speculate this ethnic variation is multifactorial. African American and Hispanic patients could present at an earlier stage due to lack of access to outpatient care, or they could have less access to hospitals that specialize in colorectal surgery. Another possibility is that there is disparities in physician patient trust or patient preference for a high risk procedure such as ileostomy or ileal pouch. In order to better understand ethnic variation in colectomy, and to eliminate health care disparities future studies are needed to identify other contribut- ing factors. A) Adjusted odds of patients with ulcerative colitis undergoing colectomy stratified by ethnicity B) Adjusted means of resource utilization of patients with ulcerative colitis undergo- ing colectomy stratified by ethnicity. Adjusted Odds Ratio, (95% CI), p-value A) Variable Asian or Pacific African American Hispanic Other Islander 0.54 (0.40 – 0.60 (0.44 -0.81), 0.80 (0.44 -1.46), 0.78 (0.51 – Ileostomy 0.72), <0.01 <0.01 0.47 1.19), 0.26 0.45 (0.25 – 0.47 (0.27 – 0.65 (0.23 – 0.64 (0.32 – Ileal Pouch 0.83), 0.01 0.81), <0.01 1.82), 0.41 1,31), 0.22 Asian or Pacific B) Variable African American Hispanic Other Islander $-5123 (-13326 – $2340 (-6226 – $20087 (12891 – $-1663 (-12544 – Costs(UC Pouch) 3080),0.22 10906), 0.59 27283), <0.01 9218), 0.76 Costs (UC Ileos- $11957 (-2600 – $6575 (-5031 – $34284 (-25036 – $26435 (-180 – tomy) 26514), 0.11 18182), 0.27 93603), 0.26 53049), 0.05 $-10251 (- Charges(UC $12026 (-17213 – $97071 (19076 – $-2457 (-39810 – 38609 – 18107), Pouch) 41265), 0.42 175065), 0.02 34897), 0.90 0.48 $112159 (- Charges (UC Ileos- $43385 (-12269 – $14770 (-33775 – $60800 (-86359 – 11197 – 235515), tomy) 99039), 0.13 6295), 0.55 207960), 0.42 0.07 Additional Length -0.7 (-3.05 – -0.06 (-1.90 – 7.7 (1.01 – -3.2 (-6.15 - of Stay in days 1.68), 0.57 1.79), 0.95 14.40), 0.02 -0.23), 0.04 (UC Pouch) Additional Length 3.9 (-0.89 – 0.9 (-3.38 – 4.3 (-4.37 – 5.5 (-1.78 – of Stay in days 8.62), 0.11 5.17), 0.68 13.00), 0.33 12.83), 0.14 (UC Ileostomy) Mo1014 DOES HOSPITAL SETTING AFFECT THE DELIVERY OF BARIATRIC SURGICAL SERVICES WITHIN A HEALTHCARE SYSTEM Cynthia Weber, Rami R. Mustafa, LaCresha Warren, Mujjahid Abbas, Leena Khaitan Introduction Most healthcare centers offer bariatric surgical services (BSS) at a primary site. Within our system, we deliver BSS at three Centers of Excellence: urban academic center, suburban hospital and rural site. Patient preference determines location of surgery, except high-risk patients, who are referred to the urban center. We sought to characterize the populations at each hospital with regards to procedure performed and payer mix. We hypothesize that by utilizing a decentralized model, the system is better able to service the population and reach patients that otherwise would not have access to BSS. Methods A retrospective review of an internally maintained database was performed for patients who underwent primary bariatric surgery (Vertical Sleeve Gastrectomy(VSG), Roux-en-Y Gastric Bypass(RYGB), Adjustable Gastric Band(AGB), Gastric Balloon) or revisional bariatric surgery from 2010-2018. Payer status was defined as private insurance, government insurance (Medicaid, Medicare and VA) or self-pay. Group A consists of patients who underwent BSS at the urban center; whereas Group B and Group C are patients who had surgery at the suburban hospital and rural site. Statistical analysis was performed using Chi-square; p<0.05 considered significant. Results Private insurance was the predominant payer of the entire cohort, representing 63.4% (1716/2706 patients). No difference in gender exists between sites. Payer status differs by hospital (p<0.001); rural (Group C) and suburban (Group B) locations demonstrated higher private insurance coverage; 74.9% and 71%, respectively; compared to the urban center (Group A), where government insurance accounts for 46.1%. Only 28.2% in Group B and 21.5% in Group C had government insurance. Medicaid was more common than Medicare. Zip codes were similar at A and B, but very different in Group C. The rural site saw the largest percentage of self-pay patients. We detected a significant difference in type of bariatric procedure (p<0.001). While VSG was the most common bariatric operation in Groups A and B; RYGB was the primary operation in Group C. The rate of revisional surgery was highest at the academic center (Group A), accounting for 10.5% of all procedures; compared to 4.5% and 4.9% in Groups B and C, respectively. Conclusion This study demonstrates that distributing BSS across hospital environments allows for a broad delivery of BSS. Patients tend to choose the hospital that is closest to them. While private insurance covers the largest percentage of patients, as expected, our urban academic center sees a higher proportion of patients with government insurance and more revisional bariatric surgery. Patients in the rural hospital undergo RYGB most com- monly. While the reasons for these differences are not clear, we hypothesize that decentraliza- tion across a system can allow BSS to be delivered to more patients. S-1459 SSAT Abstracts Mo1016 SURGICAL FELLOWSHIP PER ORAL ENDOSCOPIC MYOTOMY EXPERIENCE: A RETROSPECTIVE REVIEW OF FELLOW CASE LOGS David Morrell, Eric Pauli Introduction Since it was first introduced, per oral endoscopic myotomy (POEM) has been increasingly used in the management of achalasia. In 2013, POEM was added as a category to The Fellowship Council fellow case log reflecting the importance of fellow exposure to the procedure. This study reports surgical fellow experience with POEM following the addition of this category to track fellow experience in this relatively new procedure. Methods A retrospective analysis was performed on case logs of 1,117 surgery fellows who began fellowship training between 2013-2016. All fellows were enrolled in an accredited surgery fellowship program by The Fellowship Council. Fellows were grouped by year of fellowship matriculation and further subcategorized by type of fellowship program. Number of POEM procedures per fellow was calculated by year and further subcategorized by fellow role in the procedure. Results A total of 590 POEM procedures were logged by 57 unique fellows over the 4 years studied. Of the 57 fellows, 24 were enrolled in Advanced Gastrointestinal (Adv GI) Minimally Invasive (MIS), 15 in Adv GI MIS/Bariatric, 4 in Thoracic, 3 in Adv GI MIS/Flexible Endoscopy (Flex Endo), 3 in Flex Endo, 3 in Adv GI, 2 in Adv GI MIS/Foregut, 2 in Bariatric, and 1 in Hepatobiliary Surgical Oncology fellowships. 25 fellows logged cases as both primary surgeon and first assistant, 12 logged as only primary surgeon, and 20 logged as only first assistant. Of the 590 POEM procedures, fellows logged 369 as primary surgeon and 221 as first assistant. Median total procedures per fellow was 9 (range 1-65, interquartile range [IQR] 13) with 6 (range 1-64, IQR 12) as primary and 3 (range 1-19, IQR 5) as first assistant. In 2013, 2 fellows logged a total of 5 procedures with 184 cases logged the following year by 16 fellows which remained stable to 2016 with 17 fellows logging 190 procedures. Of cases logged in 2014, 59.2% were logged as primary surgeon compared to 69.5% in 2016. Conclusions Since its introduction, the POEM procedure has been rapidly adapted by a stable number of fellows doing a consistent number of annual procedures. Fellow independence, however, has been increasing as demonstrated by the increasing percentage of fellows logging this case as primary surgeon. Mo1123 VALPRONIC ACID IMPEDES THE DEVELOPMENT OF REFLUX-INDUCED ESOPHAGEAL CANCER IN A SURGICAL RAT MODEL Tomoharu Miyashita, Daisuki Matsui, John W. Harmon, Tetsuo Ohta Background: The role of histone deacetylases (HDAC) and the potential of these enzymes as therapeutic targets for cancer is an area of rapidly expanding investigation. In our previous study, the nuclear expression of HDAC was observed in all of the stages of squamous carcinogenesis and adeno carcinogenesis, although not in the normal esophageal epithelium in surgical rat model (Oncol Lett 8, 758–764, 2014). For this reason, HDAC inhibitors have recently emerged as potential esophageal cancer therapeutic agents. Valproic acid (VPA) has been shown to inhibit HDACs. We evaluated the effectiveness of VPA as a chemoprevention agent in a surgical rat reflux model of esophageal cancer. Materials and Methods: The rat reflux model was created by performing an end-to-side esophagojejunostomy in Sprague Dawley rats. The surgery promoted the reflux of gastro-duodenal contents into the esophagus. VPA (Sigma-Aldrich Co., Tokyo, Japan) was dissolved in 5ml/kg saline. Beginning four weeks post surgery, all animals were administered either 300mg/kg body weight injections of VPA or equivalent injections of saline 3 days per week into the subcutaneous tissue of the back. Animals were sacrificed 40 weeks after surgery and their esophagi were examined. Results: Forty two rats survived 40 weeks post-surgery and were included in the study. Of these, 21 were included in the control group (Figure 1a), and the remaining 21 received VPA administration (Figure 1b). While 71% (15/21) of the controls developed esophageal cancer (Figure 1c), animals administered VPA had an incidence of cancer of 24% (5/21) (p=0.002, Chi-squared) (Table 1). Barrett’s metaplasia was found on 86% (18/21) of the rats in the control group (Figure 1d), but there was a protective tendency in the VPA group with 62% (13/21) of the rats displaying signs of Barrett’s metaplasia (p=0.079, Chi-squared). All of the rats in the VPA and control groups developed proliferative hyperplasia. Conclu- sions: VPA protected against the development of esophageal cancer in a clinically relevant SSAT Abstracts