Citations

e16193 Background: Liver transplantation (LT) is curative for hepatocellular carcinoma (HCC) in patients within the Milan criteria. Readmissions are common postoperatively, and can be associated with increased morbidity and healthcare burden. Hence we aim to identify incidence, impact and independent predictors for readmission in patients who underwent LT in HCC. Methods: Retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for LT with an underlying diagnosis of HCC, in patients with cirrhosis we used the BAVENO score to categorize between compensated and decompensated cirrhosis. We aim to identify 30-day readmission rate, mortality, healthcare related utilization resources and independent predictors of readmission. Results: A total of 2,092 patients with HCC underwent liver transplantation. The 30-day readmission rate was 25.6%. Main causes for readmission were post-surgical complications from LT, sepsis, liver failure. Readmitted patients were less likely to have private insurance (40.5% vs 34.5%; P<0.01), to be obese (18.2% vs 7.9%; P<0.01), hypertensive (51.2% vs 39.5%; P<0.01), have history of non-alcoholic steatohepatitis (16.5% vs 2.3%; P<0.01). Readmission was associated with higher in-hospital mortality rate (0.1% vs. 1.5%; P<0.01). The total health care in-hospital economic burden of readmission was $56.1 million in total charges and $15.2 million in total costs. Independent predictors of readmission were type 2 diabetes, transfusion of blood products during index admission, protein-caloric malnutrition, sepsis, and preventive factors were younger age, private insurance and cannabis use. Conclusions: Readmissions after LT in HCC are associated with higher mortality and pose a high health care burden. We identified risk factors that can be targeted to decrease overall patient morbidity, mortality and health care burden.[Table: see text]

e16109 Background: Total gastrectomy with lymph node dissection is curative for early gastric malignancy which accounts for 1.5% of cancer cases in the U.S. Readmissions are common postoperatively, and are associated with increased morbidity, mortality, hospital costs and decreased quality of life. We hence aim to identify incidence, impact and independent predictors for readmission in patients who underwent total gastrectomy in gastric malignancy. Methods: We conducted a retrospective cohort study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for total gastrectomy with a concomitant diagnosis of gastric malignancy. T-test was used for continuous variables and chi square test was used for categorical variables. Multivariate regression was used to identify predictors for unplanned readmissions. ICD 10 codes were used to identify diagnoses and procedures. Results: A total of 1,779 patients with gastric malignancy underwent total gastrectomy. The 30-day readmission rate was 18.5%. Main causes for readmission were sepsis, ventricular fibrillation, recurrent STEMI. Readmitted patients were more likely to be on chemotherapy. (40.1% vs 27.2%; P<0.01) and more likely to be discharged to a skilled facility (13.5% vs 17.9%; P<0.01). The total health care in-hospital economic burden of readmission was $6.5 million in total charges and $25 million in total costs. Independent predictors of readmission were major bleeding, respiratory failure requiring mechanical ventilation, peripheral parenteral nutrition, history of non-alcoholic hepato-steatosis, and prolonged length of stay. Conclusions: Readmissions after gastrectomy in patients with gastric malignancies are associated with lower in-hospital mortality yet pose a substantial economic burden on healthcare. The lower mortality might be explained by the relatively stable course and lower comorbidities of patients who become eligible for discharge after surgery. Further studies are suggested. Modifiable risk factors like malnutrition and sepsis warrant special attention to decrease readmissions and improve overall outcomes.[Table: see text]

Myeloid sarcomas (MS) are a rare manifestation of myeloid malignancies and can often be misdiagnosed, leading to a delay in treatment. The objective of this clinical case is to highlight the challenges of the clinical presentation and to emphasize the importance of this manifestation ensuring timely diagnosis and therapy. Here, we present a 43-year-old man who was diagnosed with acute myeloblastic leukemia (AML) after being evaluated for unintentional weight loss, subcutaneous nodules, thrombocytopenia, and anemia. The patient underwent chemotherapy with complete remission and presented 4 months later with dysphagia and cranial nerve palsies. Appropriate imaging and biopsy led to a diagnosis of myeloid sarcoma, and a decision was made to begin reinduction chemotherapy for AML achieving a second complete remission although his neurological deficits did not improve. Our case illustrates the protean presentation of myeloid sarcomas; clinicians should have a high suspicion for MS and remain vigilant when unexplained signs and symptoms arise in the background of a myeloid malignancy although challenges still remain when presentation is de novo. Advancements in understanding the pathophysiology of MS have been performed but remain not completely understood. High clinical suspicion, appropriate imaging, biopsy techniques, and expertise are paramount for timely diagnosis and treatment.