of which impact cost of care. 114 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) 30. HOSPITAL ADMISSION UNNECESSARY FOR SUCCESSFUL UNCOMPLICATED RADIOGRAPHIC REDUCTION OF PEDIATRIC INTUSSUSCEPTION MU Mallicote MD, MA Isani MD, AS Roberts, MD, NE Jones BS, KA Bowen MD, RV Burke PhD, JE Stein MD, CP Gayer MD, PhD Los Angeles, CA Background: Routine hospital admission for the management of pediatric ileocolic intussusception has previously been done following successful radiographic reduction due to the concern of possible early recurrence (≤48 hours). However, due to the low recurrence rates we created a new institutional protocol starting 02/05/2014 in which routine admission was eliminated. Patients were observed in the ED and discharged 2-4 hours after nonsurgical reduction provided they were afebrile, tolerating liquids, and did not have tachycardia or abdominal pain. We hypothesize that this protocol is safe and will reduce hospital cost/resources. Method: IRB approval was obtained and we conducted a retrospective review of pediatric patients who presented with intussusception between 01/01/2011 and 02/15/2016. Each patient was identified as being managed under the old protocol versus those managed under the new protocol (implemented 02/05/2014). Outcomes measured included early recurrence vs. later recurrence, length of stay, and adverse outcomes. Patients requiring surgery at first presentation were excluded. Chi-square and Student’s t-tests were used for analysis, as appropriate. ROUT analysis was used to remove outliers. Results: 132 patients were identified as having been treated for intussusception during the study period. 57 were managed with the new protocol and 75 were managed with the old protocol. Mean age for both protocols was 1.4 years. Recurrence rates were similar for both protocols with the new having early recurrence rates (≤48 hours) of 5.97% (n=4, mean=18.25 hours) and later recurrences rates (>48 hours) of 8.96% (n=6, avg 73 days) versus the old which had early recurrence rates of 4.65% (n=4, avg 32.88 hours) and later recurrence rates of 8.14% (n=7, mean=94 days). Average time to early recurrence between old and new (t-test, p=0.1824, n=4) and later recurrence (t-test, p=0.5390, n=6) were not statistically significant. Total recurrence rates for the new protocol were 14.93% (n=10) with a mean of 44 days versus the old protocol of 12.79% (n=11) with a mean of 66 days. 1 patient from the new and 3 patients from the old protocol underwent surgical management for their recurrence. The average length of stay for patients observed in the ED under the new protocol was 5.4 hours, while those admitted for observation under the old protocol was 27.9 hours without adverse outcomes. Conclusion: Discharging patients following uncomplicated radiographic reduction of ileocolic intussusception that meet strict clinical criteria after a 2-4 hour observation period is as safe as admitting them for a 24 hour observation period. However, recurrence remains a possibility and families should be educated about both early and later recurrence. Shorter hospital observation does not appear to lead to an increase in adverse events, and larger trials will need to be conducted to help identify clinical predictors of recurrent intussusception. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 115 SCIENTIFIC PAPER ABSTRACTS (cont.) *31. RE-OPERATIVE CENTRAL LYMPH NODE DISSECTION FOR INCIDENTAL PAPILLARY THYROID CANCER CAN BE PERFORMED SAFELY CM Hall MD, DC LaSeur MD, SK Snyder MD, TC Lairmore MD Temple, TX Background: Extent of cervical lymphadenectomy for papillary thyroid cancer (PTC) remains controversial, especially after an incidental finding of PTC following thyroidectomy. Although level VI metastases are associated with increased recurrence rates, central lymph node dissection (CLND) is often reserved for patients with clinically positive lymph nodes or cancer recurrence. The purpose of this study is to compare the pathological outcomes and operative morbidity for patients undergoing a primary total thyroidectomy with CLND, to those patients undergoing an interval CLND following a previous incomplete thyroid operation, or for unsuspected diagnosis of cancer determined on final pathology. Method: A single-institution, retrospective review of all patients undergoing surgical treatment for PTC from 2000-2015 was performed under an IRB-approved protocol. Patients were divided into three treatment groups: total thyroidectomy with concurrent primary CLND, interval prophylactic CLND, and interval therapeutic CLND. Primary outcomes were number of lymph nodes removed, permanent hypoparathyroidism and recurrent laryngeal nerve (RLN) injury. Results: Results for 73 patients undergoing interval CLND (33 prophylactic, 40 therapeutic) were compared with 218 patients undergoing primary total thyroidectomy with CLND. Demographics and primary outcomes are shown in Table 1. Interval CLND was associated with similar and acceptable complication rates, including RLN injury and permanent hypoparathyroidism. Interval CLND was associated with a trend towards decreased lymph node recovery. Positive level VI lymph nodes were identified in 27% of patients undergoing an interval prophylactic CLND. Conclusion: Re-operative (interval) CLND in patients with an initial incomplete thyroidectomy, or unsuspected diagnosis of cancer revealed on final pathology, can be performed with acceptable morbidity but may be associated with decreased lymph node recovery. Interval CLND should be considered in patients with incidental PTC due to the incidence of occult level VI lymph node metastases. We recommend routine CLND at the primary operation when the diagnosis of PTC is known. 116 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) Table 1: Outcomes of Primary and Interval CLND for PTC Primary CLND [Mean±SD, % (n)] n=218 Age (years) Interval Prophylactic CLND [Mean±SD, % (n)] Interval Therapeutic CLND [Mean±SD, % (n)] n=33 n=40 p 51.7±15.5 45.0±16.2 46.5±18.1 Primary tumor Size (mm) 13.1±7.2 14.0±9.6 14.5±19.8 0.66 Lymph Node Metastases 36.7 (80) 27.3 (9) 72.5 (29) 0.29*, <0.01 Lymph Nodes Examined 11.7±7.7 10.8±6.5 8.7±5.4 0.56*, 0.06 Lymph Nodes Positive 0.74±1.3 0.9±1.9 2.7±2.7 0.52*, <0.01 0.73 0.02 Permanent Hypoparathyroidism 3.7 (8) 6.1 (2) 2.5 (1) Temporary RLN Injury 4.1 (9) 3.0 (1) 5.0 (2) 0.92 Permanent RLN Injury 0.0 (0) 0.0 (0) 2.5 (1) 0.04 * Pairwise analysis Primary CLND versus interval prophylactic CLND April 2 – 5, 2017 | Hyatt Regency, Maui, HI 117 SCIENTIFIC PAPER ABSTRACTS (cont.) 32. WHAT HAPPENS AFTER A FAILED LIFT FOR ANAL FISTULA? ME Wright MD, AG Thorson MD, GJ Blatchford MD, M Shashidharan MD, JS Beaty MD, NL Bertelson MD, P Aggrawal MD, L Taylor PAC, CA Ternent MD Omaha, NE Background: Anal fistula is a complex disease process that can sometimes be frustrating to treat. The main tenets of treatment are control of sepsis, closure of the tract, and maintenance of continence. There have been many treatments developed over the years, but one of the most recent is Ligation of Intersphincteric Fistula Tract (LIFT). This procedure preserves the sphincters by going between them to locate the fistula tract and close it. It has been described as easy to learn and has an 70 to 90% success rate. The aftermath of a failed LIFT has not been well documented. Method: Retrospective chart review of patients undergoing LIFT procedure (CPT 46275) for transsphincteric anal fistula between March 2012 and September 2016. Patient demographics, previous fistula surgeries, time to healing, time to recurrence, and any subsequent procedures and results were recorded. Statistical analyses were performed with Fisher’s Exact Test, Chi-square Test and Mann-Whitney U Test. Results: 52 patients with LIFT procedures were identified, 16 of whom developed fistula recurrence(30%) at a mean follow up time of 7.7 months. The mean time to fistula recurrence after LIFT was 4.4 months. Demographic features between the two groups did not show a significant difference(TABLE 1). Following LIFT, recurrence of fistula was transsphincteric and intersphincteric in 50%(8/16) and 31%(5/16), respectively(p=NS) in patients with available follow up. Eleven of 16 patients with fistula recurrence following LIFT underwent further surgery, four were lost to follow up and one is pending surgery. Persistent transsphincteric fistulas after LIFT were treated with seton replacement in 83%(5/6) followed by rectal advancement flap in 33%(2/6) and second stage fistulotomy in 33%(2/6) at a mean time of 11 months (range: 9-13 months). One transsphincteric fistula recurrence after LIFT treated without seton replacement underwent closure of the tract with fibrin glue. Of the 5 recurrent intersphincteric fistulas 3 underwent seton replacement (60%) followed by second stage fistulotomy, advancement flap, or seton replacement. One patient with intersphincteric fistula recurrence went directly to fistulotomy (1/5) and one was lost to followup. Of these 11 patients who underwent further surgery after failed LIFT, 45% had resolution of the fistula. Among those patients with documented healing, 80% had seton followed by fistulotomy, while the remaining 20% had a seton followed by advancement flap. Conclusion: The results of this study are consistent with previously published data indicating a success rate of 70-90% for LIFT. None of the factors studied in this group demonstrated a significant difference between patients who did or did not develop a documented recurrence after LIFT. Once patients recurred, further LIFTs were not undertaken. Among patients who undergo further surgery, healing was achieved in 45%.This study shows that the most successful treatment of recurrent fistula after LIFT 118 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) procedure is replacement of seton followed by fistulotomy. This fistulotomy may be done in stages. Rectal advancement flap has also showed some promise. TABLE 1 Non-recurrent Recurrent P-value Median Age (Range ) 44 (23-77) 48 (24-88) NS Median BMI (Range) 29.26 (17.33-53 .41) 33.14 (24.43-48.42) NS Male (%) 18 (51%) 7 (41%) NS Median weeks with seton 8 (0-44) 8 (0-52) NS Smoking (%) 8 (25%) 4 (23%) NS Horseshoe abscess 4 (11%) 4 (23%) NS April 2 – 5, 2017 | Hyatt Regency, Maui, HI 119 SCIENTIFIC PAPER ABSTRACTS (cont.) *33. THE HYPERCOAGULABILITY OF END STAGE RENAL DISEASE: THE ROLE OF FIBRINOGEN GR Nunns MD, EE Moore MD, MP Chapman MD, HB Moore MD, GR Stettler MD, E Peltz DO, CC Burlew MD, C Silliman MD PhD, A Banerjee PhD, A Sauaia MD PhD Aurora, CO Background: End Stage Renal Disease (ESRD) patients are prone to both increased rates of bleeding as well as thrombosis. We have previously conducted thromboelastography (TEG) to characterize the coagulation status in ESRD patients, observing delayed clot formation (Activated Clotting Time, ACT) and increased final clot strength (Maximum Amplitude, MA). In healthy individuals, the platelets contribution to clot strength is 80% while fibrinogen contributes 20%. However, in patients with ESRD the cause of increased clot strength is not understood. Given the known platelet dysfunction and hyperfibrinogenemia associated with ESRD, we hypothesize that the increase in clot strength in ESRD correlates with increased serum fibrinogen levels. In addition, we investigated the role of fibrinolysis in ESRD. Method: 58 ESRD patients underwent simultaneous citrated rapid TEG (rTEG) and determination of serum fibrinogen levels prior to operative creation of dialysis access. These were compared to 135 healthy controls that underwent rTEG. TEG variables examined were ACT, angle, MA, and percent clot lysis at 30 minutes (LY30). Data are presented as median and interquartile range (IQR). Cluster analysis identified subgroups with unique TEG profiles. Correlations were assessed via Spearman Rho. Results: Patients with ESRD and healthy controls demonstrate statistically significant differences in ACT (121 (IQR: 105-136) vs 113 (IQR: 105-121) seconds, p=0.0004), Angle (78.8 (IQR: 75.8-81.1) vs 73.9 (IQR 70.9-76.3) degrees, p<0.0001), MA (70.4 (IQR: 66.6-74.2) vs 65 (IQR 61.5-68) mm, p<0.0001) and LY30 (1.3 (IQR: 0.2-2.4) vs 2.7 (IQR 2.0-3.7) percent, p<0.0001). Cluster analysis revealed 3 subgroups of patients, which explained over 75% of the variation: 1) Predominant fibrinolysis shutdown phenotype (LY30 =<0.8%, n= 37); 2) Predominant physiologic fibrinolysis phenotype (LY30 0.8-2.9%, n=10); 3) Predominant hyperfibrinolysis phenotype (LY30 >=3%, n=10). Fibrinogen levels were elevated in ESRD patients (median 434 (IQR 338-535) mg/dL) compared to the clinical reference range (150-400 mg/dL) and positively correlated with MA (Rho = 0.67, p<0.0001) and Angle (Rho = 0.32, p<0.01) in ESRD patients. Conclusion: A unique coagulopathy exists in patients with ESRD consisting of delayed clot formation, but increased final clot strength and decreased clot breakdown. Additionally, a small subgroup with increased clot breakdown was identified. These findings provide insight into the dichotomous clotting and bleeding seen in ESRD. The existence of a subgroup of patients with increased clot breakdown suggests a population susceptible to hemorrhage. At the same time, stronger clots that are resistant to breakdown, may be a contributing factor towards the increased incidence of thrombosis 120 Southwestern Surgical Congress | 69th Annual Meeting SCIENTIFIC PAPER ABSTRACTS (cont.) seen in the ESRD population. This increased clot strength appears to be mediated through hyperfibrinogenemia. Therefore, strategies to ameliorate hypercoagulability in ESRD should target fibrinogen. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 121 122 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTR ACTS April 2 – 5, 2017 | Hyatt Regency, Maui, HI 123 QUICK SHOT ABSTRACTS (cont.) QS 1. MANAGEMENT AND OUTCOMES OF CHOLECYSTECTOMY IN PREGNANCY RP Won MD, S Friedlander MPH, SL Lee MD Torrance, CA Background: Cholecystitis is a common surgical emergency during pregnancy. Cholecystectomy is the treatment of choice in pregnant women due to significant recurrence and morbidity associated with non-operative management. Given the limited data in this patient population, our objective was to determine the presentation, management practices, and outcomes of cholecystectomy during pregnancy. Method: The California State Inpatient Database was queried for all women age 15-45 requiring cholecystectomy for acute and chronic cholecystitis in 2005-2011 (n=102,966). Hierarchical and multivariate regression analyses were used to compare primary outcomes including laparoscopy, morbidity, length of stay, and cost in pregnant and non-pregnant women. Rates of prematurity and fetal loss in patients undergoing cholecystectomy were also compared to baseline rates in all pregnant women from 2005-2011 (n=3,084,964). Results: Of the 102,966 cholecystectomies performed, 5,763 (5.6%) were in pregnant women and 97,203 (94.4%) were in non-pregnant women. On univariate analysis, rates of laparoscopy (pregnant=95.5% vs. non-pregnant=94.5%, p<0.01) and non-pregnancy related complications (pregnant=2.5% vs. non-pregnant=3.3%, p<0.01) appeared clinically similar despite reaching statistical significance. Univariate analysis also revealed pregnant women had a longer length of hospitalization (3.4 days vs. 3.1 days, p<0.01) and higher costs ($11,510 vs. $11,099 dollars, p<0.01). Multivariate analysis confirmed pregnant and non-pregnant women had similar rates of non-pregnancy related complications (RR 0.89, 95% CI 0.72-1.05, p=0.15). Multivariate analysis also confirmed pregnancy contributed to increased total cost (median difference $509, 95% CI $54-$963, p=0.03), despite showing no difference in length of hospitalization (RR 1.00, 95% CI 0.97-1.04, p=0.95). Compared to baseline rates in pregnancy, patients undergoing cholecystectomy had similar rates of fetal loss (0.51% with cholecystectomy vs. 0.43% without cholecystectomy, p=0.50), but higher rates of pre-term delivery (9.9% vs. 6.2%, p<0.01; RR 1.07, 95% CI 1.02-1.13, p=0.01). Conclusion: Cholecystectomy was safe during pregnancy with similar rates of maternal, non-obstetric morbidity. Pregnancy did not preclude use of laparoscopy and was performed with similar overall costs. Although cholecystectomy did increase risk of prematurity, these risks were marginal and acceptable given the potential morbidities of non-operative management. 124 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS Laparoscopy Non-Pregnancy Complications Infection Gastrointestinal Other Length of Stay (days) Cost (dollars) Non Pregnant (n = 97,203) 94.50% 3.30% 1.32% 1.48% 0.69% 3.06 11,099 (cont.) Pregnant (n = 5,763) P-value 95.49% 2.52% < 0.01 < 0.01 0.99% 1.28% 0.42% 3.41 11,510 0.03 0.26 < 0.01 < 0.01 < 0.01 April 2 – 5, 2017 | Hyatt Regency, Maui, HI 125 QUICK SHOT ABSTRACTS (cont.) QS 2. PREDICTORS OF FAILED TRANSCYSTIC LAPAROSCOPIC COMMON BILE DUCT EXPLORATION: A MULTICENTER INTEGRATED HEALTH SYSTEM EXPERIENCE MA Al-Temimi MD MPH, EB Kim MD, BA Chandrasekaran MD, CN Trujillo MD, AF Mousa BA, DC Santos MD, SD Johna MD MACM Fontana, CA Background: Transcystic laparoscopic common bile duct exploration (TLCBDE) is generally more favorable than laparoscopic choledochotomy (LCD), however, some anatomical characteristics might preclude performing TLCBDE. The characteristics for successful TLCBDE in the literature were mostly derived from expert opinion. The purpose of this study is to report cases of LCBDE from a large integrated health system and identify anatomical predictors of failed TLCBDE. Method: This is a retrospective study (2005-2015) of all patients who underwent laparoscopic common bile duct exploration (LCBDE) at thirteen Kaiser Permanente Southern California Medical Centers. Patient demographics, preoperative comorbidities, intraoperative imaging and preoperative laboratory findings were reviewed. Intraoperative details and postoperative course and complications were reported. Failure was defined as inability to clear the common bile duct (CBD), retained stone or conversion to open procedure. In a subset analysis of predictors of failed TLCBDE, failure was defined as inability to clear the CBD. Predictors of failed TLCBDE were identified using univariate and multivariate analysis. Results: Out of 3,650 patients diagnosed with choledocholithiasis during the study period, 120 (3.2%) underwent LCBDE. Of those, 15 cases were done after failed ERCP and 17 patients had roux-en-y gastric bypass. TLCBDE (89.2%) was more commonly performed than LCD (10.8%). Mean patient age was 52.6 years and the majority were females (74.2%). Average hospital length of stay was 3.8 days, which was slightly shorter with the TLCBDE than LCD (mean+/-sd; 3.7+/-2.6 days vs. 4.8+/-2.7 days, p=0.153). There was no mortality and eight patients (7.5%) had postoperative complications. Patients undergoing LCD had larger CBD (11.9+/-4.3 vs. 9.7+/-3.2, p=0.03) and were more likely to be done in an elective setting (46.2% vs. 15%, p=0.006) than TLCBDE. LCBDE was successful in 88.3% of cases (88.8% TLCBDE vs. 84.6% LCD, p=0.658). Failed LCBDE was due to conversion to open in 2 cases, equipment failure in 2 cases, need for intraoperative ERCP to visualize the proximal bile duct in 2 cases, and failure to clear the common bile duct in 8 cases. To identify predictors of failed TLCBDE, failure to clear the CBD was associated with cystic duct tortuosity (25% vs. 4.3%, p=0.018) and larger common bile duct diameter (mean+/sd, 11.9 +/- 4.3 cm vs. 9.7 +/- 3.2 cm, p=0.044). There was a suggestive association of stone size, stone size to cystic duct diameter ratio, presence of multiple stones, and stone location with failure, however that did not reach statistical significance. In multivariate analysis, only cystic duct tortuosity (OR=9.5, 95% CI 1.03-87.6) was associated with failure of TLCBDE. Conclusion: LCBDE is effective in the management of choledocholithiasis in patients with roux-en-y gastric bypass or those who fail ERCP. Cystic duct tortuosity is an independent predictor of failed TLCBDE. 126 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 3. AN ACUTE CARE SURGERY MODEL IS ASSOCIATED WITH DECREASED COSTS AND LENGTH OF STAY AFTER APPENDECTOMY MK. Srour, MD, RF Alban, MD, D Margulies MD, E Ley MD, R Chung MD, M Bloom MD, H Sax MD, N Melo, MD Los Angeles, CA Background: Appendectomy remains as one of the most commonly performed surgical procedures in the United States. With continued increase in operative expenses, efforts to improve costs associated with appendectomy are important with the advent of healthcare reform. Acute care surgery (ACS) services have been implemented in many facilities nationwide as a surgical hospitalist model for the management and intervention of urgent and emergent surgical cases such as appendicitis. Method: From October 2012 to June 2016, data was prospectively collected on all patients who underwent appendectomies at a large urban academic center with over 950 beds. Patients were divided into two groups, those who had an appendectomy performed by the ACS service (surgical hospitalist, n=445) and those who had an appendectomy by a non-ACS surgeon (including private practitioners, n=682). Primary outcome measures were length of stay (LOS), costs, and readmission rates Results: A total of 1,127 patients underwent appendectomies during the study period, of those 445 (39.5%) were performed by the ACS service. Analysis of data revealed a mean age of 36.1 in the ACS group vs. 44.4 for the non-ACS (p<0.001). There was a significant difference in both total costs observed of $12,030 for the ACS group vs. $15,697 for the non-ACS group (p<0.001) and direct institutional costs of $5,739 vs. $7,549 for the non-ACS group (respectively, p<0.001). Length of stay was shorter for the acute care surgery group at 2.1 days vs. 3.2 days for the non-ACS group (p<0.001). There was no difference in readmission rates, of 0.02% (n=7) for the ACS group, vs. 0.03% (n=17) for the non-ACS group (p=NS). Conclusion: Appendectomies performed by an acute care surgery, or surgical hospitalist group led to decrease in total and direct hospital costs and decreased length of stay, without any significant difference in readmission rate. 0.04 April 2 – 5, 2017 | Hyatt Regency, Maui, HI 127 QUICK SHOT ABSTRACTS (cont.) QS 4. OUTPATIENT LAPAROSCOPIC APPENDECTOMY MAY BE SAFE FOR NON-PERFORATED GANGRENOUS APPENDICITIS A Patel BA, CL Isbell MD, JL Regner MD, RW Smith MD, TS Isbell MD, B Hodges RN, SW Abernathy MD, RC Frazee MD Temple, TX Background: Appendicitis is one of the most common surgical emergencies with an annual incidence of 1 per 1000 of which 20% are perforated. Our institution has managed simple appendicitis with outpatient laparoscopic appendectomy (OLA) since 2010. Recently the American Association for the Surgery of Trauma (AAST) developed the Appendicitis Disease Severity Score (DSS) to assist with benchmarking outcomes. We hypothesized that local severe appendicitis (with gangrene, AAST DSS 2 or local perforation, AAST DSS 3) is clinically different than severe diffuse appendicitis (AAST DSS 4 and 5). Method: In 2014, we chose appendectomy as a targeted procedure for our participation in the National Surgical Quality Improvement Program (NSQIP). Patients with acute appendicitis were initially managed with OLA unless evidence of gangrenous or perforated appendicitis was noted at the time of surgery. We compared AAST DSS 2-5 to determine if differences existed in demographic variables and length of stay (LOS). Using our NSQIP targeted appendectomy data from July 2014 to June 2015 in the Semi-Annual Report (SAR) and concurrent chart review for AAST DSS, the outcomes for each group were analyzed and compared. Results: Between July 2014 and June 2015, 152 patients underwent appendectomy for acute appendicitis. The number of patients with each AAST DSS, demographics, and length of stay (LOS) is seen in the Table. Most patients (8/10) with AAST DSS 2 were discharged from day surgery, and none were discharged with antibiotics. Complications overall were low. Per NSQIP, we had no SSIs (1st deciles) and 5 readmissions, two related to the previous surgery (2nd decile). Wound occurrences were all considered PATOS (present at time of surgery). When comparing all groups for complications, no statistical differences could be found between any AAST DSS. No statistical differences were noted for LOS between AAST DSS 3-5. Univariate analysis showed preoperative sepsis/SIRS, AAST DSS, and age to be associated with longer hospital LOS. Median hospital LOS for those admitted was 1 (IQR 1-2 days). Patients with a LOS of one day or less had a median age of 33 years while patients with a LOS of two or more days had a median age of 53 years. All patients who were admitted were treated with antibiotics and discharged with antibiotics. Conclusion: AAST DSS 1 and 2 can safely be managed as an outpatient. No LOS differences are readily seen between AAST DSS 3-5 for perforated appendicitis. Future studies are needed to pinpoint risk factors for longer hospitalization after perforated appendicitis and development of best practice guidelines. 128 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 129 QUICK SHOT ABSTRACTS (cont.) QS 5. EVALUATION OF NEGATIVE PRESSURE WOUND THERAPY TO CLOSED LAPAROTOMY INCISIONS IN ACUTE CARE SURGERY E Schurtz MD, J Differding MPH, E Jacobson MD, C Maki MD, M Ahmeti MD Grand Forks, ND Background: Surgical site infections are a major burden to the healthcare system accounting for $1.6 billion in hospital care costs per year in the U.S. Negative pressure wound therapy (NPWT) is an established treatment for non-healing wounds and open surgical incisions. NPWT has been demonstrated to stimulate cell proliferation, reduce inflammatory mediators, increase O2 partial pressure and reduce wound stress. Surgical Incision Management Systems (SIMS) are battery-powered, single-patient use systems designed to deliver 125 mmHg of negative pressure to closed incisions. SIMS hold incision edges together, remove fluids as potential infectious sources and act as a barrier to external contamination while delivering negative pressure. Multiple studies have shown reduced rates of wound infection and complications when used in Cardiothoracic, OB-Gyn, Orthopaedic and Vascular Surgery. SIMS have not previously been evaluated for use in the non-elective trauma and acute care setting. Method: Institutional Review Board approval was obtained for a single-center, retrospective case-controlled study. Inclusion criteria: 18 years of age, non-elective closed laparotomy incision performed by Trauma & Acute Care Surgery team. Exclusion criteria: nearby ostomy, open wounds or other functional limitation precluding use of SIMS dressing. Closure of skin was performed with sutures or staples. SIMS remained in place for 4-9 days. Incisions were evaluated for infection, dehiscence, hematoma or seroma immediately after removal and at post-operative office visits. Additional data collected and analyzed included basic demographics, BMI, smoking status, immunosuppression, diabetes mellitus, operation characteristics, hospital readmissions and survival. Cases were matched with controls of equivalent comorbidity conditions, wound class, procedure and surgeon. Results: Forty-eight cases were identified along with matched controls. No statistically significant difference in age, sex, height, BMI, surgical blood loss, wound class, hospital length of stay or survival was found between groups. There were more patients with diabetes in SIMS group. Significantly lower rate of wound infections (p = 0.04) and hospital readmission (p = 0.05) were found in the SIMS group. Conclusion: Results demonstrate a decreased rate of SSIs and hospital readmission for any reason when using SIMS for management of non-elective closed laparotomy incisions in trauma and acute care surgery. To our knowledge, the use of SIMS in this setting has not previously been evaluated. Given these results, we recommend considering increased use of SIMS to non-elective closed laparotomy incisions. Strength of our findings is limited by the retrospective nature and limited sample size. 130 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 131 QUICK SHOT ABSTRACTS (cont.) QS 6. A REVISED LRINEC SCORING SYSTEM FOR NECROTIZING FASCIITIS Lara Spence, MD, Eric Pillado, BS, Huan Yan MD, Alexander Schwed MD, Jessica Keeley MD,Mohammad Karimzada BS, Mari Allison Ph.D., Angela Neville MD, David Plurad MD, Brant Putnam MD, Christian deVirgilio MD Dennis Kim MD, Torrance, CA Background: Necrotizing soft tissue infections (NSTI) are rapidly progressive, and diagnosis is based on a high index of suspicion, good clinical exam, and the Laboratory Risk Indicator for Necrotizing Fasciitis Scoring System (LRINEC). Recent data has questioned the validity of the LRINEC while studies have shown that major predictors for NSTI are hyponatremia and leukocytosis. The purpose of this study was to validate the LRINEC and create a modified LRINEC (mLRINEC) that would have better accuracy. Method: A retrospective analysis of patients referred to acute care surgery for concern of NSTI over a five-year period at a single institution. LRINEC scores were calculated from admission laboratories. The mLRINEC score excluded the c-reactive protein (CRP) value. The mLRINEC was further adjusted with sodium corrected for hyperglycemia (cNa) and leukopenia (2 pts given to WBC <4) to assess which was the best test. An mLRINEC score≥4 was considered positive. An NSTI was defined by pathologic reports. Results: There were 482 patients referred for NSTI concern. Of these, 281 patients were diagnosed with an NSTI and 201 were excluded from having an NSTI. Mean age was 47 years old and 72.4% were male. Only 15.6% (n=75) had a CRP level on admission, the LRINEC in this population had a sensitivity of 54.8% and a negative predictive value (NPV) of 66.7%. When CRP was excluded on these patients (n=75) the mLRINEC had a sensitivity of 77.4% and NPV 78.1%, (p=0.038). The mLRINEC, when applied to the whole group (n=482), had a sensitivity of 64.8% and a NPV 56%. Further adjusting mLRINEC for leukopenia had an increase in sensitivity 66.9% and NPV 57.3%, (p=0.06). When adjusting mLRINEC for cNa, or cNa and leukopenia there was no increase in sensitivity (55.5% and 58.4% respectively). The mLRINEC correlated with the number of debridements (p < 0.001) but did not correlate with mortality (p= 0.644). Conclusion: In our population, mLRINEC outperformed the traditional LRINEC. When CRP is not included in the calculation (mLRINEC), there is a significant improvement in the sensitivity. Correcting for cNa or leukopenia does not change the predictive performance of the mLRINEC. The mLRINEC has a significant correlation with the number of debridements, which indicates it may predict the severity of the infection. Overall CRP is not helpful in predicting an NSTI when incorporated into an LRINEC score. 132 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 7. “A NOT SO FORGOTTEN DISEASE”: A 10 YEAR ASSESSMENT OF PERFORATED GASTRO-DUODENAL ULCER V Pandit,MD, S Jordan,MD, H Ho,MD, S Fu,MD, I Ghaderi,MD, D Neal,MD, J McClenathan,MD Tucson, AZ Background: With increasing screening practices and awareness, the incidence of gastro-duodenal ulcer (GDU) has decreased. Perforated GDU is thought to occur rarely with advances in medical therapy. However; variability exists among institutions with patients with perforated GDU. The aim of this study was to report a 10 year single institutional experience in managing perforated GDU. Method: We performed a 10 year retrospective analysis of patients presenting to our institution with perforated GDU. Patient demographics, medication use, operative intervention, hospital and 1 year post-discharge information was collected. Outcome measures: hospital length of stay, in-hospital complications, and disease recurrence. Results: Over 10 years, a total of 41 patients with perforated GDU were included with mean age was 56.5±21.4 years, 70% male, and median American Anesthesiology Score (ASA) 3[2-3]. 51% ulcers were pre-pyloric, 30% ulcers were duodenal, and remaining was gastric. 51% patient had Helicobacter Pylori positive. 30% patient had history of anti-inflammatory medication use. 14% patients had history of gastric ulcer and treated. 83% had open primary repair with Graham patch while the rest (17%) had laparoscopic repair. The mean intensive care unit stay was 2.5±1.2 and mean hospital length of stay 6.1±3.5 days. The overall complication rate was 24% and mortality rate was 7%. One year post-operative readmission rate, complication and recurrence rate was 0%. Conclusion: Perforated gastro-duodenal ulcer continues to persist despite increasing screening and medical managements. H.pylori infection had high prevalence. Use of anti-inflammatory medications had lower incidence among our patient population. Further broadening of screening practices and spreading awareness of this disease process is warrented. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 133 QUICK SHOT ABSTRACTS 134 (cont.) Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 8. A FLIP OF A COIN: THE NATIONWIDE RISK OF MORTALITY AND ADVERSE OUTCOMES FOR ABDOMINAL COMPARTMENT SYNDROME SW Ross MD MPH, CR Huntington MD, T Prasaad, VA Augenstein MD, BT Heniford MD, AB Christmas MD, RF Sing DO Charlotte, NC Background: Abdominal compartment syndrome (ACS) is a rare but often lethal complication, therefore most of our treatment and understanding of ACS is guided by small population single center studies. Our purpose was to define the incidence of morbidity and mortality of this disease process and to identify risk factors for poor outcomes using a comprehensive national database. Method: The National Inpatient Sample (NIS) database was queried from 2006-2013 for all traumatic and non-traumatic diagnoses of ACS. Univariate analysis compared outcomes by mortality and trauma status. The primary outcome was in-hospital mortality, and secondary outcomes were hospital charges, length of stay (LOS), and medical and procedural complications. A multivariate stepwise logistic regression was then performed to identify independent predictors of mortality. Results: 4,977 patients with ACS were identified, of whom 871 had traumatic and 4,106 had non-traumatic etiologies. Of these, 3,156 (63.2%) underwent an open abdominal operation during their admission, and 2,302 (46.3%) underwent a laparotomy. Average LOS was 20.9 ± 25.2 days, and the average hospital charges were $297,643 ± 338,526 USD. 96.7% of patients developed medical complication, and 49.4% developed procedural related morbidity. Inpatient mortality was 50.2%. Traumatic ACS patients were younger (46.3 ± 18.5 vs 59.1 ± 15.9 years), less likely to be female (25.1 vs 41.6%) but more likely to be to have an open surgery (72.9 vs 61.4%) including exploratory laparotomy (59.8 vs 43.4%), and require a tracheostomy (26.2 vs 15.9%); p<0.0001 for all. While the two groups had equivalent LOS, mortality and procedural complications, traumatic ACS had lower rates of medical complications (81.3 vs 100%) and higher charges ($331,474 vs $290,520); p<0.001. Compared to survivors, ACS patients who died had equivalent rates of laparotomy, gender, and traumatic or non-traumatic etiology. However, non-survivors tended to be older, less likely to survive to tracheostomy, ventral hernia repair (VHR) or gastrostomy, had lower LOS, fewer medical and procedural complications, and decreased charges (p<0.05). On multivariate analysis, increasing age (1.02 per year, 95%CI 1.05-1.12), Charlson Comorbidity Index (1.08 per point, 1.05-1.18), and admission to a teaching hospital (1.57,1.31-1.89) were independent predictors of mortality. Survival to reopen laparotomy (0.70, 0.58-0.85), tracheostomy (0.35, 0.28-0.43), VHR (0.24, 0.15-0.38), or the development of medical (0.42, 0.27-0.64) or procedural complications (0.73, 0.62-0.86) were predictors of survival; p<0.001 for all. Conclusion: In this study of the NIS, over 50% of inpatients died from ACS and almost all patients suffered associated morbidity (97%). Despite higher rates of laparotomy, traumatic ACS has similar rates of survival and complications as nontraumatic ACS. Further investigation on treatment and early recognition of ACS is warranted to reduce the risk of mortality to less than just the “flip of a coin.” April 2 – 5, 2017 | Hyatt Regency, Maui, HI 135 QUICK SHOT ABSTRACTS (cont.) QS 9. POSTOPERATIVE MORTALITY FOR PATIENTS WITH COLONIC VOLVULUS ADVERSELY AFFECTED BY ASSOCIATED COMORBIDITIES H Dao MD, JW Kempenich MD, J Marcano MD, AJ Logue MD, KR Sirinek MD PhD San Antonio, TX Background: While colonic volvulus is a less frequent cause of large bowel obstruction in the United States, it still accounts for approximately 15% of such cases in general surgery practice. Contemporary studies demonstrate a postoperative mortality around 14% for all patients undergoing surgery and as high as 24% for those undergoing an emergent operation. Most deaths are thought to occur as a result of medical comorbidities rather than from the surgical procedure itself. This study analyzes current factors associated with mortality in patients undergoing surgery for colonic volvulus. Method: The American College of Surgeons (ACS) National Surgical Quality Improvement Program(NSQIP) database was queried for the year 2014. Patients undergoing surgery for colonic volvulus were selected for analysis. Demographics, comorbidities, surgical procedure performed, length of hospital stay, and 30-day postoperative mortality were analyzed. Categorical variables were analyzed using ChiSquare and continuous variables were compared using T-test. A logistic regression model was then created to assess the influence of independent variables for mortality. Significance was established with a P value <.05. Results: There were 1,077 patients who underwent an operation for colonic volvulus during 2014 at NSQIP participating institutions. The mean age of these patients was 63.7 years, 54.7% were female, 78.3% were white and 85.2% of operations were classified as emergent. Mean length of hospital stay was 10.2 days. Overall mortality was 3.9%. Univariate analysis revealed that mortality was higher among patients with congestive heart failure (9.5% vs. 1.0%, P< .0001), acute renal failure (7.1% vs. 0.4%, P< .0001), steroid use (11.9% vs. 2.6%, P <.001), hypertension (66.6% vs. 44.6%, P<.005), and dyspnea (23.8% vs. 4.9%, P<.0001). Other variables associated with an increased mortality rate were: an emergency operation (4.4% vs. 0.6%, P<.02) and transfer from an outside institution (6.4% vs. 3.2%, P<.03). Multivariate analysis showed that acute renal failure, dyspnea, and congestive heart failure were the only variables associated with an increased postoperative mortality in patients with colonic volvulus (Table 1). Conclusion: The postoperative mortality rate for patients with colonic volvulus has significantly decreased (3.9%) from previous reports and this is probably multifactorial. Significant patient comorbidities (renal, pulmonary, cardiac) have been shown to play a major role in the postoperative mortality of these patients with colonic volvulus. It would appear that further reductions in the overall mortality for the surgical treatment of patients with colonic volvulus depends upon early and aggressive perioperatory medical management of the pathophysiology associated with these three organ systems. 136 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Table 1 Multivariate Logistic Regression Analysis of Factors Associated with Mortality Among Patients Undergoing Surgery for Colonic Volvulus *Statistically significant. N= 1,077 Odds Ratio Emergency surgery Hospital transfer 5.7 95% Confidence Interval 0.7‐43.7 0.5 0.2‐1.1 .1 Open surgical procedure 5.9 0.7‐45.3 .08 Diabetes 1.5 0.6‐3.7 .3 Congestive heart failure 5.4 1.4‐20.3 <.01* Hypertension 1.6 0.7‐3.3 .1 Acute renal failure 19.3 2.8‐130.5 <.02* Steroid use 3.1 0.9‐9.7 .05 Weight loss 1.2 0.2‐5.8 .7 Blood transfusion 0.2 0.1‐4.1 .3 Dyspnea 4.5 1.9‐10.4 <.0001* Left vs. Right colectomy 0.5 0.2‐1.2 .1 April 2 – 5, 2017 | Hyatt Regency, Maui, HI P value .09 137 QUICK SHOT ABSTRACTS (cont.) QS 10. MANAGEMENT, OUTCOMES, AND COST OF NECROTIZING SOFT TISSUE INFECTIONS AT A COMMUNITY TEACHING HOSPITAL: SHOULD YOU SLASH BEFORE YOU DASH? BT Grover DO, KJ Kallies MS La Crosse, WI Background: Necrotizing soft tissue infections (NSTIs) are rare, highly morbid, and aggressive infections associated with substantial morbidity and mortality. Management includes aggressive debridement, antibiotics, fluid resuscitation, reevaluation, and nutritional support. Emergent operative debridement provides the best chance for survival, as delays in operative treatment can be fatal. Given the complexity of diagnosis and management of NSTI, the associated hospital charges are substantial. The objective of this study is to review the management, outcomes, and cost among patients treated for NSTI at our community teaching hospital. We also compared patients who initially presented to outside facilities and transferred without operative treatment to those who presented directly to our main campus. Method: The medical records of all adult patients admitted to our community teaching hospital with a diagnosis of NSTI from May 2006 through June 2016 were retrospectively reviewed. Statistical analysis included t tests and Fisher’s Exact Test. Results: Seventy four patients met inclusion criteria; 58% were male. Patient comorbidities included diabetes (51%), chronic kidney disease (20%), peripheral vascular disease (11%), and current or former tobacco abuse (58%). Upon admission, 65%, 17%, and 9% of patients presented with tachycardia, hypotension, and a fever, respectively. Seven patients elected to receive palliative care and did not undergo surgical treatment. The 30-day mortality rate was 22%. A total of 23 (31%) patients were transferred from outside facilities, potentially increasing time between diagnosis and operative treatment. Of all mortalities, 40% were from this group of patients. There was a 188 % increase in patients presenting with NSTIs when comparing the first 5 years to the last 5 years of the study period. Patients who died within 30 days were older (mean age 68.5 vs. 54.0 years; P=0.001), and more likely to have peripheral vascular disease (27% vs. 7%; P=0.048). Conclusion: This study is one of the largest contemporary series, over a 10-year time frame, from a U.S. community-based teaching hospital. NSTIs are becoming more common, and have a high morbidity and mortality. They require extensive hospital, staff, and financial resources. Early debridement is an essential aspect in treating this disease. Referring hospitals with surgical capabilities should consider initial operative debridement prior to transferring to the regional referral center. 138 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Table. Patient characteristics, laboratory values, hospital course, and charges for those admitted with necrotizing soft tissue infections. Patient characteristics Mean Age, years Mean BMI, kg/m2 Admission lab values, median (range) WBC Hgb Creatinine Sodium Potassium Hospital course, median (range) Hospital LOS, days Vent days (n=39) ICU days (n=54) Wound VAC days (n=51) Number of OR Procedures Total hospital charges, $ Result 56.9 ± 15.9 35.1 ± 13.6 14.38 (2.77 – 47.96) 11.2 (4.8 – 16.8) 1.12 (0.37 – 10.78) 133.0 (120.0 – 147.0) 3.85 (2.60 – 5.40) 11.0 (0 – 109) 3.0 (0 – 21) 3.7 (0 – 59) 23.0 (0 – 269) 3 (1 – 19) $115,825.49 (2, 917.30 – 883,860.99) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 139 QUICK SHOT ABSTRACTS (cont.) QS 11. EMERGENT CHOLECYSTECTOMY IS SUPERIOR TO PERCUTANEOUS CHOLECYSTOSTOMY TUBE PLACEMENT IN SEVERELY ILL PATIENT WITH EMERGENT CALCULOUS CHOLECYSTITIS BR Hall, PR Armijo, TR Burnett, D Oleynikov Omaha, NE Background: Percutaneous cholecystostomy (PC) tube placement has been well studied in critically ill patients with acalculous cholecystitis, however the role of PC remains undefined in patients who have multiple medical comorbidities who are presenting with emergent calculous cholecystitis. The aim of this study is to compare surgical outcomes in high-risk operative candidates between PC and laparoscopic or open cholecystectomy. Method: A query of the Vizient UHC database from October 2012 to October 2015 was done for high-risk patients with calculous cholecystitis, who underwent either PC, laparoscopic cholecystectomy (LC), laparoscopic converted to open cholecystectomy (CONV), or open cholecystectomy (OC) in the emergent setting. High-risk was defined by a validated clinical algorithm that assesses 29 comorbidities, patient demographics and major diagnosis. Major severity outcomes, mortality, length of stay, and direct cost were compared between the groups. Statistical analysis was performed using SPSS v23.0.0.0 using Chi-square tests with Bonferroni correction along with non-parametric tests where appropriate, α=0.05. Results: 13,521 patients with major illness severity score were analyzed (PC = 17.1%; CONV = 8.2%; OC = 7.2%; LC = 67.5%). LC was the most common approach with statistically significant lowest risk of death, complications, length of stay (LOS) and cost (Table 1). Rate of conversion for laparoscopic cases was 10.8%. The risk of overall complications was highest in OC (18.6%), and lowest in LC (4.9%) (Table 1). The rate of overall complications in patients undergoing PC was nearly three fold higher than LC (14% v 4.9%). PC had the highest death rate at 11.3% compared to 2.3% in CONV and 0.8% in LC. Post-operative infection rates were similarly highest in the PC group at 3% compared to the LC group at 0.7%. Aspiration pneumonia was highest in the PC group at 3.3% compared to 0.9% in the LC group. LOS in PC was 10 days compared to 6 days in LC. Similarly, cost in the LC group at $8,000 compared to PC and CONV, both of which were estimated at $13,000. Conclusion: Emergent cholecystectomy for calculus cholecystitis even in patients with major severity of illness is safer and more cost effective than PC. While the observed conversion rate and complication rate was higher then those reported in low risk patients, PC had significantly worse outcomes compared to both LC and CONV cases. While PC may be an option for patients with acalculous cholecystitis, our data demonstrates significantly worse outcomes for patients undergoing PC compared to both LC and CONV cases. Patients who are surgical candidates and present with calculus cholecytitis should undergo cholecystectomy as the primary approach for their disease. 140 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Table 1. Patient Outcomes by Procedure Cholecystostomy N = 2,314 Mortality N (%) Overall Complications N (%) 261 (11.28%)*-# 323 (13.96%)*- Post-Operative Infection N (%) Aspiration Pneumonia N (%) Length of Stay Median (IQR) - days Direct Cost Median (IQR) - $ Conversions N = 1,107 25 (2.26%)*#+ 186 (16.80%)* Open Cholecystectomy N = 979 Laparoscopic Cholecystectomy N = 9,121 76 (7.76%)*-+ 182 (18.59%)*- 77 (0.84%)* 444 (4.87%)* 70 (3.03%)* 76 (3.29%)*# 43 (3.88%)* 18 (1.63%)# 26 (2.66%)* 30 (3.06%)* 62 (0.68%)* 82 (0.90%)* 10 days (6 – 16) *-# 9 days (6 – 14)*#+ 12 days (8 – 19) *-+ 6 days (4 – 8)* 13,000 (7,000-23,000)*- 13,000 (10,000-21,000) *+ 18,000 (12,000-30,000) *-+ 8,000 (6,000-12,000)* *p<0.05 Lap Chole vs ALL p<0.05 PC vs Open Chole # p<0.05 PC vs Conversion + p<0.05 Open Chole vs Conversion April 2 – 5, 2017 | Hyatt Regency, Maui, HI 141 QUICK SHOT ABSTRACTS (cont.) QS 12. EFFECT OF A CLINICAL PHARMACIST ON THE TRAUMA RESUSCITATION TEAM DURING RAPID SEQUENCE INTUBATIONS: A PROSPECTIVE OBSERVATIONAL STUDY CE Frank, C Dente MD, S Miller PharmD DABAT, BC Morse MD MS, P Rhee, MD Atlanta, GA Background: Clinical pharmacists are often a valuable luxury when on the trauma resuscitation team and their value as a team member is often unrecognized. We hypothesized that the use of a trauma pharmacist during resuscitation would reduce the time to rapid sequence induction (RSI) for intubation and also administration of maintenance sedation. Method: A prospective observational cross-sectional study was employed to record times from decision to intubate to administration of RSI medications as well as to initiation of maintenance sedation at a Level I trauma center from April - July 2016. Results: There were 39 patients observed that required RSI during resuscitation. Due to limited resources, clinical pharmacists are not always present during trauma activations, and their presence was observed only 62% of the time. When the clinical pharmacist was present, time to induction was reduced by 50.49% (p<0.0001) and time to administration of maintenance sedation was reduced by 55.78% (p=0.001). A pharmacist arrived after intubation and/or maintenance sedation was withheld for several patients, accounting for lack of congruency in all time windows. (Table 1) Conclusion: Pharmacists can play a vital role in trauma resuscitations, and their presence increases efficiency in obtaining definitive airway management and sedation. Having a clinical pharmacist as a trauma team member allows nurses and physicians to concentrate on the initial care of the patient and should decrease time to necessary advanced diagnostics and interventions, which may improve outcomes. 142 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 13. GERIATRIC TRAUMA PATIENTS WITH RIB FRACTURES: IS THERE A DIFFERENCE IN OUTCOMES BETWEEN PATIENTS TREATED WITH RIB FIXATION COMPARED TO NON-OPERATIVE MANAGEMENT? FR Ali-Osman MD, AJ Mangram MD, GR Shirah MD, JS Sucher MD, AK Hollingworth MD, VA Johnson MD, P Moeser MD , JK Dzandu PHD Phoenix, AZ Background: We are seeing an increase in the number of our geriatric trauma patients age≥60 years (G-60). Traditionally, rib fractures have been managed non-operatively in the majority of cases with flail chest being the most cited exception. In the last decade, the enthusiasm to repair rib fractures has grown, however outcomes in G-60 patients treated with operative fixation (ORF) remains largely unknown. The purpose of this study was to compare outcomes in G-60 patients treated with (ORF) vs. non-operative management (NOM). Method: We performed a retrospective review at our level I trauma center. We queried our registry and identified G-60 patients who had rib fractures treated with ORF or NOM. Age, gender, mechanism of injury (MOI), BMI, # of ribs broken or fixed, ISS, hospital/ICU length of stay, ventilator days, discharge disposition and mortality were examined. We also assessed the effect of ORF on pulmonary function tests (PFT’s). T-test, Mann-Whitney U and Chi-Square test and ANOVA were used for analysis. Results: From May 2014 through October 2016, 64 patients underwent ORF, compared to 135 patients treated with NOM from May 2013 through April 2014. The median age (ORF vs. NOM) was 68.5 vs. 72, p= 0.004. There was no difference in gender, p=0.183 or BMI, p=0.777. The MOI was associated with treatment category (ORF vs. NOM), p=0.001. The median # of ribs broken (ORF vs. NOM) was 7 vs. 5, p=0.001. The number fixed was 3. The median ISS (ORF vs. NOM) was 17.5 vs. 14.0, p =0.027. The median vent days were similar p=0.935. The median ICU-LOS (ORF vs. NOM) was 6 (IQR=3-10) vs. 2 (IQR= 0-5), p=0.001. The median HLOS (ORF vs. NOM) was 12 days (IQR= 9-16_vs. 4.8 (IQR=2.9-8.4), p= 0.001. There was 1 out of 64 deaths (1.5%) in the ORF group compared to 13 out of 135 (9.6%) in the NOM; p=0.04. Discharge destinations were similar (p=0.145). Repeated measures ANOVA indicated there was a statistically significant effect of ORF on PFT’s (FEV1 and FVC) post-op. Conclusion: Our study shows that patient outcomes are different when treated with ORF vs. NOM. In particular, there was a significant decrease in mortality. Interestingly, there was a statistically significant increase in PFTs with ORF. Randomized controlled studies are needed to consolidate these results, including examination of the effect of ORF on patient satisfaction, pain control and return to pre-injury daily activities. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 143 QUICK SHOT ABSTRACTS (cont.) QS 14. ABDOMINAL SEATBELT SIGN: NO LONGER A REQUIREMENT FOR ADMISSION? TR Kopelman MD, JW Walters DO, JN Bogert MD, PG Pieri MD, KM Davis, MD, SJ Vail MD Phoenix, AZ Background: The Eastern Association for the Surgery of Trauma guideline regarding blunt abdominal trauma (BAT) states that any patient with a seatbelt sign (SBS) should be admitted for observation and serial physical examination despite radiographic evaluation. Given the improvements in computed tomographic imaging (CT) since this guideline appeared in 2002, the purpose of this study was to determine if admission remains necessary after negative CT in patients with suspected BAT and documented SBS. Method: After obtaining IRB approval, a retrospective evaluation of adult trauma patients (age > 15 years) who presented over a 5 1/2 year time period to a Level I trauma center status post motor vehicle collision were reviewed. Inclusion criteria included the presence of a documented SBS and performance of CT of the abdomen/ pelvis. Abnormal CT findings were defined as any intra-abdominal abnormality (IAA) possibly related to trauma as interpreted by the attending radiologist. A CT SBS was defined as any soft tissue changes seen on CT in the area of the SBS. Outcomes were measured at 24 hours and/or time of discharge and included clinical deterioration, need for celiotomy, and mortality. Negative predictive value of CT was defined by the subsequent need for intervention or the delayed identification of an IAA. Results: One hundred and seventy five patients met inclusion criteria. CT evidence of soft tissue changes consistent with a CT SBS was observed in 55 patients (31%). While more likely to be radiographically evident if the SBS was described on examination as an ecchymosis (39/94;42%) rather than an abrasion (16/81;25%), ultimately the presence of a CT SBS had no effect on incidence of underlying IAA. Overall, 24 patients (15%) had CT imaging concerning for IAA: 6 had radiographic evidence of an isolated solid organ injury (SOI), 14 had findings suspicious for hollow viscus injury (HVI), 3 had findings concerning for both SOI and HVI and 1 had a placental abnormality. Four patients underwent immediate celiotomy based upon CT findings concerning for HVI and one patient had a delayed celiotomy for CT evidence of a mesenteric hematoma and Grade II liver laceration with worsening clinical exam. On laparotomy, all patients had injuries confirming CT findings. An additional 2 patients had significant CT findings isolated to CT SBS, one with significant muscular transection and one with active bleeding. The remaining 149 patients (85%) had CT interpretation negative for traumatic IAA. No patient with negative imaging required delayed intervention or had delayed identification of IAA. Overall, despite the presence of a SBS, CT in a patient with suspected BAT had a negative predictive value of 100%. Conclusion: This study suggests that hospital admission and prolonged observation does not benefit patients with suspected BAT and documented SBS after negative CT. 144 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 15. NOVEL CLINICAL COAGULOPATHY SCORE IS HIGHLY SENSITIVE FOR MORTALITY RISK SECONDARY TO TRAUMA-INDUCED COAGULOPATHY RELATED HEMORRHAGE PM Einersen MD, HB Moore MD, A Sauaia MD PhD, A Banerjee PhD, CC Silliman MD PhD, EE Moore MD Aurora, CO Background: Trauma-induced coagulopathy (TIC) is the most common preventable cause of post-injury mortality, accounting for up to 50% of deaths in hospitalized patients. In the ongoing effort to improve understanding and management of TIC, the Trans-Agency Consortium for Trauma-induced Coagulopathy (TACTIC) has established a quantitative clinical coagulopathy score (CCS), which our group has previously demonstrated to provide early discrimination of injury severity, transfusion need and mortality. In this follow-up study with increased statistical power, we set out to evaluate associations between TACTIC CCS and cause of death. Method: Data were reviewed for 342 patients admitted in three prospective studies at a level 1 trauma center between April, 2014 and January, 2016, with inclusion criteria specifying highest level trauma and TACTIC CCS issued by attending surgeon at initial ED assessment as follows: 1) Normal Hemostasis (negative), 2) Mild Coagulopathy (equivocal) 3) Coagulopathy Refractory to Direct Pressure (possible positive), 4) Coagulopathy Requiring Blood Component Transfusion (positive) and 5) Diffuse Persistent Bleeding from Multiple Sites (definitive positive) (Figure 1). Cause of death was assigned by a panel of 2 physicians following retrospective chart review. Statistical variance between score groups was assessed using one-way ANOVA and Spearman’s correlation. Results: Of 342 patients reviewed, 278 (81.3%) were male, 273 (79.8%) were white and 185 (54.1%) sustained blunt injuries. Postive TACTIC CCS (i.e. score > 3) was associated with overall mortality of 48.8%, odds ratio 10.1 (p<0.0001) and mortality in the first 24 hours of 31.1%, odds ratio 12.5 (p<0.0001). The leading cause of overall and early mortality in patients with positive TACTIC CCS at ED presentation was uncontrolled hemorrhage secondary to TIC (35.0% and 46.7% respectively) and all seven patients with mortality attributable to TIC-related hemorrhage received positive initial TACTIC CCS representing 100% sensitivity in this cohort. Conclusion: Clinical assessment of trauma patients using TACTIC CCS at presentation offers a useful adjunct to conventional clotting assays and thromboelastography (TEG). Positive TACTIC CCS provides a highly sensitive indication of which patients are at greatest risk for hemorrhagic death secondary to TIC allowing for crucial therapy to be initiated promptly at the point of care while lab tests are in process or in settings where they may not be available to the provider. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 145 QUICK SHOT ABSTRACTS 146 (cont.) Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 16. VITAMIN D DEFICIENCY AND FRACTURE PROFILE IN GERIATRIC TRAUMA PATIENTS: HIPS DON’T LIE! Khalid Almahmoud, MD MPH; Christopher Pearcy, MD; Anthony Cahill, MD; Usha Mani, MD; Michael S. Truitt, MD, FACS; Vaidehi Agrawal, PhD Dallas, TX Background: Geriatric patients (≥ 60 years) are exceptionally vulnerable to single or multiple episodes of fall mediated orthopedic injury. Vitamin D deficiency has been associated with poor clinical outcomes in patients with orthopedic injury. Here we present a study assessing the impact of Vitamin D deficiency in the clinical outcomes of the geriatric trauma patient. Method: A retrospective chart review of all traumatic geriatric orthopedic injury patients from 2006 to 2016 was conducted. Patients were grouped based on initial Vitamin-D level of (A) ≤ 13 ng/mL (VD-) or (B) > 13 ng/mL (Control). General demographics, fracture characteristics and clinical outcomes were evaluated. A chisquare or Fisher’s exact test was employed for statistical significance in large or small sample sizes, respectively. A p ≤ 0.05 is considered statistically significant. Results: Out of 696 geriatric trauma patients, 28% (n = 193) were VD- (13 ± 0.7 ng/mL) vs. 72% (n = 503) were Control (26 ± 12 ng/mL). Our VD- trauma cohort consisted of 67% female, 77 ± 11 y/o and 9 ± 5 ISS. Fall (55%) was the most common cause of injury. Hypertension (24%) followed by diabetes (9%) and congestive heart failure (3%) were the dominant comorbidities. Our analysis showed statistically significant differences in fracture profiles (femoral neck displacement) and clinical outcomes (time to ambulation and hospital length of stay). VD- patients were found to have significantly more femoral neck fracture (53% VD- vs. 41% control; p<0.001), longer time to ambulation (3.8 ± 2 days VD- vs. 3.5 ± 2 days control; p=0.006) and hospital length of stay (6.4 ± 3 days VD- vs. 6 ± 5 days control; p=0.04). Conclusion: Our analysis reveals significant differences in the fracture profile and clinical outcomes of Vitamin D deficient geriatric trauma patients. Given the vulnerability of this population to fall associated orthopedic injury, muscle weakness and mortality, the effect of Vitamin D supplementation should be evaluated to determine its effect on outcomes. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 147 QUICK SHOT ABSTRACTS (cont.) QS 17. INCIDENCE AND PREDICTORS OF EMERGENCY DEPARTMENT THORACOTOMY PERFORMED OUTSIDE OF TEMPORAL GUIDELINES FOR TRAUMA ARREST FM Pieracci MD, MPH, J Clere BS, DD Bensard MD, E Campion MD, CC Burlew MD, CJ Fox MD, R Lawless MD, K McVaney MD, M Migliero RN, M Cohen MD, EE Moore MD Denver, CO Background: Emergency department thoracotomy (EDT) is a potentially lifesaving procedure, the success of which is dependent upon accurately identifying salvageable patients. Based upon the Western Trauma Association data, our trauma center has a guideline predicated upon the duration of pre-hospital cardiopulmonary resuscitation (CPR). The primary objective of this study was to examine adherence to the institutional guideline, as well as factors leading to deviation. A secondary objective was to compare survival following EDT performed within and out of guidelines. Method: Patients who underwent EDT following trauma arrest at our level I trauma center from 2011-2015 were reviewed. Time of CPR initiation was obtained from the paramedic trip sheet, and time of EDT from nursing records. An EDT was considered to be “within window” based on the following defined institutional criteria: < 15 minutes of pre-hospital CPR for penetrating torso trauma; < 10 minutes for blunt trauma; < 5 minutes for penetrating extremity trauma. Patients with isolated head trauma, as well as those who underwent EDT for refractory hypotension (without arrest) were excluded. Patients were stratified by mechanism of injury, age, and gender. Results: A total of 243 trauma arrest patients were analyzed; 146 (60.1%) underwent EDT. Overall, 65 EDTs (44.5%) occurred out of window. Deviation from the guidelines occurred more commonly in cases of penetrating extremity trauma (80.0%) and age < 18 years (57.1%), and less commonly in cases of penetrating torso trauma (41.3%) and age > 65 years (40.0%) (Table). Likelihood of deviation was not associated with mechanism of injury, age or gender. Overall, 15 (10.3%) EDT patients survived to hospital discharge; 6/75 (8.0%) for penetrating torso trauma, 7/66 (10.6%) for blunt trauma, and 2/5 (40.0%) for penetrating extremity trauma (p=0.07). Survival was 14/81 (17.3%) in the within window group and 1/65 (1.5%) for the out of window group (p<0.01). The singular patient who survived following out of window EDT sustained a brachial artery transection, underwent EDT after 6 minutes of pre-hospital CPR, and was discharged home neurologically intact. Conclusion: Almost one half of EDTs occurred outside of institutional temporal guidelines, and were nearly universally unsuccessful. Efforts to mitigate this finding should target pediatric and penetrating extremity trauma patients. The survival observed herein following EDT performed within the temporal pre-hospital CPR window represents the highest reported to date. 148 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 149 QUICK SHOT ABSTRACTS (cont.) QS 18. SHOULD INFANTS WITH BLUNT TRAUMATIC BRAIN INJURIES AND INTRACRANIAL HEMORRHAGE HAVE ROUTINE REPEAT IMAGING? EP Hill MD, B Bitter MS4, J Reyes MEd, R Grundmeyer MD, SD Helmer PhD, JM Haan MD Wichita, KS Background: Children with suspected brain injury usually undergo head CT, and if an injury is identified, follow-up CT is routine within 24 hours. To date, no studies have evaluated the practice of repeat imaging nor the diagnostic or therapeutic value of these repeat CTs in infants as a distinct population. The purpose of this study was to: (1) evaluate progression of traumatic brain injuries, (2) determine the prevalence of repeat imaging and whether or not it changes patient management, and (3) to determine if detecting worsening intracranial hemorrhage correlates with other clinical findings such as seizure, changes in neurologic exam, or retinal hemorrhage. Method: A 7-year retrospective review was conducted of all trauma patients aged ≤ 12 months with blunt traumatic head injury (N=50). Data included demographics, head injury details, number of repeat scans and findings, change in GCS or neurological exam, management changes following CT scans, and hospital outcomes. Results: Most patients (68%) had at least one repeat CT, with nearly three-quarters (74%) showing no change or a reduction in hemorrhage. Presence of neurological symptoms (p=0.025) and decrease in GCS (p=0.043) were significantly associated with having repeat CT scans. There was a correlation between increased hemorrhage on CT in those patients with subarrachnoid hemorrhages (p=0.012) and decreased GCS (0.019), but not with retinal hemorrhage or seizure activity. Repeat imaging led to changes in management (staying in the ICU, additional repeat imaging, addition of hypertonic saline, or going to the operating room) in 8 patients; in 4 patients this change in management was a surgical procedure. Repeat CT scans were associated with increased length of stay in the hospital (p<0.045), but not with increased ventilator days, ICU length of stay, or mortality. Conclusion: Findings from this study confirm a correlation between change in neurological exam, namely decreased responsiveness, and increasing size of intracranial hemorrhage in infants. However, size of initial hemorrhage, seizure, and retinal hemorrhage were not predictive of increased hemorrhage. These findings and the difficult nature of neurologic exams support the practice of routine repeat head CT in infants with blunt traumatic brain injuries. Larger and prospective studies may show that some populations are less likely to progress and may not require routine repeat imaging as has been seen in older children and adult populations. 150 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 19. DAMAGE CONTROL LAPAROTOMY IS ASSOCIATED WITH INCREASED ABDOMINAL COMPLICATIONS: A MATCHED ANALYSIS M J George MD, SD Adams MD, MK McNutt, JD Love DO, LJ Moore MD, CE Wade PhD, JB Holcomb MD, JA Harvin MD Houston, TX Background: Damage control laparotomy (DCL) is thought to be associated with increased abdominal complications compared to definitive laparotomy (DEF). Proving the difference between these two interventions is difficult retrospectively and cannot be controlled for using multivariate modelling. The purpose of this study is determine the effect of DCL on abdominal complications by comparing two groups: DCL patients who were prospectively adjudicated to have been patients who could have safely been closed at the primary laparotomy and those who underwent DEF. Method: Patients from 2011-2015 who underwent emergent laparotomy for trauma were included. From 11/1/2013 - 10/31/2015 at a major university trauma center, we performed a quality improvement project in which we prospectively and collaboratively adjudicated every DCL. The adjudication process occurred by majority vote after each emergency laparotomy. This group of adjudicated DCL patients was then matched to patients who underwent DEF in a 1:1 ratio according to mechanism of injury, abdominal injury severity, operating room transfusions, and performance of a colon resection. Results: From 2011 - 2015, 1,029 trauma patients underwent emergency laparotomy - 665 (65%) underwent DEF, 321 (31%) underwent DCL, and 43 (4%) died intraoperatively. 27 of 101 DCLs during the quality improvement period were adjudicated to have been patients who could have safely undergone DEF. Matching resulted in 16 pairs of patients who underwent DCL and DEF and were similar in terms of demographics, vital signs, injury severity, transfusions and procedures performed in the operating room. Patients undergoing DCL were more likely to have a fascial dehiscence (38% versus 0%, p=0.018), organ/space surgical site infection (56% versus 19%, p=0.066) and to be re-opened after fascial closure (38% versus 0%, p=0.018). Conclusion: In a group of matched patients, including patients who underwent DCL but could have safely undergone DEF, DCL was associated with increased abdominal complications. We believe that this study accounts for residual confounding not controlled for in other studies of DCL. Thus, this represents the least-biased treatment effect of DCL reported to date. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 151 QUICK SHOT ABSTRACTS (cont.) QS 20. ROUTINE “PAN-SCAN” IS NOT INDICATED IN THE ELDERLY AFTER GROUND LEVEL FALLS C Kim BS, R Sartin BS, S Dissanaike MD Lubbock, TX Background: Ground level falls are a common injury mechanism in elderly patients. We have noticed a trend in recent years toward performing a “pan scan” (computed tomography (CT) of head, C-spine, chest abdomen and pelvis) at initial ER evaluation of these patients, similar to what has become commonplace in motor vehicle collisions and other high impact trauma. While a head CT may be justified in this population due to age-related cerebral atrophy, dementia hindering an accurate neurologic examination, concomitant anticoagulation or other indications, we hypothesized there was little benefit from the remaining CT scans. Our hypothesis was that a panscan was not indicated in elderly patients with ground level falls, GCS of 15 and hemodynamically stable. Method: Retrospective review of patients who presented to a level 1 trauma center after a ground level fall January 2013 -May 2015. Inclusion criteria were hemodynamically stable patients > 55years of age with a GCS of 15, who received a panscan during initial ER evaluation. Radiologist reads of the scans were reviewed for new findings on CT; clinical documentation was then reviewed for evidence of a change in management based on CT findings. Results: 153 (21%) patients received panscans, resulting in an additional 134 (87.6%) new findings. The most common findings were cervical spine injuries 15 (9.8%), hematomas 13 (8.5%), rib fractures 13 (8.5%). 45 (6%) resulted in a minor change in management, such as use of a neck brace (8, 5.2%), serial examination (7, 4.6%), pain control (5, 3.3%), ICU observation (4, 2.6%), oxygen therapy (3, 2.0%), occupational therapy/ physical therapy (1, 0.7%), pulmonary toilet (1, 0.7%), non-operational sacral fracture treatment (1, 0.7%) and other alterations (3, 2.0%). One patient received tube thoracostomy for findings of pneumothorax on chest CT, and 2 patients (1.3%) underwent surgery for findings of dens and odontoid fractures on cervical spine CT. All three had clinical symptoms and signs suggestive of their diagnosis, which would have led to directed evaluation regardless of the panscan. Conclusion: The major benefit of additional CT scans in imaging patients with ground level falls was to diagnose occult cervical spine injuries or pneumothorax; however these findings occurred in fewer than 5% of patients. In patients with stable vital signs amenable to physical examination, there is no indication for routine panscan; use of CT of the cervical spine , chest, abdomen or levis should be based on clinical evaluation. Reducing the use of panscans will avoid unnecessary radiation and contrast exposure to patients while limiting waste of healthcare resources. 152 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 21. ACUTE KIDNEY INJURY IN TRAUMA PATIENTS RECEIVING CHLORIDE-RICH VS. CHLORIDE RESTRICTIVE RESUSCITATION EJ Glendinning MD, SD Barker MS4, J Reyes MEd, SD Helmer PhD, RJ Nold MD, JM Haan MD Wichita, KS Background: Recent studies have shown a positive association between fluid resuscitation with chloride-rich fluids (such as normal saline) and acute kidney injury in several patient populations. Among surgery patients, use of chloride-restricted fluids has been associated with decreased fluid requirement, transfusions, decreased length of stay and ventilator days, and decreased need for dialysis. Within the trauma population, chloride-restrictive resuscitation has been shown to be associated with less severe biochemical abnormalities compared to patients who received chloride-rich fluids. Our goal in this study was to compare clinically significant outcomes in trauma patients receiving chloride-rich vs. chloride-restrictive fluid resuscitation. Method: A retrospective chart review was conducted of all adult trauma patients who presented to our Level 1 trauma center with an injury severity score > 15, and who did not have a pre-existing diagnosis of Stage IV chronic kidney disease, from March 2011 through April 2015. In March 2013 the multidisciplinary trauma team changed the standard resuscitation fluid available in the trauma bay to chloride-restricted resuscitative fluid (Period II) as the standard for resuscitation in light of evidence in favor of its use. The standard IV fluid available prior to that time was normal saline solution, which has a supraphysiologic chloride concentration of 154 mEq/L (Period I). Data collected included the type and volume of IV fluid received as well as urine output and creatinine through hospital day 7. We also collected data regarding nephrology consultation and in-hospital dialysis. Acute kidney injury was identified based on urine output values averaged over each day and by increased creatinine values according to standard definitions. Results: Data were collected on 528 patients during the study periods. Of those patients, 274 were treated during Period I and 254 during Period II. These groups were similar with regards to initial vital signs, initial creatinine, and injury severity. Analysis of rates of acute kidney injury did not show a significant difference between these groups. Analysis of clinical outcomes showed no difference between ICU admissions, ICU days, or mechanical ventilation. There was a nonsignificant trend toward fewer ventilator days (3.5 days vs. 4 days, P =0.18) and decreased hospital length of stay (6 days vs. 7 days, P =0.10) in those treated during Period II. Conclusion: Among trauma patients presenting with ISS >15, our data do not demonstrate significant differences in rates of acute kidney injury or major outcome measures between groups who initially receive chloride-rich versus chloride-restrictive IV fluids. Nonsignificant trends were seen toward decreased length of stay and ventilator days among chloride-restricted patients. Further study may be indicated as to how the benefits of chloride-restrictive resuscitation extend to the trauma population. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 153 QUICK SHOT ABSTRACTS (cont.) QS 22. BASE DEFICIT IS SUPERIOR TO LACTATE IN TRAUMA JW Davis MD, RC Dirks PhD, Am Kwok MD, LP Sue MD, P Tran MD, MM Wolfe MD Fresno, CA Background: Base Deficit (BD) and lactate have been used as biochemical indicators of shock and effectiveness of resuscitation. An animal study demonstrated strong correlation between lactate and BD, but there has been limited data comparing BD and lactate on admission in trauma patients. The purpose of this study was to determine the association of BD and lactate and to determine if one is superior. Method: A retrospective review of all trauma patients admitted to an ACS verified level I trauma center from 3/2014 through 2/2016 was performed. An arterial blood gas and serum lactate were part of the admission trauma lab panel for the highest level of activation. Data collected included demographics, systolic blood pressure on arrival, ISS, BD, lactate, blood transfusion, volume of resuscitation and outcomes. Patients were excluded for absent BD or lactate data or if the ABG and venous blood draw were more than 10 minutes apart. BD was modeled as a continuous variable and categorically; normal (2 to -2), mild (-3 to -5), moderate (-6 to -9) and severe (< -10). Lactate was modeled as a continuous variable. Statistical analysis was performed with Mann Whitney U test, X2 and regression analysis with significance attributed to p < 0.05. Data are expressed as mean + SD. Results: 752 patients were included in analysis. BD and lactate had a strong correlation (r = -0.78 p < 0.001). As continuous variables, higher lactate and more negative BD were associated with administration of blood products within 24h and mortality. On multivariate regression, only BD was associated with administration of blood products and mortality (OR = 0.8, p < 0.001; OR = 0.9, p = 0.004, respectively). As a categorical variable, worsening BD was associated with decreased BP, higher ISS, increased transfusion need, and worse outcomes. Conclusion: BD and lactate are strongly related. BD was superior to lactate in assessing risk of mortality and the need for blood. The BD categories may discriminate high risk trauma patients better than lactate. 154 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 23. MINIMALLY INVASIVE VERSUS OPEN CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY - A COMPARISON OF SHORT TERM OUTCOMES RW Day MD, A Ashfaq MBBS, R Gray MD, B Pockaj MD, CC Stucky MD, N Wasif MD Phoenix, AZ Background: Cytoreductive surgery and HIPEC is being increasingly used as a treatment option for pseudomyxoma peritonei and peritoneal carcinomatosis. The traditional open approach has been well described in the literature, but is associated with considerable morbidity and mortality. In this study we describe our experience with minimally invasive HIPEC and compare short term outcomes with conventional open HIPEC. Method: A retrospective review of all 80 patients undergoing HIPEC at a single institution between 2010 and 2016 was performed. Demographic data and outcomes data were stratified by surgical approach and analyzed based on intention to treat. Results: Fifty-five patients undergoing open HIPEC were compared with 25 patients undergoing minimally invasive HIPEC. The two groups had similar demographics, except the minimally invasive group was more likely to have an ECOG performance status of 0 (p=0.016). Two patients undergoing minimally invasive approach were converted to an open procedure (8%) and 3 patients (12%) underwent palliative HIPEC. The median surgical peritoneal cancer index (PCI) score was higher for the group undergoing open surgery (14 vs. 3, p=<0.001). There was no difference in ability to achieve a CC-0 or CC-1 resection between groups (72.7% vs. 88%, p=0.158). The median length of stay was significantly shorter for the minimally invasive HIPEC group (3 vs. 9 days, p=<0.001), with two patients successfully undergoing outpatient HIPEC. Patients undergoing minimally invasive HIPEC had both lower morbidity overall (76.3% vs. 28%), p=<0.001) and lower major morbidity (40% vs. 4%, p=0.001) when compared to open HIPEC. There was no difference in 90-day mortality. Conclusion: Conclusion: Minimally invasive HIPEC is a safe approach for patients with primary or secondary peritoneal malignancy, with less morbidity and shorter length of stay compared to open HIPEC. Patient selection is important, and patients with low PCI scores or undergoing palliative HIPEC deserve consideration of minimally invasive approaches. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 155 QUICK SHOT ABSTRACTS (cont.) Table 1. Demographics and outcomes of patients undergoing HIPEC Age at Diagnosis* Age at HIPEC* Female Sex+ ECOG 0 StatusPrimary Carcinomatosis+ Colonic or Appendiceal Origin of cancer+ Low Grade Tumor+ Prior Abdominal SurgeryPrior Chemo+ Palliative IntentMedian Surgical PCI* LOS* CC-0 or CC-1 or palliative intentAny MorbidityMajor Morbidity (CTCAE4.0 3/4)90-Day Mortality- Open (n = 55) 55 (49 – 64) 57 (50 – 65) 25 (45.5%) 40 (72.7%) 39 (70.9%) MIS (n = 25) 50 (37.5 – 63.5) 50 (41.5 – 63.5) 15 (60%) 24 (96%) 15 (60%) p-value 0.175 0.135 0.228 0.016 0.334 48 (87.3%) 20 (80%) 0.398 36 (65.5%) 42 (76.4%) 19 (45.5%) 23 (92%) 0.346 0.128 29 (52.7%) 12 (21.8%) 14 (7 – 20) 9 (6 – 13) 52 (94.5%) 15 (60%) 3 (12%) 3 (1.5 – 7) 3 (2 – 4) 25 (100%) 0.544 0.368 <0.001 <0.001 0.548 42 (76.3%) 22 (40%) 7 (28%) 1 (4%) <0.001 0.001 1 (1.8%) 0 (0%) 0.312 MIS = Minimally Invasive Surgery, HIPEC = Hyperthermic Intraperitoneal Chemotherapy, ECOG = Eastern Cooperative Oncology Group, PCI = Peritoneal Cancer Index, LOS = Length of Stay, CTCAE = Common Terminology Criteria for Adverse Events *Mann-Whitney U Test +Chi-square -Fisher’s exact Test 156 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 24. REDUCING VTE EVENT RATES IN COMPLEX ABDOMINAL CANCER SURGERY: A RETROSPECTIVE, SINGLE INSTITUTE COMPARISON OF DEXTRAN VS HEPARIN Richard Sleightholm, John Burt, Lynette Smith, Duncan Watley, Steven Wahlmeier, Asish Patel, and Jason Foster Omaha, NE Background: VTE rates in cytoreductive surgery (CRS) for peritoneal metastasis (PM) without prophylaxis are high, 30-50%. Many factors in this population promote VTE events including tumor burden, tumor hypercoagulability, performance status, procedure duration, inflammation, and immobility. In CRS the major deterrent to heparin based prophylaxis is the significant bleeding risks inherent in these procedures which often require multi-visceral resections. When heparin prophylaxis is employed it is often postoperative, and rates still remain as high as 20%. As an alternative to heparin, Dextran has been used in PM patients at our institution both pre and postoperatively. Herein we compare VTE events for heparin & dextran in 117 PM patients who underwent CRS. Method: A retrospective analysis (2010-15) identified 69 and 48 patients who underwent CRS and received dextran-40 or heparin, respectively. Dextran was started (25 ml/hr) in the OR prior to incision and maintained for at least 72 hours postoperatively. Similarly, unfractionated heparin 5000U was administered prior to incision and continued post-operatively throughout the entire hospital stay. SCDs were used in all patients, and physical therapy ambulated patients daily. The incidences of perioperative bleeding and VTE rates in-hospital, 30 days, 90 days were determined. Results: Both dextran and heparin therapies were tolerated without any adverse events. Median lengths of stay for patients receiving dextran or heparin were 10 and 9 days respectively. No differences were observed in the demographics of the patients studied, and median age was 58 in both groups. Surgical outcomes were comparable between cohorts. The heparin group experienced slightly higher rates of kidney complications (p = 0.02), but not other differences were found between medical and surgical complications. In-patient, 30-day, and 90- day VTE rates were found to be 5.8 v 10.2%, 8.7 v 10.2%, and 8.7 v 12.5% for dextran v heparin respectively (P = 0.7, 1.0, and 0.5 respectively). No pulmonary emboli were observed in the dextran group, while 2 patients were identified in the heparin group. Overall VTE event rates were 8.7 and 12.5% (p=0.55). Conclusion: Demographics, surgical procedures, and complication rates were comparable between patients receiving dextran and heparin. Although VTE rates were lower in those administered dextran, this was not statistically significant. Based on these findings, dextran appears to be a safe and effective alternative to heparin based prophylaxis in those undergoing advanced abdominal surgeries. A non-inferiority clinical trial is warranted and necessary to validate the safety/utility of dextran based VTE prophylaxis compared to UFH or LMWH. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 157 QUICK SHOT ABSTRACTS DVT Rates In hosp 6 5 Dextran (n=69) Hep (n=48) Dex (n=69) Hep (n=48) 10.5/9.0 Dex (n=69) Hep (n=48) Dex (n=69) Hep (n=48) 158 Kidney 20 3?? 30 day 0 0 Surgery R-score Organs R0 R1 Resected R2a 7/8 2 (3%) 20 (30%) R2a 5/5 0 (0%) 20 (42%) LOS ave/ PCI med 12//10 25/26 23/24 Kidney Problems RIFLE 2 3 0 1 48 (70%) 23 (48%) 12 (17%) 12 (25%) (cont.) 5 4 (7%) (8%) 9 (19%) 4 (8%) 90 day 0 2 R2a R2b R2c 29 (42%) 17 (35%) 12 (17%) 7 (15%) 16 (23%) 9 (19%) P = 0.02 Ave/ med 1/0 21 (30%) 1/1 29 (60%) Medical Complications Organ Systems Clavien-Dindo Resp Cardiac Other 0 1 2 3 5 10 8 (12%) 41 9 (13%) 14 (20%) 1 (7.2%) (14%) (59%) (2%) 6 3 (6.3%) 7 (15%) 29 5 (11%) 13 (27%) 1 (13%) (60%) (2%) P = 0.11 4 4 (6%) 0 (0%) 5 0 (0%) 0 (0%) Southwestern Surgical Congress | 69th Annual Meeting 28 (41%) 19 (39%) QUICK SHOT ABSTRACTS Medical Complications Kidney Resp Cardiac Other 20 5 (7.2%) 10 (14.4%) 8 (12%) Dex (n=69) Hep (n=48) Dex (n=69) Hep (n=48) Age (cont.) 3?? 6 3 (6.3%) (12.5%) Anastamotic Leak 0 (0%) 7 (14.6%) Surgical Complications Wound Abdominal Fascial Infection Abscess Dehiscence 1 (1%) 1 (1%) 1 (1%) 1 Dex (n=69) Hep (n=48) Histology Dex (n=69) Hep (n=48) Pancreatic Leak 2 (3%) Total 5 (7%) 1 Median 58 Mean 58 58 57 Hep (n=48) PMP Ovarian Appendix 22 (32%) 12 (17%) 5 (7%) 10 (21%) 13 (27%) 1 (2%) Mesothelioma 4 (6%) 4 (8%) Sex Dex (n=69) April 2 – 5, 2017 | Hyatt Regency, Maui, HI Male 27 (39%) 20 (42%) CRC 11 (16%) 11 (23%) Female 42 (61%) 28 (58%) Other 15 (22%) 9 (19%) 159 QUICK SHOT ABSTRACTS (cont.) QS 25. FIT TEST FOR COLORECTAL CANCER SCREENING: OUR COMMUNITY EXPERIENCE EJ Furay MD, J Uecker MD, JM Kerr MD Austin, TX Background: The gold standard for screening for colorectal carcinoma (CRC) is colonoscopy. There are other approved methods for CRC screening from the USPSTF including stool based studies. Fecal immunochemical tests, which utilize antibodies against human hemoglobin to detect the presence of blood in stool have been gaining popularity. We set out to see if in an urban population if these were effective screening tools. Method: From 2012-2015 packets, which including qualitative Fecal Immunohistochemical Tests (FIT) and a letter explaining the purpose of the packet, were mailed to patients 50-75 years old who had been seen within the Seton Healthcare Family Clinic. Patients then mailed in these kits back and if positive were referred for colonoscopy. Patient that had a colonoscopy within a year of having a positive or negative FIT test were included. Information about patient follow up colonoscopies was determined by chart review or by requesting records from physician who performed the colonoscopy. We then determined whether the colonoscopy was normal, had premalignant lesions or cancerous lesions based on biopsy results. Normal included polyps with no malignant potential. One patient was excluded due to inability to obtain pathology records regarding polyp biopsied. Results: During these 4 years, 3505 kits were mailed out and 596 were returned making the response rate for this mode of distribution 17% overall. Of the 596 FIT tests that were returned 36 were positive and 560 were negative. Upon chart review we were able to obtain information on 32 follow up colonoscopies. Nineteen of these patients had positive FIT tests and 13 had negative FIT tests. Of the patients with positive FIT tests and a colonoscopy 12 were found to have precancerous lesions (63.16%). Of the patient with negative FIT tests and a colonoscopy 3 were found to have precancerous lesions (23.07%). Calculating specificity and sensitivity based on our results the FIT test had a specificity of 58.82% and a sensitivity of 80%. No cancerous lesions were found. Conclusion: It was hypothesized that compliance rates would be higher with a simple, less invasive test that could be performed easily at home. In our population, which includes many underserved and underfunded patients we found that the compliance rate was poor. A 17% response rate does not appear to be a promising and effective screening method for this population. FIT test in our community was not as effective screening tool as previously reported in literature. 160 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Year Mailed FIT Returned FIT + FIT neg Scope year of +test scope in year of - test Precancerous lesion found with + FIT test Precancerous lesion found with - FIT test 0 1 300 71 6 65 3 2 2 2 722 151 5 146 2 6 2 0 3 987 169 12 157 7 3 4 2 4 1496 204 13 191 7 2 4 1 TOTAL 3505 595 36 559 19 13 12 3 April 2 – 5, 2017 | Hyatt Regency, Maui, HI 161 QUICK SHOT ABSTRACTS (cont.) QS 26. SPLENECTOMY IN HEMATOLOGIC DISEASE: DO WE MAKE A DIFFERENCE? Sheaffer WW, Mikhael JR, Neville MR, Harold KH, Gray RJ, Wasif N, Pockaj BA, Stucky CCH Phoenix, AZ Background: Splenectomy is an accepted treatment for idiopathic thrombocytopenic purpura (ITP); however, its role in the management of other hematologic disorders is not well-established. We evaluated our recent splenectomy outcomes to identify benefits for patients undergoing splenectomy for diagnostic and therapeutic purposes. Method: We performed a retrospective review of patients undergoing splenectomy with an unknown diagnosis (UD), a hematologic malignancy (HM) or ITP from 2006 to 2016. Surgical indications and postoperative, hematologic, and diagnostic outcomes were evaluated. Results: Of the 113 patients undergoing splenectomy, 31% had UD, 29% had HM, and 40% had ITP. Comorbidity index, body mass index, splenic weight and length, and preoperative blood counts differed amongst the groups (Table 1). The majority (74%) of patients underwent laparoscopic splenectomy with HD patients having the highest rate of open splenectomy (36%). Post-operative complications and outcomes were similar amongst the groups in terms of transfusions, infections, and readmissions (Table 1). Indications for splenectomy in UD were cytopenias (20%), B-symptoms (3%), splenomegaly symptoms (9%) and a combination of these indications (60%). Definitive diagnosis was achieved in 46% of patients. Of these patients, 69% had cytopenias, 50% B-symptoms, 50% splenomegaly, 25% splenic mass, 63% prior bone marrow biopsy. Improvement in indications were seen in 57% of patients (50% cytopenias, 25% multiple factors, 15% splenomegaly and splenic mass symptoms, 5% B-symptoms). Indications for splenectomy in HM were cytopenias (33%), B-symptoms (3%), splenomegaly symptoms (12%), and a combination of these 52%. The diagnosis changed after splenectomy in four (12%) of the HM patients. Improvement in symptoms or labs occurred in 52% (65% multiple factors, 9% cytopenias, and 9% splenomegaly symptoms). Conclusion: Splenectomy was able to provide a diagnosis in almost 50% of undiagnosed patients with low morbidity. In addition, 50% of HM patients had improvement of labs and symptoms. These groups compare favorably to our ITP patients and therefore splenectomy may be a useful diagnostic and therapeutic tool in UD and HM patients for the correct clinical situation. 162 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS Table 1. Demographics and Surgical Outcomes in Splenectomy Patients* UD HM Patient Demographics (N=35) (N=33) (median) (cont.) ITP (N=45) Total (N=113) p-value Age (years) 58 62 61 61 0.16 Body Mass Index (kg/m2) Charlson Comorbidity Index Spleen Length (cm) Spleen Weight (grams) Preoperative platelets (x109/L) Preoperative hemoglobin (g/dL) 25 25 29 26 0.0002 2.0 4.0 3.0 3.0 0.0001 18 20 12 15 <0.0001 741 1520 190 395 <0.0001 128 73 27 65 <0.0001 11 UD (N = 35) 89% 11% 6% Procedure Performed Laparoscopic Open Conversion Surgical Complications and Outcomes (median) Venous thromboembolism Surgical site infection Overwhelming post-splenectomy infection Length of stay (days) Transfusion received 30-day readmission 30-day mortality 10 HM (N = 33) 64% 36% 3% 13 ITP (N = 45) 100% 0% 2% 12 Total (N=133) 86% 14% 4% UD (N=35) HM (N=33) ITP (N=45) Total (N=113) p-value 0% 6% 2% 2% 0.29 3% 0% 0% 1% 0.32 0% 0% 0% 0% 4.0 5.0 2.0 4.0 31% 39% 16% 27% 23% 27% 9% 19% 3% 6% 2% 3% 0.005 p-value <0.0001 <0.0001 0.6912 0.0001 0.05 0.09 0.64 *UD=undiagnosed group, HM=hematologic malignancy group, ITP=idiopathic thrombocytopenia group April 2 – 5, 2017 | Hyatt Regency, Maui, HI 163 QUICK SHOT ABSTRACTS (cont.) QS 27. INFLAMMATORY BREAST CANCER REMAINS A POOR PROGNOSIS: A SINGLE INSTITUTION REVIEW PT Hangge MD, HE Kosiorek MS, JM Chang MD, RJ Gray MD, N Wasif MD, CH Stucky MD, DW Northfelt MD, KS Anderson MD PhD, AE McCullough MD, IT Ocal MD, BA Pockaj MD Phoenix, AZ Background: Inflammatory breast cancer (IBC) accounts for approximately 1.0-2.5% of all breast cancer diagnoses and carries a poor prognosis. Current treatment involves tri-modality therapy with neoadjuvant chemotherapy, surgery and radiation therapy. Additional endocrine and targeted therapy are used as indicated. The goal of this study is to determine clinical history and outcome of patients at our institution in the modern era. Method: A retrospective review of a prospectively collected database of women with breast cancer who underwent neoadjuvant treatment from 2002-2015 was performed. A total of 37 patients were identified with IBC. Patient factors, tumor factors and response were analyzed. Kaplan-Meier curves were performed to show overall survival and survival based on tumor marker status. Results: A total of 289 breast cancer patients underwent neoadjuvant therapy; 37 (13%) had IBC. Mean age was 59.2 (range 40-74) and 74% were postmenopausal. Race was comprised of white (90%), Hispanic (8%), and Native American (3%). Mean BMI was 29.4 (range 19.9-41.2). Mean follow-up time in years was 1.2 (0-8.2). Tumor markers were 40% ER+Her2-, 32% Her2+, and 29% triple negative breast cancer (TNBC). Histologically, 73% were invasive ductal carcinoma (IDC), 5% invasive lobular carcinoma (ILC), 5% mixed IDC/ILC and 16% other. Most presented at Grade 3 (62%) and others were Grade 2 (27%) or Grade 1 (3%). 5 patients presented with stage IV disease and 3 presented with recurrent breast cancer. Most patients presented with clinically positive lymph nodes (N0 27%, N1 27%, N2 30%, N3 16%). All patients underwent pre-operative chemotherapy. All patients underwent a mastectomy except for one patient who refused mastectomy despite counseling and chose to pursue lumpectomy. Axillary staging after chemotherapy was a planned axillary lymph node dissection (ALND) in 64%, sentinel lymph biopsy followed by ALND in 28%, SLN biopsy only in 3% and no axillary procedure in 3%. Only 1 did not undergo an axillary staging due to patient preference on risk of lymphedema. After chemotherapy, breast complete pathologic response was found in 9 patients (24%). Angiolymphatic invasion was persistent at final pathology in 57%. Most patients had residual disease within the axilla (66%), but 5 patients (15%) had a complete response. TNBC was most likely to recur overall, 8/13 (61.5%), and more likely to recur to distantly, 4/13 (30.8%). Overall survival at 5 years for those who presented with stage III disease was 46.5% (n = 38). 5 year survival for ER+/Her2- was 66.7% (n = 15), Her2+ 46.9% (n =12), 2 year survival was 28% (n = 11) for TNBC (Figure 1). 164 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Conclusion: Despite advances in screening and treatment, IBC continues to carry a high mortality rate. At our institution, ER+/Her2- IBC had the highest overall survival and TNBC had the highest mortality, local and distant recurrence rates. This difference in response among tumor markers underscores the importance of tumor biology to tailor IBC treatment in the future. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 165 QUICK SHOT ABSTRACTS (cont.) QS 28. SURGICAL OUTCOMES OF LYMPHADENECTOMY IN THE ELDERLY MELANOMA POPULATION T Weidner MD, CC Stucky MD, B Pockaj MD, R Gray MD, N Wasif MD, A Mangold MD, J Jakub MD, S Bagaria MD Phoenix, AZ Background: Lymph node dissection (LND) for macroscopic metastatic or recurrent melanoma is the standard of care. LND is associated with substantial risks and therefore its use in micrometastatic disease identified on sentinel lymph node (SLN) biopsy or as a prophylactic treatment is currently under investigation. We reviewed our surgical outcomes of LND in the elderly melanoma population to examine whether this group has a higher risk of postoperative complications. Method: A retrospective review was performed on elderly patients (≥65 years of age) with a diagnosis of cutaneous or subungual melanoma who underwent LND at three Mayo Clinic sites from 2005-2015. Surgical and oncologic outcomes were the compared to a single-site cohort of patients <65 years of age. Results: 88 elderly patients underwent 111 LND for melanoma (42% neck, 30% axilla, 28% groin). Primary tumor thickness was T1 in 13 (15%) patients, T2 in 14 (16%) patients, T3 in 32 (36%) patients, T4 in 13 (15%) patients, T-in situ in 1 (1%) patient and 15 (17%) patients had either unknown primary tumors or not-reported outside pathology. Indications for LND included positive sentinel node (45%), initial palpable metastatic disease (18%), recurrence to regional nodal basin (32%), and prophylactic LND at time of primary excision (5%). All patients undergoing prophylactic LND did not have identification of metastatic disease in any of the lymph nodes examined. The median length of drain placement was 12 days (range 0-150 days). Complications included nerve injuries (19%), infection (13%) seroma (13%), wound dehiscence (4%), and chyle leak (3%). Median length of hospital stay was 2.4 days (range 0-22 days), significantly longer than for patients <65 years (1.5 days, p=0.0029). Lymphedema was noted in 38% of elderly patients (36% upper extremity vs. 54% lower extremity), which was significantly higher than among patients <65 years (18%, p=0.0185). The 30-day readmission rate was 11% versus 10% for younger patients. Conclusion: Elderly melanoma patients experience noteworthy postoperative complications after LND. These results along with those from upcoming trials of the need for completion lymph node dissection after a positive lymph node will aid in our ability to make appropriate decisions of whether or not to pursue LND in our melanoma patients especially in light of the associated morbidities especially in the elderly where the risk is somewhat higher. The use of prophylactic lymph node dissection should be discouraged. 166 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 30. SPECT-CT impacts surgical and radiographical approach in sentinel lymph node biopsy for head and neck melanoma BB Trinh MD, BC Chapman MD, A Gleisner MD PhD, JJ Kwak MD, R Morgan MD, MD McCarter MD, C Gajdos MD, N Kounalakis MD Aurora, CO Background: Detecting metastasis in a sentinel lymph node (SLN) in cutaneous melanoma predicts overall survival. Previous studies have shown that traditional pre-operative imaging in the form of 2-D planar lymphoscintigraphy (PL) has a lower detection rate of SLN in head and neck melanoma compared to other primary sites. The addition of single-photon emission computed tomography (SPECT-CT) significantly increases the likelihood of retrieving a positive SLN in this patient subset. This study aimed to examine whether SPECT-CT alters a surgeon’s incisional approach and ability to locate the SLN intra-operatively in cutaneous melanomas of the head and neck. Method: Patients who underwent SLN biopsy for cutaneous melanoma between November 2011 and October 2016 were included in a prospectively collected, retrospectively reviewed database. Surgeons were given a survey to complete postoperatively that asked whether SPECT-CT: a) influenced the incision for SLN, b) influenced the extent of incision, and c) helped distinguish a SLN difficult to visualize on PL due to proximity to the primary tumor site. Only patients who underwent SLN biopsy for head and neck primary melanoma were included. Patient demographics and pathologic outcomes were analyzed in comparison to surgeon responses using chi-square test for categorical variables and Wilcoxon rank-sum test for continuous variables. Results: Surgeon responses were available for 71 head and neck melanoma patients. Mean age was 58.9±17.9; 49 were male (69%); primary locations included scalp (33.8%), ear (14.1%), face (42.3%), neck (8.5%), and conjunctiva (1.4%). Biopsy depth was 2.6±3.2 mm; ulceration was present in 11 (15.5%); mitosis was present in 57 (80.3%). Surgeons responded that SPECT-CT influenced their incision in 58 cases (81.7%), influenced the extent of incision in 33 cases (46.5%), and helped distinguish a SLN difficult to visualize on PL due to proximity to the primary tumor site in 27 of 70 cases (38.6%). SPECT-CT most commonly improved localization of the SLN due to proximity of the primary tumor in melanomas of the face (11 patients) and scalp (10 patients). These responses did not have a statistically significant association with any patient characteristics or pathologic variables. Conclusion: According to a questionnaire answered by surgeons who performed SLN biopsy for cutaneous melanoma of the head and neck, SPECT-CT has been shown to influence the incision, extent of incision, and improve identification of SLNs near the primary tumor site. This study supports the notion that SPECT-CT is a useful adjunctive modality in SLN biopsy for cutaneous melanoma of the head and neck. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 167 QUICK SHOT ABSTRACTS (cont.) QS 31. EARLY EXPERIENCE WITH CYTOREDUCTION AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY AT A NEWLY DEVELOPED CENTER FOR PERITONEAL MALIGNANCY: LESSONS LEARNED FROM THE FIRST 50 CASES Whitney Guerrero MD, Gitonga Munene MD, Paxton V. Dickson MD, John Mays BS, Dina Darby RN/NP, Donna Freeman RN, David Shibata MD, Evan S Glazer MD, Jeremiah L. Deneve DO Memphis, TN Background: Peritoneal carcinomatosis (PC) was previously considered a terminal condition and is the pattern of metastasis for a variety of malignancies including appendiceal, ovarian and colon cancers. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has significantly improved outcomes for appropriately selected patients. We present our cumulative experience and lessons learned from the initial completed 50 CRS/HIPEC procedures in a newly developed center for peritoneal malignancy. Method: After IRB approval, a single-institution retrospective review was performed for the first 50 patients treated with CRS/HIPEC. Clinicopathologic variables and outcomes data were recorded. Twenty-six pts (34%) who underwent attempted CRS/ HIPEC were excluded as excessive disease (CCR 3) resulted in incomplete CRS (IC CRS/HIPEC) and HIPEC was therefore not performed. Results: Patients treated with CRS/HIPEC were Caucasian (66%), female (64%) with a median age of 53 years (11-73 years). Primary pathology included: appendix (42%, n=21), ovary (18%, n=9), colon (14%, n=7), desmoplastic small round cell tumor (14%, n=7) or other (12%, n=6). The median peritoneal cancer index (PCI) score was 15.5 (139). Forty-five patients (90%) underwent multivisceral resection and 92% underwent complete cytoreduction (CCR 0/1). Median hospital length of stay was 9.0 days (6-35 days). Twenty-one patients (42%) experienced a complication, 8 (16%) major morbidity (Clavien-Dindo 3-5) with 2 (4%) 30-day mortalities. With a median follow up of 18.5 months (1-49 months), recurrence-free survival was 14.1 months (95% CI: 11.1, 17.2 months) and overall 1-, 2- and 3-year survival was 82%, 54%, and 33%, respectively. Recent additions to improve outcomes included the addition of a dedicated CRS/ HIPEC coordinator to facilitate patient flow and coordination. Furthermore, the development of a goal-directed fluid therapy protocol (GDFT) was instituted with anesthesia assistance to attempt to shorten recovery and hospital stay. Physical therapy and nutritional assessment protocols were developed to improve early postoperative mobilization and optimize recovery. Selective use of diagnostic laparoscopy (DL) was instituted for high-grade appendiceal and colon malignancies as these pathologies were more often associated with IC CRS/HIPEC. Conclusion: Short-term outcomes observed after CRS/HIPEC in a newly developed center for PC are consistent with published higher volume center experiences. Hiring a CRS/HIPEC coordinator has proven instrumental in facilitating patient coordination, scheduling of preoperative studies and adherence to protocols. Appropriate patient selection, selective use of DL, institution of GDFT protocols with preoperative nutritional and physical therapy assessments will hopefully yield improved outcomes as experience develops. 168 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 32. A NSQIP ANALYSIS OF CRS-HIPEC OUTCOMES COMPARED TO OTHER MAJOR GASTROINTESTINAL SURGERIES R Sleightholm BS, L Smith PhD, A Patel MD, and JM Foster MD Omaha, NE Background: Currently less than 15% of patients with peritoneal metastasis who are candidates for cytoreductive surgery (CRS) with HIPEC are referred for surgical evaluation. One misconception that remains a major barrier for appropriate patient referral is the perceived high morbidity and mortality of CRS-HIPEC, while major gastrointestinal surgeries with similar morbidity and mortality rates such as whipple, hepatectomy, and esophagectomy have become the standard of care. Utilizing the NSQIP database the safety of CRS-HIPEC was evaluated in a comparative outcomes analysis to determine the relative safety. Method: A retrospective review of the NSQIP data base (2005-2014) was performed to identify patients who underwent CRS (1700), hepatectomy (23,579), whipple (13755), and esophagectomy (6524). Hepatectomies compared included trisegmental hepatectomy (TSH 2079) and right lobe hepatectomy (RLH 4262). Records were analyzed for rates of return to OR (RtOR), superficial infection (SI), deep incisional infection (DII), organ space infection (OSI), length of stay (LOS), and 30 day mortality. LOS was analyzed using analysis of variance (ANOVA) and Tukey adjustment for pairwise comparisons. Chi-square testing was performed on all other binary data. Results: Compared to CRS-HIPEC, rates of RtOR were higher for esophagectomies (P<0.001); SI were higher in whipple and esophagectomies (P<0.001); and OSI were higher for RH, TSH, and whipple (P<0.0001, 0.03, <0.0001 respectively). LOS for CRS was 9.8 days which was lower than whipple, 13.2 days (P<0.0001), and esophagectomy 14.7 days (P<0.0001). Overall 30 day mortality was 1.24% in CRS which was lower than TSH (4.38%), RLH(3.38%), whipple (2.65%), and esophagectomy (3.10%), P<0.001. Conclusion: In this comparative safety analysis of major NSQIP morbidity metric, CRS-HIPEC had either comparable or improved observed outcomes. The LOS was lower compared to both esophagectomy and whipple procedures but comparable to TSH and RH. Lastly, CRS-HIPEC had the lowest observed mortality rates. In this comparative analysis, CRS-HIPEC had the lowest complication, and safety concerns should not be an obstacle to patient referral. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 169 QUICK SHOT ABSTRACTS (cont.) QS 33. PERIOPERATIVE OUTCOMES AND SURVIVAL FOLLOWING NEOADJUVANT STEREOTACTIC BODY RADIATION THERAPY VERSUS INTENSITY-MODULATED RADIATION THERAPY IN PANCREATIC ADENOCARCINOMA BC Chapman MD, A Gleisner MD, PhD, D Rigg BS, DM Overbey MD, A Paniccia MD, C Meguid DNP, C Bartsch PA, T Schefter MD, K Goodman MD, C Gajdos MD, RD Schulick MD, BH Edil MD, MD McCarter MD Aurora, CO Background: Neoadjuvant chemoradiotherapy is increasingly used in borderline resectable pancreas cancer to facilitate surgical resection. We compared perioperative outcomes and survival in patients receiving neoadjuvant stereotactic body radiation therapy (SBRT) with those receiving intensity-modulated radiation therapy (IMRT). Method: We analyzed institutional data in patients receiving neoadjuvant SBRT or IMRT for pancreatic adenocarcinoma (2012-2016). A chi-squared test was utilized for categorical variables and Wilcoxon rank-sum test for continuous variables. Differences in progression-free survival (PFS) and overall survival (OS) from date of diagnosis were compared with a log-rank test. Results: We identified 54 (76.1%) patients receiving SBRT and 17 (23.9%) receiving IMRT. The median dose of radiation and duration in the SBRT group was 30 Gy and 9 days, respectively, and 45 Gy and 36 days, respectively, in the IMRT group. Patients in the SBRT group were more likely to receive neoadjuvant FOLFIRINOX (n=34, 63%) and gemcitabine/abraxane (n=17, 31%) compared to the IMRT group (FOLFIRINOX n=9, 53% and gemcitabine/abraxane n=2, 12%) (p=0.007). There was no difference in the number of patients that made it to surgery and had resectable disease in the SBRT (n=31, 57%) group compared to the IMRT (n=11, 65%) (p=0.909). Among resected patients, there was no difference in blood loss, operative time, pancreatic fistula, abdominal abscess, wound infections, length of stay, 90-day readmission and mortality (all p>0.05). Although more lymph nodes were examined in the SBRT group (median 19 vs. 13, p=0.008), there was no difference in lymph node status, margin status, lymphovascular invasion, perineural invasion, or pathologic response to neoadjuvant treatment (all p>0.05). In the SBRT group, 38 (70.4%) patients had disease progression compared to 14 (82.4%) in the IMRT Group. Among all patients, median PFS was 11 months in the SBRT group and 15 months in the IMRT group (p=0.211). In resected patients, median PFS was 18 months in the SBRT group and 20 months in the IMRT group (p=0.465). Median OS was 23 months in all patients and 25 months in resected patients; median OS was not reached in the IMRT group. Conclusion: As part of a neoadjuvant therapy regimen for borderline resectable pancreatic adenocarcinoma, SBRT and IMRT appear to have similar rates of resection and perioperative outcomes. Improved understanding of the role for selection bias and longer follow up are needed to better define the impact of neoadjuvant radiation modality on PFS and OS. 170 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 34. IMPLEMENTATION OF A NURSE-DRIVEN PROTOCOL FOR CATHETER REMOVAL TO DECREASE CATHETER ASSOCIATED URINARY TRACT INFECTION RATE IN A SURGICAL TRAUMA INTENSIVE CARE UNIT AF Tyson MD, LR Spangler RN, SW Ross MD, EF Campbell RN, CL Passaretti MD, CE Reinke MD, RF Sing DO Charlotte, NC Background: Catheter associated urinary tract infections (CAUTIs) are a significant source of morbidity, mortality, and cost in healthcare. Early removal of urinary catheters is one of the most effective strategies for CAUTI prevention; however, under traditional physician-directed systems, catheters are consistently used longer than necessary. We hypothesized that a nurse-directed catheter removal protocol would result in fewer catheter days and a decrease in CAUTI rates in a Surgical-Trauma Intensive Care Unit (STICU). Method: We performed a retrospective, cohort study following implementation of a nursing-driven protocol for early catheter removal in August 2014 in the STICU at a regional hospital. Under this protocol, nurses performed twice-daily assessment of all patients with urinary catheters. Catheters were removed when they no longer met criteria according to the protocol. Data from a 19-month historical control was compared to data from a 15-month intervention period, following a 2-month washout period. Pre- and post-intervention CAUTI rate and catheter days were compared. Results: The study population included 20803 catheter days: 11490 pre-intervention, 1127 in washout, and 8186 post-intervention. A total of 77 CAUTIs occurred during the study period, with 59 before, 2 in the washout, and 16 after the protocol. Both CAUTI rate and catheter utilization decreased following implementation of the protocol (rate 5.06 to 1.95/1000 catheter days, p-value <0.01; utilization 0.78 to 0.70, p-value <0.01). The CAUTI rate prior to the nursing protocol was 2.6 times greater than the rate following the protocol. Conclusion: Implementation of a nurse-driven protocol for early urinary catheter removal can result in measurable decreases in both catheter utilization and CAUTI rates and can be a useful adjunct for infection prevention in the STICU setting. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 171 QUICK SHOT ABSTRACTS (cont.) QS 35. LONG-TERM OUTCOMES OF FALLS IN OCTOGENARIANS TAKING ORAL ANTI-PLATELET AND ANTI-COAGULANT MEDICATIONS CM Hall MD, S Essler MD, J Dandashi BS, S Wieters MD, D Drigalla MD, K Stone MD, JL Regner MD Temple, TX Background: Falls are the leading cause of traumatic brain injury in elderly patients and account for over $31 billion annually in Medicare expenses. Oral anti-platelet (OAP) and anti-coagulant (OAC) medications increase the risk of hemorrhagic events and mortality in elderly patients following a fall. Many of these patients, however, are discharged from the Emergency Department (ED) with no obvious injuries and a normal head CT. The purpose of this study is to characterize long-term outcomes of falls in octogenarians taking OAP or OAC, including those who were not injured from their sentinel fall. Method: A single-institution, IRB-approved, retrospective review of a level I trauma center was performed on all patients over 80 years old who presented to the ED for a ground level fall and underwent a head CT between January 2014- January 2016. Patients taking OAP or OAC were included in the study. Demographic data included age, medication, place of residence, ambulatory status, and presence of intracranial hemorrhage identified on CT scan. Primary outcomes were death, readmission, recurrent falls, and delayed intracranial hemorrhage. Results: One hundred fifteen patients were identified for inclusion in this study. Mean age was 86.9 ± 5.0 years (range 80-101), 58% of patients were female, 56.5% lived at home, and 22.6% of patients were taking OAC, including warfarin, rivaroxaban, apixaban, dabigatran, and enoxaparin. One hundred patients (86.9%) were taking OAP, including aspirin, clopidogrel, or both. Demographics and primary outcomes are shown in Table 1. The incidence of traumatic intracranial hemorrhage was 13.9% (16 patients). Intracranial hemorrhage was associated with an increased risk of 30-day mortality (OR: 4.5, 95% CI: 1.3-16.0). Twenty-four of the deceased patients (57.1%) died within 1 month of the sentinel fall or a recurrent fall. Overall mortality at 6 months following the sentinel fall was 20.8%. Significant risk factors for 6-month mortality included male gender (OR 2.9, 95% CI: 1.2-7.4), history of congestive heart failure (OR 3.0, 95% CI: 1.2-7.7), and readmission within 30 days (OR 4.36, 95% CI: 1.5-12.3). Three patients who presented with intracranial hemorrhage had delayed progression of intracranial bleeding. Delayed intracranial hemorrhage was not identified in patients who presented with a negative head CT. Conclusion: Mortality and readmission rates following a ground level fall in octogenarians taking OAP and OAC medications are high, even in patients with a negative head CT. Acknowledgement of these outcomes and the likelihood of recurrent falls should direct goals of care and strategies for rehabilitation. More studies are needed to determine if this patient population would benefit from individualized care plans to decrease the burden of recurrent falls. 172 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Table 1: Demographics and Primary Outcomes Intracranial Hemorrhage n=16 87.8 ± 6.2 Age 43.8 % female Disposition Floor ICU Discharged Ambulatory Status n (%) Independent With assistance Non-ambulatory Residence n (%) Home Nursing Facility Oral AntiPlatelet n (%) 5 8 3 13 (81.2) 3 (18.8) 0 11 (68.8) 5 (31.2) 13 (81.3) Negative Head CT Admitted Discharged from from ED ED n=50 n=49 86.8 ± 86.8 ± 4.8 4.8 64.0 55.1 44 6 0 0 0 49 29 (58.0) 15 (30.0) 6 (12.0) 33 (67.3) 31 (62.0) 19 (38.0) 23 (47.0) 42 (84.0) 45 (91.8) 13 (26.5) 3 (6.2) 26 (53.0) Oral AntiCoagulant n (%) 4 (25.0) 13 (26.0) 9 (18.4) Mortality n (%) 30 days 5 (31.2) 6 (12.0) 6 months 6 (37.5) 1 year 7 (43.8) 2 years 8 (50.0) Readmission n (%) Recurrent Falls n (%) Repeat Head CTs 5 (31.2) 7 (43.8) 47 10 (20.0) 10 (20.0) 12 (24.0) 6 (12.0) 9 (18.0) 33 3 (6.1) 8 (16.3) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 10 (20.4) 16 (32.7) 9 (18.3) 15 (30.6) 46 173 QUICK SHOT ABSTRACTS (cont.) QS 36. MAJOR VENOUS INJURIES AND VTE: WHAT IS THE RISK? AE Mendoza MD, MPH, CA Wybourn MD, AR Campbell MD, MM Knudson MD San Francisco, CA Background: The true incidence of venous thromboembolism (VTE) after penetrating venous injuries is unknown and likely related to the approach to the injury (repair vs ligation), the use of anticoagulants, and post-operative imaging studies which may introduce surveillance bias. We hypothesized that venous injuries are a major independent risk factor for VTE and that such patients should receive aggressive postoperative anticoagulation. Method: This is a retrospective case-control study from 2005-2015 involving trauma patients with or without penetrating major venous injuries defined as injuries to the vena cava, iliac and/or femoral veins. The patient groups were matched on ISS and age. Patients were excluded from the analysis if they died within 24 hours of admission. Descriptive statistics were performed on demographics, repair technique (ligation or repair), injury location, VTE and outcomes. Data were analyzed using unpaired t-test for continuous variables, sign test for categorical variables, odds ratio with chi-squared analysis and logistic regression. Results: Over a 10 year period (2005-2015) 49 patients who sustained major penetrating venous injuries were compared with 70 patients with penetrating injuries not involving major veins. The mean age (31 vs 29, p=0.50), sex (88% vs 90% male, p=0.29) and ISS (20 vs 22, p=0.32) were similar between groups. The two groups had no difference in ICU LOS (p=0.07), hospital LOS (p=0.09) or overall mortality (p=0.13). However, patients with venous injury did have higher transfusion requirements (17.2 + 17.3 vs 6.53 + 7.81; p=0.00004) and mechanical ventilation days (8.57 + 16.41 vs 2.81 + 6.83; p=0.01). DVT rates were significantly higher in the venous injury group (22% vs 1.42%, p=0.001). The PE rate was also higher in the venous injury group (8.16% vs 5.71%) but this difference did not reach statistical significance (p=0.13). On regression analysis, vein injury location was not predictive of VTE but ligation was (p=0.004). The odds ratio of having a VTE with a major venous injury was significantly higher (OR 6.6, 94% CI: 1.86-29.16), p=0.0006). Conclusion: Our study suggests that major penetrating venous injuries are highly associated with VTE. Further prospective studies are warranted to evaluate the incidence of VTE in this high risk patient group. 174 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 175 QUICK SHOT ABSTRACTS (cont.) QS 37. ULTRASOUND-GUIDED JUGULAR CENTRAL VENOUS CATHETER INSERTION IN SEVERELY THROMBOCYTOPENIC CANCER PATIENTS IS SAFE WITH OR WITHOUT PLATELET TRANSFUSION Z Al Rstum, MD, TTT Huynh, MD, SY Huang, MD and GT Pisimisis, MD Houston, TX Background: Most current consensus statements support the transfusion of platelets (PLT) from donors to achieve a PLT count of at least 50,000/ μL for safe central venous catheter (CVC) insertion in thrombocytopenic patients. In patients with hematologic malignancies, CVC is often required for treatment. Routine PLT transfusion to reach the recommended threshold prior to CVC insertion in these patients can lead to delay in treatment and deplete the scarce supply of PLT. We sought to assess the incidence of bleeding after ultrasound-guided internal jugular (USGIJ) CVC insertion in severely thrombocytopenic cancer patients, with and without PLT transfusion, and to identify possible risk factors for peri-procedure bleeding. Method: This is a retrospective study of consecutive cancer patients with severe thrombocytopenia (PLT count <50 x 10/ μL) who underwent USGIJ CVC insertion (December 2014-September 2016) in single tertiary referral cancer center. Patients were divided into two groups based on whether they received PLT transfusion prior or during the procedure (peri-procedure). The decision to administer peri-procedure PLT transfusion for CVC insertion was made by the primary oncology team. Our analysis included descriptive statistics, t-test and Fisher›s exact test for continuous and categorical variables respectively, Spearman›s correlation and multivariate regression analysis for predictors. Statistical significance was at P<.05. Results: A total of 52 patients had USGIJ CVC placement. Peri-procedurally, 28 patients received at least 4 packs of PLT (200 ml) transfusion (Group A), and 24 patients received no PLT (Group B). Demographics, baseline comorbidities and procedural characteristics were equally distributed between the groups. Mean age of cohort was 53±16 year-old, mean body mass index (BMI) 27±7, median CVC size 12 F (IQR:6). In 20/52 (38%) patients CVC was tunneled. There were 29/52 (56%) patients diagnosed with acute myelogenous leukemia (AML) and 23/52 (44%) with other hematologic malignancies. Mean PLT count before transfusion was 21.4±13 x10 /μL in group A and 26.9±11 x10/ μL in group B, P=.054. After transfusion the PLT count was 31.7±18 x10 / μL in group A, and 26.9 ±10 x10/ μL in group B, P=.137. There was a mild trend towards peri-procedure PLT transfusion in patients with lower PLT count (rho= -0.237, P=.091). Overall, 10/52 patients (19%) had postoperative minor bleeding, but none with major bleeding. There was no significant drop in hemoglobin level in either group A or B. The incidence of post-procedure bleeding was similar in both groups (21% vs. 17%, P=0.736). Higher PLT count was protective (Odds ratio [OR] 0.85, 95%CI 0.74-0.98, P<.03). Larger CVC French size was associated with higher risk of bleeding ( [OR] 1.86, 95% CI 1.01-3.39, P<.05). There was a trend towards bleeding with AML diagnosis ([OR] 9.97, 95% CI 0.92-107.51, P=.058) and age ([OR] 1.07, 176 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) 95% CI 0.99-1.18, P=.083). Gender, BMI, renal dysfunction and tunneled insertion were not significant predictors. Conclusion: The results of our study show that ultrasound guided internal jugular CVC insertion has low incidence of minor bleeding in severely thrombocytopenic patients. Furthermore, our study suggests that peri-procedural platelet transfusion can be limited to patients with identified risk factors, such as for patients with the diagnosis of AML or needing large bore CVC. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 177 QUICK SHOT ABSTRACTS (cont.) QS 38. COAGULOPATHY OF HEMORRHAGIC SHOCK IN A LETHAL SWINE MODEL: TRANSITION FROM FIBRINOLYSIS TO FIBRINOGEN AND PLATELET DYSFUNCTION BR Huebner MD, HB Moore MD, P Lawson BS, G Nunns MD, G Stettler MD, M Fragso DVT, PM Einersen MD, CC Silliman MD, PhD, A Banerjee PhD, EE Moore MD Aurora, CO Background: Trauma-induced-coagulopathy (TIC) is associated with increased mortality, with hyperfibrinolysis being the most lethal form of TIC. Animal models have focused on long durations of moderate shock and have failed to establish a reproducible TIC. The combination of severe hemorrhagic shock followed by resuscitative balloon endovascular occlusion of the aorta (REBOA) allows for neardeath hemorrhage followed by continued buildup of ischemic mediators while sustaining blood flow to vital organs. We hypothesize that a fast severe hemorrhagic shock will induce a short period of hyperfibrinolysis followed by REBOA and saline resuscitation resulting in a separate unique coagulopathy. Method: Swine were anesthetized and access obtained (n =6). A short period of controlled hemorrhage and severe shock (MAP<25) was instituted followed by Zone 1 REBOA. After 15 minutes of balloon occlusion, the REBOA was deflated and resuscitation ensued with 1200cc normal saline (NS). Pigs were monitored for 15-minutes followed by two additional 5-minute REBOA occlusions and deflation with 600cc NS resuscitation with 30 minutes of monitoring. Blood was drawn over the duration of the experiment for ABG, BMP, and thromboelastography (TEG). TEG parameters were analyzed using Friedman test over the course of the experiment. Values described as mean ± SD. Results: Median blood loss was 62% total blood volume resulting in 50% mortality (prior to saline resuscitation). The survivors established a significant acidosis with a median pH of 7.18 and base deficit of 18 at the end of the experiment. Increased fibrinolysis was seen at the post-hemorrhage time-point, with an LY30 (lysis at 30 minutes) of 3.2±1.9% as compared to baseline (1.0±0.7%, p=0.025) and the end of the experiment (0.03±0.08%, p=0.079). Of the survivors, REBOA in combination with saline resuscitation resulted in slower clot formation (angle 15-minutes postNS infusion #1 30.5±8.9°) compared to baseline (55.7±5.1°) and post-hemorrhage (61.2±17.7°) (p=0.008), as well as decreased clot strength (maximum amplitude (MA) 58.0±6.9mm) compared to baseline (80.8±1.0mm) and post-hemorrhage (76.3±2.8mm) (p=0.013). These abnormalities persisted over the duration of the experiment. Conclusion: Hyperfibrinolysis (increased LY30) is seen early in hemorrhagic shock while fibrinogen dysfunction (decreased angle) and platelet dysfunction (decreased MA) occur later, likely resulting from prolonged acidosis, ischemia-reperfusion injury, and NS resuscitation. 178 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 179 QUICK SHOT ABSTRACTS (cont.) QS 39. HIGHER PAIN SCORES TRIGGER THE INITIAL ONSET OF POSTOPERATIVE DELIRIUM DM Overbey MD, BC Chapman MD, SA Hilton MD, EL Jones MD, TN Robinson MD, TS Jones MD Denver, CO Background: Postoperative delirium is a common surgical complication with direct adverse effects on morbidity and mortality. Increased pain has been implicated as an etiology of postoperative delirium, but limited evidence exists in support. Prior studies have implicated adjunctive and global pain control to have a positive impact on delirium prevention. Our purpose was to identify factors temporally antecedent to delirium onset with the goal of identifying triggering events. We hypothesize that uncontrolled pain can cause delirium, and thus be used in a goal-directed fashion to prevent delirium onset. Method: Patients aged 60 and older undergoing major elective operations requiring postoperative intensive care admission were included (n=325). A post-hoc analysis was performed to examine postoperative risk factors associated with the initial onset of delirium. Each delirium event was defined by the onset of new delirium (n=226), and that individual patient-day was evaluated for triggering events compared to delirium free days (n=1,188). Univariate analyses compared factors associated with delirium, followed by multivariable logistic regression analysis to analyze the impact of pain scores on triggering delirium. Results: 301 patients were included with an average age of 69 years. Daily pain scores, Richmond agitation sedation score (RASS), ventilator dependency, labs, and oxygen saturation are reported in Table 1. Pain scores measured at the initial onset of delirium averaged 4.1±2.8 compared to 2.9±2.3 for days without delirium (p<0.001). Each unit of elevation in pain score was independently associated with a 12% increase in delirium onset (OR 1.12, 95% CI 1.05-1.19). Interactions with delirium and pain score maintained ≤4/10 proved to be protective of delirium with incidence rates declining from 16% to 9% (p=0.012). Conclusion: In post-operative ICU patients, the initial development of delirium is significantly associated with higher pain scores. Increased pain scores are a valid independent predictor for the initial onset of delirium. The importance of these findings is that because pain can be treated, alleviating pain may prevent the initial onset of delirium. The data suggests that a goal of reducing pain scores to less than 4/10 may minimize delirium risk. Post-operative goal-directed pain control may have a protective effect against delirium. 180 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Table 1: Factors with daily fluctuation associated with delirium onset. RASS=Richmond Agitation Sedation Score, NS=not significant Pain Score (0-10) RASS Score Ve n t i l a t o r dependent (+) Creatinine (serum) WBC level (serum) Sodium (serum) Oxygen Saturation (%) Potassium (serum) Hematocrit (serum) Delirium Tigger Days (n=226) 4.11+2.83 Other days Univariate p Multivariable Odds Ratio (95% CI) 2.92+2.30 <0.001* -0.54+0.95 -0.11+0.36 <0.001* 25/226 (11.1%) 17/1188 (1.4%) <0.001* 1.12 (1.061.20) 0.33 (0.250.44) 0.33 (0.150.71) 1.28+0.72 1.12+0.40 0.001* 11.4+4.5 10.3+4.0 0.001* 1.63 (1.222.18) NS 138.5+4.1 137.6+3.8 0.004* NS 94.8+2.6 95.3+2.4 0.484 NS 4.2+0.5 4.1+1.7 0.509 NS 30.1+5.0 29.9+5.2 0.563 NS (n=1,188) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 181 QUICK SHOT ABSTRACTS (cont.) QS 40. FUTILITY NO MORE: CRITICALLY INJURED TRAUMA PATIENTS WITH SEVERE ACIDOSIS V Karun BS, NM Tapia MD, R Campana BS, EA Alore MD, BG Scott MD, SD Gordy MD, CT Wilson MD, SR Todd MD, JW Suliburk MD Houston, TX Background: Severe acidosis in trauma is a poor prognostic indicator. Historically these patients are reported to have an extremely high mortality rate, with some regarding attempts at salvage of a patient with initial pH < 7 as futile care. The purpose of this study was to evaluate mortality in patients presenting with severe acidosis. We hypothesized that severe acidosis (pH < 7.1 on the initial arterial blood gas [ABG]) would result in a 30-day mortality rate less than 50%. Method: This is a single center retrospective review from an urban level 1 trauma center. All level I trauma activations with an emergency center systolic blood pressure (SBP)<100mmHg from 2006-2015 were reviewed. In addition to ABG data, variables collected included demographics, mechanism of injury, injury severity score, and 30-day mortality. Variables were analyzed using Student’s t-test and Chi-square. For acidosis analyses we arbitrarily selected 3 ABG pH cut points: < 7.1, < 7.05, < 7.0. Results: There were 1,537 level I trauma activations with an initial SBP<100mmHg. Patients who were pronounced dead on arrival, had computed tomography evidence of a devastating head injury with Glasgow Coma Scale (GCS)<8, and those with no ABG were excluded. This left 74 patients with pH<7.1, 64 with pH<7.05, and 39 with pH<7.0. Mortality for patients with a pH<7.1, pH<7.05, and pH<7 was 42%, 45%, and 51%, respectively (p=0.071). Gender, race, MOI, and initial base excess were not significantly different among deaths or survivors. The mean ISS was significantly higher (p<0.021) and mean GCS significantly lower (p<0.029) in deceased patients at each pH cut-point (table). Patients with a pH<7.1 had overall, blunt, and penetrating injury mortality rates of 42%, 48%, and 39%, respectively, which was significantly higher than patients with a pH>7.1 whose overall, blunt, and penetrating mortality rates were 8%, 7%, and 8%, respectively (p<0.001 for all comparisons). Conclusion: Level I trauma activations with a SBP<100mmHg, without evidence of severe head injury and with severe acidosis, had significantly higher mortality rates than those without severe acidosis. However, the majority of these patients survived. Thus, an initial pH<7.1 or is not futile in modern trauma care. 182 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 183 QUICK SHOT ABSTRACTS (cont.) QS 41. AN EFFECTIVE MODEL FOR PROVIDING ACCESS TO SURGICAL CARE TO THE UN- AND UNDER-INSURED SC Walling BE, JC Heimroth MS, SK Edwards BA, EH Sutton MD Louisville, KY Background: The uninsured and underinsured population’s lack of access to necessary surgical care in the United States is well documented in the literature. Despite modern healthcare reform efforts, including the Affordable Care Act, the emergency department remains the only option for many Americans seeking surgical care. To address this deficit in the healthcare system, Surgery on Sunday Louisville (SOSL) was established in February 2013 and provides free outpatient surgery to this population in Louisville, KY. The aim of SOSL is to serve uninsured and underinsured patients seeking care by acting as a referral resource, increase access to surgical care through SOSL’s monthly ambulatory clinic, and allow this population to obtain timely care through SOSL’s free surgical events. Our objective is to show that SOSL’s model is an effective method of attaining these goals. Method: In a retrospective cohort study using data from SOS-L’s secure database, the initial outcomes of the program from October 2013 to October 2016 were analyzed, including the utilization of SOS-L’s services, the patients’ demographic, financial, social, and medical parameters, and the spectrum of surgical and endoscopic procedures performed. Results: In the first 36 months of operation, SOSL received 134 surgical referrals from 18 distinct referral sources. The number of referrals received has increased annually with 29 in the first year, 50 in the second, and 55 in the third. The referred population was 53.7% male with a mean age of 41.2 years and a range of ages from 1 to 87 years. 96.3% were uninsured, and the average patient’s financial situation placed him/her at 24% of the federal poverty level with an average annual household income of $10,001. Only 29.9% were registered US residents, and 82.1% were Hispanic. 34% of referred patients were not included in the program due to patient refusal (62%) and medical (21%) and financial (9%) exclusions. In the first 32 months of the program, 58 patients were provided consultation in a physician’s private office (mean 1.8 encounters/month); however, in the most recent 4 months, SOSL has established its own ambulatory clinic, in which 42 patient encounters have occurred (mean 10.5 encounters/month). 68 patients have undergone 70 surgical procedures: 10 in the first year, 26 in the second, and 34 in the third. The most common procedures were inguinal hernia repairs (14), cholecystectomies (12), and umbilical hernia repairs (7). 99% of patients were provided a follow-up visit with 1 patient lost to follow-up. There were no complications requiring overnight hospitalization or readmission. 8 patients remain in SOSL’s queue awaiting future surgical services. Conclusion: SOSL’s model is an effective method of serving the un- and under-insured who seek care by acting as a growing referral resource, permitting access to surgical care through its highly effective ambulatory clinic, and allowing patients to obtain care through its free surgery events. 184 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 42. ELIMINATION OF ROUTINE CHEST X-RAY AFTER IMAGE GUIDED CENTRAL VENOUS ACCESS PORT PLACEMENT IS SAFE AND COST EFFECTIVE AR Cannon MD, MC Mone RN, CL Scaife MD, EW Nelson MD Salt Lake City, UT Background: Safe, durable, central venous access remains a vital component of care for those in need of long-term access. Historically, central venous access ports (CVAP) have been inserted without real-time imaging and a post-procedure chest x-ray (CXR) utilized to ensure proper positioning and exclude complications. Since the adoption of intraoperative ultrasound and fluoroscopy, the necessity and benefit of obtaining a CXR on all patients has been questioned. To confirm the practice of eliminating a standard CXR, we performed a cohort study to examine the benefit and cost of routine CXR after guided CVAP placement. Method: A retrospective cohort study of CVAP procedures using fluoroscopy in the operating room (OR) was conducted. Data was collected for two consecutive year-long periods for CVAP procedures performed by two experienced general surgeons. We compared a historical control group that routinely received post-procedure CXR (Oct. 2011-Oct. 2012), to a second group (No-CXR) in whom a CXR was obtained only for clinical indications (Oct. 2012-Oct. 2013). Variables included: demographics, body mass index (BMI), diabetes, access site, anesthesia, OR time, complications, and use of post-procedure CXR. Results: A total of 498 patients were included: 292 (58.6%) in the historical CXR cohort and 206 in the No-CXR group (41.4%). Groups were not different with regards to age, BMI, diabetes, ASA score (1-2 vs 3-4), OR time, and anesthesia. In the NoCXR group there were significantly more attempted access sites (1.1 vs. 1.0, p=0.02), and subclavian lines placed (5.8% vs 2.1%, p=0.03). There was a 0% rate of acute pneumothorax and/or hemothorax in the entire cohort. There was no difference in catheter placement complications (arterial stick or anatomic misplacement), 1.4% in historical group vs 2.9% in the No-CXR group, p=0.19. In the historical group, five patients did not receive a post-procedure CXR (1.7%). In the No-CXR group, nine patients received a CXR (4.4%), three of which were unrelated to CVAP placement and six done for clinical indications related to difficult line placement or anatomy. There were a total of 197 CXR (95.6%) that were safely deferred with no adverse clinical consequences. Conclusion: Cost savings related to unnecessary testing is an important goal in healthcare. Imaging performed at the time of CVAP placement, can result in substantial savings based on the cost of radiographs, professional fees, and coincident staffing needs. The estimated cost of a single CXR is variable, but reports range from $100 to $150, resulting in potential savings of up to $30,000 in this sample alone. We conclude that when using fluoroscopy guided CVAP placement, additional imaging with CXR is unnecessary unless indicated due to questions related to difficult line placement, including multiple access attempts or sites, or clinical symptoms. Given the considerable number of CVAP used in patient care throughout the healthcare system, this savings could be significant. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 185 QUICK SHOT ABSTRACTS (cont.) QS 43. ACS-NSQIP RISK CALCULATOR ACCURATELY PREDICTS COMPLICATIONS IN VENTRAL HERNIA REPAIRS DESPITE THE LACK OF HERNIA SPECIFIC RISK FACTOR INPUT MM Mrdutt MD, AN Patel BS, CL Isbell MD, Y Munoz-Maldonado PhD, JL Regner MD Temple, TX Background: Risk stratification is critical when counseling ventral hernia patients. While the ACS-NSQIP surgical risk calculator predicts risk across a range of complications, it does not account for hernia specific factors such as hernia size, infected mesh, or number of prior repairs. Our study evaluates the accuracy of ACSNSQIP calculator in ventral hernia patients with attention to hernia size and previous abdominal surgery. Method: An IRB-approved, single institution, retrospective review of ventral hernia repairs (VHRs) from January 2014 through February 2016 was performed. Inclusion criteria were elective open or laparoscopic VHRs: initial or recurrent, reducible or incarcerated, umbilical, epigastric, spigelian and incisional. NSQIP database was queried for demographics and 30 day outcomes (Table 1). Chart review provided surgical history and hernia fascial defect surface area (SA). A risk profile was calculated for each patient using the ACS-NSQIP surgical risk calculator. Brier scores, which measure the accuracy of probabilistic models based on observed versus predicted outcomes, were calculated for each complication. Brier score closer to 0 reflects a more accurate model. Planned sub-group analysis for surgical site infections (SSI) and readmission compared predicted risk by hernia SA subgroups, previous open or laparoscopic surgeries and prior hernia repair. Wilcoxon-Rank-Sum test compared the distribution of predicted risk with significance at p<0.05. Results: 388 patients were included. Median age was 54, and the cohort had the following comorbidities: 187 (55.3%) BMI > 29.9, 40 (11.8%) diabetes, 145 (42.9%) hypertension and 73 (21.6%) current or recent tobacco use. 136 (40.2%) of patients had undergone previous open abdominal surgery, 117 (34.6%) previous laparoscopic surgery and 55 (16.3%) at least one previous abdominal hernia repair. 205 (60.7%) patients had a hernia with fascial defect SA < 2 cm2, 68 (20.1%) 2-5 cm2 and 65 (19.2%) >5 cm2. 185 (54.7%) cases were laparoscopic. Observed complications were lower than predicted in all complications (see Table 1) except readmission rates (3.55 vs 3.0%, Brier score 0.033) and cardiac complications (0.3 vs 0.1%, Brier score 0.003). This low complication rate prevented direct comparison of outcomes and hernia specific factors. Despite the lack of hernia specific criteria in the ACS-NSQIP calculator, subgroup analysis of predicted risk by SA and surgical history demonstrated increased complication risk with previous abdominal surgery, hernia repair, and larger hernia surface area (all P<0.0001). Conclusion: ACS-NSQIP surgical risk calculator accurately predicts complications within our VHR population. When stratified by hernia specific variables not reflected 186 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) in the NSQIP calculator, predicted risk increases with increased surface area and prior abdominal surgeries. These findings suggest current hernia repair CPT codes may better capture risk of disease than appreciated. Median observed complication rates, predicted risk and Brier scores Observed Rate (%) Predicted Risk (%) Brier Score Serious Complication 0.59 2.5 (0.70-14.1) 0.0071 Any 1.48 3.3 (1.1-19.1) 0.016 SSI 0.89 1.3 (0.3-12.0) 0.0088 Pneumonia 0 0.2 (0.0-2.9) 0.00003 Acute Renal Failure 0 0.1 (0.0-1.6) 0.000009 UTI 0.3 0.5 (0.1-3.7) 0.0029 Cardiac 0.3 0.1 (0-1.7) 0.0030 0 0.2 (0.1-1.7) 0.000017 0.3 0.6 (0.1-20.2) 0.0031 0 0.1 (0-1.7) 0.000008 DVT Discharge Rehab/Nursing Facility Death Readmission 3.55 3 (1.0-12.7) 0.033 Return to OR 0 0.8 (0.1-4.7) 0.00017 Predicted NSQIP calculator risk, stratified by previous abdominal surgeries and hernia surface area. n (%) Predicted Risk 1.3 (0.3-12.0) SSI Previous Open Abdominal Surgery P-value NA 0.0026 No 202 (59.8%) 0.9 (0.3-7.4) Yes 136 (40.2%) 1.4 (0.6-3.0 No 221 (65.4%) 1.3 (0.3-11.4) Yes 117 (34.6%) 1.5 (0.4-12.0) No 283 (83.7%) 1.2 (0.3-11.2) Yes 55 (16.3%) 1.7 (0.7-12.0) < 2 cm 205 (60.7%) 1.3 (0.3-11.4) 2-5 cm 68 (20.1%) 1.3 (0.4-10.3) >5 cm 65 (19.2%) 1.5 (0.7-12.0) Previous Laparoscopic Surgery 0.0077 Previous Hernia Repair 0.0001 Hernia size 0.0410 3.0 (1.0-12.7) Unplanned Readmission Previous Open Abdominal Surgery NA <0.0001 No 202 (59.8%) 2.5 (1-8.5) Yes 136 (40.2%) 3.8 (1.3-12.7) No 221 (65.4%) 1.3 (0.3-11.4) Yes 117 (34.6%) 3.2 (1.3-11.8) No 283 (83.7%) 2.9 (1.0-11.0) Yes 55 (16.3%) 4.4 (1.6-12.7) < 2 cm 205 (60.7%) 2.5 (1.0-10.4) 2-5 cm 68 (20.1%) 3.9 (1.6-10.9) >5 cm 65 (19.2%) 4.3 (2.2-12.7) Previous Laparoscopic Surgery <0.0001 Previous Hernia Repair <0.0001 Hernia size <0.0001 April 2 – 5, 2017 | Hyatt Regency, Maui, HI 187 QUICK SHOT ABSTRACTS (cont.) QS 44. INSURANCE STATUS IS ASSOCIATED WITH SURVIVAL IN PATIENTS WITH METASTATIC CANCER M Ali-Mucheru, MD, DA Etzioni, MD, MSHS, BA Pockaj, MD, RJ Gray, MD, CC Stucky, MD, YH Chang, PhD, N Wasif, MD, MPH Phoenix, AZ Background: Multiple factors play a role in improving survival outcomes for patients with metastatic cancer, especially the biologically less aggressive malignancies. Adequate health care coverage allows for access to multimodal cancer care which improves survival and quality of life, even though cure is rare. We hypothesize that patients with metastatic cancer who are underinsured or uninsured have worse survival outcomes. Method: Retrospective analysis of the National Cancer Database (NCDB) of patients diagnosed with Stage IV lung, colorectal, pancreas, breast and prostate cancer from 2003-2011. Survival analysis was conducted using the product limit method and displayed using Kaplan Meier curves. Overall survival was compared between patients with different insurance coverage types using a Cox proportional hazards model, controlling for age, race, sex, education, and income. In a second model chemotherapy, radiation and surgery were added to control for the influence of treatment. Results: A total of 799,678 patients with lung (58%), colorectal (14%), pancreas (13%), breast (8%) and prostate (7%) cancer were included. Most patients were treated at comprehensive community cancer centers (56%). When compared to patients with private insurance/managed care, patients who were uninsured or on Medicaid had lower rates of chemotherapy, radiation and surgery as well as lower overall survival (Figure 1). On multivariable analyses, being uninsured was associated with a higher risk of mortality [breast HR 1.41, 95% CI 1.35-1.47, colorectal HR 1.28, 95% CI 1.24-1.33, lung HR 1.29, 95% CI 1.27-1.31, pancreas HR 1.28, 95% CI 1.23-1.33, and prostate HR 1.73, 95% CI 1.63-1.83] when compared to patients with private insurance/ managed care. A similar association was also seen for patients on Medicaid (breast HR 1.35, 95% CI 1.31-1.40, colorectal HR 1.27, 95% CI 1.24-1.31, lung HR 1.21, 95% CI 1.19-1.22, pancreas HR 1.20, 95% CI 1.16-1.23, and prostate HR 1.77, 95% CI 1.68-1.87). After adjustment for use of chemotherapy, radiation and surgery these differences attenuated but persisted. Conclusion: Patients with metastatic cancer who are uninsured or on Medicaid have lower rates of treatment and worse survival in comparison to those with private insurance. This is especially notable for metastatic colon, breast and prostate cancer, suggesting that expanding insurance access for these patients may improve outcomes. 188 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Figure 1: Kaplan-Meier plots for overall survival by cancer type and insurance coverage April 2 – 5, 2017 | Hyatt Regency, Maui, HI 189 QUICK SHOT ABSTRACTS (cont.) QS 46. ESTABLISHING A SYSTEM-WIDE ASSESSMENT OF PREOPERATIVE FRAILTY IN ELECTIVE SURGERY MM Mrdutt MD, ET Bird MD, CL Isbell MD, RC Frazee MD, HT Papaconstantinou MD Temple, TX Background: Frailty is a promising metric for pre-operative risk stratification. With reimbursement now linked to outcomes, identification and management of patients at high risk for poor outcomes is paramount. Correlation of frailty with outcomes requires baseline measurements within a patient population. Our health care system implemented a quality initiative to achieve compliance with pre-operative frailty assessment. This study assesses our success with implementation of this program. Method: Our Department of Surgery includes 13 surgical subspecialties with more than 90 surgeons at 4 separate hospitals. Collectively, this group performs >1000 elective operations each month. Recent institutional goals prioritized implementation of pre-operative frailty assessment in elective surgery patients. Previously validated frailty assessment included age, gender, body mass index, American Society of Anesthesiologists Physical Status classification, handgrip strength and recent hemoglobin value. To facilitate documentation, a frailty calculator was built into our electronic health record with the score easily imported into clinic notes. Compliance with frailty measurement was tied to physician compensation, with threshold and high performance targets set at 70% and >90% compliance. A 3-month education period (January-March 2016) permitted instruction and work flow optimization. Feedback was provided during the trial period (April), without impact on compensation. Performance compliance was linked to compensation starting in May, and defined as performance month 1 (PM-1). Compliance measurement, reporting and performancebased compensation continued in subsequent months (PM-2, PM-3 and PM-4). Data was analyzed using Wilcoxon-sign-rank and Kruskal-Wallis tests with significance at p < 0.05. Results: Preoperative frailty assessment performance was evaluated for 92 surgeons, with median surgeon performance over time along with threshold and high performance targets illustrated in Figure 1. Median surgeon compliance for the system was 16% in the education period and 75% in the trial period. Compliance during PM-1 was 88%, with subsequent months showing similar or improved results (PM-2 86%, p=0.055; PM-3 90%, p=0.019; PM-4 87%, p=0.077). Surgical subspecialty and regional hospital specific analysis revealed no difference from the overall performance trend (p=0.082 and 0.66, respectively). As of PM-4, 73% of surgeons met threshold performance when considering all 4 performance months (>70%), of which over ½ achieved high level goal (>90%). Conclusion: Pre-operative frailty measurement at a system level was successfully implemented. Performance on quality initiative was tied to physician compensation. Short-term sustainability was demonstrated over the measured time frame. This program serves as a model for the implementation and compliance of physician driven quality metrics. 190 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 191 QUICK SHOT ABSTRACTS (cont.) QS 47. RACIAL AND SOCIODEMOGRAPHIC FACTORS ASSOCIATED WITH STAGE AT DIAGNOSIS IN PANCREATIC ADENOCARCINOMA DS Swords MD, C Zhang MS, AP Presson PhD, MA Firpo PhD, SJ Mulvihill MD, CL Scaife MD Salt Lake City, UT Background: Most patients with pancreatic adenocarcinoma (PDAC) are diagnosed too late for potentially curative resection. Previous studies have shown little to no association between patient characteristics and stage at diagnosis. Most studies have compared local disease (stages IA-IB), regional disease (stages IIA-III) and stage IV. Since > 70% of resected patients are node positive (Stage IIB) and many stage III patients are not resectable, it would be more clinically relevant to compare Stages IAIIB, which are all technically resectable, to all others. We hypothesized that there are disparities in being diagnosed at stages I-II by racial and sociodemographic factors. Method: Patients with PDAC in the Surveillance and End-epidemiology (SEER) database from 2007-2013 were reviewed. Characteristics of patients diagnosed at stages I-II were compared to those with stages III, IV, or unknown by a chi-squared test. Multivariable logistic regression was used to assess factors independently associated with diagnosis of stages III, IV and unknown relative to stages I-II. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are reported. As a sensitivity analysis, we repeated these analyses in Stages I-IV only (excluding unknown stage). Results: There were 43,699 patients available for analysis. The distribution by stages was: I 6.0%, II 27.1%, III 9.5%, IV 50.6%, and unknown 6.8%. The rates of being diagnosed at stages I-II were 30.5% for 18-59 year olds vs. 35.6% for >79, 34.7% for females vs. 31.6% for males, 34.1% for White patients vs. 30.0% for Black and 30.9% for Hispanic, and 34.3% for those with non-Medicaid insurance vs. 30.7% for those with Medicaid and 26.0% for the uninsured. The rate of stages I-II varied among the 18 SEER registries from 27.8% in Hawaii to 46.3% in Rural Georgia. There were annual increases in stages I-II, from 30.3% in 2007 to 34.9% in 2013 (P<0.001, test for trend). Multivariable logistic regression analysis identified the following associations with higher stage at diagnosis: young age (OR 1.5, 95% CI 1.4, 1.7), male sex (OR 1.11, 95% CI 1.1, 1.2), black (OR 1.16, 95% CI 1.1, 1.3) and Hispanic race (OR 1.18, 95% CI 1.1, 1.3) relative to non-Hispanic whites, being unmarried (OR 1.07, 95% CI 1.02, 1.1), being uninsured (OR 1.3, 95% CI 1.1, 1.5), living in a low-income county (OR 1.14, 95% CI 1.04, 1.3), and residing in the Western (OR 1.1, 95% CI 1.02, 1.2) or Northeastern US (OR 1.3, 1.2, 1.4). Results were similar when unknown stage patients were excluded. The rate of stage I-II among white patients with non-Medicaid insurance was 1.5 times higher than in Hispanic uninsured patients (Figure). Conclusion: Racial and sociodemographic disparities exist in being diagnosed at a definitively resectable stage in PDAC. This indicates that there is variation in the quality of diagnostic care received by PDAC patients, and points to an opportunity for improvement by focusing more on efficient and timely diagnoses. 192 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 193 QUICK SHOT ABSTRACTS (cont.) QS 48. SUSPECTED COMMON BILE DUCT STONE DISEASE: CURRENT PRACTICE PATTERNS FOR DIAGNOSIS, MANAGEMENT, AND DEFINITIVE SURGICAL TREATMENT FZ Zhao MD, WL Biffl MD, JA Pahang BS, GX Zhang PhD, and AU Loengard MD Honolulu, HI Background: In the patient with suspected common bile duct (CBD) stone disease, there are 2 generally accepted methods for definitive treatment: 1) endoscopic retrograde cholangiopancreatography (ERCP) with subsequent laparoscopic cholecystectomy (LC) or 2) LC with intraoperative cholangiography (IOC) and either concurrent CBD exploration (CBDE) or postop ERCP. Prior studies between the 2 groups reported equivalent clearance rates of CBD stones with 0.5 days shorter length of stay (LOS) for LC+CBDE. However, current practice patterns for diagnosis, management, and definitive treatment are still highly varied and institutionally dependent. The purpose of this study was to characterize current practice in our institution. Method: We conducted a single institution retrospective review of admitted patients with suspected CBD stone disease from July 2013 to September 2015. To capture this pathology, we selected all patients with diagnoses of biliary pancreatitis, choledocholithiasis, cholangitis, or cholelithiasis/cholecystitis with elevated total bilirubin > 1.2mg/dL. From this dataset we evaluated the diagnostic modalities performed during hospitalization (CT, MRCP, US), number of performed procedures (ERCP, cholecystectomy, IOC, and CBDE), length of stay (LOS) and hospitalization cost. Data was analyzed using Kruskal-Wallis Test (p<.05) Results: Between July 2013 and September 2015, 364 patients were admitted with suspected CBD stone disease. Average patient age was 58.3 + 17 years. Abdominal US was performed in 215 patients (59%), abdominal CT in 201 patients (55%) and MRCP in 77 patients (21%). 151 (41%) patients received 2 or more diagnostic tests prior to any procedure. 152 patients (42%) underwent ERCP + cholecystectomy (lap or open). 104 (29%) underwent only cholecystectomy (lap or open) with IOC. 26 (7%) of these patients had concurrent CBDE because of positive IOC findings of choledocholithiasis. 69 patients (19%) underwent only ERCP and were discharged with plans for elective LC. 39 patients (11%) had normalization of their bilirubin without procedures and were discharged with plans for elective LC. The median LOS did not differ significantly between groups of ERCP+LC and LC with IOC + CDBE 5.0 vs 5.2 days (p=.26). However, the median cost of hospitalization was significantly higher in the ERCP+LC group $17312 vs $14601 (p<0.0001). The 70% rate of cholecystectomy did not differ significantly when stratified by total bilirubin level on presentation. Conclusion: There is wide variation in the approach to suspected CBD stone disease. Only 70% of our patients received a cholecystectomy during their index admission. 194 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Unnecessary diagnostic testing prior to stone extraction can also lead to increased LOS and cost. A multi-institutional review could confirm the variation seen in practice patterns. Ultimately, developing a clinical guideline would streamline the management of these patients with the potential to shorten LOS and decrease hospitalization costs. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 195 QUICK SHOT ABSTRACTS (cont.) QS 49. DOES SLUDGE ON ULTRASOUND INDICATE CHOLELITHIASIS: A RETROSPECTIVE REVIEW EA Shapera MD, MT Nelson MD Albuquerque, NM Background: Ultrasound is key in diagnosis of gallstone disease. We sought ultrasonagraphic determinants predictive of gallbladder pathology to further aide physicians in the diagnosis of cholelithiasis and cholecystitis. Specifically, we examined how often an ultrasonic diagnosis of sludge equates to cholelithiasis being indentified. Method: A retrospective chart review of 500 patients with cholecystectomy was conducted at the University of New Mexico Hospital Health System. Data was collected from October 2014 to May 2016 and included presence of diabetes, postoperative symptomatic resolution, age, BMI, gender, laboratory work, findings on ultrasound and findings on pathology. Cholelithiasis was considered definitively present if identified in the operative note or the pathology report. A stepwise logistic regression determined the independent variables associated with our outcomes of interest: pathologic findings of cholelithiasis, acute cholecystitis, chronic cholecystitis and necrotizing cholecystitis. Results: Ultrasonagraphic detection of sludge without stones was predictive of cholelithiasis found on pathology or intra-operative report 58% of the time (15/26). Logistic regression found only ultrasonographic finding of stones was associated with presence of stones on pathology. The addition of sludge to this model did not increase this association. Logistic regression found that ultrasound findings of distension and fluid, white blood cell count, patient age, elevated total protein and low albumin to be associated with the pathology finding of acute cholecystitis, whilst a gallbladder found to be normal (no fluid or stones etc) was less likely associated with acute cholecystitis. Ultrasound finding of stones or read as normal was associated with the pathology finding of chronic cholecystitis, while the ultrasound finding of fluid or diabetes was less likely. White blood cell count and radiologist interpretation of gallbladder as “gangrenous” was associated with the pathology finding of necrotizing cholecystitis. Conclusion: A majority of patients with ultrasound findings of sludge without stones did have cholelithiasis per pathology report or operative report documenting spillage. Our logistic regression found the most critical predictor of the pathology finding of cholelithiasis was ultrasound finding of stones and this was unaffected by the addition of ultrasound sludge as an independent variable in its modeling. However, our focus is on finding patients who have false negative ultrasounds, and the finding of sludge without stones appears to be a substantial false negative for the presence of cholelithiasis. If patients present consistent with symptomatic cholelithiasis and ultrasound finding of sludge, even in the absence of stones, cholecystectomy should be considered. 196 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 51. IMPACT OF OPERATION TYPE ON UNPLANNED READMISSION FOLLOWING COLORECTAL SURGERY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE R Fazl Alizadeh MD, S Sujatha-Bhaskar MD, Z Moghadamyeghaneh MD, JC Carmichael MD, A Pigazzi MD PhD, MJ Stamos MD Orange, CA Background: Patients with underlying pulmonary diseases have higher complication rates following surgical operations. Given that emergency operation has worse outcomes compared with elective resections, we sought to evaluate impact of operation type on unplanned readmission (UR) in chronic obstructive pulmonary disease (COPD) patients following colorectal resections. Method: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) databases were used to examine the clinical data of patients with history of COPD who underwent emergent and elective colorectal resections from 2005 to 2014. Multivariate regression analysis was performed to investigate impact of operation type on UR in such patients. Results: A total of 10597 patients had preoperative COPD including 5634(53.2%) patients who had emergent surgery and 4963(46.8%) patients who underwent elective resections. Mean length of stay was 18±16.57 and 8±8.12 for the patients with emergent and elective resections respectively (P<0.05). Patients undergoing emergent surgery had significantly higher mortality (26.7% vs. 2.5%, AOR: 6.01, P <0.0001) and serious morbidity rate (63.2% vs. 26%, AOR: 2.55, P <0.0001) compared to the elective resection group. Prolonged hospitalization was higher among patients following emergent procedures (3.2% vs. 1.6%, AOR:0.32: P=0.01). Overall rate of UR was 6%. Patients undergoing elective resections had higher rate of UR compared to emergent cases (8.5% vs. 3.9%, AOR: 0.13, P=0. 001), and also the highest rate of UR was seen in patients who underwent elective operation and discharged home within one week of the operation (7.8% vs. 3.1%, P<0.05). However, most of the emergently operated patients were hospitalized more than one week (68%). The most common reason of UR was intra-abdominal infection in both elective (10.7%) and emergent operations (7.4%). Patients who underwent elective operations had significantly higher rate of colorectal resections without protective stoma creation (60.5% vs. 39.5%) compared to the emergent cases. This group of patients also had higher UR rate (8.3% vs. 4%, P<0.05) compared to the emergent cases. Conclusion: Emergent operation significantly increases in-hospital mortality and morbidity rate in COPD patients undergoing colorectal resections. However, UR rate is significantly higher following elective resections compared to emergent cases. This may be related to lower rate of protective stoma in elective operations and earlier discharge of these patients. Further studies are needed to investigate reason of relatively high UR following elective colorectal operations. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 197 QUICK SHOT ABSTRACTS (cont.) QS 52. THE IMPACT OF FALCIFORM PEDICLE WRAP AFTER PANCREATICODUODENECTOMY ON POST OPERA-TIVE PANCREATIC FISTULA Y Hong MD, J Rostas MD, V Hancock BA, K McMasters MD PhD, P Philips MD, E Davis MD, R Martin MD PhD, C Scoggins MD MBA Louisville, KY Background: Post operative pancreatic fistula (POPF) is a complication that occurs in up to 30% of pancreati-coduodenectomy (PD) procedures. The falciform ligament is often utilized as a pedicle flap to wrap around the pancreaticojejunostomy anastomosis with unclear benefit. We aim to deter-mine the incidence, grade, and time of closure of POPF after PD in patients with or without falci-form ligament pedicle flap coverage. Method: A retrospective review of 116 consecutive patients who underwent PD with or without falciform pedicle wrap from June 2011-April 2016 by six hepatobiliary surgeons was performed. Postop-erative pancreatic fistula was determined according to the International Study Group on Pancre-atic Fistula (ISGPF) definition. Results: A total of 62 (53.4%) patients underwent PD with the falciform ligament pedicle flap. The overall incidence of POPF was 15.5%, with no difference in the rate of fistulas between the two groups (p=0.617). There were more minor fistulas (grade A) in the wrapped group 54.5% vs 0%; p= 0.037). The average time to closure of POPF was shorter (31.2 +/- 4.36 days vs 41.2 +/- 4.67 ; p=0.166) and had lower need for secondary percutaneous drainage in the wrapped group (0.09% vs 42.8%; p = 0.245) but did not reach statistical significance. Conclusion: Falciform pedicle flap coverage of the pancreaticojejunostomy anastomosis demonstrated com-parable incidence of pancreatic fistula compared to non-falciform pedicle flap group. However, when pancreatic fistula occurred, the pedicle flap group was noted to have lower grade of se-verity with a trend towards shorter time to fistula closure and lower need for secondary proce-dures. While a randomized control trial would definitively answer the benefit of a falciform pedi-cle flap, the pedicle flap serves as a simple way to potentially reduce the morbidity of a pancre-atic fistula. 198 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 53. READMISSION AFTER PANCREATECTOMY: CAN IT BE PREVENTED? M Bonds MD, T Garwe PhD, B Oluborode MBChB, Z Sarwar MBBS, J Bender MD, R Postier MD Oklahoma City, OK Background: Pancreatectomy has a significant rate of procedure specific morbidity despite recent improvements in mortality. Morbidity is a predictor of readmission in this population. As proposals to base insurance reimbursement on quality of care are being considered, attempts to predict readmission have taken on a new focus. The goal of this study is to determine what factors are associated with readmission after pancreatectomy and whether any intervention can prevent intervention. Method: A retrospective review of a single institution’s pancreatectomies between January 2011 and April 2015 was performed. Exclusion criteria included subjects missing data for initial hospitalizations, subjects who died during initial hospitalization and pancreatectomies done for trauma. Data concerning patient demographics, intraoperative details, pathology, in-hospital complications, and follow-up were collected. Grades of delayed gastric emptying (DGE) and pancreatic fistula (PF) were calculated using the International Study Group of Pancreatic Surgery (ISGPS) calculator found on the Pancreas Club website. Information regarding 90-day readmission was gathered as well. Univariate and multivariate analyses were performed to determine which factors increase risk for readmission. Results: A total of 257 patients met inclusion criteria. Of these, 84 (32.7%) were readmitted; the average time to readmission was 21 ± 20.68 days. Based on unadjusted comparisons, readmitted patients were more likely to have a PF and the incidence of PF was higher in the readmitted patients across all PF grades (A-C). Surgical site infections, both deep and superficial, were more common in readmitted patients (18% vs 6.4%, p=0.0138). There was a trend towards higher prevalence of obesity (42% vs 33%, p=0.0713) and higher incidence of hospital-induced delirium (11% vs 5%, p=0.0985) among readmitted patients compared to those not readmitted. Upon multivariable adjustment, only pancreatic fistula (p=0.0005) and BMI (p=0.0793) remained as significant and marginally significant predictors of readmission, respectively. A positive dose-response relationship was noted between pancreatic fistula grade and the odds of readmission, with odds ratios (ORs) ranging from 1.6 (95% CI: 0.6-4.1) for Grade A to 16.7 (95% CI: 1.8-156.8) for Grade C, albeit with limited precision. Conclusion: Readmission after pancreatectomy is a common occurrence despite the many advancements in perioperative care. Our data suggests that PF and obesity are risk factors for readmission after pancreatectomy. Presently, these specific factors are not preventable but may be helpful in counselling patients regarding risk of readmission. Readmission, however, may not be the best measure of quality to utilize in the evaluation of pancreatic surgery. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 199 QUICK SHOT ABSTRACTS (cont.) QS 54. NATIONWIDE TRENDS IN ROBOTIC ANTIREFLUX SURGERY KM Coakley DO, SM Sims MD, T Prasad MA, AE Lincourt PhD MBA, VA Augenstein MD R Sing DO, BT Heniford MD, PD Colavita MD Charlotte, NC Background: In the management of esophageal gastroesophageal reflux disease, adoption of minimally invasive laparoscopic approaches is particularly widespread. Robotic surgery offers technologic advances in visualization and dexterity, however, with increased cost. The purpose of this study was to examine if a similar adoption trend was seen nationally for robotic-assisted antireflux surgery (RAS) cases, as previously noted for laparoscopy in antireflux surgery procedures. Method: The Nationwide Inpatient Sample, which captures approximately ~20% of all US inpatient admissions, was queried from October 2008 (the inception of the robotic ICD-9-CM code) to December 2013, for minimally invasive procedures. Outcomes were compared between laparoscopic and robotic technique over two time periods: early 2008-09 (T1) and later 2012-13 (T2). Results: In total, from October 2008-December 2013, 25,150 antireflux surgeries were performed, 989 (3.9%) robotically. Robotic cases have rose annually with 349 cases identified in 2013 alone (35.5%). Between T1 and T2, the total volume of robotic antireflux surgery (RAS) increased six-fold from 96 to 609. Compared with T1, T2 patients undergoing RAS were older (54.9±15.3 vs 59.1±14.8; p=0.006) but similar in race, gender and rates of chronic conditions. Robotic utilization in non-elective admission increased between T1 and T2 (2.2% vs 10.2 %, p=0.02). There was no change seen in length of stay (LOS), complications, or mortality. Total costs for RAS related admission significantly increased between T1 and T2($40,120± $19,004 vs $57,610±$41,197; p<0.0001). Over this time, RAS was more often performed in zip codes with median income <25k (10.5% v. 21.4%; p<0.01) and geographically became more common in the South(7.3% v. 43.0%; p<0.0001). When comparing laparoscopic antireflux procedures with RAS, there was no difference in age, gender or chronic conditions in either T1 or T2. In T2, LOS was slightly greater for robotic procedures (2.8±3.7 vs 2.9±3.2; p=0.02). There was no difference in complications or mortality between laparoscopic and robotic at either time points. Total charges were significantly more for robotic procedures in both T1 and T2 ($32,638.4 ± $25,348.9 vs $40120 ± $19,004; p<0.0001 and $41,678 ± $30573 vs $57,610 ± $41,197; p<0.0001). In T2, robotic procedures were more likely to be performed at urban teaching hospitals (58.5% vs 61.8%; p=0.002) and, regionally, the robot was more commonly used in the South (33.6% vs 42.53%; p<0.0001). Using multivariate regression, when controlling for age, hospital geographic region, hospital ownership type, teaching status, elective versus non-elective, and zip code median income, robotic repair remained an independent predictor of increased charges ($54, 684.3± $930.3 vs $41,654.6 ± $396.0; p<0.0001). Conclusion: Utilization of RAS has rapidly increased. Increased robot utilization in non-elective admissions has not worsened outcomes. Compared to its laparoscopic counterpart, robotic antireflux surgery has significant increased cost. 200 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 55. TEN-YEAR TRENDS IN TRAUMATIC INJURY MECHANISMS AND OUTCOMES; A TRAUMA REGISTRY ANALYSIS Z Khorgami MD, W Fleischer MD, YA Chen MD, N Mushtaq PhD MBBS MPH, MS Charles MD, CA Howard MD Tulsa, OK Background: Trauma is the leading cause of death among persons aged 1-44 years in the United States. In addition to mortality and disability, trauma can place a significant financial and social burden on individuals and families. The Oklahoma Trauma Registry collects data regarding injured patients from all state-licensed acute care hospitals. This study investigates trends and outcomes of trauma in Oklahoma using a retrospective review of the Oklahoma Trauma Registry. Method: Patient characteristics, mechanisms of injury, and outcomes of trauma were analyzed from Oklahoma Trauma Registry data from 2005-2014, excluding 379 patients (0.3%) without recorded etiologies. The study population consisted of patients with a trauma diagnosis (ICD-9 800.00-959.9) and with major severity (Abbreviated Injury Scale severity value≥ 3, Injury Severity Score≥ 9, TRISS or Burn Survival Probability < 0.90, or death). One of the following was also required: 1) length of hospital stay≥ 48 hours; 2) dead on arrival or death in the hospital, 3) hospital transfer, 4) ICU admission, or 5) surgery on the head, chest, abdomen, or vascular system. Exclusion criteria included isolated orthopedic injury to the extremities due to same level falls, overexertion injuries, electrocution and other miscellaneous injuries. Results: 107,549 patients were analyzed (62.6% male, mean age 43.3±26.1 years, and mean injury severity scale 10.6±9.2). Prevalence of falls increased during the study period with an annual percent change (APC) of 4.0 (CI 95%: 3.1 to 4.9) while motor vehicle collisions decreased with an APC of -3.9 (CI: -5.1 to -2.8). The ICU admission rate over the study period was 26.2% with the highest rates in gunshot wounds (36.6%) and motor vehicle accidents (37.2%) (p<0.001). Patients with falls had the lowest rate of discharge to home (59.4%) in contrast to 72.8% of the entire cohort (p<0.001). Mean overall mortality rate was 5.4% with the highest rates in gunshot wounds (19.3%) and auto-pedestrian accidents (11%). The number of overall deaths per year remained stable except in falls which increased proportionate to the increase of fall frequency. The mortality of patients with falls was 4.2% and intracranial bleeding was present in 60%. Conclusion: Falls are significantly increasing as a mechanism of trauma admissions and trauma-related deaths in the state of Oklahoma. Analysis of state-based trauma registries can identify trends in the etiologies and other characteristics of injuries and may indicate a reference point to prioritize action plans by trauma centers to care for injured patients. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 201 QUICK SHOT ABSTRACTS 202 (cont.) Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 56. OPERATING ROOM FIRES REPORTED TO THE FOOD AND DRUG ADMINISTRATION DM Overbey MD, SA Hilton MD, TS Jones MS, BC Chapman MD, TN Robinson MD, EL Jones MD Aurora, CO Background: Operating room fires cause catastrophic surgical complications. More than 600 operating room fires occur in the United States annually. Fires occur when all three elements of the fire triangle are present, and are therefore preventable if surgeons can understand what elements of the fire triangle are most commonly associated with surgical fires. There is a gap in knowledge in the surgical literature given no large series focused on operating room fires exists. Our PURPOSES were: (1) to describe the elements of the fire triangle common in operating room fires, and (2) to quantify injuries created by operating room fires. Method: The FDA’s Manufacturer and User Facility Device Experience (MAUDE) database was searched for reports involving a fire related to a device or product between 2006 and 2016. Three criteria were used for inclusion: location inside an operating or procedure room, involvement of a patient, and inclusion the words “fire”, “flame”, “explosion”, or “smoke”. Reports were stratified by elements in the fire triangle: ignition source, oxygen, and fuel source. Patient injury was quantified and serious patient injury was defined when a patient required an additional invasive procedure to treat the injury due to the fire. Results: 604 reports were individually examined, of which 205 met all inclusion criteria (34%). Reports increased in frequency from 10 reports in 2006 to 44 reports in 2015. Patient injuries occurred in 56% of cases (n=115). Of all injuries, serious injuries requiring further invasive procedure occurred in 34% (n=39). Surgeon injuries occurred in 2% (n=4). Examining the elements of the fire triangle involved with operating room fires: Ignition source: Ignition sources were most commonly electrosurgical devices for 89% (n=183; p<0.001 vs composite of all other ignition sources). Specific ignition sources included monopolar (n=134, 65.4%), lasers (n=19, 9.3%), bipolar (n=16, 7.8%), and peripheral equipment (n=16, 7.8%). Oxygen: Head and neck operations in close proximity to increased oxygen composed the majority of reports (n=68, 33.2%)(p<0.001 vs composite of all locations). Increased oxygen concentrations were explicitly stated to be the cause of the fire in 34% (n=70). Fuel sources: Fuel sources included equipment or devices (n=80, 39.0%), patient tissue (n=60, 29.3%), drapes (n=27, 13.2%), prep solution (n=15, 7.3%), sponges (n=15, 7.3%), and surgeon tissue or gloves (n=8, 3.9%). Conclusion: Fires cause serious injury in one in three events. In the context of the fire triangle, operating room fires most commonly occur due to electrosurgery as the ignition source, increased oxygen as the oxidizer and additional equipment material as the fuel source. These practical findings can aid surgeons to prevent fires because removing one of the elements of the fire triangle will prevent the occurrence of an operating room fire. This report represents the largest collection of operating room fire reports to date. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 203 QUICK SHOT ABSTRACTS (cont.) QS 57. PREPERITONEAL PELVIC PACKING IS EFFECTIVE FOR HEMORRHAGE CONTROL WITH OPEN PELVIC FRACTURES Eliza E. Moskowitz, Clay Cothren Burlew, Ernest E. Moore, Charles J. Fox, Eric M. Campion, Mitchel J. Cohen, Ryan A. Lawless, Fredric M. Pieracci Denver, CO Background: Open pelvic fractures are historically reported as devastating injuries with a mortality rate between 30-60%. Preperitoneal pelvic packing (PPP) has been suggested to be ineffective for hemorrhage control in open pelvic fractures. With a developing experience in PPP for hemodynamically unstable patients with pelvic fracture related hemorrhage, we questioned this belief. The purpose of this study was to evaluate the role of PPP in patients with open fractures. We hypothesize that PPP is effective at hemorrhage control for pelvic facture bleeding in patients with open pelvic fractures and reduces mortality. Method: Patients undergoing PPP for pelvic fracture hemorrhage from 2005-2015 were studied prospectively. We identified a subgroup of patients with open pelvic fractures, defined as direct communication of the bony injury with overlying soft tissue, vagina, or rectum. Indication for PPP is persistent systolic blood pressure (SBP) <90 mmHg in the initial resuscitation period despite the transfusion of 2 units of packed RBCs. In addition to PPP, all patients also had external fixation of their fractures performed. Results: During the 10-year study, 126 patients underwent PPP; 14 (11%) patients sustained an open pelvic fracture; their mean age was 35  14 years and ISS 46  12. The lowest mean emergency department SBP was 75 mmHg, highest heart rate was 119, and worst base deficit was 12. Median time to operation was 44 minutes. Median RBC transfusions prior to SICU admission compared to the 24 postoperative hours were 12 versus 3 units (p<0.05). After PPP, 1 (7%) patient underwent angioembolization with a documented arterial blush. Fracture classification included APC-III (5), APC-II (4), LC-III (3), and LC-II (2) patterns. The open fracture classification included perineal/sacral wounds (8) and vaginal lacerations (4). PPP controlled pelvic hemorrhage; there was one death in the study population which was due to a traumatic brain injury. The overall mortality rate was 7%. Conclusion: PPP is effective for hemorrhage control in patients with open pelvic fractures. Mortality in this unstable pelvic fracture group was 7% which is lower than previous reports. PPP should be used in a standardized protocol for hemodynamically unstable patient with pelvic fractures regardless of associated perineal injuries. 204 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 61. END TIDAL CARBON DIOXIDE (ETCO2) BEFORE AND AFTER RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA WITH CLOSED CHEST COMPRESSION (REBOACCC) IS HIGHER COMPARED TO OPEN CHEST CARDIAC MASSAGE WITH AORTIC CROSS-CLAMP (OCCMACC) M Brenner MD MS, WA Teeter MD MS, M Bradley MD, A Romagnoli MD MS, P Hu PhD, S Yang, T Scalea MD, D Stein MD MPH Baltimore, MD Background: EtCO2 is a marker of quality of cardiopulmonary resuscitation (CPR). The purpose of this study is to compare OCCMACC versus REBOACCC on resuscitation outcomes. Method: Between Feb 2013 and September 2016, patients who received REBOACCC for traumatic arrest were compared to patients receiving OCCMACC for the same indication. Physiologic data was calculated from continuous vital sign monitoring, and timing metrics were recorded by time-stamped videography. Final measurements were collected at 15mins or death, whichever occurred first. Total cardiac compression fraction represents the duration of cardiac compression relative to duration of resuscitation in a patient in arrest. Results: 45 patients were enrolled; 21 REBOACCC and 24 OCCMACC. 89% were male with mean age of 37±13 years. 22 patients suffered penetrating trauma in the OCCMACC group compared to 7 of the REBOACCC group (p=0.0001). Mean ISS did not differ between OCCMACC (40.9±14.6) and REBOACCC (35.7±15.6), p=0.25. During the period of CPR prior to aortic occlusion, there was no significant difference in initial EtCO2 values between groups, but mean, median, peak, and final EtCO2 values were lower in OCCMACC (p < 0.013). During the periods of CPR after aortic occlusion, the initial, mean, median, and final EtCO2 values were higher with REBOACCC than OCCMACC (p=0.006, 0.014, 0.013, 0.04). The rate of return of spontaneous circulation (ROSC) was higher in REBOACCC (57%) vs OCCMACC (24%) (p = 0.037), and REBOA/CCC patients survived to operative intervention more frequently (p=0.09). REBOACCC patients had greater total cardiac compression fraction prior to AO than OCCMACC (85.3±12.7% vs. 35.2±18.6% p<0.0001), as well as after AO (88.3±7.8% vs. 71.9±24.4%, p=0.0052). In-hospital mortality was 93% (100% OCCMACC vs. 86% REBOACCC, p=0.9). Location of death differed between groups (p=0.03); all OCCMACC patients died in resuscitation area or operating room, while 3 REBOACCC patients died in the ICU, 2 were discharged from the hospital, and 1 discharge is currently pending. Conclusion: REBOACCC patients have higher EtCO2 levels before and after aortic occlusion compared to patients who receive OCCMACC, suggesting that REBOACCC may offer improved resuscitation as measured by EtCO2. REBOACCC patients also receive a greater duration of cardiac compression, have a higher rate of ROSC, and survive more often beyond the resuscitation area compared to OCCMACC patients. Further research is needed to determine whether these findings can translate into improved clinical outcomes. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 205 QUICK SHOT ABSTRACTS (cont.) QS 59. PATHOLOGIC FINDINGS OF THE GALLBLADDER IN PATIENTS UNDERGOING SURGERY FOR BILIARY DYSKINESIA H AHMED MD, D HWANG, S DISSANAIKE MD Lubbock, TX Background: Cholecystectomies have been shown to be effective for patients with symptomatic cholelithiasis, but have shown variable success in patients with acalculous gallbladders. Some studies attempted to correlate factors such as gallbladder ejection fraction by hepatobiliary iminodiacetic acid (HIDA) scans as indicators of pathology in cholecystectomy patients, to our knowledge there are only few studies that have compared the direct pathologic characteristics such as cholecystitis and cholesterolosis of acalculous gallbladders with biliary dyskinesia. Method: In this study, we reviewed the gallbladder pathology reports of 100 patients from 2005-2016 who underwent cholecystectomies for acalculous biliary dyskinesia at our institution. We also documented the results of preoperative diagnostic tests, and general demographic information. Results: Patients had a mean age of 32 (9,85) and were predominantly female (81%) (Table 1). The majority of our patients reported as white or Hispanic (50% and 43% respectively). All patients had abnormal HIDA scan/Ejection fraction (EF<35%). The pathology reports were normal for 35% of patients, while 28% reported cholecystitis. 37% of patients also reported other pathology such as mucosal hyperplasia, cholesterosis, and sinuses/polyps. In females, the average age of cholecystitis affected individuals was younger than all other pathologies. Although not a large enough difference to be statistically significant, there could be a correlation between age and cholecystitis. Normal Cholecystitis Cholesterosis Mucosal Hyperplasia Sinuses and Polyps Prevalence 352819144 Female 28 (80%)21 (75%) 18 (95%) 11 (79%) 3 (75%) Average Age of Female 33 23 35 33 32 Race White 20 11 6 10 3 Race Hispanic 12 17 11 2 1 Race AA 10220 Conclusion: The finding of other pathologies suggest that the preoperative diagnosis of biliary dyskinesia may not be the only cause of symptoms for patients and could be due to other pathologies of the gallbladder in two thirds of patients that may also be related to biliary dyskinesia. A majority of patients undergoing surgery for Biliary Dyskinesia show some pathologic abnormality, the relative significance of these findings need to be further explored. 206 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 58. ROUGH DAY AT THE BEACH: EPIDEMIOLOGY AND CLINICAL PRESENTATION OF SPINAL CORD INJURY IN HAWAII S Steinemann MD, W Biffl MD, J Cheng BA, D Galanis PhD Honolulu, HI Background: Spinal cord injuries (SCI) result from a broad spectrum of blunt trauma mechanisms, predominantly falls and motor vehicle crashes. However in our state, ocean related activities are a common cause of SCI. We propose that ocean related SCI represent a unique subset of SCI in terms of geographic and demographic clustering and pattern of injury. Method: Data from our state trauma registry, capturing trauma team activations and admissions at 7 hospitals, were reviewed. SCI were identified by ICD9-CM diagnosis codes in the 806.0-806.9 and 952.0-952.9 series. Statistics were adjusted for patients who were transferred between hospitals. Results: A total of 630 SCI cases from 2009-2013 were identified. The most frequent causes were ocean related activities (209 patients, 33% of the total), followed by falls (25%), and motor vehicle crashes (22%). The incidence of ocean related SCI nearly doubled over the 4 years, from 27 to 52 cases annually. Among the 209 patients injured in ocean activities, most (85%) were injured by “wave forced impact” (WFI) while surfing (14), body boarding (46), body surfing (54) or being “tossed by a wave” (63). There were also 31 injuries from dives into the ocean. 84% of patients injured by WFI were out-of-state visitors, as well as 45% of those injured from dives. 89% of ocean related SCI were isolated to the cervical spine. Only 27% had a fracture in addition to SCI. A complete cord lesion was suffered by 23% of those injured by diving and 10% injured by WFI. The locations of ocean related SCI were dispersed statewide; the 4 beaches with the highest numbers were all on different islands. However, 55% of injuries were clustered on 10 beaches which host a minority of beachgoers. 2 of these beaches, facing northwest, had most incidents during the winter. Conclusion: Ocean related activities are the leading cause of SCI in our state. These are typically isolated cervical injuries, most without an associated fracture. Ocean related SCI, particularly those caused by WFI, disproportionately affects out-of-state visitors at distinct high risk beaches. These data may inform the development of targeted injury prevention efforts. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 207 QUICK SHOT ABSTRACTS (cont.) QS 60. SURGICAL EVACUATION OF ACUTE SUBDURAL HEMATOMA IN OCTOGENARIANS: A TEN YEAR EXPERIENCE FROM A SINGLE TRAUMA CENTER MJ McGinity MD, JS Rodriguez PhD, JE Michalek PhD, JR Floyd MD San Antonio, TX Background: Elderly patients presenting with an acute subdural hematoma (aSDH) have historically had unfavorable outcomes. Traditionally, elderly has been defined as greater than sixty five years of age when discussing traumatic brain injury. However, an aging population has lead to an increase in low mechanism induced traumatic brain injury in the very elderly(>80). Prior series have discussed surgical outcomes of subdural hematoma evacuation in patients >80, but have not separated chronic subdural hematoma(cSDH) from aSDH which act markedly different. We sought to determine surgical outcome of acute subdural hematoma evacuation via craniotomy for patients >80 years old. Method: We retrospectively reviewed all charts of patients from 2005 through 2015 who were 80 years of age or older and underwent craniotomy or craniotomy for surgical evacuation of aSDH. Metrics collected were as follows: Glascow Outcome Score (GOS), age, mechanism of injury, procedure used for clot evacuation (craniotomy vs. craniectomy), pre-hospital use of anticoagulants or antiplatelets, pupillary reactivity, thickness of aSDH, amount of midline shift, initial Glascow Coma Score (GCS), presence of neurological decline prior to surgery, best post operative GCS, length of hospital stay, # of ICU days, # and type of comorbidities, # of major in-house complications, # of total invasive procedures performed, requirement of percutaneous endoscopic gastrostomy (PEG) tube placement, requirement for tracheostomy, and initial disposition from hospital. Specific metrics were compared against the primary outcome measure, Glascow Outcome Score. GOS of 4-5 was deemed a good outcome and a GOS of 1-3 was deemed to be a poor outcome. Results: Thirty-four patients met inclusion criteria, with a mean age of 84 years (range 80-91) and an overall mean follow up of 65 days. Patients with good outcome (GOS 4-5) had mean follow up of 112 days (range 25-245). Six patients had good outcome at last follow up (GOS 4-5) and 27 patients had poor outcome (GOS 1-3). One patient’s medical record was incomplete and did not indicate outcome. The majority of injuries resulted from falls (31 falls, 2 motor vehicle accidents, 1 assault). The mean number of days spent in the ICU was 9.9 days (median 9 days, IQR 11). The mean length of stay in the hospital was 13.2 days (median 14, IQR 13). The pre-injury use of antiplatelet, anticoagulant or combinations of the above did not statistically correlate with outcome. It was noted, however, that all patients taking Plavix (5 patients) had a poor outcome. Six patients were operated on with at least one dilated and non-reactive pupil with 1 of these patients surviving and recovering to normal. Although the thickness of the subdural hematoma’s effect on outcome did not reach statistical significance, the difference appears to be clinically relevant [(good outcome: mean 16.6mm, median 17mm, IQR 7) vs (poor outcome: mean 21.1mm, median 20mm, IQR 8.5), p=0.17, 208 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) Figure 1]. In addition, the amount of midline shift similarly did not reach statistical significance, but also appears to be clinically relevant [(good outcome: mean 8.75mm, median 10mm, IQR 6.5) vs. (poor outcome: mean 14mm, median 14, IQR10), p=0.07, Figure 1]. The presenting GCS trended towards being higher in patients who had good outcome compared to poor outcome (good: mean 13.1, median 14.5, IQR 2.5; poor: mean 9.6, median 10, IQR 8). This did not reach statistical significance but also appears to be clinically relevant (p=0.06). Patients with a higher in-hospital post-operative GCS had much better overall outcome than patients who left the hospital with lower GCS which was highly statistically significant (good: mean 14.5, median 14.5; poor: mean 8.4, median 9, p=0.001). Thirteen of the included patients arrived to the hospital with GCS scores of 14 or 15 and were initially managed conservatively. However, all but 1 of these patients had a decline in neurologic examination, prompting surgical intervention and inclusion into the study. Patients with an in-hospital decline in neurological exam prior to operative intervention fared slightly better than patients who presented with an exam necessitating emergent surgical intervention, but this was not statistically significant (p=0.66). No individual major comorbidity was statistically predictive of outcome (renal disease, cardiac disease, hypertension, diabetes mellitus, pulmonary disease, prior cerebral vascular accident, any other prior neurological disease). Mean overall number of comorbidities was 3.3 (median 3, IQR 1). Patients with poor outcomes had mean number of comorbidities of 3.4 (median 3, IQR1) compared to good outcomes of 3 (median 3, IQR 0). Every patient in the study had at-least one comorbidity except one, where no past medical history was available. Total number of in-house complications trended towards being higher for patients with good outcomes (mean 3, median 3, IQR 1.5) compared to poor outcomes (mean 2.2, median 2.5, IQR 2), presumably because they were alive to have complications arise. This did not reach statistical significance, p=0.26, however. The most common complications were pneumonia, deep venous thrombosis or pulmonary embolism, seizures, new onset cardiac arrhythmia, and urinary tract infection. Mean overall number of invasive procedures performed was 6 for the entire population (median 6, IQR 2). There was no statistically significant difference between number of procedure performed on patients with good outcome (mean 5.33, median 4.5 IQR 2.5) compared to poor outcome (mean 6.1, median 6, IQR2), p=0.19. No patient requiring gastrostomy placement (n=3) recovered to have a good outcome. One patient requiring tracheostomy (n=5) recovered to having a good outcome. Conclusion: Although very frequently associated with poor prognosis, the evidence presented here does not indicate acute subdural hematoma in the very elderly to be a universally fatal or debilitating disease. Surgical evacuation should be considered in these patients. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 209 QUICK SHOT ABSTRACTS 210 (cont.) Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 62. HYPERTRIGLYCERIDEMIA INDUCED PANCREATITIS: DOES PLASMAPHERESIS REALLY MAKE A DIFFERENCE? LB O’Meara CRNP, BC Eaton CRNP, AM Pasley DO, ES Wise MD, LA Harmon MD, AV Herrera MS, JD Pasley DO, JJ Diaz MD, RB Tesoriero MD Baltimore, MD Background: Hypertriglyceridemia (HTG) accounts for up to 10% of all cases of acute pancreatitis (AP). Optimal treatment of HGT-AP is not well characterized. Plasmapheresis (PLX) rapidly reduces plasma triglyceride concentration and may ameliorate cytokine-mediated inflammation. Its efficacy as an adjunctive therapy to reduce disease severity in HTG-AP has thus far only been suggested in case reports and small case series. We sought to review our institutional experience with PTX in HTGAP to evaluate its effect on outcomes compared to conventional therapy. Method: A retrospective review of consecutive adult patients who presented with HTG-AP to a single quaternary care center from 2010-2015 was performed. Hospital records were reviewed for demographics, comorbidities, laboratory values, computed tomography (CT) severity of AP, mortality, intensive care unit (ICU) and hospital length of stay (LOS), use of mechanical ventilation, and 6 week readmission rate. Patients were stratified based on the presence or absence of PLX treatment at any point during their hospital stay. The decision to initiate PLX was at the discretion of the medical team. Statistical comparisons between PLX cohorts were conducted using Fisher’s exact test or the Mann-Whitney U Test, as appropriate. The criterion P<.05 was used to denote statistical significance. Results: Eighteen patients who presented with HTG-AP were identified, eight of whom received plasmapheresis. The two cohorts were well-matched with respect to demographics, admission triglyceride and lipase levels, and CT severity scores. There were no significant differences in mortality, hospital LOS, ICU LOS, mechanical ventilation, and readmission rates evaluated (Table 1). Thirteen patients required admission to the ICU, 7 of whom received PLX. Within the ICU subgroup, there was no difference in overall LOS (20 [17-29] days vs. 20 [10-26]; P = .58), ICU LOS (13 [12-20] days vs. 10 [5-15] days; P = .37) nor days on the ventilator (10 [5-10] days vs. 12 [9-13] days; P = .57), when comparing those who received PLX with those treated with conventional therapy. Conclusion: We report one of the largest North American series comparing patients with HTG-AP who received plasmapheresis to those treated with conventional therapy. Though limited by a restricted sample size, this comparison of two well-matched groups of patients did not show a benefit in LOS, requirement for ventilator support, or patient mortality in those who were treated with PLX. Considering the added expense and potential morbidity from PLX further well designed studies are needed to more thoroughly understand its role in the management of HTG-AP. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 211 QUICK SHOT ABSTRACTS (cont.) QS 63. THE GREY’S ANATOMY EFFECT: TELEVISION PORTRAYAL OF TRAUMA PATIENTS MAY CULTIVATE UNREALISTIC PATIENT AND FAMILY EXPECTATIONS FOLLOWING INJURY RO Serrone MD, JA Weinberg MD, PW Goslar PhD, EP Wilkinson PA, JL Dameworth MD, S Hosler, SR Petersen MD Phoenix, AZ Background: Prior research has demonstrated that public perception of healthcare is influenced by medical television dramas, and representations of medical interventions are relatively inaccurate. This is salient for trauma patients and families, given that exposure to genuine trauma patient experience is sparse. It is our perception that portrayal of hospitalization following acute injury is inaccurate. The purpose of this study was to compare outcomes and course of hospitalization following major trauma on television dramas versus reality. Method: Providers from an ACS level-1 Trauma Center screened 269 episodes of seasons 1-12 of the television series Grey’s Anatomy, the most popular fictional medical drama airing from 2005 to present. A TV registry was constructed by collecting demographics, injury characteristics, procedures, length of stay, and discharge disposition for each fictional trauma patient. A certified trauma registrar calculated ISS. Comparison data were obtained from a sample selected from the 2012 National Trauma Databank (NTDB) to reflect a level-1 trauma center in a similar geographic region as the setting for Grey’s Anatomy. Results: 290 patients comprised the TV registry versus 4812 patients from NTDB sample. Demographically, TV patients were younger (mean age 34vs.41,p<0.0001), more likely female (40%vs.30%, p<0.0001), and had higher ISS (mean 14vs.12,p=0.013). Mortality following injury was significantly higher on TV compared with reality (22%vs.7%,p <0.0001), with most TV patients dying within the first 24 hours. Most TV patients went straight from ED to OR (71%), compared with 25% in NTDB (p<0.0001). Among TV survivors, hospital length of stay appeared to be less than one week for most patients followed by discharge home (92%), whereas 30% of the NTDB cohort had a length of stay beyond 1 week and 22% were discharged to long-term care. Conclusion: On television, trauma patients typically go straight from ED to OR, and survivors experience a short hospital course followed by return to home, whereas in reality, most patients do not go immediately to OR, and a significant portion have a prolonged length of stay followed by discharge to long-term care. TV portrayal of rapid functional recovery following major injury may cultivate false expectations among patients and families who are regular television viewers. 212 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 64. ADRENALECTOMY IN OCTOGENARIANS: ASSESSMENT OF OUTCOMES SM Sims MD, KM Coakley DO, T Prasad MA, VA Augenstein MD, KW Kercher MD, R Sing DO, BT Heniford MD, PD Colavita MD Charlotte, NC Background: The increasing life span of Americans and rising prevalence of advanced imaging studies have led to a greater incidence of elderly patients presenting with adrenal lesions. The purpose of this study is to evaluate outcomes after adrenalectomy in patients age 80 and over as compared with younger patients. Method: The National Surgery Quality Improvement Program database was utilized to investigate patients with CPT codes associated with laparoscopic and open adrenalectomies from 2005-2014. Patient demographics, mortality, hospital length of stay, discharge disposition and complication rates were compared in octogenarians and in patients ages 50-79. Results: 4785 patients age 50 or older in the United States who underwent adrenalectomy were identified. There were 190 (3.97%) age 80 and above and 4595 (96.03%) in the younger group, utilizing laparoscopic technique in 3330 (69.6%) and an open approach in 1455 (30.4%). 4231 (88.4%) were performed by general surgeons and 515 (10.8%) by urologic surgeons. More patients in the older group underwent an open adrenalectomy (41.6% v. 30.0% p=0.0006). Rates of diabetes, COPD, CHF, history of an MI or CVA, and chronic renal failure were similar between the two groups. There was a greater incidence of current tobacco use in the younger group (10.5 v. 23%). There were similar rates of wound complications, DVTs, pulmonary embolism, acute MI, sepsis, and transfusion requirement between the two groups, but an increased rate of prolonged ventilator use for >48 hours (5.79 v. 2.46% p= 0.016), progression to renal insufficiency (2.63 v. 0.44% p= 0.003), and stroke with neurologic deficit (1.58 v. 0.22% p= 0.01) in the older group. The hospital length of stay (LOS) was significantly higher in the patients age 80 and above (9.36 ± 11.85 v. 4.67 ± 6.92 p=0.0001. Controlling for confounding variables, with multivariate linear regression, age >80 was independently associated with longer LOS (10.3 ± 0.81 v. 6.21 ±0.19 p<.0001). The surgical approach also independently impacted LOS in this analysis (laparoscopic 5.06 ± 0.43 v. open 11.5 ± 0.49 p<0.0001). The overall 30-day mortality rates were similar (2.11 v. 1.04%, P=0.15). Conclusion: Although advanced age can be associated with increased LOS and rates of need for prolonged intubation and cerebrovascular accidents, there is not significant difference in 30-day mortality or most complications following adrenalectomy. The increased LOS was still found to be higher in the older population, even when controlled for the greater proportion performed with an open approach in this group, signifying age as well as surgical approach independently impact hospital stay postoperatively. As such, in appropriately selected patients, adrenalectomy can be considered in patients age 80 and older without prohibitively increased risks as compared with their younger counterparts. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 213 QUICK SHOT ABSTRACTS (cont.) QS 65. CHANGING PRACTICES: THE ADDITION OF A NOVEL SURGICAL APPROACH TO GYNECOMASTIA DL Wyrick MD, M Roberts MD. ZT Young MD, AT Mancino MD Little Rock, AR Background: Gynecomastia can be a significant impediment to quality of life for men who suffer from this affliction. Numerous techniques have been described in the literature ranging from minimally invasive options such as liposuction to incision based reductions. The standard for the general surgeons at our institution has been subcutaneous mastectomy through a circumareolar incision, which often proved inadequate for patients with grade II or III gynecomastia. In November 2013 we adopted a new technique, the “double donut”, that offers the post-operative appearance of a limited incision, with the additional benefits of mastopexy, skin reduction, and mastectomy through an enlarged incision which is not superficially evident at the completion of the procedure. Method: We reviewed our surgical database for all cases performed for gynecomastia in the period from May 2005 to August 2016. Basic demographic information, diagnostic modality, symptoms, indication for procedure, operation performed, and final pathology were collected and analyzed. Results: There were 70 mastectomies performed on 52 subjects. All subjects were male; 14 were African American and 38 were Caucasian. The average age was 47 (2373) years old. The majority of the patients were evaluated with mammogram and/or ultrasound. All but one patient presented with pain as their chief complaint. There were 41 mastectomies done prior to initiation of this technique and 29 were performed after. The total volume of breast tissue excised via the previous technique was 127.1cm3, this increased to 157.2cm3with the new technique. No necrosis of the NAC was seen and no wound infections resulted in complication. Cosmetic satisfaction was seen in 98 percent of patients. Conclusion: The “double donut” technique is particularly useful for males with grades II or III gynecomastia. It provides good wound results, with acceptable patient satisfaction and cosmetic outcomes. Although initially developed for patients with higher grade gynecomastia, the improved visibility and increased patient satisfaction allowed this to become the preferred technique at our institution. 214 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 66. PROGNOSTIC FACTORS IN CUTANEOUS HEAD AND NECK MELANOMA BC Chapman MD, A Gleisner A MD, PHD, DM Overbey MD, C Stewart MD, JJ Kwak MD, C Gadjos MD, NW Pearlman MD, MD McCarter MD, N Kounalakis MD Aurora, CO Background: Head and neck (H&N) melanoma accounts for 15-30% of primary melanomas. The objective of this study is to identify and assess novel prognostic features associated with cutaneous melanomas of the head and neck. Method: Retrospective review of patients undergoing sentinel lymph node biopsy for cutaneous melanoma of the H&N (1998-2016). Using Cox proportional hazards model, variables associated with disease free survival (DFS) and overall survival (OS) on univariate analysis with a p<0.1 were analyzed on multivariate analysis. Results: Among 256 patients identified, median age was 57 years (range 14-91) years, 196 (77%) were male, and median tumor depth was 1.6 mm (range 0.2512.0). The majority of melanomas (65%) were first noticed by patients although 9% were diagnosed by a hairdresser. Cryotherapy was performed on the melanoma site prior to diagnosis in 9% of patients. Transection at the base of the diagnostic biopsy occurred in 96 (38%) patients, yet 74 (77%) had no residual melanoma on the wide local excision (WLE). In total, residual melanoma was found on WLE in 108 (42.2%) patients. A positive SLN was identified in 40 (16%) patients. At a median follow-up time of 2.3 years, 40 (16%) patients had a loco-regional recurrence and 43 (17%) had distant disease. Gender, diagnostician, prior cryotherapy, type of melanoma, mitosis, and a transected biopsy were not associated with DFS or OS. On multivariate analysis, factors associated with both a worse DFS and OS included increasing age and tumor depth, scalp melanoma, ulceration, and a positive SLN. Although residual melanoma on the wide local excision was associated with a poorer DFS, it was not found to be significant for OS. Conclusion: Increasing age and tumor depth, scalp melanoma, ulceration, and a positive SLN are poor prognostic features in H&N melanoma. Three quarters of patients with a positive deep margin on diagnostic biopsy had no residual melanoma at WLE. Independent of other prognostic variables, residual melanoma was associated with a worse DFS. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 215 QUICK SHOT ABSTRACTS 216 (cont.) Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 67. ASSESSING EMERGENCY EXPLORATORY LAPAROTOMIES IN PATIENTS WITH ADVANCED MALIGNANCIES EB Pillado BS, ZW Ashman MD, MP O’Leary MD, DY Kim MD, DS Plurad MD Torrance, CA Background: Advanced cancer often requires emergent surgical interventions despite high rates of complication and death. To quantify in-hospital mortality, 30day mortality, and overall outcomes in patients with advanced malignancies who underwent emergency exploratory laparotomy. Method: We reviewed our institutional experience between 2008 and 2016 of acute care surgery consultations among patients with advanced malignancy that underwent emergency exploratory laparotomy. Results: Out of 52 patients, 26 (50%) were male. Twelve (23.1%) patients were newly diagnosed with cancer on exploratory laparotomy while 4 (7.7%) patients were upstaged to Stage IV. Common primary malignancies were colorectal (n=26, 50%), prostate (n=4, 7.8%), and gastric (n=4, 7.8%). Remaining diagnoses included other intra-abdominal malignancies and lung cancer. Indications for surgery included obstruction (n=25, 56.8%), perforation (n=11, 25%), or a combination (n=8, 18.2%). In-hospital mortality was 13.5% (n=7), post-discharge thirty-day mortality was 7.7% (n=4), and 32.7% (n=17) had post-operative complications. Seventy-one percent were discharged home, 3.9% were discharged to hospice, and 5.8% were discharged to home hospice. Overall ICU stay was significantly longer in those who died within 30 days (18.4±7.1 versus 1.9±0.78, p<0.01). Two patients had preadmission DNR orders. Thirteen patients (25.5%) had DNR orders placed during the hospitalization, 8 of which expired within 30 days (p<0.01). Conclusion: Selective use of surgical intervention in patients with advanced malignancy can result in acceptable short term outcomes including discharge home. Additional efforts should be directed at increasing the rate of advanced directives in this population with limited life expectancy. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 217 QUICK SHOT ABSTRACTS (cont.) QS 69. 4- HOUR POST-OPERATIVE PTH LEVEL PREDICTS HYPOCALCEMIA AFTER THYROIDECTOMY IN CHILDREN LB Hsieh MD, SW Bruch MD Ann Arbor, MI Background: Hypocalcemia is a common complication of total thyroidectomy in pediatric patients, reported to be anywhere from 30-40%. Four hour postoperative PTH monitoring has been shown to be predictive of the need for calcium supplementation in the adult thyroidectomy population. We evaluated the role of the 4 hr post-operative PTH level in determining calcium supplementation after thyroidectomy in the pediatric patient. Method: This is a retrospective review of pediatric patients undergoing total thyroidectomy by a single pediatric surgeon from July 2011 to June 2016. Intact PTH obtained four hours post-operatively was used to determine the use for calcium supplementation for patients beginning in November 2014 onward. Total calcium levels were monitored concurrently with intact PTH levels. Each patient had at least one post-operative visit 2-4 weeks after surgery to assess healing as well as development of hypocalcemia. Results: From July, 2011 to June 2016, there was a total of 53 thyroid procedures, of which 34 are total thyroidectomies. Prior to November 2014, all pediatric total thyroidectomies received calcium supplementations per our institutional protocol, with 30% (6/20) post-operative hypocalcemia based on ionized calcium levels. From November 2014 to June 2016, there was a total of 14 pediatric patients with total thyroidectomies. 4/14 (29%) had low 4-hour post-operative PTH levels. 3 out of the 4 patients with low 4-hour post-operative PTH levels had corresponding total calcium levels less than 8, with only one patient with symptomatic hypocalcemia. 10 of the 14 patients had normal 4-hour post op PTH levels, with 1/10 having hypocalcemia based on lab values (Table 1.) A single 4-hr post-operative PTH <10pg/dl has a sensitivity of 75% and specificity of 90% in predicting post-operative hypocalcemia (<8mg/dl), with a positive and negative predictive value of 75% and 90% respectively (Table 1). Only one patient developed persistent hypocalcemia. Conclusion: The 4-hour post-operative PTH level can help determine the need for calcium supplementation in pediatric patients undergoing total thyroidectomy, thereby reducing unnecessary calcium supplementation and serial lab draws to monitor for hypocalcemia. 218 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 219 QUICK SHOT ABSTRACTS (cont.) QS 70. QUICK CAROTID SCAN FOR STROKE PREVENTION GS Lavenson MD Bethesda, MD Background: Over 800,000 seniors have strokes every year that have been unabated for at least the last 10 years. Strokes result in over 100,000 deaths and 300,000 cases of disability requiring long term institutionalization annually. Effort to reduce strokes has been primarily expended at determining which treatment is best for carotid artery disease (CAD), the leading immediate cause of strokes. However, the reason that strokes continue is that 80% of carotid strokes are due to silent asymptomatic carotid stenosis (ACS) and while management is effective, the ACS is not known and the management cannot be applied preemptively to prevent the strokes. The only means to reduce strokes is to screen large numbers of seniors for ACS so that it can be managed before strokes occur and the stroke prevented. Method: A Quick Carotid Scan (QCS) using image only without use of velocities, hard copies, history, or counseling can be done in 1-2 minutes and rapidly triage out those with normal carotids from those with visible lesions, color shift connoting increased velocity due to stenosis, or those with an indeterminate scan who are referred for a full duplex examination. The QCS had a sensitivity of 93% in our laboratory and 97% at NYU compared to only 50% with an audible bruit or presence of risk factures in the Framingham Risk Scale. The QCS is far different than the long, complicated protocol of the IAC and avoids many objections of the United States Preventive Services Task Force. Results: A large composite screening of 22,000 seniors by the SVS/SVU for which I was a principal investigator, NYU, Madigan Army Hospital (still screening under Colonel Charles Andersen), and by those of us in Central California found a nearly uniform incidence of 7.5% of seniors >60 years of age with a >60-70% carotid stenosis. So, if at least 5% or our 44 million seniors or 2.2 million have significant ACS, and with a stroke rate without identificatikon and managemnt at least as high as the 10% with Best Medical Treatment in the Asymptomatic Carotid Artery Stenosis and Asymptomatic Carotid Surgical Trial studies. This contrasts to the risk of stroke with current management of 1-2% or less. Thus there are at least 220,000 strokes annually in the United States due to ACS or 28% of our 800,000 strokes which pencils out to prevailing estimates which could be prevented. Conclusion: A QCS of large numbers of seniors can discover the ACS that causes 80% of strokes due to CAD allowing excellent low risk preemptive management, potential prevention of strokes on an epidemiological scale, and cost reduction exceeding 60 billion dollars for the health care system. 220 Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 72. COMPARATIVE ANALYSIS OF PEDIATRIC NON-POWDER VS POWDER FIREARM INJURIES MC Johnson MD, E Scherer MD, L Lilian MD, B Eastridge MD, J Myers MD, S Nicholson MD, M Price MD, D Jenkins MD, R Stewart MD San Antonio, TX Background: Firearm injuries remain a significant public health and safety concern in the United States. Less appreciated is the role non-powder firearm [NPF] injuries play, especially in our pediatric population. NPF can be purchased in the toy section of many stores and national estimates show on average over 10,000 pediatric non-powder firearm-related injuries are seen in US Emergency rooms each year. However, research regarding the severity and outcomes related to these injuries in children is limited to small case series and reports. We sought to characterize pediatric injuries from NPF versus powder firearms [PF] on a national level in regards to demographics, injury patterns, and outcomes to better understand the extent of morbidity and mortality in children with NPF injuries. Although likely associated with a decreased mortality, we hypothesized non-powder firearm injuries would be associated with high morbidity and operative need. Method: The National Trauma Data Bank Research Data Set from 2012-2014 was utilized for analysis. Pediatric population was defined as ages 1-17, and firearm injuries were searched using e-codes. NPF was defined as propulsion by spring, air, or CO2 (ie: pellets and bb’s) while PF was defined as propulsion by explosion (ie: handguns, rifles, etc.). Data included demographics, firearm type, intent, disposition, diagnoses, procedures, and outcomes. Injuries were categorized by body region and associated procedures were reviewed. Analyses were performed using t-test for continuous and chisquared for categorical variables. Results: We identified 1,080 children injured by non-powder firearms and 4,525 children injured by powder firearms. Majority of both NPF and PF injuries involved males. Average age of NPF injuries was significantly less than PF injuries (10.7 vs. 14.16 years; p- <0.001) with a significant predisposition towards non-Hispanic, whites (p- <0.0001). Comparative analyses showed a significant proportion of non-powder firearm injuries were unintentional (82.1% p- <0.0001). The majority of NPF injuries were orbital (29.17%) followed by cranial (14.07%), thoracic (14.81%), and abdominal (13.70%) injuries. Emergency department disposition indicated a need for operative intervention in 23.33% vs 28.46% of NPF and PF injuries, respectively. Mortality was 0.37% and 12.55% for NPF and PF, respectively. Conclusion: A majority of non-powder firearm injuries are unintentional and occur in the pre-teen population while requiring operative intervention at a clinically similar rate to powder firearm injuries. Non-powder firearm injury patterns and their associated operative rate raise concerns for extensive, long-term morbidity in our young population. These findings further emphasize the need for a comprehensive approach to reduce NPF injuries. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 221 QUICK SHOT ABSTRACTS 222 (cont.) Southwestern Surgical Congress | 69th Annual Meeting QUICK SHOT ABSTRACTS (cont.) QS 73. SHORT AND LONG TERM OUTCOMES OF CHILDREN AND ADOLESCENTS WITH PAPILLARY THYROID CARCINOMA B Wallace MD, D Partrick MD, A Kulungowski MD, S Travers MD, D Bensard MD, R McIntyre Jr MD Aurora, CO Background: Over previous decades, significant evolution of care for children and adolescents with papillary thyroid carcinoma (PTC), including the advent of ultrasound technologies, the advancement of standardized care to total thyroidectomy, and the use of radioiodine ablation, has made the assessment of applicable modern outcomes difficult. Therefore, our group evaluated the short and long term outcomes of a contemporary cohort of pediatric patients treated for PTC by a multidisciplinary team. Method: We performed a retrospective chart review over 77 patients less than 21 years of age diagnosed and surgically treated for PTC at two academic institutions between 2000 and 2016. Presentation, preoperative workup, surgical procedure, short term outcomes of wound complications, vocal cord paralysis, hypoparathyroidism and hypocalcemia; long term outcomes of disease free survival, recurrence rates, need for further surgeries, follow up, and overall survival were assessed. Results: Median patient age was 14 years ranging between 3.5 and 20 years of age (SD 4.5), 72% were female, and all patients presented with a palpable neck mass, occasionally with additional symptoms such as dysphagia. Overall patient survival rate was 100% with median 4 years follow up. Only 2 patients did not receive preoperative imaging to evaluate possible metastases. Regional lymph-node metastases at time of surgery were identified in 67% of patients, with distant metastases occurring in 8%, most commonly in the lungs. Consequently, 92% of patients were TNM Stage I at time of operation. Central lymph-node dissection (LND) was performed in 71%, additional lateral LND in 41%, bilateral LND in 12%, and lobectomy in 8 patients (all but one had a negative or indeterminate preoperative FNA), with 5 lobectomy patients receiving immediate subsequent completion total thyroidectomy following pathology results. Of all patients, 90% measured a nadir serum calcium that met hypocalcemia definitions, although only half of these patients became symptomatic (not significant to type of operation nor presence of incidental parathyroid glands). 8% of patients had longer than 6 months of treatment for hypocalcemia. The cohort had no wound complications, no axillary nerve injuries, and no unintentional permanent laryngeal nerve injuries. 62% of patients received I-131 treatment, and 10% of the children had a local recurrence in the neck additional to the previously mentioned 8% with distal metastases by time of operation. Conclusion: Similar to previous reviews, our data demonstrate an increased incidence of PTC in females, greater pediatric incidence of lymph-node and distant metastases by time of diagnosis compared with adult populations, and greater need for repeat surgery in those receiving less than total thyroidectomy. However, while this pediatric cohort still showed higher recurrence rates than adults, this contemporary pediatric patient group highlights recurrence rates significantly lower than in alternate studies. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 223 QUICK SHOT ABSTRACTS (cont.) QS 74. SURGICAL TRAINEE AUTONOMY DURING ARTERIOVENOUS FISTULA CREATION: IS THERE A COST? A Korn MD,H Alipour MD; J Zane, K Gray MD; A Shahverdani, MD; A Kaji, MD, PHD, T Ryan, MD; C deVirgilio MD Torrance, CA Background: Background: Upper extremity arteriovenous fistula (AVF) creation for hemodialysis access is a common vascular procedure performed during general surgical residency. As such, it may provide an opportunity for resident autonomy. We examined the effect of level of trainee and teaching assistant (TA) on operative times and the 30day complications. Method: Methods: At a public teaching hospital, consecutive upper extremity (AVF) performed by surgical trainees were retrospectively reviewed from a 20 month period. Procedures were classified into those with one trainee taught by the attending (no resident teaching assistant), and those with two trainees (a junior resident as primary surgeon, assisted by a more senior trainee who served as TA, supervised by an attending surgeon. Primary outcome measures were surgical time and 30 day complications. Results: Results: 261 total cases were performed in the study period. In 157 (60.1%), there was no trainee TA, whereas a TA was present in 104 (39.8%) operations. The postgraduate (PG) level of the TA was as follows: a vascular fellow in 17 cases (PGY6 or 7); in 59, a general surgery chief resident (PGY-5); in 5, a PGY-4, and in 23, a PGY-3 resident. In the majority of cases (65%) the primary surgeon was a PGY-3. Presence of a TA was associated with increased operative times (112 vs 97 minutes Wilcoxon p-value= 0.001) as compared to procedures done without a TA. Within the group without a TA, the PG year of trainee did not affect surgical time (p= 0.7). Complication data were available for 249 cases. There were 19 total complications. Presence of a TA was not associated with increased complications within 30 days of operation (7.7% vs 7.4% OR 1.05 CI 0.4-2.7 p= 0.91). Conclusion: Conclusion: The AVF appears to be suited for providing graduated general surgery resident autonomy. The 30 day complication rates are similar whether or not a TA is utilized. However, the presence of a TA is associated with significantly longer operative times. With an increasing emphasis on efficiency in the operating room, hospitals will need to determine whether lengthier operations for the sake of autonomy are feasible. 224 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTR ACTS April 2 – 5, 2017 | Hyatt Regency, Maui, HI 225 ePOSTER ABSTRACTS (cont.) P 1. TYPE OF CERVICAL SPINE FRACTURE AND VASCULAR INJURY OF THE NECK Y Ishida MD, VJ Olivas MD El Paso, TX Background: Due to advancement in imaging technology, more vertebral or carotid vascular injuries are detected after trauma. Vertebral and carotid vascular injuries are serious conditions that could lead to stroke, irreversible neurological sequelae and mortality. Up to 70% of traumatic vertebral artery injuries have an associated cervical spine fracture. However, there exists no consensus on when to obtain radiographic imaging of the neck to evaluate for vascular injury. Our purpose is to determine which type of cervical spine fracture is more associated with carotid or vertebral artery injuries and to determine if CT angiography of the neck is warranted in a patient with an isolated occipital condyle fracture. Method: This was a retrospective chart review of all carotid and vertebral artery injuries at UMC of El Paso’s Level I Trauma Center from January 2004 to December 2014. Results: We had 54 patients total including 16 blunt carotid artery injury patients (30%) and 38 blunt vertebral artery injury patients (70%). The most common mechanism was motor vehicle collision (60%) followed by fall (15%). The mortality was 18%. Angiography was performed in 42% and 18% required intervention such as stent placement. Facet dislocation/subluxation (31%) was the most common type of cervical fracture associated with cervical arterial injury, followed by C1-3 vertebral body fracture (25%), and transverse process fracture involving the transverse foramen (22%). (Figure 1) None of isolated occipital condyle fractures were associated with a carotid or vertebral artery injury. One patient with a transverse process fracture not involving the transverse foramen had a vertebral artery injury (2%). Comparing the number of carotid and vertebral artery injury in each type of fracture, C1-3 vertebral body fracture and facet sublaxation/dislocation were both more associated with vertebral artery injury versus carotid artery injury. (93% vs 7%, p=0.042; 94% vs 6%, p=0.011) The basal skull fracture was more associated with carotid artery injury than vertebral artery injury. (100% vs 0%, p=0.0003) Conclusion: Facet subluxation/dislocation, C1-3 vertebral body fracture and transverse process fracture involving transverse foramen are the type of fractures that are frequently associated with carotid or vertebral artery injury. It is important to assess for vascular injury in a patient with cervical spine fracture using radiographic imaging. Vascular imaging may be low-yield in a patient with isolated occipital condyle fracture. 226 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 227 ePOSTER ABSTRACTS (cont.) P 2. MASS CASUALTY PLANNING: A SURVEY OF TEN TEXAS TRAUMA CENTERS SE Long, MD; PG Teixeira, MD; TB Coopwood, MD; CVR Brown, MD; JD Aydelotte, MD Austin, TX Background: The general audience of the Disaster and Emergency Preparedness committee of the Texas Governor’s EMS & Trauma Advisory Council (GETAC) was polled about cooperation and communication between emergency preparedness planners (EPP) and clinical providers, specifically in reference to mass casualty incident planning and preparation. Over 80% suggested there was little to no cooperation between those who are hired by hospitals to develop the mass casualty plans and those who are charged with clinically executing them. Members of the committee were alarmed at this informal result and put together a task force to help answer this question at the hospital level. Our hypothesis was that the coordination and communication within major trauma centers in Texas was better than the committee poll would indicate. Method: We conducted an in-person survey of ten Level I and II trauma centers in Texas (Ben Taub, Parkland, Memorial Hermann, University Hospital San Antonio, San Antonio Military Medical Center, University Medical Center Brackenridge, South Austin Medical Center, John Peter Smith, Baylor Scott and White-Temple, and Baylor Scott and White-Dallas). A 31-question survey was administered assessing perceptions of communication, cooperation, and key elements of each institution’s mass casualty plans. Four key individuals of the disaster preparedness committee from each institution were interviewed: the Emergency Planner, the Trauma Medical Director, a chief Administrator (CMO, COO, CEO), and the Charge Nurse on duty in the Emergency Department at the time of our visit. The primary outcome was how often all parties felt that they met expectations in both the development and practice of mass casualty plans. Secondary outcomes included agreement on who would serve as the triage officer, which triage system would be used, and awareness of the designated delayed area in each hospital. Results: Forty respondents completed the survey for a response rate of 100%. In 80% of the hospitals, the interviewees considered the coordination and communication for developing the mass casualty plan either met or exceeded expectations. However, only 40% of the respondents rated the coordination and communication for carrying out the plan as either met or exceeding expectations. Only 20% of the hospital respondents agreed on who would function as the triage officer and in only one hospital did all three respondents agree on which space would serve as the delayed treatment area. 45% of the respondents were unaware of the location of the delayed area altogether. Only 30% of the charge nurses surveyed had actively participated in the development of the mass casualty plan for the emergency department and only half had been involved in practicing the mass casualty plan. 228 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) Conclusion: Significant deficiencies in communication and coordination regarding mass casualty plan execution was identified in the majority of the Texas trauma centers surveyed. And major disagreement regarding roles and responsibilities during a mass casualty exist. This seems to validate the original polling numbers and suggests our hospitals may not be as prepared as expected for a true mass casualty event. A bestpractice model for mass casualty planning and practice should be developed and an education / support system to standardize the practice in the state is warranted. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 229 ePOSTER ABSTRACTS (cont.) P 3. GEOGRAPHIC ANALYSIS OF TRAUMA READMISSIONS IN NORTH TEXAS DJ Sanchez MS, RE Gilder RN, M Dome MS, LB Petrey MD Dallas, TX Background: Due to the high cost and increased risk of mortality associated with unplanned patient readmissions, research has aimed to identify risk-factors in patients with high hospital utilization and recidivism. This study sought to identify geographic and clinical factors that are predictive of readmissions in trauma patients. Method: 11 years of data were collected for 21,231 patients admitted to a level 1 trauma center and readmissions following an index trauma admission were identified over this time. Data was queried from a regional database comprised of 88 member institutions that encompass more than 150 hospitals in the North Texas region. Patient ZIP code and county of residence were analyzed using binary logistic regression to determine significance of predictability of readmission by patient geography. Clinical variables such as demographics, diagnosis, ISS, procedure, Elixhauser comorbidity, insurance, and disposition data were also analyzed to create a full clinical and geographic regression model describing patterns in readmissions. Results: 4,487 patients were identified as having been readmitted during the data collection period with a combined 12,235 encounters. 52 variables were identified as significant predictors of readmissions including 21 geographic variables. Several counties and patient residence distance to the admitting hospital exhibited higher odds of readmission. While some ZIP codes were found to show an increased likelihood of readmission, others were identified as having a decreased likelihood. Median household income for each significant ZIP code was collected from a demographic data sharing website. Although income was not tested by statistical analysis, 7 out of the 12 significant ZIP codes had household incomes below the Texas average with no observable relation to odds ratio. Conclusion: This study found that a patient’s location can be used to help determine a likelihood of readmission following an initial admission for trauma. We believe that identifying risk factors for readmissions may help to aim targeted interventions toward patients to reduce chances of readmission and therefore, hospital utilization and cost. Identifying geographic areas that exhibit high readmission rates may help to develop outreach programs specialized in serving local patients to ensure adequate postdischarge follow-up and better quality recovery. 230 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 4. SERIOUS INJURY REPORTING SYSTEMS IN CHILDREN PLAYING ORGANIZED SPORTS: A SURVEY OF ALL 50 US STATES P Daher MD, J Aydelotte MD, K Rix MPH, B Ford MD, A Mardock, PG Teixeira MD, T Coopwood MD, CVR Brown MD Austin, TX Background: Participation in school sanctioned sporting events is at an all-time high. While efforts have been made by some states and private reporting agencies to estimate injury rates and patterns, no uniform reporting systems exist to capture major injuries on a large scale. Recent cases of catastrophic injuries sustained in sporting events that have garnered national attention prompted the authors to identify the overall landscape of injury reporting systems for both catastrophic injuries, deaths, and minor injuries sustained during sporting events. Method: All 50 states’ health departments and state governing athletic bodies were contacted via phone or email. Both agencies were surveyed to assess the presence and nature of an athletic injury reporting structure, the types of injuries collected (spinal cord injury, head injury, abdominal injuries, major fractures, and concussion), and the location of the compiled data. Results: 46 out of 50 states responded to our survey. Two states actively declined to participate and two states failed to respond at all. Twelve states had at least some sort of state-wide reporting system for sports-related injuries. Eleven states reported that they partially collected sports injury information, including 8 states (Alaska, Arkansas, Idaho, Illinois, Indiana, Ohio, Massachusetts, and Michigan) that only reported concussion and brain injury information (Figure1). Wisconsin collects only voluntary reported information on hospitalizations. Florida has an organized reporting structure but not a uniform data collection or storage platform. Nevada has only voluntary reporting by officials at games for any (but not all) injuries. All of which are highlighted in grey. Only Hawaii (highlighted in black) reported that they required schools to report all injuries sustained during athletic competition. Hawaii reports all injuries to their department of education and are analyzed by the state department of health. Conclusion: Injury reporting systems for school-sanctioned sports-related injuries are inconsistent in the United States with only Hawaii having any sort of formalized data collection for major injuries. Efforts should be made to create an easy to use, standard reporting system for both state health agencies and athletic governing bodies to capture injuries. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 231 ePOSTER ABSTRACTS 232 (cont.) Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 5. INFECTION AFTER PENETRATING BRAIN INJURY -- A DECADE OF ANALYSIS LA Harmon MD, LB O’Meara CRNP, MJ Joshi MBBS, TA Paterson MD, A Dhanda MD, J Kufera MS, TM Scalea MD, DM Stein MD, MPH, DJ Haase MD. Baltimore, MD Background: Penetrating brain injuries (PBI) are common, but the incidence of secondary central nervous system infections (INF) after PBI is poorly described. We determined the incidence and identified factors predictive of INF after PBI. Method: We retrospectively reviewed all patients with PBI, age greater than 18 years who survived over 72 hours, at a level 1 trauma center from 2006 to 2015. Patients were stratified by the presence or absence of INF. PBI was defined as the evidence of dural penetration by either CT scan or operative findings. Data included type of surgical intervention or intracranial pressure (ICP) monitoring, duration of antibiotic therapy, and type of INF. Descriptive statistics were calculated for all variables of interest, including age, sex, abbreviated injury score (AIS), length of antibiotics, length of stay, and disposition. Mantel-Hansel Chi square test was used to compare distribution of categorical variables between patients with and without INF. The Wilcoxon’s rank-sum statistic test was used to compare the distribution of non-parametric variables between the populations. Results: One hundred and fourteen patients with PBI were identified. Eight patients (7%) developed INF. Sixty two percent (n=71) of patients underwent operative intervention. Forty six percent (n=53) of patients had intracerebral pressure (ICP) monitors placed; 9% developed INF, compared to 5% without ICP monitors (p=0.19). INF rate was 10% in those patients compared to 2% in patients treated without operation (p=0.10). CSF or tissue cultures were obtained on all infections. Four patients (50%) had cultures positive for Staphylococcus or Propriobacteria. Four patients had negative CSF cultures but clinical signs of cerebral infection including one parenchymal abscess and three cases of ventriculitis were treated empirically. Two patients had surgical debridement. Eighty nine percent of patients (n= 101) received at least one dose of prophylactic antibiotics. All patients with INF received prophylactic antibiotics and 75% received an extended course (p=0.04). Prophylactic antibiotics did not impact the development of INF (p=0.37). Eighty seven percent (n=7) patients with INF had associated facial fractures and only one patient with INF had an isolated brain injury. Median Face AIS in patients with INF was 2 versus 1 in patients without INF (p=0.36). Median age was 48.5 years in those with INF and 27 years in those without INF (p=0.02). Mortality was 12.5% and 14%, respectively (p=0.27) Patients with INF had significantly longer hospitalization (p=0.02). Conclusion: INF occurs in only 7% of patients with PBI. Patients with INF were more likely to be older and have associated facial fractures. INF was not higher in patients treated with operation or ICP monitoring. Prophylactic antibiotics did not reduce the rate of INF. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 233 ePOSTER ABSTRACTS (cont.) P 6. THE HIGH COST OF LARGE BORE TUBE THORACOSTOMY FOR TRAUMATIC PNEUMOTHORAX BW Thomas MD, WB Lyman MD, RS Descamp BS, AB Christmas MD, KW Cunningham MD, RF Sing DO Charlotte, NC Background: Tube thoracostomy is a common procedure in patients that have sustained a traumatic pneumothorax. Within the last five years smaller diameter chest tubes have been used with increasing frequency to treat traumatic pneumothorax (PTX) The purpose of this study was to compare small bore chest tubes (SmCT) as defined as < 20 French (Fr) to large bore chest tubes (LgCT) defined as≥ 20 Fr. Hospital charges during admission and chest tube related complications were the primary outcomes. Method: A retrospective chart review of all trauma patients admitted to a regional American College of Surgeons verified Level 1 trauma center over a 38 month time period (01/2013-03/2016) was conducted. Patients requiring chest tube (CT) insertion for a traumatic pneumothorax either prior to arrival or during their hospitalization were included. All patients not surviving to removal of their initial chest tube were excluded. Patients requiring CT insertion for other indications including hemothorax, hemopneumothorax, and extremis were excluded and Injury Severity Score (ISS) of each subset was calculated in order to compare patients of similar acuity. Demographics, interventions, and outcomes were measured. Statistical analyses were performed using Fischer’s Exact Test and two sample t-tests. Results: A total of 327 patients received a chest tube for a traumatic PTX. 69.1% (n=233) had a LgCT initially inserted and 30.9% (n=104) had a SmCT initially inserted. LgCTs and SmCTs stayed in for an average of 5.8 and 3.0 days respectively. Primary outcomes for the small vs. large chest tube cohorts are reported in table 1. Conclusion: Small bore chest tubes (<20 Fr) are associated with a shorter duration of treatment, lower total hospital charges, and lower incidence of tube thoracostomy related complications. In light of these findings, small bore chest tubes should be the initial treatment of choice for traumatic pneumothorax. 234 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 7. CAN CT IMAGING OF THE CHEST, ABDOMEN, AND PELVIS IDENTIFY ALL VERTEBRAL INJURIES OF THE THORACOLUMBAR SPINE WITHOUT DEDICATED REFORMATTING? J Imran MD, T Madni MD, C Cornelius BS, J Pruitt MD, M Subramanian MD, A Clark MD, A Mokdad MD, I Nassour MD, J Minei MD, M Cripps MD, A Eastman MD Dallas, TX Background: Patients who sustain blunt trauma are at risk for multiple injuries and often undergo computed tomography (CT) imaging of the chest, abdomen and spine. Screening for thoracolumbar spine (TLS) injuries with reformatted CT imaging (CT T/L) is recommended; however it may not be necessary if CT imaging of the chest, abdomen, and pelvis (CT CAP) adequately screened for TLS injuries. The objective of this study was to compare TLS fracture detection rates between CT CAP and CT T/L. Method: We identified all patients at our institution with a TLS fracture after sustaining blunt trauma from July 2013 to December 2015. Patients who had both CT CAP and reformatted CT T/L imaging were included. Patients with isolated cervical spine fractures or incomplete imaging were excluded. The CT CAP imaging was reviewed and interpreted by one faculty radiologist who was blinded to the results of the reformatted images. Fractures were divided into groups based on type and location of fracture. The sensitivity of CT CAP to identify fracture was calculated for each fracture type. Continuous variables were represented as median and interquartile range (IQR) and categorical variables were expressed as percentages. Results: A total of 514 TLS fractures were identified in 125 patients using reformatted CT T/L spine imaging, with an equal number of lumbar and thoracic fractures. Multilevel fractures found in 33 patients (26.4%). The sensitivity of CT CAP for detecting TLS compression/vertebral body fractures and chance/burst fractures was 77% and 96%, respectively. Overall, 79 fractures (15%) were missed on CT CAP that were identified on CT T/L. However, only one fracture that was missed on CT CAP required therapy (bracing). Eleven vertebral body compression fractures with no height loss and one thoracic burst fracture were missed on CT CAP. Those with missed compression fractures did not require intervention. The median patient age and injury severity score were 43 years (IQR 30-53 years) and 27 (17-34), respectively. Conclusion: CT CAP could potentially be used as a screening tool for clinically significant TLS injuries. Improvements in imaging technologies should improve detection of present but clinically insignificant fractures. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 235 ePOSTER ABSTRACTS (cont.) P 8. POST-TRANSFER TUBE THORACOSTOMY PLACEMENT AMONG TRAUMA PATIENTS DIAGNOSED WITH A PNEUMOTHORAX OR HEMOTHORAX: IS IT ASSOCIATED WITH POOR OUTCOMES? Cullen McCarthy MD, Tabitha Garwe MPH PhD, Alexis Graham-Stevenson MD, Babawale Oluborode MD, Prasenjeet Motghare, Mary K. Lindemuth MD, Roxie M Albrecht MD, Aaron Scifres MD Oklahoma City, OK Background: Tube thoracostomy is commonly utilized in the trauma patient population. The benefits of tube thoracostomy placement can be immediate and lifesaving, though there are inherent risks. In all patients diagnosed with pneumothorax or hemothorax, Advanced Trauma Life Support (ATLS) guidelines currently recommend tube thoracostomy prior to transfer to definitive care facility. The purpose of this investigation is to describe the demographic characteristics, clinical characteristics and outcomes of chest trauma patients transferred to a Level 1 trauma center based on pre- and post-transfer tube thoracostomy placement. We hypothesize that pre-transfer placement of chest tubes does not improve outcomes in the trauma population and therefore may unnecessarily delay transfer to definitive care. Method: A retrospective study based on a cohort of chest trauma patients transferred to a Level I trauma center between January 2013 and June 2014. These patients carried the diagnosis of either pneumothorax or hemothorax, both with tube thoracostomy. Initially, 310 patient charts were reviewed. Exclusion criteria included patients were excluded for being under age 18, the diagnosis of bilateral pneumothoraces or hemothoraces, or a diagnosis of a pneumothorax or hemothorax that was not evident upon review of plain chest radiograph taken at presentation. Outcomes data was analyzed for the remaining patients. Results: Of the initial 310 patients, 77 met study eligibility. Thirty-eight patients had a chest tube placed by outside facility prior to transfer to our trauma center, while 39 had initial chest tube placed after transfer. There was no statistical significance in the demographics or comorbidities between the patient populations. Despite the presenting similarities, trends were noted in length of stay and days on ventilator; both were decreased in the patient population who received their chest tube after transfer. Complication rates between the two groups were nearly identical, though there was a slight trend towards higher rate of dislodgement in chest tubes placed prior to transfer. Interestingly, statistical significance was noted in the need for additional procedures, with 50% of all patients who had underwent chest tube prior to transfer requiring either additional chest tubes, video-assisted thoracoscopy, or formal thoracotomy. Of the patients who received their initial tube thoracostomy after transfer, less than 13% required additional procedures for pleural pathology. Conclusion: This survey of one trauma center’s patient population suggests that deferring tube thoracostomy placement until after transfer to definitive facility may be a safe strategy for management of hemodynamically stable traumatic pneumothoraces and hemothoraces. It may also serve to spare patients further invasive procedures. However, future, large-scale studies are needed to assess the risks and benefits of tube thoracostomy placement in trauma patients prior to transfer to trauma centers. 236 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 9. PRE-HOSPITAL SPINAL IMMOBILIZATION: NEUROLOGICAL OUTCOMES FOR SPINAL MOTION RESTRICTION VS. SPINAL IMMOBILIZATION A Nilhas MD, RM Drake MEd, SD Helmer PhD, J Reyes MEd, M Foster MD, JM Haan MD Wichita, KS Background: A new recommendation for EMS spinal precautions limits long spinal board (LSB) use to extrication purposes only. The purpose of this study was to determine neurological outcomes for spinal motion restriction vs. spinal immobilization using LSB. Method: Beginning in January 1, 2014, a protocol for selective use of LSB was instituted by EMS with the agreement that LSB would not be used if patients were oriented, not clinically under influence of alcohol/drugs, without distracting injury, and without spinal tenderness. A 2-year retrospective review was conducted of all trauma patients admitted to a level 1 trauma center with documented spinal injury, while using the selective protocol. Demographics, accident events, injury severity scores (ISS), Glasgow Coma Scale (GCS) scores, alcohol/drug screen, and neurologic assessments from EMS, trauma teams, and hospital staff were collected for those transported with or without LSB. Results: Of the 277 trauma patients reviewed, 25 (9.0%) had LSB in place upon arrival. Thirty-five (12.6%) patients had previous neurologic deficit/diagnosis. Patients placed on LSB more often had documented neurological deficits by EMS (30.4% vs. 8.8%, P=0.01) and the trauma team (29.2% vs. 10.9%, P=0.02). Patients placed on LSB were more often moderately or severely injured [ISS>15 (36.0% vs. 9.9%, P=0.001)] and had a GCS <9 (12.0% vs. 2.8%), but this was not statistically significant (P>0.05). Of note, there was an increased motor deficit noted from post extraction to trauma team (4.4% vs 8.5%) for those not on LSB. On further review, in all but one instance these were patients with peripheral nerve deficits and extremity fracture. The final patient had an L1 fracture with diffuse weakness of bilateral lower and upper extremities, which later improved. As such, no progression of injury occurred in any patient with and without LSB. Conclusion: This study suggests that LSB is being properly used in the majority of more critically injured patients. No progression of injury was identified in patients with spinal injury, even without long board immobilization. Further research is needed to compare neurological outcomes for spinal restriction vs. immobilization using a larger sample size and more consistent documentation of pre-extraction EMS examination. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 237 ePOSTER ABSTRACTS (cont.) P 10. RIDE-SHARING PLATFORM TECHNOLOGY’S IMPACT ON DRUNK DRIVING CRASHES AND DEATHS E Ross MD, S Radpour MA, PGR Teixeira MD, TB Coopwood MD, CVR Brown MD, JD Aydelotte MD Austin, TX Background: Drunk driving represents a severe public health problem in the state of Texas. In 2014, 14.5% of all alcohol involved traffic fatalities in the United States occurred in Texas. Mothers Against Drunk Driving estimates the 2013 taxpayer burden of alcohol related crashes in Texas at $6.2 billion. According to the University of Washington’s Institute of Health Metrics and Evaluation, in 2012 Travis County had rates of any alcohol consumption, heavy drinking and binge drinking above the national average. Ride-sharing companies such as Uber and Lyft began to operate in Austin in the Spring of 2014. A study in Seattle, Washington, found that drunk driving arrests decreased after the implementation of ride-sharing platforms. Our hypothesis was that the emergence of ride-sharing platforms contributed to an overall decrease in drunk driving crashes and deaths in our city. Method: All crashes and deaths involving drunk drivers recorded in the Texas Department of Transportation’s (TxDoT) Crash Records Information System (CRIS) database for Travis County were extracted from May 2011 through August 2015. In order to correct for changes in traffic volumes, total vehicle traffic, calculated as millions of vehicles per month (mvpm) was estimated by the TxDoT Traffic Count Database System (TCDS) at two permanent points in Travis County. This system serves as part of the the raw data for vehicle miles travelled as reported to the US Department of Transportation. Time periods were compared as monthly averages in the entire period prior to ride sharing implementation (PreRide) and after the platforms were implemented in Austin (PostRide). The two time periods (pre and post-ride sharing implementation were compared using a student’s t-test. Results: PreRide and PostRide drunk driving crashes (43.6, 44.2, p=0.81), deaths (3.3, 3.2, p=0.81) and vehicle traffic (10.0 mvpm, 10.1 mvpm, p=0.46) were compared. The monthly rate of drunk driving crashes per million vehicles was 4.3 crashes per mvpm in the PreRide period and 4.4 crashes per mvpm in the PostRide period (p=0.63). The monthly rate of drunk driving fatalities per million vehicles was 0.33 deaths/mvpm in the PreRide period and 0.32 deaths/mvpm in the PostRide period (p=0.84). Conclusion: There does not appear to be an association with ride-sharing platforms and a decrease in drunk driving crashes or deaths in Austin, TX. A larger, multi-city/ multi-state, study should be done over a longer time period to better analyze the data. 238 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 239 ePOSTER ABSTRACTS (cont.) P 12. HAWAII: ISLANDS OF PARADISE- AND PERFORATED DUODENAL ULCERS C Souther MD, WL Biffl MD Honolulu, HI Background: The incidence of complications from duodenal ulcers has been decreasing since the introduction of proton-pump inhibitor (PPI) therapy. Despite this trend in the literature, we seem to see perforated duodenal ulcers relatively frequently in our local hospitals in Hawaii. The purpose of this study was to determine whether the incidence of perforated duodenal ulcers is truly higher in Hawaii and to characterize the patient population. Method: A retrospective review was conducted using data obtained from the Healthcare Cost and Utilization Project (HCUP) database provided by the US Department of Health and Human Services. The total number of hospital discharges with the principal diagnosis of chronic duodenal ulcer with perforation (ICD-9 code 532.50) and associated demographic data were obtained from the state of Hawaii and from the national level (which includes 47 states) during the years of 1997 through 2013. The data from Hawaii were compared with national numbers using T-tests (a p-value of <0.05 was considered significant). Results: From 1997 to 2013, a significantly higher proportion of hospital discharges in Hawaii (17.8 cases per 100,000 hospital discharges) were associated with a principal diagnosis of perforated duodenal ulcer than in the US as a whole (13.7 cases per 100,000 hospital discharges; p=0.006), with cases increasing in Hawaii throughout the study period (Figure 1). A significantly higher percentage of these patients were discharged home in Hawaii than at the national level (p=0.002). The mean charges for these hospitalizations were significantly different between Hawaii and the entire US ($48,754 and $61,666 respectively; p=0.027). The mean age of these patients was similar in Hawaii and nationally (59.6 vs 61.5; p=.097). Conclusion: The diagnosis of chronic duodenal ulcer with perforation was seen more frequently in Hawaii than in the US as a whole during the time period between 1997 and 2013. This may be due to lower accessibility of PPIs especially for patients who have recently moved from other Pacific Islands. More of the patients were discharged directly home and the average charges were lower in Hawaii which may be due to the familiarity of managing this disease process due to its higher incidence. In contrast to the rest of the US, perforated duodenal ulcers remain an important surgical problem in Hawaii. This regional variation in incidence should prompt further investigation to elicit the causative factors so that earlier interventions can be made. 240 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 241 ePOSTER ABSTRACTS (cont.) P 13. DESTRUCTIVE TORNADOS: A COMPARISON OF TORNADOASSOCIATED INJURIES IN ADULT VERSUS PEDIATRIC PATIENTS FROM A COMBINED TRAUMA CENTER A Landmann MD; RW Letton MD; RM Albrecht MD; JS Lees MD Oklahoma City, OK Background: Tornados are among the deadliest of all natural disasters. Each year, approximately 2,000 tornados occur worldwide. The purpose of this study was to characterize patterns of injury in adult and pediatric patients treated at at a combined pediatric and adult trauma center. Method: After institutional IRB approval, patients treated with tornado-associated injuries were identified from the trauma registry at a combined pediatric and adult trauma center. Results: During the study period from May 1999-June 2013, 96 patients were seen as trauma activations corresponding to two EF5 and four EF4 tornados in the surrounding community, 38 pediatric and 58 adult patients. There were tendencies to different presentations between groups in terms of injuries, interventions and hospital length of stay. (Table 1) Pediatric patients were more likely to be male (70% vs. 50%), have soft tissue injuries (61% versus 31%) and long bone fractures (26% versus 17%). TBI was common in both groups (18% versus 21%). Children were less likely to have spine fractures (3% versus 43%) and no spinal cord injuries were identified in pediatric patients (0% versus 7%). Conclusion: This patient cohort represents the highest concentration of deadly tornados in one geographic area. Since Mmulti-system injuries were common in ; both pediatric and adult patients, tornado victims should be delivered to benefit from treatment at trauma centers capable of providing multidisciplinary care. 242 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 16. OUTCOMES OF RURAL TRAUMA PATIENTS WHO UNDERGO DAMAGE CONTROL LAPAROTOMY PA Harwell MD, J Reyes MEd, SD Helmer PhD, JM Haan MD Wichita, KS Background: Rural trauma patients have nearly twice the mortality of their urban counterparts. A majority of fatal motor vehicle collisions occur in a rural setting. While rural hospitals may be ill-equipped to treat these patients long-term, there may be a role for operative stabilization before transfer to higher-level trauma centers. Method: A 5-year retrospective review was conducted of all trauma patients≥18 years of age with abdominal injuries transferred to an ACS verified Level 1 Trauma Center from a rural facility. Demographics, injury severity and details, operative procedures, and hospitalization outcomes were evaluated for those patients who had a damage control laparotomy performed at an outside hospital (DCL), were considered unstable and had an exploratory laparotomy within two hours of arrival from an outside hospital (ILU), or were considered stable and had an exploratory laparotomy within two hours of arrival from an outside hospital (ILS). Results: Among the 16 patients included in this study, 25% (n=4) had DCL, 25% (n=4) had ILU, and 50% (n=8) had ILS. Only 18.8% (n=3) of patients sustained penetrating injuries. All other injuries were from blunt trauma. Half of the DCL group had significant intra-abdominal vascular injuries. Three patients in the ILU group had significant intra-abdominal injuries and two patients were hypotensive on arrival. Small bowel and colon injuries were more common in ILS. All patients in DCL and ILS survived while no patients in ILU survived hospitalization (see table). Conclusion: While this study has limited patients for comparison, the data would support that a patient’s mortality is improved with damage control laparotomy prior to transfer in unstable trauma patients. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 243 ePOSTER ABSTRACTS (cont.) P 17. GLOBAL HEALTH OPPORTUNITIES: DOES INTEREST EQUAL ACTION? AM Pasley DO, ES Wise MD, U Shah, S Gupta MD, N Hansraj MD, JD Pasley DO, A Kushner MD, M Brenner MD, JJ Diaz MD Baltimore, MD Background: Trauma has become a worldwide pandemic projected to be the 4th leading cause of death by 2030, the burden of which is highest in low-and-middle income countries (LMICs). Interest to help tackle this global burden of injury is rising within the trauma community after the Haiti earthquake and Typhoon Haiyan. It is unknown whether surgical critical care fellowship programs (SCCFP) offer opportunities in this area, or if these experiences are represented at national conferences. Method: All ACGME SCCFP websites were identified. Inclusion criteria included mention of global or international opportunities for fellows. Details of opportunities were recorded. Program brochures from The American Association for the Surgery of Trauma (AAST), Eastern Association for the Surgery of Trauma (EAST), and Western Trauma Association (WTA) from 2015 and 2016 meetings were examined to determine the number of presentations discussing global/international health issues. Results: 110 SCCFP were identified. Four (3.6%) programs mention an international/ global trauma opportunity. One level 1 trauma center mentions the opportunity to be exposed to international trauma systems, another advertises opportunity to “train abroad” with no further specifications, and a third describes opportunities of “global health” to develop programs in “economy-restricted environments”. A fourth program describes direct international collaboration with an international trauma society. Representation of this topic on a national forum is equally dismal; in 2015, zero of 208 presentations were on global health (0.0%), in 2016 only three of 376 presentations (0.008%) discussed the topic. Conclusion: Despite a recognized need and interest in global trauma care, there is a clear lack of opportunity available to prospective applicants to SCCFP. The almost absent representation of such experiences at national meetings is likely a direct outcome of this unfortunate reality. Educational relationships with accredited SCCFP and LMIC collaborators would provide a valuable opportunity to trainees while concurrently helping to improve global trauma care. 244 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 18. LAPAROSCOPIC APPENDECTOMY IN THE NON-ACUTE APPENDIX: IS IT APPROPRIATE? DL Wyrick MD, AT Mancino MD Little Rock, AR Background: Although laparoscopy is the common approach to appendectomy for acute appendicitis, there is debate on the preferred approach for appendiceal masses and mucoceles. Our aim was to review our experience with management of these entities. Method: We reviewed our surgical database for appendectomies performed for reasons other than appendicitis, in the period from July 2006 to October 2016. Basic demographic information, diagnostic modality, symptoms, indication for procedure, operation performed, and final pathology were collected and analyzed. Results: Eleven cases were identified, all were male. The median age was 60 years. Five were African American and the remainder were Caucasian. Seven patients were asymptomatic; four were identified incidentally on computed tomography (CT) and three on screening colonoscopy. Four patients presented with pain and appendiceal pathology was diagnosed on CT. Preoperative diagnosis included two appendiceal masses, three polyps, and six mucoceles. Eight of the operations were approached laparoscopically with one conversion to open due to difficult dissection. The remainder were done via an open approach; two due to previous surgeries/adhesions and one due to concern for mucinous cancer. Appendectomy was performed on all, including a portion of cecum on the three patients with polyps at appendiceal orifice. Final pathology on the two masses were an angiomyolipoma and a carcinoid tumor. The three polyps were benign. The final pathology on the mucoceles included three low grade mucinous neoplasms, one mucocele, and one benign appendix. No patients needed further resection after review of final pathology. Conclusion: Laparoscopy is an effective technique in the management of these uncommon appendiceal pathologies. Appendectomy with additional partial cecectomy or hemicolectomy should performed as indicated. Conversion to open should be considered in the face of difficult dissection to prevent spillage of mucin. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 245 ePOSTER ABSTRACTS (cont.) P 20. EPIDEMIOLOGY PROJECT REVEALS SIGNIFICANTLY LOWER INCIDENCE OF FUNCTIONAL GALLBLADDER DISORDER THAN THE STATE AND NATIONWIDE ADMINISTRATIVE DATABASE MO Mohamed MBBS, CA Thiels DO, J Bingener MD Rochester, MN Background: Recently, several authors have postulated that there is an unjustified increase in the use of cholecystectomy for functional gallbladder disorder (FGBD) nationwide based on large administrative data sets. We aimed to identify the incidence and the cholecystectomy rate for FGBD in an epidemiologically well-defined population and to compare results to previously published administrative data. Method: After IRB approval had been obtained, we extracted data from the Rochester Epidemiology Project (REP), a unique population-based research infrastructure system that links together nearly all of the medical records of residents of Olmsted County, MN. Olmsted County includes a community and a teaching hospital serving a population base of about 135,000 people. Similar to other studies, we used ICD9 codes for “˜gallbladder disease not elsewhere specified’ (575.8) and “˜unspecified disorder of gallbladder’ (575.9) to identify all patients with FGBD from 2000 to 2014. Medical records were abstracted for demographics, diagnostic testing, additional diagnosis and imaging findings including HIDA scan. Patients with the concomitant diagnosis of cholelithiasis were excluded. Results: Over a 15-year period, after excluding patients with cholelithiasis (n=354), we identified 253 patients with a CPT code for unspecified gallbladder disease. Of those, 184 patients had other confirmed diagnosis such as Primary Sclerosing Cholangitis. Sixty-nine patients had biliary symptoms with no gallstones on ultrasound. In the community hospital, 22/25 (88%) of the patients underwent HIDA scan as part of the diagnostic workup compared to 18/44 (41%) in the teaching hospital. Based on the review of their medical records 24 of these patients had confirmed FGBD, 20 women (83%), mean age 38.2±14.4 years.The incidence of FGBD in Olmsted County was 1.77/10,000. (15/141 (11%) of patients with ICD-9 code 575.8 and 9/112 (8%) with ICD-9 code 575.9). The rate of cholecystectomy for FGBD was 70% at both hospitals. Conclusion: The incidence of FGBD in Olmsted County (1.7) was much lower than the previously published incidence in administrative data for Minnesota 3.0/100,000. In our study, only a small fraction of patients (11%) with the ICD-9 codes for unspecified gallbladder diagnosis had FGBD compared to the State Inpatient Sample which postulated that FGBD accounted for more than 80% of administrative code 575.8. Medical diagnosis patterns differed between teaching and community hospitals, whereas the cholecystectomy rate was similar between the two hospitals (around 70%) and only slightly lower than the previously published rate in a nationwide sample (78%). Additional investigation may be needed to understand if the rate of cholecystectomy is truly increasing. 246 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 247 ePOSTER ABSTRACTS (cont.) P 21. PHEOCHROMOCYTOMA: A CASE OF DEVASTATING RESPIRATORY FAILURE WITH ECMO SALVAGE Greenleaf CE MD, Griffin LA MD,Cox KM MD Shake JE MD , Orr WS MD Jackson, MS Background: Pheochromocytoma (Pheo) is an uncommon adrenal tumor that typically presents with headaches, sweating, palpitations, and paroxysmal hypertension (HTN). Surgical resection of Pheo is the curative treatment. Preoperative management includes alpha-blockade and volume expansion followed by beta-blockade, after sufficient alpha-blockade has been established in order to prevent hypertensive crisis. Pheo crisis can lead to cardiomyopathy, pulmonary edema, and total circulatory collapse. Method: Here we describe our experience with a patient who was transferred to our institution with Pheo crisis in hypoxic respiratory failure requiring extracorporeal membrane oxygenation (ECMO) to stabilize prior to surgical resection of a left Pheo. Results: A 37 year old female presented to an outside hospital (OSH) with complaints of nausea, vomiting and abdominal pain. In the emergency department (ED), she had a syncopal episode, and was found to be hypoxic with oxygen saturations in the 80s and profoundly hypertensive with a blood pressure (BP) of 200s/100s. She was intubated and transferred to our tertiary center. Upon arrival, she was found to have worsening oxygenation and ventilation (OV) despite increasing ventilatory support. Initial arterial blood gas showed a pH of 6.8, pCO2 of 51, pO2 of 71 and a lactate of 10. She was admitted to the medical intensive care unit (MICU). Multiple ventilatory modes to improve respiratory status were tried unsuccessfully. The patient also had BP lability with systolic BP ranging from the 80s to 200s. Due to failure to ventilate and oxygenate, she was placed on veno-venous ECMO (ECMO). Her OV markedly improved. After stabilization, further work-up was obtained. Family discussion revealed the patient had a long history of refractory HTN as well as a history of intermittent headaches and palpitations. Due to financial strain, the patient had not been able to afford her anti-hypertensive medications for two weeks prior to presentation. Computerized tomography scan showed bilateral, diffuse areas of ground glass opacity in the lung parenchyma as well as a large left adrenal mass. Laboratory work-up revealed elevated serum and urinary metanephrines. The patient spent 3 days on ECMO and temporary hemodialysis. After two weeks of alpha blockade, the patient underwent an open left adrenalectomy. Final pathology showed Pheo without local invasion. The patient was discharged on only one antihypertensive medication, and at two months postoperatively she was found to be doing well with a BP of 120/80 and normal kidney function. Conclusion: This case highlights the difficulty in the management of cardiogenic shock and respiratory failure secondary to pheochromocytoma and the important role that ECMO can have in the successful resuscitation and management of these patients. 248 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 22. DIRECT PERITONEAL RESUSCITATION IN SEVERE NECROTIZING PANCREATITIS: A STRATEGY FOR PREVENTION OF ABDOMINAL COMPARTMENT SYNDROME? A CASE REPORT AM Pasley DO, L O’Meara CRNP, F Boulos MD, N Hansraj MD, B Eaton CRNP, JD Pasley DO, R Tesoriero MD, JJ Diaz MD. Baltimore, MD Background: Intra-abdominal hypertension (IAH) complicates 15-60% of severe acute pancreatitis (SAP) cases. Up to 30% develop abdominal compartment syndrome (ACS) with mortality rates as high as 75%. The use of direct peritoneal resuscitation (DPR) has been shown to increase primary fascial closure and reduce intra-abdominal complications in acute care surgery due to reductions in crystalloid infusion and prevention of visceral edema. We hypothesized that DPR may be able to mitigate ACS in patients with SAP. Method: We present a case report describing the use of DPR to prevent ACS in SAP. Results: A 54 year old male presented with acute necrotizing pancreatitis with a computed tomography severity index (CTSI) of 9. He was intubated for rapidly progressive respiratory failure and despite ongoing resuscitation developed circulatory failure requiring three vasopressors, acute kidney injury, and ACS. He was taken to the operating room and a standard peritoneal dialysis catheter was placed. He received DPR with 2.5% Deflex; 1 liter infusion with a 1 hour dwell time every 4 hours. Over the next three days he gradually improved [post-operative day (POD) 1; bladder pressure (BP): 25, urine output (UO): 505 milliliters (mL), vasopressors: 3. POD 2; BP: 16, UO: 1700 mL, vasopressor: 1. POD 3 BP: 13, UO: 2735 mL, vasopressors: 0.] He received a tracheostomy due to prolonged respiratory failure and was discharged to a rehabilitation center on hospital day 37 without permanent organ failure. Conclusion: Due to need for aggressive fluid resuscitation in SAP there is an increased risk for ACS. Patients failing medical management require decompressive laparotomy with significant morbidity and mortality. As an alternative, DPR may be able to treat and prevent ACS in the setting of SAP. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 249 ePOSTER ABSTRACTS (cont.) P 23. ACE INHIBITOR INDUCED INTESTINAL ANGIOEDEMA: A LITTLE KNOWN BUT SIMPLY CORRECTED PROCESS CONFUSED WITH INTESTINAL ISCHEMIA SW Ross MD, VA Augenstein MD, BW Thomas MD, Avery MJ BS, Heniford BT, Sing RF Charlotte, NC Background: Angiotensin converting enzyme inhibitors (ACE-i) are the most commonly prescribed anti-hypertensives in the US. Oropharyngeal and lingual angioedema related to ACE-i is a well-recognized allergic reaction to the drug. Less well known is that the small intestine can also experience the same swelling, edema, and hyperemia that can often have a similar radiographic appearance to intestinal ischemia (Figure). There have been less than 30 case reports in the literature of this phenomenon and, herein, we report our experience with of ACE-i induced intestinal angioedema. Method: A retrospective analysis was performed of all cases of suspected ACE-i induced bowel angioedema evaluated by an Acute Care Surgery service at a regional tertiary referral center, from 2010 to 2016. The primary outcomes of interest were resolution of symptoms, readmission, any surgical intervention. Standard descriptive statistical tests were used. Results: Fourteen patients were identified over the time period, all with surgery consulted for concern for enteritis with bowel ischemia. Patient mean age was 46 ± 15 years and 78.6% of patients were female. Patients most commonly had symptoms of abdominal pain (100%), nausea (71.4%), emesis (57.1%), diarrhea (21.4%), and a leukocytosis (64.3%). 28.6% of patients were admitted from clinic with 71.4% presenting from the emergency department. Only 3 patients (21.4%) had a diagnosis of ACE-I induced angioedema at admission. Time from onset of symptoms from initiation of ACE-i was variable with a range of 1 - 709 days, with a mean time of 188.6 ± 226.0 days. On CT scan 100% had bowel wall thickening, 50% had surrounding edema, and 35.7% had surrounding free fluid. On initial admission no patients were taken to surgery, but only 6 (42.9%) had correct diagnosis and discontinuation of ACE-I; 8 (57.2%) had supportive care. Of those with ACE-I discontinuation, none had recurrence of symptoms, but of those still taking ACE-I, 7/8 (87.5%) were readmitted. 3/8 (37.5%) had endoscopy during the readmission, but only 2/8 (25%) had ACE-I discontinued on readmission. 4/6 (50%) patients still on ACE-i then represented for a second readmission. All these patients eventually had ACE-i discontinued and had resolution of symptoms. Two patients were lost to follow-up. Conclusion: ACE-I induced angioedema is a rare disorder with a worrisome radiologic appearance, but benign straightforward course if the medication is discontinued in a timely fashion. Similar to the oral angioedema, ACE-I induced intestinal angioedema can present years after initiation of therapy, and therefore can be very hard to diagnose if not clinically suspicious. Failure to recognize the condition will result in delayed diagnosis, return of symptoms, and readmission until the ACE-i use has been discontinued. However, while often consulted to evaluate as a surgical emergency, in our experience this clinical entity does not require surgical intervention. 250 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 251 ePOSTER ABSTRACTS (cont.) P 24. GALLBLADDER WALL THICKNESS MEASURED ON ULTRASOUND: IS IT ASSOCIATED WITH OPERATIVE TIME AND SURGICAL PATHOLOGY? RS Watson MD, KA Brusky BS, AJ Borgert PhD, KJ Kallies MS, SN Kothari MD La Crosse, WI Background: Ultrasound (US) is the primary initial imaging study to diagnose potential gallbladder pathology as it is efficient, noninvasive, cost-effective, and is highly accurate. Gallbladder wall thickness is routinely measured on initial US and incorporated into the evaluation of patients with various gallbladder pathologies. The impact of gallbladder wall thickness area of interest for many, however large series are relatively missing from the literature, and correlation with pathologic measurement and severity are not widely reported. Method: A retrospective review of the medical records of all patients who underwent cholecystectomy at our community teaching hospital from January 2013 through April 2016 was completed. Gallbladder wall thickness measured by US was compared to pathology measurements. US wall thickness was also correlated with pathologic severity, graded as follows: 1. Normal gallbladder, 2. Cholelithiasis, 3. Chronic cholecystitis, 4. Acute on chronic cholecystitis, 5. Acute cholecystitis, 6. Gangrenous cholecystitis. Statistical analysis included Wilcoxon sign test, and Pearson correlation. Results: There were 976 patients included, 68% were female. Mean age and BMI was 49.2 ± 18.1 years and 32.2 ± 7.4 kg/m2, respectively. Thirtythree percent of cholecystectomies were performed urgently, and 98.7% were performed laparoscopically. Intraoperative cholangiograms were done in 65% of cholecystectomies. Median operative time was 77 minutes (20 - 292). Mean common bile duct diameter was 5.1 ± 2.4 mm. The mean gallbladder wall thickness was 3.4 ± 2.1mm on US, and 3.8 ± 2.6mm on pathology. Gallbladder wall thickness on US was strongly correlated with wall thickness on pathology (r = 0.44, P<0.001). Operative time increased with thickness of the gallbladder wall on ultrasound with (r = 0.29, P< 0.0001) and on linear regression analysis, each mm of wall thickness correlated to an increase of 5.1 minutes in operative time. The mean differences between gallbladder wall thickness on US vs. pathology were greater as pathologic severity increased (0.7 mm difference for least severe vs. 3.4 for most severe; P<0.001). Conclusion: This is one of the largest series evaluating ultrasound predicting operative outcomes and provides definitive data on the subject. Increased wall thickness correlated to more difficult operations as indicated by the increase in operative time. Contrary to previous studies in the literature, we did not observe any significant difference in conversion to laparotomy or complications with increasing wall thickness. Gallbladder wall thickness on ultrasound becomes less accurate compared to pathology with increasing severity of disease. These data suggest that increasing gallbladder wall thickness could be included in preoperative planning for equipment needs, timing of intervention, availability of assistants and anesthesia considerations. 252 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 25. SAFETY AND FEASIBILITY OF SEMI-RIGID INCOMPLETE ANNULOPLASTY RING IMPLANTATION FOR FUNCTIONAL MITRAL REGURGITATION PG Chan MD, EG Chan MD, C Hamilton, D Chu MD Pittsburgh, PA Background: Previous studies have shown that incomplete mitral annuloplasty ring implantation incurs poor freedom from recurrent mitral regurgitation (MR) in patients with functional mitral regurgitation (FMR). Recently, semi-rigid incomplete mitral annuloplasty rings with preservation of intercommissural distance have been introduced. We hypothesize that semi-rigid incomplete mitral annuloplasty rings are safe and feasible treatment option for patients with FMR. Method: From January 2011 to 2016, fifty-three consecutive patients underwent mitral valve repair for FMR in a single quaternary referral institution. Safety and feasibility were evaluated by percentage completion of mitral valve repair, mortality, and freedom from recurrent MR (defined as >2+) as determined by echocardiograms. Results: The mean age for the cohort is 66.8±1.9 years old. Completion of implantation of the semi-rigid mitral annuloplasty ring was 100%. 30-day and 1-year mortality rates were 1.9% and 3.7% respectively. Freedom from recurrent MR was 90.6% (48/53) during median follow up period of 11 months. Conclusion: In the surgical treatment of FMR, semi-rigid incomplete mitral annuloplasty ring may be considered a safe and feasible alternative with low mortality rates and high freedom from recurrent MR. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 253 ePOSTER ABSTRACTS (cont.) P 26. STRAY ENERGY TRANSFER TO REINFORCED ENDOTRACHEAL TUBES DURING NECK SURGERY SA Hilton MD, E Jones MD, A Kiourti PhD, S Bojja-venkatakrishnan MS, A Madani MD PhD, DM Overbey MD, DJ Mikami MD, JW Hazey MD, TS Jones MD, TN Robinson MD Aurora, CO Background: Energy based devices are used in virtually all operations for dissection and hemostasis. Ensuring a dry operative field is especially important in head and neck operations where hematoma formation can result in airway compromise. Reinforced endotracheal tubes are widely used to protect the airway during head and neck surgery. These tubes are reinforced with a coiled metal wire that could absorb stray energy from common electrosurgical devices resulting in airway injury. The purpose of this study was to confirm stray energy transfer to reinforced endotracheal tubes and to identify surgeon-controlled factors that may reduce this energy transfer. Method: A 7 Fr, reinforced endotracheal was placed in a live porcine model. A standard monpolar “bovie” pencil, an advanced bipolar device and an ultrasonic device were activated for 5 seconds or one cycle on the superficial and deep tissues of the neck. Stray energy was measured with radiofrequency energy probes placed around the cable to the energy device (energy input) and the reinforced endotracheal tube as it emerged from the animal’s mouth (stray energy). Stray energy transfer was compared to control (no energy activation) with statistical significant set at p < 0.05. Results: Stray energy is transferred to the reinforced ETT with all energy types. (Table 1). The use of energy devices in deep tissue transfers significantly more energy than on the skin (3270±170.3 vs. 57.4±15.7 milliAmps, p<0.001). Bipolar and ultrasonic devices do result in stray energy transfer to the endotracheal tube but the overall amount is an order of magnitude less. Using cut mode instead of coag mode also reduces the amount of stay energy transfer in the superficial and deep tissues of the neck (502±115.5 vs. 3270±170.3 mA, p<0.001 for deep neck tissue; 12.8±8.3 vs. 57.4±15.7 mA for superficial tissue, p<0.001). Conclusion: Stray energy is transferred to the wires within a reinforced endotracheal tube during neck surgery. The amount of energy transferred is significantly higher with monopolar energy compared to bipolar or ultrasonic energy. Surgeons can decrease the risk of stray energy transfer by avoiding reinforced endotracheal tubes or using bipolar or ultrasonic energy devices during deep neck dissection. 254 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) Table 1 – Stray Energy Transfer during Neck Surgery Device Mean Energy Input Mean Stray Energy Transferred (%) 57.4mA (1.4%) Monopolar Superficial 4264±331mA Monopolar Deep Tissue Advanced Bipolar 3532±166.6mA 3270mA (93%) 41.34±8.17mA 87.3mA (212%) Ultrasonic Device 3.98±0.1mA 3.58mA (90%) Table 1 legend: stray energy was measured as the percentage of energy input, measured as milliAmps (mA) on the cable to the energy device, that was returned on the reinforced endo-‐tracheal tube. The monopolar device utilized settings of 30W on Coag mode, the advanced bipolar device utilized the 3 bar (max) setting and the ultrasonic device was utilized on the max setting. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 255 ePOSTER ABSTRACTS (cont.) P 27. THE SENSITIVITY OF 4D MRI IN PREOPERATIVE LOCALIZATION OF PARATHYROID ADENOMA IS INFLUENCED BY THE SIZE OF THE ADENOMA KO Memeh MD, JE Palacios, MA Guerrero MD Tucson, AZ Background: 4D MRI is a relatively novel image modality for pre-operative localization of parathyroid adenoma in patients with primary hyperparathyroidism ( PHPT).Experience with this image modality for this specific indication continues to evolve. Our group has previously demonstrated the superiority of 4D MRI over conventional imaging in the diagnosis of single gland parathyroid adenoma (PTA). We have also showed that 4D MRI performs well in quadrant localization of single gland PTA but poorly identifies and/or localizes multi-gland PTA. In this study, we set out to determine if the size of the diseased gland(s) has any role in the performance of the 4D MRI in the diagnosis and correct localization of PTA. Method: We analysed and matched the result of 4D MRI of all patients who underwent parathyroidectomy at our center between Feb 2015 and May 2016 with the intra-operative findings. All resections were confirmed successful with adequate decrease in intraoperative PTH as defined by the Miami criteria. We then examined the effect of size of parathyroid lesion (as measured by the pathologist) on the performance of the 4D MRI as mentioned above. Results: 26 patients underwent parathyroidectomy for PHPT after undergoing pre-op localization with 4D MRI. 14 patients had single gland while 12 patients had multigland PTA respectively. MRI accurately diagnosed all 26 patients as having PTA preoperatively. It also identified and quadrant localized the adenoma in all 14 patients with single gland PTA. However, it was only able to correctly diagnosed 33% of the 12 patients as having multi-gland disease. There was a statistically significant difference between the mean diameter of the single gland PTA and the multi-gland PTA respectively [ 2.11cm ( 1- 4.2cm) vs 1.33cm( 0.7-2.1)P< 0.05]. Conclusion: Our cohort study suggests that the performance of 4D MRI in the quadrant localization of PTA is improved with increasing size of the PTA. Further studies, with preferably larger sample size, are needed to determine the cut off diameter of the PTA at which the 4D MRI may become less sensitive as well as determine other factors that may affect the accuracy of the 4D MRI in the diagnosis and quadrant localization of PTA. 256 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 28. THE EFFECT OF ARCHITECTURAL DESIGN ON THE INCIDENCE OF HOSPITAL WIDE DELIRIUM AD Lynn MD, PhD; NR Lamborn MD; HW Hollis, Jr, MD Denver, CO Background: Delirium is a significant problem in medical and surgical patients resulting in prolonged length of stay, escalation to higher levels of care and increased use of skilled facilities following discharge. Medications and physiologic abnormalities associated with patient illness are known to increase the risk of delirium. This report seeks to evaluate hospital architectural design as a predisposing factor affecting rates of delirium. The authors’ old hospital was built in 1961. Outdated infrastructure mandated change achievable only by building an entirely new hospital, located one block from the old site, that conformed to new building codes and safety standards. It also provided an opportunity to investigate whether architectural design might affect the incidence of delirium. The old hospital was designed with dual patient rooms emanating radially from a central nursing station with poor noise control, while the new hospital was designed with linear hallways, single patient rooms, and minimal noise from work stations. This presents a unique opportunity to explore how architecture may affect incidence of delirium in a relatively unchanged patient population in the absence of significant hospital wide changes in delirium prevention protocols or shifts in clinician staffing. The authors hypothesized that a change in hospital architecture might facilitate a decrease in the incidence of delirium or improve outcomes. Method: A retrospective chart review was performed using an administrative database of all hospitalized patients. We selected two calendar years remote from the year of move for comparison. A total of 38,299 admissions occurred during the two years of study. Of these patients, 1,033 were identified with the diagnosis of delirium by ICD9/10 codes. Among the patients with delirium, outcome variables included mortality, length of stay (LOS), discharge level of care, and ICU LOS. Sample proportions were compared using a two tailed z-test with significance designated at a p < 0.05. The study was approved by SCL-Front Range IRB. Results: There were no significant differences in age, gender or co-morbidities between the cohorts examined. The overall incidence of delirium was significantly decreased among patients after the move to the new hospital (3.43 %vs 1.99%, p< 0.001). Of the patients who were diagnosed with delirium, the rate of in-hospital mortality in the old hospital compared to new was 5.93 vs 6.51% respectively (p = 0.71), 30 day mortality was 9.54 vs. 11.32%, respectively ( p=0.36) and overall LOS old to new was 9.2 days vs 8.2days ( p=0.18); these were not significantly different. Conclusion: Noise levels, single patient rooms and access to nursing are all factors that contribute to delirium. The linear hallway design of modern hospital construction results in improvements in overall incidence of hospital-wide delirium. Within the cohort of patients that experienced delirium, outcomes appear to be unaffected by hospital architecture. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 257 ePOSTER ABSTRACTS (cont.) P 29. HERNIA FORMATION FOLLOWING AORTOILIAC INTERVENTIONS Sara C. McKeever, Barrett Burger, Joseph E. Boyle, Mohammed M. Moursi, Ahsan T. Ali, Lewis C. Lyons, Richard H. Turnage, Matthew R. Smeds Little Rock, AR Background: Previous studies have suggested patients undergoing midline abdominal incisions for aneurysmal disease (AAA) have a higher rate of subsequent incisional hernia formation than similar patients with aortoiliac occlusive disease (AIOD). We sought to evaluate the rates of post-operative incisional hernia formation following AIOD and AAA using either bilateral subcostal (BS) or midline (ML) and to determine if there is a difference in these surgical approaches in subsequent hernia formation. Method: Patients undergoing procedures for AAA or AIOD at a single institution between January 2003 and December 2010 were reviewed (n = 447). Demographics, intraoperative data, post-operative complications, imaging and follow-up data were evaluated. All computed tomography (CT) performed after surgery was evaluated for presence of hernia, and all follow-up notes were reviewed for presence of incisional hernias on clinical exam. Results: Over this time period, 171/447 (38%) patients had ML incisions, while 276/447 (62%) had BS incisions. CT was available for review in 200/447 (45%) patients. 38/447 (8.5%) patients developed a hernia postoperatively with 12/171 (7%) ML incision patients and 26/276 (9.4%) BS incision patients developing hernias (p = .49). Only 20/38 (53%) patients with hernias were clinically evident, the remainder being incidental findings on CT imaging. Patients with bilateral subcostal incisions were more likely to have been treated for AAA (218/276 vs. 93/170, p = .0001), have a smoking history (264/276 vs. 146/171, p = .03), have hypertension (235/276 vs. 130/171, p = .02) and hyperlipidemia (189/276 vs. 62/171, p = .0001), have a perioperative wound complication (23/276 vs. 5/171, p = .03), and have a shorter procedure time (200 minutes vs. 291 minutes). There was no difference in the risk of hernia development according to incision type, aortic pathology treated (AIOD vs. AAA), demographics, procedure time or estimated blood loss. Patients with hernias were more likely to have a perioperative wound complication (11/38 vs. 18/409, p = .0001) and higher BMI (28.7 vs. 25.3, p = .0007). 15/38 (40%) patients underwent hernia repair at a median of 448 days post index procedure. Conclusion: There is no difference in rates of hernia development when comparing midline abdominal and bilateral subcostal incisions or aortic pathology being treated (AIOD vs. AAA). Postoperative CT examination may identify an additional portion of patients with incidental hernia formation, but the clinical relevance of this is not determined, as in our series, these patients were all asymptomatic. Patients with perioperative wound complications and increased BMI may be at increased risk of postoperative incisional hernia, regardless of incision type. 258 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 30. CARDIAC ARREST SECONDARY TO ACCIDENTAL HYPOTHERMIA: DOES EXTRACORPOREAL BYPASS WORK? Julia R. Coleman MD MPH, Clay Cothren Burlew MD, Ernest E. Moore MD, Charles J. Fox MD, Eric M. Campion MD, Mitchel J. Cohen MD, Fredric M. Pieracci MD Denver, CO Background: Accidental hypothermia is commonly encountered. Surgeons often become involved when invasive warming techniques are necessary. The purpose of this study is to evaluate rewarming techniques and outcomes for accidental hypothermia, specifically patients who require extracorporeal bypass (ECB). We hypothesize: 1) patients who require invasive techniques have a higher mortality rate, 2) ECB is a futile intervention. Method: All patients with a primary diagnosis of hypothermia (T<35°) from 20062015 were reviewed. Rewarming strategies included external (Bare hugger, blankets, heating lamps), internal (warm fluids/bladder irrigation/chest lavage), Alsius catheter, or ECB. Results: During the study period, 238 adult patients were hypothermic, with an average temperature of 31.0o. Of those evaluated, 79 (33%) patients (average temperature 32.6o) were discharged from the ED after external warming techniques. Of those admitted (159 patients, 82% men, mean age 55), rewarming techniques included: 68 patients (43%) external warming, 48 (30%) internal warming, 29 (18%) Alsius, 14 (9%) ECB. Patients undergoing ECB had a mean temperature of 23.8°, base deficit of 16, and potassium of 4.4. Conclusion: One-quarter of patients who present with accidental hypothermia require invasive rewarming techniques. For patients with cardiac arrest, survival rates are dismal but not 100%. There were no variables that determined survival following ECB. Therefore, aggressive rewarming including ECB should be performed in hypothermic arrest patients. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 259 ePOSTER ABSTRACTS (cont.) P 31. RADIOGRAPHIC VENTRAL HERNIAS ARE PREVALENT BEFORE AND AFTER ABDOMINAL SURGERY DV Cherla MD, ML Moses BS, KM Mueck MD, C Hannon, J Holihan MD, S Millas MD, LS Kao MD, MK Liang MD, TC Ko MD Houston, TX Background: Increasing emphasis has been placed on the use of imaging such as CT scan to identify and diagnose ventral hernias (VH) in patients. Our aims are to identify the prevalence of radiographic VH among patients before and after abdominal surgery. Method: An observational study of all patients undergoing abdominal surgery for gastrointestinal cancer from 2011-2015 at a single institution was conducted. Preoperative and postoperative CT scans were reviewed in a standardized manner for presence of a VH as defined by the European Hernia Society: any abdominal wall gap with or without a bulge. Results: A total of 242/289 (83.7%) patients had both a preoperative (obtained a median/range of 29/0-1886 days prior to surgery) and postoperative (obtained a median/range of 448/2-2570 days following surgery) CT scan. Of the 242 included patients, 149 (61.6%) had no prior abdominal surgeries while 93 (38.4%) had one or more prior abdominal surgeries. Among the patients with no prior abdominal surgery (n=149), the majority (n=87, 58.4%) had radiographic evidence of a primary VH. Following surgery, 24 (16.1%) developed an incisional VH, 28 (18.8%) had evolution of their primary VH into a larger incisional VH, 36 (24.2%) had no change in the appearance of their VH, and 21 (14.1%) had their primary VH repaired (overall, 59.1% had a VH on post-operative CT scan; Figure 1). Among the patients who had prior abdominal surgery (n=93), 58 (62.4%) had a radiographic VH prior to their surgery for gastrointestinal cancer. Following surgery, 17 (18.3%) developed a new incisional VH, 30 (32.3%) had enlargement of their VH, 23 (24.7%) had no change in the appearance of their VH, and 5 (5.3%) had their VH repaired (overall, 75.3% had a VH on post-operative CT scan; Figure 1). Conclusion: The prevalence of radiographic VH among those before and after abdominal surgery is high and increases with subsequent surgery. Presently, clinical assessment and judgment remains the standard to diagnose VH. However, the clinical significance of these radiographically-identified VH remains unknown. 260 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 261 ePOSTER ABSTRACTS (cont.) P 33. TRENDS IN FEMORAL HERNIA REPAIRS PERFORMED FOR RECURRENCE IN THE UNITED STATES BL Murphy MD, DS Ubl, J Zhang MD, EB Habermann PhD, DR Farley MD, KH Paley MD Rochester, MN Background: Nearly 30,000 femoral hernia repairs occur each year. As surgeons gain more experience with laparoscopic groin hernia repair, one could hypothesize that the rate of hernia recurrence would decrease over time. While inguinal hernia repair recurrence rates are carefully scrutinized, the rate of femoral hernia recurrence has not been reliably established in the United States. We sought to determine the trend of femoral hernia repairs for recurrence over time. Method: We identified all patients age≥ 18 who underwent femoral hernia repair from three sources: the ACS National Surgical Quality Improvement Program (NSQIP) database, providing data from 121 to 517 hospitals from 1/2005-12/2014, the Premier database, which provides data from over 700 US hospitals from 1/2010-09/2015, and an institutional database including the experience of three large academic sites from 1/2005-12/2014. In all patient populations, we identified the incidence of primary and recurrent femoral hernia repairs stratified by gender. Trends were analyzed for a decrease over time using a one-tailed Cochran-Armitage test. Results: The three data sets contained 11,459 patients (75% female) undergoing femoral hernia repair. In the NSQIP database, there were 6,649 femoral hernia repair patients (73% female). In females the proportion of femoral hernia repairs done for recurrence decreased over the study period: from 14.0% in 2005 to 6.2% in 2014 (p=0.02). In males there was no change over time: recurrences were 16.7% in 2005 and 16.1% in 2014 (p=0.18). The Premier database contained data on 4,495 (76% female) femoral hernia repairs. In contrast to the NSQIP database there was no difference for either gender. In females, 8.3% of repairs were performed for recurrence in 2010 and 4.7% in 2015 (p=0.10). In males, the rate was 22.6% in 2010 and 21.1% in 2015 (p=0.08). Within our institution 315 patients (67% female) underwent femoral hernia repair during the study period. There was no difference for femoral hernia repairs over time for either gender (p=0.20 for females and p=0.15 for males); however we were underpowered as only 17 recurrent repairs occurred for females and 12 for males during the study period. Conclusion: Although our large multi-site institutional data base was too small from which to draw conclusions, national databases show the proportion of femoral hernia repairs performed for recurrence remained relatively constant in males and may be decreasing in females in the United States between 2005 and 2015. 262 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 263 ePOSTER ABSTRACTS (cont.) P 34. ROBOT-ASSISTED DIAPHRAGM PLICATION VIA AN ABDOMINAL APPROACH DA Hill MD, EY Kuo MD, SB Roy MD, P Kang MPH, T Ipsen MPH, C Haworth MS, T Fey BAS, A Do BA Phoenix, AZ Background: Diaphragmatic paralysis, a known cause of dyspnea, can drastically reduce breathing efficiency and result in decreased quality of life. Diaphragmatic plication is the preferred surgical intervention for such patients. Here we report our 3.5-year experience with 22 consecutive patients who underwent robot-assisted diaphragmatic plication via an abdominal approach. Method: We retrospectively reviewed records of 22 consecutive patients who underwent robot-assisted diaphragmatic plication for diaphragmatic paralysis between 9/5/12 to 5/12/16. The primary outcome measure in this single-surgeon series was the change in dyspnea severity. Dyspnea levels were measured with the Medical Research Council (MRC) dyspnea scale, a 5-point scale with 5 describing the worst dyspnea (i.e., breathlessness so severe the individual is homebound). Univariate analysis via linear regression was used to assess associations between demographic and clinical covariates (e.g., length of stay, estimated blood loss, operation time). Multiple linear regression models were adjusted for other covariates and baseline MRC scores. Results: Of the 22 patients who underwent robotic diaphragmatic plication, 17 (77.3%) were male. Median body mass index was 30 + 4.8 kg/m2. Most procedures (59%) were left-sided plications. One patient (4.6%) underwent bilateral plication. Median operating time was 161+ 45 minutes, but the procedure was associated with a steep learning curve. Median operating time for the first 3 procedures was 255 ± 27 minutes, but dropped to 151±44 minutes for remaining 19 cases. The median length of stay was 3 days, and median time to chest tube removal was 1 day. Upon followup, 19 patients reported improved postoperative breathing, 2 patients reported no change, and 1 patient could not be reached. Preoperatively, the median MRC score in this cohort was 4.0; this number dropped to a median of 2.2 postoperatively (p=0.001). Conclusion: Transabdominal robotic diaphragmatic plication is an emerging technique that offers attractive benefits, such as small incisions, improved surgical dexterity, and a quick learning curve (approximately 3 to 4 cases). It can be easily adopted with good OR times and early results have shown good functional outcomes. 264 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 36. SPLENIC INJURIES AFTER ERCP MJ Yelenich-Huss MD, CJ Maki MD, F Nammour MD; M Ahmeti MD Grand Forks, ND Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a common technique for diagnosis and treatment in pancreatico-biliary disease, associated with a complication rate of 5%-10% and a mortality rate of 0.5% (1). Common complications include pancreatitis, gastrointestinal hemorrhage, intestinal perforation, and cholangitis (2). Less common complications such as pneumothorax, hepatic hematoma, air emboli, & portal vein/hepatic artery cannulation are also reported (1,3). Splenic injury due to ERCP is extremely rare. We present 2 cases of patients requiring splenectomy after ERCP Method: Retrospective case series Results: 1. A 76 y/o was admitted with obstructive choledocholithiasis, with exam and labs consistent with diagnosis. Ultrasound (US) showed a dilated common bile duct (CBD). ERCP showed multiple stones in the CBD, which were incompletely removed after sphincterotomy and a stent was placed with difficulty. She then had symptomatic bradycardia with hypotension. She was taken to the OR. With induction of general anesthesia, the patient became quite hypotensive. Upon laparoscopically entering the abdomen, about 1.5L of hemoperitoneum was noted, consisting of fresh and old blood. The only abnormality found was an actively bleeding grade 2 inferior pole splenic laceration, controlled with packing. Cholecystectomy was performed, but she had refractory hypotension and a further 400mL of fresh blood was around the spleen. Emergent splenectomy was performed. After she did well and discharged home. 2. A 57 y/o with was admitted with symptoms of obstructive choledocholithiasis and consistent labs. US revealed dilated ducts. ERCP was performed; CBD cannulation was difficult. Several hours later he developed refractory hypotension. He was transferred to the ICU, transfused, and given vasopressors. Imaging showed active bleeding from the spleen with hemoperitoneum. His status deteriorated and he was intubated. Radiology performed splenic and short gastric artery embolization. His shock state resolved. Exploratory laparotomy with evacuation of hemoperitoneum and cholecystectomy were performed. Complete splenic avulsion was identified with 5L of blood & ascites present. Splenectomy was performed. He did well and discharged home. Conclusion: Multiple reviews and single case reports have been published since 1988 detailing splenic injury after ERCP, but we are the only series with 2 patients (1-9). Cases include splenic laceration, rupture, and avulsion of splenic vessels (3). Mechanisms of splenic injury have been proposed as excessive traction of the splenocolic/gastrosplenic ligament during the ERCP, adhesions causing decreased mobility, and direct trauma (4, 5). Complications after ERCP are uncommon, and splenic injuries leading to splenectomy after ERCP represent an extremely rare subset. Procedural difficulty is the only common theme we found. A hemoglobin drop or hemodynamic instability following ERCP should raise suspicion for splenic injury and prompt rapid investigation April 2 – 5, 2017 | Hyatt Regency, Maui, HI 265 ePOSTER ABSTRACTS (cont.) P 38. LAPAROSCOPIC VENTRAL HERNIA AND INGUINAL HERNIA REPAIR USING ONLY TWO 5MM PORTS Hugo Bonatti Schwaz, Austria Background: Most surgeons use one 10-12mm and two 5mm trocars for laparoscopic repair of abdominal hernias. Attempts to further miniaturize and reduce surgical trauma include SILS and use of micro instruments amongst others. Method: All patients undergoing laparoscopic ventral and inguinal hernia repair by a single surgeon were reviewed and patients who had the procedure done with only two 5mm trocars were investigated in detail. For inguinal hernias and a subset of ventral hernias the Teleflex mini-grasper, a 2.3mm needle grasper that is introduced without trocar was used as an additional instrument. The MESH was introduced into the abdomen through a port site after removal of the trocar. For fascia closure and fixation of the MESH in ventral hernias a suture passer was used. Results: A total of 14 patients were identified who had their hernias repaired with only two 5mm trocars. In five patients with inguinal hernias and in two patients with Spigelian hernias, the Teleflex mini-grasper was used and all patients had a transabdominal preperitoneal repair (TAPP) with use of a ProGrip self fixating MESH without tacks. For the TAPP inguinal hernia repair, the peritoneal flaps were created from a vertical incision between the umbilicus and the bladder dome. For the Spigelian hernias the flap was created from an incision at the dome of the reduced hernia sack. The peritoneum was re-approximated with a running 3-0 silk suture or a V-lock suture using the mini-grasper instead of a Maryland. For one small Spigelian hernia and umbilical and epigastric hernias, a suture passer was used to close the hernia defect and a 9cm coated MESH was used for reinforcement. Median age of the eleven men and three women was 73 (range 23-88) years. The patients tolerated the hernia repair well and was done in six patients as an outpatient procedure and eight patients were placed in extended recovery or remained admitted. Conclusion: This pilot study shows that abdominal hernia repair using only two 5 mm trocars is feasible in many patients and well accepted. The Teleflex mini-grasper can completely replace a laparoscopic grasping instrument. 266 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 39. USE OF LIGHTED URETERAL STENTS IN LAPAROSCOPIC COLON SURGERY Hugo Bonatti Schwaz, Austria Background: Injury to the ureter is one of the most feared complications in surgery for left colonic, sigmoid, rectal pathologies especially in patients with inflammatory disease involving the left pelvic wall. Ureteral stents have been used in previous series and whereas detection of ureter leaks was reported to be better, conflicting data on prevention of this severe complication have been published. Lighted stents have been in use for several years now but there remains paucity on data. This has multiple reasons one of them is availability of a urologist willing to place such a stent prior to colonic surgery. Method: All patients from a single rural hospital who had colonic resection and had a lighted ureteral stent placed cystoscopically prior to the procedure during a two years period were included in this study. The stent was removed immediately after the procedure, a Foley catheter remained in place for 24-48 hours per protocol. Results: A total of 18 patients including 10 men and 8 women with a median age of 62.4 (range 28.0 - 88.5) years were identified. Cystoscopic placement of the ureteral stent was successful in all cases and took average less than 30 minutes. In 17 cases the stent was placed in the left ureter with fifteen patients having a laparoscopic sigmoid colectomy/low anterior resection. Two patients had a laparoscopic Hartman reversal. Only one patient who had a right hemicolectomy after previous pelvic surgery had a right lighted ureteral stent provided. In all cases the lighted stent was well visualized (figure 1) allowing safe dissection of tissue far away from the critical structure and in no case an injury to the ureter or bladder occurred. Macrohematuria was observed in the majority of patients but no patient suffered ureter injury or kidney injury. Conclusion: Lighted ureteal stents were found extremely useful in laparoscopic colon surgery with risk of ureter injury. This is not only a matter of patient safety but also allows much faster dissection of tissue and potentially shortens the surgical procedure. Based on the data of our pilot study, lighted stents placement has become standard at our hospital. These stents may be particularly useful in the rural setting. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 267 ePOSTER ABSTRACTS 268 (cont.) Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 40. PATIENT OUTCOMES FOLLOWING ROUX-EN-Y GASTRIC BYPASS REVERSAL PE Ernest MD, FA Husain MD, BJ Pottorf MD, HW Hollis MD Denver, CO Background: Roux-en-Y gastric bypass (RYGB) continues to be one of the most common surgical weight loss procedures performed in the US. Complications can occur early in the postoperative period or years following operation. Longterm complications include: malnutrition/failure to thrive, hyperinsulinemic hypoglycemia, recurrent marginal ulcer, and recalcitrant hypocalcemia associated with hypoparathyroidism. Medical management alone is not always successful. Occasionally, restoration of normal anatomic physiology (RYGB reversal) is required to meliorate symptoms and untoward metabolic consequences. To avoid weight regain, given the chronicity of obesity as a disease, reversal can be done with conversion to sleeve gastrectomy. This study was designed to analyze the results of patients requiring reversal of their RYGB with and without conversion to sleeve gastrectomy. Method: Procedures were performed by a formally trained bariatric surgeon. Data was analyzed after retrospective chart review. Analysis of demographics, pre and post-operative Body Mass Index (BMI), comorbidities, and outcomes accompany this review. Results: From November 2012 to June 2014, 14 patients (3 male, 11 female) required laparoscopic reversal of their RYGB to normal anatomy, and 3 included concomitant revision to sleeve gastrectomy. Complications mandating reversal included refractory neuroglycopenia (n=4), malnutrition/failure to thrive (n=7), persistent hemorrhaging from marginal ulcer (n=2), and chronic abdominal pain (n=1). Patients diagnosed with neuroglycopenia received a complete workup and medical optimization from an endocrinologist prior to operation. Patients with malnutrition/failure to thrive, marginal ulcer, and chronic abdominal pain underwent an esophagogastroduodenoscopy (EGD) before operation and were optimized nonoperatively. Prior to reversal, the mean BMI was 29.1 kg/m2 (18.5-42.6 kg/m2). Post reversal the mean BMI increased to 32.9kg/m2 (24-42.7kg/m2). Patients reversed for hyperinsulinemic hypoglycemia showed the greatest weight gain with a BMI increase of 6 versus 3.28 for the rest of the study group. Postoperative complications included anastomotic leak requiring reoperation (n=1), superficial port site infection (n=1), and chronic pain (n=2). Average hospital stay was 3 days. Two patients were lost to follow-up. All but one patient had resolution of their symptoms at two years post procedure. Two additional patients sustained unwanted weight gain and underwent laparoscopic sleeve gastrectomy within one-year of reversal. Conclusion: Laparoscopic reversal of RYGB with or without sleeve gastrectomy may alleviate most chronic complications of a RYGB. Weight gain can be expected after reversal of RYGB alone, and even with adjunctive sleeve gastrectomy. Weight gain following intervention was greatest among those patients reversed for refractory hyperinsulinemic hypoglycemia demonstrating that medical and behavioral optimization of these patients is important prior to considering surgical reversal. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 269 ePOSTER ABSTRACTS (cont.) P 41. FEMALE VERSUS MALE MORBIDLY OBESE SURGICAL PATIENTS VARY SIGNIFICANTLY IN PRE-OPERATIVE CLINICAL CHARACTERISTCS: ANALYSIS OF 67,514 BARIATRIC SURGERY WOMEN AND MEN CM Bashian, DO, GJ Slotman, MD Vineland, NJ Background: While more women than men undergo bariatric surgery, differences between the sexes in obesity-related pre-operative clinical conditions have not been investigated. The objective of this study was to identify variations in age, BMI, and the incidence of obesity co-morbidities between morbidly obese women and men. Method: Pre-operative clinical data on 53,292 women and 14, 222 men in the Surgical Review Corporation’s BOLD database who underwent adjustable gastric band (AGB) was examined retrospectively. Female versus male age and BMI, race, insurance, and the frequency of major obesity co-morbidities were compared by analysis of variance and the Chi-squared equation. Results: Female/male age (45.2+-12/48.2+-12; p<0.001), BMI (44.6+-7/46.2+-7; p<0.0001), race (African-American 12.4%/6.8%, Caucasian 73.5%/78.3%, p<0.001), and health insurance (Medicaid 3.1%/1.6%, Medicare 7.1%/9.9%; p<0.0001) varied significantly. Obesity co-morbidities (%) are detailed in the Table. Overall, females carried 12 weight-related illnesses more frequently than did males (abdominal panniculitis, cholelithiasis, GERD, stress urinary incontinence, asthma, back pain, fibromyalgia, pseudotumor cerebri, mental health diagnosis, depression, and psychological impairment - p<0.0001 - and lower extremity edema - p<0.01). Males had higher incidences of 18 obesity co-morbidities, compared with females (abdominal hernia, liver disease, obesity hypoventilation syndrome, obstructive sleep apnea, angina, hypertension, CHF, ischemic heart disease, peripheral vascular disease, dyslipidemia, diabetes, gout, impaired functional status, alcohol use, tobacco use, substance abuse, and unemployment - p<0.0001 - and DVT-PE - p<0.01). Pulmonary hypertension and musculoskeletal pain did not vary female/male. Conclusion: The pre-operative clinical characteristics of morbidy obese women and men varied significantly. Women were more frequently African-American and on Medicaid while men were more often Caucasian and on Medicare. Before AGB, compared with women, men were older, had higher BMI, used alcohol, drugs, and tobacco more frequently, and had higher rates of cardiovascular pathology, obesity hypoventilation syndrome and obstructive sleep apnea, diabetes, gout, abdominal hernia, liver disease, and impaired functional status. Among women, asthma, cholelithiasis, stress urinary incontinence, abdominal panniculitis, and mental health issues/dysfunction were more frequent than for men. These findings could aid care of AGB patients. Although AGB patients were self-selected, significant variations by sex can be applied to other obese individuals. Since all surgeons now operate on morbidly obese patients, the advance clinical knowledge reported here can increase clinical acumen and may facilitate anticipatory management. Understanding the weight-related characteristics of obese men and women thus may improve outcomes for all procedures that must be performed on the morbidly obese. 270 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 271 ePOSTER ABSTRACTS (cont.) P 42. INITIAL EXPERIENCE WITH LAPAROSCOPIC SLEEVE GASTRECTOMY IN A SAFETY NET HOSPITAL SYSTEM I Ibrahim-zada MD PhD, MJ Hopman NP, L Rieder NP, K Schutte RD, T Vigil RD, A Berens RD, A Lieberman PhD, JL Johnson MD, FM Pieracci MD MPH Aurora, CO Background: Laparoscopic sleeve gastrectomy (LSG) is an increasingly utilized bariatric operation, with large studies reporting similar and sustained weight loss, resolution of comorbidities, and decreased peri-operative morbidity as compared to laparoscopic Roux-en-Y gastric bypass (LGB). The purpose of this study was to evaluate our initial experience with LSG performed by general and acute care surgeons in a safety net hospital. We hypothesized that weight loss outcomes were comparable between LSG and LGB. Method: We retrospectively reviewed the first 15 patients who underwent LSG at our safety net hospital and compared them to 15 patients who underwent LGB during the same time period. All surgeries were performed by two general/acute care surgeons. The primary outcome was a decrease in body mass index (BMI) at 1 year after surgery. Outcomes were compared with Student’s t-test or chi-square test using SPSS. Results: A total of 30 patients underwent either LGB or LSG (15 each) during the study period. Within this population, 70% patients had hypertension, 27% had dyslipidemia, 40% had type 2 diabetes mellitus, 26.7% obstructive sleep apnea with half of those requiring continuous positive pressure airway pressure, and 47% had gastroesophageal reflux disease symptoms. There was no difference in baseline characteristics between two groups, including age, gender, and cardiometabolic comorbidities. Outcomes are summarized in the Table. Weight loss after LSG at 1 year after surgery was similar to LGB [82.9 lbs (32.4%) vs. 81.7lbs (28.3%), p= 0.93]. The mean BMI decrease was 14.4 (LSG) vs 11.9 (LGB), p=0.14. A total of 72% patients went off anti-hypertensive medications at 1 year with the mean decrease of the MAP by 10.8% in LSG compared to 10.6% LGB group. Hospital length of stay (LOS) for LGB was 6.3 days compared to 2.67 days in LSG (p=0.332). Number of readmissions were higher in LGB compared to LSG group (40% vs 6.7%, p=0.03). Conclusion: In our safety net system, LSG resulted in equivalent weight loss at 1 year with good clinical outcomes and improvement in cardiometabolic comorbidities, shorter length of stay, and decreased hospital re-admissions as compared to LGB. Long term outcomes are needed to fully evaluate the efficacy of this operation. 272 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) Table: Outcomes 1 year following surgery Variables Weight loss (lbs, SD) BMI (kg/m2) change (SD) % wt loss (SD) Readmission SBP change at 1 year MAP change at 1 year LOS ( in days) LGB 82.9 ± 30.8 14.4 ± 4.6 32.4% ± 10.1 6 (40.0%) 18.5 (12.1%) 11.7 (10.8%) 6.27 LSG 81.7 ± 45.5 11.9 ± 4.6 28.3% ±11.9 1 (6.7%) 16.8 (11.9 %) 11.5 (10.6%) 2.67 April 2 – 5, 2017 | Hyatt Regency, Maui, HI P value 0.933 0.139 0.322 0.031 0.747 0.945 0.332 273 ePOSTER ABSTRACTS (cont.) P 43. LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS VERSUS SLEEVE GASTRECTOMY: 3-YEAR OUTCOMES EE Nearing II MD, AJ Borgert PhD, KJ Kallies MS, MT Baker MD, BT Grover DO, SN Kothari MD La Crosse, WI Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a well-established procedure for the surgical treatment of obesity. In the past 5 years, laparoscopic sleeve gastrectomy (LSG) has increased in popularity, with case volumes doubling according to recent estimates. Data comparing these two procedures are limited. The objective of this study was to compare weight loss and comorbidity improvement for LRYGB versus LSG over a 3-year follow-up period. Method: A retrospective review of our institution’s prospective bariatric surgery registry and integrated multispecialty health system electronic medical record system was completed. Patients who underwent LRYGB or LSG from 2010-2015 were included. Comorbidity status was defined according to 2015 Standards for Outcome Reporting. Statistical analysis included chi-square test. A P value <0.05 was considered significant. Results: During the study period, 539 patients underwent LRYGB and 201 underwent LSG. The mean preoperative BMI was 47.0 ± 6.5 in the LRYGB group vs. 45.3 ± 5.3 in the LSG group (P=0.002). Mean follow-up was 2.6 ± 1.5 years in the LRYGB group and 1.6 ± 1.2 years in the LSG group (P<0.001), with 1, 2, and 3-year follow-up rates of 78%, 51% and 44% for LRYGB and 68% 27%, and 19% for LSG, respectively. Thirty-day complications in the LRYGB vs. LSG groups included anastomotic/ staple line leak (0.2% vs. 0; P=0.990), venous thromboembolism (0.6% vs. 0.5%; P=0.990), bleed requiring transfusion (0.7% vs. 0; P=0.570), surgical site infections (0.7% vs. 0; P=0.580), and urinary tract infection (1.1% vs. 0.5%; P=0.680). There was one conversion to open in the LRYGB group. There were no 30-day mortalities. Preoperatively, type II diabetes (T2DM) was observed in 185 (34%) and 35 (17%) LRYGB and LSG patients, respectively; dyslipidemia in 310 (58%) LRYGB patients vs. 88 (44%) LSG patients; and hypertension in 451 (84%) and 154 (77%) LRYGB and LSG patients, respectively. Conclusion: Case volumes and popularity for LGS are increasing, however long term data is limited. In comparison to LSG, LRYGB results in increased excess weight loss with similar improvements in patient comorbidities. There was no difference in complication rates between the two procedures. The long-term durability of LSG outcomes has yet to be fully elucidated; however, intermediate evaluation suggests that LSG is a safe and comparable alternative to LRYGB. 274 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 275 ePOSTER ABSTRACTS (cont.) P 44. INITIAL ROBOTIC EXPERIENCE IN COMBINED RECURRENT UMBILICAL HERNIA AND DIASTASIS RECTI REPAIR D Vargo MD Salt Lake City, UT Background: Umbilical hernia repair is typically quoted as having a high success rate, with recent 5 year data showing a 6.3% recurrence rate in primary repair and no recurrences in mesh repair. However, there is a sub-population of patients with diastasis recti who do have a higher rate of recurrence. Recent literature, however, showed a 31% recurrence rate in patients with diastasis recti compared to to 8% without diastasis. Hypothesis is that repair of the diastasis at the time of umbilical hernia repair will decrease the recurrence rate. Method: A case series utilizing prospectively collected data at a single institution was evaluated for short term outcomes in robotic repair of upper abdominal diastasis in conjunction with recurrent umbilical hernia repair. Biographical data, co-morbidities, operative technique, and post-operative outcomes were evaluated. Primary outcome measure was wound complication and early hernia recurrence. Results: 10 patients with recurrent hernia and associated diastasis were evaluated over a ten month period from August 2015 through June 2016 . Average time to recurrence from initial operation was 13.8 months (range 5-37 months). 10% of patients had a wound complication after the initial procedure. Diastasis was diagnosed by physical exam +/- CT scan. Secondary procedures were all performed robotically, with the upper midline diastasis being closed primarily, along with the umbilical defect, and mesh being implanted for just the umbilical defect. Average follow up was 248 days (range 100-397 days). There was one early hernia recurrence, the first case in the series, that was thought to be due to a technical error. The remaining 9 patients have intact repairs. There was one small skin separation at a trocar site. No other wound issues were identified. Conclusion: Robotic repair of diastasis recti in association with recurrent umbilical hernia repair is a safe operation with good short term outcomes. Results point to a possible need to stratify patients with umbilical hernia into different categories that require different operative approaches. 276 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 45. THE EFFECTS OF OPERATING ROOM RESTRUCTURING ON QUALITY OF SURGICAL CARE FOR BENIGN BILIARY DISEASE AT A SAFETY-NET HOSPITAL KM Mueck MD MPH, S Wei MD, CJ Wray MD, MK Liang MD, LS Kao MD MS, TC Ko MD Houston, TX Background: Limited access to cholecystectomy for benign biliary disease has been associated with worsened care in at least 3 of the 6 domains of quality: timeliness (avoidance of delays), efficiency (limited waste of resources), and safety (complications). Prior study of cholecystectomies at our safety-net hospital demonstrated that the majority of patients received non-elective surgery. Of these patients, 30% underwent nighttime surgery which was associated with a small but increased risk of complications. We hypothesized that operating room restructuring by opening an ambulatory outpatient center (OC) and dedicating daytime operating rooms for urgent and emergent cases (acute care surgery or ACS rooms) would increase timeliness and efficiency of surgical care and improve patient safety. Method: A retrospective single-center analysis was performed of patients undergoing elective laparoscopic cholecystectomy at a safety-net hospital before (October 2010May2011) and after opening of an OC (October 2014-May 2015), as well as before and after (March-August 2016) opening of ACS rooms. Data were collected on demographics, diagnosis, emergency room and clinic visits, imaging tests, time to surgery, length of stay (LOS), and 30-day complications (surgical site infections, bile leak, retained stone, bile duct injury, pneumonia). Univariate analyses were performed using chi-square and Kruskal-Wallis tests (STATA). Results: A total of 1826 cholecystectomies were performed over the 3 periods. The number of both elective and non-elective cholecystectomies performed per month increased significantly over the three time periods (Table 1). Patients were older in the later periods, but were otherwise similar in sex, race/ethnicity, and body mass index. Among patients undergoing elective cholecystectomy, the median time from first surgery clinic visit to surgery and from diagnosis of benign biliary disease to surgery decreased significantly. Despite increased timeliness, patients had more imaging and emergency room visits prior to surgery. There were no significant differences in complications or readmissions. Among patients undergoing non-elective surgery, after the addition of daytime ACS rooms, the proportion of patients undergoing nighttime surgery paradoxically increased. Conclusion: Operating room restructuring at a safety-net hospital did not improve overall quality of surgical care for benign biliary disease. The opening of an outpatient center was associated with a greater number of elective cholecystectomies per month being performed and a shorter time from initial diagnosis and first clinic visit to surgery. However, addition of daytime acute care surgery rooms was associated with a paradoxical increase in nighttime cholecystectomies and greater resource utilization prior to surgery. Additional strategies to improve the quality of care should focus on further improving access to and timeliness of surgical consultation for underserved patients. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 277 ePOSTER ABSTRACTS 278 (cont.) Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 47. DECREASING TRANSFERS TO HIGHER LEVEL OF CARE FOLLOWING TRANSFERS OUT OF THE ICU S McAllister RN MSN, GT Tominaga MD, J Darnell BSN, Z Mayors RN BSN, DS McCaul, MD La Jolla, CA Background: This study was undertaken to determine whether close follow-up by a trained RN on emergency standardized procedures could decrease transfer to a higher level of care in patients recently transferred out of the ICU. Method: Patients transferred from the ICU to the step-down unit, telemetry or ward in one regional community hospital that is a designated ACS-COT Level II Trauma Center, certified stroke center, and regional Cardiology Institute were studied. Designated Critical Care nurses (Code RN) that respond to all in-hospital code blues and Rapid Response Team activation underwent training on emergency standardized procedures. This includes basic management in acute changes in heart rate or symptomatic hypotension, chest pain, acute mental status change, airway compromise, anaphylaxis, seizure, medication inducted respiratory depression, suspected sepsis, and emergency cardiac management. Beginning September 1, 2015, the Code RN was dedicated to rounding on all patients discharged from the ICU within the past 24 hours and attend all the Rapid Response Team activations. We compared data from 2014 (A -pre-implementation) to Jan through September 2016 (B -post-implementation). Demographic data, RN interventions and outcome data were collected. Transfer back to the ICU or higher level of care was the outcome variable studied. Results: Similar number of RN interventions were performed during each time but the procedures performed during the post-implementation were standardized. The most common problems encountered were related to airway problems and changes in heart rate or blood pressure. Mean age was similar in each group. Significantly more patients did not require transfer to a higher level of care during the Post Implementation group (51.6% versus 40.3%, p=0.0107). There was a trend toward decreased mortality in the Post Implementation group (p=0.063). See table. Conclusion: We found a decrease in transfers to higher level of care in patients recently transferred out of the ICU that were evaluated by a Critical Care nurse trained in basic standardized procedures. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 279 ePOSTER ABSTRACTS P value 263 70.9 247 2016 PostImplementation * 256 73.4 256 120 (45.6%) 28 (10.6%) 102 (39.8%) 20 (7.8%) 0.1849 0.2911 106 (40.3%) 132 (51.6%) 0.0261 9 (3.42%) 2 (0.78%) 0.063 2014 (PreImplementation) Number of patients Mean Age (years) Number of RN interventions Transfers Back to ICU Transfer to Stepdown unit or telemetry No transfer required to higher level of care Death (cont.) * January through September 2016 280 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 48. STANDARDIZING HANDOFFS BETWEEN OPERATING ROOM AND SURGICAL INTENSIVE CARE UNIT IMPROVES INFORMATION EXCHANGE D Mukhopadhyay MD, KC Wiggins-Dohlvik MD, MM MrDutt MD, JS Hamaker MD, GL Machen MD, ML Davis MD, JL Regner MD, RW Smith MD, DP Ciceri MD, JG Shake MD Temple, TX Background: The transfer of critically ill patients from the operating room (OR) directly to the surgical intensive care unit (SICU) involves handoffs between multiple care providers of various specialties. Incomplete handoffs lead to poor communication, which is a major contributor to sentinel events resulting in medical error and patient death. The aim of the study was to identify areas of improvement in the current method of patient handoffs at our institution, standardize the process, and determine whether this led to improvements in caregiver involvement and information omissions. Method: A prospective intervention study was designed to observe the process surrounding patient transfer from OR to SICU at Scott & White Memorial hospital, a 635 bed tertiary care academic center in a semi-rural setting. Over a two month period, thirty one patient handoffs from the OR to SICU were observed for 49 critical parameters including caregiver presence, pre-operative and intra-operative details, and time required to complete key steps. Over the following six months, a standardized protocol was implemented and all caregiver groups educated regarding the new protocol. Thirty one follow-up handoffs were then observed over two months to determine whether there was an improvement in caregiver involvement and reduction in information omission. Results: Standardization led to a significant improvement in presence of an ICU physician provider as well as a member of the surgical team during the bedside handoff and transfer (p=0.0004 and p<0.0001, respectively). Resultantly, there was an overall improvement in information omissions in both the surgical report, e.g. identification of the procedure performed (p=0.0048), operative complications (p<0.0001), and surgical concerns (p<0.0001), and the anesthesia report, including easy of laryngoscopy (p<0.0001), ventilator settings (p<0.0001) and pressor requirements (p=0.0134). Protocolization also led to an average decrease in time required for physical transfer to the ICU monitor by 27 seconds (p=0.11) and the ventilator by 12 seconds (p=0.58) while only increasing time required for handoff from 5:37 to 6:16 (p=0.22), which was not statistically significant. Conclusion: Implementation of a standardized handoff protocol when transferring patients from the OR to the SICU led to a significant improvement in caregiver involvement and reduction in information omission without a drastic increase in time commitment of involved providers. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 281 ePOSTER ABSTRACTS (cont.) P 49. A THREE PRONGED APPROACH FOR PRACTICE-BASED LEARNING AND QUALITY OF CARE IMPROVEMENT IN A SURGICAL RESIDENCY PROGRAM. KM Rose MD, LA Steber PA, DJ Johnson MD, AB Chapital MD PhD Phoenix, AZ Background: The value of morbidity and mortality conference (M&M) has been well established in the surgical literature. Traditionally, M&M relies on voluntary selfreported retrospective data, which may preclude a consistent analysis for improvement in patient care. Recently, the popularization of systems-based responsibility for patient outcomes such as the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) has led some departments to abandon the traditional M&M conference. Our surgical department sought to improve the collection, analysis, and reporting of adverse events by integrating a new systems-based practice approach that focuses on patient care, resident education, and systems issues. Method: Beginning July 1st, 2016, our institution has progressively refurbished M&M conferences in three distinct ways. First, we prospectively define and collect daily complications, readmissions, and returns to the operating room daily with the Chair of Surgery and Hospital Medical Director. Second, we participate and engage in a weekly department-wide M&M conference with residents, attending physicians, and allied health staff. During this time, residents or fellows present patient information in an anonymous, case-based format open to any questions, concerns, or suggestions. Representatives from other departments such as transplant surgery, plastic surgery, etc., are invited to attend and present in a collaborative effort. Readmissions and reoperations from the previous week are addressed at this time. Third, patient safety incidents are reported with quality personnel, nursing, and attending physician presence. Issues and solutions are recorded and presented to department personnel to address policy change for improved patient care. We then compared our institution’s current academic year data to previous year’s to better understand the impact of reshaping our M&M conference. Results: Since the initiation of the three-pronged approach, our surgical department’s M&M has recorded improved attendance, resident satisfaction, increased discovery of events, opportunities to affect patient care during prospective collection, and resident reflection on care in an open forum. During the 2015-2016 academic year, 65 patient cases were presented at the General Surgery M&M Conference. Following the structural change and implementation of the three-pronged approach, we have presented 36 cases in the first quarter of the 2016-17 academic year alone, projecting to an annualized total of 108 cases with continued implementation. Additionally, our discussion of hospital safety issues has led to hospital wide policy changes to improve patient safety and monitoring. Conclusion: Our surgical department believes this three-pronged model provides an avenue for shared learning and best practices, monitoring of safety and regulatory issues, and an opportunity for staff and resident physicians to directly contribute to system improvements. 282 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 50. HEALTH LITERACY DISPARITIES AMONG TRAUMA PATIENTS: A TARGET OF OPPORTUNITY JL Dameworth MD, JA Weinberg MD, PW Goslar PhD, TM Thompson MA, NV Peters, DJ Stout RN, SR Petersen MD Phoenix, AZ Background: Low functional health literacy (HL) can complicate physician-patient communication, compromise care, and is associated with worse outcomes. Disparities in HL have been observed with respect to race/ethnicity and socioeconomic status. Although HL has been studied in diverse patient populations, relatively little attention has been given to this issue in trauma patients. To date, trauma patient HL has not been assessed with a validated instrument. The purpose of this study was to assess the prevalence of low HL with a validated assessment tool among hospitalized trauma patients, and to determine patient characteristics that are associated with low HL. Method: A convenience sample of adult patients admitted to an urban, ACS level 1 trauma center completed the Short Assessment of Health Literacy (SAHL) assessment prior to hospital discharge over a six-month period. This validated test involves a standardized 2-3 minute interview at bedside. Patient’s medical decision maker (MDM) was interviewed in setting of cognitive impairment. Demographic and clinical data were prospectively collected, including age, gender, race/ethnicity, injury severity, and self-reported level of education. In addition, the Community Need Index (CNI), which stratifies community health need by zip code, was recorded for each patient. Results: 128 adult trauma patients (with 17 MDM) completed the SAHL. Average patient age was 44, 33% female, and median ISS 10. 31 patients (24.2%) had low HL by SAHL result. Low HL was associated with education level (high school or less: 32% vs. college: 12%; p = 0.009), self-opinion of knowledge of medical terms (NO: 35% vs. YES: 16%; p = 0.017), and CNI (High CNI: 29% vs. Low CNI: 8%; p = 0.025). In addition, white non-Hispanic patients were significantly more likely to have adequate HL than all others (Figure, p = 0.007). Conclusion: Low HL is prevalent among hospitalized trauma patients. Similar to prior studies concerning non-trauma patient populations, significant HL disparities were associated with education level, community health need, and race/ethnicity. Bedside assessment of HL is relatively easy to perform, is associated with disparities known to affect outcomes, and allows opportunity for targeted interventions that may improve both provider-patient communication and quality of care. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 283 ePOSTER ABSTRACTS 284 (cont.) Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 51. MANAGING BARRIERS TO RECYCLING IN THE OPERATING ROOM Solomon Azouz M.D. M.Sc., Nikki Castel M.D., Terry Maffi M.D., Piper Boyll B.Sc., Alanna Rebecca M.D. MBA Phoenix, AZ Background: Operating rooms contribute to the ever-increasing volumes and costs of hospital waste. Little is known concerning barriers to recycling and perception of hospital waste, despite continued improvement in recycling programs. The estimated amount of waste produced per hospital bed per day varies from 0.2kg to 33kg. Approximately 75% to 90% of this is considered general waste, with the remainder being hazardous waste which must be transported and disposed of by specialized means. Waste production can be minimized by four means: (1) source reduction, (2) management and control measures that guide hospital product use, (3) waste segregation before disposal and (4) recycling or reuse of products. The operating room contributes approximately 20-33% of total healthcare waste, which can be quite costly to dispose of. General waste disposal costs $0.03-0.08/lb, regulated medical waste $0.20-0.50/lb, hazardous waste $1.70-2.00/lb, and universal waste $0.75-1.00/lb. However, the disposal of recyclables costs only $0.01/lb. Proper disposal of appropriate recyclable materials in the OR could drastically reduce unnecessary costs and wasted healthcare dollars. Method: A survey of operative personnel was performed in order to identify any potential barriers to recycling. Questions addressed knowledge of recyclable materials and improvement strategies. The survey design was validated using pretesting and clinical sensibility testing. The survey took approximately 5-10 minutes to complete, and consisted of 22 questions. Data was anonymous and subjects were permitted to opt-out of the survey if they desired. These data facilitated the creation of a recycling program. Results: Over four hundred completed the survey. Most respondents reported having a positive attitude toward recycling, and were active recyclers in their homes. According to our survey, 75.4% of participants responded that it is unclear what waste items are recyclable, and 50% of participants reported that they never recycle or only sometimes recycle in the OR. The results revealed a general misunderstanding regarding proper recycling techniques, but not a lack of willingness to recycle. The majority supported greater operating room waste recycling, and thought indefinable barriers included labeling and training. These data facilitated the creation of labeling and directed education to proper disposal of waste. Conclusion: Recycling is an important component of dealing with operating room waste, and is critical in lowering disposal costs. Despite an active recycling program, the majority of respondents reported that improvements could be made in recycling education and availability in the operating room. Optimizing how recycling is managed in operating rooms requires building a framework that improves knowledge, training, and availability. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 285 ePOSTER ABSTRACTS (cont.) P 52. IMPLEMENTATION OF AN ERAS PROTOCOL FOR COLECTOMY IS ASSOCIATED WITH IMPRESSIVE RESULTS I Van Dyken MD, S Nishida MD, L Kanai MD, K Mah MD, GX Zhang, PhD, WL Biffl MD Honolulu, HI Background: Enhanced recovery after surgery (ERAS) protocols have been implemented around the world, for numerous types of abdominal surgery, with good clinical outcomes and patient satisfaction. For unclear reasons- perhaps because the published protocols appear daunting- they have not been embraced broadly in the U.S. In our institution, we see a great deal of variation in colorectal surgery, and it continues to be the highest risk procedure for surgical site infections (SSIs). We hypothesized that implementation of an ERAS protocol would improve hospital length of stay and reduce surgical site infections following colorectal surgery. Method: A protocol focusing on preoperative (bowel preparation, showering), intraoperative (non-narcotic adjuncts for analgesia, judicious fluid administration), and postoperative (early diet and ambulation) factors was implemented in June 2015. Patient expectations were focused on early diet, mobility, and discharge. Cases were reviewed, along with non-ERAS controls during the same time period. Outcomes were compared by Wilcoxon tests for continuous variables and Fisher’s exact tests for categorical variables (*=p<0.05). Results: ERAS (n=30) patients had shorter median hospital length of stay (LOS) than non-ERAS (n=116) patients (3.4 vs 6.0 days*). Median time to ambulation (0.5 vs 0.9 days*) and from surgery to discharge (3.0 vs 4.8 days*) were also shorter. The ERAS group had nonstatistically-significant reductions in SSIs (0 vs 6%), mortality (0 vs 3%) and 30-day readmission (3% vs 5%). Conclusion: Implementation of the modified ERAS protocol was straightforward and led to substantial reduction in both hospital and postoperative length of stay. ERAS also may help to reduce surgical site infections. There does not seem to be any downside to implementing such a protocol universally. 286 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 53. IMPACT OF SURGICAL FELLOWSHIPS ON AMERICAN BOARD OF SURGERY PASS RATES FOR GENERAL SURGERY PROGRAMS MJ Al Fayyadh MBChB, C Foote MS, JA Rawlings BS, B Bankhead-Kendall MD, M Truitt MD, JW Kempenich MD, RE Willis PhD, DL Dent MD San Antonio, TX Background: Fellowship programs may result in lost case volume and variety for residents operating as primary surgeons. We hypothesized that the increased number of fellows would lead to lower pass rates on American Board of Surgery (ABS) Examinations. Method: Retrospective review of publicly available five-year rolling pass rate for first time examinees on ABS Qualifying Exam (QE), Certifying Exam (CE) and QE/CE index from 2010-2015 was performed. Surgical fellow positions for 2015 were examined by specialty. Pass rates were compared between general surgery residents who trained with fellows and without fellows. Fellow to resident ratio was calculated by dividing the number of fellows over the number of approved general surgery PGY5 categorical positions. We further categorized the programs based on fellow to resident ratio. We defined high fellow to resident ratio as greater than 0.5 and low resident to fellow ratio as lower than 0.5. Statistical analysis was performed using Fisher’s exact test with α± <0.05. Results: Of the 242 programs, 148 had fellows. General surgery residents who trained with fellows had higher pass rates than without fellows on QE (88% vs 86%), CE (83% vs 80%) and combined QE/CE (74% vs 69%; p<0.05). Pass rates were also higher for residents who trained with fellows in all QE, CE, and QE/CE for vascular, cardiothoracic, pediatric surgery, abdominal transplant and breast oncology (p<0.01). CE and QE/CE scores were higher for surgical critical care and hepatobiliary (p<.01). In surgical oncology only higher CE pass rates were found (p<0.05). No significant difference in pass rate was found for colorectal and MIS. In general surgery residency programs with fellows, higher QE, CE and QE/CE scores were found in programs with a high fellow to resident ratio (p<0.05). No significant difference was found between general surgery residents who trained with no fellows compared to the ones who trained in programs with a low fellow to resident ratio. Conclusion: General surgery examinees performed better on ABS examinations when trained in programs that had more fellows. This may represent a significant selection bias. It could also represent an educational or curricular benefit associated with the presence of fellows. More research to examine the factors affecting board pass rates and effect of fellowships on training is needed. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 287 ePOSTER ABSTRACTS (cont.) P 54. CLINICAL CHARACTERISTICS OF SUPER-OBESE FEMALE SURGICAL PATIENTS VARY BY RACE: ANALYSIS OF 1212 BOLD DATABASE PATIENTS MD Davis DO, GJ Slotman, MD Vineland, NJ Background: The obesity epidemic has transformed every surgical practice into a bariatric office. Obesity affects more females than males, and every clinical insight helps surgical care of these medically fragile women. Racial differences among superobese women have not been investigated. The objective of this study was to identify clinical variations by race among super-obese female surgical patients. Method: Pre-operative data from 1,212 women in the Surgical Review Corporation’s BOLD database who chose bilio-pancreatic diversion/duodenal switch (BPD/DS) was analyzed in five groups: African-American (n=106), Caucasian (n=1,000), Hispanic (n=34), and Other (Pacific Islander, Native American, or >1 race listed in BOLD; n=72). Age, weight and Body Mass Index (BMI) were compared by analysis of variance. Dichotomous variable distribution was assessed by the Chi-squared equation. Results: Black/Caucasian/Other/Hispanic weight (kg: 152.9+/-28., 138.5 +/-27.0, 138.8 +/-26.4, 136.2 +/-27.8), BMI (56.3 +/-10.1, 51.0 +/-9.2, 51.1 +/-9.0, 52.8 +/-11.4), age (40.3 +/-10.3, 45.3 +/-11.3, 42 +/-12.4, 41.7 +/-10.8) varied significantly (p<0.0001), as did unemployment (22.6%, 29.9%, 44.1%, 15.3%, p<0.05). Obesity co-morbidities are detailed in Table 1. African-Americans had highest abdominal hernia, obstructive sleep apnea, and stress urinary incontinence, and lowest cholelithiasis, GERD, dyslipidemia, and pseudotumor cerebri. Caucasian mental health diagnoses, depression, GERD, menstrual irregularities, polycystic ovarian disease and psychological impairment were highest. Hispanics had the highest rates of abdominal panniculitis dyslipidemia, pseudotumor cerebri, and pulmonary hypertension. Other group had the highest stress urinary incontinence, and the lowest abdominal hernia and panniculitis, mental health diagnosis, depression, menstrual irregularities, obstructive sleep apnea, polycystic ovarian disease, psychological impairment, and pulmonary hypertension. African American and Caucasians alcohol use was highest, and lowest in Other. Health insurance, angina, asthma, back pain, congestive heart failure, DVT/PE, fibromyalgia, functional status, diabetes, gout, HTN, ischemic heart disease, liver disease, lower extremity edema, musculoskeletal, obesity hypoventilation, peripheral vascular disease, substance abuse and tobacco use did not vary. Conclusion: Super-obese women vary clinically by race. Pre-operative BPD/DS, African-American females were heaviest, Caucasians oldest, and Hispanics most unemployed. African-Americans were highest in 3 co-morbidities and lowest in 4, versus Caucasians highest 7/lowest 0, Hispanics highest 5/lowest 0, and Other highest 1/lowest 10. This advance information can raise clinical suspicion for medical problems in super-obese surgical patients, and may, thereby, facilitate improved peri-operative surgical management. 288 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 289 ePOSTER ABSTRACTS (cont.) P 55. TACKLE TRAUMA 5K RUN/WALK: A CONTEMPORARY AND INNOVATIVE WAY TO INCREASE COMMUNITY AWARENESS AND RAISE FUNDS TO REDUCE THE BURDEN OF TRAUMA AJ Mangram MD, GR Shirah MD, J Sucher MD, CJ DHuyvetter MSN, MS Byrne MSN, PA Prichard MD, KD Shatto BSN, MM Moyer, JR Leaf, JK Dzandu PhD Phoenix, AZ Background: The Arizona Trauma Association (ATA), formerly Arizona Trauma & Acute Care Consortium, was established by level I trauma centers in Arizona to provide leadership and education. The state of Arizona has seen a significant increase in the number of American College of Surgeons verified and state designated trauma centers in recent years. As a result, the ATA leadership has been seeking innovative ways to collaborate, educate, generate funds for research, and enhance trauma awareness. Although traumatic injuries remain the leading cause of death for children and adults ages 1-49, we as trauma providers have not embraced the community as a major stakeholder for awareness, education, research and revenue. Therefore, we sought to establish a yearly community family-oriented 5Krun/walk for trauma as an innovative method of generating funds for trauma research and injury prevention while engendering community awareness and support. Method: We identified Super Bowl Sunday for our yearly event as a symbol of community and family gathering along with injury prevention opportunities. This was a collaboration of multiple trauma centers within Arizona. Bi-weekly meetings started in November with web and phone conferencing to accommodate all centers involved, meetings increased to weekly in January. Planning Committee agenda consisted of: advertisement and website development, obtaining sponsorship, volunteer recruitment, medic-tent arrangement and day of event planning. The course and timing were facilitated by professional race planners. Results: From the inception to our first event race was 3 months. Our inaugural event was a great success with 293 participants in 2015 and 307 in 2016. Our participants included physicians, RN, NP, hospital personnel, Red Cross members, college students, medical students, and community members at large. For the two years, participants and sponsors generated $83,485, 11 sponsors in 2015 and 19 in 2016. Expenses for the events totaled $19,311 making a net income for these events of $64,173 in two years. Our second event was covered live on ABC. Conclusion: In our effort to improve trauma care we must bring more attention to the disease of trauma. This creative, contemporary event generated a spirited community response and increased awareness of the burden of trauma all while gaining a substantial profit, to aid in other trauma initiatives. First funding initiative will revolve around texting and driving/walking as we have seen a significant increase in pedestrian injuries related to texting. Our Tackle Trauma event can easily be replicated nationwide, on Super Bowl Sunday morning. 290 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 291 ePOSTER ABSTRACTS (cont.) P 56. TIMING IS EVERYTHING: OUTCOMES IN TRAUMATIC SUBDURAL HEMATOMAS BASED ON TIME TO OR RJ Caiafa MD, JW Davis MD, RC Dirks PhD Fresno, CA Background: Traumatic subdural hematomas (SDH) requiring operative intervention occur relatively frequently. Per ACS-COT performance guidelines, craniotomy should occur within 4 hours. These guidelines do not differentiate between patients with acute (ASDH), mixed (MSDH) (both acute and chronic components), or chronic SDH (CSDH). Patients with MSDH or CSDH often present with mild or no symptoms, suggesting that they differ clinically from those with ASDH. The purpose of this study was to determine if outcomes are dissimilar between patients with ASDH versus MSDH or CSDH evaluated by time to OR. Our hypothesis was that time to OR had less impact in patients with MSDH or CSDH. Method: A retrospective review was performed of all patients with acute, mixed, and chronic SDH due to trauma undergoing craniotomy at an ACS verified Level I trauma center from 1/10 to 12/15. Data included age, GCS, ISS, time to OR, ICU length of stay (LOS), hospital LOS, and outcomes. Groups were compared to patients with ASDH who underwent craniotomy in ≤ 4 hours. Statistical analysis utilized Chi square and Mann Whitney U tests, with significance attributed to a p-value <0.05. Results: During the 5 year study period, 402 patients were admitted with SDH requiring operative intervention: 260 ASDH, 50 MSDH, and 92 CSDH. Conclusion: Patients with ASDH who go to the OR within 4 hours have a lower GCS, higher ISS, and worse outcomes than those with MSDH or CSDH. Patients with MSDH or CSDH with minimal neurologic findings may safely undergo surgery outside the 4 hour window without worse outcomes. This suggests that patients’ neurologic status at time of presentation is more predictive of their outcomes than time to OR. ACS-COT performance guidelines should be updated to reflect these differences. 292 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 57. RELATIONSHIP OF OIL PRICES AND ACTIVITY TO TRAUMA IN NORTHWESTERN NORTH DAKOTA C Pratt MD, S Johnson MD, A Sahmoun PHD, R Szlabick MD Grand Forks, ND Background: The top oil producing counties in North Dakota have seen a rapid change in the trauma activity with the rise and fall of oil prices. Oil production in the state of North Dakota has risen from 30.8 to 432 million barrels from 2002 to 2015. The active drilling rig count had risen from less than 20 to over 200 from 2002 to 2012; but then has fallen to 84 in 2015. This caused an initial influx of population into the region that has plateaued. This region is largely a rural area served by critical access hospitals. As the population and infrastructure have grown, and subsequently fallen; this study was done to determine how the industry has and continues to affect trauma systems in the region. Method: Data from the North Dakota trauma database was collected for all trauma patients in top oil producing counties that were admitted to the hospital from January 1, 2008 until December 31, 2015. Data collected included age, county of injury, injury severity score (ISS), cause, work relation, time, transport method, and outcome (mortality). Patients were assigned to early (2008-2010), late (2011-2013), and extended (2014-2015). Severely injured was defined as ISS >15. Using SAS software Chi-square test was used to analyze the differences between groups for categorical variables and Wilcoxon signed-rank tests for continuous variables. Statistical significance was defined as P-value < 0.05. Results: 4821 patients met inclusion criteria. In the high oil production area there was a 130% increase in total number of trauma admissions in the early vs. late time period from 334 to 775 total admissions (p<0.05) with a fall to 746 in the extended time period. Motor vehicle crashes were the most prevalent cause of trauma in the high oil production area and more than doubled between the early (148) and late (438) time periods (p<0.05), with downtrend of 356 being seen in the extended time period. The occurrence of work related accidents and severely injured patients have similarly fluctuated. Mortality of the severely injured patients has also fluctuated over the three time periods starting at 7%, increasing to 13%, and finally decreasing to 8%. Conclusion: Increased drilling for and production of oil during times of high oil prices resulted in significant increases in trauma admissions and mortality in counties where oil was produced. There is an increased need for trauma systems in areas of high oil production. Continued study will be necessary to see if this trend remains despite the decrease in oil prices and growth of the industry. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 293 ePOSTER ABSTRACTS (cont.) P 58. INCIDENCE OF ACUTE KIDNEY INJURY IN SEVERELY INJURED PEDIATRIC TRAUMA PATIENTS IS NOT AFFECTED BY RECEIVING IV CONTRAST McGaha, Paul; Johnson, Jeremy; Garwe, Tabitha; Motghare, Prasenjeet; Daly, William; Letton, Robert Oklahoma City, OK Background: Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population is limited. While obtaining a creatinine value prior to receiving IV contrast for elective CT scans is a relatively accepted standard of care, we sought to determine whether there was any significant difference in the incidence of AKI between severely injured pediatric trauma patients who had a CT scan with IV contrast and those who did not receive IV contrast. Method: This was an Institutional Review Board approved single institution, retrospective, study in which we reviewed the data from the trauma registry at our Level 1 Adult and Pediatric Trauma Center between 2008 -2013. We limited the patient population to severely injured (ISS > 15) pediatric trauma patients (<15 years old) who were directly transported from the scene of injury and had a creatinine level measured upon arrival. 1,214 patients were initially reviewed and 211 patients were included in the study, as these 211 had a repeat creatinine. AKI was defined as a 50% increase in creatinine that resulted in a post scan/arrival creatinine of >1.0 mg/dl within 24 hours. We then compared incidence of AKI in the groups who received a CT scan with IV contrast (CON; n=166) versus the group that did not receive IV contrast (nonCON; n=47). Results: The two groups were comparable in age, gender, GCS, ISS, mean creatinine on arrival and mean creatinine post CT scan/arrival. There were significantly more traumatic brain injuries in the non-CON group than the CON group (83% vs 59%; p < 0.002). None of the patients in either group ever met criteria for AKI. Two patients (4%) in the non-CON group and 9 patients (5%) in the CON group arrived with a creatinine > 1.0mg/dl, none of which had any evidence of increasing creatinine during their hospitalization. No patients required a nephrology consult during or after hospitalization suggesting that clinically significant AKI did not occur during or after their hospitalization. Conclusion: Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine prior to exposure is ideal, obtaining an indicated CT scan with contrast in severely injured children should not be delayed in order to obtain a creatinine value. 294 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) April 2 – 5, 2017 | Hyatt Regency, Maui, HI 295 ePOSTER ABSTRACTS (cont.) P 59. 10 YEAR RETROSPECTIVE REVIEW OF INJURY PATTERNS BETWEEN 4-WHEELERS AND SIDE-BY-SIDE ALL TERRAIN VEHICLES Shawn Olson MD Grand Forks, ND Background: All-terrain vehicles (ATVs) have increased in size and horsepower over the last 45 years. Current models now offer 140 horsepower. Side-by-side configured models or utility-terrain models (UTVs) were introduced in the late 80’s, but gained in popularity over the last 10-15 years. The newest variety of side-by-side ATVs are sport models that allow for high speed travel over uneven terrain. Safety features have also been introduced with newer models having, seatbelts, doors or side curtains. There is no available published literature to suggest whether newer ATV types are more or less dangerous than previous models. North Dakota is a ideal research site as rural states have a much higher per capita ATV related death rate than more densely populated states. Method: ATV-injured patients admitted to level II trauma centers in Eastern North Dakota were reviewed between years 2004 through 2015. ATV Type, helmet/seatbelt use, and length of stay were recorded. These were compiled with existing data for age, sex, trauma activation level, safety device usage, GCS, length of stay, injury severity score, mortality, and alcohol use. Data were analyzed with Chi-Squared and ANOVA statistical models. Results: The ten-year period produced 550 consecutive records for review. The number of ATV trauma related patients each year increased from 32 to 53 admissions over the 10 year period. The number of side-by-side injured patients per year increased from 0 to 16. Overall, 75% of the patients were male, mean age was 31 years, 36% had alcohol involved, 16% were helmeted and 48% were seat belted. The review demonstrated that 64% of the patients were riding traditional 4-wheelers, 13% side-by-sides, 3% threewheelers and 20% could not be determined what type of vehicle (ATV-NOS) was in operation. Helmet use was 13% for 3-wheelers, 19% for 4-wheelers, 9% of side-by-sides and 9% ATV-NOS riders. There were was no difference between ATV type and alcohol use, trauma response level, length of stay, GCS, ISS and mortality rate. Conclusion: This represents a large sample of ATV related injuries during a time frame where ATVs became more powerful and different configurations became popular. ATV type was able to be determined by retrospective chart review in the majority of cases. ATV related injuries became more frequent over this time period with side-by-side injuries becoming common. This study suggests that side-by-side configured ATVs do not appear to result in more severe injuries. 296 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 60. FAILURE OF INTRACRANIAL PRESSURE RESPONSE TO BARBITURATE COMA RJ Vasak MD, A Sharp MD, DY Kim MD, DS Plurad MD Torrance, CA Background: Barbiturate coma is used as a medical therapy for refractory intracranial hypertension (ICH). Its therapeutic benefit must be weighed against its considerable side effect profile and variable metabolism. Despite achieving goal electroencephalographic (EEG) burst suppression, many patients do not have a therapeutic response in intracranial pressure (ICP). Method: Utilizing our prospectively maintained trauma brain injury registry, we identified 84 patients from the last 21 month period who had intracranial pressure monitors placed. 15 patients were treated with barbiturate coma for refractory ICH. Of these, data tracking clinical response to pentobarbital were retrospectively gathered. Therapeutic response to pentobarbital was defined as an ICP<25 for the 24 hour period after initiation of goal burst suppression. 73% of the patients were males with an overall mean age of 34.1. Results: 6 of the 15 patients had failure of ICP response to pentobarbital within the first 24 hours. Of these patients, there was a 100% mortality and 50% went on to organ donation. These six patients were on pentobarbital infusion for a mean of 2.33 days. After the start of infusion, all had episodes of hypotension, 2 developed lactic acidosis, and 3 developed pneumonia. Conclusion: Failure of ICP response within 24 hours to barbiturate coma in our series was associated with 100% mortality. By incorporating these data into clinical decision making, it may be possible to limit duration of barbiturate comas in patients for whom there is no therapeutic benefit. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 297 ePOSTER ABSTRACTS 298 (cont.) Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 62. CORRELATING GEOGRAPHIC LOCATION WITH INCIDENCE OF MOTOR VEHICLE INDUCED PEDESTRIAN INJURY N Bhutiani MD, KR Miller MD, MV Benns, MD, NA Nash MD, GA Franklin MD, JW Smith MD PhD, BG Harbrecht MD, CR Scoggins MD, MC Bozeman, MD Louisville, KY Background: Previous studies have demonstrated a positive correlation between alcohol and illicit drug use and the likelihood of a pedestrian being struck by a motor vehicle. However, to date, none have examined the relationship between infrastructural and socioeconomic factors and the frequency of pedestrians sustaining traumatic injuries from a motor vehicle. The objective of conducting this retrospective analysis was to analyze the impact of location on the frequency of pedestrian injury by motor vehicle. Method: The University of Louisville Trauma Registry was queried for patients who had been struck by a motor vehicle between January 2010 and December 2015. A total of 615 such patients were identified and grouped by injury zip code. Demographic, clinicopathologic, and outcome measures were recorded for each patient. Median household income, population density, and median age for each zip code were also recorded. Statistical analysis was performed after exclusion of all zip codes with fewer than 5 incidents during the study period. Heat mapping was performed to evaluate geographic distribution of incidents. The heat map was compared to a heat map of motor vehicle accidents during the study period generated using publicly available accident data. Statistical analyses were performed using the Pearson correlation. For all analyses, p-values <0.05 were considered significant. Results: Incidents of pedestrians being struck by motor vehicles clustered most densely in the downtown Louisville area (Figure 1A). The distribution of these incidents did not correspond directly to the distribution of motor vehicle accidents (Figure 1B). Number of incidents was correlated with lower median household income (r=-0.47, p=0.008). While there was a moderate correlation between number of incidents with population density, this did not reach statistical significance (r=0.33, p=0.078). There was no correlation between number of incidents and age (r=-0.10, p=0.59). Similarly, there were no significant correlations between zip code demographic variables and patient age, gender, ICU and total length of stay, abbreviated injury scale and injury severity scale scores, and proportion of surviving patients. Conclusion: Incidence of pedestrian injury by motor vehicles is influenced by regional socioeconomic status. Efforts to decrease the frequency of these events should include further investigation into the mechanisms underpinning this relationship and identification of public safety programs and infrastructural improvements to educate and protect pedestrians in such areas. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 299 ePOSTER ABSTRACTS (cont.) P 64. MANAGEMENT OF MULTIPLE RIB FRACTURES AND FLAIL CHEST WITHOUT OPERATIVE RIB STABILIZATION AND IMPACT ON PATIENT OUTCOMES Hanna Park MD MPH, Esther Bae DO, David Wong MD, Samir John MD Colton, CA Background: Multiple rib fractures, including flail chest, can be a severe consequence of thoracic trauma, resulting in high morbidity and mortality. Surgical management of rib fractures has been gaining popularity but there are no definitive, randomized trials that demonstrate it’s superiority to multidiscipkinary, nonoperative management. Moreover, rib stabilization can he rare but morbid complications. Our aim was to validate multidisciplinary strategies in management of multiplease rib fractures and flail chest without rib stabilization. Method: We performed a retrospective analysis of adult trauma patients (n=96) with a median Injury Severity Score of 12.5 (range 4-43) who presented to Arrowhead Regional Medical Center with multiple rib fractures and flail chest between December 2015 to March 2016. Patients with three or more rib fractures (four or more if under age 65) were included; fourteen patients had flail chest by traditional definition (21.2%). We excluded any patient who died within 24 hours of arrival. Sixty-six patients met inclusion criteria. Primary outcomes included days on ventilator, days in intensive care unit as well as total hospital days, incidence of pneumonia, and mortality. Results: Patients averaged 6.2 ventilator days (1-16), 5.5 intensive care unit days (118), 8 total hospital days (1-46). Nine percent of patients developed pneumonia during hospitalization. In-hospital mortality averaged 4.5%. When compared to published data for surgically stabilized patients, management of multi-rib fractures and flail chest without operative rib stabilization in thoracic trauma patients results in comparable outcomes with respect to length of ventilator support, incidence of pneumonia, total ICU and hospital days, as well as mortality. Conclusion: Multidisciplinary management for multiple rib fractures and flail chest without rib stabilization has comparable outcomes to surgical fixation. With rare exceptions, it should continue to be considered standard of care for this population of severely injured patients. 300 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) P 65. THE FAST EXAM CAN RELIABLY IDENTIFY PATIENTS FOR ZONE III RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA (REBOA) DEPLOYMENT IN LIFE THREATENING PELVIC FRACTURES NT Townsend MD, CC Burlew MD, EE Moore MD, AE Geddes MS, AE Wagenaar MD, C Fox MD, FM Pieracci MD Denver, CO Background: While there is enthusiasm for REBOA use in zone III for unstable pelvic fractures, there is controversy over placement in zones I and II. Additionally, delineating associated intraabdominal hemorrhage using the Focused Abdominal Sonography for Trauma (FAST) exam in these multiply injured patients has been reported to be unreliable. We hypothesized that FAST is a reliable method for detecting clinically significant intraabdominal hemorrhage in the face of complex pelvic fractures and can be used to direct the use of REBOA in life threatening pelvic injuries. Method: Our pelvic fracture database of all hemodynamically unstable patients requiring intervention from 1/1/05 to 7/1/15 was reviewed. FAST exam performed in the ED was compared to operative and CT scan findings. Confirmatory evaluation for FAST(-) patients was considered positive if therapeutic intervention was required. Patients with imaging at an outside hospital or no recorded FAST in the ED were excluded. Results: During the study period, 81 patients in refractory shock with FAST imaging in our ED underwent pelvic packing. Mean age was 45 ± 2 (range 6 to 88) years and ISS was 50 ± 1.5. FAST exam results and subsequent confirmatory evaluation are reported. The sensitivity and specificity for FAST in this hemodynamically unstable pelvic fracture population was 96% and 96% respectively; PPV was 93% and NPV was 98%. The false negative and positive rates for FAST were 2% and 7%. Conclusion: FAST reliably identifies clinically significant hemoperitoneum in life threatening, pelvic fracture related hemorrhage. The incidence of false negative FAST in this unstable pelvic fracture population was 2%. FAST results can reliably be used when determining the role of REBOA in these multisystem trauma patients. Placement of REBOA in hemodynamically unstable pelvic fracture patients who are FAST(-) should be considered while caution should be used in FAST(+) patients. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 301 ePOSTER ABSTRACTS (cont.) P 11. HEMOSTATIC MASSIVE TRANSFUSION PROTOCOLS AND TRAUMA LAPAROTOMIES SF Mclean MD, AH Tyroch MD El Paso, TX Background: Massive transfusion protocols (MTP) have been created to improve resuscitation of bleeding trauma patients. MTP associated with laparotomy have been associated with abbreviated laparotomy ( AL) designed to optimize physiologic resuscitation. Recently, attention has focused on MTP design to aid coagulation. Although it has been shown that AL with MTP enhances survival, studies on specific MTP have not been done. The purpose of this study was to examine the relationship between a newer, hemostatic MTP, incidence of AL, number of OR trips for closure, and survival; compared with old-style non-hemostatic MTP. Hypothesis was that hemostatic MTP (H-MTC) would improve survival compared with other types of massive transfusion or non-protocolled transfusion. Method: In a level-one trauma center, the massive transfusion protocol was revamped to maintain a 1:1:1:1 ratio of PRBC: FFP: Platelets: cryoprecipitate. A retrospective chart review was used to examine activation of new MTP, AL, eventual closure type, survival. Chi square was used to assess categorical variables and T-test was used to evaluate continuous variables. Results: 258 consecutive laparotomies, 2012-2015, 252 with operative notes occurred. Mean ISS was 20.3, Mean LOS was 16.3 days, Mean ICU LOS was 14.4 days. A transfusion occurred in 150 (58%). H_MTC occurred in 65 (25%), old MTC in 2, 83 (32%) transfused, no MTP. Of the H_ MTP, mean (range )totals ( in units): Mean PRBC : 26.5(3-184), Mean FFP: 21.8 0-145), Mean platelets 28 (0-180) , Cryoprecipitate 18.6 (0-200). Analyzing laparotomies, 118 had AL (45.7%). 55(47%) of AL patients had H-MTC; 53.4% did not; of those closed 1st case, only 9(6.7%) had HMTC, 2 Old MTC(1.5%). This was significant, p=.000. In AL patients, 107 (91%) had 1st closure with negative pressure wound therapy. 61 (52%) were able to be closed primarily at second closure, 27 (23%) had repeated NPWT, 4 Wittman patch. Looking only at AL patients, 46 (81%) of those with no MTC vs 37% of those with hemostatic MTC and AL had primary closure at 1st takeback. (p=.000). Primary fascial closure was achieved in 55% of H-MTC patients vs. 88% in no-MTC patients. (p=.000). For patients with H-MTC 86% had AL, compared to 34% with no MTC. (p=.000). Comparing postoperative issues which may indicate visceral edema, there was no significant difference in percent of dehiscence or compartment syndrome, but there was an increase incidence of reopening in patients who had H-MTC (5.9% of no MTC vs. 12.7% of H-MTC patients reopened (p=.020). 8 Wittman patches were evenly divided among no vs HMTC groups. 302 Southwestern Surgical Congress | 69th Annual Meeting ePOSTER ABSTRACTS (cont.) Overall survival in this group was 86.8%, compared to previous laparotomies (n-742) from 2013-2011, where survival was 85%, with mean ISS of 21.9. 66% of H-MTC patients survived vs 95% of those with no MTC, (p=.000); Patients with HMTC had ISS mean 31 vs. 16.6 in patients with no MTC (p=.000). Conclusion: Hemostatic MTC was achieved in 65 patients since 2012. Those patients had higher ISS and decreased survival compared with patients who did not require MTC. MTC was associated with increased rate of AL and re-opening after closure. Although MTC was lifesaving, it is associated with the problems of repeated takebacks and reopening and lower rates of primary fascial closure for final closure. April 2 – 5, 2017 | Hyatt Regency, Maui, HI 303 304 Southwestern Surgical Congress | 69th Annual Meeting MEMBERSHIP BY LOCATION April 2 – 5, 2017 | Hyatt Regency, Maui, HI 305 MEMBERSHIP ALABAMA Nabil M. Habib Terry A. Treadwell ARKANSAS Alison A. Acott David S. Bachman Thomas E. Bell David W. Bevans, Jr. Janina B. Bonwich John R. Broadwater John P. Burge Hugh F. Burnett Gilbert S. Campbell William G. Cooper Melvin S. Dassinger John W. Dorman Darryl W. Eckes David D. Fried William M. Gibbs John E. Hearnsberger Ronda S. Henry-Tillman Robert L. Hill David W. Hunton Robert H. Janes, Jr. Joseph C. Jensen Donna D. Johnson John M. Johnson V. Suzanne Klimberg Samuel E. Landrum Nicholas P. Lang Franklin M. Lockwood Anne T. Mancino A. Scott Marotti H. Scott McMahen Ronald D. Robertson Porter R. Rodgers Marc A. Rogers Boyd M. Saviers Glenn P. Schoettle Steve P. Schoettle Howard Schwander Stephen J. Seffense Robert H. Shaw James W. Slezak 306 (cont.) Samuel Smith David E. Stearns Emilio Tirado Richard H. Turnage James R. Walt Kent C. Westbrook John H. Wikman Elbert H. Wilkes Philip A. Woodworth David M. Yocum ARIZONA Joseph G. Abdo Andrew Aldridge Charles A. Atkinson Bart J. Carter Daniel M. Caruso Alyssa B. Chapital Ismar Cintora Neil C. Clements Michael J. Conway Joseph A. DiPasquale Heinz J. Elsner Richard E. George Richard J. Gray Donald F. Griess Marlon A. Guerrero Harry W. Hale Jr. John W. Hamilton Richard J. Harding Kristi Harold Harold H. Haston George L. Hoffmann David G. Hoherz M.D. Roger G. Howlett Kenneth H. Huey John D. Hughes Glenn C. Hunter Kenneth R. Johnson Robert R. Koefoot tammy R. kopelman Robert S. Krouse Narong Kulvatunyou Rifat Latifi Marc A. Levison Alex G. Little Terrence J. Loftus O. W. Longwood Venor F. Lovett James M. Malone Alicia J. Mangram Harold J. Mills Medo Mirza Robert E. Montgomery David D. Neal Alan Y. Newhoff Arthur M. Palrang Scott R. Petersen Barbara A. Pockaj Donald A. Polson C. Thomas Read Steve J. Sawyer Jolyon D. Schilling Richard T. Schlinkert James B. Shields susan A. stuart Joseph Sucher Max T. Taylor William J. Waldo Richard A. Walsh James A. Warneke Nabil Wasif Dennis E. Weiland Eugene L. Weston Victor J. Zannis CALIFORNIA Seyed M. Alavi Robert J. Albo Edward J. Alfrey Maria D. Allo Parviz K. Amid Frank R. Arko Mitchell E. Bailey Burton H. Baker Cristobal Barrios Robert S. Bennion James A. Booker James D. Borge Michael Bouvet Southwestern Surgical Congress | 69th Annual Meeting MEMBERSHIP Mary C. Burchell Robert A. Bush Andre R. Campbell James H. Carlisle Craig B. Carter Sebastiano V. Cassaro David C. Chen Christine S. Cocanour Scott A. Cunneen Mark A. Cunningham Lawrence A. Danto James W. Davis Roger R. Delgado Howard E. Denbo Christian M. deVirgilio John H. Ellyson Carlos O. Esquivel Mathias A. L. Fobi George V. Frankhouser F. Julian Freeman Roy M. Fujitani Steven L. Goldberg Bernard Goodhead Julien M. Goodman Wallace G. Gosney Jason I. Green Phil P. Gutierrez Alden H. Harken Jonathan R. Hiatt Denitsu Hirai Darryl T. Hiyama William B. Hutchinson David K. Imagawa Forrest L. Junod Krista L. Kaups Dennis Y. Kim Stanley R. Klein Leslie M. Kobayashi Amy M. Kwok Robert R. Larsen James N. Lau Terrence H. Liu G. Andrew MacBeth Robert C. MacKersie Charles R. Maino (cont.) Antoine Y. Mansour Daniel R. Margulies Nathaniel M. Matolo Nicolas Melo Brian A. Palafox Dilip Parekh James E. Payne David S. Plurad Erich W. Pollak Bruce M. Potenza Benjamin T. Richards Marc A. Rifkin Homero Rivas Antonio E. Robles Walter A. Rohlfing Robert K. Salter Andrew G. Sharf Clayton H. Shatney John P. Sherck Scott S. Short Howard Silberman David E. Smith Brian R. Smith Michael J. Stamos Robert W. Steyskal Gerald R. Swafford Arnold D. Tabuenca Myron J. Talbert Laurence K. Tanaka Robert M. Taylor John P. Thomassen Jesse E. Thompson Gail T. Tominaga Robert R. Torrey W. L. Verlenden Richard E. Ward Lawrence W. Way Dennis P. Welcome Wendell W. Wenneker Russell A. Williams Randolph W. Wong Fred P. Wurlitzer COLORADO Maria B. Albuja-Cruz David A. Baer Carlton C. Barnett Kathryn Beauchamp Paul G. Becker Denis D. Bensard Brock M. Bordelon Clay C. Burlew Eric M. Campion Louis J. Cenni James G. Chandler Jeffrey R. Clark John A. Collins Alicia Conrad Chris Cribari Kenneth R. Douglas James B. Downey David D. Dugan William R. Fry Kent E. Gay Frederick L. Grover Fred B. Groves James S. Haley Frank C. Harmon Stanley W. Henson Jan S. Hildebrand David E. Hutchison susan L. jackson Albert E. James K. Michael Jay Charles B. Jenney Edward L. Jones Teresa S. Jones Sarah E. Judkins jennifer S. kang Glenn R. Kempers James R. Kennedy Ed Kimm David Kramish Robert R. Linnemeyer Richard G. Lovato Robert C. Malowney Martin D. McCarter Robert C. Mcintyre April 2 – 5, 2017 | Hyatt Regency, Maui, HI 307 MEMBERSHIP James H. McKnight Edward G. Merritt Ernest E. Moore John T. Moore Thomas G. Mordick Gordon D. Murley Kyle C. Nickel Donald L. Nicolay Patrick J. Offner Merlin G. Otteman Sally A. Parsons David A. Partrick Nathan W. Pearlman Erik D. Peltz Fredric M. Pieracci Benson M. Powell Richert E. Quinn Paul R. Radway Chris D. Raeburn William G. Rainer, Jr Christine D. Rogness David B. Roos Theodore R. Sadler Robert B. Sawyer Paul B. Stidham Greg V. Stiegmann Robert T. Stovall Krista L. Turner Joseph A. Tyburczy Jeffrey L. Varnell Rebecca L. Wiebe James K. Wise Franklin L. Wright Robert C. Wrona R. Douglas Yajko H. Rolan Zick CONNECTICUT Donald B. Butler Anees B. Chagpar Stanley J. Dudrick WASHINGTON DC Karen R. Borman 308 (cont.) FLORIDA Donald A. Barnhorst Adela T. Casas-Melley David J. Ciesla Rodney C. Dwyer Sanford Glanz Donald F. Guisto Ronald A. Hinder Harry E. Keig Frederick A. Moore R Stephen Smith Michael J. Vuksta Saul F. Weinstein GEORGIA Rondi B. Gelbard J. Patrick Hooker W Andrew Lawrence Bruce V. MacFadyen Bryan C C. Morse Crystal R. Szczepanski HAWAII Walter L. Biffl Victor P. Bochkarev James D. Gibson Michael S. Hayashi George S. Lavenson Dean J. Mikami Kenric M. Murayama Irminne Van Dyken IOWA Molly E. Gross Bruce A. Obbink IDAHO Robert L. Coscia James M. Curtis Adam Deutchman June E. Heilman Russell W. Newcomb John L. Shuss Douglas R. Stafford Marcus J. Torgenson William W. Wheeler ILLINOIS Peter Angelos John E. Courtney Norman C. Estes Don E. Fry David B. Hoyt John R. Potts Derek B. Wall Thomas R. Weber INDIANA David V. Feliciano James D. Finfrock Evan R. Kokoska R. Lawrence Reed KANSAS Mazin F. Al-Kasspooles Alex D. Ammar John H. Ashcraft Patrick N. Barker R. Larry Beamer Dwane M. Beckenhauer Bernita Berntsen Frank G. Bichlmeier F. Calvin Bigler Charles S. Bollman E. Holmes Brinton Frederic C. Chang Claudio R. Decena Roy F. Drake S. Jim Farha James E. French Ira R. Grimes James M. Haan Kenneth E. Hedrick Arlo S. Hermreck Lenly T. Hopkins Robert S. Huebner Teresa F. Johnson John L. Kiser Gene A. Klingler Sammy H. Kouri Southwestern Surgical Congress | 69th Annual Meeting MEMBERSHIP Brent A. Lancaster Marvin K. Lawton Lee V. Ludwig Ted L. Macy Joshua M. Mammen George J. Mastio Marilee F. McBoyle Charles F. McElhinney Warren E. Meyer Stephen F. Miller Michael Moncure William A. Nixon Calvin R. Openshaw Jacqueline S. Osland David G. Pauls Joseph B. Petelin Norman K. Pullman Padma Raju Noel C. Sanchez Gilbert S. Santoscoy Jack L. Shellito Robert G. Sheppard Charles F. Shield, III David E. Smith John L. Smith G. Rex Stone David E. Street Harl G G. Stump Patty L. Tenofsky William A. Waswick Jason D. Woolard KENTUCKY Robert C. Martin Kelly M. McMasters Charles R. Scoggins LOUISIANA Gregory M. Savoy MASSACHUSETTS Kamal M. Itani MARYLAND Brandon R. Bruns (cont.) Barbara C. Eaton Laurence W. Greene Laura A. Harmon Lindsay O’Meara Mario Rueda MICHIGAN Steven W. Bruch Mark S. Cohen jeffrey L. johnson Peter P. Lopez MINNESOTA William K. Becker Juliane Bingener Joshua P. Froman Megan M. Gilmore David K. McAfee Keith Paley Nathaniel P. Reuter Melanie L. Richards Kevin P. Riess Christian P. Schmidt James S. Wagner MISSOURI Pablo Aguayo Charles B. Anderson Vatche H. Ayvazian Thomas J. Blanke L. Michael M. Brunt John B. Buettner John E. Codd Joseph A. Corrado Walter C. Dandridge Burleigh E. DeTar Doak P. Doolittle Theodore J. Dubuque Charles W. Dunn Jameson Forster Raymond O. Frederick Paul J. Garvin Morris S. Harless Loren J. Humphrey Frank E. Johnson James W. Jones Raymond M. Keltner Richard J. Kloecker Vernon W. Kolze Paul G. Koontz Russell R. Kraeger William K. Mangum Daniel J. Margolin David J. Meiners Ryan L. Neff George A. Oliver Meredith J. Payne Richard C. Pennell Brian G. Peterson James B. Pitt Thomas J. Safley William F. Sasser David E. Schlarman Joseph W. Sharlow Ronald J. Sharp Edward J. Shaw William Shieber Gregorio A. Sicard Mohsin P. Soliman Steven P. Stark Robert F. Szczys Bryan R. Troop George L. Tucker Charles W. Van Way, III Gus S. Wetzel MISSISSIPPI Thomas S. Helling MONTANA Jeffrey R. Balison Kelly L. Banks John R. Grierson Harold C. Habein John J. McGahan David L. Parks Charles F. Rinker John F. Weber Glenn A. Winslow April 2 – 5, 2017 | Hyatt Regency, Maui, HI 309 MEMBERSHIP NORTH CAROLINA T (Chip) E. Barnes Gena Brawley J. Gary Maxwell John F. McPhail Robert C. Simon Ronald F. Sing Bradley W. Thomas NORTH DAKOTA Mary O. Aaland Wayne L. Anderson David R. Antonenko William C. Elder Luis A. Garcia Enej Gasevic Clif S. Hamilton Mark O. Jensen Stefan W. Johnson John B. LaLonde Martin L. Rothberg Robert P. Sticca Randolph E. Szlabick Michael D. Traynor Robert W. Zarrett NEBRASKA Robert L. Anderson Juan A. A. Asensio Robert J. Buchman Gregory L. Eakins James A. Edney Richard J. Feldhaus Robert J. Fitzgibbons JASON M. FOSTER Ray D. Gaines Clark F. Hehner Jeff A. Holloway Thomas C. Howard Rommie J. Hughes F. William Karrer Timothy K. Kingston Rudy P. Lackner Sean J. Langenfeld keith C. leatherbury 310 (cont.) Corrigan L. McBride John F. McLeay Michael J. McNamara David W. Mercer Dmitry Oleynikov Chester N. Paul Richard M. Pitsch Barney B. Rees Herbert E. Reese James H. Rickman Scott G. Rose Byers W. Shaw, Jr. Louis A. Sojka Joseph C. Stothert Harold D. Thomason Jon S. Thompson Alan G. Thorson Karin P. Trujillo Rick J. Windle NEW HAMPSHIRE S. Dwight Woods NEW JERSEY Todd L. Demmy John M. Porter Gus J. Slotman NEW MEXICO William E. Badger Elwood D. Bair Raymond C. Doberneck William R. Dougherty James D. Goodman T. Philip Jacob David L. Kendall Lindell M. Kinman William E. Labarre William J. Langlois Jearl R. Lindley Daniel T. Martin Alfred J. Martin Jr Jack D. McCarthy Sam E. Neff M. Timothy Nelson Livingston Parsons David E. Pitcher David M. Robillard Dennis J. Robison John C. Russell Raphael I. Shapiro Philip L. Shultz Albert G. Simms, II Daniel E. Smith Joseph M. Smith William A. Sterling Omkar Tiku Sonlee D. West David H. Young NEVADA Annabel E. Barber John W. Batdorf Franklin R. Black G. Norman Christensen Hugh S. Collett Jorge De Amorim Filho Barry L. Fisher Margo Hendrickson Mark T. Hoepfner Brian E. Juell Daniel M. Kirgan Frederick K. Magnuson Paul W. Nelson Lorne M. Phillips Kevin R. Rayls George E. Reynolds John B. Sorensen Charles R. St.Hill Shawn T. Tsuda John M. Watson William A. Zamboni NEW YORK Norman Ackerman Stacy D. Dougherty Randeep S. Jawa Irving B. Margolis Aaron R. Sasson John S. Simon Southwestern Surgical Congress | 69th Annual Meeting MEMBERSHIP OHIO William C. Cirocco Marc Cooperman Kevin L. Grimes Edward W. Martin Edward W. Martin, Jr. R Lawrence Moss Arnold F. Nothnagel John G. Whitcomb OKLAHOMA Roxie M. Albrecht Jeffrey S. Bender James C. Brogden George M. Brown Jordan M. Bush James H. Bushart John M. Carson Donald R. Carter Thomas E. Cashero Robert N. Cooke Ernest R. Daffer William C. Dooley Gary D. Dunn Berno S. Ebbesson Ronald C. Elkins D. L. Garrett Thomas C. Glasscock Charles K. Harmon Ned D. Hemric Charles A. Howard Van H. Howard Robert Jabour William C. Jennings James S. Jones A.C. Lisle James B. Lockhart Bill P. Loughridge Jahanyar Makipour P. Cameron Mantor William C. McCurdy James R. McCurdy Mark R. Meese Harold H. Mings Harris J. Moreland (cont.) Larry R. Pennington John W. Phillips Russell G. Postier Alexander Raines Orville L. Rickey Olaseinde I. Sawyerr Charles A. Tollett James A. Totoro Dan W. Tubb Rance R. Wadley Gregory F. Walton Robert J. Weedn Ryan F. Wicks Michael B. Wiens Richard E. Witt OREGON K. Dean Gubler Albert H. Krause Milton C. Mackett PENNSYLVANIA Danny Chu Edward O. Goodrich SOUTH CAROLINA Amos D. Garner Wesley B. Jones Brent E. Krantz Stephen L. Wangensteen SOUTH DAKOTA Paul M. Bjordahl Gary L. Timmerman TENNESSEE Jeremiah L. Deneve J. Russell Smith Melvin W. Twiest TEXAS Stephen W. Abernathy Sasha D. Adams Lawrence N. Alexander Bohn D. Allen Ted W. Allen James A. Allums Joseph D. Amos Richard J. Andrassy Gregory D. Andreassian Robert T. Angel John A. Aucar Mark L. Bailey Harold R. Bailey Stephen A. Barnes Lawrence A. Beyer James T. Billups Alfred P. Bowles George H. Brandau Mary L. Brandt Clark W. Brazil Harold J. Brelsford George V. Brindley Carlos V. Brown Laura B. Bruce Petrey C. Glenn Buckingham Clifford J. Buckley Francis P. Buckley Robert B. Caraway John S. Cargile Carlos M. Chavez Stephen S. Clark Stanley L. Clayton Charles M. Cole James A. Conyers MIchael G. Corneille Jess M. Cornell Philip H. Croyle Anatolio B. Cruz Craig O. Daniel Millard A. Davis Milton V. Davis Wayne E. Delaney Daniel L. Dent Howard C. Derrick Ramon F. Diaz Richard M. Dickerman Walter E. Dickinson Alfred G. Dietrich Sharmila D. Dissanaike April 2 – 5, 2017 | Hyatt Regency, Maui, HI 311 MEMBERSHIP Charles P. Donoho James P. Dorman Ernest L. Dunn Michael J. Dwyer Brian J. Eastridge Alex Esquivel Sheridan S. Evans Robert K. Fanning Barry W. Feig Robert W. Feldtman Harris R. Fender Luis G. FernandezCarreno Morris J. Fogelman Michael L. Foreman George P. Fosmire Richard H. Franklin Richard C. Frazee Gerald F. Geisler Brijesh S. Gill Robert M. Goldstein Ernest A. Gonzalez Stephanie D. Gordy John A. Griswold John A. Harvin Kenneth Helmer George K. Hempel William Hibbitts Michael Hillis Larry J. Hines Herbert E. Hipps John B. Holcomb Steven F. Holtzman Jimmy F. Howell Ted T. Huang Philip J. Huber, Jr. Thomas L. Hudson Ginger L. Huggins Tam T. Huynh Glenn M. Ihde Charles A. Iliya Robert M. Jacobson Kenneth Jastrow Henry C. Jefferson Ronald C. Jones 312 (cont.) Adolph F. Kauffmann Michael H. Kleinman Tien C. Ko Henry M. Kuerer Paul C. Laird Terry C. Lairmore Jeffrey P. Lamont John W. Lanius Rakhshanda L. Layeequr Rahman Jeffrey E. Lee Donald Lesslie H M. Lewis Harry M. Lewis Lillian F. Liao Ralph E. Ligon Peter H. Lin Thomas N. Long Matthew A. Lovitt Emmett R. Mackan David E. Mangold Lorenzo Manuel Thomas P. Marinis Todd M. McCarty Charles H. McCollum Susan F. McLean David G. McNeir Michelle McNutt Mark M. Mettauer Harold M. Mims Laura J. Moore Philip R. Morrow John G. Myers David T.J. Netscher Jed G. Nuchtern Carey P. Page R. Don Patman George N. Peters Laurens R. Pickard George E. Pierce James E. Pittman Ernest Poulos Basil A. Pruitt Ross B. Reagan Jordan K. Reed Justin L. Regner Joe H. Roberts Emily K. Robinson Peter P. Rojas Wade R. Rosenberg Pedro A. Rubio Scott A. Russell Randolph Rutledge Edward C. Saltzstein Pon Satitpunwaycha Martin F. Scheid Elizabeth P. Scherer Wayne H. Schwesinger W. Burgess Sealy John H. Selby M. Michael M. Shabot Suhail Sharif Kenneth R. Sirinek Robert H. Smiley David C. Smith Joe E. Smith Randall W. Smith Eduardo Souchon Michael J. Spebar Donal W. Steph Michel K. Stephan Gustavo F. Stern Ronald M. Stewart Beth H. Sutton Thomas V. Taylor S. Rob R. Todd I. Richard Toranto Michael S. Truitt David W. Tuggle William W. Turner Lee L. Tuttle Clinton W. Twaddell, Jr. Alan H. Tyroch John M. Uecker David Vanderpool Raul Vela Peter A. Walker Matthew J. Wall Walter C. Watkins Matthew V. Westmoreland Southwestern Surgical Congress | 69th Annual Meeting MEMBERSHIP Kevin D. Wheeler W. Riggs Whitehouse Katie Wiggins-Dohlvik Erik B. Wilson William S. Wolff Don C. Wukasch Donald J. Young Emile Zax UTAH Dominic Albo Eric D. Anderson Richard E. Anderson Lyle H. Archibald Richard G. Barton A. Robert Bauer Michael P. Collins Alexander L. Colonna Toby M. Enniss Samuel R. Finlayson Jan S. Freeman Ute Gawlick Stuart A. George Brittany A. Gerali Lillian Grant Kelly H. Gubler Frederick V. Jackman Annika B. Kay Robin D. Kim Larry W. Kraiss Harrison M. Lazarus Edward C. Lewis, III Sarah Majercik Jim M. McGreevy Robert C. Moesinger Stephen E. Morris Robert G. Naylor Edward W. Nelson Raminder Nirula Kelly D. Nolan Thomas D. Noonan Jon C. Oberg William Peche Bartley Pickron Raymond R. Price (cont.) Richard R. Price Robert S. Price Clark J. Rasmussen Brian L. Rasmussen Mark T. Savarise Courtney Scaife Sherman C. Smith Charles M. Swindler Dean W. Tanner Daniel J. Vargo Thomas W. White Gilbert L. Wright Vernon W. Miller Oscar J. Rojo David G. Silver Sara C. Smith Travis S. Walker AUSTRIA Gerold J. Wetscher VIRGINIA Thomas A. Broughan Jonathan M. Dort Terry M. Gilliland WASHINGTON William O. Coleman S. G. Ogle Evan S. Ong Jacinto R. Orozco Monroe C. Whitman WISCONSIN Matthew I. Goldblatt Jon C. Gould Brandon T. Grover Joel D. Harris Shanu N. Kothari Jared H. Linebarger Stephen B. Shapiro Alexander D. Wade WEST VIRGINIA David C. Borgstrom Glenn D. Warden WYOMING James A. Anderson Rodney C. Biggs Paul E. Collicott Richard K. Gorton Sara L. Hartsaw April 2 – 5, 2017 | Hyatt Regency, Maui, HI 313 NOTES 314 Southwestern Surgical Congress | 69th Annual Meeting NOTES April 2 – 5, 2017 | Hyatt Regency, Maui, HI 315 NOTES 316 Southwestern Surgical Congress | 69th Annual Meeting NOTES April 2 – 5, 2017 | Hyatt Regency, Maui, HI 317 NOTES 318 Southwestern Surgical Congress | 69th Annual Meeting NOTES April 2 – 5, 2017 | Hyatt Regency, Maui, HI 319 NOTES 320 Southwestern Surgical Congress | 69th Annual Meeting 70th Annual Meeting TER N S URGIC A LC O ND ES MT ID GR UT W ES N H SO UTHWE STE R N SU RG I C AL CO N G R E SS SD S• WY NV NE UT CA CO AZ NM MO KS OK AR TX HI OR GANIZED 1948 April 8 - April 11, 2018 The Meritage Resort and Spa Napa, CA TER N S URGIC A LC O UT ES • SO ND MT ID GR H ES N W SD WY NV NE UT CA CO AZ NM SURGICAL CONGRESS S• THE SOUTHWESTERN MO KS OK AR TX HI OR GANIZED 1948 Southwestern Surgical Congress 2625 W. 51st Terrace Westwood, KS 66205 t: 913-402-7102 [email protected] swscongress.org
