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Effects of Implementation of Lung Cancer Screening at a Veterans Affairs Medical Center
CARDIOTHORACIC SURGERY either consultation with a general surgeon (GS) or a general surgical procedure (GSP). We aimed to evaluate the incidence and outcomes of adult ECMO patients who underwent GSP.
Effects of Implementation of Lung Cancer Screening at a Veterans Affairs Medical Center Maria F Bates, MD, Matthew D Jankowich, MD, Sharon I Rounds, MD, Brian A Kimble, MD, Thomas T Ng, MD, FACS, Linda L Nici, MD, Ikenna C Okereke, MD, FACS University of Texas Medical Branch Galveston, TX, Warren Alpert Medical School of Brown University, Providence Veterans Administration Medical Center, Providence, RI
METHODS: This was a single institution retrospective study of adult ECMO patients from 2012 to 2015. Outcomes were compared between patients who underwent GSP and those who did not. Bleeding complications for GSP patients were compared for those therapeutically anticoagulated vs not anticoagulated. RESULTS: Of the 115 patients, 54 (46.9%) required a GS; 42 (36.5%) required a GSP. No significant differences were observed in mortality (35.7% vs 46.6%; p¼0.256) and ECMO-related complications (45.7% vs 32.5%; p¼0.175). Patients with GSP had longer duration of ECMO (13 vs 5 days; p<0.0001), longer length of stay (36 vs 15 days; p¼0.0005), more wound infections (19.05% vs 5.5%; p¼0.029), more urinary tract infections (38.1% vs 10.96%; p¼0.0006), and more pulmonary emboli (19.05% vs 5.48%; p¼0.029). In GSP patients, no difference in bleeding complications was observed regardless of anticoagulation status (29.4% vs 16%; p¼0.44) (Table).
INTRODUCTION: Lung cancer screening recommendations have been developed, but none has focused on veterans. We report the results of the lung cancer screening program at our veterans center and compare them to historic results. METHODS: All patients between 55 and 80 years old with a smoking history of at least 30 pack years were invited to receive an annual low-dose chest CT scan beginning in December 2013. Demographics, CT results, and pathologic data of screened patients were recorded retrospectively. Overall results during the screening period were compared with results in patients diagnosed from January 2011 to December 2013 (pre-screening period).
Table. Variable
RESULTS: From December 2013 through December 2014 (screening period), 1,832 patients obtained a screening CT scan. Mean age was 65 years old. A lung nodule was present in 24% (439/1,832) of patients. Lung cancer was diagnosed in 3.0% (55/1,832) of screened patients. During the pre-screening period, 37% (30/82) of every lung cancer detected at our center were stage I or stage II. After implementation of the screening program, that percentage rose to 60% (52/87, p < 0.01). During the screening period, 63% (55/87) of all diagnosed lung cancers were detected through the screening program. The number of lung cancers detected per month rose from 2.4 to 6.7 after implementation of the screening program (p < 0.01).
GSP (n¼42)* No GSP (n¼73)
Sex, male, n (%) 19 (45.2) Age, y (mean, SD) 53.2 (13.6) Mortality (n, %) 15 (35.7) SOFA score (mean, SD) 11.6 (2.8) Duration of ECMO, d (median, IQR) 13 (5e23) Length of stay, d (median, IQR) 36 (16e50) ECMO-related complications, n (%)y 16 (38.1) Patient-related complications, n (%)z 41 (97.6)
CONCLUSIONS: Implementation of lung screening in the veteran population leads to detection of increased number and proportion of early stage lung cancers. Lung cancer screening in veterans may also increase the rate of lung cancer diagnoses in the immediate post-implementation period.
p Value
51 (69.9) 53.1 (17.3) 34 (46.6)
0.009 0.940 0.257
11.6 (2.7)
0.907
5 (3e7)
<0.0001
15 (7e33)
0.0005
19 (26.0)
0.176
67 (91.7)
0.419
*Most common GSP performed were tracheostomy (30%), gastrostomy tube placement (24%), and laparotomy (14%). y Includes oxygenator failure, cannula issues, or circuit changes. z Includes deep vein thrombosis, pulmonary embolism, urinary tract infection, wound infection, sepsis, myocardial infarction, stroke, renal failure, and pneumonia. ECMO, extracorporeal membrane oxygenation; GSP, general surgical procedure; IQR, interquartile range; SOFA, Sequential Organ Functional Assessment.
Incidence and Analysis of General Surgical Procedures in Adult Patients on Extracorporeal Membrane Oxygenation Biren Juthani, DO, Timothy S Misselbeck, MD, Scott Beman, MD Lehigh Valley Health Network, Allentown, PA, Danbury Hospital, Danbury, CT INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a life support device for patients with severe cardiac and/or respiratory failure. Use of ECMO is increasing in adults secondary to advances and familiarity with this technology. ECMO use may predispose patients to developing conditions that require
CONCLUSIONS: Common general surgical procedures are safe and feasible in adult ECMO patients. Duration of ECMO was longer for patients requiring GPS. Despite the common use of anticoagulants, there was no increase in bleeding events in GSP patients. The overall survival is similar in both groups.
S22
http://dx.doi.org/10.1016/j.jamcollsurg.2016.06.057 ISSN 1072-7515/16
Effects of Implementation of Lung Cancer Screening at a Veterans Affairs Medical Center Maria F Bates, MD, Matthew D Jankowich, MD, Sharon I Rounds, MD, Brian A Kimble, MD, Thomas T Ng, MD, FACS, Linda L Nici, MD, Ikenna C Okereke, MD, FACS University of Texas Medical Branch Galveston, TX, Warren Alpert Medical School of Brown University, Providence Veterans Administration Medical Center, Providence, RI
METHODS: This was a single institution retrospective study of adult ECMO patients from 2012 to 2015. Outcomes were compared between patients who underwent GSP and those who did not. Bleeding complications for GSP patients were compared for those therapeutically anticoagulated vs not anticoagulated. RESULTS: Of the 115 patients, 54 (46.9%) required a GS; 42 (36.5%) required a GSP. No significant differences were observed in mortality (35.7% vs 46.6%; p¼0.256) and ECMO-related complications (45.7% vs 32.5%; p¼0.175). Patients with GSP had longer duration of ECMO (13 vs 5 days; p<0.0001), longer length of stay (36 vs 15 days; p¼0.0005), more wound infections (19.05% vs 5.5%; p¼0.029), more urinary tract infections (38.1% vs 10.96%; p¼0.0006), and more pulmonary emboli (19.05% vs 5.48%; p¼0.029). In GSP patients, no difference in bleeding complications was observed regardless of anticoagulation status (29.4% vs 16%; p¼0.44) (Table).
INTRODUCTION: Lung cancer screening recommendations have been developed, but none has focused on veterans. We report the results of the lung cancer screening program at our veterans center and compare them to historic results. METHODS: All patients between 55 and 80 years old with a smoking history of at least 30 pack years were invited to receive an annual low-dose chest CT scan beginning in December 2013. Demographics, CT results, and pathologic data of screened patients were recorded retrospectively. Overall results during the screening period were compared with results in patients diagnosed from January 2011 to December 2013 (pre-screening period).
Table. Variable
RESULTS: From December 2013 through December 2014 (screening period), 1,832 patients obtained a screening CT scan. Mean age was 65 years old. A lung nodule was present in 24% (439/1,832) of patients. Lung cancer was diagnosed in 3.0% (55/1,832) of screened patients. During the pre-screening period, 37% (30/82) of every lung cancer detected at our center were stage I or stage II. After implementation of the screening program, that percentage rose to 60% (52/87, p < 0.01). During the screening period, 63% (55/87) of all diagnosed lung cancers were detected through the screening program. The number of lung cancers detected per month rose from 2.4 to 6.7 after implementation of the screening program (p < 0.01).
GSP (n¼42)* No GSP (n¼73)
Sex, male, n (%) 19 (45.2) Age, y (mean, SD) 53.2 (13.6) Mortality (n, %) 15 (35.7) SOFA score (mean, SD) 11.6 (2.8) Duration of ECMO, d (median, IQR) 13 (5e23) Length of stay, d (median, IQR) 36 (16e50) ECMO-related complications, n (%)y 16 (38.1) Patient-related complications, n (%)z 41 (97.6)
CONCLUSIONS: Implementation of lung screening in the veteran population leads to detection of increased number and proportion of early stage lung cancers. Lung cancer screening in veterans may also increase the rate of lung cancer diagnoses in the immediate post-implementation period.
p Value
51 (69.9) 53.1 (17.3) 34 (46.6)
0.009 0.940 0.257
11.6 (2.7)
0.907
5 (3e7)
<0.0001
15 (7e33)
0.0005
19 (26.0)
0.176
67 (91.7)
0.419
*Most common GSP performed were tracheostomy (30%), gastrostomy tube placement (24%), and laparotomy (14%). y Includes oxygenator failure, cannula issues, or circuit changes. z Includes deep vein thrombosis, pulmonary embolism, urinary tract infection, wound infection, sepsis, myocardial infarction, stroke, renal failure, and pneumonia. ECMO, extracorporeal membrane oxygenation; GSP, general surgical procedure; IQR, interquartile range; SOFA, Sequential Organ Functional Assessment.
Incidence and Analysis of General Surgical Procedures in Adult Patients on Extracorporeal Membrane Oxygenation Biren Juthani, DO, Timothy S Misselbeck, MD, Scott Beman, MD Lehigh Valley Health Network, Allentown, PA, Danbury Hospital, Danbury, CT INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a life support device for patients with severe cardiac and/or respiratory failure. Use of ECMO is increasing in adults secondary to advances and familiarity with this technology. ECMO use may predispose patients to developing conditions that require
CONCLUSIONS: Common general surgical procedures are safe and feasible in adult ECMO patients. Duration of ECMO was longer for patients requiring GPS. Despite the common use of anticoagulants, there was no increase in bleeding events in GSP patients. The overall survival is similar in both groups.
S22
http://dx.doi.org/10.1016/j.jamcollsurg.2016.06.057 ISSN 1072-7515/16