Munson Medical Center

BackgroundLong-acting lipoglycopeptides (LaLGPs) are emerging as promising alternatives for the treatment of cellulitis in patients who might otherwise require short-stay hospitalization. Compared to standard intravenous antibiotic regimens, LaLGPs may offer advantages in both clinical efficiency and healthcare resource utilization. In September 2024, Munson Medical Center (Traverse City, MI) implemented a LaLGP-based clinical pathway in the emergency department (ED) to streamline cellulitis care and reduce hospital admissions.MethodsThis single-center retrospective cohort study compared two groups: a pre-implementation cohort (patients hospitalized ≤ 72 hours for cellulitis from July 2022 – August 2024) and a post-implementation cohort (patients receiving ED-administered dalbavancin from September 2024 – April 2025). The primary outcome was 30-day hospital admission for recurrent cellulitis. Secondary outcomes included ED or urgent care visit within 30 days for recurrent cellulitis, antibiotic prescriptions for recurrent cellulitis within 30 days, and all-cause hospital admission within 72 hours. A cost analysis estimated potential savings by calculating avoidable hospital days using publicly available financial data and the average length of stay from the pre-implementation cohort.ResultsOf the 208 patients screened, 60 met inclusion criteria: 48 in the pre-implementation cohort and 12 in the post-implementation cohort. No statistically significant differences were observed between cohorts in 30-day outcomes for recurrent cellulitis, including hospital admissions (2.1% vs. 8.3%; p=0.36), ED or urgent care visits (4.2% vs. 8.3%; p=0.50), antibiotic prescriptions (27% vs. 8.3%; p=0.26), or 72-hour all-cause hospital admission (0% vs. 8.3%; p=0.20). Over the 8-month study period, an estimated 22.8 hospital days were avoided in the ED-LaLGP cohort (n=12). Excluding initial ED visit costs, this corresponds to a projected cost savings of $52,919 USD – approximately $4,409 USD per patient.ConclusionThese findings support the use of an ED-LaLGP clinical pathway as a viable strategy to reduce short-stay hospitalizations for cellulitis, offering comparable clinical outcomes with improved cost-efficiency for both patients and healthcare systems.DisclosuresAll Authors: No reported disclosures

Abstract Background β-lactam allergy (BLA) labels in the preoperative setting often lead to avoidance of cefazolin in favor of alternative agents, increasing the risk of surgical site infections, adverse events, antimicrobial resistance, and healthcare costs. Although recent literature supports preoperative cefazolin use in BLA-labeled patients, data on implementing sustainable, scalable system-wide changes to increase cefazolin use remains limited. Methods This multi-center, retrospective cohort study included adults with complete allergy data who underwent initial surgery with preoperative antibiotics at one of three Munson Healthcare sites (MMC, MHC, MHG) between 1/1/2020, and 12/31/2024. Outcomes were compared before and after a revision to the preoperative antibiotic prophylaxis guidelines on 2/28/2023, promoting cefazolin use for all patients except those with a cefazolin allergy or a BLA-label consistent with a type II-IV reaction. The primary outcome was rate of prophylactic cefazolin use among BLA-labeled patients, with a subgroup analysis comparing two sites (MMC, MHC) with pharmacy-to-dose (PTD) antibiotic prophylaxis protocols to one site (MHG) without such a protocol. Secondary outcomes included rates of alternative prophylactic antibiotic use and new cefazolin allergies within 24 hours. Results Among 39,104 included patients, BLA-label rates were similar pre- and post-intervention (21.0% vs. 20.8%; p=0.56). Following implementation of the revision, cefazolin usage among BLA-labeled patients increased from 69.9% to 90.8% (p< 0.001), while alternative antibiotic use declined from 30.2% to 8.5% (p< 0.001). All sites saw significant increases in cefazolin use among patients with a BLA-label (p< 0.001); however, usage remained higher at PTD sites compared to the non-PTD site both pre- (71.5% vs. 48.1%) and post-implementation (92.6% vs. 65.6%), with a larger absolute increase at PTD sites (p< 0.001). The incidence of new cefazolin allergies within 24 hours remained unchanged (0.01% vs. 0.03%; p=0.26). Conclusion Implementing revised cefazolin use criteria within a PTD antimicrobial prophylaxis protocol increased cefazolin use while reducing alternative antibiotic use among BLA-labeled patients, without increasing new cefazolin allergies within 24 hours. Disclosures All Authors: No reported disclosures

The addition of lateral extra-articular augmentation procedures (LEAP) to anterior cruciate ligament reconstruction (ACLR) reduces graft failure rates in hamstring ACLR. However, their effects on return-to-sport (RTS) testing are not well understood in the setting of quadriceps (Quad) or bone-tendon-bone (BTB) autograft ACLR. The purpose was to evaluate the effects of adding LEAP to Quad or BTB autograft ACLR in young athletes, with respect to formal RTS testing outcomes. We hypothesized that the addition of LEAP to Quad or BTB ACLR would result in non-inferior outcomes as compared to isolated ACLR. A retrospective case-control analysis was performed of prospectively collected data from 93 patients under the age of 25 undergoing Quad or BTB ACLR from a single surgeon between 2021 and 2023. A control group of isolated ACLR was compared to the study group of ACLR/LEAP (either anterolateral ligament reconstruction [ALLR] or lateral extra-articular tenodesis [LET]). All patients underwent standardized RTS testing at 6 and 9 months post-surgery. The study was powered based on a priori power analysis to assess non-inferiority of the ACL/LEAP group. There were 51 patients (54.8%) in the isolated ACLR group and 42 (45.2%) in the ACLR/LEAP group. The ACL/LEAP group was non-inferior to the isolated ACLR group for the limb symmetry index (LSI) and passing rates for each of the 6- and 9-month RTS tests, as well as psychological readiness, as measured by Anterior Cruciate Ligament-Return to Sport after Injury. There was no significant difference in overall pass rate between the control and ACL/LEAP groups (33% vs. 45.2%, respectively, p = 0.273) at 9 months. Subgroup analysis showed no differences in any outcome variables at 6 or 9 months between ACL/ALLR and ACL/LET. This study confirmed our hypothesis that the addition of LEAP to Quad or BTB ACLR is non-inferior to isolated ACLR in terms of RTS testing and psychological readiness for sport at 6 and 9 months post-operatively. Level III, case-control study.

Cancer peer support groups are crucial in improving quality of life outcomes and extending cancer survival. Using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB) as guiding frameworks, this study examined perceptions of telehealth-based cancer support groups among individuals treated for cancer at a rural oncology program. We distributed online surveys to 34 survivors or individuals undergoing cancer treatment who actively participated in virtual cancer support groups, achieving a 79.4% response rate (27 participants). The survey, blending quantitative and qualitative methodologies, assessed demographic characteristics, overall telehealth satisfaction, satisfaction with telehealth-based peer support, and perceived social support. Quantitative data were analyzed using descriptive statistics, while qualitative responses were examined through template analysis, focusing on the HBM and TPB constructs. Participants expressed general satisfaction with telehealth and indicated a willingness to use telehealth services again. Participants cited ease of use and broader access to cancer support groups with telehealth approaches. Barriers to telehealth included the lack of interpersonal connection, internet access, and technical difficulties. The findings underscore the nuanced perceptions of telehealth-based cancer support groups in a rural oncology setting. Despite acknowledging telehealth's limitations, participants appreciated its role in facilitating access to support. The findings provide valuable insights for optimizing digital health interventions, emphasizing the need for a balanced approach that considers both the potential and the challenges of telehealth in cancer care. This study offers critical guidance in optimizing digital health interventions and ensuring accessible, effective support for cancer patients in rural areas.

298 Background: The phase III FLAME trial demonstrated that in localized prostate cancer, an external beam radiotherapy (EBRT) simultaneous integrated microboost to an MRI-defined dominant intraprostatic lesion improves biochemical control without affecting toxicity and quality of life. Given the complexity required to deliver high microboost doses, we hypothesized that practice patterns are variable in clinical practice. We aimed to characterize microboost utilization and evaluate dosimetric parameters within the statewide Michigan Radiation Oncology Quality Consortium (MROQC). Methods: Men with intermediate or high-risk prostate adenocarcinoma treated with curative intent radiotherapy for intact disease were included. Data was prospectively collected, including T/N-category, Gleason score, prostate-specific antigen, and percent positive biopsy cores. Full DICOM files were available for dosimetric data. Multivariable analyses (MVA) were used to evaluate associations between receipt of microboost, known prognostic factors, and fiducial marker and rectal spacer placement (advanced image guided radiation therapy (IGRT)). Results: From 10/26/20 to 06/26/23, 741 patients across 26 centers were enrolled, 71% (n=528) with intermediate-risk and 29% (n=213) with high-risk disease. Androgen deprivation therapy was planned in 61%. EBRT + whole-gland brachytherapy boost was utilized in 29% (n=217/741) of patients. Of those treated with EBRT (71%, n=524/741), 10% received a microboost (n = 53/524). Brachytherapy boost and microboost were used in 9 and 7 centers, respectively. Most patients received either conventional fractionation or moderate hypofractionation- 11% and 66% in EBRT without microboost and 21% and 60% with microboost, respectively. Microboost treatment was associated with use of a planning MRI (91% vs. 62%, p <0.0001) as well as fiducial marker and rectal spacer placement (76% vs. 45%, p <0.0001). Median prostate planning target volume (PTV) was smaller in microboost patients (127 cc vs. 91 cc, p = 0.002); median boost volume was 21 cc. Median boost dose (D0.1cc) was 117% (IQR 115% – 119%) of the PTV prescription. Microboost patients had significantly higher mean bladder D1cc[%] (105.7% vs. 103.4%, p = 0.002) and numerically lower rectal D1cc[%] (90.7% vs. 94.1%, p = 0.065). On MVA, receipt of microboost was significantly associated with grade group 4 or 5 disease, planning MRI use, and fiducial and rectal spacer use. Conclusions: Within a large, diverse prospective cohort of men with prostate cancer treated in both academic and community settings, a microboost was utilized in 10% of EBRT cases. Microboost use was associated with higher grade group, MRI planning, and advanced IGRT. EBRT microboost is an emerging dose escalation strategy and further studies confirming safety and improved clinically meaningful outcomes may increase uptake in routine practice.

PurposeData on treatments for male breast cancer patients are limited owing to rarity and underrepresentation in clinical trials. The real-world POLARIS study gathers data on palbociclib use for the treatment of hormone receptor–positive/human epidermal growth factor receptor 2–negative (HR+/HER2–) advanced breast cancer (ABC) in female and male patients. This sub-analysis describes real-world palbociclib treatment patterns, clinical outcomes, and quality of life (QoL) in male patients.MethodsPOLARIS is a prospective, noninterventional, multicenter, real-world study of patients with HR+/HER2– ABC receiving palbociclib. Assessments included medical record reviews, patient QoL questionnaires (European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire–Core 30), site characteristics questionnaires, and physician treatment selection surveys. Variables included demographics, disease history, global health status/QoL, clinical assessments and adverse events. Analyses were descriptive in nature. For clinical outcomes, real-world tumor responses and progression were determined by physician assessment in routine clinical practice. Real-world progression-free survival (rwPFS) was described using the Kaplan–Meier method.ResultsAt data cutoff, 15 male patients were enrolled (median age, 66 years). Nine patients received palbociclib as a first-line treatment and 6 as a second-line or later treatment. Patients received a median of 20 cycles of palbociclib. Neutropenia was experienced by 2 patients and grade ≥ 3 adverse events were reported in 11 patients. Global health status/QoL scores remained generally consistent during the study. One patient (6.7%) achieved a complete tumor response, 4 (26.7%) a partial response, and 8 (53.3%) stable disease. Median rwPFS was 19.8 months (95% CI, 7.4–38.0). Median follow-up duration was 24.7 months (95% CI, 20.0–35.7).ConclusionThis real-world analysis showed that palbociclib was well tolerated and provides preliminary data on treatment patterns and outcomes with palbociclib in male patients with HR+/HER2– ABC, helping inform the use of palbociclib in this patient subgroup.Trial identifierNCT03280303.