Citations

Background: Breast cancer is the most common malignancy and the second most common cause of death in women worldwide. Axillary lymph node metastasis (ALNM) is the most significant prognostic factor in breast cancer. Under the current guidelines, sentinel lymph node biopsy (SLNB) is the standard of axillary staging in patients with clinically-node negative breast cancer. Despite the minimally invasive nature of SLNB, it can cause short and long-term morbidities including pain, sensory impairment, and upper limb motor dysfunction. However, lymphedema remains the most feared adverse event, and it affects 7% of patients within 36 months of follow-up. Recently, we have witnessed the implication of radiomics and artificial intelligence domains in the diagnosis and follow-up of many malignancies with promising results. Therefore, we have conducted a systematic search to investigate the potentials of radiomics and artificial intelligence in predicting ALNM. Methods: Four electronic databases were searched: PubMed, Scopus, CINAHL, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization. Results: For radiomics, area under the curve (AUC) for the included studies ranged from 0.715 to 0.93. Accuracy ranged from 67.7% to 98%. Sensitivity and specificity ranged from 70.3% to 97.8% and 58.4% to 98.2%, respectively. For other artificial intelligence methods, AUC ranged from 0.68 to 0.98, while accuracy ranged from 55% to 89%. Conclusion: The results of radiomics and artificial intelligence in predicting ALNM are promising. However, validation as a substitute to SLNB requires more substantial evidence from large randomized trials.

Objectives: Traditional hospital at home models often have high patient experience scores. The purpose of this study is to look at the patient experience of a new virtual hybrid model of hospital at home called Advanced Care at Home. Methods: Patients in Mayo Clinic’s Advanced Care at Home program received a survey via email from 1 January–31 May 2021. Each survey consisted of 20 questions divided into 18 multiple-choice and two open-ended questions. Results: Ninety-nine surveys were sent and 41 partially or completely finished surveys were returned for a response rate of 41.4%. Patients responded positively, denoted by answering “strongly agree or somewhat agree,” with regard to the ability to reach the team right away 100% of the time, being kept informed 92% of the time, the command center responding promptly to their needs 95% of the time, the team providing comfort and support 98% of the time, feeling comfortable with interacting with their provider by phone or tablet 95% of the time, the ease of use from the equipment 97% of the time, the virtual and in-person staff working well together 98% of the time, the staff treating patients with courtesy and respect 100% of the time, and the ease of understanding the discharge process and feeling ready to leave the program 100% of the time. All providers received positive responses on listening ⩾88% of the time. Patients gave a top rating in likelihood to recommend the program 100% of the time. Conclusion: Overall, the Advanced Care at Home model of hospital at home was highly recommended by patients. Patients scored the program high on responsiveness, staff engagement and communication, ease of equipment use, and readiness for discharge, strengthening the overall confidence in this novel program.

Background Patients with mild to severe chronic systemic disease undergoing low-risk procedures are often hospitalized for observation. The Care Hotel is a novel virtual medicine hybrid model of care that offers patients a comfortable, out of hospital environment where they can receive both in-person and virtual care after a surgery or procedure. This study aimed to analyze if virtual hybrid post-procedure care in a hotel could be both conducted on and accepted by patients, even those with moderate to severe chronic diseases. Methods This retrospective cohort study was conducted between July 23, 2020 and June 4, 2021 at Mayo Clinic in Florida, a 306-bed community academic hospital. We collected the sex, age, race, ethnicity, acceptance rate, ASA score, and primary procedure of patients using the Care Hotel. Results Out of 392 patients, 272 (69.4%) opted for care in the program. Median patient age was 61.5 years, 59.56% were males, and 86.40% were white. We found that 50.37% had an ASA score of 2 and 43.4% had an ASA score of 3. Ten different surgical specialties were able to utilize the Care Hotel for care in 47 different procedure types. Urology had the most patients (n=70, 25.7%). Post-electrophysiologic procedures were the most common procedures (n=39, 14.3%). Conclusion Our virtual hybrid Care Hotel program was widely accepted by patients and could care for a multitude of post-operative procedures. Additionally, this novel program can care for patients with both mild and severe systemic diseases.

Abstract Background: Endocrine therapy (ET) reduces breast cancer (BC) recurrence risk and improves BC outcomes. However, patients (pts) may refuse ET, potentially impacting their outcomes. However, the exact incidence and factors associated with ET refusal are largely unknown. Methods: We conducted a retrospective study of BC pts in the National Cancer Data Base between 2003 and 2017. Demographic, socioeconomic, co-morbidity index and tumor-specific data were compared between BC pts who refused ET versus those who agreed to ET using bivariate and multivariate models. Female pts 18 to 89 years of age with stage I, II, and III were included. Logistic regression was used to determine associations with ET refusal. Results: Among 463,228 pts, the incidence of ET refusal was 5.26% (24, 401). Of these pts, 85% were non-Hispanic White, 7.9% were Non-Hispanic Black, 3.1% non-Hispanic Asian/pacific islander, and 3.6% were Hispanic. A majority (56.9%) had government insurance, and 87.2% were from a metro residential area. Infiltrating ductal carcinoma BC subtype comprised 78% of pts. Most pts were 51-89 years of age (80%), and 20% were 18-50 years of age. On multivariable analysis (Table 1), non-Hispanic black (OR 0.82), non-Hispanic Asian (OR 0.72), and Hispanic (OR 0.84) pts had a reduced odds of refusing ET than non-Hispanic white pts. Pts with government insurance (OR 1.6, p<0.001) and noninsured pts (OR 1.3, p<0.001) had increased odds of refusing ET compared to privately insured pts. Estrogen receptor (ER) -/Progesterone (PR) +, and ER +/PR - had increased odds of refusing therapy (OR 2.9, and 1.1 respectively, p<0.001) than ER +/PR + pts. Patients with positive lymph nodes had reduced odds of refusing ET than those with negative lymph nodes (p<0.001). Additionally, pts with a 2.1-5 cm (OR 0.92) or >5 cm (OR 0.87) tumor size had a reduced odd of refusing ET than those with tumors less than 2 cm (p<0.001). Finally, patients with well-differentiated BC (grade I) had increased odds of refusing ET (OR 1.2, p<0.001) than moderately differentiated (grade II) BC. Conclusions: The incidence of ET therapy refusal is relatively low; however, survival outcomes may be negatively impacted. This is the first study to evaluate specific demographic and disease-specific factors associated with ET refusal, which can inform strategies to improve ET acceptance rate. Table 1.Multivariable Logistic Regression – ET Therapy Acceptance (Referent) vs. Refusal.VariableOR95% CIp-valueAge51 - 89 years18 - 50 years0.940.900.970.001Race/EthnicityWhite Non-HispanicBlack Non-Hispanic0.820.760.88<0.001Pacific Islander Non-Hispanic0.720.660.76<0.001Hispanic0.840.790.87<0.001InsurancePrivateGovernment1.61.521.61<0.001Not insured1.31.181.47<0.001ResidenceMetroUrban0.900.870.87<0.001Rural0.870.780.970.014HistologyInfiltrating ductal carcinomaLobular carcinoma0.840.800.87<0.001Infiltrating duct and lobular carcinoma0.900.850.95<0.001Others1.171.101.24<0.001Positive Nodes01 - 30.620.600.65<0.0014 - 90.610.570.66<0.00110 +0.610.550.68<0.001VariableOR95% CIp-valueER/PR ExpressionER +/PR +ER -/PR +2.92.563.18<0.001ER +/PR -1.11.061.14<0.001Tumor size≤ 2 cm2.1 - 5 cm0.920.880.94<0.001> 5 cm0.870.800.93<0.001GradeIII1.211.181.25<0.001III0.980.951.020.518Charlson-Deyo Score010.940.910.980.00421.070.991.150.071≥31.120.981.280.079 Citation Format: Pooja P Advani, Ricardo Torres Guzman, Francisco Avila Verduzco, Karla Maita, John Garcia, Abdullah Eldaly, Antonio Forte, Aaron Spaulding. Factors associated with endocrine therapy refusal in hormone receptor-positive breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-16.

Abstract Background Posttraumatic lymphedema develops more frequently than expected and reports on its management are scarce in the literature. We aimed to report the clinical outcomes of a case series of posttraumatic lymphedema patients treated with different vascularized lymph node transfers (VLNTs). Patients and Methods Five patients with secondary posttraumatic lower limb lymphedema treated with VLNT were included in this report. The groin-VLNT (n = 1), supraclavicular-VLNT (n = 2), and gastroepiploic-VLNT (n = 2) were implemented. The average flap area was 69.8 cm2. Patients underwent postoperative complex decompressive therapy for an average of 10.0 months. Results The average mean circumference reduction rate was 24.4% (range, 10.2–37.6%). Postsurgical reduction in the number of infection episodes per year was observed in all patients. The mean follow-up was 34.2 months. Conclusions VLNT is a promising surgical treatment for posttraumatic lymphedema patients. In our report, VLNT has demonstrated to reduce the volume and number of infections per year in posttraumatic lymphedema.

An 85-year-old male presented to the podiatry clinic following a 1st to 5th left toe amputation as a complication of severe peripheral arterial disease and nonhealing wound despite endovascular intervention with an angiogram. At the visit, cellulitis with gangrene of the surgical site was noted. The patient was admitted to the brick and mortar (BAM) hospital and taken to surgery for a transmetatarsal amputation of the left limb. In the immediate postoperative period, the incisional margins appeared dusky creating concern for flap viability. The medical team recommended a vascular bypass versus a below-knee amputation. However, given the age, comorbidities, and nutritional status, the family refused further surgical intervention. As such, Mayo Clinic’s home hospital program, Advanced Care at Home (ACH), was consulted for continued nonsurgical acute management at home. The patient was transferred to ACH and transported home three days after BAM admission to continue IV antibiotic therapy and wound care. Discharge from ACH occurred 11 days after admission to the BAM hospital. This case highlights the importance of developing health care alternatives to traditional hospitalization and demonstrates that ACH can manage highly complex, elder postoperative patients from the comfort of their homes.

AbstractBackgroundDue to duty hour regulations, patient safety and inadequate operative time simulation have become a necessary part of surgical education and training in residency. Currently, there is no formal adoption of simulators for the use of surgical education or assessment in hand surgery. This literature review analyzes that the simulation techniques established thus far in hand surgery.MethodsA comprehensive literature search was performed on PubMed. Search results were filtered by title and abstract to isolate articles that were relevant to simulation in hand surgery. Articles that were nonspecific to the hand, non‐English and cadaveric were excluded. Additional articles were identified through references from the initial search.ResultsA total of 1192 articles were yielded from the initial query. After the application of the inclusion criteria, this was narrowed down to 28 articles. Another 8 additional articles were excluded as they did not pertain to the hand although the simulators could be adapted for hand surgery. A total of 20 articles were included in this study.ConclusionsSurgical simulation is a growing and essential field of surgical education. Simulators in hand surgery are limited and require further research and validation. Like other surgical subspecialties, hand surgery may benefit from the adoption of an official simulation curriculum for the assessment of residents and enhancement of technical skills.