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S79Vol. 207, No. 3S, September 2008 Surgical Forum Abstracts

�0.0001]; VTE at any BMI�35 [OR 8.1 (1.5-44.2), P�.017];nd mortality at any BMI�30 [OR 2.1 (1.1-4.8), P�.049]. Usingogistic regression multivariate analysis obesity remained an indepen-ent predictor of cardiac complications with a graduated increase indjusted odds ratios (AOR) as BMI increased: BMI�30�AOR 2.01.2-3.4), P�.011; BMI�35�AOR 2.7 (1.3-5.5), P�.009; andMI�40�AOR 3.9 (1.3-11.9), P�.015. For mortality, obesity was

ound to be predictive at BMI�35 [AOR 5.0 (1.6-15.3), P�.005].

ONCLUSIONS: Obesity has a significant impact on outcomes foratients undergoing CEA. This relationship is especially pertinent asbesity is alarmingly more prevalent. Obese patients undergoingEA can expect to have worse outcomes than patients with BMI less

han 30. These results have implications on patient selection andounseling.

levated breast cancer mortality in young women<40 years) compared with older women isttributed to poorer survival in early-stage disease

ennifer Gnerlich MD, Anjali D Deshpande PhD,onna B Jeffe PhD, Allison Sweet BS, Nick White BS,

ulie A Margenthaler MDashington University School of Medicine, St Louis, MO

NTRODUCTION: We investigated differences in breast cancerortality between young (�40 years) and older (�40 years) women

y stage at diagnosis to identify patient and tumor characteristicsccounting for disparities.

ETHODS: We conducted a retrospective study of women diag-osed with breast cancer in the 1988-2003 Surveillance, Epidemiol-gy, and End Results (SEER) program. Multivariate Cox regressionodels calculated adjusted hazard ratios (aHR) and 95% confidence

ntervals (CI) to compare overall and stage-specific breast cancerortality in women �40 years and women �40 years, controlling

or potential confounding variables identified in univariate tests.

ESULTS: Of 243,012 breast cancer patients, 6.4% were �40 yrs35.1 3.6), while 93.6% were ?40 yrs (62.2 � 13.3). Compared withlder women, young women were more likely to be Black, neverarried, diagnosed at later stages, treated by mastectomy, and their

umors were more likely to be T2/T3, grade III, ER negative andymph-node positive (each P�0.001). Young women were moreikely to die from breast cancer compared with older women (crude

R 1.39, CI 1.34-1.45). Controlling for confounders, youngomen were more likely to die compared with older women if diag-osed with Stage I (aHR 1.44, CI 1.27-1.64) or Stage II (aHR 1.09,I 1.03-1.15) disease and less likely to die if diagnosed with Stage IV

aHR 0.85, CI 0.76-0.95).

ONCLUSIONS: The higher breast cancer mortality in youngomen was attributed predominantly to poorer outcomes with early-

tage disease. Further studies should focus on the specific tumoriology contributing to the increased mortality of young women

ith early-stage breast cancer. p

rends in adrenal surgery and adrenal cancerncidence and survival in the era of laparoscopicurgery

oseph Lupo MD, Jason Kemp MD, Ian Paquette MD,amuel R G Finlayson MD, MPH, FACSartmouth-Hitchcock Medical Center, Lebanon, NH

NTRODUCTION: In the laparoscopic era we have witnessed higherates of utilization of many surgical procedures, including cholecys-ectomy, gastric bypass, and anti-reflux surgery. It is unknownhether there has been a change in rates of surgery for adrenal tu-ors, many of which are incidentally discovered with the prolifera-

ion of advanced abdominal imaging.

ETHODS: Nationwide Inpatient Sample and US Census data weresed to calculate national population-based rates of adrenal surgery forhe years 1988 to 2003. We then used SEER data to examine trends inge-adjusted incidence and survival with adrenal cancer over the sameime period. The statistical significance of changes in rates over time wasested using Spearman’s rank correlation tests.

ESULTS: Between 1988 and 2003, rates of adrenal surgery in-reased 30%, from 1.9 to 2.5 per 100,000 population (Spearman’sho�0.92, p�0.001). Incidence of adrenal cancer in the US popu-ation was 0.3 per 100,000 population (95% CI 2.8-3.2) and did nothange significantly during this time (Spearman’s rho�0.27,�0.33). Five-year survival with adrenal cancer did not change sig-ificantly (incident cases 1998 to 1999 overall survival 45%, Spear-an’s rho�0.10, p�0.77), nor did two-year survival (incident cases

998 to 2002 overall survival 59%, Spearman’s rho�0.37, p�0.20).

ONCLUSIONS: During the era of advanced abdominal imagingnd diminished morbidity with laparoscopic adrenal surgery, rates ofdrenal surgery have significantly increased over time, without sig-ificant changes in incidence or mortality related to adrenal cancer.hese findings suggest that greater intensity of interventions for ad-

enal findings may not result in improvements in population out-omes related to adrenal cancer.

he omission of a diverting ileostomy in a selectroup of patients meeting strict clinical criteria,ndergoing ileal pouch anal anastomosis (IPAA),ffers cost savings to the hospitalyles R Joyce MB, BCH, BAO, MD, Ravi P Kiran MD, FACS,

ames M Church MD, FRACS, FACS, Jeffrey P Hammel MS,eza H Remzi MD, FACS, FASCRS,ictor Fazio MD, FRACS, FACSleveland Clinic Foundation, Cleveland, OH

NTRODUCTION: Ileal-anal pouch anstomosis (IPAA) is the standardf care for the majority of patients with MUC or FAP, requiring surgery.revious data has shown that omission of an ileostomy in a carefullyelected patient group is not associated with any long-term pouch dys-unction. The aim of this study was to determine whether a single-stagePAA without ileostomy diversion, offered cost-savings to the hospital.

ETHODS: Using our institutional review board-approved pelvic

ouch database we identified patients who underwent IPAA between