Same-Day Discharge for Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy Is Safe and Feasible: Results of a Pilot Study.

INTRODUCTION: With healthcare reform, cost and patient satisfaction will directly affect hospital reimbursement. We present data on same-day discharge (SDD) for patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: Patient data were gathered in an IRB-approved database. In April 2015, the surgeon (S.J.) began SDD. The SDD protocol for RALP includes multimodal anesthesia/analgesia and extended recovery. Interim analysis revealed that government insurance (CMS) refused hospital reimbursement for SDD. As of that time, only patients with commercial insurance were offered SDD. The demographic and peri-operative data were compared between the two cohorts (Group 1, SDD; Group 2, Admitted patients) by using Mann-Whitney U, chi-squared, or fisher exact tests, where appropriate. RESULTS: During the study period, 21 patients had undergone RALP. Eleven of 21 patients were offered SDS, and nine (81.8%) were discharged. Both those who elected to stay were successfully discharged on the next day. Patient age, body mass index (BMI), prostate-specific antigen, operative time, estimated blood loss (EBL), prostate weight, distance from home to hospital, margin status, marital status, and household income were not statistically significantly different between the two groups. The same is true between patients who underwent RALP both before and after initiation of the SDD protocol with the exception of EBL (greater in the SDD group). There have been no reported complications or readmissions for any of the patients in Group 1. CONCLUSION: Our novel pilot study reveals that SDS is safe and feasible. We are currently conducting a further evaluation of patient satisfaction. Future research is needed to verify these conclusions.

The impairment of methylmenaquinol:fumarate reductase affects hydrogen peroxide susceptibility and accumulation in Campylobacter jejuni.

The methylmenaquinol:fumarate reductase (Mfr) of Campylobacter jejuni is a periplasmic respiratory (redox) protein that contributes to the metabolism of fumarate and displays homology to succinate dehydrogenase (Sdh). Since chemically oxidized redox-enzymes, including fumarate reductase and Sdh, contribute to the generation of oxidative stress in Escherichia coli, we assessed the role of Mfr in C. jejuni after exposure to hydrogen peroxide (H2 O2 ). Our results show that a Mfr mutant (∆mfrA) strain was less susceptible to H2 O2 as compared to the wildtype (WT). Furthermore, the H2 O2 concentration in the ∆mfrA cultures was significantly higher than that of WT after exposure to the oxidant. In the presence of H2 O2 , catalase (KatA) activity and katA expression were significantly lower in the ∆mfrA strain as compared to the WT. Exposure to H2 O2 resulted in a significant decrease in total intracellular iron in the ∆mfrA strain as compared to WT, while the addition of iron to the growth medium mitigated H2 O2 susceptibility and accumulation in the mutant. The ∆mfrA strain was significantly more persistent in RAW macrophages as compared to the WT. Scanning electron microscopy showed that infection with the ∆mfrA strain caused prolonged changes to the macrophages' morphology, mainly resulting in spherical-shaped cells replete with budding structures and craters. Collectively, our results suggest a role for Mfr in maintaining iron homeostasis in H2 O2 stressed C. jejuni, probably via affecting the concentrations of intracellular iron.