Purpose: Daily aspirin use following cardiovascular intervention is commonplace and creates concern regarding bleeding risk in patients undergoing surgery. Despite its cardio-protective role, aspirin is often discontinued 5e7 days prior to major surgery due to bleeding concerns. Single institution studies have investigated perioperative outcomes of aspirin use in robotic partial nephrectomy (RPN). We sought to evaluate the outcomes of perioperative aspirin (pASA) use during RPN in a multicenter setting. Materials and Methods: We performed a retrospective evaluation of patients undergoing RPN at 5 high volume RPN institutions. We compared perioperative outcomes of patients taking pASA (81 mg) to those not on aspirin. We analyzed the association between pASA use and perioperative transfusion. Results: Of 1,565 patients undergoing RPN, 228 (14.5%) patients continued pASA and were older (62.8 vs 56.8 years, p <0.001) with higher Charlson scores (mean 3 vs 2, p <0.001). pASA was associated with increased perioperative blood transfusions (11% vs 4%, p <0.001) and major complications (10% vs 3%, p <0.001). On multivariable analysis, pASA was associated with increased transfusion risk (OR 1.94, 1.10e3.45, 95% CI). Conclusions: In experienced hands, perioperative aspirin 81 mg use during RPN is reasonable and safe; however, there is a higher risk of blood transfusions and major complications. Future studies are needed to clarify the role of antiplatelet therapy in RPN patients requiring pASA for primary or secondary prevention of cardiovascular events.
Introduction:This study aims to determine the differences between urological consulting service utilization in an academic setting compared to a private setting at a single institution during its transition from private to academic medical center.Methods:A retrospective review of patients undergoing inpatient urology consultation from July 2014 to June 2019 was performed. Consults were weighted using patient-days to account for hospital census.Results:A total of 1,882 inpatient urology consults were ordered, with 763 occurring prior to and 1,187 occurring after transition to academic medical center. Consults were placed more frequently in the academic than private setting (6.8 vs 4.5 consults/1,000 patient-days, P < .00001). The monthly consult rate in the private setting remained steady throughout the year, while the academic rate rose and then fell in accordance with the academic calendar, until statistically equaling the private rate in the final month of the academic year. Urgent consults were more likely to be ordered in the academic setting (7.1% vs 3.1%, P < .001), along with consults for urolithiasis (18.1% vs 12.6%, P < .001). Retention consults were more common in the private setting (23.7% vs 18.3%, P < .001).Conclusions:In this novel analysis, we demonstrated that significant differences exist between inpatient urological consult use in private and academic medical centers. Consults are ordered more frequently in academic hospitals until the end of the academic year, suggesting a learning curve for academic hospital medicine services. Recognition of these practice patterns identifies a potential opportunity to decrease the number of consultations through improved physician education.
Introduction Retrograde ureteroscopy with holmium laser lithotripsy (HLL) is a standard treatment for urolithiasis. Moses technology has been shown to improve fragmentation efficiency in vitro; however, it is still unclear how it performs clinically compared to standard HLL. We performed a systematic review and meta-analysis evaluating the differences in efficiency and outcomes between Moses mode and standard HLL. Material and methods We searched the MEDLINE, EMBASE, and CENTRAL databases for randomized clinical trials and cohort studies comparing Moses mode and standard HLL in adults with urolithiasis. Outcomes of interest included operative (operation, fragmentation, and lasing times; total energy used; and ablation speed) and perioperative parameters (stone-free rate and overall complication rate). Results The search identified six studies eligible for analysis. Compared to standard HLL, Moses was associated with significantly shorter average lasing time (mean difference [MD] -0.95, 95% confidence interval [CI] -1.22 to -0.69 minutes), faster stone ablation speed (MD 30.45, 95% CI 11.56–49.33 mm 3 /min), and higher energy used (MD 1.04, 95% CI 0.33–1.76 kJ). Moses and standard HLL were not significantly different in terms of operation (MD -9.89, 95% CI -25.14 to 5.37 minutes) and fragmentation times (MD -1.71, 95% CI -11.81 to 8.38 minutes), as well as stone-free (odds ratio [OR] 1.04, 95% CI 0.73–1.49) and overall complication rates (OR 0.68, 95% CI 0.39–1.17). Conclusions While perioperative outcomes were equivalent between Moses and standard HLL, Moses was associated with faster lasing time and stone ablation speeds at the expense of higher energy usage.
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