Cheriyath, P

Abstract Introduction Chronic Lymphocytic Leukemia(CLL) is the most common leukemia in adults in the United States. CLL patients are at higher risk of bacterial infections, and Pseudomonas aeruginosa is a notable pathogen. Limited data is available comparing the demographics and outcomes of pseudomonas sepsis in CLL. Our study aims to analyze the patient characteristics and mortality between intensive care unit (ICU) and non-ICU admissions for pseudomonas sepsis among CLL patients. Methods Adults with active CLL admitted with a primary diagnosis code of pseudomonas sepsis(ICD-10 code: A41.52) were identified via the National Inpatient Sample(NIS)(2016-2022), excluding COVID-19 cases. Admissions to ICU were estimated if the patients required mechanical ventilation , vasopressors or central venous catheter placement, as per prior NIS-based studies. The predictors of ICU admissions were identified using multivariable regression models, with further analyses focused on estimating the in-hospital mortality. All analysis incorporated adjustments for weight, cluster, and strata, as advised by the data source. Results A total of 1,650 admissions were identified, of which 335 (20.3%) required intensive care. The intensive care cohort was younger (mean age: 73.19 vs. 76.86 years), yet age was not a significant predictor for the need for intensive care. Significant racial disparities were observed, with Black patients demonstrating significantly higher odds of intensive care use than White patients. In contrast, Hispanic patients had comparable odds to White patients. Sex, weekend admission status, private insurance coverage versus Medicare, and income quartiles did not significantly impact intensive care utilization. Among comorbidities, liver cirrhosis and palliative care encounters predicted higher ICU admission rates. Paradoxically, hypertension was associated with lower odds. Other comorbidities showed no significant association with intensive care admission (Table 1). Intensive care patients demonstrated an in-hospital mortality rate of 40.91% versus 8.75% in non-intensive care patients (aOR: 6.690, 95% CI: 2.648-16.906, p < 0.01). Furthermore, intensive care had a substantially greater resource utilization, longer stays (mean: 16.49 vs. 8.83 days, p < 0.01) and markedly higher hospitalization charges (mean: $314,311 vs. $89,614, p < 0.01). Conclusions Our study revealed that black race, comorbidities like liver cirrhosis and palliative care encounters were key predictors for ICU admissions. ICU utilization was associated with higher inpatient mortality, length of stay and hospitalization costs. These findings highlight the disparities and resource burden, and warrants strategic interventions to address them. This abstract is funded by: None

Abstract Introduction Minimally invasive surgical techniques including Robotic-Assisted thoracoscopic surgery (RATS) have advanced the treatment of lung cancer and enhanced patient outcomes from early recovery to improved quality of life. The “July effect” hypothesizes that morbidity and mortality outcomes worsen during the beginning of academic year when new residents and fellows begin training. We investigated the impact of the same on outcomes of RATS among lung cancer patients. Methods Using the National Inpatient Sample (2016-2019), we identified adults(ages≥18 years) with lung cancer who underwent RATS(lobectomy/sublobar resection) at urban teaching centers(UTC). Patients were stratified by surgical timing: July-September versus other months. Multivariable logistic regression compared perioperative outcomes between groups, adjusting for confounders. Results We analyzed 25,480 RATS procedures, with 25.59% performed during July-September. Baseline characteristics were comparable between groups regarding sex, race (White, Hispanic), insurance type, comorbidity burden, and age; however, fewer Black patients underwent surgery during July-September (Table 1a). Multivariable logistic regression revealed no significant differences in perioperative outcomes between the July-September and other months of the year. Evaluated outcomes included thoracic complications like pneumonia (aOR 0.89, 95% CI 0.62-1.28, p = 0.526), pneumothorax (aOR 1.07, 95% CI 0.85-1.34, p = 0.583), air leak (aOR 0.98, 95% CI 0.79- 1.22, p = 0.873), respiratory failure (aOR 0.9, 95% CI 0.50-1.63, p = 0.729) , atelectasis (aOR 1.12, 95% CI 0.88-1.42, p = 0.372), thromboembolic events like pulmonary embolism (aOR 0.63, 95% CI 0.13-2.97, p = 0.557), deep venous thrombosis (aOR 1.01, 95% CI 0.65-1.57, p = 0.952), bleeding complications like transfusion (aOR 0.95, 95% CI 0.55-1.64, p = 0.866), hemothorax/hemoperitoneum/hematoma (aOR 0.58, 95% CI 0.22-1.52, p = 0.264), renal complications (aOR 1.00, 95% CI 0.32-3.17, p = 0.994), conversion to open surgery (aOR 0.53, 95% CI 0.11-2.47, p = 0.417), extended length of stay (>7 days) (aOR 0.96, 95% CI 0.78-1.17, p = 0.667), and in-hospital mortality (aOR 0.57, 95% CI 0.21-1.50, p = 0.250)(Table 1b). Conclusions Our study suggested no “July effect” in the perioperative outcomes of RATS. This demonstrates the robust hospital support systems ensuring the safe transition of resident classes without affecting the patient care negatively. This abstract is funded by: None