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09.08.2022 | Original Article

Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age

verfasst von: Alexandria F. Naftchi, John Vellek, Julia Stack, Eris Spirollari, Sima Vazquez, Ankita Das, Jacob D. Greisman, Zehavya Stadlan, Omar H. Tarawneh, Sabrina Zeller, MD, Jose F. Dominguez, Merritt D. Kinon, Chirag D. Gandhi, Syed Faraz Kazim, Meic H. Schmidt, Christian A. Bowers

Erschienen in: Dysphagia | Ausgabe 3/2023

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Abstract

Frailty is a measure of physiological reserve that has been demonstrated to be a discriminative predictor of worse outcomes across multiple surgical subspecialties. Anterior cervical discectomy and fusion (ACDF) is one of the most common neurosurgical procedures in the United States and has a high incidence of postoperative dysphagia. To determine the association between frailty and dysphagia after ACDF and compare the predictive value of frailty and age. 155,300 patients with cervical stenosis (CS) who received ACDF were selected from the 2016–2019 National Inpatient Sample (NIS) utilizing International Classification of Disease, tenth edition (ICD-10) codes. The 11-point modified frailty index (mFI-11) was used to stratify patients based on frailty: mFI-11 = 0 was robust, mFI-11 = 1 was prefrail, mFI-11 = 2 was frail, and mFI-11 = 3 + was characterized as severely frail. Demographics, complications, and outcomes were compared between frailty groups. A total of 155,300 patients undergoing ACDF for CS were identified, 33,475 (21.6%) of whom were frail. Dysphagia occurred in 11,065 (7.1%) of all patients, and its incidence was significantly higher for frail patients (OR 1.569, p < 0.001). Frailty was a risk factor for postoperative complications (OR 1.681, p < 0.001). Increasing frailty and undergoing multilevel ACDF were significant independent predictors of negative postoperative outcomes, including dysphagia, surgically placed feeding tube (SPFT), prolonged LOS, non-home discharge, inpatient death, and increased total charges (p < 0.001 for all). Increasing mFI-11 score has better prognostic value than patient age in predicting postoperative dysphagia and SPFT after ACDF.

Barsa P, Suchomel P, Buchvald P, Kolárová E, Svobodník A. Multiple-level instrumented anterior cervical fusion: a risk factor for pseudoarthrosis? A prospective study with a minimum of 3-year follow-up. Acta Chir Orthop Traumatol Cech. 2004;71(3):137–41.PubMed

Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine. 2015;40(12):E675-693. https://doi.org/10.1097/BRS.0000000000000913.CrossRefPubMed

Saifi C, Fein AW, Cazzulino A, et al. Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J Off J North Am Spine Soc. 2018;18(6):1022–9. https://doi.org/10.1016/j.spinee.2017.10.072.CrossRef

Stieber JR, Brown K, Donald GD, Cohen JD. Anterior cervical decompression and fusion with plate fixation as an outpatient procedure. Spine J Off J North Am Spine Soc. 2005;5(5):503–7. https://doi.org/10.1016/j.spinee.2005.01.011.CrossRef

Perez-Roman RJ, Luther EM, McCarthy D, et al. National trends and correlates of dysphagia after anterior cervical discectomy and fusion surgery. Neurospine. 2021;18(1):147–54. https://doi.org/10.14245/ns.2040452.226.CrossRefPubMedPubMedCentral

Maroon JC, Bost JW, Petraglia AL, et al. Outcomes after anterior cervical discectomy and fusion in professional athletes. Neurosurgery. 2013;73(1):103–12. https://doi.org/10.1227/01.neu.0000429843.68836.91 (discussion 112).CrossRefPubMed

Omidi-Kashani F, GhayemHasankhani E, Ghandehari R. Impact of age and duration of symptoms on surgical outcome of single-level microscopic anterior cervical discectomy and fusion in the patients with cervical spondylotic radiculopathy. Neurosci J. 2014. https://doi.org/10.1155/2014/808596.CrossRefPubMedPubMedCentral

Lee R, Lee D, Gowda NB, et al. Increased rates of septic shock, cardiac arrest, and mortality associated with chronic steroid use following anterior cervical discectomy and fusion for cervical stenosis. Int J Spine Surg. 2020;14(5):649–56. https://doi.org/10.14444/7095.CrossRefPubMedPubMedCentral

Singh K, Marquez-Lara A, Nandyala SV, Patel AA, Fineberg SJ. Incidence and risk factors for dysphagia after anterior cervical fusion. Spine. 2013;38(21):1820–5. https://doi.org/10.1097/BRS.0b013e3182a3dbda.CrossRefPubMed

10.

Epstein NE. A review of complication rates for Anterior Cervical Diskectomy and Fusion (ACDF). Surg Neurol Int. 2019;10:100. https://doi.org/10.25259/SNI-191-2019.CrossRefPubMedPubMedCentral

11.

Yue WM, Brodner W, Highland TR. Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year follow-up study. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2005;14(7):677–82. https://doi.org/10.1007/s00586-004-0849-3.CrossRef

12.

Segebarth B, Datta JC, Darden B, et al. Incidence of dysphagia comparing cervical arthroplasty and ACDF. SAS J. 2010;4(1):3–8. https://doi.org/10.1016/j.esas.2009.12.001.CrossRefPubMedPubMedCentral

13.

Rihn JA, Kane J, Albert TJ, Vaccaro AR, Hilibrand AS. What is the incidence and severity of dysphagia after anterior cervical surgery? Clin Orthop. 2011;469(3):658–65. https://doi.org/10.1007/s11999-010-1731-8.CrossRefPubMed

14.

Leonard R, Belafsky P. Dysphagia following cervical spine surgery with anterior instrumentation: evidence from fluoroscopic swallow studies. Spine. 2011;36(25):2217–23. https://doi.org/10.1097/BRS.0b013e318205a1a7.CrossRefPubMed

15.

Miles A, Jamieson G, Shasha L, Davis K. Characterizing dysphagia after spinal surgery. J Spinal Cord Med. 2021;44(5):733–41. https://doi.org/10.1080/10790268.2019.1665613.CrossRefPubMed

16.

Wewel JT, Brahimaj BC, Kasliwal MK, Traynelis VC. Perioperative complications with multilevel anterior and posterior cervical decompression and fusion. J Neurosurg Spine. 2019. https://doi.org/10.3171/2019.6.SPINE198.CrossRefPubMed

17.

Yin DH, Yang XM, Huang Q, et al. Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol—Head Neck Surg. 2015;272(8):2077–82. https://doi.org/10.1007/s00405-014-3483-7.CrossRef

18.

Shem K, Castillo K, Wong S, Chang J. Dysphagia in individuals with tetraplegia: incidence and risk factors. J Spinal Cord Med. 2011;34(1):85–92. https://doi.org/10.1179/107902610X12911165974981.CrossRefPubMedPubMedCentral

19.

Krnacik MJ, Heggeness MH. Severe angioedema causing airway obstruction after anterior cervical surgery. Spine. 1997;22(18):2188–90. https://doi.org/10.1097/00007632-199709150-00019.CrossRefPubMed

20.

Olsson EC, Jobson M, Lim MR. Risk factors for persistent dysphagia after anterior cervical spine surgery. Orthopedics. 2015;38(4):e319-323. https://doi.org/10.3928/01477447-20150402-61.CrossRefPubMed

21.

Sarbinowska J, Wiatrak B, Waśko-Czopnik D. Esophageal motility disorders in the natural history of acid-dependent causes of dysphagia and their influence on patients’ quality of life-a prospective cohort study. Int J Environ Res Public Health. 2021;18(21):11138. https://doi.org/10.3390/ijerph182111138.CrossRefPubMedPubMedCentral

22.

Elsamadicy AA, Koo AB, David WB, et al. Ramifications of postoperative dysphagia on health care resource utilization following elective anterior cervical discectomy and interbody fusion for cervical spondylotic myelopathy. Clin Spine Surg. 2021. https://doi.org/10.1097/BSD.0000000000001241.CrossRef

23.

Cameron K, Lawless MH, Conway R, et al. Risk factors for dysphagia following a cervical fusion in a trauma population. Cureus. 2018. https://doi.org/10.7759/cureus.3489.CrossRefPubMedPubMedCentral

24.

Nguyen S, Sherrod BA, Paziuk TM, et al. Predictors of dysphagia after anterior cervical discectomy and fusion: a prospective multicenter study. Spine. 2021. https://doi.org/10.1097/BRS.0000000000004279.CrossRefPubMed

25.

Wilson JRF, Badhiwala JH, Jiang F, et al. The impact of older age on functional recovery and quality of life outcomes after surgical decompression for degenerative cervical myelopathy: results from an ambispective, propensity-matched analysis from the CSM-NA and CSM-I international, multi-center studies. J Clin Med. 2019;8(10):E1708. https://doi.org/10.3390/jcm8101708.CrossRef

26.

Azizkhanian I, Rothbaum M, Alcantara R, et al. Demographics and outcomes of interhospital neurosurgical transfer patients undergoing spine surgery. World Neurosurg. 2020;144:e221–6. https://doi.org/10.1016/j.wneu.2020.08.080.CrossRefPubMed

27.

Dicpinigaitis AJ, Hanft S, Cooper JB, et al. Comparative associations of baseline frailty status and age with postoperative mortality and duration of hospital stay following metastatic brain tumor resection. Clin Exp Metastasis. 2022. https://doi.org/10.1007/s10585-021-10138-3.CrossRefPubMed

28.

Walid MS, Robinson JS. Economic impact of comorbidities in spine surgery. J Neurosurg Spine. 2011;14(3):318–21. https://doi.org/10.3171/2010.11.SPINE10139.CrossRefPubMed

29.

Patel AJ, Sivaganesan A, Bollo RJ, Brayton A, Luerssen TG, Jea A. Assessment of the impact of comorbidities on perioperative complications in pediatric neurosurgery. J Neurosurg Pediatr. 2014;13(5):579–82. https://doi.org/10.3171/2014.1.PEDS13372.CrossRefPubMed

30.

Eskesen V, Rosenørn J, Schmidt K. The impact of rebleeding on the life time probabilities of different outcomes in patients with ruptured intracranial aneurysms a theoretical evaluation. Acta Neurochir (Wien). 1988;95(3–4):99–101. https://doi.org/10.1007/BF01790768.CrossRefPubMed

31.

Dominguez JF, Shah S, Ampie L, et al. Spinal epidural abscess patients have higher modified frailty indexes than back pain patients on emergency room presentation: a single-center retrospective case-control study. World Neurosurg. 2021;152:e610–6. https://doi.org/10.1016/j.wneu.2021.06.035.CrossRefPubMed

32.

Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. Scientific World J. 2001;1:323–36. https://doi.org/10.1100/tsw.2001.58.CrossRef

33.

Ng C, Dominguez JF, Hosein-Woodley R, et al. Utility of frailty as a predictor of acute kidney injury in patients with aneurysmal subarachnoid hemorrhage. Interv Neuroradiol J Peritherapeutic Neuroradiol Surg Proced Relat Neurosci. 2022. https://doi.org/10.1177/15910199221076626.CrossRef

34.

Wilson JRF, Badhiwala JH, Moghaddamjou A, Yee A, Wilson JR, Fehlings MG. Frailty is a better predictor than age of mortality and perioperative complications after surgery for degenerative cervical myelopathy: an analysis of 41,369 patients from the NSQIP database 2010–2018. J Clin Med. 2020;9(11):E3491. https://doi.org/10.3390/jcm9113491.CrossRef

35.

Adams P, Ghanem T, Stachler R, Hall F, Velanovich V, Rubinfeld I. Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery. JAMA Otolaryngol-Head Neck Surg. 2013;139(8):783–9. https://doi.org/10.1001/jamaoto.2013.3969.CrossRefPubMed

36.

Kazim SF, Dicpinigaitis AJ, Bowers CA, et al. Frailty status is a more robust predictor than age of spinal tumor surgery outcomes: a NSQIP analysis of 4,662 patients. Neurospine. 2022. https://doi.org/10.14245/ns.2142770.385.CrossRefPubMedPubMedCentral

37.

Ali R, Schwalb JM, Nerenz DR, Antoine HJ, Rubinfeld I. Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J Neurosurg Spine. 2016;25(4):537–41. https://doi.org/10.3171/2015.10.SPINE14582.CrossRefPubMed

38.

Fisher C, Tee J. Editorial: the utility of the modified frailty index for risk stratification in patients undergoing spine surgery. J Neurosurg Spine. 2016;25(4):535–6. https://doi.org/10.3171/2016.1.SPINE151261.CrossRefPubMed

39.

Ahmed AK, Goodwin CR, De la Garza-Ramos R, et al. Predicting short-term outcome after surgery for primary spinal tumors based on patient frailty. World Neurosurg. 2017;108:393–8. https://doi.org/10.1016/j.wneu.2017.09.034.CrossRefPubMed

40.

Shin JI, Kothari P, Phan K, et al. Frailty index as a predictor of adverse postoperative outcomes in patients undergoing cervical spinal fusion. Spine. 2017;42(5):304–10. https://doi.org/10.1097/BRS.0000000000001755.CrossRefPubMed

41.

HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Published online 2019. 2016. www.hcup-us.ahrq.gov/nisoverview.jsp

42.

Rofes L, Arreola V, Romea M, et al. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2010;22(8):851-e230. https://doi.org/10.1111/j.1365-2982.2010.01521.x.CrossRef

43.

Qureshi SA, Koehler SM, Lu Y, Cho S, Hecht AC. Utilization trends of cervical artificial disc replacement during the FDA investigational device exemption clinical trials compared to anterior cervical fusion. J Clin Neurosci Off J Neurosurg Soc Australas. 2013;20(12):1723–6. https://doi.org/10.1016/j.jocn.2013.03.002.CrossRef

44.

Nandyala SV, Marquez-Lara A, Fineberg SJ, Singh K. Comparison between cervical total disc replacement and anterior cervical discectomy and fusion of 1 to 2 levels from 2002 to 2009. Spine. 2014;39(1):53–7. https://doi.org/10.1097/BRS.0000000000000044.CrossRefPubMed

45.

Pierce KE, Naessig S, Kummer N, et al. The five-item modified frailty index is predictive of 30-day postoperative complications in patients undergoing spine surgery. Spine. 2021;46(14):939–43. https://doi.org/10.1097/BRS.0000000000003936.CrossRefPubMed

46.

Yagi M, Michikawa T, Hosogane N, et al. The 5-item modified frailty index is predictive of severe adverse events in patients undergoing surgery for adult spinal deformity. Spine. 2019;44(18):E1083–91. https://doi.org/10.1097/BRS.0000000000003063.CrossRefPubMed

47.

Zreik J, Alvi MA, Yolcu YU, Sebastian AS, Freedman BA, Bydon M. Utility of the 5-item modified frailty index for predicting adverse outcomes following elective anterior cervical discectomy and fusion. World Neurosurg. 2021;146:e670–7. https://doi.org/10.1016/j.wneu.2020.10.154.CrossRefPubMed

48.

Huang CT, Lin WC, Ho CH, et al. Incidence of severe dysphagia after brain surgery in pediatric traumatic brain injury: a nationwide population-based retrospective study. J Head Trauma Rehabil. 2014;29(6):E31-36. https://doi.org/10.1097/HTR.0000000000000032.CrossRefPubMed

49.

Tian H, Abouzaid S, Sabbagh MN, et al. Health care utilization and costs among patients with AD with and without dysphagia. Alzheimer Dis Assoc Disord. 2013;27(2):138–44. https://doi.org/10.1097/WAD.0b013e318258cd7d.CrossRefPubMed

50.

Ritzwoller DP, Glasgow RE, Sukhanova AY, et al. Economic analyses of the be fit be well program: a weight loss program for community health centers. J Gen Intern Med. 2013;28(12):1581–8. https://doi.org/10.1007/s11606-013-2492-3.CrossRefPubMedPubMedCentral

51.

Killien EY, Mills B, Errett NA, et al. Prediction of pediatric critical care resource utilization for disaster triage. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2020;21(8):e491–501. https://doi.org/10.1097/PCC.0000000000002425.CrossRef

52.

Berger JS, Haskell L, Ting W, et al. Evaluation of machine learning methodology for the prediction of healthcare resource utilization and healthcare costs in patients with critical limb ischemia-is preventive and personalized approach on the horizon? EPMA J. 2020;11(1):53–64. https://doi.org/10.1007/s13167-019-00196-9.CrossRefPubMedPubMedCentral

53.

Garfinkle R, Abou-Khalil M, Salama E, et al. Development and validation of a clinical risk score for intensive care resource utilization after colon cancer surgery: a practical guide to the selection of patients during COVID-19. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2021;25(1):252–9. https://doi.org/10.1007/s11605-020-04665-9.CrossRef

54.

Aubert CE, Schnipper JL, Roumet M, et al. Best definitions of multimorbidity to identify patients with high health care resource utilization. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):40–9. https://doi.org/10.1016/j.mayocpiqo.2019.09.002.CrossRefPubMedPubMedCentral

55.

Siebenhüner K, Blaser J, Nowak A, et al. Comorbidities associated with worse outcomes among inpatients admitted for acute gastrointestinal bleeding. Dig Dis Sci. 2021. https://doi.org/10.1007/s10620-021-07197-7.CrossRefPubMedPubMedCentral

56.

Tracy BM, Carlin MN, Tyson JW, Schenker ML, Gelbard RB. The 11-item modified frailty index as a tool to predict unplanned events in traumatic brain injury. Am Surg. 2020;86(11):1596–601. https://doi.org/10.1177/0003134820942196.CrossRefPubMed

57.

Pulik Ł, Jaśkiewicz K, Sarzyńska S, Małdyk P, Łęgosz P. Modified frailty index as a predictor of the long-term functional result in patients undergoing primary total hip arthroplasty. Reumatologia. 2020;58(4):213–20. https://doi.org/10.5114/reum.2020.98433.CrossRefPubMedPubMedCentral

58.

Traven SA, Reeves RA, Althoff AD, Slone HS, Walton ZJ. New five-factor modified frailty index predicts morbidity and mortality in geriatric hip fractures. J Orthop Trauma. 2019;33(7):319–23. https://doi.org/10.1097/BOT.0000000000001455.CrossRefPubMed

59.

Araújo-Andrade L, Rocha-Neves JP, Duarte-Gamas L, et al. Prognostic effect of the new 5-factor modified frailty index in patients undergoing carotid endarterectomy with regional anesthesia - a prospective cohort study. Int J Surg Lond Engl. 2020;80:27–34. https://doi.org/10.1016/j.ijsu.2020.05.074.CrossRef

60.

Aceto P, Bassi P, Sollazzi L, et al. Implementation of frailty preoperative assessment to predict outcome in patients undergoing urological surgery: a systematic review and meta-analysis. BJU Int. 2021;127(5):507–17. https://doi.org/10.1111/bju.15314.CrossRefPubMed

61.

Jung JM, Chung CK, Kim CH, Yang SH, Ko YS. The modified 11-item frailty index and postoperative outcomes in patients undergoing lateral lumbar interbody fusion. Spine. 2022;47(5):396–404. https://doi.org/10.1097/BRS.0000000000004260.CrossRefPubMed

62.

Nunley PD, Jawahar A, Kerr EJ, Cavanaugh DA, Howard C, Brandao SM. Choice of plate may affect outcomes for single versus multilevel ACDF: results of a prospective randomized single-blind trial. Spine J Off J North Am Spine Soc. 2009;9(2):121–7. https://doi.org/10.1016/j.spinee.2007.11.009.CrossRef

63.

Danto J, DiCapua J, Nardi D, et al. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy. J Neurosurg Anesthesiol. 2012;24(4):350–5. https://doi.org/10.1097/ANA.0b013e3182622843.CrossRefPubMed

64.

Grant DG, Bradley PT, Pothier DD, et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol Off J ENT-UK Off J Neth Soc Oto-Rhino-Laryngol Cervico-Facial Surg. 2009;34(2):103–12. https://doi.org/10.1111/j.1749-4486.2009.01889.x.CrossRef

65.

Mays AC, Worley M, Ackall F, D’Agostino R, Waltonen JD. The association between gastrostomy tube placement, poor post-operative outcomes, and hospital re-admissions in head and neck cancer patients. Surg Oncol. 2015;24(3):248–57. https://doi.org/10.1016/j.suronc.2015.08.005.CrossRefPubMedPubMedCentral

66.

Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 2014;20(24):7739–51. https://doi.org/10.3748/wjg.v20.i24.7739.CrossRefPubMedPubMedCentral

67.

Kirshblum S, Johnston MV, Brown J, O’Connor KC, Jarosz P. Predictors of dysphagia after spinal cord injury. Arch Phys Med Rehabil. 1999;80(9):1101–5. https://doi.org/10.1016/s0003-9993(99)90068-0.CrossRefPubMed

68.

Li YD, Chi JE, Chiu PY, Kao FC, Lai PL, Tsai TT. The comparison between anterior and posterior approaches for removal of infected lumbar interbody cages and a proposal regarding the use of endoscope-assisted technique. J Orthop Surg. 2021;16(1):386. https://doi.org/10.1186/s13018-021-02535-x.CrossRef

69.

Seng C, Tow BPB, Siddiqui MA, et al. Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty. Spine J Off J North Am Spine Soc. 2013;13(7):723–31. https://doi.org/10.1016/j.spinee.2013.02.038.CrossRef

Titel: Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age
verfasst von: Alexandria F. Naftchi
John Vellek
Julia Stack
Eris Spirollari
Sima Vazquez
Ankita Das
Jacob D. Greisman
Zehavya Stadlan
Omar H. Tarawneh
Sabrina Zeller, MD
Jose F. Dominguez
Merritt D. Kinon
Chirag D. Gandhi
Syed Faraz Kazim
Meic H. Schmidt
Christian A. Bowers
Publikationsdatum: 09.08.2022
Verlag: Springer US
Erschienen in: Dysphagia / Ausgabe 3/2023
Print ISSN: 0179-051X
Elektronische ISSN: 1432-0460
DOI: https://doi.org/10.1007/s00455-022-10505-6

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Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age

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