Perioperative Medicine最新文献

{"title":"A predictive tool for early identification of moderate-to-severe pain following open colorectal surgery in older adults: a retrospective cohort study.","authors":"Yan Jin, Rongrong Feng, Hui Wang, Jianhui Huo","doi":"10.1186/s13741-025-00595-9","DOIUrl":"https://doi.org/10.1186/s13741-025-00595-9","url":null,"abstract":"<p><strong>Background: </strong>Moderate-to-severe pain is a common but often under-recognized complication after open colorectal surgery in older adults, leading to delayed recovery and extended hospitalization. Early identification of high-risk patients is essential for timely pain management. The objective of this study was to develop and internally validate a predictive model, presented as a nomogram, for estimating the risk of moderate-to-severe postoperative pain within 24 h among elderly patients undergoing open colorectal surgery.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 300 patients aged ≥ 60 years who underwent elective open colorectal surgery. Postoperative pain within 24 h was assessed using the Numerical Rating Scale (NRS); NRS ≥ 4 was defined as moderate-to-severe pain. Preoperative psychosocial, cognitive, inflammatory, and perioperative factors were evaluated. Multivariable logistic regression with stepwise AIC selection identified independent predictors. Model performance was assessed using ROC curves, calibration plots, the Hosmer-Lemeshow test, and decision curve analysis (DCA). A nomogram was developed for clinical use.</p><p><strong>Results: </strong>Of the 300 patients, 120 (40.0%) experienced moderate-to-severe pain. These patients were older and had higher preoperative NRS and CRP levels, along with worse psychosocial and cognitive scores (P < 0.01). Seven variables independently predicted pain severity: GAD-7, PHQ-9, MMSE, MOS-SSS, CRP, operative duration, and undergoing a Miles procedure (P < 0.05). The model showed good discrimination (AUC = 0.79 in training; 0.77 in validation) and calibration. DCA demonstrated net clinical benefit across a range of thresholds.</p><p><strong>Conclusion: </strong>We developed and validated a nomogram incorporating psychosocial, inflammatory, and procedural factors to predict moderate-to-severe postoperative pain. This tool may enable early risk stratification and guide individualized analgesic strategies in elderly patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"105"},"PeriodicalIF":2.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The older adult surgical patient: a review of optimization and gaps in clinical practice.","authors":"Cecilia Canales, Leslie Wann, Jeanna Blitz, Robert Whittington","doi":"10.1186/s13741-025-00593-x","DOIUrl":"10.1186/s13741-025-00593-x","url":null,"abstract":"<p><p>As the number of older adults undergoing surgery increases, the perioperative community must address the unique challenges of this vulnerable population. Age alone is not a sufficient indicator of risk and other factors like functional status, nutrition, and cognition also play a crucial role in determining a patient's vulnerability. Identifying high-risk patients requires targeted assessment to identify those who can most benefit from optimization. With an already strained perioperative workforce, integrating comprehensive geriatric programs, which rely on multidisciplinary teams to conduct frailty and geriatric assessments and to target prehabilitation and optimization, is a strategy to improve outcomes. By utilizing comprehensive geriatric programs that combine preoperative, intraoperative, and postoperative strategies to optimize care for older adults, the perioperative community can address the unique needs of high-risk older adults to reduce complications, mortality, and healthcare costs while improving the quality of life of these patients. In this review, we highlight strategies to optimize older adults undergoing surgery and identify significant gaps in practice that must also be addressed to improve the perioperative care of this often vulnerable patient population.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"104"},"PeriodicalIF":2.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New-onset postoperative atrial fibrillation and burden imposed by CYP2C19 metabolizer phenotype on clopidogrel in off-pump coronary artery bypass: a retrospective cohort study.","authors":"Qin Jiang, Yalu Yu, Keli Huang, Jiurong Huang, Neng Wang, Shengshou Hu","doi":"10.1186/s13741-025-00592-y","DOIUrl":"10.1186/s13741-025-00592-y","url":null,"abstract":"<p><strong>Background: </strong>The pathogenesis of new-onset postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass graft (OPCABG) surgery remains to be partly known. The association between clopidogrel metabolizer phenotype and the occurrence of POAF was investigated.</p><p><strong>Methods: </strong>A total of 320 patients undergoing elective first-time OPCABG surgery and receiving 100 mg/day oral aspirin and 75 mg/day oral clopidogrel was reviewed from May 2017 to November 2023. These patients were categorized as normal metabolizer (NM), intermediate metabolizer (IM), and poor metabolizer (PM) according to cytochrome P450, family 2, subfamily C, polypeptide 19 (CYP2C19) genotyping. The incidences of POAF in the first week were compared using the log-rank test for cumulative risk. Platelet aggregability, inflammatory indexes, prothrombotic effect, and POAF burden were analyzed. Three phenotype categories were divided by genotyping as NM group (CYP2C19 1*1, n = 163), IM group (CYP2C19 1*2 or 1*3 n = 112), and PM group (CYP2C19 2*2 or 2*3, n = 45). The incidence of POAF after OPCABG was 20.9% in the NM group, contrasting with 35.7% in the IM group (hazard ratio [HR] versus NM group, 1.843; 95% confidence interval [CI], 1.155 to 2.940; P = 0.0076) and 57.8% in the PM group ([HR] versus NM group, 3.363; 95% CI, 1.753 to 6.499; P < 0.0001). Adenosine diphosphate-stimulated platelet aggregation (17.8% ± 4.4% vs. 27.8% ± 4.3% vs. 37.2% ± 5.8%, F = 367.594, P < 0.001), inflammatory cytokines (interleukin-6, 43.5 ± 11.5 pg/ml vs. 46.8 ± 11.8 pg/ml vs. 51.2 ± 11.4 pg/ml, F = 8.471, P < 0.001), and prothrombotic effect (D-dimer, 2.1 ± 0.6 ng/ml vs. 2.4 ± 0.7 ng/ml vs. 3.2 ± 1.3 ng/ml, F = 37.61, P < 0.001) at 5 days after OPCABG, POAF burden (3.0% [1.2%, 6.1%] vs. 4.8% [2.4%, 11.9%] vs. 8.9% [4.8%, 17.4%], P < 0.001), and postoperative hospital stay (9.9 ± 1.6 days vs. 10.4 ± 1.7 days vs. 10.8 ± 1.7 days, P = 0.004) were notably lower in the NM group compared to the IM group and PM group.</p><p><strong>Conclusions: </strong>The weaker CYP2C19 metabolizer phenotype was at the risk of developing POAF after OPCABG surgery with oral clopidogrel regimen.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"103"},"PeriodicalIF":2.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of remimazolam tosylate and sevoflurane for anesthesia induction with preserved spontaneous respiration during tracheal intubation: a prospective, single-center, randomized controlled trial.","authors":"Yu Hong, Shiyu Meng, Jiayi Liu, Qiong Zhao, Jun Peng, Yuqing Chen","doi":"10.1186/s13741-025-00588-8","DOIUrl":"10.1186/s13741-025-00588-8","url":null,"abstract":"<p><strong>Background and objectives: </strong>Remimazolam tosylate is a novel anesthetic agent known for its rapid onset, non-irritating and non-polluting properties, effective sedation with minimal respiratory depression, short duration of action, and suitability for continuous infusion. Additionally, it can be efficiently antagonized by flumazenil. This study aims to explore the feasibility and safety of Remimazolam tosylate for anesthesia induction while maintaining spontaneous respiration.</p><p><strong>Methods: </strong>This prospective, randomized controlled trial involved patients aged 18-65 years with non-difficult airways who were scheduled for endotracheal intubation under general anesthesia. Participants, after receiving the same protocol of dexmedetomidine sedation and Lidocaine surface anesthesia, were randomly assigned to either the sevoflurane induction group or the remimazolam tosylate induction group, with 30 patients in each group. Anesthesia induction was performed while maintaining spontaneous respiration, followed by endotracheal intubation.</p><p><strong>Results: </strong>All enrolled patients successfully underwent intubation, and no severe respiratory depression or other complications were observed in either group (Successful anesthesia induction intubation is defined as follows: (1) successful anesthesia induction without the need for rescue measures during the induction of anesthesia, (2) no awakening during anesthesia induction, (3) spontaneous breathing is preserved throughout the entire procedure, and (4) successful completion of intubation.). There were no statistically significant differences in heart rate, blood pressure, oxygen saturation, or blood gas results between the groups. Regarding the time required for anesthesia induction, the average time to achieve the condition for topical anesthesia to the throat was 7.3 min in the remimazolam group and 17.7 min in the sevoflurane group, which was statistically significant (P < 0.01). The total time to complete intubation was 11.4 min in the remimazolam group and 21.3 min in the sevoflurane group, which was statistically significant (P < 0.01). During the local anesthetic throat spray procedure, 47% of patients in the sevoflurane group and 80% in the remimazolam group experienced coughing. This difference was statistically significant. During intubation, 20% of patients in the sevoflurane group and 33% in the remimazolam group continued to cough, but this difference was not statistically significant..</p><p><strong>Conclusion: </strong>Compared with sevoflurane, remimazolam can be safely and effectively used for intubation while preserving spontaneous breathing, with a shorter time to achieve conditions for topical anesthesia and intubation.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"102"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of intraperitoneal bupivacaine vs magnesium sulfate on early postoperative outcomes after laparoscopic sleeve gastrectomy: a randomized clinical trial.","authors":"Sina Ghasemi, Behzad Imani, Naeeme Shabani, Erfan Ayubi, Bahman Shams Shafigh","doi":"10.1186/s13741-025-00586-w","DOIUrl":"10.1186/s13741-025-00586-w","url":null,"abstract":"<p><strong>Background: </strong>Obesity is now recognized as a major global health challenge, associated with various comorbidities. Sleeve gastrectomy, a minimally invasive surgery, is accompanied by short-term complications such as postoperative pain, which undermines the advantages of this technique. Therefore, this study aims to compare the efficacy of intraperitoneal instillation with bupivacaine versus magnesium sulfate on early postoperative outcomes in patients undergoing sleeve gastrectomy.</p><p><strong>Materials and methods: </strong>This study was conducted in Iran as a randomized controlled trial. A total of 105 patients candidates for laparoscopic sleeve gastrectomy were divided into three groups of 35 patients each: Group A(bupivacaine), Group B (magnesium sulfate), and Group C (normal saline). The VAS was used to assess postoperative pain in the first 24 h after surgery. Data were analyzed using SPSS version 16.</p><p><strong>Results: </strong>Based on the results of the Kruskal-Wallis test, there was a significant difference in abdominal pain levels among the study groups at 1, 2, 4, and 6 h post-surgery (P-value < 0.05). Abdominal pain levels in both the bupivacaine and magnesium sulfate groups were significantly lower than those in the control group during the initial postoperative hours; however, no significant difference was observed between the bupivacaine and magnesium sulfate groups. Total rescue analgesic requests in the bupivacaine group was significantly lower than that in the control group (P-value = 0.010), with no significant difference observed between the bupivacaine and magnesium sulfate groups. Neither drug caused a significant difference in postoperative shoulder pain levels or the incidence of postoperative nausea and vomiting (P-value = 0.562).</p><p><strong>Conclusion: </strong>This study revealed that intraperitoneal administration of bupivacaine at 1, 2, and 4 h postoperatively, and magnesium sulfate at 2, 4, and 6 h postoperatively, significantly reduced pain in patients undergoing sleeve gastrectomy compared to those who didn't receive these analgesics. The lack of efficacy of both interventions in alleviating shoulder pain underscores the necessity of investigating alternative approaches to achieve comprehensive pain management in this patient population.</p><p><strong>Trial registration: </strong>Clinical Trial Registration  https://www.irct.ir/ , identifier (IRCT20230129057271N2).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"96"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause of refractory hypoxaemia after hiatus hernia surgery: a case report of platypnoea-orthodeoxia syndrome.","authors":"Siddarth Sriram, Devisha Raina, Julia De Groot","doi":"10.1186/s13741-025-00585-x","DOIUrl":"10.1186/s13741-025-00585-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Platypnoea-orthodeoxia syndrome (POS) is a clinical manifestation that arises from an underlying pathological process, most commonly a right-to-left intracardiac shunt such as a patent foramen ovale (PFO). The precise incidence of platypnoea-orthodeoxia syndrome remains undefined; nevertheless, it is widely regarded as an exceedingly rare clinical entity, particularly within the postoperative context. Its occurrence following upper gastrointestinal surgery is even more uncommon, with only a few cases scarcely reported in the literature. We describe an unusual case of POS following laparoscopic repair of a large type IV hiatus hernia with gastric volvulus reduction, highlighting the role of thoracoabdominal anatomical shifts in precipitating this syndrome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;A 74-year-old man with a history of obstructive sleep apnoea and a longstanding giant type IV hiatus hernia underwent laparoscopic gastric volvulus reduction, hernia repair, and gastropexy. Postoperatively, he developed profound hypoxaemia, initially attributed to atelectasis. However, during intensive care unit admission, his SpO&lt;sub&gt;2&lt;/sub&gt; was observed to drop dramatically in the upright position and improve in the supine position. Arterial blood gas analysis confirmed positional hypoxaemia consistent with POS. Transthoracic echocardiography with bubble contrast demonstrated a previously silent patent foramen ovale exhibiting significant right-to-left shunting, accompanied by marked left atrial dilatation, while right atrial and ventricular pressures remained within normal limits. Additionally, a CT pulmonary angiogram demonstrated a small pulmonary embolism in the right upper lobe with associated bilateral atelectasis. After initial stabilisation with anticoagulation and physiotherapy, the patient was discharged with outpatient plans for a transcatheter PFO closure. Three months later, he re-presented with hypoxaemic respiratory failure and cyanosis. Repeat imaging demonstrated marked worsening of the right-to-left shunt, necessitating urgent transcatheter PFO closure, which was successfully performed. The patient made a full recovery and was discharged on room air.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This case illustrates the potential for thoracoabdominal surgeries, such as hiatus hernia repairs with extensive mediastinal dissection, to unmask intracardiac shunts by altering venous return and cardiac geometry. It underscores the importance of considering POS in patients with unexplained postoperative or positional hypoxaemia. Early orthostatic oximetry and targeted imaging are critical for timely identification of the syndrome. A high index of suspicion for this rare but treatable condition is crucial, as prompt recognition and timely intervention have the potential to prevent diagnostic delays, reduce morbidity, and markedly improve perioperative outcomes in patients with otherwise unexplained refractory hypoxaemia.","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"101"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining postoperative quality metrics: risk factors for emergency department visits within 3 days after hemorrhoidectomy.","authors":"Ming-Chang Li, Yuh-Huey Chao, Szu-Yuan Wu, Chi-Jie Lu","doi":"10.1186/s13741-025-00583-z","DOIUrl":"10.1186/s13741-025-00583-z","url":null,"abstract":"<p><strong>Background: </strong>Very early hospital revisits following hemorrhoidectomy, particularly within 3 days of discharge, may reflect preventable peri-discharge complications more accurately than traditional 30-day readmission rates. However, few studies have systematically examined risk factors associated with this short-term outcome under real-world conditions.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 662 patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids at Lotung Poh-Ai Hospital between 2021 and 2023. The primary outcome was return to the emergency department (ED) within 3 days of discharge. Clinical, operative, and postoperative variables were analyzed using multivariate logistic regression.</p><p><strong>Results: </strong>Of 662 patients, 46 (6.95%) returned to the ED within 3 days. The most common presenting symptom was severe wound pain (78.3%). Multivariate analysis identified thrombosed hemorrhoids (adjusted odds ratio [aOR], 3.05; 95% CI, 1.56-5.96; p = 0.001) and use of ≥ 2 postoperative analgesics (aOR, 3.96; 95% CI, 1.99-7.84; p < 0.001) as independent predictors of early ED revisit. Other clinical and laboratory variables were not significantly associated.</p><p><strong>Conclusions: </strong>This study is among the first to identify specific predictors of ED visits within 3 days after hemorrhoidectomy. The presence of thrombosed hemorrhoids and escalated analgesic use may signal patients at risk for very early unplanned revisits. These findings challenge reliance on 30-day readmission metrics and support 72-h revisit rates as a sensitive quality indicator for discharge appropriateness and perioperative care.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"97"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral oxygenation when ventilated or spontaneously breathing: a randomised control trial.","authors":"Andrew J D Cameron, Adam W Durrant, Dug Yeo Han, David Choi, Jennifer C Stephens, Nicholas J Lightfoot","doi":"10.1186/s13741-025-00584-y","DOIUrl":"10.1186/s13741-025-00584-y","url":null,"abstract":"<p><strong>Background: </strong>Cerebral oxygenation is an important area of concern during shoulder surgery in the beach chair position. Although infrequent, patients may experience serious morbidity or mortality secondary to the cerebral ischaemia which may follow cerebral desaturation. There is no published randomised control trial studying the effect of spontaneous ventilation vs intermittent positive pressure ventilation (IPPV) on cerebral oximetry.</p><p><strong>Methods: </strong>We randomised 40 patients (20 in each treatment group) undergoing arthroscopic shoulder surgery to either breathe spontaneously or receive IPPV during their surgery. Other elements of anaesthetic care were standardised. We recorded a baseline measure of cerebral oxygen saturation immediately prior to induction of anaesthesia for each cerebral hemisphere. We measured cerebral oxygenation throughout the intraoperative period, but the treating anaesthetist was blinded to this data. The primary outcome was time-averaged change in cerebral oxygenation during the intraoperative period. The secondary outcome was the incidence of cerebral desaturation events, defined as a ≥ 20% fall below baseline, or an absolute value of 55% or less.</p><p><strong>Results: </strong>We collected and analysed data on all 40 patients. The intraoperative increase in cerebral oximetry (mean, sd) for the left and right cerebral hemispheres was 10.5 (7.62) and 12.6 (6.24) for spontaneously breathing patients and 12.9 (7.65) and 11.0 (6.49) for IPPV patients (p = 0.332 and p = 0.427 respectively). There were three cerebral desaturation events in spontaneously breathing patients and eight in ventilated patients (p = 0.155).</p><p><strong>Conclusions: </strong>Ventilatory strategy (IPPV vs spontaneous ventilation) did not have a statistically significant impact on cerebral oxygenation in this study.</p><p><strong>Trial registration: </strong>This trial was retrospectively registered on 10/2/2023 with the ANZCTR. TRN ACTRN12623000143628.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"95"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a machine learning-based prediction model for intraoperative hypothermia in Chinese patients undergoing gastrointestinal surgery.","authors":"Likui Huang, Yanqing Xu, Shaohua Chen, Juanjuan Zhang, Shuwei Weng","doi":"10.1186/s13741-025-00587-9","DOIUrl":"10.1186/s13741-025-00587-9","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypothermia, defined as a core temperature < 36.0 °C, is a common complication during gastrointestinal surgery, potentially affecting patient outcomes. This study aimed to develop a predictive model for intraoperative hypothermia based on clinical features.</p><p><strong>Methods: </strong>In this retrospective, single-center study, we analyzed data from 418 patients who underwent gastrointestinal surgery between January and March 2024 at the First Hospital of Putian City, China. Core temperature was measured intraoperatively using a deep nasal probe every 15 min. Five machine learning models (logistic regression, random forest, support vector machine, XGBoost, and multilayer perceptron) were evaluated to develop a prediction model for hypothermia. Logistic regression (LR) was identified as the optimal model and used to develop a nomogram based on key features.</p><p><strong>Results: </strong>Among 25 clinical features, 12 showed significant differences between the two groups. The LR model demonstrated the best predictive performance [accuracy = 0.808, area under the curve (AUC) = 0.872] and identified six key predictors: temperature at surgery start, surgery duration, cisatracurium use, preoperative temperature, anesthesia time, and preoperative red blood cell count. A nomogram constructed with these features exhibited excellent predictive ability (AUC = 0.877) and clinical utility, as confirmed by decision curve analysis.</p><p><strong>Conclusion: </strong>This study highlights key predictors of intraoperative hypothermia and presents a reliable nomogram for risk prediction in patients undergoing gastrointestinal surgery. These findings can inform targeted interventions and improve perioperative care. Further validation with diverse cohorts is warranted to enhance generalizability.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"99"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric nutritional risk index and prognostic nutritional index improves predictive value of postoperative mortality: a large-scale retrospective cohort study.","authors":"Kaixi Liu, Sichen Liu, Qifeng Han, Yichen Cui, Lu Hua Chen, Zhuzhu Li, Xinning Mi, Taotao Liu, Xiangyang Guo, Xiaoxiao Wang, Zhengqian Li","doi":"10.1186/s13741-025-00582-0","DOIUrl":"10.1186/s13741-025-00582-0","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition increases the risk of mortality. However, the predictive role of preoperative nutritional status in postoperative mortality remains underexplored. This study investigates the link between preoperative objective nutritional indices and postoperative mortality across all adult surgical patients and evaluates the predictive value of malnutrition for postoperative mortality.</p><p><strong>Methods: </strong>This retrospective study included patients aged 18 or older who underwent surgery. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI) and the Prognostic Nutritional Index (PNI). Logistic regression analysis was performed to explore the relationship between preoperative nutritional status and postoperative mortality and to evaluate the predictive value of nutrition scores for mortality.</p><p><strong>Results: </strong>The study included 79,648 patients. Among them, 12,392 (15.6%) were identified with malnutrition by GNRI, 13,773 (17.3%), by PNI, and 8,633 (10.8%) by both indices. A total of 276 patients died within 30 days after surgery. After adjusting for traditional risk factors, poorer nutritional scores were linked to increased mortality risk. GNRI and PNI also enhanced the predictive accuracy of postoperative mortality models, as evidenced by significant improvements in integrated discrimination and net reclassification.</p><p><strong>Conclusions: </strong>Poor preoperative nutritional status, as indicated by GNRI and PNI scores, is associated with a higher risk of postoperative mortality. Integrating these scores into mortality prediction models significantly enhances their accuracy. These findings highlight the importance of screening surgical patients for malnutrition risk to inform perioperative nutritional management.</p><p><strong>Trial registration: </strong>The Institutional Review Board (IRB) of Seoul National University Hospital No. H-2210-078-1368).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"98"},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}