447 Night Time Is Not the Right Time: Increased Risk of Complications After Laparoscopic Cholecystectomy At Night Uma R. Phatak, Curtis J. Wray, Debbie Lew, Richard Escamilla, Winston M. Chan, Tien C. Ko, Lillian S. Kao Evidence from a large national database has shown that performance of non-emergent general surgery procedures at night does not predispose patients to increased morbidity or mortality. However, these results may not be generalizable to high risk populations of medically underserved patients. We hypothesized that performance of laparoscopic cholecystectomy (LC) at night in such a population would be associated with increased post-operative complications. We conducted an IRB approved single center retrospective review of consecu- tive LC patients between October 2010 and May 2011 at a safety-net hospital in Houston, TX. Data were collected regarding demographics, date and site of diagnosis (defined as first imaging study demonstrating gallstones), number of biliary-related admissions and emergency room (ER) visits between diagnosis and surgery, length of stay (LOS) for each admission, dates and types of procedures, dates and types of imaging studies, and 30-day postoperative complications (bile leak/biloma, common bile duct injury, retained stone, superficial surgical site infection, organ space abscess, pneumonia, readmission, and death). We defined "night" as 7PM to 7AM. Statistical analyses were done using STATA 12 (College Station, TX). During the 8-month period, 580 patients received LC and incision times were available for 549. Of these 38% (n=208) were elective and 62% (n=341) were non-elective. A majority were female (n=460, 84%) and Latino (n=456, 83%). There were 196 LC performed at night of which 186 were non-elective and 10 were elective. Of the 353 daytime LCs, 198 were elective and 155 were non-elective. There were 35 complications in 22 patients (4 elective, 18 non-elective). Multivariate analysis revealed age (OR 1.05, 95% CI 1.01 to 1.08, p=0.003) and LC at night (OR 3.1, 95% CI 1.3 to 7.6, p=0.012) to be associated with increased risk of complications. The predicted probability of a complication increased three fold for older patients who received LC at night (Figure). Age and performance of LC at night were predictive of an increased risk of complications among medically underserved patients treated at a high volume safety net hospital with limited resources. Restricting performance of LCs to the daytime in high risk patients, such as the elderly, may lead to improved outcomes in this challenging clinical setting. Predicted probability of complication after LC at night by age 448 Short-Term but Not Long-Term Patency of Venous Reconstruction During Pancreatic Resection Predicts Survival Irmina Gawlas, Irene Epelboym, Megan Winner, Joseph DiNorcia, Yanghee Woo, James A. Lee, Beth Schrope, John A. Chabot, John D. Allendorf BACKGROUND Pancreatic surgery with concomitant vascular reconstruction is being per- formed with increasing frequency, and offers the benefits of surgical resection to patients with locally advanced disease. The technique is not standardized, however, and the short and long-term patency rates and the clinical significance of thrombosis of a reconstructed venous system are unknown. METHODS We reviewed clinical and operative characteristics as well as follow up records of patients who underwent pancreatic resections requiring venous resection and reconstruction from 1994 to 2011. We sought to identify predictors of acute (occurring within 30 days) thrombosis of the venous reconstructions using logistic regression, and predictors of late loss of patency using Cox-proportional hazards. We com- pared survival of patients with thrombosis of the mesenteric venous system to that of patients with patent reconstructions. RESULTS Between 1994 and 2011, 203 pancreatic operations requiring venous reconstruction were performed. Of these, 106 (52.2%) included resection of the portal vein (PV), 59 (29.1%) included the superior mesenteric vein (SMV) only, and in 38 (18.7%) patients, the confluence of the PV and SMV was resected. Segmental resection was performed in 131 (64.5%), and 72 (35.5%) underwent tangential resection. Ninety- seven veins (47.8%) were repaired primarily, 67 (33.0%) were repaired using a venous interposition graft, and 34 (16.8%) were repaired using an autologous vein patch. Acute thrombosis occurred in 9 (4.4%) cases, and was significantly associated with increased perioperative mortality (22.2% versus 4.6%, p=0.023). After excluding cases of perioperative mortality, acute thrombosis was associated with decreased median survival (7.1 versus 15.9 months, p=0.011) and increased hazard of death (HR 8.6, CI 3.7-19.9, p ,0.001). These events were more common in cases of total or subtotal resection compared to Whipple or distal resections (22.2 versus 2.7%, p ,0.001). Long-term follow-up imaging was available for 138 patients at a median of 11.7 months. Of these, 43 (31.2%) experienced a loss of patency of the portal venous system at a median of 9.5 months; the majority of these were associated with tumor recurrence. Independent predictors of late loss of patency were age under 65 (HR 2.2, CI 1.2-4.1, p=0.015) and segmental resection (HR 3.3, CI 1.5-7.2, p= S-1049 SSAT Abstracts 0.002). Later loss of patency was not associated with decreased median survival (18.1 versus 16.8 months, p=0.455) or increased hazard of death (HR 1.3, CI 0.8-2.1, p=0.375). CONCLUSIONS Acute thrombosis of the reconstructed portal venous system after pancreatic surgery is clinically significant; it is associated with increased perioperative mortality, and even when non-fatal, is associated with decreased survival. Late loss of patency occurs in one-third of patients but does not affect survival. 449 Simultaneous Surgical Resection of Primary and Metastatic Carcinoid and Neuroendocrine Tumors Is Both Safe and Effective Nicholas N. Nissen, Vijay G. Menon, Edward M. Wolin, Run Yu, James M. Mirocha, Alagappan Annamalai, Deepti Dhall, Ashley Wachsman, Marc L. Friedman, Steven D. Colquhoun Introduction: Management strategies for patients with carcinoid and neuroendocrine tumors (CNETs) generally include removal of the primary tumor and cytoreduction (CR) of metastatic tumor burden, both to improve survival and control symptoms. Patients with synchronous presentation of primary tumors and hepatic metastases present a unique challenge. We reviewed our experience with simultaneous surgical removal of primary abdominal CNETs and hepatic metastases. Patients: Forty-seven patients underwent simultaneous hepatic resec- tion and removal of either small bowel carcinoid (n=32) or pancreatic NET (n=15) by two experienced hepatobiliary surgeons as part of a multidisciplinary CNET treatment group. Surgical details are shown in the Table. In 22 patients, surgery was undertaken with a goal of near total surgical CR, while in 25 patients partial surgical CR was performed as part of a plan to include postoperative hepatic arterial or ablative therapy. Tumor progression was categorized using RECIST criteria. Results: Nineteen patients had carcinoid syndrome and all had dramatic improvement after surgery, with complete resolution in 11 (58%) cases. Overall there were 8 complications of Clavien grade . 2 including bile leak requiring ERCP (n=2) and repeat laparotomy (n=4). There was no 30-day mortality. Median length of stay was 7 days. Overall survival for the entire cohort at 1, 3 and 5 years was 95%, 82% and 82%, while the progression free survival at 1, 3 and 5 years was 77%, 37% and 28%. In the 22 patients undergoing near total surgical CR, no patient required repeat hepatic intervention within 12 months. In the 25 patients undergoing partial surgical CR, 18 (72 %) went on to receive postoperative hepatic treatments within 12 months. Progression free survival was similar in patients whether they underwent total CR or partial CR with staged hepatic treatment. Patients who failed to undergo postoperative hepatic therapy (n=7) were at increased risk of progression compared either to patients with near total CR (HR = 3.10, P = 0.044) or partial CR and staged liver treatment (HR = 3.37, P = 0.029) (Figure). Conclusion: To our knowledge this series represents the largest single center report of simultaneous resection of primary abdominal CNETs and hepatic metastases in the literature. Our results demonstrate that this surgical approach is safe and effective in expert hands. In patients undergoing near total hepatic CR, which made up almost half of our series, no additional hepatic treatments were required over the next year, which in turn demonstrates the effective consolidation of treatments into a single surgical endeavor. In remaining patients, resection of the primary tumor combined with partial hepatic CR combined with postopera- tive hepatic therapy was equally effective. A multidisciplinary and multimodal approach is essential in these patients. Variables Associated with Simultaneous Resection SSAT Abstracts