Perioperative Medicine最新文献

{"title":"The association between atherogenic index of plasma and postoperative delirium in cardiac surgery patients: an analysis of the MIMIC-IV database.","authors":"Xiaqing Zhang, Mingliang Xing, Afen Zhang, Rongzhi Zheng, Huiru Hu, Xianming Zeng","doi":"10.1186/s13741-026-00717-x","DOIUrl":"10.1186/s13741-026-00717-x","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the relationship between the atherogenic index of plasma (AIP) and the risk of postoperative delirium (POD) in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from the MIMIC-IV 2.2 with patients who underwent cardiac surgery. Propensity score matching (PSM) was used in a 1:1 ratio to balance baseline characteristics (age, sex, race) between delirium and non-delirium groups. Multivariable logistic regression models were employed to assess the independent association between AIP (analyzed as both a continuous and categorical variable in quartiles) and POD, with adjustments for demographics, comorbidities, laboratory parameters, vital signs, medication use, and surgical details. Restricted cubic spline (RCS) were used to explore nonlinearity. Subgroup and mediation analyses were also performed.</p><p><strong>Results: </strong>Among 6,067 eligible patients, 1,565 (25.8%) developed POD. After PSM, 3,130 patients were analyzed. Multivariable regression revealed a significant positive association between AIP and POD (OR: 1.622, 95% CI: 1.455-1.81, P < 0.001). Quartile stratification revealed that higher AIP levels were associated with an increased risk of POD (OR: 1.708, 95% CI: 1.399-2.088, P < 0.001). In the fully adjusted model (Model 3), AIP remained significantly associated with POD (OR: 1.435, 95% CI: 1.249-1.652, P < 0.001). RCS analysis revealed a significant nonlinear relationship between AIP and POD (P < 0.001), consistent across gender subgroups. Subgroup analysis revealed no significant interactions. Mediation analysis indicated that hemoglobin (Hb), red cell distribution width (RDW), albumin (Alb), and respiratory rate (RR) partially mediated the association between AIP and POD.</p><p><strong>Conclusion: </strong>AIP was independently and nonlinearly associated with an increased risk of POD following cardiac surgery. As an easily calculable composite lipid indicator, AIP may serve as a potential biomarker for preoperative risk stratification.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412415","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":"Association between intraoperative hypothermia and total hospitalization cost after liver transplantation: a retrospective cohort study.","authors":"Jingjing Zheng, Ying Wang, Xia Yao, Kailing Zhou, Caide Lu, Yuying Shan, Shengdong Wu, Qingwei Zhou","doi":"10.1186/s13741-026-00723-z","DOIUrl":"10.1186/s13741-026-00723-z","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypothermia is common during major surgery, but its economic implications in liver transplantation remain unclear. This study evaluated the association between intraoperative hypothermia and total hospitalization cost in adult liver transplant recipients.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included adult liver transplant recipients who underwent transplantation between January 2020 and December 2025. Intraoperative hypothermia was defined as any recorded intraoperative core temperature < 36.0 °C. Multivariable linear regression with log-transformed total hospitalization cost was used to evaluate the association after adjustment for prespecified covariates. Sensitivity analyses used additional adjustment models and alternative temperature exposure metrics. Cost components were analyzed descriptively.</p><p><strong>Results: </strong>Among 343 recipients, 239 (69.68%) experienced intraoperative hypothermia. Median total hospitalization cost was higher in the hypothermia group than in the normothermia group (161,173.00 [127,519.50-218,826.50] vs. 120,691.00 [104,492.25-150,064.00] Chinese yuan (CNY); P < 0.001). After multivariable adjustment, intraoperative hypothermia remained associated with higher log-transformed total hospitalization cost (β, 0.153; 95% CI, 0.065 to 0.241; P < 0.001), corresponding to an approximately 16.6% higher cost. The association remained robust in additional adjustment models, although alternative temperature exposure metrics did not show a consistent dose-response pattern. Cost-component analysis suggested that the cost difference was mainly attributable to medication, laboratory, treatment, material, and blood transfusion costs.</p><p><strong>Conclusions: </strong>Intraoperative hypothermia was associated with higher total hospitalization cost following liver transplantation after adjustment for prespecified covariates. These findings suggest that intraoperative hypothermia may be a marker of increased perioperative resource use. Prospective studies are needed to clarify whether targeted temperature management can improve clinical outcomes and resource utilization in liver transplantation.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397352","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":"Factors associated with catheter-related bladder discomfort and its correlation with urinary catheter-related pain after minimally invasive urological surgery: a retrospective cohort study.","authors":"Jiayi Tang, Ming Yao, Huadong Ni","doi":"10.1186/s13741-026-00725-x","DOIUrl":"10.1186/s13741-026-00725-x","url":null,"abstract":"<p><strong>Background: </strong>Catheter-related bladder discomfort (CRBD) can significantly hinder patient recovery. Research on factors associated with CRBD following minimally invasive urological surgery under general anesthesia remains limited. Moreover, while urinary catheter-related pain (UCRP) has been recognized as a contributing factor to CRBD, the relationship between these two conditions remains poorly understood. Therefore, this study aimed to identify factors associated with CRBD and to investigate the correlation between UCRP and CRBD severity after minimally invasive urological surgery, with the goal of informing clinical prevention and management strategies.</p><p><strong>Methods: </strong>A total of 150 patients who underwent minimally invasive urological surgery with indwelling urinary catheters under general anesthesia at the First Hospital of Jiaxing between October 2023 and August 2024 were included. Patient clinical data and information on the incidence and severity of CRBD were collected. Univariate and multivariate logistic regression analyses were performed to identify factors associated with CRBD; Spearman 's correlation analysis was used to examine the relationship between UCRP and CRBD severity.</p><p><strong>Results: </strong>Among the 150 patients, 95 experienced CRBD and 55 did not, yielding an overall incidence of 63.33%. Multivariate logistic regression identified male sex (OR = 3.848, 95% CI: 1.553-9.535, P = 0.004), endoscopic surgery (OR = 2.205, 95% CI: 1.017-4.778, P = 0.045), absence of postoperative analgesia (OR = 2.763, 95% CI: 1.273-5.997, P = 0.010), and UCRP score > 3 (OR = 2.446, 95% CI: 1.096-5.459, P = 0.029) as factors independently associated with CRBD. Spearman 's correlation analysis revealed a significant positive correlation between UCRP and CRBD severity (r = 0.264, P = 0.001).</p><p><strong>Conclusion: </strong>This observational study reveals a high incidence of CRBD after minimally invasive urological surgery. Factors independently associated with CRBD include male sex, endoscopic surgery, absence of postoperative analgesia, and UCRP score > 3. Furthermore, UCRP severity was positively correlated with the severity of CRBD.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405395","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":"Perioperative neurocognitive disorders in older patients: a narrative review of current knowledge in 2026.","authors":"Xingbo Zhou, Jiaxin Yang, Zhiyin Tang, Sheng Yang, Hai Zhao, Fan Yang","doi":"10.1186/s13741-026-00716-y","DOIUrl":"10.1186/s13741-026-00716-y","url":null,"abstract":"<p><p>Perioperative neurocognitive disorders (PNDs) are frequent and severe complications in older surgical patients, encompassing postoperative delirium, delayed neurocognitive recovery, postoperative neurocognitive disorder, and long-term cognitive impairment. These complications lead to prolonged hospital stay, elevated medical expenditure, and compromised long-term quality of life. In this 2026 narrative review, we systematically outline up-to-date evidence on the pathophysiology, risk factors, screening approaches, and evidence-based interventions for PNDs. The core mechanisms involve neuroinflammation, gut microbiota dysbiosis, blood-brain barrier disruption, cerebral hypoperfusion, oxidative stress, and tau hyperphosphorylation. Key risk factors include advanced age, preoperative cognitive impairment or frailty, intraoperative hypotension, deep anesthesia, hypothermia, cardiopulmonary bypass, and suboptimal postoperative pain and sleep control. Bedside tools (Mini-Cog, MoCA, MMSE, FRAIL scale) permit feasible risk stratification; tau-PT217, NfL, S100A12, and GFAP are emerging predictive biomarkers. Dexmedetomidine is a pharmacologic agent that has been extensively studied and has relatively strong supporting evidence. Non-pharmacological interventions and multidisciplinary care are recommended as first-line strategies. Outstanding issues include optimal intraoperative hemodynamic and anesthetic thresholds, causal links between delirium and long-term cognitive decline, and clinical validation of biomarkers. Future research demands large-scale multicenter randomized controlled trials and standardized workflows to strengthen personalized perioperative brain protection in elderly surgical patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382641","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":"Factors associated with prolonged use of newly prescribed gabapentinoids in older adults undergoing colorectal surgery.","authors":"Sohil Patel, Karen Trang, Tasce Bongiovanni, Siqi Gan, John Boscardin, Elizabeth C Wick","doi":"10.1186/s13741-026-00714-0","DOIUrl":"10.1186/s13741-026-00714-0","url":null,"abstract":"<p><strong>Background: </strong>Gabapentinoids are one component of multimodal analgesia in enhanced recovery programs after colorectal surgery. Long-term use can be especially harmful in older adults. This study sought to identify factors associated with prolonged gabapentinoid use in older adults following colorectal surgery.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data on a 20% representative sample of patients with Medicare. Patients were included if they were ≥ 66 years old, underwent colorectal surgery between October 1, 2015 and June 30, 2018, had continuous Part D enrollment during the time of operation, and were gabapentinoid naïve. Patients were excluded if they died within 180 days after surgery or were discharged to hospice or skilled nursing facility. The main outcome measure was prolonged gabapentinoid use, defined as prescription refills > 90 days after discharge, in those newly prescribed a gabapentinoid.</p><p><strong>Results: </strong>Among the 979 patients who met inclusion criteria and had a new gabapentinoid prescription after colorectal surgery, 22% had prolonged gabapentinoid use. Concurrent peri-discharge opioid use was associated with reduced likelihood of prolonged gabapentinoid use (OR 0.48 [0.34, 0.66], p < 0.0001). In patients who had both opioid and gabapentinoid prescriptions at discharge, opioid use beyond 90 days was associated with prolonged gabapentinoid use (OR 3.45 [2.43, 4.89], p < 0.0001). Patients discharged home with home health services had increased likelihood of prolonged gabapentinoid use (OR 1.53 [1.08, 2.17], p = 0.047).</p><p><strong>Conclusions: </strong>Factors associated with prolonged gabapentinoid use after colorectal surgery in the older adult population include initial prescription of a gabapentinoid without opioids, prolonged opioid use beyond discharge, and discharge to home with health services. Identifying these factors may reveal potentially modifiable interventions to curb prolonged gabapentinoid use in this population.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376446","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":"Definition, analysis, reporting, and interpretation of perioperative bleeding in randomized controlled trials: a methodological systematic review.","authors":"Yasaman Mohammadi Kamalabadi, Guangyong Zou, Maha El-Shimy, Natalie Mariam Zitoun, Justyna Bartoszko, Pavel S Roshanov","doi":"10.1186/s13741-026-00715-z","DOIUrl":"10.1186/s13741-026-00715-z","url":null,"abstract":"<p><strong>Background: </strong>Perioperative bleeding is a common surgical complication and a frequently used outcome in randomized trials; however, its definition and analysis are not straightforward and have important implications for trial design, statistical power and interpretation of treatment effect. This review aimed to summarize how perioperative bleeding was defined in randomized controlled trials, along with sample size considerations, analytic approaches, and interpretation practices.</p><p><strong>Methods: </strong>On April 9th, 2025, we systematically searched the CENTRAL database for randomized trials in surgical settings published after January 2024 that evaluated perioperative bleeding as the primary outcome. Two reviewers independently screened and extracted data. Where appropriate, we categorized findings into conceptually similar domains and applied descriptive analysis.</p><p><strong>Results: </strong>We included 115 trials reporting 116 primary bleeding outcomes and identified 36 unique definitions, with assessment periods ranging from intraoperative to more than 30 days postoperatively. Volumetric or gravimetric measures were most common (n = 46 [39.6%]), whereas patient-reported events (n = 5 [4.3%]) and clinical management of blood loss (n = 4 [3.4%]) were rare. Most trials reported a sample size calculation based on the primary outcome (n = 90 [78.3%]), but over one-third lacked effect-size justification (n = 34 [37.8%]). Analyses were predominantly parametric (n = 69 [59.5%]), while a few adjusted for baseline covariates (n = 18 [15.6%]). Interpretation in superiority trials relied mainly on statistical significance (n = 49 [47.6%]). Among noninferiority trials, noninferiority was often claimed without prespecified margins (n = 4 [33.3%]).</p><p><strong>Conclusion: </strong>Perioperative bleeding outcomes are defined and analyzed with high inconsistency. Standardized outcome definitions and reporting practices are needed in this field to improve trial comparability and clinical relevance.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369517","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":"Individualized PEEP titration guided by static lung compliance reduces postoperative atelectasis in elderly patients during laparoscopic Trendelenburg surgery: a randomized controlled trial.","authors":"Jinze Li, Xuepeng Cao, Liquan Huang, Guojie Han, Xiuqin Wang","doi":"10.1186/s13741-026-00708-y","DOIUrl":"10.1186/s13741-026-00708-y","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the lung protective effects of individualized positive end-expiratory pressure (PEEP) titration guided by static lung compliance (Cstat) in elderly patients undergoing laparoscopic surgery in the Trendelenburg position.</p><p><strong>Methods: </strong>Seventy elderly patients aged 65-75 years scheduled for elective laparoscopic rectal cancer surgery with anticipated duration > 2 h were enrolled. Patients had ASA physical status II-III and BMI 19-28 kg/m². Patients were equally divided into two groups: individualized PEEP guided by static lung compliance (CV group) and fixed PEEP group (DV group). Lung ultrasound scores (LUS) were performed after invasive arterial monitoring establishment (T1), immediately post-surgery (T4), before discharge from PACU (T5). Central venous blood samples were collected at T1 and T5 for ELISA determination of IL-6, CC16, and SP-A. Peak airway pressure, plateau pressure, alveolar dead space fraction (VD/VT), PaO₂/FiO₂ ratio, and invasive arterial pressure were recorded.</p><p><strong>Results: </strong>Compared with the DV group, the CV group demonstrated significantly lower lung ultrasound scores at T4 (mean difference: -4.0, 95% CI: -7.0 to -2.0) and T5 (mean difference: -4.06, 95% CI: -6.3 to -1.7), significantly higher SP-A (median difference: 33.39, 95% CI:15.90 to 47.44) at T5, and increased dynamic and static compliance with decreased driving pressure at T3 and T4 (all p < 0.05). No significant differences were observed in VD/VT, PaO₂/FiO₂ ratio, or invasive arterial pressure.</p><p><strong>Conclusion: </strong>For elderly patients undergoing laparoscopic rectal cancer surgery in the Trendelenburg position, individualized PEEP titration based on static lung compliance is associated with lower postoperative lung ultrasound scores (primarily located in the lateral and posterior zones) and may potentially alleviate atelectasis. This strategy is associated with improved intraoperative lung compliance, decreased driving pressure, and increased postoperative serum SP-A concentration, potentially providing intraoperative lung protection. Future studies should evaluate hard clinical outcomes, such as postoperative pulmonary complications (PPCs), as primary endpoints.</p><p><strong>Trial registration: </strong>China Clinical Trial Registry, 7/26/2024, ChiCTR2400087409.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284102","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":"Stellate ganglion block for attenuating postoperative sore throat after double-lumen tube intubation in thoracic surgery: a randomized clinical study.","authors":"Shaowen Zhang, Shaoshuang Wang, Zongzhao He, Yun Wang","doi":"10.1186/s13741-026-00710-4","DOIUrl":"10.1186/s13741-026-00710-4","url":null,"abstract":"<p><strong>Background: </strong>For thoracic surgery patients who undergo double-lumen endotracheal intubation, postoperative sore throat (POST) remains one of the most common postoperative complication.</p><p><strong>Objective: </strong>To evaluate whether preoperative ultrasound-guided stellate ganglion block (SGB) can reduce the incidence and severity of POST, and decrease the postoperative throat VAS score in patients undergoing double-lumen tube (DLT) intubation for thoracic surgery.</p><p><strong>Methods: </strong>This prospective, randomized, double-blind, controlled clinical trial enrolled 120 patients undergoing elective thoracic surgery with DLT intubation. Participants were randomized into two groups: the SGB group (n = 60) received 2-3 ml of 0.25% ropivacaine under ultrasound guidance on the right stellate ganglion, while the control group (n = 60) received no regional anesthetic intervention prior to anesthesia induction. The primary outcomes included the incidence and severity of POST and the visual analogue scale (VAS) scores for throat pain. Secondary outcomes included the incidence of postoperative hoarseness, cough, and postoperative pulmonary complications (PPCs), as well as the levels of serum inflammatory markers before and 1 day after surgery.</p><p><strong>Results: </strong>The incidence of POST was significantly lower in the SGB group at 1 h, 6 h, and 24 h postoperatively compared to the control group (10.3%, 13.8%, and 5.2% vs. 44.1%, 35.6%, and 20.3%, respectively, p < 0.05). The severity grading of POST in the SGB group was also lower than that in the control group at all three time points (p < 0.05). Additionally, the throat VAS scores in the SGB group at 1 h and 6 h postoperatively (0.45 ± 1.45 and 0.34 ± 1.05, respectively) were significantly lower than those in the control group (1.88 ± 2.54 and 0.93 ± 1.41, respectively; p < 0.05). Cough incidence was significantly lower in the SGB group at 1 h and 6 h (both 5.2%) than in the control group (both 20.3%, P = 0.014).</p><p><strong>Conclusions: </strong>Preoperative ultrasound-guided SGB significantly alleviates POST and reduces the early postoperative cough incidence in thoracic surgery patients undergoing DLT intubation.</p><p><strong>Trial registration: </strong>The study was registered on Chinese Clinical Trial Registry, (ChiCTR2500106117) on 17/07/2025.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271882","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":"Remimazolam vs. propofol for prevention of postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized non-inferiority trial.","authors":"Yaodong Zhang, Qiqing Song, Kangjia Xie, Zhaojie Ou, Liqiu Mo","doi":"10.1186/s13741-026-00713-1","DOIUrl":"10.1186/s13741-026-00713-1","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) is a prevalent complication, occurring in approximately 30% of surgical patients and reaching 80% in high-risk individuals. PONV is associated with prolonged recovery, increased healthcare costs, and reduced patient satisfaction. Although propofol can reduce the risk of PONV, it can cause adverse effects such as injection pain and hemodynamic instability. Remimazolam, a novel ultra-short-acting benzodiazepine, has a favorable safety profile, with more stable hemodynamics. While recent studies suggest that remimazolam may reduce PONV, the evidence comparing its antiemetic efficacy directly with propofol remains inconclusive, largely due to limited sample size. Therefore, this non-inferiority trail was conducted to determine whether remimazolam is non-inferior to propofol for the prevention of PONV.</p><p><strong>Methods: </strong>This was a single-center, prospective, randomized, double-blind, non-inferiority trial. A total of 334 women aged 18-65 years, with American Society of Anesthesiologists (ASA) physical status I-III, undergoing elective laparoscopic gynecological surgery were enrolled. Patients were randomly assigned to receive either remimazolam or propofol for anesthesia induction and maintenance. The primary outcome was the incidence of PONV within 24 h. Secondary outcomes included the incidence of rescue antiemetic therapy, the types of PONV, the incidence of injection pain, the incidence of hypotension, the incidence of bradycardia, postoperative pain, and patient satisfaction.</p><p><strong>Results: </strong>In the per-protocol analysis (n = 326), the incidence of PONV was 58.3% (95/163) and 57.1% (93/163) in the remimazolam and propofol groups, respectively. The absolute difference was 1.2% (95% CI-9.5% to 12.0%), and the upper confidence limit exceeded the predefined non-inferiority margin of 5%. Remimazolam significantly reduced injection pain (9.6% vs. 54.5%; P < 0.001), hypotension within 10 min after induction (16.8% vs. 28.1%; P = 0.013), and intraoperative bradycardia (25.6% vs. 52.5%; P < 0.001). No significant differences were observed in the use of rescue antiemetics, PONV types, postoperative pain scores, or patient satisfaction.</p><p><strong>Conclusion: </strong>Although non-inferiority of remimazolam to propofol for PONV prevention was not demonstrated in this high-risk population, remimazolam provided a superior safety profile, with significantly reduced injection pain and improved hemodynamic stability. These advantages position remimazolam as a valuable alternative for general anesthesia in settings where such adverse effects are of particular concern.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2300076452,09/10/2023).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265507","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":"Multicenter external validation of the FW-TRIC score for predicting red blood cell transfusion in on-pump cardiac surgery.","authors":"Tianlong Wang, Shifu Wang, Renbin Tian, Jing Wang, Qiaoni Zhang, Shan Guo, Bo Wang, Bing Liang, Yisheng Song, Ximeng Yao, Guanglei Li, Lian Duan, Junbo Chuai, Jianchao Li, Liping Shi, Fuqing Jiang, Yi Song, Jian Wang, Gang Liu, Shujie Yan, Yu Liu, Jianxi Ye, Bingyang Ji","doi":"10.1186/s13741-026-00707-z","DOIUrl":"10.1186/s13741-026-00707-z","url":null,"abstract":"<p><strong>Background: </strong>Perioperative red blood cell (RBC) transfusion remains common in cardiac surgery and is associated with increased morbidity and mortality. Accurate preoperative risk prediction is essential for patient blood management. The Fuwai-transfusion risk of on-pump cardiac surgery (FW-TRIC) score was previously developed and internally validated as a tool to estimate transfusion risk. This study aimed to externally validate the FW-TRIC score in a multicenter cohort.</p><p><strong>Methods: </strong>A retrospective multicenter study was conducted across nine cardiovascular centers in China from January to December 2024. Adult patients undergoing on-pump cardiac surgery were included, while those undergoing transplantation, mechanical circulatory support, or preoperative transfusion were excluded. The discriminative performance of the FW-TRIC score was evaluated using receiver operating characteristic (ROC) curve analysis, and calibration was assessed through linear regression of observed versus predicted transfusion rates.</p><p><strong>Results: </strong>A total of 3,287 patients met inclusion criteria, with an overall perioperative RBC transfusion rate of 40.1%. The FW-TRIC score demonstrated good discrimination for predicting transfusion, with an AUC of 0.713 (95% CI, 0.696-0.731) and excellent calibration. All individual predictors of FW-TRIC score, including age, sex, NYHA classification, body surface area, previous cardiac surgery, emergency surgery, and surgery type, underperformed the prediction ability of FW-TRIC score (all P < 0.05 for AUC comparison). Performance remained good across all nine centers (AUCs > 0.65). Across all transfusion risk categories in the external validation cohort, the observed transfusion rates compared well with those predicted by the FW-TRIC model.</p><p><strong>Conclusions: </strong>The FW-TRIC score was externally validated as a robust and generalizable preoperative tool for predicting perioperative RBC transfusion in on-pump cardiac surgery. Its use enables effective transfusion risk stratification and supports personalized patient blood management strategies across diverse clinical settings.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259161","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}