Sex differences in the experience of pain have been widely observed across an array of acute and chronic pain conditions. We examined differences between men and women undergoing surgical management of knee osteoarthritis (OA), one of the most common and disabling persistent pain conditions in the developed world. In the United States, rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA, have been growing steadily. While TKA outcomes are generally good, post-operative trajectories of pain vary widely, and the sources of this variability are not entirely clear. Previous TKA studies have reported that measures of negative affect (anxiety, depression) are associated with both acute and chronic pain, and these cognitive/emotional factors are often more prominent in women than men. The goal of the present study was to investigate the contribution of sex and psychosocial factors to pain-related outcomes among patients undergoing unilateral TKA. In this prospective study, 100 patients (50 men and 50 women) completed measures of pain, physical function, and negative affect (i.e., depression, anxiety) at baseline and up to 6 months after surgery. Although women reported more pre-operative pain-related physical dysfunction and higher anxiety and depression, as well as higher acute post-operative pain scores during the 2 weeks following TKA than men, there was an association of higher pre-operative levels of negative affect with post-TKA pain only among men (B = .45, p < .001), and not among women (B = -.07, ns). Men with higher pre-operative levels of negative affect reported more severe pain after TKA than men with lower negative affect. Findings from this study underline the impact of sex and negative affect, as well as their interaction, on postsurgical pain trajectories.

SESSION TITLE: Quality Improvement 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Widespread use of ‘routine’ imaging studies in the hospital setting is concerning. It is a common practice to obtain a routine chest X Ray with each admission, many times without a valid indication. Many such studies require follow up or further clarification, which lead to subjecting the patient to more imaging studies and invasive tests of varying modality. In this retroscpective chart review, we aim to assess the estimated number of chest X-Ray (CXR), Computed Tomographic Scan of chest (CT) performed and resulting ionizing radiation exposure among a random group of patients admitted with respiratory symptoms in our institution. Although the focus of this study was chest imaging and hence patient cohort with respiratory symptoms were selected, we anticipate the trend would be similar in case of head, abdominal or extremity imaging studies among the patients admitted respectively with head, abdominal and extremity symptoms. METHODS: One hundred seventeen hospitalized patients were seen by the teaching Pulmonary Consult service during the months of August and September 2016 and were selected to be the random cohort. Electronic medical records were reviewed and length of hospital stay (LOS), number of total CXR and CT in each patient was recorded. The dose of ionizing radiation was also determined based on hospital radiology department disclosure of radiation per imaging study protocol. RESULTS: One hundred seventeen inpatients underwent a total of 649 chest imaging studies (CXR 85%, CT chest 15%). Average LOS per hospitalization is 10.5 days (Range: 2- 39 days). Average chest imaging per hospital day was 0.44 for CXR and 0.12 for CT chest. The average ionizing radiation exposure per hospital day is 0.044mSv and 0.96mSv respectively for CXR and CT( Measured per study according to Institutional radiation usage protocol). Average rate of CXR/day were 0.02, 0.15 and 0.26 in patients with LOS <3d, <7d and >7d respectively. Similarly, average number of CT/day was 0.01, 0.06, and 0.05 respectively. Patients with LOS > 7d had an average daily radiation dose of 0.026mSV and 0.4mSv from CXR and CT respectively. CONCLUSIONS: Our data clearly shows that in our current hospital practice model, patients admitted with respiratory symptoms get a significantly high number of chest imaging studies and the number of imaging studies increases dramatically with length of stay >3 days. Cumulative radiation dose is significantly higher in patients with LOS >7 d and as expected significantly increased radiation incur from Chest CT. CLINICAL IMPLICATIONS: This data should raise awareness among physicians about excessive use of chest imaging studies in hospitalized patients. This data adds a new dimension to the problems associated with increased hospital LOS i.e. with increasing LOS, number of imaging studies/day increases dramatically which leads to more radiation exposure and potentially increasing number of follow up testing, thus creating a domino effect. Our ongoing studies are trying to assess clinical implication of each imaging study in terms of change in management. DISCLOSURE: The following authors have nothing to disclose: Eman Albaddawi, Zahia Esber, John Wright, Ahmed Khan No Product/Research Disclosure Information

Catastrophizing has consistently been found to be associated with negative pain outcomes, and one of the postulated mechanisms involves maladaptive interactions with the social environment. To explore the role of spousal support in the association between catastrophizing and daily pain intensity among patients with knee osteoarthritis (KOA). On the basis of the communal coping model of pain, we hypothesized that the association between catastrophizing and daily pain intensity would vary as a function of spousal support. We recruited 124 patients with KOA who were scheduled to undergo total joint replacement surgery. Patients were first asked to provide demographic information and to complete the Pain Catastrophizing Scale. Patients then provided reports of pain intensity and spousal support once a day for a period of 7 days using a personal digital assistant (PDA). Results of multilevel models (MLM) indicated that catastrophizing was associated with heightened daily levels of pain, B = .63, p < .001. A two-way (catastrophizing * spousal support) interaction was then modeled to examine whether spousal support moderated the association between catastrophizing and daily pain intensity. Results of this multilevel moderation analysis was significant (p < .05), and revealed that the association between catastrophizing and daily pain intensity was stronger among patients reporting low spousal support (B = .56) than among patients reporting high spousal support (B = .45). Our findings are consistent with the communal coping model (CCM) and suggest that high catastrophizers might report elevated levels of pain in order to compensate for the low spousal support being received and to seek support from others in the social environment. Additional research is needed to examine the specific mechanisms underpinning these effects, and to determine whether psychosocial interventions may modulate the maladaptive interactions between catastrophizing and the social environment.

Osteoarthritis is one of the leading causes of pain and disability across the world. While Total Knee Arthroplasty (TKA) has been shown to result in significant improvements in both functioning and pain, a substantial subset of patients continue to experience pain and disability. One potentially important factor in predicting the trajectory of pain and function following TKA is sex; however, although arthritis pain is more frequent and disabling in women than in men, few studies have evaluated sex differences in outcomes following joint replacement. From our ongoing multi-site study, we selected a sample of 100 patients (50 men and 50 women, matched on other demographic characteristics), to compare pain and physical functioning outcomes for 6 months after TKA. The Brief Pain Inventory (BPI) was used to assess patients’ pain pre-operatively, in the acute post-operative period, and at various other post-operative time points (6 weeks, 3 months, 6 months). While men and women had similar BPI pain scores pre-operatively, women had significantly higher BPI pain scores at surgery and two weeks after surgery (p < .01). Men and women’s pain scores were not significantly different at any other post-operative time point. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) was used to assess patients’ knee pain, stiffness, and physical functioning at these time points as well. While WOMAC pain scores between men and women were not significantly different, women did exhibit higher stiffness and physical functioning scores pre-operatively (p < .05). WOMAC subscale scores did not significantly differ at any of the post-operative time points. Overall, our findings suggest that while men and women may have similar long-term outcomes following TKA, they may differ in pre-operative characteristics and acute pain outcomes, which may have clinical implications for the care and treatment provided to women before, during, and shortly after surgery.

We report here a 16-year-old Caucasian male with an 8 years history of acute lymphoblastic leukemia who died of an acute invasive systemic aspergillosis 163 days after allergenic bone marrow transplantation. One week prior to death, he had drowsiness, lethargy, and fever. Both CT scan and MRI of the head demonstrated multiple ring enhancing lesions consistent with intracerebral abscesses. Autopsy showed extensive brain involvement of aspergillosis in the frontal cortex, occipital cortex, hippocampus, basal ganglia, medulla, ponds, and cerebellum. Aspergillosis also presented in multiple organs including heart, lungs, liver, kidney, thyroid gland, and lymph nodes.