Background: Preoperative malnutrition is a significant factor in patients with pancreatic tumors undergoing pancreaticoduodenectomy. The aim of this study was to assess the association between preoperative malnutrition and delayed discharge within a ten-day timeframe and potential correlations between preoperative malnutrition and postoperative surgical complications. Methods: A retrospective cohort study was conducted, recruiting a final sample of 79 patients with benign or malignant cephalic pancreatic tumors from 2015 to 2022. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool, while length of hospital stay and relevant clinical data were extracted from clinical documentation. Results: The preoperative malnutrition risk was high in 21.52% of the sample, moderate in 36.71%, and low in 41.77%. Body mass index (BMI) (p = 0.007) and postoperative surgical complications (p < 0.001) were significantly correlated with delayed discharge. No statistically significant differences were found between levels of malnutrition risk and delayed discharge (p = 0.122), or postoperative surgical complications (p = 0.874). Conclusions: Postoperative complications and BMI emerge as significant risk factors. The limited sample size may have compromised the collection of homogeneous and significant data. Future studies should evaluate the implementation of personalized nutritional screening tools, nutritional assessment plans, and the involvement of specialized health professionals.

Background/Aim: Nutrition is a key element of the prehabilitation process prior to surgery. The aim of this study was to identify the clinical pathways of nutritional prehabilitation before cystectomy. Methods: A systematic literature review was conducted in PubMed, the Cochrane Library, CINAHL, Scopus and the Web of Science databases. Quality and risk of bias assessment was conducted adhering to the JBI framework and evidence was evaluated according to the Oxford Centre for Evidence Based Medicine levels of evidence. Results: Out of 586 records identified, six studies were included. Among them, only two were randomized controlled trials. Immunonutrition has been shown to improve postoperative bowel function (3.12 vs. 3.74 days; RR 0.82; CI, 0.73–0.93; p = 0.0029) and decrease postoperative complications (−36.7%; p = 0.008) and readmission rates (−15.38%; p = 0.03). Furthermore, oral nutritional supplements combined with nutritional counseling demonstrated an accelerated recovery of bowel function (−1 day; p < 0.01), a reduction in the length of hospital stay (−1.75 days; p = 0.01), an improvement in handgrip strength (+6.8%, p < 0.001), an increase in bone mass (+0.3 kg, p = 0.04), and a better BMI value (+2.3%, p = 0.001). Conclusions: Nutritional prehabilitation demonstrates potential in enhancing postoperative outcomes following radical cystectomy. Oral supplements, immunonutrition, and counseling exhibit efficacy in improving postoperative results.

Background: As part of simulation-based learning, it is well known that debriefing plays a crucial role; ineffective debriefing can lead to a reiteration of errors in decision-making and a poor understanding of one’s limitations, compromising the learner’s psychological safety and making future simulated learning experiences less effective. In Italy, although simulation has been used in nursing education for more than 20 years, there is a general lack of data regarding the elements of debriefing. Methods: An exploratory, cross-sectional, multicenter nationwide study was conducted to identify current debriefing practices in Italian simulation-based nursing education. A non-probability sample of all directors of the Italian Bachelor school of Nursing and the directors of simulation centers on Italian national territory was surveyed with an online questionnaire. Results: Fifty-four nursing degree programs and 11 simulation centers participated in the survey. Significant differences were found between debriefing practices used by simulation centers and those used by the Bachelor School of Nursing. Specifically, differences concerned the training of debriefers, the knowledge of a debriefing framework, the use of different rooms for debriefing and the time spent on this activity. Conclusions: There is an emerging need for a harmonization process in Italian nursing education debriefing practices that would align the current reality with the best practices of the literature.

The transition from open and laparoscopic techniques to robotic-assisted surgery has transformed the landscape of urologic oncology. However, few studies have directly compared institutional outcomes before and after the adoption of robotic platforms. The objective is to evaluate the clinical and organizational impact of implementing robotic surgery by comparing perioperative outcomes and hospital metrics between the pre-robotic era (2019–2020) and the robotic era (2021–2023) in a high-volume tertiary referral center. A retrospective cohort analysis was conducted on patients undergoing radical prostatectomy (RP), partial nephrectomy (PN), or radical cystectomy (RC) between January 2019 and December 2023. Surgical approach was laparoscopic (RP, PN) or open (RC) during 2019–2020, and robotic for all procedures from 2021 onward. Data on operative time, length of stay (LOS), extended hospitalizations (> 15 days), and 30-day readmissions were collected and compared between the two periods. A total of 1179 procedures were performed, with a marked increase in surgical volume after the implementation of robotic platforms (189 procedures in 2019–2020 vs. 990 in 2021–2023). The robotic era was associated with a significant reduction in median LOS across all procedures: RP (7.5–3.0 days), PN (6.5–4.1 days), and RC (15.5–7.3 days). The rate of extended hospitalizations dropped from 20.3 to 2.1% overall. Readmission rates remained stable, except for RC, which maintained a higher rate in both eras. Operative times remained comparable between the two periods. The transition to robotic-assisted surgery was associated with a substantial increase in surgical volume and significant improvements in perioperative outcomes, including shorter hospital stays and fewer prolonged admissions, while maintaining surgical safety. These results underscore that such improvements are primarily linked to the structured implementation of the program under the guidance of experienced robotic surgeons, rather than to the technology itself.

Background/Objectives: Robot-assisted radical cystectomy (RARC) has become the primary approach for treating bladder cancer, replacing the traditional open procedure. The robotic approach, when combined with ureterocutaneostomy (UCS), offers significant advantages for octogenarians, who are at increased risk for perioperative complications. Methods: This observational, prospective, multicenter analysis is based on data from the Italian Radical Cystectomy Registry (RIC), collected from January 2017 to June 2020 across 28 major urological centers in Italy. We analyzed consecutive male and female patients undergoing radical cystectomy (RC) and urinary diversion via the open, laparoscopic, or robot-assisted technique. Inclusion criteria: patients aged 80 years or older, with a WHO Performance Status (PS) of 2–3, an American Society of Anesthesiologist score ≥3, a Charlson Comorbidity Index (CCI) ≥ 4, and a glomerular filtration rate (GFR) <60 mL/min. Results: A total of 128 consecutive patients were included: 41 underwent RARC with UCS (Group 1), 65 open RC (ORC) with UCS (Group 2), and 22 laparoscopic RC (LRC) with UCS (Group 3). The cystectomy operative time was longer in robotic surgeries, while the lymph node dissection time was shorter. RARC with UCS showed statistically significant advantages in terms of lower median estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) compared to open and laparoscopic procedures. Intra- and postoperative complications were also lower in the RARC groups. Conclusions: Robotic cystectomy in high-volume referral centers (≥20 cystectomies per year) provides the best outcome for fragile patients. Beyond addressing the baseline pathology, RARC with UCS may represent a leading option, offering oncological control while reducing complications in this vulnerable age group.