Dedicated Next Day Discharge Post Minimalist TAVI: The Tasmanian Experience.

OBJECTIVES: To assess the safety, feasibility and independent predictors of next day discharge (NDD) in patients undergoing minimalist transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) in a real-world Australian population. METHODS: This single centre study reviewed 135 consecutive patients who underwent minimalist transfemoral TAVI from June 2020 to February 2022. Baseline demographics, procedural characteristic and outcomes were obtained. All patients were assessed by the local protocol for NDD. Patients were then divided into two groups: those who achieved next day discharge (NDD) and those requiring >1 overnight hospital stay. Univariate, bivariate and stepwise multivariate logistic regression modelling was used to identify the predictors of successful next day discharge. RESULTS: The mean age of the cohort was 82.9±5.7 years with 62.3% patients male, the average STS score was 4.1±2.4. All 135 patients underwent a successful transfemoral TAVI procedure, with 131 (97%) receiving a balloon-expandable valve. Ninety-seven (97) (71.9%) patients achieved NDD. Thirty (30)-day outcomes were excellent with a 30-day mortality of 0.7%, transient ischaemic attack/cardiovascular accident (TIA/CVA) 1.5%, major vascular complication 1.5% and 11.4% need for permanent pacemaker (PPM). In patients not achieving NDD, the average length of stay (LOS) was 3.0 days. Baseline characteristics demonstrated pre-existing first degree atrioventricular (AV) block and right bundle branch block (RBBB) as statistically significant negative predictors of NDD on univariate analysis. Next day discharge was achievable in only 50% of patients who suffered any minor or major procedural complication (15/30). Stepwise multivariate logistic regression modelling demonstrated female gender (OR 3.094, 95% CI 1.141-8.391, p=0.026), smaller aortic valve area (AVA) (OR 48.265, 95% CI 2.269-102.6, p=0.013), the presence of diabetes mellitus (OR 0.594, 95% CI 0.356-0.991, p=0.046) and a longer procedure time (OR 0.960, 95% CI 0.935-0.986, p=0.002) as statistically significant negative predictors of NDD. In addition, there was no difference in 30-day readmission rates between the NDD and non-NDD cohort (7.2% vs 10.5%, p=0.386). CONCLUSION: Next day discharge is safe and feasible in almost three quarters of patients undergoing minimalist TAVI for severe AS in a predominantly balloon expandable valve cohort, with a very low rate of 30-day readmission. NDD provides advantages for hospital efficiency and improved cost-effectiveness. Female gender, smaller AVA, the presence of diabetes mellitus and a longer procedure time were independent negative predictors of successful NDD.

Postoperative outcomes following trabeculectomy and nonpenetrating surgical procedures: a 5-year longitudinal study.

PURPOSE: To assess and compare the long-term postoperative outcomes of trabeculectomy (TE), phacotrabeculectomy (PTE), and viscocanalostomy (VC) and to correlate postoperative intraocular pressure (IOP) with visual outcome. PATIENTS AND METHODS: This retrospective cohort observational study included 520 eyes which underwent TE with mitomycin C (MMC) (n=205), PTE with MMC (n=189), and VC ± combined cataract surgery and MMC (n=126) to control IOP between June 2010 and June 2014 by a single surgeon. Complete success was defined as postoperative IOP <20 mmHg, and qualified success with IOP <20 mmHg with single topical agent. Cases requiring more than one topical agent and/or repeat surgery were considered as failure. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, topical prescriptions, baseline and postoperative IOP, and optical assessment (ie, best-corrected visual acuity and mean deviation) profile. RESULTS: Follow-up ranged from 12 to 66 months (mean 26 months). At last follow-up, 139 (93.9%), 118 (91.5%), and 98 (94.2%) eyes achieved complete success in TE, PTE, and VC groups, respectively (p=0.0007). Failure rates were 2.7%, 3.9%, and 2.9% following TE, PTE, and VC, respectively (p=0.0052). The between-group difference of mean IOP reduction was greater in the short term (p=0.0002). Good postoperative IOP control correlates to optical outcomes reflected by best-corrected visual acuity and mean deviation following TE (ß = -4.7577, p=0.0384) and PTE (ß = -4.5083, p=0.02741). CONCLUSION: Significant association was observed between good postoperative IOP control and optical outcome. TE remains the more effective surgical intervention for sustained lowering of IOP. Most complications were transient and self-limiting.

Desperately seeking outcomes: quantifying the effectiveness of community mental healthcare using Health of the Nation Outcome Scales.

BACKGROUND: Community mental health services in the UK have struggled to measure the clinical effectiveness of their services.AimsTo measure clinical outcomes for different diagnostic clusters. METHOD: Clinicians measure the clinical status of patients by the Health of the Nation Outcome Scales (HoNOS), and HoNOS scores should be recorded annually after treatment. Clinical outcomes were measured by changes in HoNOS for diagnostic clusters. RESULTS: In two time periods (2014 and 2016), the health of patients with mild to moderate common mental disorders deteriorated after intervention. Patients with severe common mental disorders and psychoses improved in their clinical status. CONCLUSIONS: British community mental health teams may be effective in improving the clinical status of people with severe mental illness, but may have a negative effect on people with mild to moderate illnesses. These teams need to focus on the severely mentally ill and build on this demonstrable effectiveness.Declaration of interestNone.