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Li C, Du Y, Wang S, Zhang J, Yang Y, Zhao Y, Zhang H, Ye X. Risk factors for intensive care unit admission following correction surgery for adult spinal deformity. J Orthop Surg Res 2023; 18:753. [PMID: 37794490 PMCID: PMC10548749 DOI: 10.1186/s13018-023-04227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE The literature currently available on the characteristics of patients who require intensive care unit (ICU) admission after correction surgery for adult spinal deformity is lacking; this study aimed to identify risk factors for postoperative ICU admission following correction surgery for adult spinal deformity. METHODS A retrospective review of patients who underwent primary posterior-based spinal fusion from 2015 to 2023 was performed. According to the ward they returned to, patients were further divided into an ICU group and a non-ICU group. Univariate and multivariate analyses were performed to evaluate preoperative and perioperative parameters to identify independent risk factors for postoperative ICU admission in adult spinal deformity patients. RESULTS A total of 274 patients were included, including 115 males (41.97%) and 159 females (58.03%). The mean age of the patients was 32.00 ± 11.16 years (19-77 years). Following adjusted analysis, the preoperative and perioperative factors that were independently associated with ICU admission were age, body mass index ≥ 28 kg/m2, neuromuscular spinal deformity, respiratory disease, grade III-IV American Society of Anesthesiologists (ASA) classification, a scoliosis Cobb angle ≥ 90°, a kyphosis Cobb angle ≥ 90°, and ≥ 12 fused segments. Compared with the non-ICU group, the ICU group had a higher incidence of complications, a longer hospital stay, and higher medical costs (P < 0.05). CONCLUSION This study identified independent risk factors associated with postoperative ICU admission in adult spinal deformity patients; and explored relative measures to decrease or avoid the risk of postoperative ICU admission. Surgeons could use these data to develop and plan appropriate perioperative care processes in advance and provide consultation for family members before surgery.
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Affiliation(s)
- Chenkai Li
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - You Du
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yang Yang
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yiwei Zhao
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Haoran Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xiaohan Ye
- Department of Orthopedics, Peking Union Medical College Hospital, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, People's Republic of China
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Improving Safety and Efficacy in the Surgical Management of Low-tone Neuromuscular Scoliosis: Integrated Approach With a 2-attending Surgeon Operative Team and Modified Anesthesia Protocol. J Pediatr Orthop 2021; 41:e1-e6. [PMID: 32804863 DOI: 10.1097/bpo.0000000000001658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Substantially increased operative time and amount of bleeding may complicate the course of surgical treatment in neuromuscular scoliosis. A well-organized team approach is required to reduce morbidity. The aim of this study is to review our early, short-term surgical outcomes with our new integrated approach that includes a 2-attending surgeon team and modifications in the anesthesia protocol in low-tone neuromuscular scoliosis and compare with a matched cohort of our historic patients. METHODS We retrospectively reviewed our patients with (1) neuromuscular scoliosis with collapsing spine deformity, (2) low-tone neuromuscular etiology, (3) multilevel posterior column osteotomies with posterior all pedicle screw spinal fusion, and (4) more than 1-year follow-up. Patients were grouped into 2: group 1 consisted of patients managed with the integrated surgical team approach, group 2 included the matched historic patients. RESULTS There were 16 patients in group 1 and 17 patients in group 2. There was no significant difference between the groups regarding age, sex, body mass index, number of levels fused, major coronal deformity magnitude, pelvic obliquity, number of posterior column osteotomies, or amount of deformity correction. However, significantly shorter operative time (241 vs. 297 min, P=0.006), less intraoperative bleeding (1082 vs. 1852 mL, P=0.001), less intraoperative blood transfusion (2.1 vs. 3.1 U, P=0.028), less postoperative intensive care unit admission (23% vs. 100%, P=0.001), and shorter hospital stay (4.7 vs. 5.9 d, P=0.013) were observed in group 1. CONCLUSIONS Our results indicate that spinal deformity surgery in patients with underlying low-tone neuromuscular disease may not be as intimidating as previously thought. Our surgical team approach integrating a 2-attending surgeon operative team, a new anesthetic protocol that includes a modification of perioperative blood management is effective in reducing operative times, blood loss, transfusion rates, intensive care unit admission, and length of hospital stay. LEVELS OF EVIDENCE Level III-retrospective comparative study.
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Prolonged Postoperative Intubation After Spinal Fusion in Cerebral Palsy: Are There Modifiable Risk Factors and Associated Consequences? J Pediatr Orthop 2020; 40:431-437. [PMID: 32301849 DOI: 10.1097/bpo.0000000000001566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Instrumented spinal fusion is performed to correct severe spinal deformity that commonly complicates cerebral palsy (CP). Prolonged intubation (PI) is a common perioperative complication, though little is known about the risk factors and consequences of this phenomenon. QUESTIONS/PURPOSES The purpose of this study was to determine (1) the preoperative and intraoperative risk factors associated with PI after spine surgery for CP; (2) the perioperative and postoperative complications associated with PI; and (3) any long-term impacts of PI with respect to health-related quality of life. PATIENTS AND METHODS A retrospective case-control analysis of prospectively collected, multicenter data was performed on patients with Gross Motor Function Classification System (GMFCS) 4 or 5 CP who underwent instrumented spinal fusion. Patients extubated on postoperative day (POD) 0 were in the early extubation (EE) cohort and those extubated on POD 3 or later were in the PI cohort. Comparisons were made between PI and EE groups with respect to several preoperative and intraoperative variables to identify risk factors for PI. Multivariate logistic regression was performed to identify independent predictors of this outcome. The postoperative hospital course, rate of complications, and health-related quality of life at 2 years were also compared. RESULTS This study included 217 patients (52% male individuals; mean age, 14.0±2.8 y) who underwent spinal fusion for CP. In this cohort, 52 patients (24%) had EE and 58 patients (27%) had PI. There were several independent predictors of PI including history of pneumonia [odds ratio (OR), 6.2; 95% confidence interval (CI), 1.6-24.3; P=0.01], estimated blood loss of >3000 mL (OR, 16.5; 95% CI, 2.0-134; P=0.01), weight of <37 kg (OR, 6.4; 95% CI, 1.5-27.1), and Child Health Index of Life with Disabilities (CPCHILD) Communication and Social Interaction score of <15 (OR, 10.8; 95% CI, 1.1-107.3; P=0.04). In addition, PI was associated with a higher rate of perioperative and postoperative respiratory (P<0.001), cardiovascular (P=0.014), gastrointestinal (P<0.001), and surgical site (0.027) complications, in addition to prolonged hospitalization (P<0.001) and intensive care unit stay (P<0.001). CONCLUSIONS Surgeons should seek to optimize nutritional status and pulmonary function, and minimize blood loss in patients with CP to decrease the risk of PI after spinal fusion. Efforts should be made to extubate patients on POD 0 to decrease the risk of complications associated with PI.
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Burjek NE, Rao KE, Wieser JP, Evans MA, Toaz EE, Balmert LC, Sarwark JF, Jagannathan N. Preoperative Pulmonary Function Test Results Are Not Associated With Postoperative Intubation in Children Undergoing Posterior Spinal Fusion for Scoliosis: A Retrospective Observational Study. Anesth Analg 2020; 129:184-191. [PMID: 31210654 DOI: 10.1213/ane.0000000000004143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Preoperative pulmonary function tests are routinely obtained in children with scoliosis undergoing posterior spinal fusion despite unclear benefits as a perioperative risk assessment tool and frequent inability of patients to provide acceptable results. The goal of this study was to determine whether preoperative pulmonary function test results are associated with the need for postoperative intubation or intensive care unit admission after posterior spinal fusion. METHODS The electronic medical records of patients who underwent posterior spinal fusion at a pediatric tertiary hospital between June 2012 and August 2017 were reviewed. Pulmonary function tests were consistently ordered for all patients, unless the patient was deemed unable to perform the test due to cognitive disability. Cases were categorized as primary or secondary scoliosis.Demographic data, preoperative bilevel positive airway pressure use, Cobb angle, intraoperative allogeneic blood transfusion, and ability to produce acceptable pulmonary function test results were collected for each patient. In patients with satisfactory pulmonary function test results, forced vital capacity and maximum inspiratory pressure were collected. Primary outcomes for analysis were postoperative intubation and intensive care unit admission. Univariable logistic regression models were used to assess the association between each variable of interest and the primary outcomes. RESULTS The study sample included 433 patients, 288 with primary scoliosis and 145 with secondary scoliosis. Among patients with primary scoliosis, 90% were able to produce acceptable pulmonary function test results, zero remained intubated postoperatively, and 6 were admitted to the intensive care unit. Among patients with secondary scoliosis, 44% could not attempt pulmonary function tests. Among those who did attempt the test, 30% were unable to produce meaningful results. Forced vital capacity and maximum inspiratory pressure were not found to be associated with postoperative intubation or intensive care unit admission. Weight, Cobb angle, intraoperative blood transfusion, American Society of Anesthesiologists physical status classification, and preoperative bilevel positive airway pressure use were associated with patient outcomes. Among 357 total patients who attempted pulmonary function tests, 37 had high-risk results. Only 1 of these 37 patients remained intubated postoperatively. CONCLUSIONS Patients undergoing posterior spinal fusion, especially those with secondary scoliosis, are frequently unable to adequately perform pulmonary function tests. Among patients with interpretable pulmonary function tests, there was no association between results and postoperative intubation or intensive care unit admission. Routine pulmonary function testing for all patients with scoliosis may not be indicated for purposes of risk assessment before posterior spinal fusion. Clinicians should consider a targeted approach and limit pulmonary function tests to patients for whom results may guide preoperative optimization as this may improve outcomes and reduce inefficiencies and costs.
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Affiliation(s)
- Nicholas E Burjek
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristen E Rao
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John P Wieser
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michael A Evans
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin E Toaz
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren C Balmert
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John F Sarwark
- Division of Orthopaedic Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Narasimhan Jagannathan
- From the Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Issac E, Menon G, Vasu BK, George M, Vasudevan A. Predictors of Postoperative Ventilation in Scoliosis Surgery: A Retrospective Analysis. Anesth Essays Res 2018; 12:407-411. [PMID: 29962607 PMCID: PMC6020573 DOI: 10.4103/aer.aer_18_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Patients undergoing corrective surgery for scoliosis may require postoperative ventilation for various reasons. Aim: The aim was to study the correlation of preoperative (pulmonary function test [PFT], etiology, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature at the end of surgery) on postoperative ventilation following scoliosis surgery. Settings and Design: patients' medical records of scoliosis surgery at a tertiary care center during 2010–2016 were retrospectively analyzed. Materials and Methods: We studied retrospectively 108 scoliosis surgeries done in our institute during this period by the same group of anesthetists using standardized anesthesia technique. We analyzed preoperative (etiology, preoperative PFT, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature) influencing postoperative ventilation. Statistical Analysis: For all the continuous variables, the results are either given in mean ± standard deviation, and for categorical variables as a percentage. To obtain the association of categorical variables, Chi-square test was applied. Results: Patients with Cobb's angle above 76° and spinal segment involvement of 11 ± 3 required postoperative ventilation. Forced expiratory volume in 1 s (FEV1%) <38 and forced vital capacity (FVC%) <38.23 of the predicted could not be extubated. Increased blood transfusion and hypothermia were found to affect postoperative ventilation. Conclusion: Preoperative factors such as etiology of scoliosis, Cobb's angle, spirometric values FEV1% and FVC% of predicted and intraoperative factors like number of spinal segments involved, affect postoperative ventilation following scoliosis surgery. Increased blood transfusion and hypothermia are the preventable factors leading to ventilation.
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Affiliation(s)
- Eldo Issac
- Department of Neuroanaesthesia, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - Gokuldas Menon
- Department of Neuroanaesthesia, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - Bindu K Vasu
- Department of Neuroanaesthesia, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - Mathew George
- Department of Neuroanaesthesia, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - Anu Vasudevan
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
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Cawley DT, Carmody O, Dodds MK, McCormack D. Early limited instrumentation of scoliosis in Duchenne muscular dystrophy: is a single-rod construct sufficient? Spine J 2015; 15:2166-71. [PMID: 26070283 DOI: 10.1016/j.spinee.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 05/02/2015] [Accepted: 06/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Correction of scoliotic deformity in Duchenne muscular dystrophy (DMD) is performed to maintain adequate seating posture and facilitate comfort. Delaying surgery can predispose to greater morbidity as DMD exhibits progressive cardiorespiratory compromise. Early limited instrumentation may provide a solution to optimize patients with this condition. PURPOSE The aim was to assess outcomes for a cohort of DMD patients who had posterior single-rod instrumentation and bilateral spinal fusion of their neuromuscular scoliotic deformity. STUDY DESIGN This was a retrospective cohort study. PATIENT SAMPLE Forty-one consecutive patients were included. OUTCOME MEASURES Perioperative morbidity, seating outcomes, pulmonary function, deformity correction, and instrumentation integrity were assessed. METHODS Clinical and radiographic review was performed. RESULTS No perioperative mortality or neurologic deterioration was encountered. Total surgical time was 96 minutes, mean total blood loss was 2.3l, mean intensive care unit stay was 41 hours, and overall length of stay was 11 days. Mean Cobb angle improved from 24.3° to 15.6°, pelvic obliquity improved from 7° preoperatively to 5° postoperatively. Three patients had failure of fixation at a mean of 3.5 years. Forced vital capacity was 60% preoperatively and 56% at 1 year, forced expiratory volume/1 second was 67% and 62% at 1 year postoperatively. Seating and posture was satisfactory in all these patients. CONCLUSIONS The authors advocate early operative intervention using a limited instrumentation technique in patients with DMD to maintain seating balance and minimize perioperative morbidity.
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Affiliation(s)
- Derek T Cawley
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland
| | - Olan Carmody
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland
| | - Michael K Dodds
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland
| | - Damian McCormack
- Department of Trauma & Orthopaedic Surgery, The Children's University Hospital, Temple St, Dublin 1, Ireland.
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Lee SJ, Chang JY, Ryu YJ, Lee JH, Chang JH, Shim SS, Hwang JY. Clinical Features and Outcomes of Respiratory Complications in Patients with Thoracic Hyperkyphosis. Lung 2015; 193:1009-15. [PMID: 26307506 DOI: 10.1007/s00408-015-9795-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/19/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There are few data about thoracic hyperkyphosis which focused on respiratory events and prognoses. We investigated the clinical features and outcomes of respiratory complications requiring hospitalization in patients with thoracic hyperkyphosis. METHODS Following a retrospective review of the medical records between 2002 and 2011, we included 51 patients with thoracic hyperkyphosis who had visited the respiratory department due to respiratory symptoms. RESULTS Of total 51 patients, 35 patients were hospitalized due to respiratory events. Among 56 total hospitalized events, acute respiratory failure (ARF) (n = 18) and exacerbation of a chronic airway disorder (n = 18) were the most common causes. Respiratory events related mortality was 13.7 % (7/51). The median value of the thoracic kyphosis angle was 89.0°. The ratio of the measured kyphosis angle to the normal value according to age and sex showed the median value of 2.38 (interquartile range 1.61-2.87). This ratio was negatively correlated with both predicted forced vital capacity (γ = -0.647, p < 0.0001) and predicted forced expiratory volume for 1 s (γ = -0.518, p = 0.008). After adjustments for age and sex, hyperkyphosis (angle ≥90°) was not found to influence the development of ARF (hazard ratio 3.2; 95 % confidence interval, 0.86-12.14; p = 0.082). CONCLUSIONS Patients with thoracic hyperkyphosis presenting to a respiratory department with respiratory issues commonly experienced respiratory events requiring hospitalization and had a poor prognosis. In addition, the severity of the kyphosis angle was correlated with respiratory insufficiency although it was not a risk factor for the development of ARF.
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Affiliation(s)
- Seok Jeong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, 1071, Anyangcheon-ro, Yangcheon-Gu, Seoul, 07985, Republic of Korea
| | - Ji Young Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, 1071, Anyangcheon-ro, Yangcheon-Gu, Seoul, 07985, Republic of Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, 1071, Anyangcheon-ro, Yangcheon-Gu, Seoul, 07985, Republic of Korea.
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, 1071, Anyangcheon-ro, Yangcheon-Gu, Seoul, 07985, Republic of Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, 1071, Anyangcheon-ro, Yangcheon-Gu, Seoul, 07985, Republic of Korea
| | - Sung Shine Shim
- Department of Radiology, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Ji Young Hwang
- Department of Radiology, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Republic of Korea
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