BJA open最新文献

{"title":"Implementation and prospective performance evaluation of an intraoperative duration prediction model using high throughput real-time data","authors":"York Jiao ,&nbsp;Thomas Kannampallil","doi":"10.1016/j.bjao.2024.100285","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100285","url":null,"abstract":"<div><h3>Background</h3><p>Accurate real-time prediction of intraoperative duration can contribute to improved perioperative outcomes. We implemented a data pipeline for extraction of real-time data from nascent anaesthesia records and silently deployed a predictive machine learning (ML) algorithm.</p></div><div><h3>Methods</h3><p>Clinical variables were retrieved from the electronic health record via a third-party clinical decision support platform and contemporaneously ingested into a previously developed ML model. The model was trained using 3 months data, and performance was subsequently evaluated over 10 months using continuous ranked probability score.</p></div><div><h3>Results</h3><p>The ML model made 6 173 435 predictions on 62 142 procedures. Mean continuous ranked probability score for the ML model was 27.19 (standard error 0.016) min compared with 51.66 (standard error 0.029) min for the bias-corrected scheduled duration. Linear regression did not demonstrate performance drift over the testing period.</p></div><div><h3>Conclusions</h3><p>We implemented and silently deployed a real-time ML algorithm for predicting surgery duration. Prospective evaluation showed that model performance was preserved over a 10-month testing period.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100285"},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000297/pdfft?md5=49f333345f70ce50da62ada51e35d356&pid=1-s2.0-S2772609624000297-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140880539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of anaesthesia on cell death in a porcine model of neonatal hypoxic-ischaemic brain injury","authors":"Julia K. Gundersen ,&nbsp;Ela Chakkarapani ,&nbsp;David A. Menassa ,&nbsp;Lars Walløe ,&nbsp;Marianne Thoresen","doi":"10.1016/j.bjao.2024.100283","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100283","url":null,"abstract":"<div><h3>Background</h3><p>Hypothermia is neuroprotective after neonatal hypoxic-ischaemic brain injury. However, systemic cooling to hypothermic temperatures is a stressor and may reduce neuroprotection in awake pigs. We compared two experiments of global hypoxic-ischaemic injury in newborn pigs, in which one group received propofol–remifentanil and the other remained awake during post-insult hypothermia treatment.</p></div><div><h3>Methods</h3><p>In both studies, newborn pigs were anaesthetised using halothane during a 45-min global hypoxic-ischaemic insult induced by reducing <em>F</em>i<span>o</span>₂ and graded hypotension until a low-voltage &lt;7 μV electroencephalogram was achieved. On reoxygenation, the pigs were randomly allocated to receive 24 h of normothermia or hypothermia. In the first study (<em>n</em>=18) anaesthesia was discontinued and the pigs' tracheas were extubated. In the second study (<em>n</em>=14) anaesthesia was continued using propofol and remifentanil. Brain injury was assessed after 72 h by classical global histopathology, Purkinje cell count, and apoptotic cell counts in the hippocampus and cerebellum.</p></div><div><h3>Results</h3><p>Global injury was nearly 10-fold greater in the awake group compared with the anaesthetised group (<em>P</em>=0.021). Hypothermia was neuroprotective in the anaesthetised pigs but not the awake pigs. In the hippocampus, the density of cleaved caspase-3-positive cells was increased in awake compared with anaesthetised pigs in normothermia. In the cerebellum, Purkinje cell density was reduced in the awake pigs irrespective of treatment, and the number of cleaved caspase-3-positive Purkinje cells was greatly increased in hypothermic awake pigs. We detected no difference in cleaved caspase-3 in the granular cell layer or microglial reactivity across the groups.</p></div><div><h3>Conclusions</h3><p>Our study provides novel insights into the significance of anaesthesia/sedation during hypothermia for achieving optimal neuroprotection.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100283"},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000273/pdfft?md5=b9ef365c3f529eb8b09476831e938eae&pid=1-s2.0-S2772609624000273-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140825748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative fasting and the risk of pulmonary aspiration—a narrative review of historical concepts, physiological effects, and new perspectives","authors":"Anne Rüggeberg ,&nbsp;Patrick Meybohm ,&nbsp;Eike A. Nickel","doi":"10.1016/j.bjao.2024.100282","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100282","url":null,"abstract":"<div><p>In the early days of anaesthesia, the fasting period for liquids was kept short. By the mid-20th century ‘nil by mouth after midnight’ had become routine as the principles of the management of ‘full stomach’ emergencies were extended to include elective healthy patients. Back then, no distinction was made between the withholding of liquids and solids. Towards the end of the last century, recommendations of professional anaesthesiology bodies began to reduce the fasting time of clear liquids to 2 h. This reduction in fasting time was based on the understanding that gastric emptying of clear liquids is rapid, exponential, and proportional to the current filling state of the stomach. Furthermore, there was no evidence of a link between drinking clear liquids and the risk of aspiration. Indeed, most instances of aspiration are caused by failure to identify aspiration risk factors and adjust the anaesthetic technique accordingly. In contrast, long periods of liquid withdrawal cause discomfort and may also lead to serious postoperative complications. Despite this, more than two decades after the introduction of the 2 h limit, patients still fast for a median of up to 12 h before anaesthesia, mainly because of organisational issues. Therefore, some hospitals have decided to allow patients to drink clear liquids within 2 h of induction of anaesthesia. Well-designed clinical trials should investigate whether these concepts are safe in patients scheduled for anaesthesia or procedural sedation, focusing on both aspiration risk and complications of prolonged fasting.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100282"},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000261/pdfft?md5=1835d3a376703ef20b66bf8e87f4e357&pid=1-s2.0-S2772609624000261-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140825750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local anaesthetics and chemotherapeutic agents: a systematic review of preclinical evidence of interactions and cancer biology","authors":"Ahmed Abdelaatti ,&nbsp;Donal J. Buggy ,&nbsp;Thomas P. Wall","doi":"10.1016/j.bjao.2024.100284","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100284","url":null,"abstract":"<div><h3>Background</h3><p>Local anaesthetics are widely used for their analgesic and anaesthetic properties in the perioperative setting, including surgical procedures to excise malignant tumours. Simultaneously, chemotherapeutic agents remain a cornerstone of cancer treatment, targeting rapidly dividing cancer cells to inhibit tumour growth. The potential interactions between these two drug classes have drawn increasing attention and there are oncological surgical contexts where their combined use could be considered. This review examines existing evidence regarding the interactions between local anaesthetics and chemotherapeutic agents, including biological mechanisms and clinical implications.</p></div><div><h3>Methods</h3><p>A systematic search of electronic databases was performed as per Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Selection criteria were designed to capture <em>in vitro</em>, <em>in vivo</em>, and clinical studies assessing interactions between local anaesthetics and a wide variety of chemotherapeutic agents. Screening and data extraction were performed independently by two reviewers. The data were synthesised using a narrative approach because of the anticipated heterogeneity of included studies.</p></div><div><h3>Results</h3><p>Initial searches yielded 1225 relevant articles for screening, of which 43 met the inclusion criteria. The interactions between local anaesthetics and chemotherapeutic agents were diverse and multifaceted. <em>In vitro</em> studies frequently demonstrated altered cytotoxicity profiles when these agents were combined, with variations depending on the specific drug combination and cancer cell type. Mechanistically, some interactions were attributed to modifications in efflux pump activity, tumour suppressor gene expression, or alterations in cellular signalling pathways associated with tumour promotion. A large majority of <em>in vitro</em> studies report potentially beneficial effects of local anaesthetics in terms of enhancing the antineoplastic activity of chemotherapeutic agents. In animal models, the combined administration of local anaesthetics and chemotherapeutic agents showed largely beneficial effects on tumour growth, metastasis, and overall survival. Notably, no clinical study examining the possible interactions of local anaesthetics and chemotherapy on cancer outcomes has been reported.</p></div><div><h3>Conclusions</h3><p>Reported preclinical interactions between local anaesthetics and chemotherapeutic agents are complex and encompass a spectrum of effects which are largely, although not uniformly, additive or synergistic. The clinical implications of these interactions remain unclear because of the lack of prospective trials. Nonetheless, the modulation of chemotherapy effects by local anaesthetics warrants further clinical investigation in the context of cancer surgery where they could be used together.</p></div><div><h3>Clinical trial regis","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100284"},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000285/pdfft?md5=bbcd5c2c0f4210ef07591c9bee0cc2e4&pid=1-s2.0-S2772609624000285-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140825749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a lower versus a higher oxygenation target in intensive care unit patients with chronic obstructive pulmonary disease and acute hypoxaemic respiratory failure: a subgroup analysis of a randomised clinical trial","authors":"Maria B. Nielsen ,&nbsp;Thomas L. Klitgaard ,&nbsp;Ulla M. Weinreich ,&nbsp;Frederik M. Nielsen ,&nbsp;Anders Perner ,&nbsp;Olav L. Schjørring ,&nbsp;Bodil S. Rasmussen","doi":"10.1016/j.bjao.2024.100281","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100281","url":null,"abstract":"<div><h3>Background</h3><p>Oxygen supplementation is ubiquitous in intensive care unit (ICU) patients with chronic obstructive pulmonary disease (COPD) and acute hypoxaemia, but the optimal oxygenation target has not been established.</p></div><div><h3>Methods</h3><p>This was a pre-planned subgroup analysis of the Handling Oxygenation Targets in the ICU (HOT-ICU) trial, which allocated patients with acute hypoxaemia to a lower oxygenation target (partial pressure of arterial oxygen [<em>P</em>a<span>o</span>₂] of 8 kPa) <em>vs</em> a higher target (<em>P</em>a<span>o</span>₂ of 12 kPa) during ICU admission, for up to 90 days; the allocation was stratified for presence or absence of COPD. Here, we report key outcomes for patients with COPD.</p></div><div><h3>Results</h3><p>The HOT-ICU trial enrolled 2928 patients of whom 563 had COPD; 277 were allocated to the lower and 286 to the higher oxygenation group. After allocation, the median <em>P</em>a<span>o</span>₂ was 9.1 kPa (inter-quartile range 8.7–9.9) in the lower group <em>vs</em> 12.1 kPa (11.2–12.9) in the higher group. Data for arterial carbon dioxide (<em>P</em>a<span>co</span>₂) were available for 497 patients (88%) with no between-group difference in time-weighted average; median <em>P</em>a<span>co</span>₂ 6.0 kPa (5.2–7.2) in the lower group <em>vs</em> 6.2 kPa (5.4–7.3) in the higher group. At 90 days, 122/277 patients (44%) in the lower oxygenation group had died <em>vs</em> 132/285 patients (46%) in the higher (relative risk 0.98; 95% confidence interval 0.82–1.17; <em>P</em>=0.67). No statistically significant differences were found in any secondary outcome.</p></div><div><h3>Conclusions</h3><p>In ICU patients with COPD and acute hypoxaemia, a lower <em>vs</em> a higher oxygenation target did not reduce mortality. There were no between-group differences in <em>P</em>a<span>co</span>₂ or in secondary outcomes.</p></div><div><h3>Clinical trial registration</h3><p>NCT 03174002, EudraCT number 2017-000632-34.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100281"},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277260962400025X/pdfft?md5=85af0e0347b7c556d6035e0d378e2595&pid=1-s2.0-S277260962400025X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140813730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of continuous bilateral parasternal block with lidocaine on patient-controlled analgesia opioid requirement and recovery after open heart surgery: a double-blind randomised controlled trial","authors":"Mark Larsson ,&nbsp;Ulrik Sartipy ,&nbsp;Anders Franco-Cereceda ,&nbsp;Anders Öwall ,&nbsp;Jan Jakobsson","doi":"10.1016/j.bjao.2024.100279","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100279","url":null,"abstract":"<div><h3>Background</h3><p>We hypothesised that a continuous 72-h bilateral parasternal infusion of lidocaine at 2×35 mg h⁻¹ would decrease pain and the inflammatory response after sternotomy for open heart surgery, subsequently improving quality of recovery.</p></div><div><h3>Methods</h3><p>We randomly allocated 45 participants to a 72-h bilateral parasternal infusion of lidocaine or saline commencing after wound closure. The primary outcome was the cumulative patient-controlled analgesia (PCA) morphine consumption at 72 h. Secondary outcomes included total morphine requirement, pain, peak expiratory flow, and serum interleukin-6 concentration. In addition, we used an eHealth platform for a 3-month follow-up of pain, analgesic use, and Quality of Recovery-15 scores.</p></div><div><h3>Results</h3><p>The 72-h PCA morphine requirement was significantly lower in the lidocaine than the saline group (10 mg [inter-quartile range: 5–19 mg] and 28.2 mg [inter-quartile range: 16–42.5 mg], respectively; <em>P</em>=0.014). The total morphine requirement (including morphine administered before the start of PCA) was significantly lower at 24, 48, and 72 h. Pain was well controlled with no difference in pain scores between treatment groups. The peak expiratory flow was lower in the lidocaine group at 72 h. Interleukin-6 concentrations showed no difference at 24, 48, or 72 h. Quality of Recovery-15 scores did not differ between treatment groups at any time during the 3-month follow-up.</p></div><div><h3>Conclusions</h3><p>After sternotomy for open heart surgery, a 72-h bilateral parasternal lidocaine infusion significantly decreased PCA and total morphine requirement. However, neither signs of decreased inflammatory response nor an improvement in recovery was seen.</p></div><div><h3>Clinical trial registration</h3><p>EudraCT number 2018-004672-35.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100279"},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000236/pdfft?md5=d1f87500618cab5e179e57980abf7be1&pid=1-s2.0-S2772609624000236-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140622454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daytime dexmedetomidine sedation with closed-loop acoustic stimulation alters slow wave sleep homeostasis in healthy adults","authors":"S. Kendall Smith ,&nbsp;MohammadMehdi Kafashan ,&nbsp;Rachel L. Rios ,&nbsp;Emery N. Brown ,&nbsp;Eric C. Landsness ,&nbsp;Christian S. Guay ,&nbsp;Ben Julian A. Palanca","doi":"10.1016/j.bjao.2024.100276","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100276","url":null,"abstract":"<div><h3>Background</h3><p>The alpha-2 adrenergic agonist dexmedetomidine induces EEG patterns resembling those of non-rapid eye movement (NREM) sleep. Fulfilment of slow wave sleep (SWS) homeostatic needs would address the assumption that dexmedetomidine induces functional biomimetic sleep states.</p></div><div><h3>Methods</h3><p>In-home sleep EEG recordings were obtained from 13 healthy participants before and after dexmedetomidine sedation. Dexmedetomidine target-controlled infusions and closed-loop acoustic stimulation were implemented to induce and enhance EEG slow waves, respectively. EEG recordings during sedation and sleep were staged using modified American Academy of Sleep Medicine criteria. Slow wave activity (EEG power from 0.5 to 4 Hz) was computed for NREM stage 2 (N2) and NREM stage 3 (N3/SWS) epochs, with the aggregate partitioned into quintiles by time. The first slow wave activity quintile served as a surrogate for slow wave pressure, and the difference between the first and fifth quintiles as a measure of slow wave pressure dissipation.</p></div><div><h3>Results</h3><p>Compared with pre-sedation sleep, post-sedation sleep showed reduced N3 duration (mean difference of −17.1 min, 95% confidence interval −30.0 to −8.2, <em>P</em>=0.015). Dissipation of slow wave pressure was reduced (<em>P</em>=0.02). Changes in combined durations of N2 and N3 between pre- and post-sedation sleep correlated with total dexmedetomidine dose, (<em>r</em>=−0.61, <em>P</em>=0.03).</p></div><div><h3>Conclusions</h3><p>Daytime dexmedetomidine sedation and closed-loop acoustic stimulation targeting EEG slow waves reduced N3/SWS duration and measures of slow wave pressure dissipation on the post-sedation night in healthy young adults. Thus, the paired intervention induces sleep-like states that fulfil certain homeostatic NREM sleep needs in healthy young adults.</p></div><div><h3>Clinical trial registration</h3><p>ClinicalTrials.gov <span>NCT04206059</span><svg><path></path></svg>.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100276"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000200/pdfft?md5=e7d6d12302990a8e911d449be4d1ec8c&pid=1-s2.0-S2772609624000200-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140309825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of methadone in cardiac surgery for management of postoperative pain","authors":"Jordan N. Edwards ,&nbsp;Madeline A. Whitney ,&nbsp;Bradford B. Smith ,&nbsp;Megan K. Fah ,&nbsp;Skye A. Buckner Petty ,&nbsp;Omar Durra ,&nbsp;Kristen A. Sell-Dottin ,&nbsp;Erica Portner ,&nbsp;Erica D. Wittwer ,&nbsp;Adam J. Milam","doi":"10.1016/j.bjao.2024.100270","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100270","url":null,"abstract":"<div><h3>Background</h3><p>This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids.</p></div><div><h3>Methods</h3><p>Patients undergoing cardiac surgery with cardiopulmonary bypass (<em>n</em>=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M).</p></div><div><h3>Results</h3><p>Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (<em>P</em>&lt;0.01). Both Groups M and M+O had lower total opioid administered compared with Group O for all days POD0–POD6 (all <em>P</em>&lt;0.001). The median number of hours until initial postoperative opioid after surgery was 2.55 (inter-quartile range [IQR]=1.07–5.12), 6.82 (IQR=3.52–12.98), and 7.0 (IQR=3.82–12.95) for Group O, Group M+O, and Group M, respectively. The incidence of postoperative complications did not differ between groups.</p></div><div><h3>Conclusions</h3><p>Intraoperative administration of methadone was associated with better pain control without significant side-effects after cardiac surgery.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100270"},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000145/pdfft?md5=e5a3c7b90cf6b2662d8e8bf8dfa852d1&pid=1-s2.0-S2772609624000145-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140188029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing clinical selection criteria for intraoperative transoesophageal echocardiography in isolated coronary artery bypass graft surgery","authors":"Emily J. MacKay ,&nbsp;Charlotte J. Talham ,&nbsp;Bo Zhang ,&nbsp;Chase R. Brown ,&nbsp;Peter W. Groeneveld ,&nbsp;Nimesh D. Desai ,&nbsp;John G. Augoustides","doi":"10.1016/j.bjao.2024.100278","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100278","url":null,"abstract":"<div><h3>Background</h3><p>There is a lack of evidence associating intraoperative transoesophageal echocardiography (TOE) use with improved outcomes among coronary artery bypass graft (CABG) surgery subpopulations.</p></div><div><h3>Methods</h3><p>This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with <em>vs</em> without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses.</p></div><div><h3>Results</h3><p>Of 42 249 patients undergoing isolated CABG surgery, 24 919 (59.0%) received and 17 330 (41.0%) did not receive TOE. After matching, intraoperative TOE was significantly associated with a lower, 30-day mortality: 2.63% <em>vs</em> 3.20% (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.71–0.92; <em>P</em>=0.002). In the subgroup matched comparisons, intraoperative TOE was significantly associated with a lower, 30-day mortality rate among those with congestive heart failure: 4.20% <em>vs</em> 5.26% (OR: 0.78; 95% CI: 0.66–0.94; <em>P</em>=0.007) and among those undergoing multivessel CABG with congestive heart failure: 4.23% <em>vs</em> 5.24% (OR: 0.80; 95% CI: 0.65–0.97; <em>P</em>=0.025), but not among those undergoing multivessel CABG without congestive heart failure: 1.83% <em>vs</em> 2.15% (OR: 0.85; 95% CI: 0.70–1.02; <em>P</em>=0.089, nor any of the remaining three subgroups.</p></div><div><h3>Conclusions</h3><p>Among US adults undergoing isolated CABG surgery, intraoperative TOE was associated with improved outcomes in patients with congestive heart failure (<em>vs</em> without) and among patients undergoing multivessel (<em>vs</em> single vessel) CABG. These findings support prioritised TOE allocation to these patient populations at centres with limited TOE capabilities.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100278"},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000224/pdfft?md5=6b88fb2de000fa1ac379cc84977ecb1a&pid=1-s2.0-S2772609624000224-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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 Spanish version of the Obstetric Quality of Recovery-10 item score (ObsQoR-10-Spanish)","authors":"Jennifer Guevara ,&nbsp;Carlos Sánchez ,&nbsp;Jessica Organista-Montaño ,&nbsp;Benjamin W. Domingue ,&nbsp;Nan Guo ,&nbsp;Pervez Sultan","doi":"10.1016/j.bjao.2024.100269","DOIUrl":"https://doi.org/10.1016/j.bjao.2024.100269","url":null,"abstract":"<div><h3>Background</h3><p>Spanish is the second most spoken language globally with around 475 million native speakers. We aimed to validate a Spanish version of the Obstetric Quality of Recovery-10 item (ObsQoR-10) patient-reported outcome measure.</p></div><div><h3>Methods</h3><p>ObsQoR-10-Spanish was developed using EuroQoL methodology. ObsQoR-10-Spanish was assessed in 100 Spanish-speaking patients undergoing elective Caesarean or vaginal delivery. Patients &lt;38 weeks, undergoing an intrapartum Caesarean delivery, intrauterine death, or maternal admission to the intensive care unit (ICU) were excluded. Validity was assessed by evaluating (i) convergent validity—correlation with 24-h EuroQoL and global health visual analogue scale (GHVAS) scores (0–100); (ii) discriminant validity—difference in ObsQoR-10-Spanish score for patients with GHVAS scores &gt;70 <em>vs</em> &lt;70; (iii) hypothesis testing—correlation of ObsQoR score with maternal and neonatal factors; and (iv) cross-cultural validity assessed using differential item functioning analysis. Reliability was assessed by evaluating: (i) internal consistency; (ii) split-half reliability and (iii) test–retest reliability; and (iv) floor and ceiling effects.</p></div><div><h3>Results</h3><p>One hundred patients were approached, recruited, and completed surveys. Validity: (i) convergent validity: the ObsQoR 24-h score correlated moderately with the 24-h EuroQoL (<em>r</em>=−0.632) and GHVAS scores (<em>r</em>=0.590); (ii) discriminant validity: the ObsQoR-10-Spanish 24-h scores were higher in women who delivered vaginally compared to via Caesarean delivery, (mean [standard deviation] scores were 89 [9] <em>vs</em> 81 [12]; <em>P</em>&lt;0.001). The 24-h ObsQoR-Spanish scores were lower in patients experiencing a poor <em>vs</em> a good recovery (mean [standard deviation] scores were 76 [12.3] <em>vs</em> 87.1 [10.6]; <em>P</em>=0.001); (iii) hypothesis testing: the ObsQoR-10 score correlated negatively with age (<em>r</em>=−0.207) and positively with 5-min (<em>r</em>=0.204) and 10-min (<em>r</em>=0.243) Apgar scores. Remaining correlations were not significant; and (iv) differential item functioning analysis suggested no potential bias among the 10 items. Reliability: (i) internal consistency was good (Cronbach alpha=0.763); (ii) split-half reliability was good (Spearman–Brown prophesy reliability estimate of 0.866); (iii) test–retest reliability was excellent with an intra-class correlation coefficient of 0.90; and (iv) floor and ceiling effects: six patients scored a maximum total ObsQoR-10 score.</p></div><div><h3>Conclusions</h3><p>The ObsQoR-10-Spanish patient-reported outcome measure is valid, reliable, and clinically feasible, and should be considered for use in Spanish-speaking women to assess quality of inpatient postpartum recovery.</p></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"10 ","pages":"Article 100269"},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772609624000133/pdfft?md5=ab561d1e65b006327b8fa0c7a786943d&pid=1-s2.0-S2772609624000133-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140188143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}