Faculty Bibliography

INTRODUCTION/BACKGROUND:Anemia occurs before and after kidney transplantation. Determining the impact of perioperative transfusion on post-transplant outcomes can help determine best management of anemia. PROJECT AIM/UNASSIGNED:The current study aims to describe clinical outcomes associated with packed red blood cell transfusions in the peri-operative management of anemia after transplantation. DESIGN/METHODS:This was a single-center, retrospective study of adult kidney recipients with anemia at the time of transplantation. 1271 patients were stratified by donor-type due to the potential variability in underlying recipient and transplant characteristics; living donor (n = 698, 62%) or deceased donor (n = 573, 38%). RESULTS:Living donor recipients that received blood during the index hospitalization were more likely to experience rejection within 30 days (18% vs. 10%, p = 0.008) and 1 year of transplant (32% vs. 16%, p = 0.038). In multivariate analysis, receiving both blood and darbepoetin (HR: 1.89 [1.20,3.00], p = 0.006), age at transplant (HR: 0.98 [0.97, 0.99], p = 0.02), number of HLA mismatches (HR: 1.17 [1.05,1.30], p = 0.003), and whether the case was a repeat transplant (HR: 2.77 [1.93,3.97], p < 0.01) were significantly associated with hazard of rejection. For deceased donor recipients, there were no differences in acute rejection, graft failure or mortality at 30 days or 1 year. When analyzing hazard of rejection in a multivariate model, treatment received was not found to be significantly associated with rejection. CONCLUSION/CONCLUSIONS:Our findings suggest there may be a role for more aggressive pre-transplant treatment of anemia for those patients undergoing living donor transplants.

OBJECTIVE:This study aimed to assess whether elderly patients (aged ≥ 70 years) face an elevated risk of complications following pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD) compared with younger patients (< 70 years) and to evaluate if clinical and radiological outcomes differ between these age groups. METHODS:A retrospective analysis of 513 patients undergoing PSO for ASD by a single surgical team between January 2006 and January 2023 was conducted. Patients were categorized by age (≥ 70 years and < 70 years). Data on clinical, demographic, comorbidity, and radiographic details were collected and compared between the groups. For health-related quality of life assessment, the authors recorded the Oswestry Disability Index (ODI), numeric rating scale (NRS), and Scoliosis Research Society-22 revised (SRS-22r) scores preoperatively and at 6 weeks and 1 year postoperatively. Perioperative complications included major (neurological deficit, death, acute myocardial infarction, stroke), minor (ileus, arrhythmia, delirium), and intraoperative (durotomy, vascular injury). RESULTS:Of 513 patients, 412 were included in the study. Clinical outcomes, as measured by NRS, ODI, and SRS-22r scores, were comparable between groups, with both groups showing significant improvements postoperatively. Radiographic outcomes also showed significant and comparable improvements in sagittal balance and spinopelvic harmony in both groups. Deformity corrections were also well maintained at 1 year postoperatively. The elderly group (mean age 75.48 years) had a higher rate of perioperative complications (44.64%) than the younger group (mean age 59.60 years; 30.33%) (p = 0.0030), primarily minor complications such as delirium and arrhythmia (16.07% vs 8.61%, p = 0.0279). There was no significant difference between groups regarding the major complication rate (elderly group: 20.83% vs younger group: 14.34%, p = 0.1087), intraoperative complication rate (2.98% vs 3.69%, p = 0.6949), short-term complication rate (10.12% vs 8.20%, p = 0.5024), mechanical complication rate (30.95% vs 32.79%, p = 0.6949), and reoperation rate due to mechanical complications (38.46% vs 43.75% p = 0.5470). CONCLUSIONS:Elderly patients undergoing PSO for ASD experience a higher rate of minor complications but can achieve clinical and radiological outcomes that are comparable to those of younger patients. The authors found no significant increase in major, intraoperative, short-term, or mechanical complication rates and their subsequent reoperation rates among the elderly. These findings underscore the effectiveness of PSO in improving the quality of life for patients with ASD across age groups, emphasizing the critical role of personalized perioperative management in enhancing outcomes and minimizing risks for all patients.

BACKGROUND:Whereas racial disparities in thyroid cancer care are well established, the role of social determinants of health is less clear. We aimed to assess the individual and cumulative impact of social determinants of health on mortality and time to treatment among patients with thyroid cancer. METHODS:We collected social determinants of health data from thyroid cancer patients registered in the National Cancer Database from 2004 to 2017. We created a count variable for patients in the lowest quartile of each social determinant of health (ie, low income, low education, and no insurance). We assessed the association of social determinants of health with mortality and time to treatment and the association between cumulative social determinants of health count and time to treatment using Cox regression. RESULTS:Of the 142,024 patients we identified, patients with longer time to treatment had greater mortality compared to patients treated within 90 days (90-180 days, adjusted hazard ratio 1.21 (95% confidence interval 1.13-1.29, P < .001); >180 days, adjusted hazard ratio 1.57 (95% confidence interval 1.41-1.76, (P < .001). Compared to patients with no adverse social determinants of health, patients with 1, 2, or 3 adverse social determinants of health had a 10%, 12%, and 34%, respectively, higher likelihood of longer time to treatment (1 social determinant of health, hazard ratio 0.90, 95% confidence interval 0.89-0.92, P < .001; 2 social determinants of health, hazard ratio 0.88, 95% confidence interval 0.87-0.90, P < .001; 3 social determinants of health, hazard ratio 0.66, 95% confidence interval 0.62-0.71, P < .001 for all). On subgroup analysis by race, each adverse social determinant of health was associated with an increased likelihood of a longer time to treatment for Black and Hispanic patients (P < .05). CONCLUSION:A greater number of adverse social determinants of health leads to a higher likelihood of a longer time to treatment for patients with thyroid cancer, which, in turn, is associated with an increased risk for mortality.

Artificial intelligence models have been increasingly used in the analysis of tumor histology to perform tasks ranging from routine classification to identification of molecular features. These approaches distill cancer histologic images into high-level features, which are used in predictions, but understanding the biologic meaning of such features remains challenging. We present and validate a custom generative adversarial network-HistoXGAN-capable of reconstructing representative histology using feature vectors produced by common feature extractors. We evaluate HistoXGAN across 29 cancer subtypes and demonstrate that reconstructed images retain information regarding tumor grade, histologic subtype, and gene expression patterns. We leverage HistoXGAN to illustrate the underlying histologic features for deep learning models for actionable mutations, identify model reliance on histologic batch effect in predictions, and demonstrate accurate reconstruction of tumor histology from radiographic imaging for a "virtual biopsy."

Retroperitoneal lymph node dissection (RPLND) has been an integral part of a multimodal treatment strategy in testicular cancer. Surgeons, over the last decade, have advanced the understanding of RPLND by adopting perioperative care pathways, innovative biomarkers, surgical techniques, and developing algorithms for managing complications. This review summarizes updates on various aspects including the enhanced recovery after surgery pathway, imaging techniques, surgical approaches, dissection templates, and the management of complications. We conclude that RPLND has undergone significant evolution and refinement in the modern era and will continue to hold a critical role in the care of patients with testicular cancer.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Pediatric spine surgery has evolved considerably over the past century. No previous study conducted a bibliometric analysis of the corpus of pediatric spine surgery. We used big data and advanced bibliometric analyses to evaluate trends in the progression of pediatric spine surgery as a distinct field since the beginning of the 20th century. METHODS:A Web of Science query was designed to capture the representative corpus of pediatric spine literature. Statistical and bibliometric analyses were performed using various Python packages and the Bibliometrix R package. RESULTS:The collection, published from 1902 to 2023, comprised a total of 11 861 articles from 61 journals and 32 715 unique authors. The overall growth rate annually for publications was 5.08%. An upsurge in publications was seen in the 1980s, after the advent of specialty and subspecialty journals. Illustratively, over 90% of all articles pertaining to pediatric spine surgery were published in the past 3 decades. International and domestic collaboration also increased exponentially over this time period. Reference publication year spectroscopy allowed us to identify 75 articles that comprise the historical roots of modern pediatric spine surgery. There was a recent lexical evolution of topics and terms toward alignment, outcomes, and patient-centric terms. Coauthorship among under-represented groups increased since 1990, but remains low, with disparities persisting across journals. CONCLUSION/CONCLUSIONS:This comprehensive bibliometric analysis on the corpus of pediatric spine surgery offers insight into the evolving landscape of research, authorship, and publication trends over the past century. Advancements in the understanding of the natural history and technology have led the field to become increasingly outcomes focused, all of which have been fueled by pioneering authors. While diversity among authors improves, under-representation of various groups continues to persist, indicating a critical role for further outreach and promotion.

To assess the effect of World Trade Center (WTC) exposure on cardiovascular disease (CVD) in career firefighters. Methods: Firefighters from four US cities completed health questionnaires that provide information about demographics, CVD diagnoses, and CVD risk factors. Firefighters were also compared with respondents of the 2019 National Health Interview Survey. Results: Greater WTC exposure was positively associated with combined coronary artery disease, myocardial infarction, and angina (termed "CAD") when comparing WTC-exposed with non-WTC-exposed firefighters. Compared with the National Health Interview Survey population, firefighters had lower odds of CAD and stroke. Conclusions: An occupationally appropriate comparison is important to mitigate potential bias from the healthy worker effect. While the risk of CVD in WTC-exposed and non-WTC-exposed firefighters was significantly lower than a general US population, we observed an exposure gradient where greater WTC exposure was associated with greater odds of CVD.

OBJECTIVES/OBJECTIVE:Characterisation of firefighters' exposures to dangerous chemicals in smoke from non-wildfire incidents, directly through personal monitoring and indirectly from work-related records, is scarce. The aim of this study was to evaluate the association between smoke particle exposures (P) and pulmonary function. METHODS:). Models controlled for age, race/ethnicity, height, smoking and weight. RESULTS:(β=-26.87; 95% CI=-34.54 to -19.20). When evaluating P estimated within 3 months of a pulmonary function test (PFT), stronger associations were observed among those most highly exposed to the World Trade Center (WTC) disaster (β=-12.90; 95% CI=-22.70 to -2.89); the association of cumulative exposures was similar for both highly and less highly exposed individuals. DISCUSSION/CONCLUSIONS:Smoke particle exposures were observed to have modest short-term and long-term associations with pulmonary function, particularly in those who, previously, had high levels of WTC exposure. Future work examining the association between P and pulmonary function among non-WTC exposed firefighters will be essential for disentangling the effects of ageing, routine firefighting and WTC exposures.