Perioperative Medicine最新文献

{"title":"Influence of proprioceptive enhancement training combined with staged rehabilitation training on knee joint function of patients after total knee arthroplasty.","authors":"Chao Li, Shengkui Xue, Qi Shu, Hui Wu, Le Kang","doi":"10.1186/s13741-026-00698-x","DOIUrl":"10.1186/s13741-026-00698-x","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the improvement effect of proprioceptive enhancement training combined with staged rehabilitation training on knee joint function in patients post-total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>This prospective, randomized controlled trial enrolled 80 patients with knee osteoarthritis after TKA, who were randomly allocated to a control group (routine rehabilitation training, n = 40) or an observation group (proprioceptive enhancement training + staged rehabilitation training, n = 40). Both groups underwent continuous training for 4 weeks, with the intensity tailored to the patients' tolerance levels. Outcome measures included pain (VAS), knee function (HSS score), balance (BBS), range of motion (MKFA), and daily living ability (ADL). Postoperative complications were recorded.</p><p><strong>Results: </strong>Both groups showed noticeable post-intervention improvement in all functional measures. After the intervention, the observation group had lower VAS score (Z = -4.448, η² = 0.228, p < 0.001) and ADL score (Z = -2.654, η² = 0.088, p = 0.008), and higher HSS score (t = 3.219, Cohen's d = 0.720, p = 0.002), BBS score (t = 2.980, Cohen's d = 0.665, p = 0.004), and MKFA (t = 4.464, Cohen's d = 0.999, p < 0.001) than the control group. The observation group exhibited a lower incidence of postoperative complications after TKA than the control group (p = 0.048).</p><p><strong>Conclusion: </strong>Proprioceptive enhancement training & staged rehabilitation training provides superior outcomes in pain relief, functional recovery, and complication reduction post-TKA. This combined approach presents a clinically valuable strategy for optimizing postoperative knee rehabilitation.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974307","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 mortality in pediatric non-cardiac surgery in Ethiopia: a systematic review and meta-analysis.","authors":"Sitotaw Tesfa Zegeye, Eshetu Tesfaye Dejen, Meseret Hulualem Nega, Belete Muluadam Admassie","doi":"10.1186/s13741-026-00689-y","DOIUrl":"10.1186/s13741-026-00689-y","url":null,"abstract":"<p><strong>Background: </strong>Perioperative mortality in children continues to be a major concern, with rates significantly exceeding those observed in adults. This issue remains despite improvements in anesthesia, surgical, and perioperative management. The aim of this systematic review and meta-analysis is to generate evidence regarding perioperative pediatric mortality in Ethiopia.</p><p><strong>Methods: </strong>This systematic review was conducted in strict adherence to the PRISMA 2020 guidelines. A thorough literature search was undertaken to identify published and unpublished English-language studies. Electronic databases, including PubMed, African Journals Online, Cochrane Library, and CINAHL, were systematically searched to capture relevant studies for inclusion. The methodological quality of the selected studies was appraised using the Joanna Briggs Institute critical appraisal tools. Data analysis was performed using Stata version 17, whereby the pooled incidence of perioperative pediatric mortality was calculated, and potential predictors were examined.</p><p><strong>Results: </strong>A total of 23 studies, comprising 7,059 participants, were included in this analysis. The pooled incidence of perioperative pediatric mortality was found to be 15.81% (95%CI: 11.82-19.79). Factors significantly associated with elevated perioperative pediatric mortality included neonatal surgery (pOR = 8.65; 95%CI: 4.06-18.45), pediatric trauma surgery (pOR = 8.07; 95%CI: 4.66-13.98), delayed presentation and surgical intervention following the onset of disease (pOR = 4.41; 95%CI: 2.02-9.62), prolonged hospital stays (pOR = 3.46; 95%CI: 2.10-5.68), and emergency surgery (pOR = 2.35; 95%CI: 1.80-3.08).</p><p><strong>Conclusion: </strong>The meta-analysis indicates that perioperative pediatric mortality in Ethiopia is elevated. Significant factors include pediatric trauma surgery, emergency surgery, delayed presentation and intervention following disease onset, prolonged hospital stay, and neonatal surgery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13360044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974457","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":"A WeChat mini-program-based perioperative cognitive management tool (WACDAM): development and clinical evaluation in elderly patients undergoing oromaxillofacial malignancy surgery-a mixed-methods study.","authors":"Yujia Wu, Zhen Feng, Jiangyan Fu, Yan Hou, Feng Gao","doi":"10.1186/s13741-026-00692-3","DOIUrl":"10.1186/s13741-026-00692-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postoperative cognitive dysfunction (POCD) is a common and serious complication among geriatric patients undergoing surgery for oromaxillofacial malignancies, significantly impedes rehabilitation and increases healthcare costs. Therefore, effective perioperative cognitive management is essential, yet it remains challenging. While mobile health (mHealth) applications offer potential solutions, their adoption among elderly populations remains low due to usability barriers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to develop and comprehensively evaluate a novel WeChat-based mHealth intervention, the WeChat Applet of Cognitive Dysfunction Assessment and Management (WACDAM), for the perioperative management of POCD in older adults undergoing surgery for oromaxillofacial malignancies, with a focus on its clinical effectiveness, usability, and implementation value .&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a mixed-methods, participatory design study. This study employed a participatory design strategy to develop WACDAM in collaboration with geriatric patients, clinical specialists, and technical developers. Patients who underwent oral malignancy resection with neck dissection under general anesthesia between December 2020 and December 2021 were enrolled. POCD was assessed using the Z-score method, and risk factors were analyzed using multivariable logistic regression. Usability and user satisfaction were evaluated using the System Usability Scale (SUS), the user version of the Mobile Application Rating Scale (uMARS), and semi-structured interviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 112 elderly patients who underwent surgery for oromaxillofacial malignancy and completed both preoperative and postoperative (day 7) assessments, the incidence of POCD was 33.1% (37/112). Multivariable logistic regression identified older age (OR = 1.269, 95% CI: 1.056-1.525), lower education level (OR = 0.792, 95% CI: 0.644-0.974), hypertension (OR = 4.153, 95% CI: 1.355-12.732), sleep disorders (OR = 1.272, 95% CI: 1.001-1.617), prolonged anesthesia time (OR = 1.009, 95% CI: 1.001-1.018), and intraoperative hypotension (OR = 5.512, 95% CI: 1.240-24.506) as independent risk factors for POCD. The WACDAM performance evaluation demonstrated a SUS score of 70.17 and a mean objective quality score of 3.65 ± 1.03 on the uMARS, with the highest score in functionality (3.87 ± 0.98) and the lowest in engagement (3.48 ± 1.07). Subjective quality assessments (3.66 ± 1.06) corresponded closely with these objective metrics. In semi-structured interviews involving 20 patients and 10 clinicians, users reported that WACDAM significantly enhanced doctor-patient communication (mean satisfaction increase: 1.63 ± 1.32 points, P &lt; 0.01), improved the efficiency of POCD management, and was overall perceived as an acceptable and valuable clinical tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study developed WACDAM, a pioneering WeChat-based mini-pr","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932373","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":"\"Just the way we always did it\": ophthalmologist perspectives on changing routine anesthesia care for cataract surgery in the United States.","authors":"Nora Lyang, Rachel Schwartz, Saras Ramanathan, Neeti Parikh, Meghan Lane-Fall, Daniel Dohan, Catherine L Chen","doi":"10.1186/s13741-026-00697-y","DOIUrl":"10.1186/s13741-026-00697-y","url":null,"abstract":"<p><strong>Background: </strong>Cataract surgery is one of the most common elective outpatient surgeries performed among older adults in the United States. Modern surgical technique makes cataract surgery a relatively quick, low-risk, minimally invasive outpatient procedure that can be performed solely under ophthalmologist-directed local or topical anesthesia. However, in the US, the procedure is routinely performed with additional monitoring and intravenous sedation administered by anesthesia-trained personnel. Given the procedure's safety profile, we sought to characterize ophthalmologists' perspectives on barriers preventing the adoption of more individualized approaches to cataract surgery sedation that do not automatically default to employing routine anesthesia care.</p><p><strong>Methods: </strong>This study was conducted between December 2022 to January 2024. Using a semi-structured interview guide developed with the Consolidated Framework for Implementation Research (CFIR) framework, we completed interviews with ophthalmologists who performed cataract surgery with or without anesthesia care in hospital outpatient departments, ambulatory surgery centers, minor procedure rooms, and/or office-based surgery suites across the United States. Data were analyzed using an inductive thematic analysis approach to uncover descriptive themes.</p><p><strong>Results: </strong>We interviewed 19 ophthalmologists (5 women), including 6 who had experience routinely performing cataract surgery without anesthesia care. Three major themes emerged: (1) inertia, defined as the tendency to continue established practices that serve to maintain the status quo, (2) financial considerations, and (3) the interdependent relationship between ophthalmology and anesthesiology. While some participants supported a more selective approach to the use of anesthesia services, study participants identified multiple barriers to change, including difficulty overcoming the current inertia, decreased reimbursement for office-based surgery, and concerns about implications for patient safety without routine anesthesia involvement.</p><p><strong>Conclusion: </strong>Ophthalmologists identified multiple barriers to changing current anesthesia-led sedation models for cataract surgery. Our findings can help inform future efforts to better align anesthesia care with patient and procedural needs in an aging US population.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874922","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":"Reduced hypopharyngeal muscle strength in patients with dysphagia symptoms after anterior cervical discectomy and fusion.","authors":"Chih-Jun Lai, Fon-Yih Tsuang, Jing-Rong Jhuang, Ming-Yen Hsiao, Ya-Jung Cheng, Yeun-Chung Chang, Jo-Yu Chen","doi":"10.1186/s13741-026-00691-4","DOIUrl":"10.1186/s13741-026-00691-4","url":null,"abstract":"<p><strong>Background: </strong>Dysphagia symptoms are a common complication following anterior cervical discectomy and fusion (ACDF). The Eating Assessment Tool-10 (EAT-10) is widely used to screen for dysphagia symptoms, particularly in patients with scores ≥ 3. However, the underlying pathophysiological mechanisms and specific swallowing muscle impairments associated with dysphagia symptoms after ACDF remain incompletely understood. Videofluoroscopy is considered the gold standard for evaluating swallowing function. High-resolution impedance manometry (HRIM) enables quantitative assessment of pressure dynamics during swallowing. Therefore, this study aimed to identify alterations in pharyngeal contractile function and pathophysiological changes associated with dysphagia symptoms following ACDF using HRIM and videofluoroscopy.</p><p><strong>Methods: </strong>Patients who underwent ACDF within one year postoperatively were enrolled in this cross-sectional study. Dysphagia symptoms were defined as an EAT-10 score ≥ 3. Swallowing function was evaluated using HRIM and videofluoroscopy. Swallowing tests were performed with two food textures, as defined by the International Dysphagia Diet Standardisation Initiative (IDDSI): level 0 (thin liquid) and level 4 (extremely thick liquid). HRIM parameters were compared between patients with and without dysphagia. Aspiration was defined as a Penetration-Aspiration Scale (PAS) score ≥ 6 on videofluoroscopic examination.</p><p><strong>Results: </strong>A total of 43 patients were included, comprising 29 with dysphagia symptoms and 14 without. During thin liquid swallowing (IDDSI level 0), patients with dysphagia symptoms had significantly lower hypopharyngeal mean peak pressure (hypoPeakP) and higher Swallow Risk Index (SRI) compared with those without dysphagia symptoms (median 55.79 vs. 104.85 mmHg and 18.60 vs. 4.30, respectively). During extremely thick liquid swallowing (IDDSI level 4), hypoPeakP remained significantly lower in the dysphagia symptoms group (median 86.96 vs. 161.19 mmHg), whereas SRI did not differ significantly between groups. No aspiration events were observed.</p><p><strong>Conclusions: </strong>Post-ACDF dysphagia symptoms were associated with reduced hypopharyngeal contractile pressure. These findings offer physiological insights into the association between dysphagia symptoms and swallowing biomechanics and may inform future research on swallowing assessment in this population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04591665; IRB Approval: 202008024RINC.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841056","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 preoperative regular exercise on mental health in patients undergoing Type II incision surgery.","authors":"Xiwen Yang, Sibin Yi","doi":"10.1186/s13741-026-00694-1","DOIUrl":"10.1186/s13741-026-00694-1","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the effect of preoperative regular exercise on postoperative mental health in patients undergoing Type II incision surgery. Explore the correlations between preoperative exercise and postoperative mental health in this patient group.</p><p><strong>Methods: </strong>A total of 480 patients who underwent Type II incision surgery at a tertiary Grade A hospital in Pingxiang from July 2024 to June 2025 were enrolled. Preoperative physical activity was assessed via the International Physical Activity Questionnaire (IPAQ) short form, and patients were divided into an exercise group (EH, n = 133) and a nonexercise group (NEH, n = 347) on the basis of the \"sports population\" criteria in China. Mental health was evaluated via the Hospital Anxiety and Depression Scale (HADS) and the 12-Item Short-Form Health Survey (SF-12) on the 14th postoperative day.</p><p><strong>Results: </strong>Compared with the NEH group, the EH group had significantly lower postoperative HADS-Anxiety (HADS-A) scores (5.3 ± 2.0 vs. 8.5 ± 3.3) and higher SF-12 Mental Component Summary (MCS, 49.1 ± 7.5 vs. 42.1 ± 8.3) and Physical Component Summary (PCS, 47.3 ± 7.1 vs. 42.8 ± 7.6). Correlation analysis revealed that preoperative regular exercise in the EH group was negatively associated with postoperative anxiety (r = -0.55) and positively associated with the SF-12 PCS (r = 0.72) and MCS (r = 0.60). No significant correlations were observed in the NEH group for anxiety or depression.</p><p><strong>Conclusion: </strong>Preoperative regular exercise significantly alleviates postoperative anxiety and improves both physical and mental function in patients undergoing Type II incision surgery, with these effects remaining significant after adjusting for confounders. However, its effect on improving postoperative depression is not significant. Additionally, preoperative exercise is closely associated with better postoperative psychological status in the EH group, while the NEH group shows no significant correlations between preoperative activity and postoperative anxiety/depression, and weaker correlations with physical/mental function-suggesting that establishing preoperative exercise habits may be a key factor in promoting postoperative psychological recovery.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841147","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":"Rethinking ejection fraction for anesthesiologists: a narrative review.","authors":"Marco Rabis, Patrick Moldzio","doi":"10.1186/s13741-026-00690-5","DOIUrl":"10.1186/s13741-026-00690-5","url":null,"abstract":"<p><p>Left ventricular ejection fraction (EF) is one of the most frequently cited cardiac parameters in perioperative risk assessment and is often used as a surrogate marker of global cardiac stability. However, EF was validated primarily in chronic cardiovascular disease and long-term heart failure management, raising important questions about its suitability as a dominant marker of short-term perioperative risk. EF does not capture key determinants of perioperative vulnerability, including diastolic function, ventricular compliance, right ventricular function, venous congestion, or contractile reserve. Contemporary clinical data suggest that only severely reduced EF (< 30%) is consistently associated with markedly increased perioperative risk, whereas mildly to moderately reduced EF in clinically stable patients often carries less prognostic significance than preserved EF in the presence of heart failure with preserved ejection fraction (HFpEF), congestion, or right ventricular dysfunction. Common perioperative scenarios such as HFpEF, distributive shock, hypovolemia, venous congestion, and chronic compensated heart failure illustrate that EF may substantially underestimate or overestimate true hemodynamic vulnerability depending on the physiological context. In contrast, functional capacity, volume status, and clinical stability emerge as more robust determinants of short-term perioperative risk. Advanced echocardiographic parameters, including diastolic indices, global longitudinal strain (GLS), and focused assessment of right ventricular function, together with biomarkers provide a more physiologically coherent risk profile. The uncritical use of EF as a primary perioperative risk marker is not supported by current evidence. For anesthesiologists, EF should be interpreted as one component within a multidimensional, physiology-guided assessment that integrates focused perioperative ultrasound, clinical history, and targeted biomarkers to more accurately characterize perioperative cardiovascular risk.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841070","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":"Risk factors for postoperative pneumonia following intracranial aneurysm surgery: a propensity score matching analysis.","authors":"Yuting Zeng, Xi Chen, Ka Yan Ho, Weihong Huang, Jianting Tang, Jiao Xu, Li Li, Janelle Yorke","doi":"10.1186/s13741-026-00686-1","DOIUrl":"10.1186/s13741-026-00686-1","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pneumonia (POP) after intracranial aneurysm surgery is common and can lead to prolonged hospitalization, respiratory failure, or death, significantly worsening patient outcomes.</p><p><strong>Aim: </strong>This study aimed to identify independent preoperative, intraoperative, and postoperative risk factors for POP in patients undergoing intracranial aneurysm surgery using propensity score matching to control for confounding.</p><p><strong>Methods: </strong>This retrospective cohort study included 1,115 patients aged ≥ 18 years who underwent intracranial aneurysm surgery at a hospital between January 2019 and July 2022. Patients were grouped by the presence or absence of POP. Logistic regression analysis with 1:1 propensity score matching (PSM) was performed to identify independent risk factors for POP in patients with intracranial aneurysms.</p><p><strong>Results: </strong>After 1:1 propensity score matching, 668 patients (334 per group) were analyzed. Multivariate logistic regression identified six independent risk factors for POP: preoperative antimicrobial prophylaxis, operative duration ≥ 4 h, indwelling gastric tube, intensive care unit (ICU) admission on the day of surgery, postoperative use of analgesics or sedatives, and white blood cell (WBC) count ≥ 10,000 cells/µL.</p><p><strong>Conclusions: </strong>Six risk factors for POP after intracranial aneurysm surgery were identified in this study, some of which are modifiable. Targeting these factors may reduce POP. These variables may inform risk stratification; some may represent potential targets for intervention; however, prospective validation is required before any changes to clinical pathways can be recommended.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841054","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":"Phase-specific dynamics of coagulation factors V, VIII, and XIII during liver transplantation: insights from a prospective study.","authors":"Sarah Thaler, Anna Zorn, Isabell Aster, Dionysios Koliogiannis, Markus Guba, Bernhard W Renz, Philipp Groene","doi":"10.1186/s13741-026-00695-0","DOIUrl":"10.1186/s13741-026-00695-0","url":null,"abstract":"<p><strong>Background: </strong>Liver dysfunction is associated with a rebalanced but fragile hemostatic system, in which alterations in coagulation factor synthesis and activity contribute to both bleeding and thrombotic risks. During liver transplantation, this fragile equilibrium is further challenged by major physiological stress. This study aimed to characterize the phase-specific intraoperative dynamics of coagulation factors V, VIII, and XIII (FV, FVIII, and FXIII) to better understand hemostatic modulation and its clinical implications during liver transplantation.</p><p><strong>Methods: </strong>A subset of 17 liver transplant recipients receiving transfusion support without administration of recombinant FVIII or FXIII was analyzed. Measurements were obtained at three defined intraoperative time points: T1 anesthesia induction, T2 end of anhepatic phase, T3 end of surgery. Activities of FV, FVIII, and FXIII were quantified and analyzed for temporal trends.</p><p><strong>Results: </strong>All three coagulation factors declined during surgery. FV was already markedly reduced at T1 (37% (22/55)) and further decreased to 26% at T3 ((19/34); p = 0.0309). FVIII showed supranormal levels at T1 (193% (160/254) and declined to near-normal levels at T3 (109% ((67/143); p < 0.0001). FXIII remained close to the lower limit of normal (T1: 68% (50/85)); T3: (63% (55/78)) without significant change.</p><p><strong>Conclusion: </strong>This prospective analysis reveals distinct, phase-specific trajectories of FV, FVIII, and FXIII during liver transplantation. Understanding these differential patterns may help identify critical periods of hemostatic vulnerability and guide individualized factor-specific therapeutic interventions to optimize perioperative coagulation management in liver transplant recipients.</p><p><strong>Trial registration: </strong>German Clinical Trials Register (DRKS00032827).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"15 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841164","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":"FXII decline during cardiopulmonary bypass and the limits of routine coagulation assays: a prospective observational analysis.","authors":"Sarah Thaler, Isabell Aster, Emmanuelle Patton, Charlotte Voigt, Sven Peterss, Matthias Feuerecker, Philipp Groene","doi":"10.1186/s13741-026-00687-0","DOIUrl":"10.1186/s13741-026-00687-0","url":null,"abstract":"<p><strong>Background: </strong>The contact activation system is triggered when blood comes into contact with artificial surfaces. Cardiopulmonary bypass (CPB) induces such activation, however the extent of factor XII (FXII) reduction and its reflection in routine coagulation assays remain unclear.</p><p><strong>Methods: </strong>In this prospective observational study, 20 adult patients undergoing elective cardiac surgery with CPB (10 coronary artery bypass grafting (CABG), 10 aortic aneurysm repair) were analyzed. Blood samples were collected immediately prior to anesthesia induction (T1) and three minutes after protamine administration (T2). Laboratory analyses included FXII, factor VIII (FVIII), and factor V (FV) activities, activated partial thromboplastin time (aPTT), prothrombin time (Quick/INR), fibrinogen, and viscoelastic testing (ROTEM).</p><p><strong>Results: </strong>FXII activity decreased significantly after CPB (whole cohort: 98% (79/122) vs. 62% (51/83); CABG: 108% (83/124) vs. 64% (47/85); aortic: 92% (75/119) vs. 61% (52/82), p < 0.001 each). FV declined, whereas FVIII tended to increase. aPTT prolongation was minimal and remained within the normal range. A strong correlation between FXII decline and aPTT change was observed only in CABG patients (ρ = - 0.835, p = 0.003). ROTEM clotting times were moderately prolonged after CPB but showed no correlation with FXII activity.</p><p><strong>Conclusions: </strong>CPB induced a significant reduction in FXII activity. Global coagulation assays such as aPTT or ROTEM have limited sensitivity for contact factor deficiencies. Isolated prolongation of these parameters after CPB should be interpreted cautiously and, in the absence of clinical bleeding, should not routinely prompt hemostatic interventions. Future studies should address subgroup differences (CABG vs. aortic surgery) in larger cohorts.</p><p><strong>Trial registration: </strong>The trial was registered in the German Clinical Trials Register (DRKS00034174).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777908","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}