S112 Surgical Forum Abstracts J Am Coll Surg

surgery may lead to higher smoking cessation rates and decreasedperioperative risks.

METHODS: We designed a resident-led quality improvementinitiative targeted at urology patients undergoing inpatient surgeryat UCSF to determine patients’ smoking status and obtain an inpa-

tient smoking cessation consult for current smokers. Analysis wasconducted using t-test for continuous predictors, chi-squared anal-ysis for categorical predictors, and logistic regression for multivar-

iate analysis (p < 0.05 significant).

RESULTS: 9.8% of patients identified as current tobacco users. Inmultivariate logistic regression adjusted for age, sex, hospital, and

cancer- or tobacco-related diagnosis, male sex predicted current to-bacco use (p < 0.01, 95% CI 0.19-0.81) while increasing age (p <0.01, 95% CI 1.01-1.04) and a cancer diagnosis (p ¼ 0.02, 95%

CI 1.16-4.50) were significant predictors of past use. Consultswere obtained on the majority of smokers; there were no significantpredictors of likelihood to refuse a consult. Individuals receiving aconsult were more likely to receive nicotine-replacement therapy

(NRT) during hospitalization (97.4% vs 40.0%, p < 0.01) andthe majority (73.75) continued NRT after discharge (Table).

Characteristics of Patients undergoing Urologic Surgery

nCurrent

tobacco userCurrent tobacco

non-user p Value

Age, y 562 60.0 53.9 <0.01

Sex (% male) 60.4% 75.4% 0.02

Cancer diagnosis 46.3% 59.5% 0.10

Tobacco-relateddiagnosis 36.6% 32.5% 0.59

Cancer center 46.0% 52.7% 0.36

If nonsmoker, +past tobaccouse 512 38.6%

If smoker,consult placed 50 79.0%

CONCLUSIONS: A significant proportion of urology patients un-dergoing surgery are current tobacco users, putting them at higherperioperative risks. Assessing patients’ tobacco use is a feasible andeasily implemented method to identify smokers and obtain smok-

ing cessation counseling and treatment for patients at a time whenthey are perhaps most amenable to quitting.

The Impact of Untreated Obstructive Sleep Apnea onCardiopulmonary Complications in General and VascularSurgery: A Cohort StudyZaid Abdelsattar, MD, Samantha Hendren, MD, MPH, FACS,Sandra LWong,MD,MS, FACS,Darrell ACampbell Jr,MD,FACS,Satya Krishna Ramachandran, MD, FRCAUniversity of Michigan, Ann Arbor, MI

INTRODUCTION: Obstructive sleep apnea (OSA) may be a surgi-cal risk factor. Unfortunately, the majority of OSA patients are

undiagnosed or untreated before surgery. In this context, we studythe association between treated vs untreated OSA and postoperative

cardiopulmonary complications.

METHODS: Between 7/2012 and 9/2013, information about pre-operative OSA was abstracted for patients undergoing general or

vascular surgery at 52 Michigan hospitals. From detailed chart re-views, patients were categorized as: 1) no diagnosis/low-risk ofOSA; 2) documented diagnosis/suspicion of OSA but no regularhome treatment; and 3) diagnosis of OSA with regular home treat-

ment (e.g., CPAP). 30-day cardiopulmonary complications wereabstracted, including arrhythmias, cardiac arrest, myocardial infarc-tion, unplanned re-intubation, pulmonary embolism and pneu-

monia. Multivariate models were used to compare complicationrates between treated and untreated OSA, while adjusting for pa-tient demographics, BMI, comorbidity, procedure type, urgency

and clustering within hospitals.

RESULTS: Of 26,842 patients, 2,646 (9.9%) had a diagnosis orsuspicion of OSA. Of those 1,465 (55.4%) were untreated. Patientand procedural risk factors were balanced between treated and un-

treated groups. Compared to treated OSA, untreated OSA wasindependently associated with more cardiopulmonary complica-tions (risk-adjusted rates 6.7% v. 3.9%; aOR¼1.91 p¼0.001),

particularly unplanned re-intubations (aOR¼ 2.43 p¼0.005) andmyocardial infarction (aOR¼2.57 p¼0.04).

CONCLUSIONS: This study shows that patients with OSA whoare not treated with positive airway pressure are at increased risk

for cardiopulmonary complications after general and vascular sur-gery. This suggests that improving the recognition of OSA andensuring adequate treatment may be a strategy to reduce risk for

surgical patients with OSA.

Costs, Outcomes, and Value in Major Lung Resection: DoAll Patients Benefit Equally from High-Volume Referral?Elliot Wakeam, MD, Joseph A Hyder, MD, PhD,Roland A Hernandez, MD, JD, Stuart R Lipsitz, ScD,Samuel RG Finlayson, MD, MPH, FACSBrigham and Women’s Hospital, Boston, MA, University ofToronto, Toronto, Ontario

INTRODUCTION: Little empirical evidence exists regarding howintegrated delivery systems like Accountable Care Organizations

(ACOs) may selectively refer patients to decrease cost and maintainquality. We wanted to understand how patient groups might differ-entially benefit from referral to high volume (HV) hospitals forelective lung resection.

METHODS: We identified 37,746 patients undergoing electivelung resection in 1,273 hospitals in the Nationwide Inpatient Sam-ple from 2007-2011. Patients were stratified by hospital volume

quartiles and sub-stratified by preoperative mortality risk, age,and COPD status. Logistic regression, clustered by hospital, wasused to evaluate mortality risk controlling for patient co-morbidity

and demographics. Adjusted median regression was used to eval-uate costs in these patient groups across volume quartiles.