SummaryWith the popularity of ambulatory surgery ever increasing, we carried out a systematic review and meta-analysis to determine whether the type of anaesthesia used had any bearing on patient outcomes. Total intravenous propofol anaesthesia was compared with two of the newer inhalational agents, sevoflurane and desflurane. In total, 18 trials were identified; only trials where nitrous oxide was administered to, or omitted from, both groups were included. A total of 1621 patients were randomly assigned to either propofol (685 patients) or inhalational anaesthesia (936 patients). If surgical causes of unplanned admissions were excluded, there was no difference in unplanned admission to hospital between propofol and inhalational anaesthesia (1.0% vs 2.9%, respectively; p = 0.13). The incidence of postoperative nausea and vomiting was lower with propofol than with inhalational agents (13.8% vs 29.2%, respectively; p < 0.001). However, no difference was noted in post-discharge nausea and vomiting (23.9% vs 20.8%, respectively; p = 0.26). Length of hospital stay was shorter with propofol, but the difference was only 14 min on average. The use of propofol was also more expensive, with a mean (95% CI) difference of £6.72 (£5.13-£8.31 (€8.16 (€6.23À€10.09); $11.29 ($8.62-$13.96))) per patient-anaesthetic episode (p < 0.001). Therefore, based on the published evidence to date, maintenance of anaesthesia using propofol appeared to have no bearing on the incidence of unplanned admission to hospital and was more expensive, but was associated with a decreased incidence of early postoperative nausea and vomiting compared with sevoflurane or desflurane in patients undergoing ambulatory surgery.

Background Adolescence is a vulnerable period for paediatric renal transplant recipients (RTR), with many losing their allografts within years of transferring to adult care. A transition programme was developed to better equip RTR for adulthood. It features a five-year education framework with a phased-handover to the adult team over two years via joint-clinics. Aims To evaluate the impact of the transition programme on post-transfer renal allograft survival and to evaluate the patient education arm of the transition programme. Methods A retrospective cohort study of RTR who transferred from a paediatric centre before the transition programme was introduced (non-transition cohort) and RTR who transferred via the transition programme (transition cohort). RTR who transferred to one of four adult centres between January 1999 and January 2014 were followed up to their first four years in adult care. Data on renal allograft survival and therapeutic drug monitoring of immunosuppressive medications were collected. Additionally, RTR currently on the programme approaching transfer completed a questionnaire to indicate self-care competencies they possessed and post-transfer RTR were asked if the transition programme helped them develop said competencies. Results 106 (69 non-transition, 37 transition) RTR were followed-up. Non-transition RTR were 2.76 times more likely to lose their allografts during their first four years in adult care; when controlling for donor type (live/deceased), prior number of renal transplants and the time (days) post–transplant prior transferring (95% CI = 0.808 – 9.51; p = 0.1). The transition cohort also had on average 21% (65% vs. 44%) more of their trough levels within their therapeutic target levels (95% CI = 2.5–38.4%; p = 0.03). 41 RTR at the paediatric centre and 7 post-transfer RTR completed the questionnaire. Responses indicated patients possessed most competencies, except for managing administrative tasks relating to their care. Over 50% of post-transfer RTR reported the programme helped them develop all, but one, competencies they possessed. Conclusion We report the largest follow-up to-date of RTR from a single centre evaluating a novel, multicomponent transition programme. Our data indicates a longitudinal transition programme with a phased-handover via joint–clinics is positively associated with post-transfer renal allograft survival.