Abstract: Introduction The human papillomavirus (HPV) vaccine is highly effective in the prevention of cervical, vulvar, and anal cancers in women. Federally Qualified Health Centers (FQHCs) are safety-net clinics that serve a population disproportionately burdened by a lack of preventative health care services that would benefit from additional measures such as the HPV vaccine. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may help in promoting evidence-based practices for vulnerable populations. Methods The specific aims of this study include: 1) to assess a baseline rate of HPV vaccination and counseling among women attending an FQHC clinic, and 2) to identify FQHC clinic and practitioner barriers for effective HPV vaccine recommendations. We performed a retrospective chart review of 105 women who attended an OB/GYN clinic at an FQHC in Santa Ana, CA between 1/1/2019 and 3/30/2019. Data included patient demographics, insurance type, and documentation of HPV vaccine counseling or vaccine administration. Provider data, as detailed from completion of a nationally validated HPV vaccination survey from an estimated 50 providers will also be discussed. Results 78% of patients self-identified as Hispanic, 14% reported Spanish as their primary language, and 86% of patients were enrolled in Medi-Cal. 25% (n = 27) of patients reviewed had documented administration of the HPV vaccine in the FQHC medical chart. Of those that had documented vaccine administration, 52% (n = 13) completed 3 doses of the vaccination program. During the study period, 11% of patient visits had documented counseling regarding the HPV vaccine, 14% had documentation of counseling within the prior 12 months of the encounter. Patients who were primarily English speaking versus Spanish were more likely to have received the HPV vaccine (29.9% vs 5.6%, p = 0.0374). Patients enrolled in Medi-Cal were more likely to receive the vaccine compared to other insurance types, including uninsured (31.5% vs 12.5%, p = 0.522). Hispanic women were less likely to have documented counseling regarding the HPV vaccine compared to non-Hispanic women (18.4% vs 0% (p = 0.0198). Conclusion Overall, OB/GYN providers at an FQHC are not routinely recommending the HPV vaccine for their patients. Patients who are primarily Spanish speaking are less likely to have received counseling regarding the vaccine documented in their chart. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women. Citation Format: Kiran Clair, Melissa Perez, Patrick Penalosa, Kristine Penner, Suellen Hopfer. Human papillomavirus vaccine recommendations for the medically underserved: A pilot study on provider communication in a safety net clinic [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C133.

BACKGROUND:Gastrointestinal leak remains one of the most dreaded complications in bariatric surgery. We aimed to evaluate risk factors and the impact of common perioperative interventions on the development of leak in patients who underwent laparoscopic bariatric surgery. STUDY DESIGN:Using the 2015 database of accredited centers, data were analyzed for patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass (LRYGB). Emergent, revisional, and converted cases were excluded. Multivariate logistic regression was used to analyze risk factors for leak, including provocative testing of anastomosis, surgical drain placement, and use of postoperative swallow study. RESULTS:Data from 133,478 patients who underwent laparoscopic sleeve gastrectomy (n = 92,495 [69.3%]) and LRYGB (n = 40,983 [30.7%]) were analyzed. Overall leak rate was 0.7% (938 of 133,478). Factors associated with increased risk for leak were oxygen dependency (adjusted odds ratio [AOR] 1.97), hypoalbuminemia (AOR 1.66), sleep apnea (AOR 1.52), hypertension (AOR 1.36), and diabetes (AOR 1.18). Compared with LRYGB, laparoscopic sleeve gastrectomy was associated with a lower risk of leak (AOR 0.52; 95% CI 0.44 to 0.61; p < 0.01). Intraoperative provocative test was performed in 81.9% of cases and the leak rate was higher in patients with vs without a provocative test (0.8% vs 0.4%, respectively; p < 0.01). A surgical drain was placed in 24.5% of cases and the leak rate was higher in patients with vs without a surgical drain placed (1.6% vs 0.4%, respectively; p < 0.01). A swallow study was performed in 41% of cases and the leak rate was similar between patients with vs without swallow study (0.7% vs 0.7%; p = 0.50). CONCLUSIONS:The overall rate of gastrointestinal leak in bariatric surgery is low. Certain preoperative factors, procedural type (LRYGB), and interventions (intraoperative provocative test and surgical drain placement) were associated with a higher risk for leaks.