107 Restricted Feeding and Weight Loss Positively Change Fecal Microbiota Populations of Obese Dogs

Canine obesity negatively influences health and well-being and appears to negatively modify gastrointestinal microbiota populations. Restricted feeding of a specially formulated diet and consequent weight loss may be used to improve health and modify gastrointestinal microbiota. In this study, we aimed to determine the effects of restricted feeding and weight loss on fecal microbiota populations of obese dogs. All procedures were approved by the University of Illinois IACUC prior to experimentation. Twenty-four obese spayed female dogs (BW = 15.2±1.7 kg; BCS = 8.7±0.4; age = 7.2±1.6 y) were used in a 24-wk weight loss study. A control (OR) food was fed during a 4-wk baseline to identify intake needed to maintain BW. After baseline (wk 0), dogs were allotted to one of two diets: OR or a test (FT) diet and then fed to lose 1.5% BW/wk. Fecal samples were collected at wk 0, 4, 8, 12, 16, 20, and 24 for microbiota and metabolite analyses. Fecal microbiota data were evaluated using QIIME2 and Mixed Models procedure of SAS, with P< 0.05 considered significant. Alpha-diversity was affected by diet and weight loss, with dogs fed OR having a greater alpha-diversity than those fed FT. Weight loss increased alpha-diversity (wk 16, 20, and 24 > wk 0 and 4). Beta-diversity, as assessed by weighted and unweighted PCoA plots, showed separation between dietary groups and between wk 0 and all the other time points after wk 8. Weight loss increased fecal Allobaculum and Ruminococcus torques. Weight loss also increased fecal Bifidobacterium, Faecalibaculum, Parasutterella in dogs fed both diets, but greater in dogs fed OR. Weight loss decreased fecal Collinsella, Turicibacter, Blautia, Ruminococcus gnavus, Faecalibacterium, Peptoclostridium in dogs fed both diets, but greater in dogs fed OR. Our data demonstrate that restricted feeding and weight loss alter fecal microbiota of obese dogs.

117 Assessment of Complete Blood Count and Biochemistry Parameters in Adult Dogs fed a Grain-Free Diet with up to Forty-Five Percent Pulse Inclusion

With interest in grain-free diets (GFD) and plant-based diets, understanding the use of pulse ingredients is warranted. Recently our laboratory found that high pulse inclusive diets did not cause echocardiographic changes in healthy adult dogs after 20 weeks of feeding. Thus, the objective of this study was to assess the safety of pulse ingredient inclusion up to 45% in canine diets using gross physiological, hematological and biochemical measurements. Twenty-eight healthy adult Siberian huskies were fed one of four experimental diets formulated to achieve the same macronutrient targets and the same micronutrient supplementation for 20 weeks: 1) grain-inclusive diet, with 45% corn, 0% pulses (Control); 2) GFD, 15% pulses (Pulse15); 3) GFD, 30% pulses (Pulse30) 4) GFD, 45% pulses (Pulse45). All diets included chicken meal and the same combination of pulse ingredients; green and yellow peas, pinto beans, chickpeas, and lentils. Dogs were fed once daily. Body weight was measured weekly, feed intake measured daily, and body composition was measured using DEXA at baseline and week 20. Fasted blood samples were collected at weeks -3, 3, 6, 10, 14 and 18. Data were analyzed as repeated measures in SAS using PROC GLIMMIX. Body weight, body composition, and feed intake were similar among treatments and over time (P >0.05). Several blood parameters were different among treatments but remained within defined reference ranges for healthy dogs. Red blood cells, hemoglobin and carbon dioxide were greater, while lymphocytes were reduced in Pulse45 than Pulse15 (P< 0.05), but similar to Control and Pulse30. Mean corpuscular hemoglobin concentration was decreased in Control and Pulse15 compared with Pulse30 and Pulse45 (P< 0.05). Gamma-glutamyl transferase was less in Control and Pulse15 than Pulse45 (P< 0.05), but similar to Pulse30. These data suggest that feeding diets with up to 45% pulse inclusion for 20 weeks does not impact gross health parameters of healthy adult dogs.

110 Evaluation of High-Protein Diets Differing in Protein Source in Healthy Adult Dogs

Given the dynamic market for protein-based ingredients in the pet food industry, demand continues to increase for both plant- and animal-based options. Animal and plant protein sources contain different amino acid profiles and vary in digestibility, which can affect the protein quality provided to the animal. Our objective was to evaluate the apparent total tract digestibility (ATTD) and compare protein quality of canine diets differing in protein source using healthy adult dogs. Four isocaloric and isonitrogenous, extruded diets were formulated to meet all AAFCO nutrient recommendations for adult dogs, with the primary difference being protein source: 1) chicken by-product meal (CBPM), 2) deboned chicken, dried chicken, and spray dried chicken (DC), 3) corn gluten meal (CGM), or 4) wheat gluten meal (WGM). Adult female beagles (n = 20; BW = 9.9 kg; age = 6.3 yr) were used in a replicated 4×4 Latin square design (n=12/treatment). Each period consisted of a 22-d adaptation phase, 5 d for total and fresh fecal collection, and 1 d for blood collection. All data were analyzed using the Mixed Models procedure of SAS 9.4. Diets contained similar crude protein (CP) concentrations (39.8%-41.7%), but DC had the most balanced AA profile (indispensable AA:dispensable AA ratio). Fecal scores were greater (P< 0.01) in dogs fed DC or CBPM than those fed WGM or CGM, but all remained within an appropriate range. Apparent dry matter digestibility was less (P< 0.0001) in dogs fed CBPM or CGM than those fed DC or WGM. Dogs fed CBPM had decreased (P< 0.0001) apparent organic matter, CP, and energy digestibilities than those fed the other 3 diets. Apparent CP digestibility was also reduced (P< 0.0001) in dogs fed DC or CGM than those fed WGM. Considering AA profiles and digestibility data together, the DC diet clearly provided the most and greatest quality protein of all diets tested.

954 Sarcoidosis Mimicking Progression of Melanoma: A Case Report

A 78-year-old lady with a history of malignant melanoma on the dorsal aspect of her left foot, presented with a new fluorodeoxyglucose positron emission tomography (FDG-PET) avid lesion in her left fibular head.

The patient had been diagnosed eight months previously with a 5.1mm Breslow thickness invasive melanoma. Following initial diagnosis, she underwent a wide local excision and sentinel lymph node biopsy (SLN). The melanoma was completely excised and SLN was negative for malignancy.

Postoperatively, she underwent radiological staging with computed tomography scans (CT) of her thorax, abdomen, and pelvis. This showed scattered pulmonary nodules, and multiple indeterminate liver lesions. A PET scan was then performed, which showed an expansile, FDG-avid, lytic lesion in the left fibular head, suspicious for bone metastasis. Following discussion at the multidisciplinary team meeting, the patient underwent an open biopsy of the fibular head. Histology revealed non-necrotising epitheloid granulomata without evidence of malignancy. Ziehl-Neelsen and periodic acid Schiff stains were negative. The findings were suggestive of sarcoidosis.

The patient revealed she had a previous diagnosis of pulmonary sarcoidosis 25 years prior, however, had no known extrapulmonary disease and was not attending a specialist. The pulmonary findings on CT were consistent with sarcoidosis.

Sarcoidosis is a systemic inflammatory disease characterised by the development of non-caseating granulomata which typically affect the lungs and lymph nodes but can affect multiple organ systems. This case highlights the diagnostic uncertainty of an FDG-avid lesion on PET, necessitating diagnostic biopsy. Sarcoidosis is an uncommon but possible differential in this setting.

POS0098 LINC01871, IMPLICATED IN SJÖGREN’S DISEASE PATHOGENESIS, IS REGULATED BY INTERFERON-G AND CALCINEURIN SIGNALING

Background

Sjögren’s disease (SjD) is an autoimmune disease characterized by exocrine gland dysfunction. Long non-coding RNAs (lncRNAs) are a functionally diverse class of non-protein coding RNAs that are longer than 200 nucleotides. Our previous study using whole blood RNA-seq found that lncRNA, LINC01871, is overexpressed in SjD relative to controls [1]. CRISPR-Cas9 targeting in HSB2 T cells yielded a LINC01871-/- clone with altered expression of many genes implicated in immune regulation [1].

Objectives

The goal of this study was to analyze the gene expression perturbations resulting from the loss of LINC01871 and to characterize the regulation of LINC01871 in both the LINC01871-/- clone and primary human T cells in response to immune stimuli.

Methods

Flow cytometry and LegendPlex bead assays were used to compare surface and secreted protein expression changes, respectively, in LINC01871-/- cells and the parental HSB2 cells. Parental HSB2 T cells, LINC01871-/- cells, Kasumi-3 myeloid cells, and primary human T cells were stimulated in vitro and changes in gene expression were measured over time using qRT-PCR. Responses to interferons (IFN) were assessed using universal type I IFN (IFNα) or IFNγ. TCR signaling responses were assessed using PMA/Ionomycin (PMA/I) or anti-CD3/CD28 stimulations in the presence or absence of the calcineurin inhibitor, FK506.

Results

Previous RNA-seq analysis found 1166 differentially expressed (DE) transcripts (log2FC ≥1 or ≤-1; padj ≤0.05) in LINC01871-/- cells compared to parental HSB2 cells, including many prominent immune regulatory genes. Changes in the basal expression of 7 proteins in LINC01871-/- cells were confirmed using flow cytometry (significantly decreased: CD8a (p=0.0004), CD30 (p=0.0008), CXCR3 (p=0.037), T-Bet (p=0.0002), and Aiolos (p=0.02); significantly increased: CD226 (p=0.0059) and CD44 (p=0.024)). Analysis of LINC01871-/- cells revealed a growth inhibition in LINC01871-/- cells (p=0.0014 at 72h), in which multiple secreted growth and adhesion factors were significantly reduced: GM-CSF (p=2.0e-06), M-CSF (p=2.7e-09), IGBPF4 (p=1.2e-07), s-ICAM1 (p=0.015), MMP9 (p=3.0e-14), and MMP2 (p=6e-08). In contrast, the IL-6 cytokine family member, LIF, was significantly increased in LINC01871-/- cells (p=1.2e-07). Because HSB2 cells were not responsive to all IFNs, IFN-mediated regulation of LINC01871 expression was examined in the Kasumi-3 myeloid cell line. While LINC01871 expression was not modulated by type I IFN stimulation, it was robustly responsive to IFNγ treatment. Since LINC01871 was expressed in T cells and implicated in T cell pathways, responses to TCR signaling pathways were characterized in HSB2 cells or purified primary human T cells treated with PMA/I. In both cell types, LINC01871 exhibited a prolonged decrease in expression that was abrogated by concurrent treatment with FK506, indicating that LINC01871 is regulated by calcineurin signaling. Treatment of primary human T cells with anti-CD3/CD28 to mimic true TCR engagement resulted in a modest decrease of LINC01871 expression at early time points, followed by an increase in expression with longer stimulation (2d).

Conclusion

Our findings suggest that LINC01871 is a potential mediator of the dysregulated T cell inflammatory response pathways implicated in SjD pathogenesis. LINC01871 influences the expression of many important immune cell genes and growth factors, is inducible by IFNγ, and is regulated directly by calcineurin signaling and TCR ligand engagement. Although LINC01871 functions are still unknown, observed LINC01871 overexpression in whole blood of SjD cases and after prolonged TCR stimulation in primary human T cells suggests that it could be a biomarker of SjD.

References

[1]Joachims, et al. Annals of the Rheumatic Diseases 2020;79:90.

Disclosure of Interests

Michelle L Joachims: None declared, Bhuwan Khatri: None declared, Chuang Li: None declared, Kandice L Tessneer: None declared, John Ice: None declared, Anna M Stolarczyk: None declared, Nicolas Means: None declared, Kiely Grundahl: None declared, Stuart Glenn: None declared, Jennifer Kelly: None declared, David Lewis: None declared, Lida Radfar: None declared, Donald Stone: None declared, Joel Guthridge: None declared, Judith A. James: None declared, R Hal Scofield: None declared, Graham B Wiley: None declared, Jonathan Wren: None declared, Patrick M Gaffney: None declared, Courtney Montgomery: None declared, Kathy Sivils Employee of: Current employee of Janssen., Astrid Rasmussen: None declared, A Darise Farris: None declared, Indra Adrianto: None declared, Christopher Lessard: None declared

Magseed localisation of non-palpable breast lesions: experience from a single centre

AIM

To prospectively analyse patients undergoing magnetic seed (Magseed) localisation (MSL) to evaluate the outcome, and to retrospectively compare re-excision rates for MSL with previous wire-guided localisation (WGL) to assess the hypothesis that the introduction of MSL may lead to a lower re-excision rate.

MATERIALS AND METHODS

MSL commenced at University Hospital Crosshouse in December 2017. No other changes were made to radiological or surgical practice during this time. Data were collected prospectively on all patients undergoing MSL between December 2017 and December 2019, in a single breast unit. Data were gathered retrospectively on patients who had undergone localised breast procedures between January 2016 and December 2019 for comparison of re-excision rates.

RESULTS

Two hundred and fifty-five patients underwent MSL surgery between December 2017 and December 2019. Of those, 98% (n=250) patients underwent successful MSL at the first attempt. The Magseed was identified intraoperatively in 100% patients and surgical excision was performed. The re-excision rate reduced from 18.9% in 2016/2017, to 11.6% in 2018/2019 (p=0.098).

CONCLUSION

In conclusion, Magseed localisation has proved to be a safe and effective way of localising breast lesions, with the advantage of high accuracy. The reduction in re-excision rates at University Hospital Crosshouse with the introduction of Magseed® localisation is a potential benefit, which requires further study.

Realizing topologically ordered states on a quantum processor

[Figure: see text].

Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer

AIMS

Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT).

MATERIALS AND METHODS

Data were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre.

RESULTS

High-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0-30.0) months and 37.0 (18.5-64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively.

CONCLUSION

We report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.

141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy

Objectives

Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.

Method

The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.

Results

Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p < 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.

Conclusions

Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.

1459 Intravesical Chemohyperthermia Versus Bacillus Calmette-Guerin Instillation for Intermediate- And High-Risk Non-Muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

Introduction

Traditional intravesical chemotherapy instillations under room temperature post trans-urethral resection (TUR) of non-muscle invasive bladder cancer (NMIBC) have lower efficacies than maintenance BCG installations. Intravesical chemo-hyperthermia (CHT) at higher temperatures is developed to improve the efficacy of chemotherapy instillation. This systematic review aims to compare the use of CHT and BCG instillation post-TUR.

Method

The protocol of this review is registered on PROSPERO(CRD42020223277). A comprehensive literature search was performed on Medline, EMBASE, and Cochrane CENTRAL to identify studies comparing CHT and BCG post-TUR for intermediate- or high-risk NMIBC. Primary outcomes include recurrence-free survival (RFS) and progression-free survival (PFS). Secondary outcomes include adverse events (AE).

Results

From 2,375 identified records, four randomised control trials incorporating 327 patients were included for meta-analysis. The use of CHT was found to be non-inferior to BCG in RFS, PFS and AEs (Grades 1-3) (p > 0.05). Sensitivity analysis, excluding patients with BCG failures, show 24-36 months recurrence rate to be significantly lower in CHT group (RR 0.64, 95% CI 0.42-0.98, p = 0.04) compared to the BCG group. In patients without carcinoma in situ (CIS), RFS is also significantly better in CHT patients (HR 0.52, 95% CI 0.32- 0.85, p < 0.01). Safety profile remains non-inferior to the BCG group in sensitivity analyses. Quality of evidence across all outcomes ranged from moderate to low.

Conclusions

In well-selected patients, intravesical CHT has superior oncological outcomes and non-inferior safety profile when compared to BCG maintenance therapy for patients with intermediate- and high-risk NMIBC. CHT is a possible alternative treatment during BCG shortage.

283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

Aim

Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.

Method

1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.

Results

There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).

Conclusions

SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.

732 Delay to Elective Colorectal Cancer Surgery and its Potential Implications During the Covid-19 Pandemic: A Systematic Review and Metanalysis

Aim

The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS).

Method

A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs).

Results

Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis.

Conclusions

This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.

O43 Virtual: virtual interactive surgical skills classroom: a randomized controlled trial (protocol)

Introduction

High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method

72 medical students will be randomly assigned to three equal intervention groups based on surgical skills experience and confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention. Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts.

Result

Change in confidence, time to completion and a novel granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.

Conclusion

This will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and beyond.

Take-home Message

This is the first RCT assessing virtual basic surgical skill classroom training and serves as a comprehensive appraisal of the suitability of virtual classrooms as an alternative to face-to-face training. The findings will assist the development and implementation of further resource-efficient training programs during the COVID-19 pandemic and in the future.

O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy

Introduction

Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.

Method

The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.

Result

Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.

Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P < 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.

Conclusion

Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.

Take-home Message

Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.

Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey

BACKGROUND

Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments.

OBJECTIVES

We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation.

METHODS

Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model.

RESULTS

Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations.

CONCLUSIONS

Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.