Perioperative Medicine最新文献

{"title":"National Institute of Academic Anaesthesia (NIAA) research grants: analysis of awardee characteristics and preliminary grant outputs.","authors":"Naomi Watson, Gudrun Kunst","doi":"10.1186/s13741-025-00505-z","DOIUrl":"10.1186/s13741-025-00505-z","url":null,"abstract":"<p><strong>Background: </strong>The National Institute of Academic Anaesthesia (NIAA) is a major UK-based funder of academic anaesthesia and perioperative medicine. It holds two grant rounds per year. Since 2019, research outputs have been collected via a widely used online platform, enabling assessment of grant impact. The aim of our study was to report the characteristics of funding awards and awardees, including equality, diversity, and inclusion (EDI) data.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of NIAA grant data submitted by award holders (2019-2023) and assessed EDI characteristics for all applicants and recipients, collected since 2022. The primary objective was to assess grants by geographical distribution, type of institutions and research category. Secondary objectives included preliminary grant outputs and EDI characteristics of applicants and awardees.</p><p><strong>Results: </strong>Between 2019 and 2023, 63 grants totalling £2,488,857 were awarded. Grants were well-distributed across the UK and Ireland, with London-based research groups receiving the most (n = 16, 25%) and securing £825,591 (33% of total funding). University-affiliated institutions received 38 grants (60%), while 25 grants (40%) were awarded to teaching and non-teaching hospitals. By research type, pre-clinical studies received 41% of funding (n = 26), followed by clinical observational (24%, n = 15), clinical interventional (14%, n = 9), and epidemiological studies (13%, n = 8). Fifty-one publications have been reported by 20 principal investigators across 30 journals, with a total of 1723 citations and a median of 17 citations per paper. More than half (n = 28, 55%) were published in journals with an impact factor of 7 or higher. Most applicants were white, heterosexual males, but no EDI characteristic was significantly associated with application success.</p><p><strong>Conclusion: </strong>NIAA grants were geographically diverse and supported a broad range of research types. Most funded research was published in high-impact journals. However, a notable lack of diversity was observed among applicants, both successful and unsuccessful. Future NIAA strategies should focus on increasing diversity and representation among grant applicants.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"29"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616722","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":"Changes of perioperative cognitive function and its effect on quality of life in laryngeal cancer.","authors":"Zehui Gao, Lina Jia, Jianli Yao, Chenxin Wang, Hui Huang-Fu","doi":"10.1186/s13741-025-00507-x","DOIUrl":"10.1186/s13741-025-00507-x","url":null,"abstract":"<p><strong>Background: </strong>Few studies have been published on the cognitive function and its relationship with quality of life (QoL) in patients with laryngeal squamous cell carcinoma (LSCC) undergoing surgery.</p><p><strong>Objective: </strong>This study aimed to assess the association between changes in cognitive function perioperatively with QoL among patients with LSCC.</p><p><strong>Methods: </strong>This was a prospective study. Eighty-eight cases with LSCC treated with radical surgery were assessed using the Montreal Cognitive Assessment (MoCA), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and EORTC QLQ-C30. Statistical analysis was performed using SPSS 21.0 software.</p><p><strong>Results: </strong>The MoCA scores were 24.78 ± 2.42 before surgery and 23.02 ± 3.06 after surgery (p < 0.001). Correspondingly, 39 patients (44.32%) had cognitive impairment before surgery, and 47 patients (53.41%) had cognitive impairment after surgery. Age (p = 0.003) and preoperative anxiety (p = 0.016) were independent factors related to preoperative cognitive dysfunction, while age (p = 0.023), postoperative anxiety (p = 0.041), operation mode (p = 0.05, p = 0.016 respectively) and preoperative MoCA score (p = 0.008) were associated with postoperative cognitive dysfunction. Patients with cognitive impairment postoperatively had poorer QOL in the score of the overall health function scale (p = 0.030).</p><p><strong>Conclusion: </strong>LSCC patients exhibit a high prevalence of cognitive dysfunction, which significantly associated with reduced overall QoL. Age, postoperative anxiety, operation mode, and preoperative MoCA score were significantly associated with postoperative cognitive dysfunction.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"28"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616617","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":"Assessment of perioperative anxiety levels at three time-points during hospital stay in patients undergoing elective surgery.","authors":"Priya Goyal, Prisha, Joshua S Chacko, Aman Goyal, Shikha Gupta, Suneet Kathuria","doi":"10.1186/s13741-025-00504-0","DOIUrl":"10.1186/s13741-025-00504-0","url":null,"abstract":"<p><strong>Background: </strong>Perioperative anxiety is associated with complications during and after surgery, resulting in prolonged hospital stays, and long-term physical and cognitive decline. A prospective observational study was conducted to assess anxiety levels at three time-points and identify sociodemographic factors influencing it.</p><p><strong>Methodology: </strong>Three assessments were conducted on 105 patients (18-65 years) undergoing elective surgery after informed consent: A1 (day before surgery) using the State-Trait Anxiety Inventory (STAI-Trait) form, STAI-State form, and demographic data collection; A2 (on the day of surgery) with the STAI-S2 form; and A3 (24 h post-surgery) with the STAI-S3 form and a questionnaire on information requirements and pain.</p><p><strong>Results: </strong>Average state anxiety scores were S2 (18.06) > S1 (17.55) > S3 (16.38). The primary concerns were fear of feeling pain after surgery (41%), fear of the results of the surgery(33.3%), and concerns about family (32.40%). Unmarried individuals had significantly higher anxiety scores than married individuals in S1 (20.80 vs. 16.79, p - 0.009) and S2 (23.10 vs. 16.87, p - 0.001). Females consistently scored higher than males, with a significant difference in S2 (19.51 vs. 16.79, p - 0.05). Patients with a medical history showed the highest anxiety in S3 (18 vs. 15.67, p - 0.037). Skilled workers displayed the highest anxiety levels in S1 (20.20) and S2 (22.40, p - 0.044) as compared to other groups, while professionals showed the highest anxiety in S3 (18.05). Females (33%), rurals (29%), and ≤ 8th-grade education group (54.5%) were significantly more likely to report receiving inadequate information about surgery compared to males (12.5%, p - 0.018), urbans (13%, p - 0.036), and higher education group (18%, p - 0.022). Younger individuals of < 30 years (47%) were more likely to feel that more information about surgery would have relaxed them compared to 41-50 age group (7.14%, p - 0.016).</p><p><strong>Conclusion: </strong>The anxiety levels fluctuated over three time-points and were influenced by demographic, cultural, and psychological factors. Therefore, anxiety should be identified both preoperatively and postoperatively through an individualized approach. Additionally, a significant proportion of the population still requires more information, and the diverse informational needs across the groups underscore the necessity for individualized interviews to ascertain specific information requirements, thereby preventing any paradoxical increase in anxiety due to inappropriate information delivery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"27"},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616612","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":"Exploring the predictive value of carotid Doppler ultrasound and clinical features for spinal anesthesia-induced hypotension: a prospective observational study.","authors":"Esmée C de Boer, Joris van Houte, Catarina Dinis Fernandes, Tom Bakkes, Jens Muehlsteff, R Arthur Bouwman, Massimo Mischi","doi":"10.1186/s13741-025-00508-w","DOIUrl":"10.1186/s13741-025-00508-w","url":null,"abstract":"<p><strong>Background: </strong>The induction of spinal anesthesia is often followed by hypotension, which has been associated with post-operative end-organ damage. A timely prediction of spinal anesthesia-induced hypotension (SAIH) paired with appropriate interventions may reduce the risk of adverse outcomes. This study investigated the value of carotid Doppler ultrasound measurements and clinical variables, both individually and combined, to predict SAIH.</p><p><strong>Methods: </strong>Adult patients who were scheduled for elective surgery under spinal anesthesia were included. Carotid ultrasound imaging and baseline vital sign measurements were performed pre-operatively, well in advance of the induction of spinal anesthesia. The occurrence of hypotension was observed for ten minutes after the induction of spinal anesthesia. Logistic regression models studied linear relationships within the derived set of ultrasound and clinical features, and support vector machine models evaluated nonlinear relationships.</p><p><strong>Results: </strong>A total of 40 patients were included, and 45% of them developed SAIH. The logistic regression models performed better than the support vector machine models. The best-performing logistic regression model combined carotid ultrasound and clinical features and had a sensitivity of 75 [73-81]%, specificity of 75 [71-81]%, AUROC of 0.81 [0.75-0.95], positive predictive value of 75 [65-81]%, negative predictive value of 75 [71-88]% and F1 score of 0.75 [0.71-0.76]. The key features that were shown to predict SAIH were baseline mean arterial pressure, fasting time, ASA class, and weight.</p><p><strong>Conclusions: </strong>Combining carotid Doppler ultrasound measurements and clinical variables can predict the occurrence of SAIH.</p><p><strong>Trial registration: </strong>The study was retrospectively registered at clinicaltrials.gov (NCT06711289) on 2 December 2024.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"26"},"PeriodicalIF":2.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586460","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":"PACU discharge: equally safe and more cost-effective than floor admission for uncomplicated laparoscopic appendectomy.","authors":"Christopher Hendrix, Sarah Swint, Rachel Krawczyk, Tyler Soderling, Jana Alford, John Shellenberger","doi":"10.1186/s13741-025-00511-1","DOIUrl":"10.1186/s13741-025-00511-1","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic appendectomy is a common emergency surgical procedure worldwide, known for its benefits of reduced pain, shorter hospital stays, and quicker recovery times. Although postoperative care typically involves observation on the surgical floor, advances in surgical techniques and perioperative care have introduced the potential for discharging patients directly from the post-anesthesia care unit (PACU). This study aims to evaluate the safety and cost-effectiveness of direct PACU discharge compared to traditional floor admission for patients undergoing uncomplicated laparoscopic appendectomy.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed adult patients diagnosed with uncomplicated appendicitis between January 2021 and December 2023. Patients were divided into two cohorts: those discharged directly from PACU and those admitted to the floor before discharge. Primary outcomes included 30-day readmission rates, reoperation rates, and postoperative complications. Secondary outcomes assessed costs, surgery times, and demographic variables. Statistical analysis involved Pearson's chi-square tests, t-tests, and multivariate logistic regression.</p><p><strong>Results: </strong>A total of 203 patients were included, with 103 in the PACU cohort and 100 in the floor cohort. PACU patients were younger and had fewer comorbidities than floor patients. No significant differences were found in 30-day readmission, reoperation rates, or complications between the groups. PACU discharge was associated with significantly shorter hospital stays (8 h vs. 26 h, p < 0.001) and lower costs, with average charges of $27,739 for PACU discharges versus $31,593 for floor discharges, primarily due to reduced labor costs.</p><p><strong>Conclusion: </strong>Direct discharge from the PACU following uncomplicated laparoscopic appendectomy is both safe and cost-effective compared to floor admission. These findings suggest that PACU discharge is a viable option for well-selected patients, with the potential for significant healthcare savings. Future research should focus on refining patient selection criteria and validating these findings in diverse healthcare settings.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"25"},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567794","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":"Sublingual sufentanil after orthopaedic and abdominal surgery: long-term outcome and safety.","authors":"Michael Borck, Jan D Wandrey, Claudia Spies, Sascha Tafelski","doi":"10.1186/s13741-025-00506-y","DOIUrl":"10.1186/s13741-025-00506-y","url":null,"abstract":"<p><strong>Background: </strong>Acute postoperative pain management often requires opioid treatment with patient-controlled analgesia (PCA). Non-invasive PCA with a sublingual sufentanil tablet system (SSTS) may reduce acute pain sufficiently, but opioids are associated with central nerve system side effects and risk of long-term opioid use postoperatively. The objective of this study was to observe the SSTS to assess the incidence of postoperative chronic pain (PCP) and postoperative delirium (POD).</p><p><strong>Methods: </strong>This was a longitudinal cohort study based at a university hospital between November 2017 and November 2021. Adults undergoing elective orthopaedic knee or abdominal surgery planned for PCA as postoperative pain management were included. They received the SSTS in addition to a standardised pain medication protocol depending on the surgery they underwent. Exclusion criteria were pregnancy, emergency surgery, concurrent participation in another clinical trial and chronic opioid use before surgery. Patients were followed after surgery in hospital and over 3 and 12 months for pain, cognitive function and side effects.</p><p><strong>Results: </strong>Altogether N = 80 patients were included with SSTS postoperatively. Daily pain experience decreased from pre-operatively 89.2% of patients to 45.7% and 22.5% at 3 and 12 months. None of our patients developed postoperative delirium after surgery. Patients reported high overall satisfaction with SSTS (median 8.0/10 points, IQR 3). However, 51% of patients had difficulties with handling the SSTS and required acute replacement of the authentication tag.</p><p><strong>Conclusions: </strong>SSTS sufficiently treated acute postoperative pain without incidence of POD and demonstrated good tolerability and overall ease. Postoperative pain improved significantly over time but 22% still reported chronic pain related to surgery. Technical issues with the identification thumb tag limited the feasibility of SSTS.</p><p><strong>Trial registration: </strong>This prospective longitudinal cohort study was approved by the ethics committee of the Charité Universitätsmedizin Berlin (Ethics committee 2, Campus Charité Virchow Klinikum, EA2/041/17, Prof. Dr. jur. R. Seeland, 21.03.2017) and was registered in the study register ( https://clinicaltrials.gov/ct2/show/NCT03133858 ).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"23"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531743","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":"Non-fasting versus fasting before percutaneous cardiac procedures: a systematic review and meta-analysis of randomized controlled trials.","authors":"Elsayed Balbaa, Ahmed A Ibrahim, Mohammad Bazzazeh, Shehroze Tabassum, Shrouk Ramadan, Ahmed Farid Gadelmawla, Abdelrahman Elshimy, Obieda Altobaishat, Mohamed Abuelazm","doi":"10.1186/s13741-024-00485-6","DOIUrl":"10.1186/s13741-024-00485-6","url":null,"abstract":"<p><strong>Background and objective: </strong>Despite the absence of scientific evidence, fasting before percutaneous cardiac catheterization is still recommended to minimize complications. This systematic review and meta-analysis aimed to compare the outcomes of non-fasting protocols in patients undergoing percutaneous cardiac procedures.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, Scopus, WOS, Embase, and Cochrane was conducted until September 2024. Dichotomous outcomes were pooled using risk ratio (RR), while continuous outcomes were pooled using standardized mean difference (SMD).</p><p><strong>Prospero id: </strong>CRD42024586147.</p><p><strong>Results: </strong>Five RCTs with 2034 patients were included. There was no significant difference between both groups regarding patient satisfaction score [SMD - 0.65, 95% CI (- 1.39, 0.09), P = 0.08], intra/postoperative aspiration (RR 1.00, 95% CI [0.20, 4.96], P = 1.00), postprocedural pneumonia (RR 0.60, 95% CI [0.14, 2.51], P = 0.49), emergency endotracheal intubation (RR 0.99, 95% CI [0.10, 9.51], P = 1.00), nausea/vomiting (RR 0.89, 95% CI [0.46, 1.76], P = 0.75), anti-emetic use (RR 0.49, 95% CI [0.24, 1.03], P = 0.06), hypoglycemia (RR 0.74, 95% CI [0.43, 1.28], P = 0.28), and the need for inotrope/vasopressor therapy (RR 1.03, 95% CI [0.81, 1.30], P = 0.82). However, the non-fasting approach significantly decreased the sensation of tiredness/fatigue (SMD - 0.31 with 95% CI [- 0.51, - 0.11], P < 0.001).</p><p><strong>Conclusion: </strong>The non-fasting protocol demonstrated comparable efficacy, safety, and overall satisfaction to the conventional fasting approach. REVIEW REGISTRATION : PROSPERO CRD42024586147.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"24"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531740","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":"Synthetic colloids as priming fluids in cardiopulmonary bypass and postoperative acute kidney injury: a propensity score-matched study.","authors":"Jing Wang, Luyu Bian, Tianlong Wang, Han Zhang, Jieru Zhang, Qiaoni Zhang, Gang Liu, Jian Wang, Yuan Teng, Zhenzhen Li, Shujie Yan, Bingyang Ji","doi":"10.1186/s13741-025-00503-1","DOIUrl":"10.1186/s13741-025-00503-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal fluid management strategy for patients undergoing on-pump cardiac surgery was controversial regarding the fluid types. This study aimed to compare the impact of hydroxyethyl starch (HES) and succinylated gelatin on postoperative acute kidney injury (AKI).</p><p><strong>Methods: </strong>This is a single-center, retrospective study. Adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) between 2018 and 2022 were included. Patients were grouped by the priming solution used: HES (the HES group) or succinylated gelatin (the gelatin group). The primary outcome was the incidence of postoperative AKI, and secondary outcomes included continuous renal replacement therapy (CRRT), blood transfusions, myocardial infarction, lung infection, cerebrovascular events, chest drainage, duration of mechanical ventilation, intensive care unit (ICU) stay, in-hospital mortality, and associated costs. Propensity score matching (PSM) was conducted to adjust for characteristic differences between the two groups.</p><p><strong>Results: </strong>A total of 14,443 patients were included. After 1:1 propensity score matching, 1880 pairs were analyzed. Baseline characteristics were comparable between the matched groups. The incidence of AKI was significantly lower in the gelatin group (3.0% vs. 5.1%, P = 0.001). No significant differences were found in transfusion requirements after score-matching. The use of HES was independently associated with increased odds of AKI (adjusted odds ratio [aOR], 1.785; 95% CI, 1.262-2.526; P = 0.001). The effects of HES use on the occurrence of postoperative AKI were greater in elderly and female patients.</p><p><strong>Conclusion: </strong>The use of HES as a priming solution in on-pump cardiac surgery was associated with an increased risk of postoperative AKI compared to gelatin, although it did not affect transfusion requirements. These findings highlight the importance of considering the priming solution type in fluid management during cardiac surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"22"},"PeriodicalIF":2.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11846327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476536","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":"Comparing the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants: a meta-analysis.","authors":"Yuxi Wei, Chi Chen, Zhihong Yu, Jun Guo","doi":"10.1186/s13741-025-00502-2","DOIUrl":"10.1186/s13741-025-00502-2","url":null,"abstract":"<p><strong>Background: </strong>Hip fracture in the elderly is considered a significant public health burden due to a high rate of mortality and this is globally being seen as a serious concern. However, comorbidities requiring anticoagulants are of particular concern in the post-operative setting. In this analysis, we aimed to systematically compare the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants (NOACs).</p><p><strong>Methods: </strong>Web of Science, EMBASE, Google Scholar, the Cochrane databases, MEDLINE, and http://www.</p><p><strong>Clinicaltrials: </strong>gov were searched for relevant studies from January to February 2024. The post-operative complications were considered the endpoints in this study. Risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the data following statistical analysis. Weighted mean difference (WMD) calculated with mean and standard deviation, with 95% CIs, was used to represent the result for mean length of hospital stay.</p><p><strong>Results: </strong>A total number of 15,019 participants with hip fracture were included in this analysis. Eleven thousand two hundred and fifteen (11,215) participants were on warfarin therapy prior to fracture and surgery, whereas 3804 participants were on NOACs. Results of this analysis showed that the risks of post-operative mortality (RR, 1.03; 95% CI, 0.92-1.16; P = 0.57), deep vein thrombosis (RR, 1.10; 95% CI, 0.41-2.98; P = 0.84), pulmonary embolism (RR, 1.17; 95% CI, 0.44-3.10; P = 0.75), stroke (RR, 1.25; 95% CI, 0.23-6.71; P = 0.80) and myocardial infarction (RR, 0.42; 95% CI, 0.03-6.98; P = 0.55) were not significantly different in patients who underwent surgery for hip fracture and who were on warfarin versus on NOACs. The risks of infection (RR, 0.90; 95% CI, 0.28-2.93; P = 0.87) and blood transfusion (RR, 1.08; 95% CI, 0.80-1.45; P = 0.62) were also similarly manifested. However, the length of hospital stay [WMD, - 0.93; 95% CI, - 1.83 to 0.03; P = 0.04] was significantly less in patients who were on NOACs in comparison to those who were on warfarin.</p><p><strong>Conclusions: </strong>The post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on NOACs were similar. However, those patients who were on warfarin had a significantly longer length of hospital stay.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"21"},"PeriodicalIF":2.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441785","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 combination of remimazolam and sevoflurane on elderly patients' recovery quality from general anesthesia after laparoscopic abdominal surgery: a randomized controlled trial.","authors":"Xiawei Lai, Shuxian Liu, Di Wang, Yuqing Chi, Xiaoqun Su, Lideng Guo, Zhijing Zhang, Haihui Xie","doi":"10.1186/s13741-025-00501-3","DOIUrl":"10.1186/s13741-025-00501-3","url":null,"abstract":"<p><strong>Purpose: </strong>Remimazolam toluene sulfonic acid is a short-acting benzodiazepine primarily studied for intravenous anesthesia. To date, few studies have focused on the effects of the combination of remimazolam and inhalation anesthesia or its impact on postoperative recovery. Our study aims to investigate the influence of remimazolam combined with sevoflurane for general anesthesia maintenance on postoperative recovery quality in elderly patients undergoing laparoscopic abdominal surgery.</p><p><strong>Methods: </strong>A total of 109 patients, aged 60 to 80 years old, scheduled for laparoscopic gallbladder or hernia surgery were randomly divided into two groups: remimazolam group (Group R) and remimazolam-sevoflurane combination group (Group S). Group R had remimazolam for anesthesia maintenance, while Group S received remimazolam and sevoflurane. Both groups followed the same induction protocol, with bispectral index (BIS) maintained between 40 and 60 during surgery. The primary outcome was assessed with the Quality of Recovery (QoR)-15 score. The secondary outcomes included loss of consciousness (LoC), perioperative hemodynamic variables, extubation time, and the incidence of postoperative adverse events. During the study, 7 patients were lost to follow-up, and finally, 102 patients were included in the statistical analysis. The data will be analyzed in a modified full analysis set.</p><p><strong>Results: </strong>Group S had higher QoR-15 and physical comfort scores on postoperative day (POD) 1 and POD3 compared to Group R (135.0[8.0] vs. 132.0[11.0], P = 0.004; 143.0[6.0] vs. 141.0[7.0], P = 0.007). Despite using less remifentanil (P = 0.021), Group S had a significantly longer extubation time (P = 0.048). There were no significant differences in induction time, perioperative hemodynamic variables, or postoperative adverse events between the groups.</p><p><strong>Conclusion: </strong>Combining remimazolam with sevoflurane improves postoperative recovery quality in elderly patients undergoing laparoscopic abdominal surgery. This approach ensures optimal anesthesia depth and sedation while minimizing adverse events and complications.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry ChiCTR2200065332. Date of registration: 02/11/2022.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"20"},"PeriodicalIF":2.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414752","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}