IntroductionGeorge Floyd’s death in 2020 galvanised large protests around the country, including the emergence of the Capitol Hill Autonomous Zone (CHAZ) in Seattle, Washington, a non-policed, organised protest region that may have differing injury risks than other regions. We sought to quantitatively describe characteristics of injuries related to protests documented at visits to two nearby major emergency departments, including the only Level 1 trauma centre in the state.MethodsUsing the International Classification of Diseases, 10th Revision code inclusion criteria, we identified 1938 unique patient visits across the two emergency departments from 29 May 2020 and 1 July 2020. We reviewed provider notes to identify keywords to determine if the visit was related to the CHAZ protest. We quantitatively described demographics and injury characteristics.ResultsWe identified 48 injury visits related to the protest, with 25 from assault, 11 from crowd-control weapons and 8 from ground-level falls. Crowd-control weapons consisted of five visits from pepper spray, five from tear gas and a smaller number from flash-bang grenades, rubber bullets or other projectiles or a baton. In terms of body region injuries, 23 involved the head, 13 involved the knee and lower leg and 11 involved the thorax. Five patients required transfer to the operating room for surgery and admission and two died.DiscussionThe demonstrations during the CHAZ in Seattle in 2020 resulted in several violent injuries. Given the high proportion of assault and head injuries, these injury patterns can help prepare healthcare workers and first responders to plan care needs during protests.

Adverse childhood experiences (ACEs) have been shown to impact mental health. Risk associated with ACEs is commonly estimated based on counts from the conventional ACE types, but ACEs may not all carry the same health risk, either individually or in combination. Evidence is needed to understand the health impact of different ACE types and combinations of ACE types. We aimed to assess variation in risk of mental illness diagnosis and severe psychological distress in young adulthood based on differences in exposure to individual ACEs and combinations of ACEs, which can improve precision of ACE-based risk assessment. We used data from six waves of the Transition to Adulthood Supplement (2007–2017; n = 1832 young adults ages 18–28) of the Panel Study of Income Dynamics. We used logistic regression with cluster-robust variation estimation to test associations between each ACE, pairwise combinations of ACEs, and outcomes including new or existing mental illness diagnoses and severe psychological distress. Individual ACEs associated with greatest risk for new or existing mental illness diagnoses and severe psychological distress were parental mental illness and sexual abuse. Combinations of ACEs associated with greatest risk were parental mental illness-plus-sexual abuse and parental mental illness-plus-emotional neglect. ACEs associated with the lowest risk were parental substance use, physical abuse, and household violence. In this nationally representative longitudinal study of mental health outcomes in young adults, different individual and combinations of ACEs were associated with varying levels of mental health risk. This carries implications for risk assessment and ACE intervention prioritization.

Importance Understanding health conditions with the most spending and variation across locations and over time is important for identifying trends, highlighting inequalities, and developing strategies for lowering health spending. Objective To estimate US health care spending for each of 3110 US counties, across 4 payers (Medicare, Medicaid, private insurance, and out-of-pocket payments), and according to 148 health conditions, 38 age/sex groups, and 7 types of care from 2010 to 2019. Design, Setting, and Participants Observational analysis using more than 40 billion insurance claims and nearly 1 billion facility records. Exposures Ambulatory care, dental care, emergency department care, home health care, hospital inpatient care, nursing facility care, and purchase of prescribed retail pharmaceuticals. Main Outcomes and Measures Health care spending and utilization (eg, number of visits, admissions, or prescriptions) estimates from 2010 through 2019. Results Between 2010 and 2019, 76.6% of personal health care spending was captured by this study. More spending was on type 2 diabetes ($143.9 billion [95% CI, $140 billion-$147.2 billion]) than on any other health condition, followed by other musculoskeletal disorders, which includes joint pain and osteoporosis ($108.6 billion [95% CI, $106.4 billion-$110.3 billion]), oral disorders ($93 billion [95% CI, $92.7 billion-$93.3 billion]), and ischemic heart disease ($80.7 billion [95% CI, $79 billion-$82.4 billion]). Of total spending, 42.2% (95% CI, 42.2%-42.2%) was on ambulatory care, while 23.8% (95% CI, 23.8%-23.8%) was on hospital inpatient care and 13.7% (95% CI, 13.7%-13.7%) was on prescribed retail pharmaceuticals. At the county level, age-standardized spending per capita ranged from $3410 (95% CI, $3281-$3529) in Clark County, Idaho, to $13 332 (95% CI, $13 177-$13 489) in Nassau County, New York. Across counties, the greatest variation was in age-standardized out-of-pocket spending, followed by private insurance spending. Cross-county variation was driven more by variation in utilization rates than variation in price and intensity of care, although both types of variation were substantial for all payers but Medicare. Conclusions and Relevance Broad variation in health care spending was observed across US counties. Understanding this variation by health condition, sex, age, type of care, and payer is valuable for identifying outliers, highlighting inequalities, and assessing health care gaps.

Suicide is the leading cause of death for Asian American and Pacific Islander youths. 1 Asian American individuals are the fastest growing racial group in the United States, and Native Hawaiian and Pacific Islander individuals are the third fastest.Despite the critical importance of preventing suicide among this growing population, the study of mental health among Asian American and Pacific Islander populations has been historically understudied and underfunded nationally. 2 Elsewhere in JAMA Network Open, Keum et al 3 present a cross-sectional analysis examining trends in suicide rates among Asian American and Pacific Islander youths aged 10 to 19 years.Utilizing national mortality data from the National Center for Health Statistics, the authors calculate crude suicide rates across male and female groups and conduct a trend analysis to assess annual percent changes.The authors found that Asian American and Pacific Islander youth suicide rates have been increasing.In 2021, the Asian American and Pacific Islander male and female youth suicide rates were 6.49 and 3.72 per 100 000 individuals, respectively.The authors found large increases in suicide rates from 1999 to 2021, with a 72% increase in youth suicide rates for males and 125% increase for females during the 22-year period.They detected that Asian American and Pacific Islander male and female youths experienced growth in suicide rates, starting in 2009 and 2004 and peaking in 2019 and 2020, respectively.The findings of this study bring up several important points for discussion.

P-glycoprotein (Pgp) is a multidrug transporter that uses the energy from ATP binding and hydrolysis to export from cells a wide variety of hydrophobic compounds including anticancer drugs, and mediates the bioavailability and pharmacokinetics of many drugs. Lipids and cholesterol have been shown to modulate the substrate-stimulated ATPase activity of purified Pgp in detergent solution and the substrate transport activity after reconstitution into proteoliposomes. While lipid extracts from E. coli, liver or brain tissues generally support well Pgp’s functionality, their ill-defined composition and high UV absorbance make them less suitable for optical biophysical assays. On the other hand, studies with defined synthetic lipids, usually the bilayer-forming phosphatidylcholine with or without cholesterol, are often plagued by low ATPase activity and low binding affinity of Pgp for drugs. Drawing from the lipid composition of mammalian plasma membranes, we here investigate how different head groups modulate the verapamil-stimulated ATPase activity of purified Pgp in detergent-lipid micelles and compare them with components of E. coli lipids. Our general approach was to assay modulation of verapamil-stimulation of ATPase activity by artificial lipid mixtures starting with the bilayer-forming palmitoyloyl-phosphatidylcholine (POPC) and -phosphatidylethanolamine (POPE). We show that POPC/POPE supplemented with sphingomyelin (SM), cardiolipin, or phosphatidic acid enhanced the verapamil-stimulated activity (Vmax) and decreased the concentration required for half-maximal activity (EC50). Cholesterol (Chol) and more so its soluble hemisuccinate derivative cholesteryl hemisuccinate substantially decreased EC50, perhaps by supporting the functional integrity of the drug binding sites. High concentrations of CHS (>15%) resulted in a significantly increased basal activity which could be due to binding of CHS to the drug binding site as transport substrate or as activator, maybe acting cooperatively with verapamil. Lastly, Pgp reconstituted into liposomes or nanodiscs displayed higher basal activity and sustained high levels of verapamil stimulated activity. The findings establish a stable source of artificial lipid mixtures containing either SM and cholesterol or CHS that restore Pgp functionality with activities and affinities similar to those in the natural plasma membrane environment and will pave the way for future functional and biophysical studies.

This cross-sectional study examines suicide mortality rates among Asian American youths and young adults overall and by ethnic subgroup from 2018 to 2021.

You have accessJournal of UrologyCME1 Apr 2023PD18-10 A MARKOV MODEL FOR FERTILITY TREATMENT: SUBFERTILE COUPLES WITH A VARICOCELE SAVE TIME AND MONEY BY PURSUING MALE-FIRST EVALUATION PRIOR TO TREATMENT George Wayne, Albert Ha, Anthony Bui, and Joseph Alukal George WayneGeorge Wayne More articles by this author , Albert HaAlbert Ha More articles by this author , Anthony BuiAnthony Bui More articles by this author , and Joseph AlukalJoseph Alukal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003273.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical practice presents a variety of obstacles to prompt male evaluation in a subfertile couple. Varicocele repair improves sperm parameters in most patients and has been suggested to improve pregnancy rates in both natural conception and assisted reproductive technologies (ART). The course of an infertile couple’s work-up, however, is often non-linear and hard to predict. We constructed a discrete-time Markov model to simulate various evaluation and treatment strategies and thereby estimate success rates and costs for a couple with a clinically significant varicocele. METHODS: A discrete-time Markov chain was constructed to represent the various treatment and evaluation states for a couple with a clinically significant varicocele. Transition probabilities, treatment success rates, and discontinuation rates were estimated from the literature. Treatment strategies included Current Practice (CP), Male-First Evaluation (MF), IUI-First (IUI), and IVF-First (IVF). A sensitivity analysis predicted total cost and time-to-pregnancy for 50%, 75%, and 99% of couples at different treatment-cost levels and different expected success rates following varicocelectomy. RESULTS: At 1% increased pregnancy rate following varicocele diagnosis and treatment, 75% of couples pursuing CP treatment were pregnant at 20.1 months at a cost of $35,550, compared to those pursuing MF (21.2 months, $38,892), IUI (16.8 months, $41,324.51), or IVF (12.3 months, $49,537.29). At 5% improved success rate, there was an inflection – 75% of couples were pregnant via MF at 19.2 months at a cost of $33,976.81, compared to CP (19.9 months, $34,172.18), IUI (16.6 months, $39,757.48), or IVF (12.2 months, $48,589.41). CONCLUSIONS: For couples that harbor a clinically significant varicocele, strict adherence to MF treatment with even a modest benefit (5% increase in pregnancy rate), varicocele ligation leads to significant cost- and time-savings over CP. Moreover, transitioning directly to ART too soon achieves limited gains in time (2-5 months), at 40-80% increased costs when compared to MF. Adherence to an MF approach, in addition to these benefits, offers couples valuable opportunities to screen for other pathologies and ensure male health. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e506 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information George Wayne More articles by this author Albert Ha More articles by this author Anthony Bui More articles by this author Joseph Alukal More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND:Understanding pelvic anatomy is an important part of education during obstetrics and gynecology residency. Traditional teaching methods to learn pelvic anatomy have obstacles and are often costly.METHOD:We provide a self-constructed clay pelvic model to aid in the mastery of pelvic anatomy for obstetrics and gynecology residents and to estimate whether building a clay pelvic model would increase residents' confidence and knowledge in pelvic anatomy.EXPERIENCE:Each resident constructed a clay pelvic model on a bony pelvis, along with the traditional didactic on pelvic anatomy. Demographics of the participants were obtained, followed by a knowledge test and confidence level and satisfaction surveys. Descriptive analysis and Wilcoxon signed-rank test were used for data analysis. Nine residents (three postgraduate year [PGY]-1, one PGY-2, two PGY-3, three PGY-4) completed the knowledge and confidence questions before and after the simulation, along with the satisfaction survey. The median score from the 10 multiple-choice knowledge questions was 50% (30-70%) on the pretest and 70% (40-100%) on the posttest (P=not significant). Although most residents scored higher on the posttest, two residents scored 10% lower. Overall, 66.7% of residents improved their knowledge scores up to 30% after the simulation session. Self-assessed confidence level scores improved from 2-3 to 4 (1, lowest; 5, highest) for all questions asked (P=.010 to approximately .019). A majority of residents responded with 4 or 5 to the satisfaction statements.CONCLUSION:A low-budget clay pelvic model is easy to build and did increase residents' confidence in pelvic anatomy knowledge and satisfaction. Self-constructing a clay pelvic model would provide an excellent way of reviewing the major landmarks of pelvic anatomy.

Objectives Despite increasing use of robotic technology for minimally invasive hysterectomy with sacrocolpopexy, evidence supporting the benefits of these costly procedures remains inconclusive. This study aimed to compare differences in perioperative complications, 30-day readmissions, and costs between robot-assisted and conventional laparoscopic hysterectomy with concurrent sacrocolpopexy using a large national database. Methods Using the 2009-2015 Nationwide Readmissions Database and procedure codes, we identified patients who underwent a robot-assisted or conventional laparoscopic hysterectomy with sacrocolpopexy. We measured in-hospital perioperative complications using diagnosis and procedure codes and measured 30-day readmissions based on patient linkages across hospitalizations. Hospital costs were estimated using charges and cost-to-charge ratios. These outcomes were compared between robot-assisted and conventional laparoscopic procedures using bivariate and multivariable regression analysis. Results Our weighted sample included a total of 7,675 patients. Major perioperative complications occurred in 6.7% of robot-assisted and 11.2% of conventional laparoscopic procedures (unadjusted P < 0.001; adjusted odds ratio, 0.69; 95% confidence interval, 0.51-0.93; P = 0.02). Hospital costs were higher in robot-assisted than in conventional laparoscopic procedures (respective median costs, $16,367 vs $13,898; P < 0.001), with an adjusted cost ratio of 1.24 (95% confidence interval, 1.17-1.31; P < 0.001). The risk of 30-day readmission was similar between robot-assisted and conventional laparoscopic procedures. Conclusions Nationally representative data suggest that, in laparoscopic hysterectomy with sacrocolpopexy, the robot-assisted approach is associated with a lower risk of perioperative complications, despite higher costs, compared with the conventional one. The risk of 30-day readmission was similar between the robot-assisted and conventional laparoscopic approaches.

BACKGROUND: Understanding pelvic anatomy is an important part of education during obstetrics and gynecology residency. Traditional teaching methods to learn pelvic anatomy have obstacles and are often costly. METHOD: We provide a self-constructed clay pelvic model to aid in the mastery of pelvic anatomy for obstetrics and gynecology residents and to estimate whether building a clay pelvic model would increase residents' confidence and knowledge in pelvic anatomy. EXPERIENCE: Each resident constructed a clay pelvic model on a bony pelvis, along with the traditional didactic on pelvic anatomy. Demographics of the participants were obtained, followed by a knowledge test and confidence level and satisfaction surveys. Descriptive analysis and Wilcoxon signed-rank test were used for data analysis. Nine residents (three postgraduate year [PGY]-1, one PGY-2, two PGY-3, three PGY-4) completed the knowledge and confidence questions before and after the simulation, along with the satisfaction survey. The median score from the 10 multiple-choice knowledge questions was 50% (30–70%) on the pretest and 70% (40–100%) on the posttest (P=not significant). Although most residents scored higher on the posttest, two residents scored 10% lower. Overall, 66.7% of residents improved their knowledge scores up to 30% after the simulation session. Self-assessed confidence level scores improved from 2–3 to 4 (1, lowest; 5, highest) for all questions asked (P=.010 to approximately .019). A majority of residents responded with 4 or 5 to the satisfaction statements. CONCLUSION: A low-budget clay pelvic model is easy to build and did increase residents' confidence in pelvic anatomy knowledge and satisfaction. Self-constructing a clay pelvic model would provide an excellent way of reviewing the major landmarks of pelvic anatomy.

BACKGROUND:Uncontrolled bleeding is the leading preventable cause of death after injury. Stop the Bleed (STB) is a bleeding control training with proposed expansion into schools. However, the attitudes of guardians, specifically those with past trauma/injury, towards expanding STB into schools are unknown.METHODS:A cross-sectional survey evaluated guardian attitudes towards STB training in high schools, and compared responses between guardians based on the experience of prior trauma. Logistic regression models evaluated the association between prior trauma and guardian-reported acceptability of STB training.RESULTS:Of 750 guardians who received the survey, 484 (64.5%) responded. Most guardians (95.3%) wanted their child trained. Few (4.2%) felt this training would be harmful; 44.9% felt their child might be held responsible if something went wrong, and 28.4% reported it might be too scary for their child. In adjusted models, guardians with prior trauma were more likely to want their child trained (odds ratio [OR] = 3.50, 95% confidence interval [CI] 1.11-15.50), and identify STB as important to them (OR = 4.07, 95% CI 1.66-12.26).CONCLUSION:Our results support STB training in high schools, and guardians with a trauma history may be more likely to want their child trained. Further work to understand the perceived potential harm, and work to design trauma-informed first-response trainings is warranted.

Reduced availability of agricultural water has spurred increased interest in using recycled irrigation water for U.S. food crop production. However, there are significant knowledge gaps concerning the microbiological quality of these water sources. To address these gaps, we used 16S rRNA gene and metagenomic sequencing to characterize taxonomic and functional variations (e.g., antimicrobial resistance) in bacterial communities across diverse recycled and surface water irrigation sources. We collected 1 L water samples (n = 410) between 2016 and 2018 from the Mid-Atlantic (12 sites) and Southwest (10 sites) U.S. Samples were filtered, and DNA was extracted. The V3-V4 regions of the 16S rRNA gene were then PCR amplified and sequenced. Metagenomic sequencing was also performed to characterize antibiotic, metal, and biocide resistance genes. Bacterial alpha and beta diversities were significantly different (p < 0.001) across water types and seasons. Pathogenic bacteria, such as Salmonella enterica, Staphylococcus aureus, and Aeromonas hydrophilia were observed across sample types. The most common antibiotic resistance genes identified coded against macrolides/lincosamides/streptogramins, aminoglycosides, rifampin and elfamycins, and their read counts fluctuated across seasons. We also observed multi-metal and multi-biocide resistance across all water types. To our knowledge, this is the most comprehensive longitudinal study to date of U.S. recycled water and surface water used for irrigation. Our findings improve understanding of the potential differences in the risk of exposure to bacterial pathogens and antibiotic resistance genes originating from diverse irrigation water sources across seasons and U.S. regions.

Introduction: Atypical infections are often considered as a potential etiology for men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). We aimed to describe the prevalence of atypical infections in this patient population to inform clinical management for male patients complaining of pelvic pain. Methods: We retrospectively reviewed patients at a single center from January 2016 to January 2019. We included patients with CP/CPPS Type III diagnosed with pelvic or genital pain in the absence of bacterial infection. All patients underwent an atypical infection panel. The primary outcome measure was the presence of any atypical infection. Results: In total, 345 patients met the inclusion criteria. Of those, 9/345 (2.6%) had an atypical infection (5 mycoplasma and 4 ureaplasma). The mean age of patients with positive atypical infections was 34 compared to the overall study population (44 years, P=0.01). Two patients with atypical infections were also followed for infertility. Urinalysis was available for 6 of the 9 patients with positive atypical infection: 50% (3 out of 6) were normal and 50% (3 out of 6) had >5 WBC/hpf. Symptoms resolved in 66% (2 out of 3) of the patients with positive atypical infection with available follow-up data. Conclusion: Atypical infectious agents were uncommon causes of CP/CPPS. Screening for atypical microbes such as chlamydia, ureaplasma, or mycoplasma may not be necessary for male patients complaining of pelvic or genital pain.

Introduction: Although physicians from a variety of specialties encounter infants with possible craniosynostosis, judicious use of computed tomography (CT) imaging is important to avoid unnecessary radiation exposure and healthcare expense. The present study seeks to determine whether differences in specialty of ordering physician affects frequency of resulting diagnostic confirmations requiring operative intervention. Methods: Radiology databases from 2 institutions were queried for CT reports or indications that included "craniosynostosis" or "plagiocephaly." Patient demographics, specialty of ordering physician, confirmed diagnosis, and operative interventions were recorded. Cost analysis was performed using the fixed unit cost for a head CT to calculate the expense before 1 study led to operative intervention. Results: Three hundred eighty-two patients were included. 184 (48.2%) CT scans were ordered by craniofacial surgeons, 71 (18.6%) were ordered by neurosurgeons, and 127 (33.3%) were ordered by pediatricians. One hundred four (27.2%) patients received a diagnosis of craniosynostosis requiring operative intervention. Craniofacial surgeons and neurosurgeons were more likely than pediatricians to order CT scans that resulted in a diagnosis of craniosynostosis requiring operative intervention (P < 0.001), with no difference between craniofacial surgeons and neurosurgeons (P = 1.0). The estimated cost of obtaining an impact CT scan when ordered by neurosurgeons or craniofacial surgeons as compared to pediatricians was $2369.69 versus $13,493.75. Conclusions: Clinicians who more frequently encounter craniosynostosis (craniofacial and neurosurgeons) had a higher likelihood of ordering CT images that resulted in a diagnosis of craniosynostosis requiring operative intervention. This study should prompt multi-disciplinary interventions aimed at improving evaluation of pretest probability before CT imaging.

Earp, Lewis, and Hart (2021) write about the racism entrenched in policies criminalizing drug use and possession and describe the disparate impact that these policies have on certain racialized com...

OBJECTIVE:This study aimed to determine the prevalence of unanticipated uterine cancer and cervical cancer in women undergoing hysterectomy for uterovaginal prolapse.METHODS:Using data from the 2015-2018 American College of Surgeons National Surgical Quality Improvement Program, we identified adult women who underwent a hysterectomy with a concurrent procedure for uterovaginal prolapse. Patients who underwent a radical hysterectomy or had other procedures or diagnoses suggestive of preoperatively suspected or known gynecologic cancer were excluded. Our outcome measures were pathology-confirmed diagnoses of uterine cancer and cervical cancer. Bivariate statistical tests and multivariable logistic regression were used to identify patient characteristics associated with the likelihood of having unanticipated uterine cancer.RESULTS:Among 9,687 patients meeting the sample eligibility criteria (median age, 60 years), 51 (0.53%; 95% confidence interval, 0.39%-0.69%) had a diagnosis of uterine cancer. Forty-three (84.3%) were stage I-IB. Multivariable logistic regression showed that older age (adjusted odds ratio, 2.75; 95% confidence interval, 1.47-5.51, for age >60 vs 41-60 years) and uterine weight greater than 250 g (adjusted odds ratio, 4.34; 95% confidence interval, 1.48-10.79) were associated with a significantly higher likelihood of having unexpected uterine malignancy. In addition, in a subsample of 7,908 patients who underwent a total hysterectomy, 7 (0.09%; 95% confidence interval, 0.04%-0.18%) had a diagnosis of cervical cancer.CONCLUSIONS:The risk of unexpected uterine cancer and cervical cancer in women undergoing hysterectomy for uterovaginal prolapse was relatively low but should be appropriately considered when counseling patients desiring uterine- or cervix-sparing procedures.

Feelings of Safety From School Security PracticesSchool security has increased over the years with an aim to improve student safety, 1,2 but students may experience greater criminalization. 3Of the more than 290 600 students referred to the police in 2015-2016, Black students represented more than twice their proportion of enrollment. 3eneral pediatricians monitor social determinants of health for youths, which should include school safety.Parents and guardians are important stakeholders in school safety. 4We surveyed parents and guardians of students to assess their feelings of safety across various school security practices and examined differences of perceived safety associated with child race/ethnicity.

Supplemental digital content is available in the text. Objective To investigate incidence and risk factors for postoperative complications after rectovaginal fistula (RVF) repairs, based on different surgical routes. Methods This retrospective cohort study utilized CPT codes to identify RVF repairs performed during 2005 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program database. Demographic/clinical characteristics were compared among different surgical routes. Logistic regression was performed to identify associations. Results Among 1398 RVF cases, 1391 were included for final analysis: 159 (11.4%) were performed transabdominally (group 1), 253 (18.2%) transperineally (group 2), and 979 (70.4%) transvaginally/transanally (group 3). Group 1 was older compared with groups 2 and 3 (58.72 ± 15.23 years vs 44.11 ± 13.51 years vs 46.23 ± 14.31 years, P < 0.0001). Race/ethnicity was comparable in all groups with non–Hispanic-White most common. Comparably, group 1 had higher preoperative comorbidities: hypertension requiring medication (P < 0.0001), chronic obstructive pulmonary disease (COPD) (P = 0.0347), preoperative infection (P = 0.002), functional dependence (P = 0.0001), and longer time between hospital admission to operation (P < 0.0001). Group 1 also had longer operating time (P < 0.0001); more American Society of Anesthesiologist ≥ 3 classification (P < 0.0001); and more likely inpatient status (P < 0.0001). The overall incidence of any postoperative complications was 13.2% (25.2%, group 1 vs 15.8%, group 2 vs 10.6%, group 3; P < 0.0001). The most common postoperative complications included unplanned readmission, postoperative superficial surgical site infection, and reoperation. The incidence of severe postoperative complications was 7.9% (17%, group 1 vs 7.1%, group 2 vs 6.6%, group 3, P < 0.0001): group 1 had highest rates of pulmonary embolism (P = 0.0004), deep venous thrombosis (P = 0.0453), bleeding requiring transfusion (P < 0.0001), stroke (P = 0.0207), unplanned reintubation (P = 0.0052), and death (P = 0.0004). Group 1 also had highest rates of minor postoperative complications like urinary tract infection (P = 0.0151), superficial surgical site infection (P = 0.0189), and pneumonia (P = 0.0103). In addition, group 1 had the greatest postoperative length of stay (P < 0.0001). In multivariate analysis, age (P = 0.0096), inpatient status at the time of surgery (P = 0.0004), and operating time >2 to 3 hours (P = 0.0023) were significant predictors of postoperative complications within 30 days after surgery. Conclusions The overall incidence of complications after RVF repairs+/−concomitant procedures was 13.2%. The overall incidence of severe complications was 7.9%. The abdominal approach had more postoperative complications but it was not an independent predictor of postoperative complications after RVF repair.