European Journal of Anaesthesiology最新文献

{"title":"Beyond discharge score: postoperative care unit nurses' clinical assessments improve postoperative risk stratification: A prospective cohort study.","authors":"Lea B Hvidberg, Eske K Aasvang, Emilie Bak, Victoria Bank, Lene R Poulsen, Martin G Tolsgaard, Nicolai B Foss","doi":"10.1097/EJA.0000000000002362","DOIUrl":"10.1097/EJA.0000000000002362","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications frequently occur within 24 h of surgery and are challenging to detect early. Tools such as the Modified Aldrete Score (MAS) and National Early Warning Score (NEWS) support postanaesthesia care unit (PACU) discharge decisions; however, their prognostic performance is uncertain. Clinical nurse assessments may offer additional value.</p><p><strong>Objectives: </strong>To compare the prognostic performance of MAS, NEWS, and PACU nurse clinical assessments in predicting early postoperative complications (within 72 h of PACU discharge) in high-risk surgical patients.</p><p><strong>Design: </strong>Prospective, two-centre observational cohort.</p><p><strong>Setting: </strong>Conducted in two PACUs in the Capital Region of Denmark.</p><p><strong>Patients: </strong>Two hundred and forty high-risk adult surgical patients were included after elective or emergency procedures. Complications were defined according to Clavien-Dindo grade II to V. Patients with missing nurse assessments ( n  = 15) were excluded from analyses involving this variable.</p><p><strong>Main outcome measures: </strong>The primary outcome was the prognostic performance of MAS in identifying early postoperative complications. Secondary outcomes included the performance of NEWS and PACU nurse assessments. Early complications were defined as events occurring within 72 h of PACU discharge.</p><p><strong>Results: </strong>MAS and NEWS showed limited predictive ability (AUC = 0.555 and 0.589, respectively). PACU nurse assessments were significantly associated with early complications (AUC = 0.652, P  = 0.006). Patients rated as 'Potentially unstable' or 'Unstable' had a higher risk despite meeting MAS criteria: odds ratio (OR) = 3.65, 95% confidence interval (CI), 1.53 to 8.76; relative risk (RR) = 0.32, 95% CI, 0.15 to 0.70. The optimal threshold yielded 72.4% sensitivity, 61.2% specificity, 21.6% positive-predictive value (PPV), and 93.8% negative-predictive value (NPV). Early complications were associated with increased risk of subsequent complications: OR = 5.0, 95% CI, 1.8-14.1, P  < 0.001.</p><p><strong>Conclusions: </strong>PACU nurse assessments outperformed MAS and NEWS in predicting early postoperative complications. Integrating structured clinical judgment into discharge decisions may enhance risk stratification and safety.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT06013891.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"703-711"},"PeriodicalIF":7.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative liquid fasting practices in twelve European countries: A prospective multicentre cohort study (Thirst study).","authors":"Anne Marie Camilleri Podesta, Stephen Sciberras, Emanuel Moisa, Leon Valletta, Sara Farrugia, Peter Paal, Pinelopi Kouki, Diana Gasiūnaitė, Sérgio Vide, Armen Varosyan, Iveta Golubovska, Vesna Durnev, Mamuka Chkhaidze, Saimir Kuci, Bojana Vujovic, Federico Bilotta, Dan Corneci, Mădălina Dutu, Narcis Valentin Tănase, Florentina Ioniță-Radu, Laura Hostiuc, Silvius Negoiță, Valentin Calu, Dana Rodica Tomescu, Gabriela Droc, Liliana Mirea, Răzvan Ene, Raluca Ileana Ungureanu, Bianca Liana Grigorescu, Mircea Stoian, Anca Irina Ristescu, Olguța Lungu, Mihaela Blaj, Alexandru Igna Răzvan, Daniela Ionescu, Cristina Osoian, Cristina Petrişor, Ovidiu Bedreag, Marius Păpurică, Alice Drăgoescu, Marius Novac, Mihai Sava, Alina Simona Bereanu, Bogdan Ioan Vintilă, Ioana Zacheu, Maria Suditu, Mihai Florea, Iosif Cosmin Trebuian, Andreea Latiş, Carmen Orban, Sebastian Rauhut, Helmar Bornemann-Cimenti, Michael Eichlseder, Gabriel Honnef, Thomas Danninger, Johanna Lang, Joanna Baron, Markus Köstenberger, Kateryna Kovalevska, Mario Kößlbacher, Verena Wirnsberger, Andreas Schmid, Michael Hüpfl, Sarah Götsch, Vlasios Karageorgos, Areti Falara, Eleni Chrona, Eleni Tataki, Eleni Iordanidi, Anna Gizli, Dimitra Tsitoura, Justina Krauklytė, Andrius Macas, Tomas Bukauskas, Andrew Attard Montalto, Maureen Bezzina Sultana, Christopher Gauci, Rita Miranda, Catarina Chaves, Joana Cabral, Cátia Martins, Joana Mourão, Yelena Varosyan, Irina Evansa, Marina Sarkele, Tatjana Trojikj, Sanja Kolevska, Tsotne Samadashvili, Tea Kareli, Marsela Goga, Jelena Visnjic","doi":"10.1097/EJA.0000000000002347","DOIUrl":"10.1097/EJA.0000000000002347","url":null,"abstract":"<p><strong>Background: </strong>International guidelines recommend pre-operative clear liquid fasting for 2 h before anaesthesia. However, excessive fasting times remain widespread, potentially contributing to patient discomfort and adverse clinical outcomes.</p><p><strong>Objective: </strong>To evaluate current pre-operative liquid fasting practices among adults undergoing elective procedures across multiple European centres.</p><p><strong>Design: </strong>Prospective, observational, multicentre study.</p><p><strong>Setting: </strong>Forty-six centres in 12 European countries, conducted between November and December 2024.</p><p><strong>Patients: </strong>A total of 5100 adults undergoing elective surgery or interventional procedures under general anaesthesia, regional anaesthesia or sedation.</p><p><strong>Main outcome measures: </strong>Self-reported duration of pre-operative liquid fasting; incidence of prolonged fasting duration (defined as liquid fasting times of more than 4 h). Median [IQR] fasting time was calculated, with subgroup analyses by country and procedure type.</p><p><strong>Results: </strong>The median [IQR] pre-operative liquid fasting time was 12 [10 to 14.6] h. Only 4% of patients consumed clear liquids within 2 to 4 h, and 0.8% within 2 h. Fasting durations were consistently prolonged across most countries and procedures, except for notably shorter times in Albania. Overall, 95% of patients fasted beyond 4 h.</p><p><strong>Conclusions: </strong>Excessive pre-operative liquid fasting remains highly prevalent across Europe, with poor implementation of established guidelines. These findings underscore the need for educational, institutional, and quality improvement interventions to align clinical practice with evidence-based recommendations and enhance patient-centred care.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06527703.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"672-679"},"PeriodicalIF":7.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure thresholds for the administration of balanced crystalloids and the effect on intra-operative hypotension: A proof-of-concept causal inference analysis featuring idealised dynamic treatment regimens.","authors":"Markus Huber, Hyung-Chul Lee, Patrick Y Wuethrich","doi":"10.1097/EJA.0000000000002356","DOIUrl":"10.1097/EJA.0000000000002356","url":null,"abstract":"<p><strong>Background: </strong>Haemodynamic management and fluid administration constitute a challenging cornerstone of intra-operative care to counteract hypotension. Observational studies remain a vital source of evidence regarding the associations of fluids and vasopressors with peri-operative outcomes.</p><p><strong>Objective: </strong>To evaluate dynamic treatment regimens (DTRs) of balanced crystalloids on the incidence of intra-operative hypotension. DTRs constitute a statistical framework to evaluate the causal impact of different treatment strategies (e.g. fluid administration) on an outcome (e.g. hypotension) whilst accounting for time-dependent treatments and treatment-confounder feedbacks.</p><p><strong>Design: </strong>Analysis of observational data using modern causal inference methods.</p><p><strong>Setting: </strong>Tertiary institution in South Korea during January 2011 to December 2020 (INSPIRE dataset).</p><p><strong>Patients: </strong>N  = 23 305 patients undergoing elective surgery under general anaesthesia.</p><p><strong>Interventions: </strong>The DTRs refer to thresholds of mean invasive arterial blood pressure (MAP) to guide a hypothetical administration of 250 ml of balanced crystalloids. As example, a DTR implies administering 250 ml of balanced crystalloids if MAP drops below a 70 mmHg threshold, and to administer no crystalloids otherwise. MAP thresholds of 60, 65, 70 and 75 mmHg were evaluated.</p><p><strong>Main outcome measures: </strong>Primary endpoint was intra-operative hypotension defined as a MAP below 65 mmHg averaged in 15-min windows.</p><p><strong>Results: </strong>The DTRs resulted in clinically similar incidences of intra-operative hypotension for surgeries shorter than 2 h. For surgeries lasting longer, the DTRs with early fluid administration resulted in a reduction of hypotension of more than 4% towards the end of the surgery. As higher MAP-thresholds imply higher amounts of fluid, our findings suggest there is in general a positive effect of fluid administration on intra-operative hypotension.</p><p><strong>Conclusions: </strong>Using modern causal inference methods, we demonstrated the clinical utility of idealised DTRs to study the impact of time-dependent haemodynamic management on the incidence of intra-operative hypotension in idealised settings. Future studies are required to investigate more complex DTRs mirroring clinical practice and to assess the robustness of the findings with respect to the different surgical populations.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"680-691"},"PeriodicalIF":7.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left head rotation manoeuvre to improve laryngoscopic view in elective surgery: A prospective cohort study.","authors":"David Conrad, Darius Kubulus, Henrik Fuchs, Thomas Volk, Ulrich Berwanger","doi":"10.1097/EJA.0000000000002343","DOIUrl":"10.1097/EJA.0000000000002343","url":null,"abstract":"<p><strong>Background: </strong>The left head rotation (LeHeR) manoeuvre has been proposed to improve the laryngoscopic view based on case reports of unexpectedly difficult intubation under emergency conditions.</p><p><strong>Objectives: </strong>To evaluate the potential of the LeHeR manoeuvre to improve the direct laryngoscopic view under elective surgical conditions and to investigate the dependence on patient- and examiner-dependent factors.</p><p><strong>Design: </strong>Single-centre prospective cohort study.</p><p><strong>Setting: </strong>This study was conducted at the Department of Anesthesiology of Saarland University Hospital between November 2022 and March 2023. Laryngoscopy findings in the Jackson position and after the application of the LeHeR manoeuvre were recorded during the routine surgical program by the responsible anaesthetists in the presence of a study physician.</p><p><strong>Patients: </strong>One hundred and two adult patients scheduled for elective surgery, general anaesthesia with endotracheal intubation, and without a particular risk of aspiration.</p><p><strong>Main outcome measures: </strong>primary outcome was the laryngoscopic view graded according to the modified Cormack and Lehane classification score (CLS) and subsequently in the percentage of glottic opening (POGO) score before and after application of the LeHeR manoeuvre. The secondary outcomes were the differences in laryngoscopic views according to both scores (ΔCLS, ΔPOGO).</p><p><strong>Results: </strong>With the improved Jackson-position, the median laryngoscopic view was CLS grade 2a [1 to 2a], with a POGO score of 80 [42.5 to 100]. With LeHeR, the median laryngoscopic view was CLS grade 2a [1 to 2b], with a POGO score of 70 [42.5 to 90], indicating a reduced laryngoscopic view (CLS, P  < 0.001; POGO, P  = 0.041). While patient characteristics had no influence on the difference in laryngoscopic views, longer professional experience correlated significantly with an improvement in the laryngoscopic view according to the POGO ( r  = 0.242, P  = 0.018), but not the Cormack and Lehane scores ( r  = -0.29, P  = 0.004).</p><p><strong>Conclusions: </strong>The LeHeR manoeuvre failed to significantly improve the direct laryngoscopic view compared to the improved Jackson-position under standard conditions for elective surgery. However, experienced anaesthetists achieved better results with this manoeuvre than novice anaesthetists.</p><p><strong>Trial registration: </strong>This study was prospectively registered in the German Clinical Trials Register (DRKS00029944).</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"665-671"},"PeriodicalIF":7.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building resilience in perioperative medicine: ensuring safe care for all: A white paper from the European society of anaesthesiology and intensive care (ESAIC).","authors":"Wolfgang Buhre, Michel Struys, Markus Klimek, Edoardo de Robertis, Else-Marie Ringvold, Anne Marie Camilleri, Cathy Weynants, Idit Matot","doi":"10.1097/EJA.0000000000002433","DOIUrl":"10.1097/EJA.0000000000002433","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"655-664"},"PeriodicalIF":7.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative single-level ultrasound-guided superficial parasternal intercostal plane block and pulmonary recovery after cardiac surgery with sternotomy: a randomised controlled trial.","authors":"Pierre Huette, Camille Daumin, Rémi Fontaine, Thomas Lefebvre, Paul Tarpin, Christophe Beyls, Brigitte Gubler, Yazine Mahjoub, Adrien Ollier, Osama Abou-Arab","doi":"10.1097/EJA.0000000000002419","DOIUrl":"10.1097/EJA.0000000000002419","url":null,"abstract":"","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":"712-713"},"PeriodicalIF":7.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant hyperthermia in France: characteristics of 93 diagnosed patients in one French reference centre: A retrospective data analysis.","authors":"Pierre Pardessus, Béatrice Bruneau, Martin Lagarde, Yara Maroun, Nathalie Roux Buisson, Julien Faure, Souhayl Dahmani, Florence Julien-Marsollier","doi":"10.1097/EJA.0000000000002444","DOIUrl":"10.1097/EJA.0000000000002444","url":null,"abstract":"<p><strong>Background: </strong>Malignant hyperthermia (MH) is a rare but potentially fatal complication of general anaesthesia, triggered by volatile anaesthetics and depolarising muscle relaxants in genetically predisposed individuals. Although outcomes have improved with better monitoring and dantrolene administration, diagnosis remains challenging. This study aimed to describe patients referred after suspected MH crises in France and to compare clinical features and Larach grading between MH-susceptible and non-susceptible patients.</p><p><strong>Material: </strong>We conducted a retrospective, monocentric study of patients referred to a French MH reference centre between 1968 and 2020. Clinical, biological and anaesthetic data from suspected MH crises were analysed. MH susceptibility was determined using genetic testing and/or in vitro contracture testing. The diagnostic performance of the Larach clinical grading scale was assessed using receiver operating characteristics curve.</p><p><strong>Results: </strong>Of 1258 patients evaluated, 182 experienced a suspected MH crisis, of these 93 were fully investigated; 49 were confirmed as MH-susceptible (MHS) and 44 MH-negative (MHN). The specific triad (Hyperthermia, hypercapnia and muscle rigidity) was observed in 86% of the MHS patients. Adequate treatment with Dantrolene was given in 64% of cases after 2000. The threshold of 45 on Larach's score exhibited a specificity of 90% [87 to 93%] and a sensitivity of 59% [54 to 94%].</p><p><strong>Conclusion: </strong>In this French cohort of 93 cases fully evaluated for MH susceptibility, the typical triad was present in 86% of MHS patients. Performance of Larach score as determined by this study was similar to its original description.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specific neurotoxicity of local anaesthetics revisited: An evidence-based narrative review.","authors":"Pierre Goffin, Jean-Pierre Lecoq, Michele Carella, Hipolito Labandeyra, Martí Flò Csefkó, Xavier Sala-Blanch","doi":"10.1097/EJA.0000000000002461","DOIUrl":"https://doi.org/10.1097/EJA.0000000000002461","url":null,"abstract":"<p><p>Local anaesthetics are essential to regional anaesthesia but may exert neurotoxic effects on peripheral nerves under specific conditions. Although perioperative nerve injury is increasingly recognised, the contribution of local-anaesthetic neurotoxicity, the relative toxicity of different agents and concentrations, and the influence of patient-related risk factors remain incompletely defined. This evidence-based narrative review synthesises experimental and clinical data on peripheral nerve neurotoxicity associated with local anaesthetics and discusses implications for clinical practice and future research. A prospectively registered search was conducted across major biomedical databases for studies published between 1990 and 2024. Experimental evidence consistently demonstrates dose-dependent and time-dependent neurotoxicity for all clinically used local anaesthetics, characterised by ultrastructural damage, oxidative stress, mitochondrial dysfunction and activation of apoptotic and intracellular signalling pathways. Relative toxicity varies between agents and concentrations, with lidocaine and bupivacaine often appearing more potent than ropivacaine or chloroprocaine in preclinical models, while findings for articaine remain heterogeneous. Diabetic and metabolically compromised nerves exhibit increased susceptibility, supporting a 'two-hit' model of injury. In contrast, clinical evidence directly linking specific agents, concentrations or exposure durations to permanent peripheral nerve injury is limited, and such injuries are typically multifactorial. Overall, chemical neurotoxicity should be considered one component of a broader perioperative risk profile. Risk mitigation should prioritise avoidance of intraneural injection, adherence to recommended doses and cautious use of high concentrations or prolonged exposure, particularly in vulnerable nerves. Further research should integrate mechanistic and clinical outcomes while accounting for patient-level risk factors.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148619019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting postoperative infections: prediction models and their evaluation: A systematic review.","authors":"Nikki de Mul, Katja M Scheffer-Wesdorp, Diede Verlaan, Gabriele Mondelli, Willem-Jan M Schellekens, Marc J M Bonten, Lennie P G Derde, Olaf L Cremer, Lisette M Vernooij","doi":"10.1097/EJA.0000000000002470","DOIUrl":"10.1097/EJA.0000000000002470","url":null,"abstract":"<p><strong>Background: </strong>Pre-operative assessment for postoperative infection risk helps identify patients for personalised decision-making and management.</p><p><strong>Objective: </strong>This systematic review evaluates existing prediction models for infection, focusing on their validation and implementation status.</p><p><strong>Data sources and eligibility criteria: </strong>PubMed, Embase and the Cochrane Library were searched for studies on the development, validation- and implementation of multivariable models utilising pre-operative predictors to estimate the risk of postoperative infections within 30-days of elective, major noncardiac, non-intracranial surgery.</p><p><strong>Results: </strong>Of 151 included studies, 88 reported model development (267 distinct models), 88 assessed model validity (314 validation analyses), and none described implementation. Models predominantly predicted surgical site infections (SSI, n  = 88), pneumonia ( n  = 45) and general (unspecified) infections ( n  = 57). Age (66%), sex (53%) and ASA score (48%) were the most common predictors. The American College of Surgeons Surgical Risk Calculator (ACS SRC) and SUrgical Risk Pre-operative Assessment System (SURPAS) were most frequently validated, with 225 and 35 external validations respectively. Reported c -statistics of the ACS SRC were median 0.61 [range 0.43 to 0.85], 0.66 [0.44 to 0.95] and 0.64 [0.31 to 0.97] for prediction of SSI, pneumonia, and urinary tract infection (UTI), respectively. For SURPAS, median c -statistics were 0.62 [range 0.52 to 0.78] and 0.59 [0.52 to 0.82] for UTI and general infection. Overall, most studies scored high risk of bias.</p><p><strong>Conclusions: </strong>Out of 267 prediction models for postoperative infections identified, ACS SRC and SURPAS were most frequently validated. However, the clinical utility of even these models is limited because of poor and highly variable predictive performance and low methodological quality of validation studies.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148600680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related patterns in postoperative pain: insights from the paediatric pain out registry: A prospective cohort study.","authors":"Rachele Simonte, Ruth Zaslansky, Francesca Oppitz, Alinde Hindriks, Wolfgang Buhre, Edoardo De Robertis, Lisette Vernooij, Winfried Meissner, Ulrike Stamer, Mienke Rijsdijk","doi":"10.1097/EJA.0000000000002459","DOIUrl":"10.1097/EJA.0000000000002459","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain is common in children, yet its relationship to age and sex remains underexplored.</p><p><strong>Objectives: </strong>We hypothesise that postoperative pain intensity varies across age groups. The objective is to identify ages at which high pain with functional impairment is most prevalent and assess any sex difference in the association between age and postoperative pain.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Data were extracted from the paediatric PAIN OUT registry, an international registry. Data were prospectively collected at hospitals in Germany, the Netherlands and Austria.</p><p><strong>Patients: </strong>The study includes 2005 patients aged 4 to 18 years who underwent appendectomy, tonsillectomy, hernia repair, orthopaedic, or spinal fusion surgery.</p><p><strong>Main outcome measures: </strong>Postsurgical pain scores (Faces Pain Scale 0 to 10) were compared between surgical procedures, stratified by sex, and age. The association between the primary outcome, 'worst pain' score on the first day after surgery, and age and sex was analysed using regression models adjusted for confounding factors: surgery type, duration, perioperative opioid consumption, and use of regional anaesthesia.</p><p><strong>Results: </strong>Postoperative pain intensity was high with 79% of children experiencing moderate to severe pain, increasing with age, peaking around 12 years, particularly in girls. The regression model confirmed an age-related increase in pain intensity in females (interaction coefficient: 0.08, 95% confidence interval 0.02 to 0.15, P  = 0.017). Appendectomy and not receiving regional anaesthesia were associated with higher pain intensity. Higher mean oral morphine equivalent doses were given to patients aged 12 years or older for appendectomy (0.57 ± 0.52 vs. 0.60 ± 0.66 mg kg -1 , P  = 0.003) and spine surgery (2.1 ± 1.6 vs. 2.7 ± 2.4 mg kg -1 , P  = 0.038), with comparable doses between the sexes.</p><p><strong>Conclusions: </strong>In this paediatric cohort, 79% experienced moderate to severe postoperative pain, with higher scores in children aged 12+ and a peak in girls around the onset of puberty. These findings emphasise the need for improved paediatric pain management with consideration for age and sex-related differences.</p>","PeriodicalId":11920,"journal":{"name":"European Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}