Perioperative Medicine最新文献

{"title":"Prediction of anxiety in children aged 7-12 during preoperative anaesthesia evaluation - a prospective observational study.","authors":"Armin Sablewski, Katarina Krebs, Anna Karstensen, Maximilian Grosser, Charlotte Neitzel, Axel Fudickar, Barbara Schmidt, Tobias Becher","doi":"10.1186/s13741-026-00669-2","DOIUrl":"10.1186/s13741-026-00669-2","url":null,"abstract":"<p><p>BACKGROUND: Preoperative anxiety is a common challenge in paediatric anaesthesia. High anxiety levels are associated with adverse perioperative outcomes. Although risk factors for preoperative anxiety in children are well known, validated assessment tools are rarely used in everyday clinical practice. Instead, anaesthesiologists rely on clinical judgment during preoperative assessments. However, the accuracy of such anxiety predictions in clinical practice remains unclear. METHODS: This prospective observational study included children aged 7–12 years undergoing elective surgery or diagnostic procedures under general anaesthesia. During the preoperative consultation, anaesthesiologists, parents, and children were asked to predict the child’s anxiety on a Visual Analogue Scale (VAS), while actual anxiety during anaesthesia induction was assessed using the Modified Yale Preoperative Anxiety Scale – Short Form (mYPAS-SF). Spearman’s correlations (rs) between predicted and observed anxiety were calculated, and the predictive performance for clinically significant anxiety (defined as mYPAS-SF > 30) was evaluated using the area under the receiver operating characteristic curve (AUC). Potential predictors of preoperative anxiety, including demographic and psychosocial factors, were also evaluated. RESULTS: 91 datasets sets were analysed. Anxiety prediction by parents correlated moderate to children’s anxiety during anaesthesia induction (AUC 0.661; rs=0.327, 95% CI 0.12–0.51). Anxiety predictions by anaesthesiologists (AUC 0.604; rs=0.173, 95% CI -0.04–0.37) and children (AUC 0.612; rs=0.147, 95% CI -0.08–0.36) correlated weakly with children’s anxiety. Children reporting being worried before anaesthesia showed significantly higher anxiety during induction (mYPAS-SF 38.5 [22.9–57.3] vs. 22.9 [22.9–38.0]; P = 0.006). Children’s anxiety at consultation and on the ward correlated with increased anxiety during induction (rs=0.271, 95% CI 0.06–0.46 and rs=0.297, 95% CI 0.09–0.48, respectively). Intravenous induction was associated with lower anxiety compared with inhalational induction (mYPAS-SF 22.9 22.9 [22.9–38.0] vs. 38.5 [22.9–57.3]; P < 0.001). No significant associations were found for age, gender, prior medical experiences, or parental anxiety. CONCLUSIONS: Clinical anxiety assessments in preoperative consultations are often inaccurate, with parents performing slightly better than anaesthesiologists and children. Structured screening approaches are needed to enhance the early identification of high-risk children and improve perioperative anxiety management. TRIAL REGISTRATION: German Clinical Trials Registry, registration number DRKS00033395. Date of registration: 06/05/2024. </p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444545","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 randomized evaluation of early oral feeding after ambulatory non-gastrointestinal surgical patients under general anesthesia.","authors":"Lijia Chen, Hui Huang, Jiajia Wang, Yan Qiu, Huamei Zhong, Minyan Zhao","doi":"10.1186/s13741-026-00652-x","DOIUrl":"10.1186/s13741-026-00652-x","url":null,"abstract":"<p><p>BACKGROUND: The optimal timing and safety of early oral feeding after non-gastrointestinal surgery under general anesthesia remain unclear, particularly in ambulatory settings. This study aims to evaluate the impact of an evidence-based early oral feeding strategy on postoperative adverse events, patient comfort, and gastrointestinal recovery in patients undergoing day case non-gastrointestinal surgery. METHODS: A total of 117 patients were allocated to an intervention group (n = 62) receiving an early oral feeding protocol based on Steward Recovery Score and Apfel PONV risk assessment, or a control group (n = 55) following a conventional 2-4-6 h fasting protocol. Outcomes included time to first oral intake, incidence of nausea, vomiting, choking, abdominal distension, thirst and hunger VAS scores, pain NRS scores, postoperative infusion volume, and time to first flatus. RESULTS: The intervention group had significantly earlier first drink and meal times (P < 0.001). The incidences of nausea and vomiting at 2 h were reduced to 12.90% and 6.45%, significantly lower than the control group (29.09% and 16.36%, P < 0.05). Multivariable logistic regression identified early feeding as an independent protective factor, associated with a 63.9% reduction in the odds of nausea (AOR = 0.361) and a 79.7% reduction in the odds of choking (AOR = 0.203) at 2 h postoperatively. Thirst, hunger, pain scores, alongside postoperative infusion volume were all significantly lower in the intervention group (all P < 0.001). Time to first flatus was markedly shortened in the intervention group (P < 0.001). CONCLUSION: In patients undergoing ambulatory non-gastrointestinal procedures with comparable discharge criteria, the early feeding protocol produced clinically meaningful improvements in patient-centered outcomes: early postoperative comfort was significantly enhanced through substantial reductions in thirst and hunger VAS scores, while the odds of early PONV were reduced. These findings support implementing this protocol in similar ambulatory surgical settings to improve recovery quality. </p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366110","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 EEG-guided opioid-free anesthesia on perioperative blood glucose variation in patients undergoing video-assisted thoracic surgery: a secondary analysis of a randomized controlled study.","authors":"Xiang Yan, Chen Liang, Meng Guo, Jia Jiang, Ying Ji, An-Shi Wu, Chang-Wei Wei","doi":"10.1186/s13741-026-00666-5","DOIUrl":"10.1186/s13741-026-00666-5","url":null,"abstract":"<p><p>OBJECTIVES: To evaluate the impact of electroencephalogram-guided opioid-free anesthesia (OFA) on perioperative blood glucose variability in patients undergoing video-assisted thoracic surgery. METHODS: This article is a secondary analysis of a randomized controlled trial. Eligible patients were randomly allocated to either the OFA group or the opioid-based anesthesia (OBA) group. Patients in the OFA group did not receive any opioids during surgery, whereas those in the OBA group received sufentanil and remifentanil intraoperatively. The primary end point was the coefficient of variation for glucose (GLUcv), calculated based on predefined time points during the perioperative period. The secondary end points were the mean of glucose (GLUmean), the standard deviation of glucose (GLUSD), mean amplitude of glycemic excursions (MAGE), and largest amplitude of glycemic excursion (LAGE). RESULTS: A total of 126 patients were included in the final analysis: the OFA group (n = 64) and the OBA group (n = 62). Blood pressure, heart rate, sedation index, and analgesia index during surgery were comparable between the two groups, and there was no significant difference in pain in the early postoperative period. The primary end point, GLUCV, was significantly higher in OFA group than in OBA group (22.7 ± 9.1 vs 14.1 ± 6.0, P < 0.001). In addition, the OFA group had higher GLUmean (5.68 ± 0.87 vs 5.31 ± 0.87 mmol/L, P = 0.003), GLUSD (1.3 ± 0.59 vs 0.76 ± 0.40 mmol/L, P < 0.001), MAGE (1.75 ± 0.86 vs 0.95 ± 0.54 mmol/L, P < 0.001), and LAGE (2.97 ± 1.35 vs 1.72 ± 0.96 mmol/L, P < 0.001). CONCLUSION: The OFA regimen provides sedation and analgesia comparable to OBA in video-assisted thoracic surgery, but is associated with greater perioperative blood glucose variation. TRIAL REGISTRATION: Clinicaltrials.gov, Identifier: NCT05411159. First posted date: 9 Jun, 2022. Date of enrolment of the first research participant: 10 Jun, 2022. </p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13085272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348804","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 feasibility of implementing and evaluating individualised digital prehabilitation prior to major elective surgery in adults aged ≥ 50 years: the PreActiv intervention.","authors":"Annabelle Emery, Rebecca Allam, David Quinn, Helen Sims, Ian-Ju Liang, Bruno Spellanzon, Julia Groot, Adam Aspbury, Harriet Bullough, Leigh Ingham, Justine Archman, Frankie Brown, Oliver J Perkin, Alec Snow, Max J Western","doi":"10.1186/s13741-026-00663-8","DOIUrl":"10.1186/s13741-026-00663-8","url":null,"abstract":"<p><p>BACKGROUND: Prehabilitation interventions prepare patients for surgery to improve postoperative outcomes such as speed of discharge and recovery time. Although more efficient and desired than centre-based, home-based prehabilitation is often ineffective due to poor adherence and its non-tailored nature. Digital technology may improve adherence to and effectiveness of home-based prehabilitation. The present study investigated the feasibility of digital, individualised, dynamic prehabilitation (‘PreActiv’) to determine whether a definitive study is viable. METHODS: In this single-arm study, N = 35 patients aged ≥ 50 years awaiting major elective surgery in ≥ 10 weeks were allocated to receive six weeks of digital exercise prehabilitation. Thrice-weekly exercise sessions included aerobic and resistance interval training, tailored to mobility and adapted according to repeat assessments of fitness within the digital platform. Primary outcome measures were retention (completing follow-up measurements) and adherence (completing all exercise sessions), assessed against Stop criteria ≤ 50%. Secondary outcome measures were compliance (to exercise intensity, type, duration), and acceptability, plus signal of effect, evaluated through pre- to post-intervention changes in cardiorespiratory and functional fitness, quality of life, mood, and typical physical activity. RESULTS: Retention rate was 69%. Exercise adherence was 88% in study completers. Exercise was performed with high compliance, as the correct intensity, type, and duration was completed in 79% of sessions. All participants reported that the exercise videos were easy to follow and they would recommend the programme. Participants expressed concern when completion of prehabilitation did not coincide with surgery date. In-person measurement visits posed a barrier to recruitment and retention. Functional fitness, quality of life, and mood improved from pre- to post-intervention. At the group level, cardiorespiratory fitness was unchanged, but there were individual clinically-meaningful improvements. There were no related serious adverse events. CONCLUSIONS: A definitive study investigating the effects of this novel digital prehabilitation programme on postoperative outcomes is feasible based on achieving predefined progression criteria, and warranted based on high compliance and acceptability. Modifications to the study design such as tailoring programme length to surgery date and removing in-person measurement visits should be implemented to optimise recruitment, retention, and participant satisfaction. TRIAL REGISTRATION: The study was prospectively registered (NCT06137781). </p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348815","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":"Development and validation of a post-operative delirium prediction model for patients undergoing abdominal surgery: a retrospective, observational, single-center study.","authors":"Zhi-Hua Huang, Maneesh Kumarsing Beeharry, Xiao-Ying Xu, Cheng-Rong Bao, Lei Tao, Yan Luo","doi":"10.1186/s13741-025-00639-0","DOIUrl":"10.1186/s13741-025-00639-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is a common complication following major surgery in elderly. The purpose of this study was to develop and evaluate a POD prediction model for patients undergoing abdominal surgery.</p><p><strong>Methods: </strong>One thousand consecutive patients scheduled for elective abdominal surgery from July 2019 to March 2021 in Ruijin Hospital, Shanghai China, were retrospectively analysed, and their demographics, pre-operative evaluation, and intra-operative parameters were collected and cross-analysed. The primary outcome was the POD incidence. A prediction model of POD was established and internal validation was conducted with various analyses including univariate and multivariate regression. Data from another cohort of346 patients enrolled from July 2021 to December 2021 were used for model external validation.</p><p><strong>Results: </strong>After screening, 838 patients were included as the training cohort and 10.9% (91/838) of the patients manifested POD. Old age, cerebrovascular disease and diazepam use history and intraoperative fluid imbalance were the main contributors of the POD prediction model. The optimum cut-off point of the predicted probability that maximised the sum of sensitivity and specificity was 0.12. The fitting set AUC was 0.703 (95% Confidence interval (CI) 0.637-0.753). The sensitivity and specificity of the model were 0.556 and 0.754 respectively. The mean AUC during the cross and external validation of the model was 0.684 [Standard Deviation (SD) 0.068] and 0.634 (95%CI 0.511-0.758) respectively.</p><p><strong>Conclusions: </strong>Our data indicated that improving perioperative management may reduce POD incidence in patients who are old age and have cerebrovascular disease history.</p><p><strong>Trial registration: </strong>The retrospective data (ChiCTR2100047405) of this study was registered in the Chinese Clinical Trial registry ( https://www.chictr.org.cn/ ).</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13020371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321798","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":"Deep neuromuscular blockade improves surgical conditions during laparoendoscopic single-site (LESS) surgery for total hysterectomy and reduces postoperative pain: a randomized controlled trial.","authors":"Yiwei Shen, Jingjie Hu, Feng Lv, Chang Yu, Yao Gong, Dan Wang, Xing Zeng","doi":"10.1186/s13741-026-00664-7","DOIUrl":"10.1186/s13741-026-00664-7","url":null,"abstract":"<p><p>PURPOSE: To evaluate the impact of neuromuscular blockade (NMB) depth on surgical conditions and postoperative outcomes in patients undergoing laparoendoscopic single-site (LESS) surgery for total hysterectomy. METHODS: A total of 243 female patients scheduled for LESS surgery for total hysterectomy under intravenous anesthesia were randomly allocated to two groups: the deep NMB group (1–2 post-tetanic count) and the moderate NMB group (1–2 train-of-four response) with continuous intravenous infusion of cisatracurium. The primary endpoint was the Surgical Rating Scale (SRS) score during the surgery. Secondary endpoints included additional NMB requirements during surgery, and postoperative outcomes including Visual Analog Scale (VAS) scores, incidence of shoulder pain, morphine consumption, and the incidence of nausea and vomiting. RESULTS: Mean (standard deviation) SRS was 4.31 (0.86) during moderate NMB and 4.75 (0.54) during deep NMB (P < 0.001). Moderate NMB resulted in 16.26% of scores at the lower end of the scale (scores 1–3), whereas deep NMB achieved 90.83% of scores at the higher end (scores 4–5). The deep NMB group demonstrated decreased postoperative shoulder pain (P < 0.001) with lower VAS scores at 6/24/48 hours (P < 0.001), and reduced morphine consumption 72 h post-hysterectomy (P < 0.001). However, the time from agent withdrawal to train-of-four (TOF) ratio 25%, to TOF ratio 90%, and to extubation was significantly prolonged in the deep NMB group (P < 0.001). No significant differences were observed between groups regarding recovery index, length of stay in the post-anesthesia care unit (PACU), blood gas analysis, or postoperative complications, including postoperative nausea and vomiting (PONV) and pulmonary infection (P > 0.05). CONCLUSION: Deep NMB significantly improves surgical conditions during LESS hysterectomy while reducing postoperative pain. </p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317685","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":"Retrolaminar versus erector spinae plane block for enhanced recovery after cesarean section: a retrospective study.","authors":"Serpil Bayındır, Cengiz Şanlı","doi":"10.1186/s13741-026-00657-6","DOIUrl":"10.1186/s13741-026-00657-6","url":null,"abstract":"<p><p>BACKGROUND: The global rise in cesarean section (CS) rates has made effective, opioid-sparing postoperative analgesia a clinical priority. The erector spinae plane block (ESPB) and retrolaminar block (RLB) are trunk blocks increasingly incorporated into multimodal analgesia protocols; however, comparative evidence between these two techniques following CS remains limited. METHODS: This retrospective, single-center study analyzed adult women undergoing elective CS under spinal anesthesia, without the use of general anesthesia. The primary outcome was total tramadol consumption within 24 h postoperatively. Secondary outcomes included time to first rescue analgesia, VAS scores at 1, 6, 12, and 24 h, 24-h ObsQoR-11 T score, time to discharge, and incidence of adverse events. RESULTS: Of 126 screened patients, 122 were analyzed (ESPB n = 64; RLB n = 58). ESPB significantly reduced 24-h tramadol consumption compared with RLB (130.94 mg vs. 141.9 mg; p = 0.001) and prolonged the time to first rescue analgesia (7.86 ± 1.50 vs. 6.78 ± 1.28 h; p = 0.001). VAS scores were significantly lower in the ESPB group at 6 h (p = 0.005) and 12 h (p < 0.001), with no differences at 1 or 24 h. ObsQoR-11 T scores and discharge times were comparable between groups. Adverse events were infrequent; hypotension occurred in 10.9% of ESPB patients and 5.2% of RLB patients (p = 0.246). CONCLUSIONS: In elective CS, ESPB provided superior early postoperative analgesia and reduced opioid consumption compared to RLB. ESPB appears to be a rational choice when prolonged analgesia and opioid sparing are prioritized in the early postoperative period, whereas RLB may serve as a reliable alternative in settings emphasizing technical simplicity and hemodynamic stability. </p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12964910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147308845","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":"An integrated random forest- and LASSO-derived nomogram for predicting postoperative nosocomial infections in colorectal cancer patients.","authors":"Ranran Lu, Xiujuan Xue, Tongtong Chen, Yanhong Wang","doi":"10.1186/s13741-026-00667-4","DOIUrl":"10.1186/s13741-026-00667-4","url":null,"abstract":"<p><p>OBJECTIVE: We sought to delineate the independent risk factors underlying postoperative nosocomial infections in colorectal cancer patients and to construct and validate a nomogram for individualized risk prediction, thereby enabling early clinical identification of high-risk individuals and the implementation of targeted preventive strategies. METHODS: We conducted a retrospective cohort study including 1,760 patients who underwent colorectal cancer surgery between 2020 and 2024. Postoperative nosocomial infection was defined as any hospital-acquired infection occurring within 30 days after surgery, including lower respiratory tract infection, surgical-site infection, multiple-site infections, and other-site infections. Patients admitted in 2020–2022 comprised the training cohort (n = 1,146), and those admitted in 2023–2024 served as a temporal validation cohort (n = 614). Univariable analyses were performed to screen candidate predictors. Predictor importance was ranked using a random forest model, and least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation was applied to reduce overfitting and multicollinearity. Predictors retained after feature selection were entered into multivariable logistic regression to construct a nomogram. Model performance was evaluated by discrimination (AUC), calibration plots, and decision-curve analysis (DCA). RESULTS: Postoperative hospital-acquired infection occurred in 166/1,760 (9.43%) patients. Lower respiratory tract infection was the most common subtype, followed by surgical-site infection. LASSO retained eight predictors with non-zero coefficients, and multivariable logistic regression confirmed that age, coronary heart disease, perioperative blood transfusion, colostomy, surgical approach, ASA grade, persistent fever for 3 consecutive days, and postoperative complications were independently associated with postoperative hospital-acquired infection. The nomogram showed good discrimination, with an AUC of 0.860 in the training cohort and 0.843 in the validation cohort. Calibration was good in the training cohort and acceptable in the validation cohort, with modest deviations at lower predicted probabilities. DCA demonstrated a positive net benefit across a broad range of clinically relevant threshold probabilities in both cohorts. CONCLUSIONS: Our nomogram enables precise stratification of colorectal cancer patients by their postoperative infection risk, highlighting perioperative factors—such as operative duration, surgical approach, and ASA grade—that warrant targeted management. Future prospective, multicentre validation will be essential to refine and generalize the model’s applicability. </p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13041146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147308801","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 Hypotension Prediction Index as an indicator of hypotensive haemodynamic instability in surgical patients.","authors":"Simon Davies, Sai Buddi, Zhongping Jian, Neal W Fleming, Maxime Cannesson, Michael Sander, Denise P Veelo, Alexander P J Vlaar, Thomas W L Scheeren, Monty Mythen, Feras Hatib","doi":"10.1186/s13741-026-00661-w","DOIUrl":"10.1186/s13741-026-00661-w","url":null,"abstract":"<p><strong>Background: </strong>The Hypotension Prediction Index (HPI) is a machine learning algorithm that was designed to detect alterations in the cardiovascular physiological control mechanisms that may lead to hypotension through multidimensional analyses of the physiological interactions of core haemodynamic parameters. Hypotension is a physiological condition where the central perfusion pressure in the cardiovascular system is too low to ensure adequate flow regulation of local organs and its threshold is the pressure at the lower limit of autoregulation. As such, hypotension can occur in a wide pressure range that can exceed considerably the conventional MAP threshold of 65 mmHg and can vary between individuals as well as within the same individual. We hypothesize that HPI is an indicator of haemodynamic instability. We used direct physiological signs of haemodynamic instability and hypoperfusion from the cardiovascular haemodynamic parameters available on the HPI technology. We conducted a retrospective analysis to investigate the performance of HPI as an indicator of haemodynamic instability related to hypotension and hypoperfusion.</p><p><strong>Methods: </strong>A dataset of 1,683 cardiac and non-cardiac surgical patients were analyzed, including 871 patients monitored with invasive arterial line and 812 monitored with non-invasive finger cuff. There were 19,685 and 21,097 HPI alerts at the threshold of 85 and 50, respectively. Haemodynamic parameters used to define instability were MAP < 65 mmHg, SVV ≥ 13%, CI ≤ 2 L·min^-1·m^-2, and SVR ≤ 800 dyn·s·cm^-5.</p><p><strong>Results: </strong>In the invasive A-line dataset, 94.6% of the HPI alerts at threshold of 85 are followed in 15 min by haemodynamic instability, and 91.4% of HPI alerts at threshold 50 are followed by haemodynamic instability. In the non-invasive finger cuff dataset, they are 96.2% and 94.1% for HPI alerts at threshold 85 and 50, respectively.</p><p><strong>Conclusion: </strong>The Hypotension Prediction Index predicts the upcoming hypotensive haemodynamic instability events with high accuracy. Further research is needed to investigate whether HPI alerts guided treatment of haemodynamic instability improves patient outcomes.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284783","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":"Bayesian statistics: a primer for perioperative medicine clinicians.","authors":"Guido Mazzinari, Fernando G Zampieri, Michael O Harhay, Marcus J Schultz, David M van Meenen, Ary Serpa-Neto","doi":"10.1186/s13741-026-00659-4","DOIUrl":"10.1186/s13741-026-00659-4","url":null,"abstract":"<p><p>Bayesian methods offer an intuitive and coherent statistical framework for updating probabilistic beliefs by integrating prior knowledge-whether from existing data or expert consensus-with new evidence via likelihood functions to generate posterior probability distributions. This approach yields clinically meaningful outputs, such as credible intervals and probabilities of treatment benefit, and can incorporate thresholds relevant to practice, like the region of practical equivalence (ROPE). Recent advances in computation-including Markov chain Monte Carlo (MCMC) sampling, Hamiltonian Monte Carlo algorithms, and probabilistic programming languages like Stan and JAGS- have made Bayesian approaches feasible even for complex hierarchical models. In perioperative medicine, these methods are particularly valuable for (1) complementing trial results by quantifying clinically important effects in the context of statistically nonsignificant findings or modest probabilities of benefit despite statistical significance, (2) enhancing meta-analyses through coherent integration of heterogeneous studies and sparse data, and (3) enabling adaptive and platform trial designs through continuous evidence synthesis. The ability to incorporate informative priors can complement existing knowledge, especially in small-sample studies, which are common in perioperative medicine, where traditional approaches provide insufficient precision. Although concerns remain regarding subjectivity in prior specification, these are increasingly addressed through structured guidelines, benchmark priors, and comprehensive sensitivity analyses. Altogether, Bayesian methods provide a flexible and powerful alternative for generating actionable insights in complex clinical settings, including in perioperative care.</p>","PeriodicalId":19764,"journal":{"name":"Perioperative Medicine","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284758","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}