survey. Results: Of 28 hospitals, 20 hospitals from across Californiacompleted the survey including 16 community, 3 university, and 1rural hospital. They ranged in size - 25% had �100 beds, 35% had101-300 beds, 30% had 301-500 beds and 10% had �500 beds. Sixtypercent of respondents stated they were most easily able to imple-ment mechanical prophylaxis guidelines. Orthopedic surgeons weremost accepting of DVT prophylaxis guidelines, as were those serviceswith standard ordersets. Respondents identified 4 major areas ofdifficulty for implementation of standing order guidelines - 40%experienced resistance to the use of pharmacologic prophylaxis byindividual surgeons (bleeding) and/or anesthesiologists (epidurals),20% experienced difficulty with accurate pre-operative risk assess-ment, 20% had problems with inadequate documentation of prophy-laxis, and 20% cited lack of comprehensive guidelines from a re-spected surgical organization. Solutions proposed by the hospitalcollaborators to deal with these difficulties included physician edu-cation, nurse or pharmacy ownership of DVT risk assessment, com-puterized order entry systems, and simple standardized ordersets.Collaborators cited a proactive surgeon-leader as the most effectivefactor in successful implementation of their DVT prophylaxis proto-col. Conclusion: The SCIP collaborative is supported by CMS andas such its measures may become a part of pay for performance insurgery. While the DVT prophylaxis measure is important, hospitalshave been performing poorly on this measure. Hospitals need toexplore their own DVT prophylaxis rates and practices in order tomake improvements. These findings should be used to assist hospi-tals in successfully effecting change and improving patient care withrespect to DVT prophylaxis.

P16. THE SF 36 AND QWB ARE NOT CORRELATED INTRAUMA PATIENTS. K. Brasel, J. Kiely, H. Yang, C. Guse,J. A. Weigelt; Medical College of Wisconsin, Milwaukee, WI

Background: More emphasis is being placed on measuring out-come of our interventions. One outcome of increasing importance isquality of life. After injury, health-related quality of life (QOL) ismeasured with many instruments. Although many factors associatedwith QOL are known, the correlation between the two most com-monly used instruments is unknown. Hypothesis: We hypothesizedthat two commonly used instruments would be poorly correlated in atrauma population. Methods: A prospective study of adults �18years of age with moderate to severe blunt injury measured by theInjury Severity Score was conducted. Patients with significant neu-rologic injury were excluded. Quality of life was evaluated using theQuality of Well Being Scale (QWB) and Short Form 36 (SF-36)questionnaires 1, 6, and 18-24 months post-injury. QWB scores werecorrelated with several scores derived from the SF-36; individualdomain scores, physical (PCS) and mental (MCS) summary scores,and the single summary score SF-6D. Data were analyzed by Spear-man rank correlation. Results: There were 196 respondents at1-month, 123 at 6-months, and 113 respondents 18-24 months afterinjury. Correlation between the QWB and any component of theSF-36 was poor to moderate (0.19-0.63). SF-36 physical item scoreswere better correlated with QWB scores than mental item scores atall time points, with the highest correlation between QWB scoresand the physical function domain. The highest initial correlation,0.54, was with the domain physical function, while the highest long-term correlation, 0.63, was with the vitality domain. Correlation ofthe SF-36 MCS and its domains improved over time, while correla-tion of the SF-6D and SF-36 PCS did not change significantly overtime. Correlation between all domains of the SF-36 PCS exceptphysical function improved over time. Conclusions: The two mostcommon instruments used to measure QOL in the trauma popula-tion are not highly correlated. Correlations between domains andover time differ significantly. This suggests that conclusions drawnabout QOL using these instruments may differ. To further our un-derstanding of QOL after trauma, efforts should be made to stan-dardize QOL measurement.

SF survey item QWB (1 month) QWB (6 month) QWB (long-term)

SF-36 MCS 0.21 0.32 0.454 MCS domains 0.19-0.33 0.36-0.44 0.41-0.63SF-36 PCS 0.48 0.50 0.544 PCS domains 0.32-0.54 0.38-0.52 0.52-0.54Summary SF-6D 0.52 0.53 0.53

P17. SHOCK WAVE THERAPY FOR ACUTE AND CHRONICSOFT TISSUE WOUNDS: A PHASE II TRIAL. W.Schaden1, R. Thiele2, C. Kolpl1, M. Pusch1, A. Nissan3, C. E.Attinger4, M. E. Maniscalco-Theberge5, G. E. Peoples5, E. A. El-ster6, A. Stojadinovic5; 1Auva-Trauma Center Meidling, Vienna,Austria, 2Zentrum Fur Extracorporale Stosswellentherapie, Ber-lin, Germany, 3Hadassah University Hospital Mount Scopus,Jerusalem, Israel, 4Georgetown University Hospital, Washing-ton, Dc, 5Walter Reed Army Medical Center, Washington, DC,6National Naval Medical Center, Bethesda, MD

Introduction: Non-healing wounds are a major, functionally-limiting medical problem impairing quality of life for millions ofpeople each year. Extracorporeal shock wave therapy (ESWT) mayaccelerate and improve wound repair. This study assesses the effi-cacy and safety of ESWT for acute and chronic soft-tissue wounds.Methods: One hundred seventy-nine patients with soft-tissuewounds were prospectively enrolled onto this trial between August2004 and March 2006. Treatment consisted of debridement, outpa-tient ESWT [100-1000 shocks/cm2 at 0.1 mJ/mm2, according towound size, every 1-2 weeks over mean 3 treatments], and moistdressings. Results: Twenty four (13.4%) patients dropped out of thestudy following first ESWT and were analyzed as incomplete heal-ing. Of 155 patients completing the study, 135 (87%) had 100%wound epithelialization. Treated wound type, percent complete heal-ing and mean healing time were: disturbed surgical wound healing(n�65; 88%; 37 � 3 d), trauma (n�58; 93%; 48 � 9 d), venous (n�25;56%; 64 � 11 d) or arterial (n�6; 100%; 54 � 25 d) insufficiency,pressure (n�13; 82%; 57 � 15 d) or plaster cast (n�7; 100%; 39 �14 d) necrosis, or burn (n�5; 100%; 21 � 9 d). During mean follow-upperiod of 45 days, there was no treatment-related toxicity, infectionor deterioration of any ESWT-treated wound. Intent-to-treat multi-variate analysis identified wound size �10 cm2 (p�0.01;OR�0.32;95%CI, 0.13-0.79) and duration �1 month (p�0.001;OR�0.11;95%CI, 0.03-0.39) as independent predictors of complete treatmentresponse. Conclusions: The ESWT strategy is feasible and welltolerated by patients with acute and chronic soft tissue wounds.Shock wave therapy is being evaluated in Phase III trials for acutecombat wounds and diabetic foot ulcers.

CLINICAL TRIALS/OUTCOMES IV:SURGICAL PREDICTORS

P18. ESTABLISHING BENCHMARKS FOR INPATIENT PAR-ATHYROIDECTOMY, A STATEWIDE ANALYSIS OF5,702 PROCEDURES. K. Haines1, M. Wahi2, J. Enriquez1, M.Murr1, P. J. Fabri1, S. Gallagher1; 1University of South Florida,Department of Surgery, Tampa, FL, 2Johnnie B. Byrd, Sr.Alzheimer’s Center and Research Institute, Tampa, FL

Introduction: Large multi-center, inpatient-parathyroidectomyoutcomes studies have not been reported. As parathyroidectomy isincreasingly done as an outpatient procedure by experienced sur-geons, patient safety is of paramount importance. Since individualoutcomes monitoring improves patient care and outcomes, it is im-portant to establish benchmarks in endocrine surgery. Surgeonsmust be aware of these issues to educate patients about potentialcomplications and to risk stratify patients accordingly. The aim of

246 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS

this study was to report contemporary outcomes of parathyroid sur-gery in Florida in order to establish benchmarks for parathyroidec-tomy. Methods: The prospectively-collected, mandatory-reported,Florida-wide, hospital-discharge, administrative database was que-ried for procedures (0681, total parathyroidectomy; 0689, other par-athyroidectomy; 0695, parathyroid reimplant; and 0699, other para-thyroid ops) from 1997-2004; data were sorted for parathyroid-related disease and were reviewed for age, gender, pre-procedurelength of stay (PPLOS), total LOS, total physicians, hospital, mor-tality, and complications. Data are percentage and mean�SEM. Todetermine access to care, associations between county populationand number of procedures on patients living in the county in 2004were analyzed. Results: All inpatient parathyroidectomy procedures(n�5,702; 71% female, 29% male) from 1997-2004 were reviewed.Mean age was different for uncomplicated vs. complicated cases(65�0.2 vs. 57�1 years, P�0.01). Overall annual complications(6.77%) were stable; 131 (8.6%) male patients and 247 (6.8%) femalepatients suffered inpatient complications including: hematoma(1.0%), hypoparathyroidism/ hypercalcemia (0.84%), vocal cord pa-ralysis (0.14%), recognized/documented nerve injury (0.07%), cere-bral vascular accident (0.05%), and MI (0.16%). In-hospital mortalitywas 0.26% (range 0%-0.64%, 1997-2004). Mean PPLOS was 1 day;mean LOS (3�0.08 days) did not change (P�0.05) during the studyperiod. Significant associations were found between frequency ofsurgeries in 2004 by county of residence and 2004 county population(R�0.92). Conclusions: Parathyroid surgery is associated with fa-vorable perioperative outcomes over the last eight years. These datadocument the safety of the largest number of inpatient parathyroid-ectomies ever reported, and it establishes a benchmark for parathy-roid surgery outcomes. With the large cohort of patients, we find noreason to believe that the outcomes of this number of uncomplicatedcases are any different than the average surgeon’s outpatient para-thyroidectomy practice across the country, and this warrants furtherinvestigation.

P19. WITHDRAWN

P20. OUTCOMES FOR SOFT TISSUE SARCOMA IN 8249CASES FROM A LARGE STATE CANCER REGISTRY. J.C. Gutierrez, E. A. Perez, D. Franceschi, F. L. Moffat, A. S.Livingstone, L. G. Koniaris; University of Miami Miller Schoolof Medicine, Miami, FL

Introduction: To date, outcome reports for soft tissue sarcoma(STS) have largely been limited to single or paired institutionalseries. To more accurately elucidate population-based outcomes andprognostic factors associated with STS, a large cancer registry wasexamined. Methods: STS arising in the Florida Cancer Data Systemwere examined (1981 - 2004). Results: A total of 8249 patients wereidentified, the calculated annual incidence of sarcoma being approx-imately 38 cases per million in 2003. The tumor histologies amongthese patients were leiomyosarcoma and GIST (LMS/GIST) (43.5%),malignant fibrous histiocytoma (MFH) (31.5%), liposarcoma (19.0%)and fibrosarcoma (6.0%). Tumors were situated in the extremities(30.7%), truncal or visceral locations (50.4%), retroperitoneum(11.7%), and head or neck (7.2%). Thirty-three percent of lesionswere over 10 cm in greatest dimension, while 50.2% were classifiedas high grade. Metastatic disease was present in 16.3% of patients atthe time of diagnosis. Median overall survival for the cohort was 25months. Superior survival was observed for liposarcomas and fibro-sarcomas as compared to MFH and LMS/GIST (p � 0.001). Retro-peritoneal and truncal sarcomas had a more ominous prognosis thandid other sites (p � 0.001). Multivariate analysis of pre-treatmentvariables demonstrated that increasing age, male gender, non-Caucasian race, advanced stage and a truncal or retroperitoneallocation were each independently associated with lower survival.Histological subtype was also an independent predictor of outcome.

Surgical resection and radiation therapy were the only treatmentvariables shown to improve survival. Conclusions: Histological sub-type, tumor site and stage are independent prognostic factors in STS.Surgical resection and radiotherapy are unique among treatmentmodalities in association with a significant survival benefit.

P21. KNOWLEDGE AND AWARENESS OF PERIPHERALVASCULAR DISEASE IS DECREASED AMONG WOMENWHO HAVE MULTIPLE CARDIOVASCULAR RISK FAC-TORS. R. L. Bush, M. A. Kallen, D. R. Liles, L. A. Petersen;Baylor College of Medicine, Houston, TX

Introduction: Peripheral vascular disease (PVD), a manifesta-tion of systemic atherosclerosis, is an independent risk factor forcardiovascular (CV) morbidity and mortality. PVD research has tra-ditionally focused on male patients, thus current studies focusingspecifically on women are lacking. We screened women aged 40 to 85for PVD and its associated risk factors, and measured their knowl-edge and awareness of both PVD and CV disease. Methods: Partic-ipants (N�162, mean age 54.8�9.3 years) were evaluated via chartreview and non-invasive screening procedures (ankle-brachial index,ABI; carotid artery intimal-medial thickness, IMT). PVD was definedby: ABI �0.9, carotid IMT �1 mm, documented PVD, or previousperipheral revascularization. CV risk levels were determined using amodification of the Framingham score. Women’s knowledge andawareness was assessed with a psychometrically sound survey (pointbiserial correlation, r�0.43) about risk factors, symptoms, andhealth consequences associated with PVD. Results: Of 162 patients,66.2% were white and 84.2% had at least some college education. AnABI of �0.9 was detected in 3.7% and carotid IMT of �1.0 mm in21.1% while 1.0 % had a prior diagnosis of PVD and 1.9% hadprevious revascularization. CV risk factor stratification was as fol-lows: low risk (0-1 risk factor) in 32.1%, moderate risk (2 risk factors)in 20.4%, and high risk (�2 risk factors) in 47.5%. Knowledge andawareness scores (% correct) for PVD were low regardless of CV riskfactor group: low 45.7, moderate 42.1, and high 46.9. Likewise, lowscores for knowledge of CV risk factors and consequences were foundin all CV risk factor groups: low 53.6, moderate 53.8, and high 54.4.Although more than 44% of the women reported they believed theywere at an increased risk for PVD, more than 68% reported that theyhad not discussed PVD or risk reduction with their physician. Con-clusions: Women in this study had multiple atherosclerotic riskfactors, yet their awareness and knowledge about PVD was disturb-ingly low. Carotid IMT may be a good screening test for subacute CVdisease to allow for early risk factor modification before the onset ofsymptoms. Future work is needed to develop and disseminate infor-mation about PVD in women.

P22. THE EFFECT OF RACE AND INSURANCE STATUS ONPATIENT PRESENTATION AND OUTCOMES AFTERSURGERY FOR DIVERTICULAR DISEASE. A. O. Lidor,S. Gearhart, A. W. Wu, D. C. Chang; Johns Hopkins School ofMedicine, Baltimore, MD

Introduction: Diverticulitis is responsible for many hospital ad-missions and high associated health care costs in the United States.Racial disparities and poor insurance status have been reported tonegatively impact on outcomes after medical care. The objective ofthis study is to determine the effects of race and insurance status onlikelihood of presenting with complicated diverticulitis and outcomeafter surgery. Methods: Retrospective analysis of a multi-institutional, multi-state hospital discharge database (the NationalInpatient Sample, NIS) from 1999 to 2003. Inclusion criteria were:admitted primarily for diverticulitis and received surgical treatment.The three outcome variables were 1) complicated status at presen-tation (obstruction, fistula, perforation), 2) surgery type (colostomyvs primary anastomosis), and 3) in-hospital mortality. Multivariateanalyses were performed with race and insurance status as primary

247ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS