Perioperative Medicine最新文献

{"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}

{"title":"Carotid corrected flow time and Doppler shock index for prediction of post-induction hypotension in patients undergoing elective abdominal surgery: a prospective observational study.","authors":"Tao Sun, Kangli Hui, Liwen Ren, Mengtong Han, Xiaoyun Shen, Jingwei Xiong, Hongwei Qi, Manlin Duan","doi":"10.1186/s13741-025-00519-7","DOIUrl":"https://doi.org/10.1186/s13741-025-00519-7","url":null,"abstract":"<p><strong>Background: </strong>Abdominal surgical patients who have deficient blood volume are at an elevated risk of post-induction hypotension (PIH). New strategies have been adopted, i.e., carotid ultrasound, to evaluate volume status. The study aimed to investigate and compare the predictive value of various carotid ultrasound parameters for PIH.</p><p><strong>Methods: </strong>Adult patients scheduled for abdominal surgery were enrolled. Carotid ultrasound was performed before induction to evaluate the carotid flow time (FT), carotid artery velocity time integral (VTI), and Doppler shock index (the DSI_FTc and DSI_VTI). Both Wodey's (W) and Bazett's (B) formulae determined the corrected flow time (FTc). The predictive ability of these parameters was analyzed via receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Finally, 94 patients were analyzed, and of those, 40 (42.6%) developed PIH. The areas under the curve for FT, FTc(W), 1/DSI_FTc, and FTc(B) were 0.790 (95% CI 0.697-0.883) (P < 0.05), 0.788 (95% CI 0.695-0.881) (P < 0.001), 0.729 (95% CI 0.626-0.832) (P < 0.001), and 0.689 (95% CI 0.582-0.796) (P < 0.05), respectively. The optimal cut-off for FTc(W) was 334.15 ms (sensitivity 82.5%, specificity 70.4%), while for FT, it was 313.33 ms (sensitivity 72.5%, specificity 79.6%), indicating FTc(W) as the best predictor among these various parameters. The 1/DSI_FTc was an inferior predictor of PIH, with an optimal cutoff value of 4.58. The sensitivity (80.0%) and specificity (61.1%) values were obtained.</p><p><strong>Conclusion: </strong>Carotid flow time corrected by Wodey's formula was a reliable indicator of PIH in patients undergoing elective abdominal surgery, superior to FT, DSI_FTc, and FTc(B).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"38"},"PeriodicalIF":2.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743514","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 postoperative delirium in cardiac surgery patients with the SDACS screening tool: a multicenter-multiphase study.","authors":"Hosein Mahmoudi, Athanasios Chalkias, Ali Moradi, Seyed Tayeb Moradian, Seyed Mohammad Reza Amouzegar, Amir Vahedian-Azimi","doi":"10.1186/s13741-025-00518-8","DOIUrl":"10.1186/s13741-025-00518-8","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative delirium is a prevalent complication in cardiac surgery patients, highlighting the importance of early risk factor identification for optimal management. This study aimed to pinpoint risk factors and devise a novel screening tool, the Screening Tool for Delirium After Cardiac Surgery (SDACS), to predict postoperative delirium in cardiac surgery patients after the first day.</p><p><strong>Materials and methods: </strong>This study employed a multiphase design consisting of three phases. In the first phase, through a scoping review of 38 finally selected published papers, 136 potential risk factors for identifying delirium after cardiac surgery were identified. These risk factors were then incorporated into three Delphi rounds of expert panels to develop a screening tool for postoperative delirium. Finally, 76 potential risk factors were examined on 920 cardiac surgery patients at three academic institutions between 2020 and 2023 (third phase of the study). All predictors were included into a screening instrument (SDACS), and the regression coefficient of each predictor was transformed into a risk score.</p><p><strong>Results: </strong>Delirium was diagnosed in 53% (n = 488) of 920 patients. Four independent predictors of delirium were identified: chronic opioid use (OR: 4.605, 95% CI: 2.163-9.804), hearing impairment (OR: 6.926, 95% CI: 3.630-12.215), benzodiazepine history (OR: 8.506, 95% CI: 5.651-11.805), and poor sleep quality on the first night after cardiac surgery (OR: 9.081, 95% CI: 6.225-12.248). The cross-validated area under receiver operating characteristics curve (AUC) for the screening instrument was 0.897 (95% CI: 0.876-0.916; P < 0.001).</p><p><strong>Conclusion: </strong>Chronic opioid use, hearing impairment, benzodiazepine history, and poor sleep quality post-surgery are linked to postoperative delirium in cardiac surgery patients. The SDACS screening tool effectively forecasts this syndrome early, offering bedside nurses a valuable tool for prompt intervention and improved patient outcomes. The SDACS screening tool aids in early delirium risk assessment, enabling timely interventions and better patient outcomes. By predicting postoperative delirium accurately, nurses can address risk factors proactively, potentially reducing its incidence and severity, leading to improved postoperative outcomes for patients.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"37"},"PeriodicalIF":2.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731056","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":"Prediction of esophagogastric anastomotic leakage by nomogram combined with preoperative nutritional status and clinical factors: a retrospective study of 775 patients.","authors":"Jiang-Shan Huang, Li-Tao Yang, Jia-Fu Zhu, Qi-Hong Zhong, Fei-Long Guo, Zhen-Yang Zhang, Jiang-Bo Lin","doi":"10.1186/s13741-024-00487-4","DOIUrl":"10.1186/s13741-024-00487-4","url":null,"abstract":"<p><strong>Aim: </strong>The purpose was to explore the independent risk factors for esophagogastric anastomotic leakage (EGAL) and establish a nomogram.</p><p><strong>Methods: </strong>Patients who underwent esophagectomy were enrolled and randomly divided into a training cohort and a validation cohort at a ratio of 7:3. The differences between the two groups of factors were analyzed by difference analysis, and multivariate regression analysis was subsequently performed. A nomogram was established, and the feasibility of the nomogram was verified by analyzing the discrimination, calibration, and decision curves.</p><p><strong>Results: </strong>A total of 775 patients were enrolled, including 532 in the training cohort and 223 in the validation cohort. Multivariate regression analysis revealed that age, smoking history, drinking history, nutritional indicators, and anastomotic location were independent risk factors. In terms of discrimination, in the training group, the area under the curve was 0.757 (P = 0.025). In the calibration curve, the curves and fitting lines before and after correction in the training group and the validation group were basically the same. The results of the Hosmer-Lemeshow test showed that the chi-square value of the training cohort was 5.48 (P = 0.791). In the decision curve analysis of the training set, when the threshold probability was in the range of 5-63%, the net benefit of patients was greater than that of the two extreme curves.</p><p><strong>Conclusion: </strong>Preoperative malnutrition is an independent risk factor for EGAL. A diagnostic model, developed on age, anastomotic location, smoking status, and drinking history, was a reliable noninvasive tool to timely predict the occurrence of AL.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"36"},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710772","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 pulmonary rehabilitation on lung cancer surgery outcomes: a matched-case analysis.","authors":"Matar Alzahrani, Rajnikant Mehta, Salma Kadiri, Saffana Algaeed, Aya Osman, Mohammed Alsanad, Joan Duda, Fang Gao, Babu Naidu","doi":"10.1186/s13741-025-00510-2","DOIUrl":"10.1186/s13741-025-00510-2","url":null,"abstract":"<p><p>Pulmonary rehabilitation programs for COPD patients are extensively accessible throughout the UK and have demonstrated efficacy in enhancing outcomes, including recovery from exacerbations. Numerous lung cancer surgery patients possess COPD, and the surgery may be regarded as a definitive aggravation of COPD. It is ambiguous in practical application whether referral to pulmonary rehabilitation programs enhances surgical and patient-reported results. We want to address this topic by conducting a propensity-score analysis (PSA) of participants in an enriched cohort trial. Methods An enriched cohort research was conducted, providing rehabilitation both pre- and post-surgery pragmatically through local pulmonary rehabilitation providers for patients undergoing lung cancer resection, and compared to a contemporaneous control group receiving standard treatment. The study enrolled 873 participants (pulmonary rehabilitation (PR) n = 135, non-intervention or control (NG) n = 738). Regression analyses for exposed and unexposed matching, effect estimation, and standard error estimations were conducted.Results A total of 114 participants were matched PR (n = 57) and NG (n = 57). The multivariate-linear regression indicated a reduction in length of stay (LOS) of 0.2 days of LOS compared to the usual care group (EE = - 0.20), and that reduction could potentially go up to 1.8 days (95% CI = - 1.8-1.6). The multivariate log-binomial regression revealed that PR had a reduction of 60% postoperative pulmonary complications (PPC) rate (EE = - 0.60, 95% CI = - 1.8-0.5). Lastly, the multivariate-linear regression showed an improvement in quality of life 6 weeks and 6 months after surgery (QoL) in patients in PR, especially in the physical functioning score in which an improvement of 6.6% was noted for the PR group compared to the NG group following surgery (EE = 6.6). Conclusion Participation in \"real world\" pulmonary rehabilitation prior to and following surgery seems to yield improved patient and clinical results post-lung cancer surgery. Nonetheless, prompt access to pulmonary rehabilitation may be a significant challenge following COVID.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"35"},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710767","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}