Predictors of failed same-day discharge in patients undergoing robot-assisted radical prostatectomy in a Canadian universal healthcare system.

INTRODUCTION: Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) has been shown to be feasible and safe. In order to improve uptake of this ambulatory model in Canada, we aimed to update our experience of SDD after RARP and identify reasons for SDD pathway non-initiation and failure in a universal healthcare system. METHODS: A review of our prospectively collected database of patients undergoing RARP at a Canadian tertiary academic center from May 2021 to May 2023 was conducted. Binary logistic regression analysis determined predictors SDD pathway non-initiation and failure. RESULTS: We identified 387 patients, of which 198 were initiated on the SDD pathway. Of those initiated, 104 (51.7 %) were successfully discharged home on the same day. Patients who travelled distances greater than 100 km, or who had non-CPAP compliant obstructive sleep apnea were significantly less likely to be initiated on the SDD pathway (both p<0.05). Patients that were scheduled to be the second case or later, had an estimated blood loss ≥300 mL, or had a postoperative abdominal drain, were predictive of failing SDD after initiation (all p<0.05). There were similar rates of readmissions, unscheduled office visits, and emergency department presentations, when compared to the traditional in-patient model (all p>0.05). CONCLUSIONS: SDD after RARP in a Canadian healthcare system remains feasible and safe for selected patients. Predictors of failed SDD identified in this study inform the development of future ambulatory protocols and highlight areas of need in infrastructure to increase uptake of these outpatient pathways.

The impact of tranexamic acid on perioperative outcomes in urological surgeries A systematic review and meta-analysis.

INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic agent widely used in surgery to decrease bleeding and reduce the need for blood product transfusion. The role of TXA in urology is not well-summarized. We conducted a systematic review of studies reporting outcomes of TXA use in urological surgery. METHODS: A comprehensive search was conducted from the following databases: PubMed, Embase, Cochrane Library, and Web of Science. Two reviewers performed title and abstract screening, full-text review, and data collection. Primary outcomes included estimated blood loss (EBL), decrease in hemoglobin, decrease in hematocrit, and blood transfusion rates. Secondary outcomes included TXA administration characteristics, length of stay, operative time, and postoperative thromboembolic events. RESULTS: A total of 26 studies consisting of 3261 patients were included in the final analysis. These included 11 studies on percutaneous nephrolithotomy, 10 on transurethral resection of prostate, three on prostatectomy, and one on cystectomy. EBL, transfusion rate, hemoglobin drop, operative time, and length of stay were significantly improved with TXA administration. In addition, the use of TXA was not associated with an increased risk of venous thromboembolism (VTE ). The route, dosage, and timing of TXA administration varied considerably between included studies. CONCLUSIONS: TXA use may improve blood loss, transfusion rates, and perioperative parameters in urological procedures. In addition, there is no increased risk of VTE associated with TXA use in urological surgery; however, there is still a need to determine the most effective TXA administration route and dose. This review provides evidence-based data for decision-making in urological surgery.

Effects of a live yeast in natural-program finishing feedlot diets on growth performance, digestibility, carcass characteristics, and feeding behavior.

Effects of live yeast (Saccharomyces cerevisiae) in steam-flaked corn-based diets fed to natural-program beef cattle on growth performance, total tract apparent digestibility, carcass characteristics, and feeding behavior were evaluated in a randomized block design experiment. Steers (n = 144; 341 ± 7.03 kg) were blocked by initial BW and assigned randomly to 1 of the 3 treatments (n = 12 pens per treatment with 4 steers per pen). Treatments included the following: 1) control (CTL; no yeast); 2) low yeast (LY; 1.5 g/animal daily [3 × 1010 CFU]); and 3) high yeast (HY; 3.0 g/animal daily [6 × 1010 CFU]). Technologies such as implants, ionophores, and antibiotics were not used, and the steam-flaked corn-based finishing diets were fed to provide ad libitum access to feed. Yeast was included in a cottonseed meal-based premix as 1% of the dietary DM. Spot fecal samples (twice daily for 5 consecutive days) and diets were composited by pen and analyzed for acid insoluble ash to estimate apparent total tract digestibility of nutrients. Cattle were slaughtered on days 183 (4 blocks) and 204 (8 blocks). Dry matter intake (P ≥ 0.29), ADG (P ≥ 0.17), and G:F (P ≥ 0.33) did not differ among treatments. The percentage of Premium Choice (P < 0.01) carcasses increased linearly with increasing yeast inclusion in the diet. A quadratic response was observed for total tract apparent digestibility, in which steers fed LY had greater digestibility (P < 0.01) of DM by 5.4%, OM by 4.8%, NDF by 15.2%, ADF by 20.2%, CP by 6.2%, and ether extract (EE) by 2.5% compared with steers fed CTL. Feeding behavior was not affected (P = 0.28) by treatments. Live yeast improved digestibility of DM, OM, CP, EE, and fiber, without changing feeding behavior and growth performance of natural-program steers fed steam-flaked corn-based finishing diets.

Gastropleural Fistula as a Rare Complication of Gastric Sleeve Surgery: A Case Report and Comprehensive Literature Review.

Gastropleural fistula (GPF) is a rare, life-threatening complication of gastric sleeve surgery. GPF is an uncommon differential diagnosis to consider in a patient presenting with a picture of pneumonia. As such, GPF should be suspected in a patient with a history of nonresolving pneumonia who recently underwent gastric sleeve surgery. To the best of our knowledge, only eight cases of gastropleural fistulas after bariatric surgery have been reported in the literature. Herein, we report a case of gastropleural fistula after gastric sleeve surgery and review the pertinent literature. A gastropleural fistula is an exceedingly rare and life-threatening complication postbariatric surgery. Nonsurgical conservative management (total parenteral nutrition, percutaneous drainage, and antibiotics with endoscopic stenting) can be considered.