Perioperative Medicine最新文献

{"title":"Incidence of prolonged time to tracheal extubation and its associated factors among adult patients undergoing elective surgery at Jimma Medical Center, Jimma, Oromia, Ethiopia, 2024.","authors":"Gemechisa Akuma Wayesa, Mitiku Berhanu Wedajo, Wondu Reta Demissie, Admasu Belay Gizaw, Assefa Hika Gudeta, Guteta Gudina Gula","doi":"10.1186/s13741-025-00520-0","DOIUrl":"https://doi.org/10.1186/s13741-025-00520-0","url":null,"abstract":"<p><strong>Purpose: </strong>Extubation refers to removing the breathing tube from the patient's airway after surgery under general anesthesia with tracheal intubation. Extubation procedures typically take less than 15 min, and if they take more, they are prolonged. Whether or not to extubate a patient depends on several factors, including the patient's preoperative status, the type of surgery, anesthetic methods, and expected recovery after the procedure. Thus, the study's objective was to determine the incidence of prolonged extubation and its associated factors among adult patients undergoing surgery at Jimma Medical Center.</p><p><strong>Methods: </strong>A prospective observational study through a consecutive sampling technique was conducted. Ethical clearance and approval were obtained from the institutional review board of Jimma University. Data on the extubation time and possible associated factors for a prolonged extubation time were collected using a data collection checklist. After being entered into EpiData 4.6 and exported into SPSS 25, descriptive analyses and logistic regression were carried out. In multivariate variables, p ≤ 0.05 was declared as statistical significance.</p><p><strong>Result: </strong>Three-hundred eight adult patients were enrolled in the current study. Of these, the incidence of prolonged extubation was 24.7% (95% CI [20.0-29.9]). The identified associated factors were age ≥ 55 years (AOR = 5.7, 95% CI [2.62, 12.69], p ≤ 001); ASAPS > II (AOR = 4.27, 95% CI [1.59, 11.45], p = 004); BMI ≥ 30 kg/m² (AOR = 6.6, 95% CI [2.37, 18.36], p ≤ 001); the use of benzodiazepine (AOR = 3.43, 95% CI [1.42, 8.25], p = 0.006); using of isoflurane (AOR = 0.35, 95% CI [0.15, 0.78], p = 0.011); prone position (AOR = 4.68, 95% CI [1.56, 14.07], p = 0.006); extubation in afternoon (AOR = 2.69, 95% CI [1.26, 5.74]; p = 0.011); and duration of surgery ≥ 210 min (AOR = 5.2, 95% CI [2.32, 11.72], p ≤ 0.001).</p><p><strong>Conclusions: </strong>The study found that prolonged time to extubation occurred in one-fourth of the patients. The independent factors statistically associated with prolonged extubation were older ages, higher ASA class, obesity (≥ 30 kg/m²), the use of benzodiazepine, halothane for maintenance, prone position, extubation in the afternoon, and longer procedures (≥ 210 min).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"48"},"PeriodicalIF":2.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005084","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":"The impact of frailty on functional recovery after cardiac surgery-a case control study.","authors":"M Abdelmonem, M Elsayed, D Awadallah, O Don, R H Bennett, O G Mackay, S Pookayil, C Archer, M Mahgoub, M J Bennett","doi":"10.1186/s13741-025-00526-8","DOIUrl":"https://doi.org/10.1186/s13741-025-00526-8","url":null,"abstract":"<p><strong>Background: </strong>Good functional recovery after cardiac surgery can be reported as 'days alive and out of hospital' in the first 30 days after a procedure (DAOH₃₀) and 'days at home' in the first year (DAH₃₆₅), which integrate several clinically important outcomes, including death, hospital length of stay, quality of recovery and hospital readmission. They depend on the preservation or early recovery of physiological and functional capacity, both of which may be lost in patients living with frailty.</p><p><strong>Case presentation: </strong>We measured frailty with a multidimensional approach, incorporating 30 variables spanning comorbidity, sensory, cognitive, psychosocial, disability and pharmaceutical domains, which together make up the Patient Frailty Index (pFI). We further explored the impact of socioeconomic factors on functional recovery using the Welsh Index of Multiple Deprivation (WIMD). The outcome measures included duration of level 3 and level 2 care, duration of hospital stay, readmission and both short- and longer-term mortality. A total of 669 patients were included in the final analysis. A total of 224 (33.5%) of the patients were 'frail'. They were more likely to have chronic obstructive pulmonary disease, heart failure and diabetes and to be in the lowest decile for deprivation. Frailty was not associated with either sex or advanced age. Patients deemed to be 'frail' had a longer stay in intensive care, required level 3 cardiovascular and respiratory support for longer and stayed longer in the hospital. They spent fewer days at home in the first 30 days, largely due to days requiring advanced cardiovascular support, and fewer days at home in the first year, with most days lost to patients who died in the first year following their surgery. A moderation analysis examined whether the WIMD modified the effect of frailty on recovery after cardiac surgery. The interaction term, after confirming there were no collinearity concerns, was not significant, either for DAOH₃₀ or DAH₃₆₅, indicating no evidence of moderation.</p><p><strong>Conclusions: </strong>Short- and medium-term measures of good functional recovery were lower in 'frail' patients, and longer-term survival was also significantly reduced. An accumulation of deficits assessment of frailty, incorporating multiple domains, builds a more accurate picture of increasing vulnerability and can be acquired from patients' electronic health records. In a surgical population that is increasingly comorbid, these findings should inform decisions on preoperative priority setting, prehabilitation, postoperative resources and discharge planning.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"46"},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011643","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":"Global trends in artificial intelligence research in anesthesia from 2000 to 2023: a bibliometric analysis.","authors":"Yi Ou, Xiaoyi Hu, Cong Luo, Yajun Li","doi":"10.1186/s13741-025-00531-x","DOIUrl":"https://doi.org/10.1186/s13741-025-00531-x","url":null,"abstract":"<p><strong>Background: </strong>Interest in artificial intelligence (AI) research in anesthesia is growing rapidly. However, there is a lack of bibliometric analysis to measure and analyze global scientific publications in this field. The aim of this study was to identify the hotspots and trends in AI research in anesthesia through bibliometric analysis.</p><p><strong>Methods: </strong>English articles and reviews published from 2000 to 2023 were retrieved from the Web of Science Core Collection (WoSCC) database. The extracted data were summarized and analyzed using Microsoft Excel, and bibliometric analysis were conducted with VOSviewer software.</p><p><strong>Results: </strong>AI research literature in anesthesia has exhibited rapid growth in recent years. The United States leads in the number of publications and citations, with Stanford University as the most prolific institution. Hyung-Chul Lee is the author with the highest number of publications. The journal Anesthesiology is highly recognized and authoritative in this field. Recent keywords include \"musculoskeletal pain\", \"precision medicine\", \"stratification\", \"images\", \"mean arterial pressure\", \" enhanced recovery after surgery\", \"frailty\", \"telehealth\", \"postoperative delirium\" and \"postoperative mortality\" indicating hot topics in AI research in anesthesia.</p><p><strong>Conclusions: </strong>Publications on AI research in the field of anesthesia have experienced rapid growth over the past two decades and are likely to continue increasing. Research areas such as depth of anesthesia (DOA) and drug infusion (including electroencephalography and deep learning), perioperative risk assessment and prediction (covering mean arterial pressure, frailty, postoperative delirium, and mortality), image classification and recognition (for applications such as ultrasound-guided nerve blocks, vascular access, and difficult airway assessment), and perioperative pain management (particularly musculoskeletal pain) have garnered significant attention. Additionally, topics such as precision medicine, enhanced recovery after surgery, and telehealth are emerging as new hotspots and future directions in this field.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"47"},"PeriodicalIF":2.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037603","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":"Clinical value of NT-proBNP, MPO, and NLR combined with echocardiography in prediction of malignant arrhythmia in elderly patients with valvular heart disease.","authors":"Jianping Liu, Apei Zhou, Meiduan Zheng, Ling Wang, Ping Zeng","doi":"10.1186/s13741-025-00527-7","DOIUrl":"https://doi.org/10.1186/s13741-025-00527-7","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to probe the clinical value of N-terminus pro-brain natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), and neutrophil lymphocyte ratio (NLR) combined with echocardiography in the prediction of malignant arrhythmias (MA) in elderly patients with valvular heart disease (VHD).</p><p><strong>Methods: </strong>MPO, NT-proBNP, and NLR were detected in blood samples. After 1 year of follow-up, receiver operating characteristic curves were analyzed to determine the clinical value of NT-proBNP, MPO, NLR, and echocardiography for predicting MA in patients with VHD.</p><p><strong>Results: </strong>MPO, NT-proBNP, and NLR were higher in the VHD group. MPO, NT-proBNP, and NLR were higher with severe cardiac dysfunction. MPO, NT-proBNP, NLR, and LVESV in the MA group were higher. NT-proBNP was an independent factor influencing the occurrence of MA in elderly patients with VHD. The AUC for predicting MA in elderly patients with VHD using NT-proBNP, MPO, NLR, and echocardiography were 0.782 (sensitivity 61.50%, specificity 94.60%, 95% CI 0.630-0.934), 0.759 (sensitivity 69.20%, specificity 81.10%, 95% CI 0.579-0.938), 0.736 (sensitivity 76.90%, specificity 64.90%, 95% CI 0.562-0.910), and 0.782 (sensitivity 76.90%, specificity 75.70%, 95% CI 0.646-0.918), respectively. The AUC for the combined prediction using NT-proBNP, MPO, NLR, and echocardiography was 0.913 (sensitivity 76.90%, specificity 94.60%, 95% CI 0.820-1.000), higher than that of each parameter alone (P < 0.05).</p><p><strong>Conclusion: </strong>The combination of NT-proBNP, MPO, NLR, and echocardiography has a predictive value in detecting MA in elderly VHD patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"44"},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064342","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 the preoperative N-terminal pro-B-type natriuretic peptide and acute kidney injury in gastrointestinal surgery patients managed with enhanced recovery strategy: a retrospective cohort study.","authors":"Zefei Zhang, Ziyu Zheng, Huang Nie, Hailong Dong, Chong Lei","doi":"10.1186/s13741-025-00528-6","DOIUrl":"https://doi.org/10.1186/s13741-025-00528-6","url":null,"abstract":"<p><p>Importance Previous evidence has indicated that N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with postoperative acute kidney injury (AKI). However, the association between preoperative NT-proBNP level and postoperative AKI in surgeries managed with enhanced recovery after surgery (ERAS) strategy requires further clarification.Objective To explore the association between preoperative NT-proBNP and the incidence of postoperative AKI in patients who underwent gastrointestinal surgeries and managed with ERAS strategy.Design A retrospective cohort study.Setting A review of documented cases of elective gastrointestinal surgeries managed with ERAS strategy occurred at Xijing Hospital from 01 May 2017 to 30 June 2022.Participants A total of 629 patients aged 18 years or older who were scheduled for elective gastrointestinal surgeries and subjected to the ERAS strategy with preoperative NT-proBNP and creatinine measurements were included in the analysis.Exposure Preoperative serum concentrations of NT-proBNP.Main outcomes and measures The primary outcome was the incidence of postoperative AKI. Preoperative NT-proBNP was divided into high- or low-level groups based on the median (165 pg/ml). Logistic regression was used to explore the association between increased preoperative NT-proBNP level and risk of AKI.Results After screening 1932 case records, 629 cases were included in the final analyses. The average age was 63.5 (15.3) years old and 197 (31.3%) of them were female. Among them, 112 (17.8%) developed postoperative AKI. The incidence of AKI was 21% in the high NT-proBNP group, and 14.6% in the low NT-proBNP group. Patients with higher preoperative NT-proBNP levels (≥ 165 pg/mL) have significant higher risk of postoperative AKI as compared to those in the lower group (adjusted OR 1.75; 95% CI 1.12 to 2.73).Conclusions and relevance Increased preoperative NT-proBNP is associated with an elevated risk of postoperative AKI in patients who underwent gastrointestinal surgery and managed with ERAS strategy.Trial registry number Clinical trial registry number: NCT06145347.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"45"},"PeriodicalIF":2.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022922","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":"Measures to accelerate recovery from stage III tuberculous empyema: tuberculous empyema surgical and recovery methods.","authors":"Jiakun Liu, Yanchao Luan, Qingsong Han, Wei Zhao","doi":"10.1186/s13741-025-00530-y","DOIUrl":"https://doi.org/10.1186/s13741-025-00530-y","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effects of video-assisted thoracoscopic decortication (VATD) and enhanced recovery after surgery (ERAS) in patients with stage III tuberculous empyema.</p><p><strong>Methods: </strong>The 360 participants were divided into four groups according to the treatment received: thoracotomy decortication (TD) + traditional recovery procedures (TRP), TD + ERAS, VATD + TRP, and VATD + ERAS. We evaluated the effects of the treatment modalities on various intraoperative and postoperative outcome measures. Multivariate analysis was then performed to identify risk factors associated with increased postoperative the length of hospital (LOS).</p><p><strong>Results: </strong>There were significant differences between the TD and VATS groups in terms of the duration of surgery, intraoperative blood loss, postoperative drainage, postoperative erythrocyte sedimentation rate (ESR), LOS, and pain levels. The use of ERAS also showed significant effects in certain outcome measures. There were no significant differences in the incidence of postoperative complications among the groups. The use of VATD and ERAS procedures, and preoperative antituberculosis therapy, was inversely associated with the LOS.</p><p><strong>Conclusions: </strong>Implementation of VATD and ERAS procedures in patients with stage III tuberculous empyema can significantly reduce the LOS and improve patient outcomes in a safe and effective manner.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"43"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031530","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":"Impact of prolonged cardiopulmonary bypass on gastrointestinal complications in cardiac surgery: a retrospective cohort study.","authors":"Xiaofang Yang, Ning Lu, Luxi Yang, Boxia Li, Wenjun Zhou, Yuanmin Li, Bing Song, Jinqiu Yuan, Wenbo Meng","doi":"10.1186/s13741-025-00524-w","DOIUrl":"https://doi.org/10.1186/s13741-025-00524-w","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal complications (GICs) following cardiac surgery with cardiopulmonary bypass (CPB) significantly impact postoperative recovery and clinical outcomes.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study evaluated the incidence, risk factors, and outcomes of GICs in patients undergoing cardiac surgery with CPB between January 2018 and December 2023. Patients were stratified by CPB duration (≥ 120 min vs. < 120 min). Propensity Score Matching (PSM) in a 1:2 ratio was used to control for baseline confounders. The primary outcome was the occurrence of GICs within 30 days post-surgery.</p><p><strong>Results: </strong>Among 1444 patients, 686 had prolonged CPB duration, with an overall GICs incidence of 8.59% (124/1444). After PSM, the prolonged CPB group exhibited a significantly higher incidence of GICs compared to the normal CPB group (8.09% vs. 4.31%, p = 0.041). Multivariate logistic regression identified prolonged CPB duration (≥ 120 min; OR, 1.86; 95% CI, 1.06-3.26, p = 0.029), hypertension (OR 1.86; 95% CI, 1.01-3.44; p = 0.049), left ventricular ejection fraction (LVEF; OR, 0.92; 95% CI, 0.88-0.96; p < 0.001), and aortic surgery (OR, 2.72; 95% CI, 1.20-6.19; p = 0.017) as independent risk factors for GICs. Additionally, prolonged ventilator time and higher in-hospital costs were more prevalent in the prolonged CPB group.</p><p><strong>Conclusions: </strong>Prolonged CPB (≥ 120 min), hypertension, LVEF, and aortic surgery are significant risk factors for GICs following cardiac surgery with CPB. Early identification of high-risk patients may facilitate timely intervention, reduce complications, and improve postoperative recovery outcomes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT06697405.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"42"},"PeriodicalIF":2.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022840","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 serum chemokines levels and delayed neurocognitive recovery after non-cardiac surgery in elderly patients: a nested case-control study.","authors":"Liu Han, Meng-Meng Dong, Ke Ding, Qing-Chun Sun, Zhen-Feng Zhang, He Liu, Yuan Han, Jun-Li Cao","doi":"10.1186/s13741-025-00523-x","DOIUrl":"https://doi.org/10.1186/s13741-025-00523-x","url":null,"abstract":"<p><strong>Background: </strong>Perioperative neurocognitive disorders encompass delayed neurocognitive recovery (dNCR). Emerging evidence suggests that chemokines play a crucial role in the pathogenesis of various cognitive impairment diseases. However, the association between chemokines and dNCR remains unclear. Therefore, we aimed to investigate the relationship between serum chemokine levels and dNCR in elderly patients undergoing non-cardiac surgery.</p><p><strong>Methods: </strong>A total of 144 patients undergoing elective major non-cardiac surgery were accessed in neuropsychological testing 1 day prior to and 1 week following the surgery. Blood samples were collected before the initiation of anesthesia and one hour following the cessation of anesthesia. We employed a retrospective nested case-control study design, utilizing one control per dNCR case. Matching criteria included age (± 5 years), duration of surgery (± 90 min), and baseline MMSE score (± 3). We compared the serum levels of CCL2, CCL5, CCL11, and CXCL8 between the matched dNCR and non-dNCR groups.</p><p><strong>Results: </strong>dNCR was observed in 31.25% (45 of 144) of the patients seven days post-surgery, resulting in a final matched sample size of 21 pairs. In the preoperative comparison, the serum concentration of CCL11 was significantly higher in the matched dNCR group compared to the matched non-dNCR group (P = 0.039). In the postoperative comparison, the CCL5 concentration was significantly lower in the dNCR than in the non-dNCR group (P = 0.030). When comparing the differences between postoperative and preoperative levels, the absolute change in CCL11 was significantly greater in the dNCR group compared to the non-dNCR group (P = 0.046). Additionally, the postoperative-to-preoperative ratios of CCL5 and CCL11 in the dNCR group were both significantly lower than those in the non-dNCR group (P = 0.046, P = 0.005). There were no significant differences in CCL2 or CXCL8 levels between the two matched groups.</p><p><strong>Conclusions: </strong>Serum levels of CCL 5 and CCL 11 significantly decreased in elderly patients with dNCR following non-cardiac surgery, which may contribute to the identification of patients at high risk for dNCR.</p><p><strong>Trial registration: </strong>This study was registered on chictr.org.cn (ChiCTR1800014473, 16/01/2018).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"41"},"PeriodicalIF":2.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027801","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":"Evaluation of routine preoperative testing practices in Sudanese public hospitals 2024: a multicenter prospective study.","authors":"Alaelddin Mohammed, Eltayeb Abdalla","doi":"10.1186/s13741-025-00522-y","DOIUrl":"10.1186/s13741-025-00522-y","url":null,"abstract":"<p><strong>Background: </strong>The practice of routine preoperative testing is common in clinical settings despite the presence of regulatory guidelines, straining patients financially and further delaying delivery of care. This study aimed to assess the practice of routine preoperative investigations and compliance with the National Institute for Health and Care Excellence (NICE) guidelines for preoperative investigations in Sudan.</p><p><strong>Methods: </strong>A prospective multicenter study was conducted in the main public hospitals at Atbara, Shendi, and Port-Sudan in January 2024; we prospectively studied 90 adults, sampled by covering all consecutive patients who underwent elective operations during the study period. Data were collected during the preanesthetic check-up and evaluated by senior clinicians for compliance with the NICE guidelines.</p><p><strong>Results: </strong>The study included 39 females (43%) and 51 males (56%), with a mean age of 38 ± 14 years. Among the 90 patients, 89 (99%) underwent at least one unnecessary investigation. Overall, out of 586 requested investigations preoperatively, 312 (53.2%) were unnecessary according to the NICE guidelines. The predictors of requesting unnecessary investigations were ASA status (p value 0.020) and surgery grade (< 0.001).</p><p><strong>Conclusion: </strong>This study reported significant overutilization of preoperative testing in Sudanese public hospitals. To address this issue, it is crucial to acknowledge widely recognized guidelines, raise clinicians' awareness of them and monitor their implementation.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"40"},"PeriodicalIF":2.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811982","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":"Performance of the early warning system score in predicting postoperative complications in older versus younger patients.","authors":"Annick Stolze, Lisette Vernooij, Dianne de Korte-de Boer, Markus W Hollmann, Wolfgang F F A Buhre, Christa Boer, Peter G Noordzij","doi":"10.1186/s13741-025-00516-w","DOIUrl":"10.1186/s13741-025-00516-w","url":null,"abstract":"<p><strong>Background: </strong>Early warning system (EWS) scores are implemented on surgical wards to identify patients at high risk of postoperative clinical deterioration, but its predictive value in older patients is unclear. This study assessed the prognostic value of EWS scores to predict severe postoperative complications in older patients compared to younger patients.</p><p><strong>Methods: </strong>This study utilized data from the TRACE study. EWS scores were routinely measured on postoperative days one (POD1) and three (POD3). The cohort was divided by age: < 70 years and ≥ 70 years. Performance measures of EWS scores on POD1 and POD3 were assessed to predict severe postoperative complications. Missed event rates (proportion of events not detected by the EWS threshold) and nonevent rates (proportion of EWS values above the threshold without an adverse event) were calculated.</p><p><strong>Results: </strong>Among 4866 patients, 39.3% were ≥ 70 years old. Severe complications occurred in 6.1% of older compared to 5.8% of younger patients (P = 0.658). EWS scores on POD1 and POD3 did not differ between age groups. For severe complications, EWS showed moderate discrimination in both older (POD1: C-statistic 0.65 (95%CI 0.59-0.70); POD3: 0.63 (95%CI 0.57-0.69)) and younger patients (POD1: 0.68 (95%CI 0.65-0.72); POD3: 0.65 (95%CI 0.61-0.70)). Overall, calibration was good. For EWS score ≥ 3, the missed event rate was at least 69% and nonevent rate 75%.</p><p><strong>Conclusions: </strong>Predicted performance of the EWS score was moderate among older and younger patients. A limitation of the EWS score is the high rate of missed events and nonevents.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"39"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753868","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}