POSTER#1ALUMBARHERNIA:LAPAROSCOPICREPAIRWITHDERMALAUTOLOGOUSNON-EPITHELIALIZEDGRAFT(DANG)RE-ENFORCEMENT.ACASESERIES.HymelAE,LavieJ,CookMBackgroundLumbarherniasaccountforapproximately1.5%ofallhernias.Duetotherarityofthisclinicalentityandtheuniquechallengesofrepairduetolocationandsurroundinganatomy,itisnotsurprisingthatthereisnotaconsensusontheoptimalsurgicalapproachortechniqueinrepairingthesehernias.Themostcommonmethodofrepairisviatrans-abdominalapproachwithprostheticmeshreinforcementeitherasunderlayorpreperitoneal.Butmeshrepairshavebeenassociatedwithmorepain,andcomplicationssuchasmeshinfectioncanbecostlyandrequireextendedhospitalcareandprocedurestocorrect.Biologicsareasecondoptionbutarecostlyfromthestart,anddisappearovertime,leadingtolaterecurrence.Atourinstitutionwashavebegunutilizinganewmethodforherniarepair.Dermalautologousnon-epithelializedgrafts(DANG)createdfromfull-thicknessskingraftfromthepatientarecheap,incorporatequickly,andwebelievewillbedurableandcauselesspainduetolessinflammation.ObjectivesTheaimofthisstudyistopresentacaseseriesofthemanagementofthreelumbarherniasvialaparoscopicrepairwithdermalautologousnon-epithelializedgraft(DANG)re-enforcementasaviablealternativetomeshrepair.MethodsCaseswereidentifiedanddatawascollectedfromasingleacademicinstitutioninNewOrleans,LAin2018.Threecasesoflumbarherniawereidentified-allfromtraumaticetiology.Thediagnosiswasconfirmedpre-operativelyonCTscan.ResultsAllthreecaseswererepairedlaparoscopicallyviaatrans-abdominalapproach.Theherniadefectswereclosedprimarilywithtrans-fascialsuturesandtheclosurewasre-enforcedwithadermalautologousnon-epithelializedgraftobtainedfromfull-thicknessskingraftfromeachpatient.Donorsitewasfromthegroinskinfoldinallthreepatients.Atfollow-upnorecurrenceshavebeenidentifiedandnocomplicationsdetected.ConclusionLaparoscopicrepairoflumbarherniaswithDANGunderlayre-enforcementprovidesauniquealternativetoprostheticmeshherniarepairswithequivalentearlyoutcomes.

POSTER#1BPREVENTIONOFINCISIONALHERNIAWITHCUTISAUTOGRAFTAUGMENTATIONAYoo,CSHORT,MLopez,CTakawira,CRogers,KIslam,PGreiffenstein,IHodgdon,FLauBackgroundTheU.S.healthcaresystemrepairs400,000incisionalhernias(IH)peryear.CurrentlymeshisthemainstayofIHrepair,however,thisoptionisstillunsatisfactoryduetotheinherentrisksofpain,infectionandmeshextrusion.Biologicgraftshavelowerratesofremoval(4.9%),butthecostissignificantwitha150cm2prosthesispricedat$2,845-$5311.Additionally,incontaminatedcases,recurrenceis23%whenrepairedwithmesh.Studiessuggesttheuseofcutisautograftsasacost-effectiveoptionthatmayhavelessassociatedpain,decreaserecurrenceandgraftremovalrates.ObjectivesTotesttheeffectivenessofcutisautograftsweperformedadouble-blinded,prospectiverandomizedcontroltrialusingavalidatedratmodel.Methods400gram,maleSprague-Dawleyratswererandomizedinto2groups:notreatmentcontrolgroup(N=17)andcutisautograftexperimentalgroup(N=10).Usingavalidatedratherniamodel,midlineincisionsweremadeandnotreatmentvsadermalexcisionandcutisautograftunderlayinterventionwasapplied.Theabdomenwasthenclosedbyasecondblindedsurgeon.TheprimaryendpointwasIHformationmeasuredonpost-operativeday(POD)28bysurgeonsblindedtogroupassignment.Secondaryendpointsincluded:fasciatensilestrength,seruminflammatorymarkers,tissueinflammatorymarkerexpressionandcollagenI/IIIratio.ResultsThecutisautograftsignificantlyreducedIHformation(10%[1/10]vs.82.4%[14/17]control;p<0.00).Secondaryendpoints,includingtensilestrengthshowednodifference(1.155N/mm2cutisvs1.219N/mm2control;p=0.37).SerumCRP&IL-6,aswellastissueIL-6,MMP11and13showednodifference.CollagenI/IIIratiotrendedhigherincutisautograftgroupbutagainwasnotsignificant.ConclusionCutisautograftunderlayaugmentationoffacialclosurereducedIHformationratesinadouble-blindedanimalRCT.Theseresultsestablishthepreclinicalbasisforstudiesinhumansubjects.

POSTER#1CTOTALLYLAPAROSCOPICDISTALESOPHAGECTOMYWITHNOCERVICALORTHORACICINCISIONErikA.Green,KaisRona,ChristopherDuCoinBackgroundEsophagectomyremainsamainstayoftreatmentforesophagealmalignanciesaswellasforrefractorybenigndisease.Advancesinlaparoscopicandthoracosopicsurgeryhavehelpedpromoteavarietyofminimallyinvasiveesophagealresectionprocedures.Allofthese,however,requireathoracicand/orneckincision.ObjectivesHerewedescribeacaseseriesofpatientstreatedwithatotallylaparoscopicesophagectomytechnique.MethodsAretrospectivereviewofpatientswhounderwenttotallylaparoscopicesophagectomyfromApril2016toApril2018wasconducted.Inclusioncriteriacomprisedofbenignstricturelessthan5cmfromtheGEjunction,adenocarcinomaSiewartclassificationII-III,andthosewithT1-T3diseasenoevidenceofnodalormetastaticdisease.Ourstandardapproachconsistedoffoursurgicalportsplacedintheupperabdomen.Intra-abdominalandmediastinaldissectionwasperformedlaparoscopically.Anastamosisinall5caseswasachievedwithanEEAstaplerwiththeanvilpassedtrans-orally.Esophagoscopywasusedasanadjunct,andajejunalfeedingtubewasplacedinallcases.ResultsFivepatientsunderwentatotallylaparoscopicdistalesophagectomyprocedure.Medianagewas65years(44-77years)andthemaletofemaleratiowas2:3.Theindicationforresectionin3patientswasbenigndistalstricture,refractorytomoreconservativetreatments.Adenocarcinomaofthedistalesophaguswastheindicationintheother2patients.Inthe2adenocarcinomacasesneoadjuvantchemoradiationwasgiven,theinitialstagingwasT2/3N0M0,andbothwereSiewerttypeII.Nocasesrequiredconversiontoanopenprocedure.Themeanoperativetimewas289minutes(234-322min).Therewasno30-daymortality.MeanICUstaywas12.8days(2-32days)andmeanhospitalstay15.6days(7-32days).3of5patientshadanuneventfulpost-operativecourse.2of5patients,includingonecaseofbenignstrictureandonecaseofadenocarcinoma,experiencedpost-operativecomplications.Onepatienthadrespiratoryfailurewithreintubation,andtheotheracontainedleak,bothnecessitatedaprolongedICUstay.Neitherofthetwopatientsrequiredreoperationorrevision.R0resectionwasachievedinbothcasesofadenocarcinoma.ConclusionWepresentacaseseriesof5patientswhounderwentatotallylaparoscopictranshiataldistalesophagectomy.Ourpreliminaryresultssuggestitmaybeasafealternativefordistalbenignstricturesaswellasforselectpatientswithadenocarcinomaofthedistalesophagus.Continuedrefinementofthistechniquemayhelpdecreasethemorbidityandmortalityofesophagectomybyavoidingathoracicorneckincision.

POSTER#1DWEIGHTLOSSANDINTERNALHERNIADEVELOPMENTINROUX-EN-YGASTRICBYPASSPATIENTSJessicaKoller-GorhamBackgroundLaparoscopicRoux-en-Ygastricbypass(LRYGB)continuestobeadurableoperationforweightloss.Despiteitsefficacyinweightlossandreducingpatients’co-morbidillnesses,internalhernias(IH)remaintobeawell-knowncomplicationoftenrequiringoperativeintervention.IdentifyingpatientswhoarehighriskforthedevelopmentofIHisimportantforreducingre-operationratesandassociatedmorbidity.ObjectivesWehypothesizedthattheincidenceofIHfollowingLRYGBinpatientwashigherinpatientswithgreatertotalbodyweightloss.MethodsThiswasaretrospectivestudyofallLRYGBpatientsatourinstitutionbetween2004-2017.Demographics,clinicalcharacteristics,andoperativedatawerereviewed.Descriptivestatisticswereperformedtocharacterizethepatientpopulation.Logisticregressionanalysiswasusedtodeterminetheadjustedoddsratioforincreasedweightlossandtheincidenceofinternalhernia.Results1,055LRYGBprocedureswereperformedatourinstitutioninthistimeframeand967wereincludedinthestudy.IHoccurredin3.7%ofpatients(n=36).Therewerenostatisticallysignificantdifferencesinthebaselinecharacteristicsofthepatientpopulation.Peterson’sdefectwasclosedinsignificantlyfewerIHpatients(28.6%ofnoIHcomparedto8.45%ofIH,p=0.007).PatientswhopresentedwithIHlostsignificantlymoreoftheirtotalbodyweight(86.7%)thanthosewhodidnot(36.6%,p<0.0001).AmultivariatelogisticregressionidentifiedPeterson’sclosureasapredictivefactorforIHinadditiontoincreasedtotalbodyweightloss.Patientswholostmorethan40%TBWLhada17.8-foldgreaterriskofdevelopinganIHthanthosewhohad≤20%TBWL(p=0.031).ConclusionThislargesingle-centerstudyshowedthatIHtendstooccurwithgreaterfrequencyinpatientswhohavelostmoreweight.KnowingthatgreaterweightlossisassociatedwithIH,wecanbetteridentifythosepatientsatriskofthiswell-knowncomplication.

POSTER#2AFIVEYEARREVIEWOFPOSTLEFTVENTRICULARASSISTDEVICE(LVAD)INRELATIONTOBODYMASSINDEX(BMI)D.Schexnayder,D.Jacks,S.Laudun,E.Parrino,A.Bansal,S.DesaiBackgroundAssumptioninthemedicalcommunityisthatpatientswithahigherBMIareatanincreasedriskforcomplicationspostdeviceimplantation.PurposeofthisstudywastoanalyzeoutcomesbygroupingpatientsusingBMIatalargequaternarycarecenter.ObjectivesToinvestigatetherelationshipofBMIandpostoperativeoutcomesinpatientswithleftventricularassistdevices.MethodsRetrospectivereviewofdatawasdoneutilizingINTERMACSregistry,andtheimplantinginstitution’sEMRafterobtainingIRBapprovalfromOctober2010-September2016.DataabstractionwaslimitedtoimplantationofprimaryLVADpatientsgreaterthan18yearsofageandwhocompleted12monthfollowup.Atotalof182primaryimplantswhereincludedforthisstudy.Patientsweregroupedaccordingtheirpre-operativeBMIintosixcategories:underweight(<18.5);normalweight(BMI18.5to24.9);overweight(BMI25.0to29.9);obese–Class1(BMI30to34.9);obese–Class2(BMI35to39.9);andsevereobesity–Class3(40≤BMI).ResultsNormalweightpatient(n=51)experiencedthehighestpercentageofmortalityof27%(at12mths)andneurologicaleventsof22%.Overweightpatient(n=67)hadthehighestpercentageofdrivelineinfections12%.Obese-class2patients(n=15)didhavethehighestpercentageofdevicemalfunction40%.Inourstudynoneofthesefindingsachievedstatisticalsignificance(p<0.05).PatientsacrossallBMIhadaweightincreaseof10to22%bythe12-monthfollow-uppostimplantation.ConclusionCommonmythinthemedicalcommunityaboutobesityisnotvalidatedfromourexperience.Howeverinterestingfindingsfromourstudyrevealthatthereisatrendforincreaseddevicemalfunctioninobeseindividualsandalsoallgroupofpatient’sexperiencedweightgainafterimplantation.Thedrawbacksofthisstudyinclude,retrospectivenature,singlecenterandlowvolumesinunderweightandsevereobesitygroup.MultiinstitutionalstudiesareneededtoaddressthisimportantissueintheVADcommunity.

POSTER#2BINCIDENCEOFRIGHTVENTRICULARFAILURE:ASINGLECENTEREXPERIENCEDanielleJacks,MD;PatrickParrino,MD;AdityaBansal,MDBackgroundInpatientswhohaveprogressionofheartfailuredespiteoptimalmedicaltherapy,implantationofamechanicalcirculatorysupportdevicecansupportcardiacfunctioneitherasabridgetotransplantoradestinationtherapy.OurstudycomparestheincidenceofrightheartfailurefollowingimplantationoftheHeartwareHVAD,anewerLVADdesignwhichisasmallintrapericardialcentrifugalflowdevice,ascomparedtotheHeartMateII,amechanical-bearingcontinuous-flowpump.ObjectivesTheaimofthisstudywastocomparethedifferenceintheincidenceofrightheartfailurefollowingimplantationofHeartMateIIversusHeartwareHVADMethodsFromJanuary2011toDecember2013,87patientswithchronicheartfailurewereimplantedwithacontinuousLVAD(77patientsreceivedaHeartMateII,14patientsreceivedHeartwareHVAD,6patientsreceivedBIVAD/TAH).ForthepurposeofthisstudyweexcludedBIVAD/TAHpatientsandpatientsinINTERMACSprofile1.Atotalof13patientswhereinprofile1,ofwhich9receivedHeartmateIIwhiletheremaining4receivedBIVADsupport.Patient’sdemographic,medicalhistory,baselinehemodynamicandfollow-updatawereretrospectivelyreviewed.IncidenceandriskofRVfailurepost-implantationwasdefinedastheneedforinotropicsupportafter14daysofLVADimplantationortemporaryRVADinsertion.ResultsPatientsimplantedwithaHeartMateIIandHVADweresimilarintermsofdemographic,medicalhistory,labvalues,andhemodynamicparameters.ThereisatrendofhigherproportionofmalesreceivingaHeartMateIIbutthedifferencewasnotstatisticallysignificant.AfterLVADimplantation,theincidenceofRVfailurewas5/68(7%)inpatientswithaHeartMateIIand6/14(43%)inpatientsimplantedwithanHVAD.Thisdifferencewasstatisticallysignificant(p-value<0.0001).Thedifferenceremainedstatisticallysignificantafteradjustingforgender.Atmeanfollowupof12months,thesurvivalwas59/68(87%)fortheHeartMateIIand8/14(57%)fortheHVADpatients.ConclusionTheseresultssuggestthatatourcentertheHVADisassociatedwithahigherincidenceofpost-operativeRVfailure.Theseobservationsarebasedonretrospectivedataanalysiscollectedfromsmallnumberofpatients.FurtherprospectivestudiesarewarrantedtoconfirmthesefindingsandunderstandthecauseofthisdifferenceintheincidenceofRVfailurebetweentheHeartMateIIandHeartwareHVADpumps.

POSTER#2CINTEGRATEDTEAMAPPROACHIMPROVESECMOOUTCOMESDanielleJacks,MD;EugeneParrino,MD;VincentAdolph,MD;AdityaBansal,MDBackgroundExtracorporealMembraneOxygenation(ECMO)isatherapeuticoptionincreasinglyusedinthemanagementofpatientswithcardiorespiratoryfailurethatisrefractorytomaximalconventionaltreatment.Thissupportmayfacilitatetherapeuticintervention,bridgetorecovery,bridgetoalong-termsupportdevice,heartorlungtransplantation,orbridgetopalliation.ObjectivesTheaimofthisstudywastocomparetherateofpatientssuccessfullyweanedfromECMOwhenamultidisciplinaryteamapproachisusedfortheselectionprocessanddevelopmentofprotocols.MethodsWereviewedsingleinstitutiondata(OchsnerMainCampus)foradultpatientstreatedwithECMO(VAorVAECMO)from1995to2015withdataobtainedfromtheELSOregistry.ResultsIntotal,43patientswereplacedonveno-arterialorveno-venoECMOfrom1995to2015.From1995-2012,1/14(0.07%)ofpatientsweresuccessfullyweanedfromECMO.In2013,4/10(40%)ofpatientsweresuccessfullyweanedfromECMO.In2014,2/8(33.33%)ofpatientsweresuccessfullyweaned.In2015,8/11(72.73%)ofpatientsweresuccessfullyweaned.ConclusionInitially,duetolackofanyintegratedapproach,missingclinicalpracticeguidelines,andlackofpointpersonpooreroutcomeswereseen.However,withamultidisciplinaryselectionprocess,properpatientselection,andadherencetoprotocols,improvementinsurvivalwasseen.EvenwithlowannualvolumeofECMOpatients,anintegratedteamapproachunderacentralleadershipcanleadtobetterutilizationofserviceswithimprovedpatientoutcomes.

POSTER#2DISPRE-OPERATIVECOLONOSCOPYSCREENINGFORLVADTHERAPYNEEDEDFORHIGHERINTERMACSPROFILEPATIENTSINTHECURRENTERA?DanielleJacks,MD;KristaMarzRN,CCRN;NathanZwintscher,MD;SapnaDesai,MD;AdityaBansal,MD,BackgroundPre-operativecolonoscopyscreeningisusedtoexcludethepresenceoflargeintestinallesionsthatcouldpossiblycomplicateanticoagulationafterimplantationofaleftventricularassistdevice(LVAD).ColonicpreparationneededforcolonoscopycanbechallengingandunattainableinpatientswithhigherINTERMACSprofileduetohemodynamicinstabilityorpresenceoftemporarymechanicalsupportdevices.ThemedicalcommunitycontinuestohesitateinproceedingwithLVADtherapywithoutgettinganegativecolonicevaluation.ObjectivesTheaimofthisstudywastoevaluatesafetyofLVADtherapywithoutapre-operativecolonoscopyinhigherINTERMACSprofile(Profile1and2)patients.Methods187patientsunderwentanLVADimplantationbetweenJanuary2014toApril2017.Inclusioncriteriaforstudyincluded:InabilitytomeetAmericanCollegeofGastroenterology(ACOG)guidelinesforcolonoscopytoruleoutcolorectalmalignancypriortoLVADimplantation.Allpatientshadarecent(<3months)abdominalCTscanperformedpriortoanimplant.123patientsmettheACOGcriteriaforneedofcolonoscopy.Ofthese,14patientsmettheinclusioncriteria.Results14patientswereextremelysick(INTERMACSProfile1and2)andcouldnothaveordidnothaveapriorpre-operativecolonoscopy.92.86%weremale(13/14)and57.14%(8/14)wereAfricanAmericans.Averageagewas58.92years(50-68years).All14patientsweretoleratinganticoagulationpostimplantandunderwentcolonoscopyat3monthsafterLVADimplantation.Atthetimeofcolonoscopynoconcerninglesionsformalignancywereidentified.Thisfindingcorrelatedwithabsenceofanycoloniclesionsonpre-operativeCTscans.Ofthe109patientswhohadcolonoscopypriortoLVADimplantalsodidnothaveanyidentifiablecoloniclesions.ConclusionHighresolutionCTscancanscreenpre-operativelyintracolonicpathologywithsignificantreliability.Pre-operativecolonoscopicevaluationinhigherINTERMACSprofile(1and2)patientsshouldnotbemandatory.PatientscansafelyproceedtoreceiveadestinationLVADandcancompletecolonicevaluationattimeoflistingforhearttransplant.

POSTER#3ATREATMENTOFERYTHROMELALGIAANDFROSTBITE:ACASEREPORTJosephD.Giaimo,MD,KellyL.Paulk,MD,FrankH.Lau,MD,ElizabethB.Grieshaber,MD,JeffreyE.Carter,MD,FACSIntroduction/ObjectiveErythromelalgiaisanexceedinglyraredisorder,withlessthat30primarycasesreportedintheUnitedStates.Individualspresentwithburning,erythema,andseverepaintotheextremities.Thelowerextremitiesaremostcommonlyaffectedwithcasesofseverewoundsandevenamputation.Thediseasepresentseitherasaprimarydisorderorsecondarywithanassociatedmyeloproliferativedisorder.CasePresentationPatientJKisa17-year-oldmalewhohadbeensufferingfromprimaryerythromelalgiaforgreaterthantenyears.Hehadbeentreatedbymultiplemedicalprofessionalswithavarietyofmedicationsresultinginlimitedreliefofsymptoms.Ultimatelyhisonlysourceofcontrolfortheburningpainwastosoakhisfeetinicewaterforuptoeighteenhoursdaily.Thiscausedhimtodevelopfrostbitewhichbecameanecrotizingsofttissueinfectioncomplicatedbyseverechronicpain,deconditioningandimpairedmobility,60-poundweightloss,andpsychosocialdisorders.DiscussionPatientJKwastreatedusingtheburncenter’smultidisciplinaryapproachwithexpertsfromburncare,dermatology,acutepain,chronicpain,physiatry,plasticsurgery,andtherapy.Heunderwentexcisionoftheinfectedtissueandplacementofallograft.Initiallyhispainwasnotwellcontrolleddespiteamultimodalpainregimenwith10differentagentsincludingketamineinfusions,sothepatientcooledhisfeetresultinginamycoticinfection.Thisrequiredrevisionexcisionandnegativepressurewoundtherapywithintermittentinstillationsofamphotericinandmafenideacetateandsubsequentlyhada1:1split-thicknessautograft.Theremarkablepartofhiscarewastheresolutionofhiserythema,allmanifestationsofpain,andanyevidenceoferythromelalgiafollowingepiduralplacementandtransitiontomethadoneandmedicationsthatalteredthesodiumchannels.Atthetimeofdischarge,hewasambulatingover350feet,abletocompleteself-carewithminimalassist,100%grafttake,andpainscores<3.ConclusionWhilesourcecontrolofanecrotizingsofttissueinfectionisawellunderstoodprinciple,thiscasedemonstratestwofurtherpointswhichmaybeappliedtosimilarlycomplexpatientsinthefuture.First,patientswitherythromelalgiahavechallengingwoundsfrequentlymanagedwithamputation,referraltovascularsurgery,orchronicwoundcarecenterswhendiseasemanagementmightbestbeservedholisticallyataburncenter.Secondly,placementofanepiduralcatheterresultedincompleteresolutionofsymptomsandpossibleremissionofadiseasewithcutaneousmanifestations.Theuseofalong-termepiduralwithanimplantablepainpumporspinalcordstimulatormayserveasaviablemeanstocontrolthediseaseprocessandpainassociatedwitherythromelalgia.

POSTER#3BANANALYSISOFTHECURRENTEDUCATIONALCOURSESOFFEREDTOVASCULARTRAINEESJKim,JJim,BAulivola,JBismuth,LPounds,JCardella,HBazan,FAziz,RNicholson,AMarjan,CSheahan,MSheahanBackgroundWhilethereisincreasingevidencethatshorteducationalcoursesprovideavaluablesupplementtovascularsurgicaltraining,thereislittledataregardingtheprevalence,content,andeducationalgoalsoftheseprograms.ObjectivesOurobjectivewastocatalogtheavailableextra-residencyexperiencesavailabletovasculartraineesinNorthAmerica.MethodsAlleducationalprogramsofferedtovasculartraineesandconductedbetween2014and2018wereidentifiedandcategorizedinconjunctionwiththerespectivecoursedirectors.Dataobtainedincludedtimingandlocationofcourse,numberoftrainees,numberofapplicants,targetaudience,courseobjectives,andeducationaltools.Programswherethecurriculumandcontentweresolelyprovidedbyindustrywereexcluded.ResultsTwenty-eightprogramswereidentifiedandallparticipatedintheproject.Mostofthecoursesprovidedmedicaldidactics(86%,24/28),withthemostcommonexceptionsbeingmockoralprograms.Endovascularsimulationtrainingwasprovidedin61%(17/28)oftheprograms,with43%(12/28)alsoofferingopensimulation.Cadavertrainingwasincludedin29%(8/28)ofcourses.Thetotalnumberoftraineesparticipatingannuallyincreasedfrom777in2014to1169in2018.Thisfollowedanincreaseininterestfrom868applicantsin2014to1472in2018.UsingUnitedStatesCensusdefinitions,therearemorefixedlocationprogramsintheSouth(8)thanNortheast(4),Midwest(3)orWest(4).TheSouthannuallyholdsmorecoursesfeaturingcadaverdissection(5)thanallotherregionscombined(3).Programshadlowfacultytotraineeratioswithamedianof1to3andamaximumof1to10.Whilethemajorityofcourseshadspecifictargetattendees(86%,24/28),fewweretargetedspecificallytomid/juniorresidentsPGY3orless(25%,7/28).Only14%(4/28)oftheprogramsprovidedformativefeedbacktotheattendees’programdirector.ConclusionBetween2014and2018,therehasbeenanincreaseininterestandparticipationinvascularsurgeryeducationalcourses.Whilefurtherresearchisneededonthecost-effectivenessandoutcomesoftheseprograms,thereseemstobedeficiencyofjuniorlevelspecificeducationalopportunitiesandofprogramsthatprovideformativefeedback.Additionally,sincethemajorityofhighfidelityopentrainingopportunitiesareintheSouth,someregionalizationmaybeappropriate.

POSTER#3CEFFICACYOFULTRASOUNDELASTOGRAPHYINPREDICTINGTHESUCCESSRATEOFETHANOLABLATIONOFNON-MALIGNANTTHYROIDNODULESMAbdelgawad,HShalaby,YRashad,EKandilBackground:PercutaneousEthanolablation(PEA)hasbeenutilizedasamodalitytotreatsomethyroidnodules,especiallyinpatientswhoarenotgoodsurgicalcandidates.ThereisascarcityofstudiesthatevaluatefactorsassociatedwithsuccessfuloutcomesofthismodalityinNorthAmerica.Wehypothesizethatultrasound(U/S)elastographycanpredictsuccessfuloutcomesinPEAfornon-malignantthyroidnodules.MaterialsandMethods:ThisisaretrospectivecohortstudyofallconsecutivepatientswiththyroidnodulesundergoingPEAbyasinglesurgeoninNorthAmericanacademicinstitute.Demographics,(U/S)elastography,peri-andpost-interventionalcompressivesymptoms,thyroidnodulescharacteristics,FNAfindings,thyroidfunction,andcomplicationswerestudied.Asubgroupanalysiswasperformedonnon-malignantthyroidnodule.Results:Atotalof22patientswith34thyroidnoduleswereenrolledinthisstudy(mean[SD]age,66.18[11.45]years;19female[86.36%]).21outof34nodules(61.76%)ofthethyroidnoduleswerenon-malignant.Accordingto(U/S)elastography,baselinethyroidnoduleswereclassifiedintostiff(19.04%),mixed(52.38%),andsoft(28.57%).Therewereasignificantvolumereductionrates(VRRs)forstiffthyroidnodulesat6months(47.82%±19.27,p=0.0157).Volumereductionrate(VRRs)wasalsomoresignificantincysticnodules(89.14±5.69,P=0.0014).At6months,36.84%ofthethyroidnodulesexhibitedaVRR>70%(84.09%±9.97,p<0.0001).WefoundoutthattheTSHwasnotaffectedbyPEA.Compressivesymptomsresolvedinall3patientswhoreportedit.Post-proceduralcomplicationswereabsentinallthepatients.ConclusionElastographyhasproventobeausefultoolinpredictingthesuccessrateofPEAfornon-malignantthyroidnodules.VRRwassignificantinstiffnodules(Vs.softnodules)andincysticnodules.EthanolAblationisbothsafeandeffectiveintermsofnodulevolumereductionrate,reliefofcompressivesymptoms.Itisproventobeanalternativetosurgicalresection.

POSTER#3DOPERATIVEPARATHYROIDECTOMYONNORMO-HORMONALVS.CLASSICPRIMARYHYPERPARATHYROIDISMMAbdelgawad,HShalaby,EAlameer,SAlAwwad,YRashad,EKandilBackgroundPrimaryhyperparathyroidism(PTH)isveryvariablediseaserangingfromasymptomatictocomplicated,life-threateningconditions.ClassicallydiagnosedwithelevatedPTHandCalevels.AnothernonclassicaldiseasecanshowupwithhighCalevelinspiteofnormaloruppernormalPTH.ObjectivesToreviewoursurgicalexperienceinparathyroidectomyandtoassessitscurerateinthenormo-hormonalprimaryhyperparathyroidism(NHPHPT)vs.classicprimaryhyperparathyroidism(CPHPT).MethodsThisisaretrospectivecohortstudyofpatientswith(PHPT)undergoingparathyroidectomybetweenJanuary2014andFebruary2018byasinglesurgeon.Patientswith(NHPHPT)arecomparedtopatientswith(CPHPT).Thetwogroupswereanalyzedinthematterofdemographics,imagingstudies,intraoperativeparathyroidhormone(IOPTH)andtheoutcomeofthepatients.ResultsOutof277patientswhounderwentparathyroidectomy,128patientsmetourstudycriteria(PHPT);24had(NHPHPT),and104had(CPHPT).Negativesestamibiscanswereseenmoreinthenormo-hormonalvs.classicgroup,(77.78vs.47.92%P50%dropinthe(IOPTH)vs.the103(99.04%)amongthe104(CPHPT)patients.Thecurerateinthenormo-hormonalvs.classicgroupswas(87.5%vs.96.15%,pConclusionOperativeparathyroidectomyonpatientswith(NHPHPT)showedalmostequivalentsuccessasthe(CPHPT).CureratesaresimilartoclassicPHPTwhenpre-operativePTHisabove56pg/ml.

POSTER#4AVENTILATORASSOCIATEDPNEUMONIA:HOWDOTHEDIFFERENTCRITERIAFORDIAGNOSISMATCHUP?CCarr,ASmith,MMartuano,LHakki,JFriedman,CGuidry,PMcGrew,CMcGinness,JDuchesne,RSchrollBackgroundVentilatorassociatedpneumonia(VAP)isthemostcommonnosocomialinfectionintheICU.Itoccursmorethan48hoursfollowingendotrachealintubationortracheostomyandaffectsupto30%ofthesepatients.IthasbeenassociatedwithincreasedICUandhospitalstayandmorbidityandmortality.VAPthatoccursearlyfollowingintubationhasbeenshowntohavebetteroutcomesasitlessofteninvolvesorganismsresistanttotreatment.ObjectivesWeidentifiedfactorsassociatedwithprolongedlatencyofVAPandevaluatedtheeffectsofthosesamefactorsonsurvival,numberofdaysontheventilator,overalllengthofstay,andlengthofICUstay.WealsodeterminedthesensitivityofvariousclinicaldefinitionsofVAP,includingthenewCDC2013criteria,forpredictingourconfirmedcases.WehypothesizedthattheCDC2013criteriawouldbetoorestrictive.MethodsWecollecteddataon102subjectswhodevelopedVAPbetween2012-2017.WeconductedaKaplan-MeiersurvivalanalysiswithCoxproportionalhazardsregressionstratifiedbyeachofthedichotomousandcategoricalvariables.Thenwerangeneralizedlinearmodels/ANOVAtolookatpredictorsoftimetoeventforVAP,totalventdays,totalhospitallengthofstay,andlengthofICUstay.Finally,weranmultivariatemodelsforeachoutcomeadjustingforvariablesidentifiedassignificantintheunadjustedmodels.WedeterminedwhichcasesmetvariousclinicalcriteriaforVAPincludingCPIS+/-BAL,ACCP,TQIP,CDC2002,andCDC2013criteria.ResultsInmultivariatemodel,COPDandcancerweresignificantlypositivelyassociatedwithtimetoVAP.Whitepatients,nonsurgicalpatients,patientswithrenalfailure,alteredmentalstatus,increasedfi02,andincreasedpeephadsignificantlyworseoverallsurvival.Traumapatients,patientswithpositivesputumcultures,andpatientswithsuspectedpneumoniahadsignificantlybettersurvival.CHF,positivesputumcultures,positivebloodcultures,andtimetoVAPweresignificantlypositivelyassociatedwithventdays.PositivesputumculturesandtimetoVAPweresignificantlypositivelyassociatedwithlengthofICUstay.SensitivitiesofCPIS+/-BAL,ACCP,TQIP,CDC2002,andCDC2013criteriaforcorrectlydetectingVAPinourstudysubjectswere0.98,94.1,74.5,95.1,and44.1percentrespectively.ConclusionManyICUshaveprotocolsinplaceforprimarypreventionofVAPthatincludescreeningwithdailychestx-rays,antibioticprophylaxis,andjudicioussputumculture,althoughmuchremainstobelearnedabouttheeffectsoftheseprogramsonsurvival.OurresultsconfirmthatearlydiagnosisofVAPinpatientswithfewmedicalcomorbiditiesresultsinbetteroutcomes.ThisfurtheremphasizestheimportanceofhavingahighindexofsuspicionforVAPinventilator-dependentpatients.Inourstudysubjects,onlyACCP,TQIP,andCDC2002criteriawereabletodetectamajorityofVAPcases.The2013CDCcriteriafailedtodetect55.9percentofconfirmedVAPcases.Theseresultsareconcerning,asundetectedVAPcanhavedevastatingconsequencesforpatients.

POSTER#4BASSOCIATIONOFCENTERSFORMEDICARE&MEDICAIDSERVICESHOSPITALSTARRATINGSWITHOUTCOMESINGENERALTRAUMA:INSIGHTSINTOPATIENTCHARACTERISTICS,LENGTHOFSTAY,HEALTHCAREUTILIZATIONANDOUTCOMES1BeatrizBriones(presentingauthor),1PiyushKalakoti,1ChadBrady,1AshleyAbrams,1NavdeepS.Samra1GeneralSurgery,LouisianaStateUniversityHealthSciencesCenter,Shreveport,LA52241BackgroundTheCentersforMedicareandMedicaidServices(CMS)HospitalCompareStarRatingshasemergedasanotablepublic-reportingsystemtogaugehospitalquality.Inadditiontoobjectiveadverseevents[mortality,readmissions],theseratingsconsidersubjectivepatient-reportedmeasuressuchaspatientexperience,effectivenessandtimelinessofcare,hospitalcleanliness.Asproposedreforms,theMedicareAccessandCHIPReauthorizationAct,advocateintegrationofsubjectivemeasuresintofuturereimbursementmodels,assessmentofthesemeasuresongeneraltraumaoutcomesarepertinent.ObjectiveToinvestigatetheassociationofsubjectiveCMShospitalstar-ratingswithobjectiveoutcomesinpatientswithgeneraltrauma.MethodsTheNationwideInpatientSample2009-2011wasqueriedforadultpatientsthatincurredemergenthospitalizationforgeneraltraumausingappropriateICD-9codes(800-959).Thecohortwasmergedwithdatafrom“HospitalCompare,”thatrateshospitals(1to5stars)baseduponamixofsubjective-objectivemeasures.Primaryendpointsweremortality,dischargedisposition,lengthofstay(LOS),hospitalcharges,andcomplications.Hospitalswerelabeledasahigh-starhospital(HSH)[ratings≥4]orlow-starhospital(LSH)[overallstar-rating1-3]basedupon75thpercentilecutoffs.Multivariablelogisticandordinaryleast-squaremodelsinvestigatedtheassociationofHSHwithprimaryendpoints.ResultsOverall,729,921patientsincurredemergenthospitalizationfortrauma.across970hospitals.Ofthese,35.9%(n=262,082)werehospitalizedatHSHs(n=373;meanstar-rating:4.34±0.47)whereasremainder64.1%patients(64.1%)atLSHs(meanstar-rating:2.16±0.78).ComparedtoHSHs,LSHshadhigherproportionofMedicaidpatients(11.1%vs7.7%;p<0.001)anduninsured(8.1%vs6.2%;p<0.001),African-Americans(10.5%vs6.9%;p<0.001)andHispanics(3.9%vs2.6%;p<0.001)andthoseatlowestincomequartiles(25.5%vs16.4%;p<0.001).Onthecontrary,patientsatHSHswerelargelywhites(81.5%vs72.8%;p<0.001)andprivatelyinsured(24.7%vs20.8%;p<0.001).However,patientsatHSHswererelativelyolder(65vs62)andhadhighercomorbidity.(modifiedCharlsonComorbidityscore:1.77vs1.74;p<0.001).RegressionmodelsnotedanassociationofHSHswithshorterhospitalstay(-0.49days;p<0.001),charges(-$5,779;p<0.001)andmortality(OR:0.97;p=0.061).However,traumapatientsadmittedatHSHswereassociatedwithhigherriskofbeingdischargedtorehabilitation(OR:1.05;p<0.001),developingacuterenalfailure(OR:1.08;p<0.001),infections(OR:1.06;p=0.01).NodifferenceswereobservedintermsofCMSdefined“neverevents”suchasvenousthromboembolicepisodes

(OR:0.97;p=0.079),woundcomplications(OR:0.99;p=0.641),adversecardiacevents(OR:1.02;p=0.555),gastrointestinal(OR:1.02;p=0.606)orrespiratorycomplications(OR:0.97;p=0.303).ConclusionThisstudydemonstratesanassociationbetweenhigh-starhospitalratingandLOSandchargesingeneraltraumapatients.However,outcomessuchasdischargedisposition,mortality,andcomplicationsatLSHsarenotinferiorcomparedtoHSHs.AsCMSstar-ratingsarebasedupongenericoverallhospitalprofilinganddonotsegregateindividualspecialties,patientsandpolicy-makersshouldweighuponsuchlimitationspriortoselectingtraumacareandreimbursements,respectively.

POSTER#4CDAMAGECONTROLLAPAROTOMYINPATIENTSOFADVANCEDAGE:HOWDOPATIENTSINTHEIRGOLDENYEARSCOMPAREINTHEGOLDENHOURSOFTRAUMA?AlisonSmith,MD,PhD;RebeccaSchroll,MD;PatrickMcGrew,MD;ChrissyGuidry,DO;CliftonMcGinness,MD;JuanDuchesne,MDBackgroundDamageControlLaparotomy(DCL)isanintegralcomponentintheimmediatemanagementofcriticallyilltraumapatientstocontrolhemorrhageandintra-abdominalcontamination.Elderlypatientshavelessphysiologicreserveandanalteredresponsetotraumaticinjurieswhencomparedtoyoungerpatients.AsthepopulationintheUnitedStatescontinuestoage,thenumberofDCLsinelderlypatientsislikelytorise.ThereisapaucityofliteratureonoutcomesforolderpatientsmanagedwithDCL.ObjectivesTheobjectiveofthisstudywastoprovideevidenceforoutcomesinolderpopulationwhoreceivedDCLfortrauma.MethodsAretrospectivechartreviewofconsecutiveadultpatientswithDCLforabdominaltraumaataLevelItraumacenterwasconductedfrom2012-2017.Thepatientswerestratifiedintotwogroups,advancedage(AA)forpatients40yearsandolderandyoungerage(YA)forpatientslessthan40yearsofage.ResultsAtotalof149patientswithDCLswereidentifiedwithanaverageageof34.0(range,19-81years).Inregardstopatientdemographics,therewasnodifferenceinISS(p=0.16),mechanism(p=0.44),andinitialINR(p=1.0).TheAAgroupdid,however,havesignificantlylowerEDSBP(p=0.01)andsignificantlyhigherinitialfibrinogen(p<0.0001).Whenanalyzingoutcomesandinterventions,AApatientsreceivedMTPmorefrequently(p=0.03).TherewasatrendtowardincreasedmortalityintheAAgroup(23%vs11%)whencomparedtoYAgroup,thoughthisdidnotreachsignificance(p=0.08).Ofsignificance,theAAgrouphadanoverallshortertimetomortality(4.5+0.4vs8.9+1.2days,p=0.02).ConclusionWithanagingpopulation,itislikelythatthenumberofDCLsinolderpatientswillincrease.AApatientsmanagedwithDCLhaddecreasedinitialEDSBPwithmoreutilizationofMTPresourcesandoverallshortertimetomortality.Futureresearchshouldemphasizestrategiesthatwilldevelopoptimalmanagementandresourceutilizationofoldertraumapatients.

POSTER#4DISTHE“DEATHTRIAD”ACASUALTYOFMODERNDAMAGECONTROLRESUSCITATION?VeraHendrix,MD;AlisonSmith,MD,PhD;MaxShapiro,MD;ShuoHuang,BS;AllisonMak,BS;RebeccaSchroll,MD;CliftonMcGinness,MD;PatrickMcGrew,MD;ChrissyGuidry,DO;DanielleTatum,PhD;JuanDuchesne,MDBackgroundClassictraumasurgeryprinciplesfocusonthe“deathtriad”ofhypothermia,acidosis,andcoagulopathyasasignificantcauseoftrauma-relatedmortality.However,thevalidityofthedeathtriadhasbeenquestionedinthemoderneraofDamageControlLaparotomy(DCL)incombinationwithDamageControlResuscition(DCR).ObjectivesTheaimofthisstudywastoevaluateifthedeathtriadcarriesthesameprognosiswiththeadventofcurrentresuscitativetraumapractices.MethodsAfive-yearretrospectivechartreviewofallconsecutiveadulttraumapatientspresentingtoalevelItraumacenterwhounderwentDCLwasconducted.Parametersassociatedwiththedeathtriadwereevaluated(temperature,lacticacidosis(LA),pH,basedeficit(BD),INR,andfibrinogenlevels)onadmission,at24hours,andat48hoursafterpresentation.KaplanMeiersurvivalplotsweremadefortheindividualcomponentsofthedeathtriad.UnivariateanalysiswasperformedusingaStudent’st-test.Amultivariatelinearregressionwasperformedtoassessfactorsindependentlyassociatedwithdeath.Resultsofthedeathtriadinthefirst48hourshadamortalityof9.3%(4/43),25.8%mortality(8/31)iftwocomponentswerepresent,and36.7%(11/30)ifallthreecomponentswerepresent.Coxproportionalhazardmodelshowednoincreasedriskofdeathwhenallthreecomponentsofthedeathtriadwerepresent(HR0.29,95%CI0.12-0.74,p=0.009).Lacticacidwastheonlyvariablefoundinmultivariateanalysistobesignificantlyassociatedwithmortality(OR1.3,95%CI1.1-1.4,p=0.002).ConclusionThisstudydemonstratedthatmortalityoftraumapatientsincreaseswithadditionalcomponentsofthedeathtriad.However,evenacompletedeathtriadwasonlyabletopredictdeath36.7%ofthetimeinpatientstreatedwithDCLandDCR,whichislowerthanexpectedandpreviouslycitedinthetraumaliterature.ResultssuggestthatthedeathtriadmightnotbeasapplicableinthemoderneraofDCL,DCR,andMTP.

POSTER#5AMEDIALSTUDENTSAS"STOPTHEBLEED"INSTRUCTORSTZeoli,ASmith,MMartin,SBaker,PGreiffenstein,MMoore,PMcGrew,JDuchesne,JAvegno,RSchrollBackgroundStoptheBleed(STB)programtrainslayrescuerstoidentifyandcontroloflife-threateningbleeding.Recently,medicalstudentswereallowedtobecomeinstructors.ObjectivesTheaimofthisstudywastoassesstheefficacyofmedicalstudentcourseparticipationasbothlearnersandinstructors.MethodsStudentsfromtwoUSmedicalschoolswereenrolledinthecourse.Participantsanonymouslyself-reportedpre-andpost-courseconfidencein6majorskillareasusingaLikertscale.Attheendofthecourse,students'abilitytoperformSTBskillswereassessedusinganinternallyvalidated15pointobjectiveassessmenttool.Apilotgroupofmedicalstudentsvolunteeredtobeinstructorsandtheirabilitytoeffectivelyteachthecoursewasobjectivelyassessed.ResultsAtotalof329medicalstudentswereevaluated.Pre-courseconfidencewashighestinholdingpressureonawound(2.9+0.1)andlowestinidentificationofsevereactivebleeding(1.8+0.1).Post-courseparticipantconfidenceincreasedsignificantlyinall5areasasshowninTable1.,includingconfidencetoteachskillstoothers.ObjectiveassessmentofmedicalstudentsbySTBinstructorsfoundgreaterthan95%skillproficiency.Anassessmentof20medicalstudentinstructorsfoundthatallstudentswereabletoproficientlyserveasinstructorswith80%receivingperfectscoresontheirteachingevaluations.ConclusionThisstudydemonstratesthatmedicalstudentscaneffectivelymasterSTBskillsandcanalsoserveascompetentcourseinstructors.FutureprogramdevelopmentshouldfocusoncontinuedtrainingofmedicalstudentsandtheirinvolvementasinstructorstohelpincreasetheavailabilityofSTBcourses.

POSTER#5BTEGINTRAUMAPATIENTS:EVERYMINUTECOUNTSMMarturano,ASmith,LHakki,CGuidry,PMcGrew,CMcGinness,RSchroll,JDuchesneBackgroundThromboelastography(TEG)hasbecomeanintegralpartofthemanagementoftraumapatients.However,optimalprotocolstoincorporateTEGintoroutinetraumaprotocolshavenotbeendetermined.WehypothesizeacorrelationbetweenearlyTEGuseandsurvivalinpatientswithseverehemorrhage.ObjectivesToidentifyacorrelationbetweenearlyTEGuseandsurvivalinpatientswithseverehemorrhage.MethodsAretrospectivereviewofconsecutiveadultpatientswhoreceivedmassivetransfusionprotocol(MTP)ataLevelITraumaCenterwasperformedfrom4/2017-2/2018.Patientdemographics,InjurySeverityScore(ISS),bloodproductusage,andmortalitywererecorded.Patientswerestratifiedinto2groupsbasedonlengthoftimebeforeTEGwasordered(TEG-L,>120minandTEG-SResultsAtotalof91patientswereidentifiedand56.0%ofthesepatientshadTEGlevelmeasured.AveragetimefortraumasurgeonstoorderTEGwas381.4minwitharangeof22-7226min.TherewasnodifferenceinbaselinepatientdemographicsbetweenTEG-LandTEG-Spatients.TheTEG-SgrouphaddecreasedICULOS(8.6+1.8vs.22.6+3.8,p=0.0031)anddecreaseddeaths(14.2%vs47.8%,p=0.0135).ConclusionThisanalysisdemonstratedasurvivalbenefitinseverehemorrhagepatientswithearlyuseofTEG.InstitutionsshouldadoptqualitymeasurestoreviewproperearlyuseofTEGinpatientswithseverehemorrhage.ProspectivevalidationisneededinordertobetterunderstandthisTEGtime-survivalcorrelation.

POSTER#5CEVALUATINGLITERACYOFVASCULARTERMINOLOGYINTHEU.S.VETERANPOPULATIONKLSummers,CSheahan,KDiLosa,AGrise,MUnruh,NZea,TPalit,BTorrance,RBatson,MSheahanBackgroundEssentiallynoevidenceisavailableregardingthepublic’sknowledgeofvasculardiseaseanditstreatments.Improvedhealthliteracyhasbeenassociatedwithincreasedscreening,adherencewithphysicianrecommendations,compliancewithmedicationregimens,andanimprovementinoverallhealthoutcomes.ObjectivesThisstudyaimstoassessthelevelofvascularliteracyamongU.S.veteransandtheirsignificantothers.Methods"Arandomcohortofveteransandtheirsignificantothersweresurveyedduringattendanceatnationalveteran’sconferencesinNewOrleans,LouisianabetweenJulyandAugustof2017.Significantotherswereonlysurveyediftheyweremeaningfullyinvolvedintheveteran’scare.Volunteerswereaskedtocompleteabackgrounddemographicformanda24questionsurveywithmultiple-choiceanswersconcerningtheirknowledgeofcommonvascularrelatedterminology.Theterminologytestedwereextractedfromourtenmostcommonlyusedvascularsurgeryconsentforms.Participantswereencouragedtoselecttheanswerchoice“IdonotknowResultsArandomcohortofveteransandtheirsignificantothersweresurveyedduringattendanceatnationalveteran’sconferencesinNewOrleans,LouisianabetweenJulyandAugustof2017.Significantotherswereonlysurveyediftheyweremeaningfullyinvolvedintheveteran’scare.Volunteerswereaskedtocompleteabackgrounddemographicformanda24questionsurveywithmultiple-choiceanswersconcerningtheirknowledgeofcommonvascularrelatedterminology.Theterminologytestedwereextractedfromourtenmostcommonlyusedvascularsurgeryconsentforms.Participantswereencouragedtoselecttheanswerchoice“Idonotknow,”whenunfamiliarwiththeterm.ConclusionThisstudyprovidesareliablemethodforevaluatingliteracyofvascularterminology,aswellasafutureplatformforimprovingphysician-patientcommunicationandvascularsurgeryoutcomesintheveteranpopulation.Wefoundthemajorityofthosesurveyedhaveinsufficientknowledgeofvasculartermswhichcouldleavethematahigherriskofpoorvascularsurgeryrelatedoutcomes.

POSTER#5DTHEFUNDAMENTALSOFVASCULARSURGERY:A6-YEARREVIEWOFTHEFIRSTU.S.DEDICATEDVASCULARSIMULATIONCOURSEJKim,ALalani,CSheahan,TPalit,BTorrance,MUnruh,RBatson,MSheahan,BackgroundDutyhourrestrictions,changingtrainingparadigms,anddiminishingopensurgicalcasevolumeshavecauseddramaticshiftsinvasculartrainees’experienceoverthepastdecade.Whilesimulationtraininghasbeenadvocatedasanaugmenttoresidenttraining,thebenefitsofshortthreetofourdaycoursesarelargelyunknown.ObjectivesThegoalofthisstudywastoperformasixyearreviewofthefirstsimulationcourseestablishedforvasculartraineesintheUnitedStates.MethodsAthreedayvascularsimulationcoursewasconductedatadedicatedlearningcentereachyearfrom2012to2017.Attendeesratedtheirconfidencepreandpostcourseona6-pointLikertscalerangingfrom1“none”to6“expert”across8differenttechnicalandcognitivecategories.Participantswerealsoaskedtoratethevalueofeachactivityusingasimilarscale.Assessmentsofeachtraineewerecompletedbythecoursedirectorandsenttotheirprogramdirector(PD).Aftersixmonths,PDsandparticipantsweresurveyedonthelastingusefulnessofthecourse.ResultsTherewere153attendees,afterexcludingmedicalstudentsandgeneralsurgeryresidents,fulldatawereavailablefor98vasculartrainees.ResidentswerecategorizedasJunior(PGY1-2,n=59)orSenior(PGY≥3,n=39).Participantsratedallteachingactivitiesasuseful(4)orbetter,withanatomicexposures(5.8)andone-on-onesuturing(5.5)ratedmostvaluable.Bothgroupsshowedsignificantimprovementinconfidenceinallmeasuresfollowingthecourse(Table1)withJuniorsimprovingsignificantlymorethanSeniorsinanastomoses,AAAmeasurements,andtibialexposures(Table2).Sixmonthfollow-upwithPDsfoundthat100%(41/41)reportedatleastonenoticeablelastingskillimprovementand85%(35/41)statingtheymodifiedtheirtraineescurriculumbasedonthecourseassessment.Attendeesurveyresponsefoundthat100%(63/63)wouldrecommendthecourseasavaluableactivityandthemajorityreportedincorporatingatleastone(97%,61/63)ormultipleskills(90%,57/63)learnedatthecourseintotheirdailyactivities.ConclusionThisstudydemonstratesthatbrief,intensivesimulationcoursescanhaveavaluableandlastingimpactonvascularresidenteducation.Modifyinglearningactivitiesbytraineelevelandfocusingonhighyieldactivitiessuchascadaverexposuresandoneononeinstructioncanaddfurtherbenefit.Providingoutsideassessmentsoftraineecompetencemaybeespeciallyusefulinindividualizingresidentcurricula.

POSTER#6ATRENDSANDOUTCOMESOFBLUNTANDPENETRATINGTRAUMAINMASSCASUALTYINCIDENTS:ANATIONALANALYSISRSantiago,ASmith,KIbraheem,JFriedman,MHoof,RSchroll,CGuidry,JDuchesne,PMcGrewBackgroundAmasscasualtyincident(MCI)isdefinedbytheNationalIncidentManagementSystem(NIMS)asanincidentinwhichthenumberofpatientsrequiringpre-hospitalemergencyservicesoverwhelmsthelocalresources.MCIsrelatedtoactiveshooterincidentsintheUnitedStateshavebeenreportedwithincreasingfrequency,whichhaspromptedacallformajorchangestohowEMSandhospitalsystemsmanageMCIs.MoststudiesofMCIsanalyzelarge-scaleevents,suchasearthquakes,planecrashes,ormassshootings.However,nostudyhasprovidedananalysisofthecharacteristicsofallnationalMCIs.ObjectivesTheaimofthisstudywastoprovideanationaldescriptiveanalysisofMCIsoverasix-yearrangeinordertobetterprepareourpre-hospitalsystemsfortheseevents,andtoimprovetriageandon-scenemortalityrates.MethodsAretrospectivereviewoftheprospectivelymaintainedNationalEMSInformationSystem(NEMSIS)databasewasperformed.AllMCIsfromJan1,2010throughDec31,2015wereidentifiedanddatawasstratifiedbyinjurymechanismandseparatedintobluntandpenetratingtraumasubgroups.Demographicinformationandonscenemortalitywasobtained.Resultswereanalyzedforstatisticalsignificance.ResultsAtotalof61,789patientswereidentified.60,294ofMCIswereblunttraumafrommotorvehiclecollisions(97.6%).Althoughonly2.4%ofMCIswereduetopenetratingmechanism;theincidenceofcompressibleinjuries:extremity(36.1%vs.30.2%,p=0.0001)andnon-compressibleinjuries:abdominal(10.7%vs.5.8%,p<0.001)andchest(16.2%vs12.4%,p=0.03)werehigherwhencomparedtoblunttraumaMCIs.PenetratingMCIshadhighermortalityrateaswell,withmostofthemoccurringinthepre-hospitalarena(12.9%vs.2.0%,p<0.001)whencomparedtobluntMCIs.ConclusionBlunttraumacontinuestobethemostcommonmechanisminMCIs,thoughpenetratingtraumaresultsinasix-foldhigherrateofpre-hospitalmortality.GivenanincreasingsurgeinMCIsrelatedtopenetratingtrauma,resultsfromthisstudyraisestheawarenessforimprovementinpre-hospitalinterventionsthatcouldpotentiallyimproveonscenemortality.

POSTER#6BNOTALLABDOMENSARETHESAMEAFlaris,ASmith,MMarturano,RFabian,BDomangue,CGuidry,RSchroll,CMcGinness,JDuchesne,PMcGrewBackgroundDamageControlSurgery(DCS)withTemporaryAbdominalClosure(TAC)forEmergencyGeneralSurgery(EGS)andTraumaSurgery(TS),arenowcommonlypracticedbytraumaandelectivesurgeons.DifferenceindemographicsandsurgicalindicationscouldinfluencesurvivalfollowingDCSbetweenEGSvs.TS.ObjectivesTodetermineiftherewasadifferenceinsurvivalbetweenthesetwogroups.MethodsAllconsecutiveadultEGSandTSpatientsfrom2012-2018,attwolargetertiarycarehospitalswerestudiedretrospectivelybychartreview.Demographics,comorbidities,admissionphysiologicaldata,outcomes,andmortality/dischargestatusinformationwascollected.MortalitybetweenthetwogroupswasanalyzedusingFisher’sexacttest.Abinarylogisticregressionanalysiswasperformedtodeterminetherelationshipofpatientriskfactorsonin-hospitalmortality.Apvalueof<0.05wasconsideredtobestatisticallysignificant.ResultsAtotalof47EGSpatientswithameanageof58+/-15yearsandatotalof79TSpatientswithameanageof33+/-11yearsunderwentDCSandmanagedwithTAC.Theincidenceofin-hospitalmortalitywas32%forEGSpatientsvs.13%forTSpatients(p<0.02).TSpatientsreceivedsignificantlymorepackedredbloodcellsduringtheirentirehospitalstay(18unitsvs.4units,p<0.01).Onmultivariateanalysis,havingEGSandfewerunitsofpackedredbloodcellswerepredictiveofmortality.ConclusionInourcohort,thetypeofsurgery(EGSvs.TS),aswellasunitsofbloodadministeredhadasignificantimpactonmortality.Futurestudiesareneededtodeterminewhichfurthercharacteristicsofthetwopopulationsandmanagementstrategiesleadtothislargedifferenceinmortality.

POSTER#6CTHEUSEOFAPORTABLEULTRASOUNDTABLETINAUTOLOGOUSBREASTRECONSTRUCTION:APROMISINGADJUNCT.ChristopherHomsy,AllenChen,MichelleMcCarthy,RaviTandon,BackgroundAutologousbreastreconstructionisatthecenterofreconstructivestrategiesaftermastectomyforbreastcancer.Althoughtechnicalskillsandtraininghaveimprovedsignificantlysincetheprocedurewasfirstdescribed,thereisstillatremendousamountofpre-operativeplanningandpost-operativeflapmonitoringinvolvedinthispatientpopulation.Ultrasonography(US)hasrecentlybecomeanessentialpartofmanymedicalandsurgicalspecialtiestrainingrequirements.Inplasticsurgery,however,itsroleisstilllimitedandtheindicationsofitsuseunclear.TheimplementationofUSbytheplasticsurgerycommunityatlarge,especiallywithinmicrosurgicalbreastreconstructionislimitedandwarrantsfurtherinvestigation.Theadventofatablet-basedUSoffershigh-definitionvisualization,acompactsize,andauser-friendlydevicethatcanbeusebyresidents.ObjectivesInthispaper,wesharethepreliminaryplasticsurgeryresidentexperienceintheuseofaportableUStablet(“LUMIFY”)asanadjunctinthecareofpatientsundergoingDIEPflapbreastreconstruction.WealsopresentindicationsfortheuseofaportableUSinautologousbreastreconstruction.MethodsThisisaseriesof11consecutivepatientswhounderwentaunilateralorbilateralautologousbreastreconstruction.AllpatientswereevaluatedwiththeLUMIFY,eitherpre-and/orpostoperativelybyasingleplasticsurgeryresidentbetweenFebruaryandSeptember2018.Bothstillimagesandvideorecordingswerecollectedinallpatients.ResultsAtotalof11patientswereincludedinthisseries.Tenpatientsunderwentdeepinferiorepigastricperforator(DIEP)flapsreconstruction,andonepatientunderwentaunilateralreconstructionwithpediclethoracodorsalarteryperforatorflap(TDAP).LUMIFYwasusedpreoperativelyin3patientsforperforatormapping:twoofthesepatientshadrenalfailureandcouldnotundergoacomputedtomographicangiography(CTA),andinonepatient,theUSwasusedtoidentifytheTDAPperforatorvessellocationanddesigntheskinpaddleaccordingly.Fortheremaining8patients,theuseofLUMIFYwasperformedpost-operatively:3patientshadalossofDopplersignalfromtheflap,howevertheuseofLUMIFYconfirmedpatencyoftheanastomosesandflapperfusion,avoidingthereforeanunnecessaryre-exploration.TwopatientsunderwentsuccessfulUS-guidedseromadrainage.Twopatientsdevelopedbreastswelling,whichwasdiagnosedwiththeLUMIFYaslateralbreasthematomas.Finally,onepatientdevelopedaclinicallysignificantecchymosisoftheDIEPskinpaddle.TheuseoftheLUMIFYconfirmedadequateflapperfusionandpatencyofbotharterialandvenoussystemswithintheflap.Therewerenoflaplossesorerrorindiagnosis.ConclusionTheuseofportableUSinplasticsurgeryisavaluableresourceforplasticsurgeryresidentstakingcareofpatientswithautologousbreastreconstruction.Itprovidesreliablepreoperativeperforatormapping,andisanexcellentbedsidemodalitytoassesspostoperativeflapperfusionwhentheusualmethodsfail.

POSTER#6DUNDERSTANDINGTHERELATIONSHIPBETWEENPULMONARYCONTUSIONANDRIBFRACTURESEVERITYPatrickGreiffenstein,MD,FACS;MarianaE.TumminelloLSUSchoolofMedicine–NewOrleansBlunttraumahasbeenfoundtobethecauseofover90%ofchestwallinjuries.Alongwithribfractures,blunttraumapatientsmaydeveloppleuraleffusion,pneumothorax,andmorecommonly,pulmonarycontusion(PC).PatientswhoexperiencePCareatahigherriskofdevelopingAcuteRespiratoryDistressSyndrome(ARDS)andhaveanincreasedmortalityrateof10%to25%.Studieshavealsoshownthatmortalityratesandcomplicationsincreaseinanalmostlinearfashionwiththeincreaseinthenumberofribfractures.TheassumptionisthatPCincidenceandseverityincreasesasthenumberofribfracturesincreases,howeverthishasnotbeenexamineddirectly.WehypothesizethatincreasedPCscoreswillbeassociatedwithincreasednumberofribfractures.Weperformedasixyear(2012-2018)retrospectivechartreviewoftraumapatientsadmittedtoUniversityMedicalCenterinNewOrleanswitharadiologicaldiagnosisofPCbasedonCTimagingofthechesttakenuponarrival.OnehundredtwentythreepatientswereidentifiedinthistimeframeashavingPC.Forty-threepatientswereexcludedashavingpenetratingtraumaand11wereexcludedbecausetheywereyoungerthan18(n=69patients).TheCTscansofthesepatientswerescoredusingtheChestTraumaScoringSystemforage,severityandlocationofpulmonarycontusions,numberofribfractures,andbilateralityofribfractures.Clinicalanddemographicdatawasalsocollectedfromtheelectronicmedicalrecord.BothunivariateandmultivariateanalyseswereperformedusingSAS.Demographicandclinicaldatashowthatthepatientsinourcohortwerepredominantlymale(75.4%),young(meanage38.2±7.8,range19-73,)andhadanaveragePCscoreof(2.1±1.2).ItfurthershowsthatpatientswhopresentedwithamoreseverePCscore(3or4),tendedtohavemoreribfracturesthanpatientswithPCscoresof1or2(p=0.0008).Whenadjustedforsex,age,andBMIthesetrendswereconfirmed(p=0.0005).Wealsofoundthatoverall,morewomenpresentedwithseverebilateralPCs(PCscore=4)thanmen(p=0.0106).Therewasnocorrelationbetweenage,BMI,ortraumafatalitywithPCscore(p>0.05).Theseresultsshowthatthereisasignificantcorrelationbetweenmildpulmonarycontusionandlownumberofribfractures,andasignificantcorrelationbetweenseverepulmonarycontusionandhighnumberofribfractures.Interestingly,thecorrelationbetweenpulmonarycontusionandribfracturesinthemoderateranges(RS2-3vs.PC2-3)becomeslessobvious,thusthecorrelativeincreaseisnotperfectlylinear.UnderstandinghowotherfactorsinfluenceboththeseverityofPCandribfracturesmayhelpusunderstandhowbesttocareforthesepatientsandanticipatepitfallsduringtheirrecovery.