ABSTRACT
BACKGROUND: The COVID-19 pandemic created delays in surgical care. The population with obesity has a high risk of death from COVID-19. Prior literature shows the most effective way to combat obesity is by weight loss surgery. At different times throughout the COVID-19 pandemic, elective inpatient surgeries have been halted due to bed availability. Recognizing that major complications following bariatric surgery are extremely low (bleeding 0-4%, anastomotic leaks 0.8%), we felt outpatient bariatric surgery would be safe for low-risk patients. Complications such as DVT, PE, infection, and anastomotic leaks typically present after 7 days postoperatively, well outside the usual length of stay. Bleeding events, severe postoperative nausea, and dehydration typically occur in the first few days postoperatively. We designed a pathway focused on detecting and preventing these early post-op complications to allow safe outpatient bariatric surgery. METHODS: We used a preoperative evaluation tool to risk stratify bariatric patients. During a 16-month period, 89 patients were identified as low risk for outpatient surgery. We designed a postoperative protocol that included IV hydration and PO intake goals to meet a safe discharge. We sent patients home with a pulse oximeter and had them self-monitor their pulse and oxygen saturation. We called all patients at 10 pm for a postoperative assessment and report of their vitals. Patients returned to clinic the following day and were seen by a provider, received IV hydration, and labs were drawn. RESULTS: 80 of 89 patients (89.8%) were successfully discharged on POD 0. 3 patients were readmitted within 30 days. We had zero deaths in our study cohort and no morbidity that would have been prevented with postoperative admission. CONCLUSION: We demonstrate that by identifying low-risk patients for outpatient bariatric surgery and by implementing remote monitoring of vitals early outpatient follow-up, we were able to safely perform outpatient bariatric surgery.
ABSTRACT
Feline infectious peritonitis (FIP) remains a major diagnostic and treatment challenge in feline medicine. An ineffective immune response is an important component of FIP pathophysiology; hence treatment with an immune stimulant such as Polyprenyl Immunostimulant™ (PI), which enhances cell-mediated immunity by upregulating the innate immune response via Toll-like receptors, is a rational approach. Records of cats with FIP treated with PI orally for over 365 days were retrospectively studied. Of these cats (n = 174), records were obtained for n = 103 cats with appropriate clinical signs and clinical pathology. Of these, n = 29 had FIP confirmed by immunohistochemistry (IHC) or reverse transcription polymerase-chain-reaction (RT-PCR). Most of the cats (25/29; 86%) had non-effusive FIP, and only 4/29 cats (14%) had effusive FIP. The mean survival time (MST) was 2927 days (eight years); with 55% of the cats (16/29) still being alive at the time data collection, and 45% (13/29) having died. A persistently low hematocrit plus low albumin:globulin (A:G) ratio, despite treatment, was a negative prognostic indicator. It took a mean of ~182 days and ~375 days, respectively, for anemia and low A:G ratio to resolve in the cats that presented with these laboratory changes. This study shows that PI is beneficial in the treatment of FIP, and more studies are needed to establish the best protocols of use.