BJA open最新文献

{"title":"The association between postoperative myocardial injury of unexplained aetiology after noncardiac surgery and sex and cancer on 1-yr survival: a retrospective, single-centre, observational cohort study","authors":"Eva P.C. van Schaik ,&nbsp;Lisette M. Vernooij ,&nbsp;Younes Haddou ,&nbsp;Remco B. Grobben ,&nbsp;Wilton A. van Klei ,&nbsp;Judith A.R. van Waes","doi":"10.1016/j.bjao.2025.100485","DOIUrl":"10.1016/j.bjao.2025.100485","url":null,"abstract":"<div><h3>Background</h3><div>The aetiology of postoperative myocardial injury (PMI) is often unexplained, and the effect of sex and cancer surgery on prognosis in patients with PMI is unknown. We aimed to estimate the proportion of patients developing PMI of unknown aetiology and compare their prognosis with those with explained PMI, and to investigate the interaction with sex and cancer surgery.</div></div><div><h3>Methods</h3><div>This retrospective, single-centre, observational cohort study included patients aged ≥60 yr undergoing noncardiac surgery. Patients with PMI (defined as an elevated troponin concentration &lt;72h after surgery) were categorised into five groups, based on the most likely aetiology of PMI: acute myocardial infarction (MI); extra-cardiac disease (acute or chronic renal failure, sepsis, pulmonary embolism, acute intracranial pathology, or all of the mentioned); known cardiac disease with regular follow-up; perioperative haemodynamic/respiratory events; and PMI of unexplained aetiology. The association between PMI group and 1-yr mortality, and between sex and cancer surgery, was estimated.</div></div><div><h3>Results</h3><div>Of 3885 patients, 823 (21%) had a diagnosis of PMI, of whom 32 (4%) had MI, 201 (24%) had extra-cardiac disease, 174 (21%) had known cardiac disease, 269 (33%) had haemodynamic/respiratory events, and 147 (18%) had PMI of unexplained aetiology. Like other patients with PMI, those with PMI of unexplained aetiology had an increased risk of 1-yr mortality (risk ratio 1.5, 95% confidence interval 1.1–2.1). PMI caused by MI or known cardiac disease occurred more often in men. Women more often had PMI owing to perioperative haemodynamic/respiratory factors. There was no interaction found between PMI and sex or cancer surgery on mortality risk.</div></div><div><h3>Conclusions</h3><div>In approximately half of the patients with a diagnosis of PMI, PMI aetiology was either related to perioperative haemodynamic/respiratory events or the aetiology was unexplained. These patients had an increased associated mortality risk. Women more often had PMI of likely haemodynamic/respiratory causes. Mortality risk in those with PMI was similar between sexes and between those undergoing cancer surgery <em>vs</em> non-cancer surgery.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100485"},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis","authors":"Kenki Matsumoto ,&nbsp;Brigitta Fazzini ,&nbsp;Hannah Malcolm ,&nbsp;Jack Eldridge ,&nbsp;Zudin Puthucheary ,&nbsp;Magda Osman ,&nbsp;Timothy J. Stephens","doi":"10.1016/j.bjao.2025.100488","DOIUrl":"10.1016/j.bjao.2025.100488","url":null,"abstract":"<div><h3>Background</h3><div>The intensive care unit (ICU) is a dynamic environment that necessitates daily clinical decisions regarding organ support treatments. The decision-making process varies significantly between clinicians (i.e. doctors, nurses, and allied healthcare practitioners), even where internationally accepted treatment guidance exists. The factors and the processes influencing clinical decision-making are poorly understood. This systematic review aims to generate a decision-making model by evaluating current evidence on the decision-making process and the factors that affect decisions on organ support treatments in the ICU.</div></div><div><h3>Methods</h3><div>We conducted a systematic search on three databases (PubMed, Embase, and CINAHL) including all papers exploring factors that influenced organ support decisions (PROSPERO: CRD42021283290). A mixed-methods meta-synthesis was performed to enable the generation of distinct themes and subthemes used to generate the decision-making model.</div></div><div><h3>Results</h3><div>After screening 8967 records, 33 studies met the inclusion criteria and were included in the analysis. The mixed-method interpretation of the data found that decision-making can be linear and primarily dictated by patient factors (i.e. patient’s clinical parameters). However, the analysis identified 11 factors that can influence and strain clinician’s decision-making. Four themes: 1) human, 2) team, 3) system, and 4) patient emerged as the potential modifiable factors to optimise the decision-making process.</div></div><div><h3>Conclusions</h3><div>Decision-making surrounding organ support treatment is complex and dynamic. However, there are four distinctive potentially modifiable themes that influence the multidisciplinary decision-making process. Further studies should focus on understanding interventions to improve decision-making and if different decision-making processes directly affect patients’ outcomes.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42021283290).</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discharge with a smartphone application for follow-up after day care surgery: a randomised controlled trial","authors":"Bram Thiel ,&nbsp;Marc Godfried ,&nbsp;Maaike van Emst ,&nbsp;Lisette Vernooij ,&nbsp;Liesbeth van Vliet ,&nbsp;Eva Rumke ,&nbsp;Marc Snoeck ,&nbsp;Seppe Koopman ,&nbsp;Cor Kalkman","doi":"10.1016/j.bjao.2025.100489","DOIUrl":"10.1016/j.bjao.2025.100489","url":null,"abstract":"<div><h3>Background</h3><div>Day care surgery patients have limited options to communicate pain or nausea to their healthcare providers after discharge. This study evaluated the effectiveness of a smartphone application for pain and nausea follow-up as an enhancement to standard care.</div></div><div><h3>Methods</h3><div>We performed a multi center non-blinded prospective randomised controlled trial including day care surgery patients. The intervention group received a smartphone application with bidirectional messaging and standard care for postoperative follow-up. The control group received standard care. The primary outcome was measured with the Quality of Recovery-15 scale on the seventh postoperative day. Secondary endpoints included quality of recovery at postoperative day 1 and 4, satisfaction with care, trust in hospital care, and patient remarks concerning recovery and complications.</div></div><div><h3>Results</h3><div>Out of 301 included patients, 149 were randomly assigned to the smartphone application and 152 to standard care. Perioperative characteristics were comparable between the groups. On postoperative day 7, no difference was observed in quality of recovery, with median difference 0.0 (95% confidence interval: −10.0 to 7.0; <em>P</em>=0.56). Ratings of satisfaction, trust, and to recommend the hospital showed no clinically important differences.</div></div><div><h3>Conclusions</h3><div>We found no differences in patient-reported quality of recovery for day care surgical patients when adding postoperative follow-up of pain and nausea via a smartphone application compared with standard care alone.</div></div><div><h3>Clinical trial registration</h3><div>NCT05244772</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100489"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the addition of a low-dose of ketamine to propofol anaesthesia on the phase-amplitude coupling features of an electroencephalogram","authors":"Ryusuke Tanaka,&nbsp;Masahide Kaneko,&nbsp;Masaki Takekoshi,&nbsp;Satoshi Tanaka","doi":"10.1016/j.bjao.2025.100486","DOIUrl":"10.1016/j.bjao.2025.100486","url":null,"abstract":"<div><h3>Background</h3><div>Low-dose ketamine as an adjunct to propofol-based total intravenous anaesthesia (TIVA) complicates hypnotic depth monitoring by increasing bispectral index values and altering electroencephalogram (EEG). Phase-amplitude coupling is a promising EEG marker of anaesthesia-induced unconsciousness, but its response to ketamine during TIVA remains unclear. Understanding this interaction may improve hypnotic depth monitoring under multimodal anaesthesia. This study aimed to investigate the effect of low-dose ketamine on EEG modulation index and preferred phase under propofol-based total intravenous . anaesthesia.</div></div><div><h3>Methods</h3><div>This prospective observational study analysed 19 patients (age 28–66 yr, American Society of Anesthsiology physical status 1 or 2) who underwent surgery during TIVA with propofol. After confirming the stability of propofol infusion, low-dose ketamine (0.5 mg kg⁻¹) was administered as a bolus, followed by continuous infusion at a rate of 0.125 mg kg⁻¹ h⁻¹. Frontal EEG was analysed at baseline (PreKet) and at 10 min (PostKet1) and 20 min (PostKet2) after ketamine administration.</div></div><div><h3>Results</h3><div>Analysis of delta-alpha phase-amplitude coupling revealed that the EEG modulation index (×10³) remained stable across the study period: 0.47 (95% confidence interval: 0.25–0.69) at PreKet, 0.46 (0.20–0.73) at PostKet1, and 0.35 (0.15–0.55) at PostKet2 (<em>P</em>=0.623). However, the mean preferred phase, representing the delta wave phase at which the alpha oscillation amplitude was maximal, exhibited a significant shift from 88° (95% confidence interval: 50°–126°) at PreKet to 29° (95% confidence interval: −10° to 69°) at PostKet2 (<em>P</em>=0.021).</div></div><div><h3>Conclusions</h3><div>This study demonstrates the effect of low-dose ketamine on EEG phase-amplitude coupling during total intravenous anaesthesia with propofol. Our findings provide new insights into the neural mechanisms of low-dose ketamine and support the feasibility of phase-amplitude coupling analysis as a potential tool for improving hypnotic depth monitoring in clinical practice.</div></div><div><h3>Clinical trial registration</h3><div>UMIN000050331.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100486"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic value of postoperative cardiac troponin I and T for major adverse cardiac events after coronary artery bypass grafting: a systematic review","authors":"Maaike S.Y. Thio ,&nbsp;Peter G. Noordzij ,&nbsp;Janice H. Klingenberg ,&nbsp;Frieda Renkens ,&nbsp;Lisette M. Vernooij ,&nbsp;Olaf L. Cremer ,&nbsp;Linda M. Posthuma ,&nbsp;Thijs C.D. Rettig","doi":"10.1016/j.bjao.2025.100484","DOIUrl":"10.1016/j.bjao.2025.100484","url":null,"abstract":"<div><h3>Background</h3><div>This systematic review describes the prognostic value of postoperative cardiac high-sensitive troponin I and T as risk markers for major adverse cardiac events (MACE) after coronary artery bypass graft (CABG) surgery and their predictive performance.</div></div><div><h3>Methods</h3><div>PubMed and Embase were searched up to 14 October 2024. Studies were included if they reported either the association between cardiac troponin I and T and MACE (using risk-, hazard-, or odds ratios) or the accuracy of troponin I and T based prediction models for MACE (using c-statistics and calibration) within 72 h after CABG. MACE was defined as the composite of myocardial infarction, coronary artery revascularisation, cardiac death, non-fatal cardiac arrest, and heart failure. Risk of bias was assessed using the Quality in Prognostic Studies tool.</div></div><div><h3>Results</h3><div>Out of 2273 studies, 10 studies were included. Five studies reported on troponin I (1956 patients) and five on troponin T (5615 patients). MACE composites were heterogenous, with only two studies using an identical composite. Increased postoperative troponin I and T concentrations were associated with higher risk of MACE, with a hazard ratio range of 1.6–11.1 for troponin I (<em>n</em>=2) and an odds ratio range of 0.9–67.9 for troponin T (<em>n</em>=5). Discriminative performance was moderate to good for troponin I (<em>n</em>=3, c-statistics range 0.60–0.81) and moderate for troponin T (<em>n</em>=3, c-statistics range 0.72–0.77). No studies reported calibration for troponin I. For troponin T (<em>n</em>=1) calibration was good for in-hospital MACE (Hosmer–Lemeshow <em>P</em>=0.20). Risk of bias was moderate to high across domains.</div></div><div><h3>Conclusions</h3><div>Postoperative cardiac troponin I and T biomarkers are associated with postoperative MACE after CABG. The current evidence on the predictive value for postoperative MACE is insufficient to use troponin I and T for risk stratification.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of the workload generated by older surgical patients referred to on-call medical registrars—SNAP-3","authors":"Claire J. Swarbrick","doi":"10.1016/j.bjao.2025.100394","DOIUrl":"10.1016/j.bjao.2025.100394","url":null,"abstract":"<div><h3>Background</h3><div>Older surgical patients who develop medical problems are commonly referred to medical teams, which can be proactive physician-led teams or through reactive referral to the on-call medical registrar.</div></div><div><h3>Methods</h3><div>A cross-sectional survey of on-call medical registrars who received referrals from surgical teams was conducted in March–June 2022 at 140 NHS hospitals. It focused on the workload derived from referrals of older surgical patients to on-call medical registrars, excluding referrals to existing services such as perioperative medicine, orthogeriatric, or medical specialty teams. To minimise recall bias, completion of the survey was encouraged regardless of whether a registrar had received a referral. The aim of this survey was to estimate the unplanned, acute workload generated by older surgical patients requiring referral to on-call medical registrars. The survey also aimed to estimate the prevalence and nature of training in perioperative medicine amongst medical registrars.</div></div><div><h3>Results</h3><div>During an on-call shift, 41.3% (266/644) of medical registrars received at least one referral regarding an older surgical patient. The commonest indications were arrhythmia, acute respiratory problems, electrolyte abnormalities, suspected myocardial infarction, sepsis, and delirium. Three-quarters of registrars reported not receiving training in perioperative management of older patients.</div></div><div><h3>Conclusions</h3><div>The findings highlight the significant workload and training gaps faced by medical registrars in managing older surgical patients. Bridging the gap between national recommendations and local services may reduce demands on on-call registrars and improve care.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100394"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Audit of anaemia in acute vascular inpatients with peripheral vascular disease","authors":"R. Cassin,&nbsp;E. Foulkes,&nbsp;T. Mankottil,&nbsp;E. Warinton,&nbsp;B. Swann,&nbsp;C. Davies","doi":"10.1016/j.bjao.2025.100469","DOIUrl":"10.1016/j.bjao.2025.100469","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100469"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Get MeFit first! Results from a successful prehabilitation service","authors":"Mav Venditti,&nbsp;Joe Clements,&nbsp;Chee-Fone Chu,&nbsp;Manisha Shah","doi":"10.1016/j.bjao.2025.100430","DOIUrl":"10.1016/j.bjao.2025.100430","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing monthly cardiac arrest simulation in the Regional Day Procedure Centre","authors":"J.T. Kennedy ,&nbsp;P. Nicol ,&nbsp;J. Netherton ,&nbsp;H. Maitland ,&nbsp;R. Deyermond ,&nbsp;L. Laverty ,&nbsp;C. Yap","doi":"10.1016/j.bjao.2025.100453","DOIUrl":"10.1016/j.bjao.2025.100453","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100453"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative information on anaesthesia for children and their families: a quality improvement project","authors":"E. Elusope,&nbsp;A. Agrawal","doi":"10.1016/j.bjao.2025.100451","DOIUrl":"10.1016/j.bjao.2025.100451","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"15 ","pages":"Article 100451"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}