To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Introduction: Anti-thyroid Drugs (ATD) have become the most frequently used treatment for Graves’ disease (GD) in the United States. However, the response to this therapy is variable. Factors that predict biochemically responsive vs. biochemically persistent disease remain unknown. Identifying predictors of disease poorly responsive to ATD can help guide treatment decision making, follow up planning and prognosis. Methods: From a database of patients with GD treated with ATD and receiving care at an academic medical center between 2009–2019, we selected adults with incident GD treated with ≥14 days of ATD. Results: 172 patients (from a database of 730 patients with GD on ATD) were sampled for the purpose of this pilot and 97 of these met inclusion criteria. Patients had a median age of 50 (18–90); female, 70.1%; never smokers, 64.9%; median goiter size of 40 g (15–100); and median TRAb on presentation of 8.1 mIU/L (1.0- 60). Graves’ orbitopathy (GO) was present in 13.4% at baseline. Patients (100%) were started on methimazole at a median dose of 20 mg (2.5–60). The median time from presentation until biochemical improvement (defined as the first instance of FT4 ≤1.7 ng/dL) was 120.9 days (18–1525), and to biochemical euthyroidism (normal TSH & FT4) was 251 days (41–1259) including a median of 3 (0–17) dose adjustments. In a univariate analysis, response to ATD was divided into two groups; biochemically responsive and biochemically persistent disease (based on reaching biochemical improvement in ≤6 months, or >6 months respectively). Biochemically persistent disease was more common in those with GO at presentation (38.5% vs.11.1%) (p .024). There was a trend towards greater prevalence of biochemically persistent disease in those with TRAb ≥ 8.0 mIU/L (46.2% vs. 27.8%) (p .204), and goiter estimated 30 grams or above by physical examination (30.8% vs. 19.4%) (p .460). Biochemically responsive disease was associated with higher frequency of hypothyroidism during treatment (p .047). Conclusion: Our preliminary results illustrate the spectrum of response to ATD and predictors of biochemically persistent disease. We aim to expand this analysis utilizing a large database. As use of ATD increases, clinicians and patients can apply this data to estimate response to therapy, and identify patients that may require more aggressive therapy, thereby tailoring management plans.

Fifty-three SPK patients were studied with a mean age of 42.7 years and a mean BMI of 25.6 kg/m 2 . Vascular calcifications were found in 74% of patients. Calcifications were most commonly present in the abdominal aorta (57% of patients). On logistic regression, only the abdominal aorta Agatston score was found to be associated with major complications (p-value¼.037). There was no association between the vascular Agatston scores and graft loss or mortality.CONCLUSION: Vascular calcifications are commonly found in patients undergoing SPK transplantation and may contribute to increased morbidity from major complications. This is likely a result of global atherosclerotic disease burden and not just at the site of the arterial anastomosis.

Introduction: Optimal initial antithyroid drugs (ATD) dosing may achieve rapid improvement in thyroid hormone levels while minimizing risk of adverse events. As ATD have become the most common first line therapy for the treatment of Graves’ disease (GD), we examined trends over time in initial ATD dosing, and the association between guideline-based ATD dosing with time to normalization of FT4 and frequency of adverse events. Methods: This is a single cohort retrospective study in Mayo Clinic, Rochester, MN. We identified adults (≥18 years old) diagnosed with new onset GD between January 1, 2002-December 31, 2019 treated with at least 14 days of ATD and with available initial follow up data within 3 months prior to a dose change. Propylthiouracil (PTU) doses were converted to Methimazole (MMI) equivalents at 10:1 ratio. Guideline concordant care was defined as initial ATD dosed based on 2016 American Thyroid Association guidelines (i.e. 5-10 mg for presenting FT4 between >1.7-2.55 ng/dL, 10-20 mg for 2.56-3.40 ng/dL, and 30-40 mg for 3.41 ng/dL and above). Based on the first follow up FT4 values, patients were grouped into categories of: normal range (FT4 0.9-1.7 ng/dL) and under treated (FT4 >1.7 ng/dL). Results: 398 patients were included; mean (SD) age was 49 years (16.6), and 75% were women. Mean initial (SD) Free T4 value was 3.9 ng/dL (2.8), with patients treated with ATD at mean (SD) starting dose of 21.9 mg (13.3) MMI equivalent. Over time there was a decrease in the starting ATD dose from 30 mg MMI equivalent in 2002-2004 to 20 mg in 2017-2019, despite steady presenting FT4 values (2.7 ng/dL in 2002-2005 and 3.1 ng/dL in 2017-2019). In the subset of 340 patients with overt hyperthyroidism, 181 (53%) received guideline concordant (GC) dosing. Patients receiving GC care had a higher initial FT4 (4.9 vs. 3.6 ng/dL, p=0.002), larger goiters (40 vs. 30 g, p<0.001) and higher initial ATD mean dose (SD) 25 mg (15.7) vs. 21.3 mg (9.9), p= 0.05. However at follow up (median 32 days vs 35 days respectively), both groups had similar proportion of patients with normal FT4 values (43% vs. 42%, p=0.79); undertreated patients (45% vs. 45%, p=0.99) and frequency of adverse events (4% vs. 6%, p=0.40). Conclusion: The initial dose of ATD for the treatment of GD has decreased over the past 2 decades. Most clinicians initiate ATD at a dose concordant to guidelines. Despite this, a significant proportion of patients have persistent hyperthyroidism on initial follow up. In light of evidence of risks associated with duration of hyperthyroidism, strategies to improve optimization of initial dosing are needed. Pending further subgroup analysis by presenting FT4 severity, these preliminary results suggest and approach factoring other variables apart from guideline based initial ATD dose is needed to optimize response. Our data will be utilized to pilot an individualized, patient specific predictive model to guide initial dosing to this end.

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