Impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy: a NSQIP retrospective cohort analysis of 25,848 patients.

BACKGROUND: Efforts to preoperatively risk stratify and optimize patients before pancreaticoduodenectomy continue to improve outcomes. This study aims to determine the impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy and outline optimal hypoalbuminemia cut-off values in this population. METHODS: The ACS-NSQIP (2016-2021) database was used to extract patients who underwent pancreaticoduodenectomy, comparing those with hypoalbuminemia (< 3.0 g/L) to those with normal albumin. Demographics and 30-day outcomes were compared. Multivariable modeling evaluated factors including hypoalbuminemia to characterize their independent effect on serious complications, and mortality. Optimal albumin cut-offs for serious complications and mortality were evaluated using receiver-operating characteristic curves. RESULTS: We evaluated 25,848 pancreaticoduodenectomy patients with 2712 (10.5%) having preoperative hypoalbuminemia. Patients with hypoalbuminemia were older (68.2 vs. 65.1; p < 0.0001), and were significantly more likely to be ASA class 4 or higher (13.9% vs. 6.7%; p < 0.0001). Patients with hypoalbuminemia had significantly more 30-day complications and after controlling for comorbidities hypoalbuminemia remained a significant independent factor associated with 30-day serious complications (OR 1.80, p < 0.0001) but not mortality (OR 1.37, p = 0.152). CONCLUSIONS: Hypoalbuminemia plays a significant role in 30-day morbidity following pancreaticoduodenectomy. Preoperative albumin may serve as a useful marker for risk stratification and optimization.

Teste Talk: A trial social media campaign to improve awareness of testicular torsion.

INTRODUCTION: Adolescent males are particularly prone to testicular torsion, often resulting in subsequent orchiectomy. A lack of knowledge about testicular pathologies, as well as hesitancy to discuss genital concerns, are fundamental, preventable barriers to early presentation. We hypothesized that a social media campaign to improve awareness of testicular torsion and other urological conditions affecting adolescents may overcome such barriers in this population. METHODS: A social media campaign, "Teste Talk," was created and promoted on Instagram and Facebook. Data was collected from June 1 to December 1, 2021. Instagram followers, Facebook page likes, Instagram and Facebook reach, post likes, Instagram follower demographics, and advertisement data were reviewed. Data was collected using Meta Business Suite. Paid promotions to improve awareness of the campaign were targeted towards 13-18-year-old males in Alberta and were funded by the Undergraduate Research Initiative Support Fund. RESULTS: The campaign reached 26 072 Instagram accounts and 14 741 Facebook accounts. The Instagram page amassed 382 followers, while the Facebook page accumulated 99 likes. Paid advertisements were seen 81 136 times on Instagram and Facebook. Instagram surveys demonstrated that over the study period, followers had an increased awareness of testicular torsion and how to recognize it. No patients presenting with torsion during the study period admitted to seeing the campaign. CONCLUSIONS: Testicular torsion remains a significant issue among adolescent males, and creative ways to disseminate information and increase knowledge and conversations about testicular pathologies are needed. Social media campaigns present a potential pathway for increasing awareness and reducing delays to presentation and orchiectomies.