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Use of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) is increasing. Perioperative GLP-1RA continuation has adverse and beneficial effects. This retrospective cohort study aimed to identify how patient factors are associated with perioperative outcomes in GLP-1RA users. Adults undergoing general anesthesia, from 2015 to 2025, were selected from the TriNetX nationwide deidentified database. GLP-1RA users had three instances of GLP-1RA use within 1month prior to surgery. GLP-1RA nonusers had no history of GLP-1RAs. Comorbidities were present within 1year prior to surgery. Patients were matched by demographics and comorbidities like atherosclerosis, diabetes, and nicotine dependence. Adverse outcomes were assessed from operation to postoperative day 3. Respiratory complications were measured to 7days post- operation. Among eligible 2,928,513 patients, 32,261 were GLP-1RA users and 2,896,252 were matched non-GLP-1RA controls. GLP-1RA users were associated with increased nausea and vomiting (N/V) but reduced mortality, cardiovascular, respiratory, metabolic, and neurologic adverse outcomes. Pneumonitis risk was heightened only in users with asthma, chronic obstructive pulmonary disease (COPD), and heart failure. Female users had more N/V but less hyperglycemia, hypoxemia, and arrhythmia. Hispanic users had worsened hemodynamic outcomes. GLP-1RAs also demonstrated protective associations in patients with COPD or asthma. GLP-1RA users generally had more favorable outcomes, but females, Hispanics, and patients with select comorbidities had increased risks. GLP-1RAs may reduce complications in patients with COPD or asthma. Clinical trials in GLP-1RA users should consider differences across comorbidities to optimize perioperative care.

91 Background: Previous evidence have evaluated the impact of GLP-1 receptor agonists (GLP-1 RA) on colon cancer risk in patients with obesity. We aim to provide updated population-based data, analyzing the potential effect of GLP-1RA on the risk of colon cancer in patients with or without obesity. Methods: This retrospective observational study leveraged the TriNetX database, forming two propensity-score–matched cohorts of type 2 diabetes (T2DM) patients without prior colon cancer. One cohort consisted of insulin-treated individuals not using GLP-1 agonists, and the other included new users of GLP-1 agonists. Both groups excluded patients with inflammatory bowel disease, personal or family history of colon cancer or polyps, or hereditary colon cancer syndromes. Matching accounted for age, sex, ethnicity, and race, resulting in 965,333 comparable patients. The main outcome was the incidence of new colon cancer diagnoses identified via ICD-10 codes. Analyses included odds ratios (ORs), risk ratios (RRs), Kaplan–Meier survival curves with hazard ratios (HRs), and statistical significance was set at p < 0.05. Results: Patients not treated with GLP-1 agonists had significantly higher colon cancer risk across all metrics: RR = 3.06 (95% CI: 2.921–3.207), OR = 3.08 (95% CI: 2.935–3.223), and HR = 2.702 (95% CI: 2.578–2.833), all with p < 0.0001. The absolute risk difference was 0.498% (95% CI: 0.478–0.517%). Additionally, the GLP-1 agonist cohort demonstrated superior overall survival regarding colon cancer. Conclusions: GLP-1 RA use was associated with significantly lower colon cancer risk and improved survival compared with insulin therapy. These findings align with previously published data showing the potential protective role of GLP-1 RA in reducing malignancy risk, supporting the need for further studies to evaluate their long-term beneficial profile.

IntroductionThalassemia trait generally has minimal clinical impact, but physiologic changes during pregnancy may increase the risk of anemia, transfusion requirements, and hypertensive disorders. Existing evidence on pregnancy outcomes in this population is limited, with some conflicting data. This study aims to evaluate pregnancy‐related outcomes in patients with thalassemia trait using a large, multicenter database.MethodsFor this retrospective cohort study, we used data from the TriNetX US Collaborative Network. Females aged 18–45 with ICD‐10 codes indicating pregnancy (Z33.1, O00–O9A, Z34, or Z3A) were included. Patients with pregnancy and coexisting thalassemia trait (D56.3) were assigned to the thalassemia cohort (n = 22,913), while those without any thalassemia diagnosis comprised the nonthalassemia cohort (n = 5,611,147). Propensity score matching was performed to balance age, race/ethnicity, obesity, smoking status, essential hypertension, and Type 2 diabetes mellitus. After 1:1 matching, 22,770 patients remained in each cohort (total N = 45,540). Outcomes were assessed within 1 year of the index date, including anemia during pregnancy, blood transfusion, preeclampsia/eclampsia, cesarean delivery, venous thromboembolism (VTE), heart failure/cardiomyopathy, preterm delivery, intrauterine growth restriction (IUGR), and intrauterine fetal demise (IUFD). Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.ResultsThalassemia trait was associated with higher risks of anemia during pregnancy (RR: 3.00 and 95% CI: 2.87–3.13), needing blood transfusion (RR: 1.90 and 95% CI: 1.69–2.20), preeclampsia/eclampsia (RR: 1.54 and 95% CI: 1.47–1.61), cesarean delivery (RR: 1.43 and 95% CI: 1.36–1.51), preterm delivery < 37 weeks (RR: 1.40 and 95% CI: 1.31–1.65), and IUGR (RR: 1.96 and 95% CI: 1.72–2.23), all were statistically significant with a p < 0.001. Increased risk was also observed for VTE (RR: 1.57 and 95% CI: 1.12–2.20, p < 0.001) and IUFD (RR: 1.37 and 95% CI: 1.087–1.75, p < 0.001). No significant association was found with heart failure/cardiomyopathy (RR: 1.28 and 95% CI: 0.93–1.76, p = 0.124).ConclusionThalassemia trait in pregnancy was associated with increased rates of anemia, transfusion, and adverse maternal and fetal outcomes. Such adverse outcomes include pre‐eclampsia/eclampsia, cesarean delivery, preterm birth and IUGR. These findings underscore the need for tailored peripartum care strategies in this high‐risk population.

Background: Recurrence of atrial fibrillation (AF) remains a concern even after catheter ablation. The impact of Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2i) on Atrial tachyarrythmia free event remains unclear. Hypothesis: This analysis aims to analyze outcomes in patients treated with SGLT2i after catheter ablation. Methods: A meta-analysis of available studies comparing SGLT2i to non- SGLT2i group following ablation was conducted using electronic databases; PubMed and Embase until May 2025. A random-effects meta-analysis using the DerSimonian–Laird model was performed. Primary outcomes: tachyarrhythmia-free survival and secondary outcomes: all-cause hospitalization and all-cause mortality, and Relative risks (RR) with 95% confidence intervals (CI) were calculated with p &lt;0.05 considered significant. Results: A total of 10 studies were included for meta-analysis with sample size of 10,985 (SGLT2i group: 5534 and non-SGLT2i group: 5451). Primary outcome: There was no significant difference in tachyarrhythmia-free survival (RR: 0.99, 95% CI: 0.76–1.29; p = 0.96), and high heterogeneity (I2 = 84.6%) was observed for this endpoint. Secondary outcome: SGLT2i therapy significantly reduced all-cause hospitalization (RR: 0.74, 95% CI: 0.59–0.94; p = 0.01; I2 = 36.4%) and all-cause mortality (RR: 0.64, 95% CI: 0.45–0.89; p = 0.01; I2 = 0%) Conclusion: SGLT2i therapy offers additive clinical benefits over non-SGLT2i group, notably in reducing hospitalizations and cardiovascular mortality. Its effect on arrhythmia prevention remains uncertain, highlighting the need for further investigation into patient selection and mechanistic interactions.

Background: Amiodarone is commonly prescribed to manage arrhythmias in Left Ventricular Assist Devices (LVADs) patients. However, its safety profile in this population remains unclear. Hypothesis: Amiodarone use may be associated with differences in mortality and adverse clinical outcomes among patients with LVADs. Aim: To evaluate the association between amiodarone use and clinical outcomes in LVAD patients using real-world data. Methods: A retrospective cohort study was conducted using the TriNetX Network, selecting patients with LVAD. Amiodarone users were matched 1:1 with non-users through propensity score matching, considering demographics, medical conditions, and medications. The primary outcome was mortality. Secondary outcomes were stroke, device thrombosis, hepatitis, hypothyroidism, and arrhythmias. Results: From 17,457 amiodarone-treated and 20,151 untreated LVAD patients, 14,138 pairs were successfully matched. Amiodarone use was associated with a significantly increased 1-year all-cause mortality (Risk Difference [RD]: 13.0%; Hazard Ratio [HR]: 2.13; 95% CI: 2.01–2.26; p&lt;0.001). The risk of device thrombosis was also higher in the amiodarone group (RD: 2.2%; HR: 2.55; 95% CI: 2.17–2.98), as was the risk of ischemic stroke (RD: 1.9%; HR: 1.37; 95% CI: 1.24–1.51). In addition, amiodarone was strongly associated with increased incidence of ventricular arrhythmias, including ventricular tachycardia (RD: 13.9%; HR: 2.58; 95% CI: 2.40–2.78) and ventricular fibrillation (RD: 6.7%; HR: 3.94; 95% CI: 3.47–4.48), as well as atrial fibrillation (RD: 16.3%; HR: 2.86; 95% CI: 2.66–3.08). Elevated risks of hypothyroidism (RD: 2.6%; HR: 1.65; 95% CI: 1.48–1.84) and hepatitis (RD: 0.4%; p=0.003) were also observed. All reported associations were statistically significant. Conclusion: In this large real-world cohort, amiodarone use in LVAD patients was consistently associated with increased risks of mortality and several clinically significant adverse events. These findings warrant cautious consideration of amiodarone use in this vulnerable population and suggest the need for closer monitoring and potential alternative therapies.

Background: Induction immunosuppression with thymoglobulin (ATG) or basiliximab in kidney transplantation reduces acute rejection while modulating cytomegalovirus (CMV) and BK virus (BKV) infection risks. Factors such as induction dosing, advanced age, and mycophenolate mofetil (MMF) exposure may contribute to infectious complications. This study investigated the effects of ATG and basiliximab dosing, age ≥70, and MMF area under the curve (AUC) on infection outcomes. Methods: A retrospective cohort study of 296 kidney transplant recipients (266 ATG, 30 basiliximab; living/deceased donors) from 2017–2023, excluding 2020 due to COVID-19 disruptions, compared ATG (3–6 mg/kg) with basiliximab (20 mg, days 0 and 4) induction. Primary outcomes were CMV viremia (>1,000 IU/mL) and BKV infection (viremia or nephropathy) within 12 months. Secondary outcomes included ATG dosing (total and adjusted body weight), MMF AUC (target 30–60 mg h/L), and age ≥70 effects. High-risk (D+/R–) patients received valganciclovir prophylaxis. Wilcoxon rank-sum tests assessed differences (p<0.05). Results: Among 296 recipients (58% male, 68% White, mean age 53), CMV incidence was 18.6% (ATG) vs. 10.0% (basiliximab, p=0.24); BKV incidence was 13.6% vs. 10.0% (p=0.78). In ATG-treated patients aged ≥70 (n=19) vs. <70 (n=247), dosing was lower (median total dose 250 vs. 400 mg, p<0.0001; adjusted 3.0 vs. 4.8 mg/kg, p<0.0001), yet CMV rates were higher (31.6% vs. 15.4%, p=0.10), with similar BKV rates (15.8% vs. 13.8%, p=0.73). Overall, ATG dosing showed no association with CMV (p=0.26 total, p=0.11 adjusted) or BKV (p=0.10 total, p=0.67 adjusted). Initial MMF AUC showed no correlation with CMV (46 [38–58] vs. 52 [40–63] mg h/L, p=0.21) or BKV (44 [38–62] vs. 51 [40–63] mg h/L, p=0.34), although dose reductions were required >20% patients. Conclusion: ATG dosing variations did not influence CMV or BKV infection rates, nor did basiliximab significantly reduce infections vs. ATG. Elevated CMV risk in recipients aged ≥70, despite significantly lower ATG dose, suggests tailored, milder immunosuppression. Additional investigation of MMF dosing and corresponding MMF AUC is warranted to clarify their roles in infection risk stratification.

253 Background: Melanoma is a rare cancer accounting for approximately 1% of all skin cancers with a higher incidence in older adults with a median age of diagnosis of 66 years. We studied national mortality trends and demographic disparities in older adults with melanoma. Methods: A retrospective analysis of mortality trends among melanoma patients aged 65 years and above, diagnosed between 2000 and 2023, was conducted using the Surveillance, Epidemiology, and End Results Program (SEER) database. Variables including age, gender, race, and age-adjusted mortality rates (AAMR) were extracted and analyzed. Annual percent changes (APCs) in AAMRs with 95% confidence intervals were calculated using Joinpoint regression analysis across demographic subgroups (sex and race/ethnicity). Results: Between 2000 and 2023, 229,445 documented deaths in the US were attributed to melanoma. The overall AAMR demonstrated: initial increase from 11.6 per 100,000 in 2000 to 13.8 in 2013 (APC: 1.5%; 95% CI: 1.2% to 1.7%), followed by significant decline to 11.3 in 2017 (APC: -5.2%; 95% CI: -6.7% to -3.6%), with continued but slower decrease to 10.8 in 2023 (APC: -0.8%; 95% CI: -1.4% to -0.3%). Significant gender disparities persisted throughout the study period, with males maintaining consistently higher AAMRs than females (19.6 vs. 7.3 per 100,000). Male mortality increased from 18.0 in 2000 to peak at 22.3 in 2013, then declined substantially to 16.9 in 2023. Female mortality showed modest increase from 7.5 in 2000 to 7.7 in 2014, followed by decline to 6.2 in 2023. Pronounced racial and ethnic disparities were observed. Non-Hispanic White patients had the highest AAMR (14.6 per 100,000), followed by Hispanic or Latino patients (3.7), non-Hispanic Black or African American patients (2.1), with non-Hispanic Asian or Pacific Islander patients having the lowest rates (1.7). Conclusions: Despite overall improvements in melanoma mortality among older adults over the past two decades, significant disparities persist. Mortality remains markedly higher in men compared to women, and among non-Hispanic White patients relative to other racial and ethnic groups. The sharp decline in mortality after 2013 likely reflects the impact of advances in melanoma treatment, including immunotherapy and targeted therapies. Further studies are needed to better understand the drivers of these disparities and guide efforts to improve outcomes across all populations.