Same-day Group Research Articles

Same-Day Regimen as an Alternative to Split Preparation for Colonoscopy: A Systematic Review with Meta-Analysis.

Background Split bowel preparation is the best regimen for colonoscopy. However, the same-day regimen can represent a valid alternative, but its use is limited by concerns about its cleansing ability, and to date, no convincing data support its use for routine colonoscopies. Aim To evaluate the cleansing, compliance, and adverse event rates of the same-day compared to the split regimen. Results A systematic literature search and meta-analysis was performed. Ten studies were included for a total of 1807 patients (880 in the same-day group and 927 in the split group). Overall, 85.3% patients in the same-day group vs. 86.3% in the split group had an adequate cleansing. Compliance was high for both, although patients were more compliant with the split than with the same-day prep (89.7% for same-day vs. 96.6% for split regimen). Sleep disturbance was more frequent in the split group, while nausea and vomit were more frequent in the same-day group. In the subgroup analysis, polyethylene glycol obtained a better cleansing rate when given as a split dose, with similar compliance and adverse events rates with both regimens. Conclusion Split and same-day regimens are both useful in bowel cleaning before colonoscopy with a different pattern of adverse events and better compliance for split preparations. Endoscopists can consider the same-day preparation as a valid alternative, especially when the split preparation does not fit the patients' needs.

Effects of intrauterine exposure to thyroid dysfunction on the development of brain neurons in neonatal rats

Objective To investigate the expression of MCT8, DCX, SHH and ARC/ARG3.1 in brain neurons of neonatal rats exposed to thyroid dysfunction in uterus. Methods Wistar pregnant rats were randomly divided into control group and experimental groups that rats were drunk water with 1, 3, or 5 ppm propylthiouracil (PTU). The thyroid function and morphological changes of PND1 and PND7 were detected. The expression of MCT8, DCX, SHH, ARC/ARG3.1 protein in cerebral cortex and hippocampus were detected by Western blot or immunohistochemistry. Results (1) The levels of TT4 decreased significantly in PND1 pups of PTU 3 ppm and 5 ppm groups (P<0.05 or P<0.01). The TSH levels significantly increased while FT4 levels significantly decreased in pups of PTU 5 ppm group on PND7(P<0.05). (2) The number NV, , , and cross-sectional area of thyroid follicles in offspring of PTU groups were significantly higher than those in the control group on postnatal day 1 and 7(P<0.05 or P<0.01, respectively). (3) The expression of MCT8 in cortex and hippocampus gradually increased with the increase dose of PTU on two postnatal days, but there was significant change in PTU 5 ppm group on PND1 (P<0.05). The expression of SHH in pup cortex decreased with the increase of PTU exposure dose on PND7. DCX protein expression in the pup cortex on two postnatal days showed an uptrend with the increase of PTU exposure dose. ARC/ARG3.1 protein levels in hippocampal CA1 area of the pups increased significantly in PTU 1 ppm group on PND1 than that in the same-day control group (P<0.05). Conclusion The damaged neurons of neonatal rats exposed to hypothyroidism in utero can be improved with the gradual recovery of thyroid function, but can not be completely restored to normal level. Key words: Thyroid dysfunction; Gestation period; Brain development

Same-Day versus Conventional Different-Day Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Cholecystectomy: A Multi-Center Retrospective Study

Same-day endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy (LC) could potentially reduce hospital length of stay (HLOS). Patients undergoing same-day procedures (N = 164) between 2012 and 2014 were compared with different-day procedures performed in the second half of 2014 (N = 276), in the Kaiser Permanente Southern California database. Both groups had comparable baseline characteristics. ERCP success rate (97.5% vs 93.5%), overall postoperative morbidity (3.66% vs 3.99%), and retained stones (2.5% vs 5.8%) were not different between groups (P > 0.05); however, HLOS was shorter in the same-day group (2.99 ± 2.34 vs 3.84 ± 2.52 days, P < 0.001). Morbidity, procedure success, and HLOS were not different in the same-day group, whether ERCP was performed before or after LC (P > 0.05). In the same-day group, those undergoing single anesthesia had higher BMI (40.1 ± 10.8 vs 30.3 ± 6.6) and were more likely to have gastric bypass (30% vs 0%) than those undergoing separate anesthesia sessions (P < 0.01). Longer HLOS (4.8 ± 3.5 vs 2.9 ± 2.2 days) and higher estimated blood loss (65 ± 90 mL vs 20 ± 29 mL) were also associated with the single-anesthetic session (P < 0.01). ERCP performed on the same day of LC reduces HLOS without increasing morbidity. This approach does not affect postoperative morbidity and ERCP success rate, whether ERCP was performed before or after LC.

Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho

Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa. However, with referral to health facilities, less than half of those who test HIV positive link to care and initiate antiretroviral therapy (ART). To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural, high-prevalence setting in sub-Saharan Africa. Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 health care facilities in northern Lesotho. During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas, 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled. Individuals from the same household were randomized into the same group. Participants were randomly assigned to be offered same-day home-based ART initiation (n = 138) and subsequent follow-up intervals of 1.5, 3, 6, 9, and 12 months after treatment initiation at the health facility or to receive usual care (n = 140) with referral to the nearest health facility for preparatory counseling followed by ART initiation and monthly follow-up visits thereafter. Primary end points were rates of linkage to care within 3 months (presenting at the health facility within 90 days after the home visit) and viral suppression at 12 months, defined as a viral load of less than 100 copies/mL from 11 through 14 months after enrollment. Among 278 randomized individuals (median age, 39 years [interquartile range, 28.0-52.0]; 180 women [65.7%]), 274 (98.6%) were included in the analysis (137 in the same-day group and 137 in the usual care group). In the same-day group, 134 (97.8%) indicated readiness to start ART that day and 2 (1.5%) within the next few days and were given a 1-month supply of ART. At 3 months, 68.6% (94) in same-day group vs 43.1% (59) in usual care group had linked to care (absolute difference, 25.6%; 95% CI, 13.8% to 36.3%; P < .001). At 12 months, 50.4% (69) in the same-day group vs 34.3% (47) in usual care group achieved viral suppression (absolute difference, 16.0%; 4.4%-27.2%; P = .007). Two deaths (1.5%) were reported in the same-day group, none in usual care group. Among adults in rural Lesotho, a setting of high HIV prevalence, offering same-day home-based ART initiation to individuals who tested positive during home-based HIV testing, compared with usual care and standard clinic referral, significantly increased linkage to care at 3 months and HIV viral suppression at 12 months. These findings support the practice of offering same-day ART initiation during home-based HIV testing. clinicaltrials.gov Identifier: NCT02692027.

Sleep facilitates generalisation of accent adaptation to a new talker

ABSTRACTLexically-guided phonetic retuning helps listeners adapt to the phonetic “fingerprint” of a talker. Previous findings show that listeners can generalise from one accented talker to another accented talker, but only for phonetically similar talkers. We tested whether sleep-mediated consolidation promotes generalisation across accented talkers who are not phonetically similar. Native-English participants were trained on a Mandarin-accented talker and tested on this talker and an untrained Mandarin talker. Experiment 1 showed adaptation for the trained talker and a weak transfer to the untrained talker. In Experiment 2, participants were trained and tested either in the morning (Same-Day group) or evening (Overnight group), and again after twelve hours. Both groups retained talker-specific learning over the 12-hour delay. Importantly, the Overnight group showed improvements for the untrained talker, whereas the Same-Day group’s performance on the untrained talker deteriorated. We suggest that sleep facilitated talker generalisation by helping listeners abstract away from specific acoustic properties of the trained talker.

Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial.

BackgroundAttrition during the period from HIV testing to antiretroviral therapy (ART) initiation is high worldwide. We assessed whether same-day HIV testing and ART initiation improves retention and virologic suppression.Methods and findingsWe conducted an unblinded, randomized trial of standard ART initiation versus same-day HIV testing and ART initiation among eligible adults ≥18 years old with World Health Organization Stage 1 or 2 disease and CD4 count ≤500 cells/mm3. The study was conducted among outpatients at the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic infections (GHESKIO) Clinic in Port-au-Prince, Haiti. Participants were randomly assigned (1:1) to standard ART initiation or same-day HIV testing and ART initiation. The standard group initiated ART 3 weeks after HIV testing, and the same-day group initiated ART on the day of testing. The primary study endpoint was retention in care 12 months after HIV testing with HIV-1 RNA <50 copies/ml. We assessed the impact of treatment arm with a modified intention-to-treat analysis, using multivariable logistic regression controlling for potential confounders. Between August 2013 and October 2015, 762 participants were enrolled; 59 participants transferred to other clinics during the study period, and were excluded as per protocol, leaving 356 in the standard and 347 in the same-day ART groups. In the standard ART group, 156 (44%) participants were retained in care with 12-month HIV-1 RNA <50 copies, and 184 (52%) had <1,000 copies/ml; 20 participants (6%) died. In the same-day ART group, 184 (53%) participants were retained with HIV-1 RNA <50 copies/ml, and 212 (61%) had <1,000 copies/ml; 10 (3%) participants died. The unadjusted risk ratio (RR) of being retained at 12 months with HIV-1 RNA <50 copies/ml was 1.21 (95% CI: 1.04, 1.38; p = 0.015) for the same-day ART group compared to the standard ART group, and the unadjusted RR for being retained with HIV-1 RNA <1,000 copies was 1.18 (95% CI: 1.04, 1.31; p = 0.012). The main limitation of this study is that it was conducted at a single urban clinic, and the generalizability to other settings is uncertain.ConclusionsSame-day HIV testing and ART initiation is feasible and beneficial in this setting, as it improves retention in care with virologic suppression among patients with early clinical HIV disease.Trial registrationThis study is registered with ClinicalTrials.gov number NCT01900080

Two cervical preparation regimens prior to surgical abortion at 10–14 weeks of gestation: A randomized clinical trial

Background: The aim of the study was to determine whether same-day cervical preparation with an osmotic dilator and misoprostol was as effective and safe as overnight cervical preparation for surgical abortions at 10–14 weeks.Methods: Seventy women seeking surgical abortion at 10–14 weeks were allocated to receive one osmotic dilator 16–17 h or 6–7 h prior to an abortion. All women received misoprostol 400 μg orally 2 h before the abortion.Results: The abortion time of the same-day group was 7.42 ± 1.73 min, and that of the overnight group was 8.00 ± 2.19 min (p = 0.23). The blood loss volume of the same-day group was 20.6 ± 10.6 mL, and that of the overnight group was 16.3 ± 7.0 mL (p = 0.55). The degree of cervical dilation for the same-day group was inferior to the overnight group (p = 0.02).Conclusions: Same-day cervical preparation with misoprostol and an osmotic dilator shortens the hospitalization days, suggesting same-day cervical preparation is safe, effective, and feasible for surgical abortion at 10–14 weeks of gestation.

Same‐Day Evaluation and Surgery for Otitis Media and Tympanostomy Tube Placement

To determine the feasibility of providing streamlined same-day evaluation and surgical management of children with recurrent otitis media or chronic serous otitis media who meet criteria for tympanostomy tube (TT) placement. Retrospective matched case series. Tertiary care children's hospital. A comparison group (age, sex, insurance product) was utilized to determine if the same-day process decreased facility time and surgical time for the care episode. A parent satisfaction survey was administered. Thirty children, with a median age of 16 months (range, 12-22 months), participated in the same-day surgery process for TT. Twenty-one patients (70.0%) were male, and these patients were matched to a comparison group (similar age, sex, and insurance product) having non-same-day (routine) TT placement. The same-day patients spent significantly less time in clinic for the preoperative physician visit (average, 15 minutes) when compared with the non-same-day patients (average, 51.5 minutes; P < .001). The operative experience for the same-day patients was similar to the non-same-day patients (average, 145 vs 137 minutes, respectively; P = .35), but the overall experience was significantly shorter for the same-day patients (average, 151 vs 196 minutes for comparisons; P < .001). All parents surveyed in the same-day group were satisfied with the efficiency of the experience. The same-day surgery process for management of children who meet the criteria for TT placement is a model of improved efficiency of care for children who suffer from otitis media.

Intraoperative Hypotension During Second Stage of Deep Brain Stimulator Placement: Same Day versus Different Day Procedures

We evaluated blood pressure management associated with implantable pulse generator (IPG) procedure on same day (SD) versus different day (DD) from deep brain stimulation (DBS) placement. A retrospective chart review of 99 records for vasopressors given during IPG using a negative binomial regression model was performed. An association between SD versus DD, cumulative vasopressor dose, and minimum and maximum mean arterial pressure (MAP) were sought. No significant association between SD versus DD DBS and the number of times vasopressors were given during stage II, estimated ratio of means (CI) of 1.8 (0.9-3.5); P= 0.07. Day of stage II had no association with the cumulative dose of vasopressor given during stage II, with an estimated difference in means (CI) of 2.4 (-0.4 to 5.3). The SD group had a significantly lower mean of minimum stage II MAP compared with DD, with an estimated difference in means (CI) of-10.5 (-17.4 to-3.5; P < 0.001). There was no association with maximum stage II MAP, with an estimated difference in means (CI) of-2.8 (-17.6 to 12.0; P= 0.63). No difference in intraoperative vasopressor use was found between SD versus DD IPG placement, but the SD group had a significantly lower minimum MAP.

Abstract WP381: DTN Too Slow? Who You Gonna Call? Clot Busters - and the Stroke Coordinator!

Background: Tissue plasminogen activator (tPA) remains the only FDA approved drug treatment for acute ischemic stroke, and research continues to provide evidence that the earlier treatment brings better outcomes. In 2013, the stroke team at this Comprehensive Stroke Center was treating 24% of patients with tPA in less than 60 minutes and 8% in less than 45 minutes. In order to meet the increasingly challenging DTN benchmarks, the program leadership recognized the need to re-invigorate the acute stroke process and to address reasons for delay: staff disengagement, lack of knowledge of stroke core measures, and little incentive to meet the benchmark. Hypothesis: Consistent presence by a stroke coordinator during acute stroke events results in improved outcomes through identification of barriers, focused recognition of nurses and providers, competitive use of data, and facilitation of relevant team education. Methods: A report card was developed for providers, identifying their average DTN, and personal best and worst times. A stacked bar graph showed the critical time frames for each case. Staff involved with good DTN times were promptly recognized publicly, via same-day group email and received ID badge holders that read “Bustin’ clots faster than you can say tPA”. The stroke coordinator and a provider “champion” developed mock brain attack scenarios utilizing simulation technology which are now available to EMS, ED and ICU nurses and providers, CT staff, and neuroscience residents. The education focused on a standardized process for the first 5 minutes. Results: In 2014, tPA was administered 66% of the time under 60 minutes- a 57% improvement. In 2015, 94% under 60 minutes and 69% under 45 minutes. In addition, 5/16 (31%) were under 20 minutes, the fastest being 9 minutes. All patients who received tPA in 20 minutes or less were back to baseline by discharge. Conclusion: Stroke coordinator’s consistent presence during acute strokes promotes: 1) healthy competition as staff become aware of the data and benchmark goals, 2)timely feedback, and 3) relevant hands-on education to appropriate team members with the ultimate outcome being significantly reduced DTN times which leads to better patient outcomes.

The characteristics of the suicide attempter according to the onset time of the suicidal ideation.

ObjectiveTo determine the timing of development of suicidal ideation and factors associated therewith in suicide attempters who required psychiatric emergency treatment.MethodsOf a total of 2818 suicide attempters in Japan who presented to the primary or secondary emergency department of Iwate Medical University Hospital (hereinafter, referred to as our hospital) or Iwate Prefecture Advanced Emergency and Critical Care Center (hereinafter, referred to as the emergency center), an affiliated institution to our hospital, during the 12-year period from April 1, 2002–March 31, 2014, 2274 patients for whom the timing of development of suicidal ideation was identified were included in the study. The study subjects were classified into three groups according to the timing of development of suicide ideation: the “same-day” group, those who developed suicidal ideation and attempted suicide on the same day; the “short-term” group, those who developed suicidal ideation 2–7 days before attempting suicide; and the “long-term” group, those who developed suicidal ideation more than 7 days before attempting suicide. Factors associated with the development of suicidal ideation in each group were analyzed by a multiple logistic regression analysis with background factors, the diagnosis according to the ICD and the situations before and after the suicide attempt as explanatory variables.ResultsThe same-day group was characterized by a high female ratio, high global functioning, low stress level, non-depressed status and a lack of seeking consultation. In contrast, the long-term group was characterized by low global functioning and a high stress level, suggesting that these patients exhibit consultation behavior, but have not received psychiatric services. In the short-term group, only male gender was identified as a significant factor.DiscussionFor those patients who developed suicidal ideation and attempted suicide on the same day, treatment strategies focusing on the acquisition of coping skills and stress management are recommended. For those with suicidal ideation lasting for more than a week or recurrent ideation, early detection and subsequent early treatment of such ideation are essential. In intermediate cases, treatment strategies that make the full use of mental health management in the workplace and gate-keeping are likely to be effective.

Same-day combined endoscopic retrograde cholangiopancreatography and cholecystectomy: Achievable and minimizes costs.

It is estimated that choledocholithiasis is present in 5% to 20% of patients at the time of laparoscopic cholecystectomy (LC). Several European studies have found decreased length of stay (LOS) when performing LC and intraoperative endoscopic retrograde cholangiopancreatography (ERCP) on the same day for choledocholithiasis. In the United States, common bile duct stones are usually managed preoperatively and typically on a day separate from the day LC was performed. Our aim was to evaluate LOS and total hospital cost for separate-day versus same-day ERCP/cholecystectomy. This was a retrospective study of patients undergoing ERCP and cholecystectomy during the same admission for the management of choledocholithiasis from 2010 to 2014 at Geisinger Medical Center. The separate-day group underwent ERCP at least 1 day before cholecystectomy and often underwent two separate anesthesia events, while the same-day group had ERCP and cholecystectomy performed on the same day under one general anesthesia event. The primary outcome measured was LOS. The study population included 240 patients. There were 175 patients in the separate-day group and 65 patients in the same-day group. Median age was similar between the two groups. The separate-day group had a median of one minor comorbidity compared with zero within the same-day group using the Charlson Comorbidity Index. Overall, LOS for the separate-day group was 5 days compared with 3 days in the same-day group (p < 0.0001). There was no difference in conversion rates to open cholecystectomy between the two groups (14% in the separate-day vs. 12% in the same-day group). Total median hospital cost for the separate-day group was $102,537 compared with $90,269 in the same-day group (p < 0.0001). Same-day ERCP and cholecystectomy is feasible and minimizes costs. Same-day procedures decreased hospital LOS by 2 days and had approximately $12,000 in cost savings. Future goals include a multidisciplinary protocol to study outcomes in larger numbers. Therapeutic study, level IV. Economic study, level III.

Rates of febrile neutropenia with pegfilgrastim on same day versus next day of CHOP with or without rituximab.

Febrile neutropenia is a complication of myleotoxic chemotherapy that can markedly decrease quality of life and increase healthcare costs. A granulocyte-colony stimulating factor (G-CSF) is used to increase neutrophil production to reduce the risk of developing febrile neutropenia. However, G-CSF administered on the same day as chemotherapy can worsen and prolong neutropenia. To study and compare the effects of pegfilgrastim on the incidence of febrile neutropenia and grade 4 neutropenia in patients receiving pegfilgrastim on the same day (day 1) versus the next day (day 2 or beyond) of chemotherapy, a retrospective, single-center, nonrandomized, cohort study was carried out of adult non-Hodgkin's lymphoma patients who received pegfilgrastim 6 mg subcutaneously on day 1 or beyond of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) with or without rituximab every 3 weeks. Six hundred and fifty-five chemotherapy cycles (320 cycles for the same day and 335 cycles for the next day) were evaluable in 141 patients. Among all cycles, the incidence of febrile neutropenia was 9.4 versus 5.1% in the same-day versus the next-day group (P=0.03). The incidence of febrile neutropenia was the highest after the first cycle in the same-day group, which was 19.4, versus 11.1% for the next-day group (P=0.27). There were three deaths among patients who developed febrile neutropenia, including two in the next-day group versus one in the same-day group. In conclusion, our findings support the need for a randomized phase III study to fully evaluate whether a G-CSF is safer when administered on the next day versus the same day of chemotherapy.

Optimal Schedule of Preoperative Embolization for Spinal Metastasis Surgery

A retrospective study. To investigate the relationship between intraoperative blood loss during spinal metastasis surgery and the surgical delay after preoperative embolization. Delaying surgery after embolization is thought to diminish its effectiveness because of revascularization, but there has been no scientific study that supports this hypothesis. We reviewed data from 66 consecutive posterior palliative decompression surgical procedures for spinal metastasis from thyroid and renal cell carcinoma (39 thyroid and 27 renal) in 58 patients between 2004 and 2012. All patients underwent preoperative angiography. The timing of preoperative embolization was determined on the basis of the operating room and interventional radiologist schedules. Excluding one case who did not receive embolization due to lack of hypervascularity, we analyzed 65 cases to compare intraoperative blood loss according to the completeness of embolization and the time lapse between embolization and surgery. Surgical procedures were performed on the same day of embolization in 21 cases (same day-group), and on the next day after embolization in 39 cases (next-day group). Five surgical procedures were performed 2 days later. The intraoperative blood loss was significantly lesser with complete embolization than with partial embolization (mean ± standard deviation: 809 ± 835 vs. 1210 ± 904 mL, P = 0.03). Among those with complete embolization, the intraoperative blood loss as well as the perioperative transfusion requirement was significantly lesser in the same-day group than in the next-day group (mean ± standard deviation: blood loss: 433 ± 376 vs. 1012 ± 974 mL, P = 0.01; transfusion requirement: 1.5 ± 1.7 vs. 4.2 ± 4.1 units, P = 0.04). Preoperative embolization showed greater effectiveness in reducing intraoperative blood loss when surgery for spinal metastasis was performed on the same day than when surgery was delayed. Surgery should be performed on the same day of embolization if possible. 4.

Colon capsule endoscopy is feasible to perform after incomplete colonoscopy and guides further workup in clinical practice

Colon capsule endoscopy (CCE) could be an option to examine the colon after incomplete colonoscopy. To investigate the extent that CCE complements incomplete colonoscopy and guides further workup. Prospective, follow-up study. Three tertiary-care centers. Consecutive outpatients after colonoscopy failure; 1-year study period. Patients underwent CCE either immediately after colonoscopy or were rescheduled. Further investigations were guided by the results of CCE. Patients were followed as long as 2 years. We studied 75 outpatients; 39 had a screening colonoscopy. One third of the patients underwent CCE immediately after colonoscopy. Overall, CCE reached or went beyond the colon segment at which colonoscopy stopped in 68 patients (91%). CCE technically complemented difficult colonoscopy independently of whether same-day CCE was performed (24 [96%]) or was not performed (44 [88%]). CCE detected additional significant findings in 36% of the same-day CCE cases and in 48% of the rescheduled ones. Two patients in the same-day group and 13 in the rescheduled CCE group underwent further colon examination that revealed additional significant findings in 3 of them. Ten percent of the patients reported mild adverse events (AE). If needed, 63 participants (84%) were willing to repeat CCE. Follow-up has not identified symptomatic missed colon cancers. Selected patient population, first-generation colon capsule, old preparation scheme. CCE performed immediately or at a scheduled date after colonoscopy failure is feasible and safe. CCE after incomplete colonoscopy appears to yield significant findings, guide further workup, and has high patient acceptance.

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified. We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0-3) or more than 3 months apart (staged 3-12) at an institution where same-day bilateral TKAs were discouraged in patients with more severe medical comorbidities. We analyzed institutional data from 3960 same-day, 172 staged 0-3, and 1533 staged 3-12 bilateral TKAs performed between 1998 and 2011. Patient demographics, comorbidities, and 30-day mortality were tabulated. Same-day patients were younger and healthier. Outcomes of interest included complications, blood transfusions, transfer to rehabilitation, and in-hospital charges. Regression models were conducted to identify independent risk factors for major morbidity or mortality. There were no differences in 30-day mortality among groups. The same-day group experienced more acute postoperative anemia, blood transfusions, and transfers to rehabilitation, but otherwise had complications comparable to those of the staged groups. In-hospital charges were lower in the same-day group. Congestive heart failure and pulmonary hypertension were the most significant factors associated with morbidity and mortality in the same-day group. In a high-volume subspecialty setting in which patients undergoing same-day bilateral TKAs were generally much healthier and younger, we found that same-day bilateral TKAs appeared to be safe.

Different Bowel Preparation Schedule Leads to Different Diagnostic Yield of Proximal and Nonpolypoid Colorectal Neoplasm at Screening Colonoscopy in Average-Risk Population

Accumulating evidence indicates that the timing of bowel preparation is crucial, but its impact on the diagnostic yield of proximal or nonpolypoid colorectal neoplasm remains unclear. This study aimed to investigate the impact of the timing of bowel preparation on the adenoma detection rate for nonpolypoid colorectal neoplasm at colonoscopy. This study is a retrospective analysis of a screening colonoscopy cohort database. The investigation was conducted at a screening colonoscopy unit in an university hospital. A consecutive series of 3079 subjects who received primary screening colonoscopy with different timing of bowel preparation was analyzed. Different timing of bowel preparation (same day vs prior day) was studied. The main outcomes measured were patient demographics, timing of bowel preparation, colon-cleansing levels, diagnostic yields of colonoscopy, including adenoma, advanced adenoma, and nonpolypoid colorectal neoplasm. There were a total of 1552 subjects in the morning group and 1527 in the evening group. More subjects had proximal adenoma (175, 11.3% vs 138, 9.0%, P = .04), advanced adenoma (68, 4.4% vs 46, 13.0%, P = .044), nonpolypoid colorectal neoplasm (98, 6.3% vs 67, 4.4%, P = .018), proximal nonpolypoid colorectal neoplasm (71, 4.6% vs 40, 2.6%, P = .004), and advanced nonpolypoid colorectal neoplasm (25, 1.6% vs 12, 0.8%, P = .036) detected by same-day preparation. On multivariate regression analysis, the adenoma detection rate was significantly higher in the same-day group regarding overall and proximal adenoma (OR 1.23, 95% CI: 1.00-1.50; OR 1.35, 95% CI: 1.05-1.74), advanced adenoma (OR 1.53, 95% CI: 1.04-2.28), overall, proximal, and advanced nonpolypoid colorectal neoplasm (OR 1.48, 95% CI: 1.06-2.08; OR 1.82, 95% CI: 1.20-2.75; OR 1.96, 95% CI: 1.12-3.37). The adenoma detection rate was also significantly different among endoscopists. This was a single-center, nonrandomized trial. Improving bowel preparation quality by same-day preparation may lead to enhanced detection of overall, proximal, and advanced nonpolypoid colorectal neoplasm.

Safety of Same-Day Coronary Angiography in Patients Undergoing Elective Aortic Valve Replacement

Coronary artery imaging is required for most adult patients undergoing aortic valve replacement (AVR). Between January 1, 2000, and December 31, 2007, 1413 patients underwent elective AVR at Mayo Clinic. Two propensity-matched groups at low risk for acute kidney injury were created: 321 patients with coronary angiography on the same day as AVR (same day) and 321 patients with coronary angiography more than 1 day before AVR (non-same day). We defined acute postoperative kidney injury with Acute Kidney Injury Network criteria (≥0.3 mg/dL or a 50% increase in serum creatinine from baseline). The same-day vs non-same-day groups were comparable in age (mean [SD] years: 70.6 [11.0] vs 70.8 [11.5]), sex (111 women [34.6%] vs 114 women [35.5%]), preoperative serum creatinine (1.14 [0.22] vs 1.15 [0.23] mg/dL), and ejection fraction (0.62 [0.12] vs 0.61 [0.12]). Coronary artery revascularization was performed in 118 patients (36.8%) in the same-day group and in 123 (38.3%) in the non-same-day group (p=0.68). Maximum (30-day) postoperative serum creatinine levels were not significantly different between the same-day and non-same day groups (1.30 [0.43] mg/dL vs 1.29 [0.42] mg/dL; p=0.87). Perioperative (30-day) acute kidney injury occurred in 75 patients (23.4%) in the same-day group and in 71 (22.3%) in the non-same-day group (p=0.99). Perioperative (30-day) death occurred in 5 patients (1.6%) in the same-day group and in 7 (2.2%) in the non-same-day group (p=0.56). Other nonfatal complications rates were comparable between groups. In properly selected patients, coronary angiography can be performed the same day as elective AVR with no increase in perioperative morbidity or death.

Randomized, double-blind, phase 2, study evaluating same-day vs next-day administration of pegfilgrastim with R-CHOP in non-Hodgkin’s lymphoma patients

7570 Background: R-CHOP is associated with a high risk of febrile neutropenia (FN). Pegfilgrastim is indicated to lower infection incidence, manifested by FN, when administered once-per-cycle 24 hrs after chemotherapy (CT). However, eliminating an office visit the day after CT is desirable. Methods: Pts ≥ 18 years with previously untreated non-Hodgkin’s lymphoma (NHL) who received R-CHOP (rituximab 375 mg/m2, C 750 mg/m2, H 50 mg/m2, O 1.4 mg/m2, prednisone 100 mg; for 6 cycles Q21D) were randomized 1:1 to pegfilgrastim 6mg within 4 hours or ∼24hrs after CT. The primary endpoint was the duration of severe (grade 4) neutropenia (DSN) in cycle 1. Same-day administration was considered noninferior to next-day if the upper limit of the 2-sided 95% CI for the difference in mean cycle 1 DSN (same day - next day) was &lt;2 days. Results: 77 pts (8 mantle-cell, 69 diffuse large B-cell) were enrolled of 90 planned (due to slow accrual). 75 pts (36 same-day, 39 next-day) received CT and pegfilgrastim. Most pts had stage 3/4 disease (69% same-day, 74% next-day), no bone marrow involvement (75% same-day, 69% next-day) and ECOG status 0 or 1 (94% same-day, 97% next-day). Difference in mean cycle 1 DSN was 0.9 days (95% CI: 0.3–1.4) longer in the same-day than the next-day group (mean [SD]: 2.1 [1.22] vs 1.2 [1.20] days; grade 4 neutropenia incidence: 86% vs 64%). In cycle 1, more pts had a DSN ≥ 3 days in the same-day (36%) than the next-day group (15%). In cycle 4, mean DSN was longer in the same-day than the next-day group (mean [SD] 1.4 [1.40] vs 0.7 [0.94] days; grade 4 neutropenia incidence: 57% vs 42%). Pts in the 2 groups had similar occurrence of FN (17% vs 15%) and serious adverse events (33% vs 36%) across the study. Full dose on schedule, and the incidence of IV anti-infective use or hospitalization due to FN were also similar between groups. Conclusions: In cycles 1 and 4, the mean DSN was nearly 1 day longer for pts in the same-day group compared with the next-day group. Although the protocol-specified 2-day non-inferiority margin for DSN was met, for pts with NHL receiving R-CHOP, we recommend administering pegfilgrastim 24 hours after CT per labeling guidelines. [Table: see text]