Objective To assess the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease (RD) at primary cytoreduction in advanced ovarian cancer. Methods A prospective, non-randomized, multicenter trial of patients who underwent primary debulking for stage III–IV epithelial ovarian cancer previously identified 9 criteria associated with suboptimal (>1cm residual) cytoreduction. This is a secondary post-hoc analysis looking at the ability to predict any RD. Four clinical and 18 radiologic criteria were assessed, and a multivariate model predictive of RD was developed. Results From 7/2001–12/2012, 350 patients met eligibility criteria. The complete gross resection rate was 33%. On multivariate analysis, 3 clinical and 8 radiologic criteria were significantly associated with the presence of any RD: age ≥60 years (OR=1.5); CA-125 ≥600 U/ml (OR=1.3); ASA 3–4 (OR=1.6); lesions in the root of the superior mesenteric artery (OR=4.1), splenic hilum/ligaments (OR=1.4), lesser sac >1cm (OR=2.2), gastrohepatic ligament/porta hepatis (OR=1.4), gallbladder fossa/intersegmental fissure (OR=2); suprarenal retroperitoneal lymph nodes (OR=1.3); small bowel adhesions/thickening (OR=1.1); and moderate-severe ascites (OR=2.2). All ORs were significant with p<.01. A ‘predictive score’ was assigned to each criterion based on its multivariate OR, and the rate of having any RD for patients who had a total score of 0–2, 3–5, 6–8, and ≥9 was 45%, 68%, 87%, and 96%, respectively. Conclusions We identified 11 criteria associated with RD, and developed a predictive model in which the rate of having any RD was directly proportional to a predictive score. This model may be helpful in treatment planning.

Background Little is known about the arterial complications and hypercoagulability associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We sought to characterize our experience with arterial thromboembolic complications in patients with hospitalized for coronavirus disease 2019 (COVID-19). Methods All patients admitted from March 1 to April 20, 2020, and who underwent carotid, upper, lower and aortoiliac arterial duplex, computed tomography angiogram or magnetic resonance angiography for suspected arterial thrombosis were included. A retrospective case control study design was used to identify, characterize and evaluate potential risk factors for arterial thromboembolic disease in SARS-CoV-2 positive patients. Demographics, characteristics, and laboratory values were abstracted and analyzed. Results During the study period, 424 patients underwent 499 arterial duplex, computed tomography angiogram, or magnetic resonance angiography imaging studies with an overall 9.4% positive rate for arterial thromboembolism. Of the 40 patients with arterial thromboembolism, 25 (62.5%) were SARS-CoV-2 negative or admitted for unrelated reasons and 15 (37.5%) were SARS-CoV-2 positive. The odds ratio for arterial thrombosis in COVID-19 was 3.37 (95% confidence interval, 1.68-6.78; P = .001). Although not statistically significant, in patients with arterial thromboembolism, patients who were SARS-CoV-2 positive compared with those testing negative or not tested tended to be male (66.7% vs 40.0%; P = .191), have a less frequent history of former or active smoking (42.9% vs 68.0%; P = .233) and have a higher white blood cell count (14.5 vs 9.9; P = .208). Although the SARS-CoV-2 positive patients trended toward a higher the neutrophil-to-lymphocyte ratio (8.9 vs 4.1; P = .134), creatinine phosphokinase level (359.0 vs 144.5; P = .667), C-reactive protein level (24.2 vs 13.8; P = .627), lactate dehydrogenase level (576.5 vs 338.0; P = .313), and ferritin level (974.0 vs 412.0; P = .47), these differences did not reach statistical significance. Patients with arterial thromboembolic complications and SARS-CoV-2 positive when compared with SARS-CoV-2 negative or admitted for unrelated reasons were younger (64 vs 70 years; P = .027), had a significantly higher body mass index (32.6 vs 25.5; P = .012), a higher d -dimer at the time of imaging (17.3 vs 1.8; P = .038), a higher average in hospital d -dimer (8.5 vs 2.0; P = .038), a greater distribution of patients with clot in the aortoiliac location (5 vs 1; P ...

documentation appeared to be of variable quality using universal eConsents. Thus, capturing the full potential of the eConsent construct, with development of standardized, procedure-specific risks, is an important enhancement to consider. Ultimately, accurate documentation can decrease medicolegal risks for surgeons and institutions.At our institution, missing or incomplete consent is the most common reason for first case delay (17 minutes per delay; range, 1-75 minutes). Operating room delays affect patient experience and staff satisfaction and have significant financial consequences. This trial demonstrates the potential to eliminate this cause for delay and to improve overall OR efficiency.Health care systems have leveraged technology to facilitate safe automation, improve speed and accuracy, and enable robust monitoring and analysis of clinical processes. 6 The process of obtaining informed consent can benefit from the same transition. In 2017, Chhin et al 5 reported successful implementation of eConsents within a radiation medicine program. This study shows that eConsents can be implemented across a range of surgical specialties and clinical settings.Limitations to this study include a small sample size, minimal surgeon overlap between groups, and lack of objective data on the clinical effect of improved consent documentation. Challenges to implementing eConsent included software build, decreased flexibility in clinician workflow, and need for considerable clinician and staff education. However, there is enough evidence to support the use of eConsents across our institution. Further research is required to evaluate the effect on efficiency, patient and clinician experience/satisfaction, and medicolegal risk. In conclusion, compared with paper-based consent forms, eConsents were associated with decreased error rates and offer the potential to improve clinical efficiency.