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Braden Scale for Pressure Ulcer Risk Predicts Rehabilitation Placement After Pancreatic Resection
Vol. 223, No. 4S2, October 2016
INTRODUCTION: Pancreatic cancer (PC) differs from other gastrointestinal cancer in its hypovascularity (thus probably also low glucose). Our previous data demonstrated low glucose microenvironment can induce epithelial mesenchymal transition (EMT) of PC cells. AMPK-a1 serves as a metabolic checkpoint in response to low nutrient availability and environmental stress. The present study aims to identify whether AMPK-a1 mediates the low glucose-induced EMT. METHODS: PC cells were cultured in different glucose concentration medium. The EMT biomarkers, AMPKa1, invasion, and metastasis ability were evaluated. Knock-in and Knock-down experiments were performed to assess the effects of potential AMPKa1/ZEB1 pathway on low glucose-induced EMT. CO-IP and MagneGST Ô Pull-Down test were employed to test whether AMPKa1 targeted ZEB1 directly. Chip was used to validate whether AMPKa1 could bind E-box of E-cadherin by interacting with ZEB1. RESULTS: Low glucose microenvironment promoted EMT of PC cell and increased the activity and expression of AMPKa1. Moreover, inhibition of AMPKa1 could reverse the low glucose-induced EMT. While overexpression of AMPKa1 induced EMT in PC cells. Further, activated AMPKa1 could phosphorylate ZEB1 and then inhibit E-cadherin by binding E-box of E-cadherin. CONCLUSIONS: The present research provides a comprehensive AMPKa1-mediated linkage mechanism which bridging the low glucose microenvironment to aggressive behaviors of pancreatic cancer. Braden Scale for Pressure Ulcer Risk Predicts Rehabilitation Placement After Pancreatic Resection Ammara A Watkins, MD, Manuel Castillo-Angeles, MD, Camila R Guetter, Mariam F Eskander, MD, MPH, Jennifer F Tseng, MD, MPH, FACS, Mark P Callery, MD, FACS, A James Moser, MD, FACS, Tara S Kent, MD, FACS Beth Israel Deaconess Medical Center, Boston, MA INTRODUCTION: Patients undergoing pancreatic resection frequently require continued recovery at rehabilitation facilities after hospital discharge. We evaluated the predictive role of validated markers of frailty on rehabilitation facility placement to identify patients who may require this service. METHODS: This is a single-center retrospective cohort study of patients who underwent pancreatic resection from 2010-2015. Ninety-day morbidity and mortality were calculated. Postoperative validated markers of frailty (Activities of Daily Living scale [ADL], Braden scale [assesses pressure ulcer risk, lower scores¼higher risk] and Morse fall scale) were evaluated via multivariate regression to identify predictors of discharge to rehabilitation facility and readmission. RESULTS: Four hundred seventy patients with complete data were included. Mean age was 62 and 49.2% were male.
Scientific Poster Presentations: 2016 Clinical Congress
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Postoperative median length of stay (LOS) was 8 (IQR 7-10). Ninety-two (19.66%) patients were discharged to rehabilitation facilities and 138 (29.49%) patients were readmitted within 90 days. On multivariate analysis, age, LOS >8 days, inpatient comprehensive complication index (CCI) and Braden scale were predictive of rehabilitation placement (Table). On a separate multivariate analysis for readmission, rehabilitation placement was not predictive for readmission; however, age and 90-day CCI were predictive.
Table. Multivariate Model for Predictors of Rehabilitation Placement among Patients with Pancreatic Resection*
Variable
Age American Society of Anesthesiologists physical classification score >2 vs < 2 Charlson comorbidity score Private insurance Length of stay >8 vs < 8 Comprehensive complication index Activities of Daily Living scale Braden scale Morse fall scale
95% confidence interval
Odds ratio
1.106 1.877
1.064 0.801
1.148 4.400
1.050 1.752 4.352 1.022 1.060 0.703 0.942
0.876 0.967 2.279 1.006 0.974 0.519 0.482
1.258 3.175 8.311 1.038 1.153 0.926 1.840
*Age, length of stay >8 days, Comprehensive Complication Index and the Braden scale were predictive of rehabilitation placement.
CONCLUSIONS: Readily available tools, including a marker of frailty routinely collected daily by nursing staff, the Braden scale, are available to help surgeons predict the need for postoperative rehabilitation placement after pancreatic resection. Earlier engagement of discharge planning services such as physical therapy and case management for at-risk patients may help prevent delayed hospital discharge and should be further evaluated. Charlson Comorbidity Index and the Ability of Patients with Localized Pancreatic Cancer to Complete Neoadjuvant Therapy and Surgery Grace Blitzer, Moha Aldakkak, MD, Kathleen K Christians, MD, FACS, Ben George, MD, Paul S Ritch, MD, Beth A Erickson, MD, Douglas B Evans, MD, FACS, Susan Tsai, MD, MHS Medical College of Wisconsin, Milwaukee, WI INTRODUCTION: Pancreatic cancer (PC) patients with multiple comorbidities are high-risk surgical candidates. Neoadjuvant therapy may improve the selection of such patients for surgery. METHODS: Charlson Comorbidity Index (CCI) was assessed at the time of diagnosis among patients with resectable and
INTRODUCTION: Pancreatic cancer (PC) differs from other gastrointestinal cancer in its hypovascularity (thus probably also low glucose). Our previous data demonstrated low glucose microenvironment can induce epithelial mesenchymal transition (EMT) of PC cells. AMPK-a1 serves as a metabolic checkpoint in response to low nutrient availability and environmental stress. The present study aims to identify whether AMPK-a1 mediates the low glucose-induced EMT. METHODS: PC cells were cultured in different glucose concentration medium. The EMT biomarkers, AMPKa1, invasion, and metastasis ability were evaluated. Knock-in and Knock-down experiments were performed to assess the effects of potential AMPKa1/ZEB1 pathway on low glucose-induced EMT. CO-IP and MagneGST Ô Pull-Down test were employed to test whether AMPKa1 targeted ZEB1 directly. Chip was used to validate whether AMPKa1 could bind E-box of E-cadherin by interacting with ZEB1. RESULTS: Low glucose microenvironment promoted EMT of PC cell and increased the activity and expression of AMPKa1. Moreover, inhibition of AMPKa1 could reverse the low glucose-induced EMT. While overexpression of AMPKa1 induced EMT in PC cells. Further, activated AMPKa1 could phosphorylate ZEB1 and then inhibit E-cadherin by binding E-box of E-cadherin. CONCLUSIONS: The present research provides a comprehensive AMPKa1-mediated linkage mechanism which bridging the low glucose microenvironment to aggressive behaviors of pancreatic cancer. Braden Scale for Pressure Ulcer Risk Predicts Rehabilitation Placement After Pancreatic Resection Ammara A Watkins, MD, Manuel Castillo-Angeles, MD, Camila R Guetter, Mariam F Eskander, MD, MPH, Jennifer F Tseng, MD, MPH, FACS, Mark P Callery, MD, FACS, A James Moser, MD, FACS, Tara S Kent, MD, FACS Beth Israel Deaconess Medical Center, Boston, MA INTRODUCTION: Patients undergoing pancreatic resection frequently require continued recovery at rehabilitation facilities after hospital discharge. We evaluated the predictive role of validated markers of frailty on rehabilitation facility placement to identify patients who may require this service. METHODS: This is a single-center retrospective cohort study of patients who underwent pancreatic resection from 2010-2015. Ninety-day morbidity and mortality were calculated. Postoperative validated markers of frailty (Activities of Daily Living scale [ADL], Braden scale [assesses pressure ulcer risk, lower scores¼higher risk] and Morse fall scale) were evaluated via multivariate regression to identify predictors of discharge to rehabilitation facility and readmission. RESULTS: Four hundred seventy patients with complete data were included. Mean age was 62 and 49.2% were male.
Scientific Poster Presentations: 2016 Clinical Congress
e133
Postoperative median length of stay (LOS) was 8 (IQR 7-10). Ninety-two (19.66%) patients were discharged to rehabilitation facilities and 138 (29.49%) patients were readmitted within 90 days. On multivariate analysis, age, LOS >8 days, inpatient comprehensive complication index (CCI) and Braden scale were predictive of rehabilitation placement (Table). On a separate multivariate analysis for readmission, rehabilitation placement was not predictive for readmission; however, age and 90-day CCI were predictive.
Table. Multivariate Model for Predictors of Rehabilitation Placement among Patients with Pancreatic Resection*
Variable
Age American Society of Anesthesiologists physical classification score >2 vs < 2 Charlson comorbidity score Private insurance Length of stay >8 vs < 8 Comprehensive complication index Activities of Daily Living scale Braden scale Morse fall scale
95% confidence interval
Odds ratio
1.106 1.877
1.064 0.801
1.148 4.400
1.050 1.752 4.352 1.022 1.060 0.703 0.942
0.876 0.967 2.279 1.006 0.974 0.519 0.482
1.258 3.175 8.311 1.038 1.153 0.926 1.840
*Age, length of stay >8 days, Comprehensive Complication Index and the Braden scale were predictive of rehabilitation placement.
CONCLUSIONS: Readily available tools, including a marker of frailty routinely collected daily by nursing staff, the Braden scale, are available to help surgeons predict the need for postoperative rehabilitation placement after pancreatic resection. Earlier engagement of discharge planning services such as physical therapy and case management for at-risk patients may help prevent delayed hospital discharge and should be further evaluated. Charlson Comorbidity Index and the Ability of Patients with Localized Pancreatic Cancer to Complete Neoadjuvant Therapy and Surgery Grace Blitzer, Moha Aldakkak, MD, Kathleen K Christians, MD, FACS, Ben George, MD, Paul S Ritch, MD, Beth A Erickson, MD, Douglas B Evans, MD, FACS, Susan Tsai, MD, MHS Medical College of Wisconsin, Milwaukee, WI INTRODUCTION: Pancreatic cancer (PC) patients with multiple comorbidities are high-risk surgical candidates. Neoadjuvant therapy may improve the selection of such patients for surgery. METHODS: Charlson Comorbidity Index (CCI) was assessed at the time of diagnosis among patients with resectable and