from 9.8% to 5.5% (P ¼ .004), and 1-year major amputation decreased from 25.4% to 18.2% (P < .001), with a corresponding odds ratio of 0.65 (95% CI, 0.517-0.838; P < .0001) as the volume increased. An increase in the chance of a revision surgery (10.6% vs 8.2%, P < .001) was seen with higher volume, with an increased odds ratio of 1.031 (95% CI, 1.005-1.057; P ¼ .018). Comment: Although the 30-day mortality for leg bypass is quite high in this series, this is another bit of evidence that outcomes for open vascular surgical procedures are better in hospitals with higher volumes of such procedures. The data have some limitations because it is unclear whether every procedure analyzed was an additional bypass, followed a failed endovascular procedure, or was a vein or prosthetic bypass. There are some additional oddities in the data, in that 54% of the patients treated with femoral distal bypass were supposedly treated for claudication. Nevertheless, the relationship between increasing volume and favorable outcomes for LEAB seems statistically solid. The data also suggest that benefits for limb salvage may be partly due to increased reintervention rates in higher-volume hospitals with perhaps better resources and willingness to attempt revisions rather than move to amputation.

The purpose of this study was to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on sexual behavior, mental health, and substance use among men who have sex with men (MSM) engaged in pre-exposure prophylaxis (PrEP) care. Generalized linear mixed models and logistic mixed-effect models examined change over time for number of sexual partners, mood, and alcohol consumption. From February 29, 2020 to July 31, 2020, 177 MSM actively engaged in PrEP care were evaluated. The median age was 37 [interquartile range (IQR 30, 51]. Patients in the sample were largely representative of the clinic population and identified as White (73.0%), Black/African American (9.2%), and other race (17.2%), and 11.8% identified as Hispanic/Latino ethnicity. Men reported an average of 2.60 fewer sexual partners (95% CI −4.04, −1.40) during the pandemic compared to pre-COVID-19. Rates of depressive symptoms and alcohol use remained stable and few patients reported substance use. The reduced number of sexual partners may be explained by patients' efforts to reduce risk of exposure to COVID-19 and low rates of psychosocial symptoms may be indicative of only the highest functioning patients continuing to engage in care. Reductions in sexual partners may offset reduced engagement in care and help mitigate risk of HIV and other sexually transmitted infections (STIs).

No abstract