Same-day Group Research Articles

Do we need group and save for trans-urethral resection of bladder tumour and trans-urethral resection of the prostate procedures?

Background: Trans-urethral resection of the prostate (TURP) and trans-urethral resection of bladder tumour (TURBT) are urological procedures essential for treating benign prostatic hyperplasia (BPH) and non-muscle invasive bladder cancer, respectively, these procedures may result in post-operative bleeding. In our hospital, pre-operative blood group and save is a routine to enhance patient safety. This study aims to evaluate transfusion rates and the potential cost benefits of limiting routine blood group and save. Methods: We conducted a retrospective audit of patients undergoing TURP and TURBT between October 2018 and October 2020. Data was collected using theatre system records and blood bank information regarding transfusions. Results: Out of 233 patients (average age 74), 141 underwent TURBT, 89 underwent TURP, and 3 underwent both simultaneously. Historical group and save were found in 214 (91.84%) patients, and 162 (69.5%) had same-day group and save. Only 2 patients (0.85%) necessitated transfusions. Conclusions: The necessity for blood transfusion after TURP and TURBT is low, indicating that routine pre-operative group and save may not be essential for all patients. Tailoring this practice to high-risk individuals may reduce costs and relieve workloads. Enhanced surgical techniques and tools are likely contributors to these improved outcomes.

When is staging complex adult spinal deformity advantageous? Identifying subsets of patients who benefit from staged interventions.

The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery. Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts. Backstep logistic regression and conditional inference tree analysis were used to identify variable thresholds associated with study-specific definitions of an optimal outcome in each cohort, defined as no intraoperative or surgery-related in-hospital adverse event. There were 439 patients with complex ASD in the dataset (mean age 64.0 ± 9.3 years, 68% female, mean BMI 28.7 ± 5.5 kg/m2). Overall, 58.8% of patients were in the same-day group, while 41.2% were in the staged group. Demographically, cohorts were not significantly different (p > 0.05), but staged patients were more frail per total Edmonton Frail Scale score (p = 0.043). Staged patients also reported greater numeric rating scale scores for back pain than same-day patients (p = 0.002). Cohorts were comparable in magnitude of planned correction of C7-S1 sagittal vertical axis, pelvic incidence-lumbar lordosis (PI-LL) mismatch, and T4-12 kyphosis (all p > 0.05). Controlling for baseline age, frailty, and number of levels fused, staged patients reported significantly higher PROMIS Discretionary Social Activities scores by 6 weeks (p = 0.029). Radiographic outcomes by 6 weeks were comparable between cohorts, in terms of both magnitude of change from baseline and overall result (all p > 0.05). Same-day patients were significantly more likely to experience in-hospital complications (p = 0.013). When considering frailty thresholds for staging, only a Charlson Comorbidity Index ≤ 1.0 was associated with optimal outcome in same-day patients, while Edmonton Frail Scale score ≥ 7 (p = 0.036), ≥ 9 levels fused (p = 0.016), and baseline PI-LL mismatch ≥ 15.3° (p = 0.028) were associated with optimal outcome for staged patients. Yet, staging alone was not significantly associated with an optimal outcome perioperatively (p = 0.056). While staged and same-day combined-approach surgeries yield comparable radiographic and patient-reported outcomes, certain subsets of complex ASD patients may benefit from staged surgery despite the invariably increased hospital length of stay. Individuals with increased frailty, moderate to severe PI-LL mismatch, and increased anticipated number of levels fused may experience a lower risk of perioperative adverse events if they undergo a staged procedure. Clinical trial registration no.: NCT04194138 (ClinicalTrials.gov).

Efficacy and safety of same-day versus next-day administration of PEG-rhG-CSF for the prophylaxis of chemotherapy-induced neutropenia and febrile neutropenia in patients with breast cancer: a retrospective cohort study

Objectives Polyethylene glycol recombinant human granulocyte colony-stimulating factors (PEG-rhG-CSFs) are used to prevent or treat chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN). This study aimed to compare the efficacy and safety of same-day versus next-day PEG-rhG-CSF administration following chemotherapy and the effects of 3 mg versus 6 mg dosages. Methods We retrospectively analyzed cohort data of patients with breast cancer who underwent chemotherapy and received PEG-rhG-CSF either within 24 h (same-day group) or 24 h (next-day group) after chemotherapy. The incidences of CIN and FN were assessed in each chemotherapy cycle between the two groups. The primary endpoint was the incidence of FN in the first cycle and throughout all cycles. The secondary endpoints included the incidences of various grades of CIN (CIN1–CIN4), antibiotic use, chemotherapy regimen modifications, and overall safety. Results Among the 2385 chemotherapy cycles with prophylactic PEG-rhG-CSF in 620 patients, 798 and 1587 cycleswere in the same-day and next-day group, respectively. No statistically significant differences were observed in the incidence of FN in the first cycle or across all cycles, CIN1-4, or adverse reactions between the two groups. However, the same-day group exhibited significantly higher rates of antibiotic use (2.88% vs. 0.42%, p = .03) and chemotherapy regimen modification (4.68% vs. 1.45%, p < .001). Subgroup analysis indicated no differences in outcomes for the 6 mg dosage, but a significantly lower incidence of CIN was observed in the same-day group receiving 3 mg (p = .025). Conclusions These findings suggest that same-day administration of PEG-rhG-CSF is as effective and safe as next-day administration in preventing FN and CIN during chemotherapy.

Comparison of Staged vs Same-Day Circumferential Spinal Fusions for Adult Spinal Deformity.

Patients often undergo circumferential (anterior and posterior) spinal fusions to maximize adult spinal deformity (ASD) correction and achieve adequate fusion. Currently, such procedures are performed in staged (ST) or same-day (SD) procedures with limited evidence to support either strategy. This study aims to compare perioperative outcomes and costs of ST vs SD circumferential ASD corrective surgeries. This is a retrospective review of patients undergoing circumferential ASD surgeries between 2013 and 2018 in a single institution. Patient characteristics, preoperative comorbidities, surgical details, perioperative complications, readmissions, total hospital admission costs, and 90-day postoperative care costs were identified. All variables were tested for differences between ST and SD groups unadjusted and after applying inverse probability weighting (IPW), and the results before and after IPW were compared. The entire cohort included a total of 211 (ST = 50, SD = 161) patients, 100 of whom (ST = 44, SD = 56) underwent more than 4 levels fused posteriorly and anterior lumbar interbody fusion (ALIF). Although patient characteristics and comorbidities were not dissimilar between the ST and SD groups, both the number of levels fused in ALIF and posterior spinal fusion (PSF) were significantly different. Thus, using IPW, we were able to minimize the cohort incongruities in the number of levels fused in ALIF and PSF while maintaining comparable patient characteristics. In both the whole cohort and the long segment fusions, postoperative pulmonary embolism was more common in ST procedures. After adjustment utilizing IPW, both groups were not significantly different in disposition, 30-day readmissions, and reoperations. However, within the whole cohort and the long segment fusion cohort, the ST group continued to show significantly increased rates of pulmonary embolism, longer length of stay, and higher hospital admission costs compared with the SD group. Adjusted comparisons between ST and SD groups showed staging associated with significantly increased length of stay, risk of pulmonary embolism, and admission costs.

Safety of Same-Day Hospital Discharge Post Patent Foramen Ovale Closure: Findings from a Multicenter Study

Transcatheter patent foramen ovale (PFO) closure is indicated for patients with cryptogenic stroke. Although procedural safety is well established, there are limited data on the safety of same-day (SD) discharge. We aimed to review the outcomes of PFO closure with SD. Patients who underwent transcatheter PFO closure between January 2011 and May 2022 at 4 large US hospitals were retrospectively analyzed, comparing outcomes of SD versus delayed discharge (DD). The primary end point was a composite of access-site complication, stroke, device embolization, atrial arrhythmia, and bleeding. Secondary analysis comparing imaging modality and outcomes was performed. 554 patients (49.2% female) were analyzed (382 discharged SD). Average age was 54.3 ± 15. Baseline characteristics in both groups were broadly similar. Previous stroke (78.0% SD vs 76.2% DD, p=0.32) was the commonest indication for PFO closure. In the SD group, there was less general anesthesia use (5.5% vs 16.9%, p <0.001). Intraprocedural intracardiac echocardiography was used more frequently in SD cases (95.0% vs 81.4%, p <0.001). In the DD group, median stay was 1 night, and 34.9% stayed beyond 1 night. At 30days, there was no difference in the primary composite end point (14.9% vs 11.6%, p=0.15). There was no inter-group difference in individual adverse events (all p >0.05). When comparing imaging modality and outcomes, there was no difference in composite end points between transesophageal and intracardiac echocardiography (6.5% vs 14.7%, p=0.063). In conclusion, SD discharge after transcatheter PFO closure appears safe. This efficient approach may be advantageous in optimizing workflow and minimizing hospital occupancy.

Same-day versus delayed simulation imaging after placement of a perirectal hydrogel spacer for prostate radiotherapy.

Placement of a perirectal hydrogel spacer has been demonstrated to reduce the risk of rectal toxicity from prostate radiation. Practices vary regarding the timing of CT simulation after hydrogel placement, and the ideal schedule remains unknown. Thirty patients with localized prostate adenocarcinoma underwent transrectal ultrasound-guided placement of an iodinated SpaceOAR™ hydrogel prior to radiotherapy. Per evolving practice, 15 completed same-day simulation and 15 returned for simulation 1-2 weeks later. Hydrogel volume, perirectal distance, air-void volume, and rectal dosimetry per NRG GU005 were compared between CT simulation, 1st fraction Cone-Beam-CT (CBCT), and final CBCT. CT simulation occurred 8.8 ± 2.4 days after placement in the delayed group, with no significant difference in the interval between simulation and 1st fraction between groups (p = 0.165). Greater observed de-creases in hydrogel volume (0.57 cc vs. 0.04 cc, p = 0.0002), and perirectal distance at both mid-gland (1.32mm vs. 0.17mm) and tallest point (2.40mm vs. 0.04mm) were seen on 1st-fraction CBCT in the same-day group (p = 0.0039; p = 0.0002). Per dosimetry recalculated on 1st fraction CBCT, five (D3 cc and D50%) versus one (D50%) rectal dose parameters were exceeded in the same-day and delayed groups, respectively, and 10 versus one parameters had a relative increase of ≥ 20%. Due to the evolving anatomic changes in the days following hydrogel placement, same-day simulation scanning may introduce unintended variability in rectal dosimetry at the time of prostate radiotherapy.

Efficacy of same-day versus next-day administration of pegfilgrastim for the prevention of chemotherapy-induced febrile neutropenia in breast cancer patients receiving dose-dense doxorubicin and cyclophosphamide: A retrospective multi-site analysis.

Administering pegfilgrastim on the same day as chemotherapy can improve patient satisfaction through convenience and may increase the utilization of cost-effective biosimilars compared to next-day administration, but the effect on clinical outcomes with commonly used breast cancer regimens is unclear. This multi-site, retrospective cohort study included breast cancer patients age 18 years or older who received dose-dense doxorubicin and cyclophosphamide (ddAC) and pegfilgrastim between 1 June 2016 and 31 May 2020. Pegfilgrastim was given on the same day as chemotherapy at one site and the day after chemotherapy at the other two sites. The primary endpoint compared the incidence of febrile neutropenia associated with pegfilgrastim administration timing. A total of 360 patients were reviewed (146 same-day administration and 214 next-day administration). In the same-day group 36 patients (24.6%) developed FN compared to 25 patients (11.7%) in the next-day group (p = 0.002). Same-day administration also significantly increased the incidences of additional acute care visits (11.6% vs 2.8%, p = 0.0016), grade ≥ 3 neutropenia (38.4% vs 13.6%, p < 0.0001), chemotherapy dose reductions (21.2% vs 6.1%, p < 0.0001), and antibiotic use (26.7% vs 12.6%, p = 0.001). Same-day administration did not significantly increase the rate of hospitalization (15% vs 11.2%, p = 0.36) and delay of next chemotherapy cycle by ≥1 day (8.2% vs 6.1%, p = 0.57) due to neutropenic complications. Administering pegfilgrastim on the same day as ddAC led to a significant increase in neutropenic complications. This study confirms the need to administer pegfilgrastim the day after chemotherapy in breast cancer patients receiving ddAC.

Acute complications with same-day versus overnight cervical preparation before dilation and evacuation at 14 to 16 weeks

Evaluate if same-day cervical preparation is associated with a clinically acceptable complication rate compared with overnight osmotic dilators for dilation and evacuation (D&E). This retrospective, noninferiority, cohort study compared complication rates for same-day versus overnight cervical preparation with D&E between 14 and 16 weeks gestation. Cervical preparation was achieved with misoprostol, osmotic dilators, or both. Our primary outcome was the acute complication rate, defined as: hemorrhage (≥500 mL); hospitalization or hospital transfer; transfusion; or unplanned procedure occurring within 24 hours of the index procedure. Secondarily we evaluated nonmajor (re-aspiration, suture repair of cervical laceration, uterine tamponade, or emergency department only transfer) and major (transfusion, uterine artery embolization, abdominal surgery, or hospital admission) complications separately. Inverse probability of treatment weighting using the propensity score was used to perform an adjusted analysis, taking into account age, ethnicity, clinic location, insurance, gestational age, gravidity, and prior pregnancy outcomes. We analyzed 1,319 subjects (n=864 same-day, n=455 overnight). Same-day cervical preparation patients were more likely to have Medicaid and a prior vaginal delivery. In both unadjusted and adjusted analyses, acute complication rates for same-day were noninferior to overnight preparation (unadjusted 0.93% vs 1.98%, difference of -1.05%, CI: -2.48% to 0.38%; adjusted difference -0.50%, CI: -1.45 to 0.44%). Only one major complication in the same-day group, a cervical laceration resulting in hemorrhage requiring transfusion, occurred in the entire sample. In this retrospective review, same-day cervical preparation was noninferior to overnight preparation for D&E between 14 and 16 weeks gestation, both with low complication rates. For early second trimester dilation and evacuation, same-day cervical preparation should be considered a safe alternative to overnight cervical preparation.

57. Staged vs same-day circumferential thoracolumbar spine surgery

<h3>BACKGROUND CONTEXT</h3> Complexity and potential risk to the patient in the perioperative period have led to circumferential spine fusion surgery often being performed in a staged fashion, whether in the same admission or split admission. There is no established protocol or clear evidence that this is beneficial to the patient. Previous studies of this topic have tended to favor same-day surgery to staged surgery with decreased blood loss, length of stay and cost. Multiple factors can potentially contribute to morbidity for these patients, including multiple insults activating inflammatory response and repeated exposures to anesthetics. <h3>PURPOSE</h3> To determine if there is a difference in complication profile between staged vs same-day circumferential, multi-approach thoracolumbar spine surgery. <h3>STUDY DESIGN/SETTING</h3> A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021 in an academic center. <h3>PATIENT SAMPLE</h3> All patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion <h3>OUTCOME MEASURES</h3> Primary outcome: complication rate at 90 days. Secondary outcomes: complication profile - readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection. Surgical characteristics - length of stay, operative time, estimated blood loss, transfusion rates. Demographic characteristics -ages, sex, BMI, diabetes, smoking habits. <h3>METHODS</h3> A retrospective single-center cohort assessment for adult patients undergoing multiple approach thoracolumbar fusion surgery from January 2012 to December 2021. Patients who underwent anterior or lateral approaches for the purpose of disc preparation and fusion and subsequently had a posterior approach for screws were included. The same-day group had both parts performed under the same anesthetic vs the staged group who had separate anesthetics on separate days in a planned fashion. Statistical comparison of demographic data (ages, sex, BMI, diabetes, smoking habits), complication rates (readmission, reoperation, DVT/PE, Ileus, delayed extubation, infection) and surgical characteristics (operative time, length of stay, estimated blood loss, transfusion rates) was made between the two groups. <h3>RESULTS</h3> A total of 1039 patients (918 same-day vs 121 staged) underwent circumferential thoracolumbar spine surgery from 2012 to 2021. The groups differed slightly in demographics with the staged group being slightly older (56.7 yrs same-day vs 59.6 yrs staged, p < 0.05) and had a higher incidence of smoking (6.6% same-day vs 22.3% staged, p < 0.001). The average time between stages was 2.5 days (SD 2.15). The total operative time was significantly longer in the staged group (354 min same-day vs 523 min staged, p < 0.001). The overall complication rate was not significantly different between the two groups (22.0% same-day vs 29.8% staged, p=0.748). Analysis of specific complications demonstrated an increase in DVT/PE (1.4% same-day vs 11.6% staged, p < 0.001) and postoperative ileus (4.2% same-day vs 15.7% staged, p < 0.001) in the staged group. The length of hospital admission was longer in the staged group (4.6 days same-day vs 7.7 days staged, p < 0.0001). <h3>CONCLUSIONS</h3> Staging circumferential surgery did not demonstrate statistical increase in complications at 90 days. However, review of specific postoperative complications including DVT/PE and postoperative ileus demonstrated significant increase in the staged group compared to the same-day group. The staged patients had a significantly longer hospital stay and their total surgery time was significantly longer. These would ultimately contribute heavily to hospital costs. There were potential limitations in the comparison of the groups with the staged patients being older and more likely to smoke. The study group recommends considering if staging the surgery is required as it can lead to increase in DVT/PE and postoperative ileus with prolonged stay in hospital. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Evaluation of Same-Day versus Next-Day Implantation of Intracanalicular Dexamethasone for the Control of Postoperative Inflammation and Pain Following Cataract Surgery.

PurposeTo evaluate the safety and efficacy of a sustained-release intracanalicular dexamethasone insert for postoperative inflammation and pain implanted in a clinical setting preoperatively or on postoperative day 1.MethodsSingle-site, retrospective, contralateral eye study of patients undergoing cataract surgery. Included were subjects with a dexamethasone intracanalicular insert implanted in the clinic immediately prior to surgery in one eye (same-day) and on postoperative day 1 (POD1) in the contralateral eye. The primary outcome measure was the resolution of anterior chamber inflammation at 1 week postoperative. Secondary outcome measures included proportion of eyes requiring additional therapy for pain and inflammation through 1 month as well as the number of eyes with IOP spikes above baseline. Safety measures included adverse events through 1 month postoperative.ResultsSixty-two eyes of 31 subjects were included in the case series. At 1 week postoperative, 52% of the eyes (n = 16) achieved complete resolution of inflammation in the same-day group and 58% (n = 18) met this endpoint at 1 week in the POD1 group. One subject in the same-day group required additional therapy for rebound inflammation and no eyes required additional therapy in the POD1 group. There were no reports of pain at 1 week or 1 month in either group. There were no implant-related adverse events in either group.ConclusionThe favorable results of this study indicate that the sustained-release dexamethasone insert can be safely implanted in the clinic either preoperatively on the day of surgery or on postoperative day 1 for the control of pain and inflammation following cataract surgery.

Abstract 14068: Prospective Evaluation of Same-Day Discharge After Cryoballoon Ablation of AF: Results of the Easy-PVI Study

Introduction: With advancements in technology and techniques, catheter ablation for the treatment of atrial fibrillation (AF) has become safer with time. Historically, standard-of-care recommended overnight stay after procedure. With improved safety and shorter procedure times, some centers have allowed for same-day discharge (SDD). We report the results of a multi-center, randomized clinical trial investigating the safety of SDD after cryoballoon (CB) ablation of paroxysmal AF. Methods: Patients underwent pulmonary vein isolation (PVI) with the Medtronic Arctic Advance TM cryoballoon at 3 experienced U.S. centers. Six hours after procedure, patients were randomized to either stay overnight or be discharged same-day after meeting study inclusion criteria. Results: A total of 51 patients were enrolled. Two were determined to be screen-fails following ablation of extra-pulmonary foci. Final analysis encompassed the 46 patients who completed randomization and follow-up, with 23 randomized to each group. No significant adverse outcomes were reported in either group, defined as major cardiovascular or cerebrovascular events. Occurrence of any adverse events, including arrhythmia recurrence, vascular complication, ventricular arrhythmia, syncope, pacemaker implant, pulmonary vein stenosis, and persistent phrenic nerve palsy, did not differ significantly between the two groups (p=1.0). Four patients had symptomatic and/or documented recurrence of atrial arrhythmia, three of which were in the same-day discharge group. Two patients developed cough post-operatively, one from each group. One patient from the next-day discharge cohort was diagnosed with pneumonia &gt;2 weeks post-procedure. No patients from either group required emergency room visits due to delayed procedural-related complications. Conclusions: This is the first randomized trial to our knowledge examining the safety of SDD post CB ablation. Based on our results, SDD following CB ablation is a safe option following uncomplicated ablation for PVI. Operators should use their discretion in selecting patients for SDD.

Adherence to Antiretroviral Treatment Among People Who Started Treatment on the Same-Day of HIV Diagnosis in Ethiopia: A Multicenter Observational Study.

IntroductionSince the launch of universal “test and treat” approach in 2016, there has been a significant increase in persons initiated on antiretroviral therapy (ART) on the same-day of human immunodeficiency virus (HIV) diagnosis in low-income settings. However, there are limited studies that investigated the effect of rapid treatment initiation on adherence. In this study, we compared adherence to ART in people who started ART on the same-day of HIV diagnosis and those started more than 7 days after HIV diagnosis.MethodsWe conducted a retrospective cohort analysis using routinely collected data from multiple ART clinics. Participants were at least 15 years old, were newly diagnosed and started on ART between October 2016 and July 2018 in the Amhara region of Ethiopia. We used doubly-robust multivariable logistic regression model to estimate the adjusted effects on adherence.ResultsA total of 415 individuals who started ART on the same-day of HIV diagnosis and 527 individuals who started 7 days after their HIV diagnosis were included in the analysis. The proportion of participants who reported optimal adherence was significantly lower in the same-day group at 6- and 12-months (absolute risk difference of 6.5%; 95% CI: 1.1%, 11.9% and 6.8%; 95% CI: 1.2%, 12.5%, respectively) compared to the >7 days group. After adjusting for baseline and non-baseline covariates, the same-day group was less likely to have optimal adherence both at 6- and 12-months (adjusted RR=0.90; 95% CI: 0.86, 0.94 and RR=0.89; 95% CI: 0.83, 0.95, respectively) compared to the >7 days group.ConclusionWe observed lower optimal adherence among individuals who started ART on the same-day of HIV diagnosis compared to those who started ART >7 days after their HIV diagnosis. Our findings highlight the importance of identifying adherence barriers, providing support, and ensuring treatment readiness before initiating individuals on same-day ART.

Real-world comparison of febrile neutropenia rates with same-day versus next-day administration of pegfilgrastim.

299 Background: Febrile neutropenia (FN) is a common side effect of myelosuppressive chemotherapy. Per guidelines, prophylactic pegfilgrastim is to be given 24-72 hours after chemotherapy in each cycle, but administering pegfilgrastim within 24 hours of chemotherapy (same day) is commonly done to reduce the burden on patients (pts) and healthcare systems. The ideal timing is under debate in the supportive oncology care field, but an increasing body of knowledge supports same-day administration as an option. The objective of this study was to compare the incidence of FN after same-day vs next-day administration of pegfilgrastim in pts with cancer receiving cytotoxic chemotherapy. Methods: A real-world, retrospective study of electronic health records of pts treated at Utah Cancer Specialists (Salt Lake City, UT) between February 2018 and December 2020 was conducted. Pts included in the study had a diagnosis of breast cancer, diffuse large B-cell lymphoma, or other cancers (eg. other lymphomas, prostate cancer); received a myelosuppressive chemotherapy regimen; and were administered either same-day or next-day prophylactic pegfilgrastim. FN was physician diagnosed; differences in FN incidence with same-day vs next-day pegfilgrastim were evaluated using a Chi-square test and Wald confidence limits. Results: 297 pts were included in this analysis. Most pts (63.6%) had a diagnosis of breast cancer, 23.6% had lymphoma, and 12.8% had other cancers. Pts received a broad range of chemotherapy regimens, with dose-dense doxorubicin and cyclophosphamide being the most common (43.4%). In cycle 1, pegfilgrastim administration timing was balanced between same-day (39.7% [118/297]) and next-day (60.3% [179/297]). The pegfilgrastim administration day changed in subsequent cycles in 27 pts (9.1%): 4 pts in the cycle 1 same-day group and 23 pts in the cycle 1 next-day group. In cycle 1, 7/117 pts (6.0%) in the same-day pegfilgrastim group and 12/180 (6.7%) pts in the next-day group experienced ≥1 episode of FN. Across all cycles, 11/118 pts (9.3%) in the same-day pegfilgrastim group and 16/179 (8.9%) pts in the next-day group experienced ≥1 episode of FN. The difference in incidence of FN between same-day vs next-day pegfilgrastim was not statistically significant in cycle 1 (0.68% [95% CI –5.0% to 6.3%]; P=.814) and across all cycles (–0.38% [95% CI –7.1% to 6.3%]; P=.910). Conclusions: The overall incidence of FN was low in this pt population receiving prophylactic pegfilgrastim, and no significant differences were detected between same-day and next-day pegfilgrastim administration. These data support the same-day administration of prophylactic pegfilgrastim.

Virologic outcomes of people living with human immunodeficiency virus who started antiretroviral treatment on the same-day of diagnosis in Ethiopia: A multicenter observational study.

IntroductionThere have been tremendous achievements in scaling-up antiretroviral therapy (ART) for treatment of human immunodeficiency virus (HIV), following universal “test and treat” policy implementation in low- and middle-income countries. However, its effects on virologic outcomes is not yet well investigated. We compared low viral load status in people living with HIV between those who were initiated on ART on the same-day and after 7 days of being diagnosed with HIV infection.MethodsWe conducted a retrospective cohort study of persons age ≥15 years-old who were newly diagnosed and started on ART between October 2016 and July 2018 at 11 public health facilities in northwest Ethiopia. Exposure was initiation of ART on the same-day of HIV diagnosis. The outcome was low viral load at 12-months following ART initiation. We used double-robust estimator using inverse-probability-weighted regression adjustment to compare the groups.ResultsA total of 398 people who started ART on the same-day of HIV diagnosis and 479 people who started 7 days after the initial diagnosis were included in this study. By 12-months following ART initiation, 73.4% (292) in the same-day group vs 83.7% (401) in the >7 days group achieved low viral load (absolute difference = 10.3% (95% CI: 4.9%, 15.8%)). After adjusting for baseline and follow-up covariates, there was statistically significant difference in low viral load status (adjusted difference = 8.3% (95% CI: 3.5%, 13.0%)) between the same-day group and the >7 days group.ConclusionsAchievement of low viral load by 12-months post-initiation of ART was not optimal among participants who started ART on the same-day of HIV diagnosis. Efforts should be made to reinforce treatment adherence while initiating same-day ART.

Short-term effects of mobilization on oxygenation in patients after open surgery for pancreatic cancer: a randomized controlled trial

BackgroundDespite the unequivocal role of progressive mobilization in post-surgical patient management, its specific effects and timing, particularly after abdominal surgery, remain debated. This study’s aim was to examine the short-term effects of mobilization on oxygenation in hemodynamically stable patients after open surgery for pancreatic cancer.MethodsA randomized controlled clinical trial was conducted in which patients (n = 83) after open pancreatic surgery were randomized to either the same-day mobilization group (mobilized when hemodynamically stable within four hours after surgery) or the next-day mobilization group (mobilized first time in the morning of the first post-operative day). Mobilization was prescribed and modified based on hemodynamic and subjective responses with the goal of achieving maximal benefit with minimal risk. Blood gas samples were taken three times the evening after surgery; and before and after mobilization on the first post-operative day. Spirometry was conducted pre-operatively and on the first post-operative day. Adverse events and length of stay in postoperative intensive care were also recorded.ResultsWith three dropouts, 80 patients participated (40 per group). All patients in the same-day mobilization group, minimally sat over the edge of the bed on the day of surgery and all patients (both groups) minimally sat over the edge of the bed the day after surgery. Compared with patients in the next-day mobilization group, patients in the same-day mobilization group required lower FiO2 and had higher SaO2/FiO2 at 1800 h on the day of surgery (p < .05). On the day after surgery, FiO2, SaO2/FiO2, PaO2/FiO2, and alveolar-arterial oxygen gradient, before and after mobilization, were superior in the same-day mobilization group (p < 0.05). No differences were observed between groups in PCO2, pH, spirometry or length stay in postoperative intensive care.ConclusionsCompared with patients after open pancreatic surgery in the next-day mobilization group, those in the same-day mobilization group, once hemodynamically stable, improved oxygenation to a greater extent after mobilization. Our findings support prescribed progressive mobilization in patients after pancreatic surgery (when hemodynamically stable and titrated to their individual responses and safety considerations), on the same day of surgery to augment oxygenation, potentially helping to reduce complications and hasten functional recovery.Trial registration: This prospective RCT was carried out at the Sahlgrenska University Hospital, Sweden. The study was approved by the Regional Ethical Review Board in Gothenburg (Registration number: 437-17). Trial registration: “FoU in Sweden” (Research and Development in Sweden, URL: https://www.researchweb.org/is/vgr) id: 238701 Registered 13 December 2017 and Clinical Trials (URL:clinicaltrials.gov) NCT03466593. Registered 15 March 2018.

Evaluation of the diagnostic utility of the aminotransferase/lactate dehydrogenase ratio for the suspension of tissue specimens during thyroid surgery for the identification of parathyroid tissue.

Identification of the parathyroid glands during surgery is crucial for preventing postoperative hypoparathyroidism. Kikumori et al. reported that the aspartate aminotransferase (AST)/lactate dehydrogenase (LDH) ratio for the saline suspension of a suspicious tissue can differentiate parathyroid tissue from other tissues. The aim of this study was to evaluate the utility of this method and investigate the appropriate time for measurement. We obtained 465 tissue specimens during thyroidectomy of 102 patients with papillary thyroid carcinoma (PTC), and 422 specimens (129 parathyroid, 92 PTC, and 201 other tissues) with measurable AST and LDH were analyzed. Small pieces of the tissues were immersed in saline and sent for measurement of AST and LDH. The assay was performed immediately after thyroidectomy for 245 specimens (the same-day group) and during the next morning for the remaining 177 specimens (the next-day group). The accuracy of diagnosing parathyroid tissue was significantly better in the same-day group than in the next-day group. A cut-off value of 0.18 gave the best diagnostic precision, with an area under the receiver operating characteristic curve of 0.95 and 88.7% sensitivity and specificity in the same-day group. When the cut-off value was set to 0.20, the specificity for excluding carcinomatous tissues was 100%. When measured on the day of the surgery, the AST/LDH ratio for the saline suspension of the surgical specimens is useful for discriminating parathyroid tissues from other tissues. This method can be utilized at most hospitals where intraoperative frozen sections or rapid parathyroid hormone assays are not available.

Effectiveness of same-day antiretroviral therapy initiation in retention outcomes among people living with human immunodeficiency virus in Ethiopia: empirical evidence

BackgroundIn August 2016, Ethiopia endorsed a universal “test and treat” strategy for people living with human immunodeficiency virus (PLHIV) based on World Health Organization recommendation. However, there is limited evidence on the routine application of the same-day “test and treat” recommendation in low-income settings. This study assessed the effect of same-day treatment initiation on individual-level retention at 6- and 12-months follow-up.MethodsA multicenter facility-based retrospective cohort study was conducted to compare retention-in-care between PLHIV who started antiretroviral therapy (ART) on the same-day and those started ART > 7 days following HIV diagnoses. Participants were at least 15 years-old and were newly diagnosed and started on ART between October 2016 and July 2018 in 11 health facilities in the Amhara region of Ethiopia. Multivariable logistic regression controlling for potential confounders and Kaplan-Meier survival analysis were used to assess differences in outcomes between the groups.ResultsIn total, 433 PLHIV started ART on the same-day of diagnosis and 555 PLHIV who started ART > 7 days after HIV diagnosis were included in the study. At 6-months, 82.0% (355) in the same-day group vs 89.4% (496) in the > 7 days group were retained-in-care (absolute risk difference (RD) = 7.4%; 95% confidence interval (CI): 2.9–11.8%). At 12-months, 75.8% (328) in the same-day group vs 82.0% (455) in the > 7 days group were retained-in-care (absolute RD = 6.2%; 95% CI: 1.1, 11.4%). The major drop in retention was in the first 30 days following ART initiation among same-day group. After adjusting for baseline and non-baseline covariates, the same-day group was less likely to be retained-in-care at 6- and 12-months (adjusted risk ratio (RR) = 0.89; 95% CI: 0.87, 0.90 and adjusted RR = 0.86; 95% CI: 0.83, 0.89, respectively).ConclusionsReduced retention-in-care can threaten the benefit of the same-day “test and treat” policy. The policy needs to be implemented cautiously with greater emphasis on assessment and preparation of PLHIV for ART to ensure treatment readiness before starting them on same-day ART and close monitoring of patients during early follow-up periods.

A Comparison of Same Day Versus Next Day Administration of Pegfilgrastim in Lymphoma Patients Receiving CHOP Chemotherapy

Background Febrile neutropenia (FN) is a potentially life-threatening complication of myelotoxic chemotherapy, with increased incidence in patients with high risk chemotherapy or with patients with predisposing comorbidities in intermediate risk regimens. Prophylactic pegfilgrastim has been shown to decrease the incidence, duration, and severity of neutropenia, fever, and infection. Current guidelines recommend at least a 24-hour time lapse from chemotherapy to administration of growth factor; however, many cancer centers give same day growth factor due to convivence. Here, we explored lymphoma patients treated with CHOP+/-R (cyclophosphamide, doxorubicin, vincristine, prednisone, with or without rituximab) and received either same-day (within 24 hours of chemotherapy) or next-day (≥24 hours post chemotherapy) pegfilgrastim to address the safety and efficacy of administration timing in the real-world setting. Methods A retrospective, single center, cohort study was conducted between October 1, 2013 and October 1, 2016 to evaluate lymphoma patients who were treated with CHOP+/-R and given pegfilgrastim for prophylaxis at the University of Arizona Cancer Center. Patients were followed up to six cycles of chemotherapy. In the first cycle, 39 patients were identified: 33 patients received same-day pegfilgrastim and 6 patients received next-day pegfilgrastim. Primary data collected included the incidence of FN, neutropenia, dose reductions, antibiotic administration, and hospitalization rate. Results Two hundred and fourteen R-CHOP (0.90) or CHOP (0.10) chemotherapy cycles (187 cycles for the same-day and 27 cycles for the next-day) were evaluated in 39 patients. Among the first cycles (33 patients in the same-day and 6 patients in the next-day), there were no significant differences in the incidence of FN (0.21 vs. 0.00, P= 0.57), grade 3/4 neutropenia (0.39 vs. 0.33, P= 0.99) and hospitalizations (0.39 vs. 0.00, P= 0.08) between the same day and the next day groups. Among cycle two to six (154 cycles for the same-day and 21 for the next-day), there were no statistically significant differences in the incidence of FN (0.07 vs 0.05, P=0.99)grade 3/4 neutropenia (0.30 vs. 0.24, P= 0.80) and hospitalizations (0.11 vs 0.10, P= 0.99) between the same-day and next-day. The same-day group, had 33% percent of patients received reduced doses of CHOP or R-CHOP (median age= 80.0 yr). The incidence of FN was 0.11 in these patients and 0.06 in patients who received the usual doses (median age=65.5 yr) (P= 0.27). The incidence of grade 3/4 neutropenia was (0.34 vs 0.29, P=0.53) and hospitalizations (0.20 and 0.08, P=0.07) between patients who received reduced doses of chemotherapy because of age versus normal dosing respectively in the same-day arm. Conclusion In our analysis, we have shown that same-day was as safe and effective as next-day pegfilgrastim administration in lymphoma patients receiving CHOP+/-R. There was not a significant increase in FN in either group. Future prospective studies are warranted to investigate the practical benefits of same-day pegfilgrastim or its biosimilar. Potential future study directions could include addressing outcomes, side effects, patient satisfaction, and reduced healthcare costs associated with same-day administration of pegfilgrastim for the prophylaxis of FN. Table Disclosures Abraham: Coherus BioSciences: Research Funding, Speakers Bureau; Celgene: Consultancy; Terumo: Consultancy; Rockwell Medical: Consultancy; Janssen: Consultancy; Mylan: Consultancy; Sandoz: Consultancy; MorphoSys: Consultancy. McBride:Coherus BioSciences: Consultancy, Speakers Bureau; Merck: Speakers Bureau; Pfizer: Consultancy; Sandoz: Consultancy; MorphoSys: Consultancy; Bristol-Myers Squibb: Consultancy.

Impact of a nurse-led same day admission pathway on hospital length of stay for transcatheter aortic valve implantation

Background/Aims Patients undergoing transcatheter aortic valve intervention are commonly admitted the day before their procedure. Same-day admission offers a potential approach to reduce length of stay and procedural costs but there are little data on the feasibility and safety of this approach. This study aimed to explore the feasibility and safety of a same-day admission programme facilitated by a specialist nurse for patients undergoing elective transfemoral transcatheter aortic valve implantation. Methods Consecutive patients undergoing transcatheter aortic valve implantation through a standard care pathway (admission to hospital before the day of procedure) from July 2015 to July 2016 were retrospectively compared to those going through a same-day admission pathway from April 2017 to December 2018 at the James Cook University Hospital. Baseline and procedural characteristics, length of stay and clinical outcomes were analysed using chi square, Student's t-test and Mann–Whitney U tests. Results Overall, 121 of 135 (90%) patients were eligible for same-day admission and all underwent successful same-day transcatheter aortic valve implantation. There were 77 patients in the standard care group. Average length of stay in the same-day group was lower than the standard care group (1.5 vs 3.9 days; P&lt;0.01) with no differences in mortality, procedural complications or readmission within 30 days between the two groups. Conclusions Routine same-day admission for transfemoral transcatheter aortic valve implantation facilitated by a specialist nurse can be safely implemented, leading to a shorter length of stay with no detrimental effect on clinical outcomes. This represents a highly effective method of reducing the procedural cost of transcatheter aortic valve implantation.

Comparison of bilateral same-day and sequential endoscopic cartilage myringoplasty for bilateral chronic tympanic membrane perforation

Background: There is debate over the applicability of bilateral same-day myringoplasty in patients with bilateral chronic tympanic membrane perforations (TMPs) requiring ear surgery on both sides.Objectives: To evaluate the healing and hearing outcomes of bilateral endoscopic ‘push-through’ cartilage myringoplasty in patients with bilateral chronic TMPs with mucosal chronic otitis media (COM) on the same day.Material and methods: The medical records of 60 patients (120 ears) with bilateral chronic TMPs who underwent bilateral same-day or sequential endoscopic push-through cartilage myringoplasty between January 2014 and March 2019 were evaluated.Results: Of the 60 patients with 120 ears, 26 patients with 52 ears were in the bilateral same-day group and 34 patients with 68 ears in the sequential group. The overall graft success rate at 3 months was 92.3% (48/52) in the same-day group and 94.1% (64/68) in the sequential group. None of the sensorineural HL and retraction pockets occurred in two groups.Conclusions and significance: Bilateral push-through cartilage myringoplasty can be performed safely for the patients with bilateral chronic TMPs in the same day, it significantly reduced the medical costs and shortened the operation time and length of stay compared to sequential myringoplasty.