Perioperative Medicine最新文献

{"title":"Effects of chronic kidney disease on complications and mortality after fracture surgery.","authors":"Bei-Bei Lu, Xu-Rui Liu, Qing-Song Chen, Xiao-Lin Yuan, Qian Luo, Yu-Dong Hu, Xiao-Hui Liao","doi":"10.1186/s13741-025-00514-y","DOIUrl":"10.1186/s13741-025-00514-y","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this meta-analysis was to evaluate the effects of CKD on postoperative complications and the survival of patients with fractures.</p><p><strong>Methods: </strong>The PubMed, Embase, Cochrane Library, and CNKI databases were searched from inception to May 15, 2024. The search strategy focused on two keywords: dialysis and hip fracture. Pooled odds ratios and mean differences were analyzed. RevMan 5.4 was used for data analysis in this meta-analysis.</p><p><strong>Results: </strong>This meta-analysis included 19 studies involving 1,615,440 patients. The CKD group had higher proportions of males, smokers, and patients with preoperative comorbidities such as diabetes, hypertension, heart failure, chronic lung disease, coronary heart disease, peripheral vascular disease, dementia, and wound infection. The CKD group also had a greater likelihood of postoperative myocardial infarction (OR = 1.67, 95% CI = 1.54-1.81, P < 0.00001, I² = 33%). There was no significant difference in cerebrovascular accidents, liver failure, sepsis, and overall complications between the two groups. Additionally, the CKD group had higher mortality rates at 30 days (OR = 2.71, 95% CI = 2.23-3.28, P < 0.00001, I² = 84%), 1 year (OR = 3.17, 95% CI = 2.64-3.82, P < 0.00001, I² = 85%), 2 years (OR = 3.06, 95% CI = 2.88-3.25, P < 0.00001, I² = 8%), and 10 years (OR = 6.85, 95% CI = 5.84-8.03, P < 0.00001, I² = 0%) post-surgery compared to the non-CKD group.</p><p><strong>Conclusion: </strong>Compared with patients in the non-CKD group, patients in the CKD group did not significantly differ in the incidence of most postoperative complications after fracture surgery. However, the CKD group had a significantly greater incidence of myocardial infarction and markedly higher postoperative mortality rates at 30 days, 1 year, 2 years, and 10 years.</p><p><strong>Trial registration: </strong>PROSPERO CRD42025648208.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"34"},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693084","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":"Intraoperative fentanyl in endoscopic procedures and their impact on PACU time and costs.","authors":"Miho Akabane, Kelsey Kukuruza, Timothy Angelotti, Subhas Banerjee, Kazuo Ando","doi":"10.1186/s13741-025-00515-x","DOIUrl":"10.1186/s13741-025-00515-x","url":null,"abstract":"<p><strong>Background: </strong>Extended stays in the postanesthesia care unit (PACU) pose challenges in high-volume endoscopies. This study investigates the impact of intraoperative fentanyl use on PACU duration, postoperative pain, and financial implications in outpatient endoscopy.</p><p><strong>Method: </strong>A retrospective analysis of upper/lower endoscopies at our facility (2020-2022) was conducted, focusing on the relationship between fentanyl use, PACU duration, and pain scales. Financial impacts were also assessed.</p><p><strong>Results: </strong>Among 11,488 patients, 5787 (50.4%) received intraoperative fentanyl, and 5225 (45.5%) had a long stay at PACU (> 50 min). A larger proportion of patients in the long-stay group (> 50 min) received fentanyl (56.3% vs. 45.4%, P < 0.01), and they reported higher Numeric Rating Scale (NRS) pain scores (> 5 in 3.6% vs. 1.2%, P < 0.01). The median PACU time was longer for fentanyl recipients (52 vs. 48 min, P < 0.01). Multivariable analysis identified fentanyl use, older age, and higher ASA scores (≥ 3) as significant factors for prolonged PACU durations. Fentanyl did not significantly reduce postoperative pain (scores > 5: 2.8% for fentanyl users vs. 2.2% for nonusers). Furthermore, most patients reported no pain post-surgery (93.0% for fentanyl users vs. 95.2% for nonusers). Fentanyl recipients did not have shorter PACU stays within any pain scale category. Financial simulations suggest that fentanyl-free anesthesia management could notably decrease the financial burden within endoscopy operations. Specifically, our institution could have realized an annual saving of at least US $100,308.</p><p><strong>Conclusion: </strong>Intraoperative fentanyl increases PACU duration by approximately 4 min per patient in endoscopies, without markedly improving pain management. Avoiding fentanyl could lead to significant time and cost savings.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"33"},"PeriodicalIF":2.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670616","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 mild hypo- and hyperventilation on cerebral oxygen supply during general anesthesia.","authors":"Philipp Groene, Miriam Rapp, Tobias Ninke, Peter Conzen, Klaus Hofmann-Kiefer","doi":"10.1186/s13741-025-00517-9","DOIUrl":"10.1186/s13741-025-00517-9","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral blood flow autoregulation is affected by several physiologic and medical factors. Especially arterial carbon dioxide pressures (PaCO₂) impact cerebral blood flow. Only extensive changes in end-tidal CO₂ have been studied so far. The aim of this study was to evaluate the impact of mild hypo- and hyperventilation on cerebral blood flow as assessed by regional cerebral red blood cell oxygen saturation (rSO₂) in two age groups.</p><p><strong>Methods: </strong>Two groups of patients were compared under general anesthesia before the surgical procedure was started: A younger patient group (age < 40 years; YP) and older patients aged > 60 years (OP). Anesthetic management was standardized. In both groups, end-tidal CO₂ was adjusted either to a low-normal value of 35-37 mmHg or a high-normal value of 43-45 mmHg for 15 min each. The sequence of these interventions was randomized. rSO₂ was estimated by near-infrared spectroscopy (NIRS). The primary outcome was defined as the difference in rSO2 between hypo- and hyperventilation between the two age groups.</p><p><strong>Results: </strong>A total of 78 patients were included. In both groups, there was a statistically significant difference in rSO2 values after 15 min of hypo- versus hyperventilation. In the YP-group, rSO₂ was 74 ± 4% after 15 min of hypoventilation and decreased to 68 ± 6% during hyperventilation (p < 0.001). In the OP-group, rSO₂ was 71 ± 5% and 65 ± 6%, respectively (p < 0.001). There was no difference concerning changes in comparison of younger and elder patient groups (in both groups, Δ rSO₂ = 6 ± 3%; p = 0.732).</p><p><strong>Conclusion: </strong>Even mild hypoventilation increased rSO₂ compared to mild hyperventilation and this difference occurred independent of age.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"30"},"PeriodicalIF":2.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649885","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 end-expiratory carbon dioxide monitoring on painless colonoscopy procedures in obstructive sleep apnea patients.","authors":"Pengxia Wang, Qiuxiang Jiang, Kaihui Li, Yinying Zeng, Zhangxing Chen, Shanshan Liu","doi":"10.1186/s13741-025-00509-9","DOIUrl":"10.1186/s13741-025-00509-9","url":null,"abstract":"<p><strong>Background: </strong>Carbon dioxide (CO2) accumulation during prolonged painless colonoscopy procedures in patients with obstructive sleep apnea syndrome (OSAS) can lead to an increased incidence of various complications. The disposable end-expiratory CO2 device monitors the respiratory function and CO2 elimination of patients in real time, providing timely feedback to physicians. This enhances the safety and success of the procedure and improves the overall medical experience for the patient.</p><p><strong>Method: </strong>A total of 158 patients with OSAS underwent colonoscopy and were divided into two groups. The study group received end-expiratory CO₂ monitoring, while the control group underwent routine monitoring. Perioperative interventions, patient satisfaction, and postoperative complications were compared between the two groups using a case-control method. All colonoscopic procedures were performed by surgeons.</p><p><strong>Result: </strong>The study group exhibited a lower incidence of hypoxemia and higher utilization of upper airway ventilation devices, resulting in greater postoperative satisfaction (P = 0.019, P = 0.002, P < 0.001, respectively). Conversely, the control group experienced a higher incidence of postoperative nausea and vomiting as well as abdominal pain and abdominal distension (P = 0.006, P = 0.038, P < 0.012).</p><p><strong>Conclusion: </strong>Employing disposable end-expiratory CO₂ monitoring during painless enteroscopic procedures in patients with OSAS reduces the incidence of hypoxemia, enhances postoperative satisfaction, and decreases the incidence of postoperative complications.</p><p><strong>Trial registration number: </strong>ChiCTR2400083702; Registration date: April 2024.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"32"},"PeriodicalIF":2.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649845","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 global trend of intravenous anesthesia and tumors: a bibliometric and visualized study.","authors":"Fangfang Han, Shi Dong, Zhou Chen, Cheng Ye, Chunlu Dong, Yan Du, Huaqing Shi, Gen Lu, Wence Zhou","doi":"10.1186/s13741-025-00513-z","DOIUrl":"10.1186/s13741-025-00513-z","url":null,"abstract":"<p><strong>Background: </strong>Through bibliometric analysis, this paper summarizes the growing literature and analyses the development trends and hot spots in the research field of the association between intravenous anesthesia and tumors.</p><p><strong>Methods: </strong>A literature overview was conducted using relevant articles retrieved from the Web of Science Core Collection published between 1991 and 2024. Bibliometric websites and tools (VOSviewer, CiteSpace, and bibliometric R package) are used to analyze the co-occurrence of keywords and reference citations, detailing countries, institutions, authors, references, journals, and keywords.</p><p><strong>Results: </strong>A total of 1198 relevant articles were included in the study. The USA, China, and Germany have the largest number of publications, with the USA and China having the most interagency cooperation and Germany relatively less cooperation. The institution that publishes the most articles is the University of National Defense Medical Center, and the journal that publishes the most articles is Anesthesiology. The five most productive authors are Li J., Liu J., Zhang B., Yu X.J., and Xu J. \"Surgery\", \"anaesthesia\", and \"propofol\" are the most common keywords. In recent years, research has focused mainly on intravenous anesthesia and tumor survival.</p><p><strong>Conclusion: </strong>Both Western countries and China have made outstanding contributions to intravenous anesthesia and tumors. In recent years, the number of publications in China has steadily increased, and the quality and influence of these articles deserve recognition. Future research should focus on the key areas of intravenous anesthesia, tumor recurrence, and survival.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":"14 1","pages":"31"},"PeriodicalIF":2.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649888","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":"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}