Data on the use of Granulocyte colony-stimulating factor (G-CSF) in pregnant cancer patients are scarce. The International Network of Cancer, Infertility and Pregnancy (INCIP) reviewed data of pregnant patients treated with chemotherapy and G-CSF, and their offspring. Among 2083 registered patients, 42 pregnant patients received G-CSF for the following indications: recent chemotherapy induced febrile neutropenia (5; 12%), dose dense chemotherapy (28, 67%), poly chemotherapy (7, 17%), or prevention of neutropenia at delivery (2; 5%). Among 24 women receiving dose dense chemotherapy, three (13%) patients recovered from asymptomatic neutropenia within 5 days. One patient developed pancytopenia following polychemotherapy after which the pregnancy was complicated by chorioamnionitis and intrauterine death. Nineteen singleton livebirths (49%) were born preterm. Sixteen neonates (41%) were admitted to the Neonatal Intensive care Unit (NICU). No neonatal neutropenia occurred. Two neonates had congenital malformations. Out of 21 children in follow-up, there were four children with a motor development delay and two premature infants had a delay in cognitive development. In conclusion, the rate of maternal and neonatal complications are similar to those described in (pregnant) women treated with chemotherapy. Due to small numbers and limited follow-up, rare or delayed effects among offspring exposed to G-CSF in utero cannot be ruled out yet.

Absorption of apixaban, a direct oral anticoagulant (DOAC), may be impaired after metabolic and bariatric surgery (MBS). The Dutch guideline advises switching to vitamin K antagonists (VKA), while patients prefer the use of DOACs. Apixaban is not regularly prescribed after MBS due to a lack of evidence regarding its efficacy and safety. This study aimed to evaluate the efficacy and safety of apixaban after MBS. In this retrospective cohort study, chronic DOAC users who received preoperative and postoperative consultation and used apixaban (5 mg twice daily) after MBS with available anti-Xa levels were included. The outcomes were incidence rate of postoperative bleeding and thromboembolic events, number of patients switching to VKA, and percentage of anti-Xa peak levels within the expected on-therapy range up to 1 year postoperatively. Of the 97 included patients, 63.9% were female, median age was 57 years (range, 51-61 years), and median preoperative body mass index was 43.2 kg/m² (range, 39.5-46.8 kg/m²), DOAC use was mostly indicated because of atrial fibrillation (59.8%), and 71.1% underwent Roux-en-Y gastric bypass. No thromboembolic events or major bleeds occurred, and 1 clinically relevant non-major bleeding was observed (incidence rate, 0.61; 95% CI, 0.02-3.38 per 100 patient-years). One patient switched to VKA, and 91.1% of patients had postoperative anti-Xa peak levels within expected on-therapy range. In this population of chronic DOAC users, apixaban with consultation including regular anti-Xa peak level measurements seems safe and effective after MBS. However, future prospective research in a larger population with longer follow-up is needed to confirm these results.

Introduction: Remote assessment of patients after same-day discharge metabolic and bariatric surgery (MBS) might be improved by continuous remote monitoring (CRM), because it provides heart and respiratory rate (HR, RR), alongside patient complaints. This study aimed to evaluate the added value of CRM on clinical decision making in the remote assessment of patients after same-day discharge MBS. Methods: A nationwide survey among MBS healthcare professionals ( n = 23) evaluated the clinical applicability of remote monitoring with general questions and its influence on clinical decision making using fictitious patient cases. Additionally, in a retrospective cohort study ( n = 213), current remote patient assessment, HR and RR, technical sensor performance and patient satisfaction in (non-)readmitted patients who underwent same-day discharge MBS was evaluated. Results: The survey showed that HR and RR along with complaints does not lead to uniform treatment policies, and only 54% of healthcare professionals always use CRM vital signs in patient assessment. The cohort study shows that CRM data was used in only 20% of remote patient assessments, however when CRM data was used, all patients with normal data but with complaints were still referred to the emergency department. Additionally, no statistically significant differences were found in HR and RR between readmitted ( n = 14) and non-readmitted patients ( n = 199), 49% of HR and 43% of RR data were missing and 72% of patients would have undergone same-day discharge MBS without CRM. Conclusion: For this specific low-risk population, CRM did not appear to influence clinical decision making after same-day discharge MBS, under the current implementation conditions.

Purpose: Despite a high prevalence of obstructive sleep apnea (OSA) in patients undergoing metabolic and bariatric surgery (MBS), there is no consensus on the best perioperative OSA strategy. Supplemental oxygen therapy without pre-operative OSA-testing (pulse oximetry) is safe and more cost-effective compared to preoperative OSA-testing using poly(somno)graphy (sleep test). This study aimed to compare these strategies on excess daytime sleepiness (EDS), its impact on daily functioning and health-related quality of life (HRQoL). Methods: Multicenter prospective cohort study including 1388 patients, 691 in the sleep test and 697 in the pulse oximetry group based on local protocols. EDS (ESS), its impact on daily functioning (FOSQ-10), HRQoL (RAND-36) and total weight loss (TWL) were assessed preoperatively and 1, 3, 6 and 12 months postoperatively. (Sub)scores were compared over time between and within groups using linear mixed models. Results: No differences between the pulse oximetry and sleep test strategy were found in EDS, its influence on daily life and HRQoL, and all improved after MBS. In the pulse oximetry group a lower TWL was found 1 month postoperative (-0.7%). Conclusion: Considering that pulse oximetry is more cost-effective, equally safe and comparable in EDS, its effect on daily functioning and HRQoL and no clinically relevant difference in TWL was found compared to the sleep test strategy, this study lends further support for pulse oximetry being the best strategy for managing OSA in patients undergoing MBS.