Anaesthesia最新文献

{"title":"Incidence of peripheral arterial catheter failure and complications in intensive care: a systematic review and meta-analysis","authors":"Annabel Levido,&nbsp;Nicole Marsh,&nbsp;Amanda Corley,&nbsp;Felicity Edwards,&nbsp;Kevin B. Laupland,&nbsp;Samantha Keogh","doi":"10.1111/anae.70074","DOIUrl":"10.1111/anae.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although there is an extensive body of literature on complications associated with central venous catheters, less is known about arterial catheter-related complications. This systematic review and meta-analysis aimed to quantify the incidence of arterial catheter-related complications and failure in intensive care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Databases were searched for relevant randomised controlled trials and cohort studies that reported on arterial catheter-related complications and failure within the adult critical care setting. Two authors independently identified studies for full review, extracted data and completed quality assessments. Pooled estimates were calculated using random-effects models with the Freeman-Tukey double arcsine transformation. Certainty of evidence for each outcome was assessed using the GRADE framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-nine studies (22 observational studies and 17 randomised controlled trials) comprising 19,018 arterial catheters, were included. The pooled proportion of all-cause arterial catheter failure was 13.0% (95%CI 7.6–19.5%, moderate certainty). Non-infectious arterial catheter failure occurred in 19.8% (95%CI 12.2–28.7%, moderate certainty) of arterial catheters. The pooled proportion of all-cause catheter-associated or related bloodstream infections was 1.3% (95%CI 0.7–2.1%, moderate certainty). Local infection occurred in 1.2% (95%CI 0.4–2.4%, high certainty). Reporting of definitions of bloodstream and local infections was limited. Incidence density could not be calculated for any outcomes due to limited reporting of total catheter days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Arterial catheter failure occurs in up to one in five catheters in intensive care. Reducing failure rates and associated complications requires system-wide interventions, clearer definitions of infection and standardised reporting to improve data synthesis and guide evidence-based improvement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"726-737"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arterial lines: is the pulse still strong?","authors":"Andrew J. Johnston,&nbsp;Andrew Conway Morris","doi":"10.1111/anae.70099","DOIUrl":"10.1111/anae.70099","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"612-616"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon footprint: an economic modelling study","authors":"Daniel Leslie,&nbsp;Christopher J. Mullington","doi":"10.1111/anae.70111","DOIUrl":"10.1111/anae.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The UK NHS is committed to reaching net zero carbon emissions by 2040. Volatile anaesthetic agents are potent greenhouse gases and alternative intravenous methods exist. We aimed to predict the cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon emissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A general anaesthetic for a 40-year-old, 78-kg patient was modelled. Two volatile anaesthetic agents (desflurane and sevoflurane) were compared with propofol-remifentanil total intravenous anaesthesia. Total intravenous anaesthesia with and without processed electroencephalography was modelled. Cost-effectiveness was calculated as the cost per kg carbon dioxide equivalent saved by transition to total intravenous anaesthesia, benchmarked against the UK emission trading scheme carbon permit price of £41.84 (US$54.90, €47.28) per tonne carbon dioxide equivalent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total intravenous anaesthesia was less carbon intensive than sevoflurane and desflurane (2.0 vs. 9.8 kg and 209.2 kg carbon dioxide equivalent, respectively). Total intravenous anaesthesia was more expensive than sevoflurane when processed electroencephalography was used (£13.03 (US$17.08, €14.72) vs. £9.76 (US$12.79, €11.03)) but cheaper when it was not (£5.31 (US$6.95, €6.00) vs. £9.76 (US$12.79, €11.03)). When processed electroencephalography was used, the incremental cost-effectiveness ratio of transitioning from sevoflurane to total intravenous anaesthesia was £416 (US$544, €470) per tonne carbon dioxide equivalent. Total intravenous anaesthesia (with and without processed electroencephalography) was cheaper than desflurane (£18.94 (US$24.77, €21.41)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Using our model parameters and the different carbon dioxide emissions and similar cost, transitioning from desflurane anaesthesia to total intravenous anaesthesia is cost-effective. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia without processed electroencephalography is likely to be cost-effective but is not recommended due to the increased risk of awareness. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia with processed electroencephalography is unlikely to be cost-effective.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"675-684"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for anaesthesia and sedation for patients who are breastfeeding","authors":"Joellene Mitchell,&nbsp;Wendy Jones,&nbsp;Samantha Morris,&nbsp;Merle Cohen,&nbsp;Fiona Breckenridge,&nbsp;Julie Baruah-Young,&nbsp;Gemma Fletcher,&nbsp;Sarah Edwards,&nbsp;Marianne White,&nbsp;Matthew D. Wiles","doi":"10.1111/anae.70128","DOIUrl":"10.1111/anae.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Breastfeeding is acknowledged widely as one of the most effective ways to ensure the health and well-being of both child and birth parent. Historically, advice given to patients who required an anaesthetic while breastfeeding was variable and inconsistent, sometimes resulting in the interruption of feeding for ≥ 24 h, or expressing and discarding breastmilk because of concerns regarding the possible adverse effects secondary to medicines passing into the breastmilk. This can be a contributory factor in the early cessation of breastfeeding. Peri-operative decisions can normally be made on the basis of pharmacokinetic data rather than on the precautionary principle.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multidisciplinary consensus guideline included anaesthetists, pharmacists, midwives, infant feeding advisers and people with lived experience relevant to these guidelines. Following the targeted literature review, a three-round modified Delphi process was conducted to produce and ratify recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Any patient with a child aged &lt; 2 y should routinely be asked if they are breastfeeding or expressing breastmilk during their pre-operative assessment for a procedure involving anaesthesia or sedation. Anaesthetic, sedative and analgesic medicines are transferred to breastmilk in only very small amounts. For almost all medicines used peri-operatively, there is no evidence of adverse effects on the breastfed child. Patients should be advised that discarding of breastmilk after anaesthesia (‘pumping and dumping’) is not necessary and that ‘sleep and keep’ is now recommended.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This pragmatic, multidisciplinary guideline aims to facilitate the peri-operative management of patients who are breastfeeding. It is hoped that these will be of value to both clinicians and patients in determining the optimal anaesthetic management strategy to support breastfeeding in the peri-operative period while ensuring minimal risk to the breastfed child.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"685-701"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-oxygenation in patients living with obesity: a reply","authors":"Andrew McKechnie,&nbsp;Helen Iliff,&nbsp;Imran Ahmad","doi":"10.1111/anae.70172","DOIUrl":"10.1111/anae.70172","url":null,"abstract":"<p>We thank Couture and Bussières for their correspondence [<span>1</span>] regarding the guidelines from the Society for Obesity and Bariatric Anaesthesia on airway management in patients living with obesity [<span>2</span>]. One key recommendation was the focus on appropriate positioning for pre- and per-oxygenation to maximise patient oxygen stores and safe apnoeic time before airway instrumentation. We are delighted to see this important aspect of the guidelines as the subject of their correspondence. The use of spontaneous facemask positive pressure ventilation was considered; however, it is less effective than other techniques in this cohort of patients [<span>3</span>]. Several methods for pre-oxygenation have been described; however, variations in patient populations and individual physiology may impact their effectiveness [<span>3</span>].</p><p>The authors used a 25° tilting table to achieve head up positioning and a soft snorkel-type mouthpiece with a nose clip to provide positive pressure spontaneous ventilation in their studies [<span>4, 5</span>]. This does not reflect UK practice and is not mentioned in the guidance. Instead, we recommend that patients should be pre-oxygenated in a ramped ≥ 30° head-up position with a high inspiratory fraction of oxygen. We do not specify how this position should be achieved. Ultimately, individuals should use the equipment available to them to optimise patient positioning and oxygen delivery for pre-oxygenation and subsequent airway management.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the medicolegal landscape of artificial intelligence in anaesthesia and peri-operative medicine","authors":"James O'Carroll,&nbsp;Kieran Brosnan,&nbsp;Paul McConnell","doi":"10.1111/anae.70157","DOIUrl":"10.1111/anae.70157","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"617-621"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146153625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Measurement and management of adult blood pressure in the peri-operative period: updated guidelines from the Association of Anaesthetists and the British and Irish Hypertension Society”","authors":"","doi":"10.1111/anae.70213","DOIUrl":"10.1111/anae.70213","url":null,"abstract":"<p>McCormack T, Wickham A, McDonagh STJ, et al. Measurement and management of adult blood pressure in the peri-operative period: updated guidelines from the Association of Anaesthetists and the British and Irish Hypertension Society. <i>Anaesthesia</i> 2026; <b>81</b>: 402–14. https://doi.org/10.1111/anae.70082</p><p>In the article cited above, the reference list contained numerous incorrect digital object identifiers (DOI) and a duplicate reference. The DOIs and the citations have been corrected, and the corrected article has been published online.</p><p>We apologise for this error.</p>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147524294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of peri-operative peripheral nerve injuries associated with general and regional anaesthesia: an observational study","authors":"Tom Luo,&nbsp;Janneke Berecki-Gisolf,&nbsp;Stuart Marshall","doi":"10.1111/anae.70081","DOIUrl":"10.1111/anae.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Peri-operative peripheral nerve injuries are rare, and estimating their incidence and identifying risk factors is difficult. Previous data attempting to determine the incidence come from single-centre studies or small database reviews, making it difficult to draw definitive conclusions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the Victorian Admitted Episodes Dataset, an established state-wide dataset of public and private hospital admissions, to determine the incidence and risk factors for developing peri-operative peripheral nerve injuries in the state of Victoria, Australia, from 2015 to 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 5,451,848 non-maternity surgical admissions were analysed, with 796 nerve injuries as a complication of care. This represents a rate of 14.6 nerve injuries per 100,000 (0.014%) surgical admissions, with a subset of 407 specific nerve injuries of interest (the most common nerve injuries previously identified by American Society of Anesthesiologists closed claims analyses) at a rate of 7.5 per 100,000 (0.007%) surgical admissions. The risk of specific peri-operative nerve injuries increased significantly in patients receiving combined regional anaesthesia with general anaesthesia or sedation (odds ratio 2.68, 95%CI 2.11–3.39); patients living with obesity (odds ratio 2.04, 95%CI 1.54–2.69) and those with increased Charlson comorbidity index (odds ratio 2.61, 95%CI 1.87–3.65 for Charlson comorbidity index of 2). Procedures on the cardiovascular system (odds ratio 3.75, 95%CI 2.85–4.92), musculoskeletal system (odds ratio 3.30, 95%CI 2.59–4.20) and nervous system (odds ratio 3.17, 95%CI 2.43–4.14) had the highest risk of specified injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The risk of peri-operative peripheral nerve injuries is lower than historical estimates and appears to be decreasing with time. The use of administrative databases allows for inclusion of denominator data to allow for a more accurate estimate of risk in rare events, such as peri-operative peripheral nerve injuries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"627-636"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism risk following surgery during the COVID-19 pandemic","authors":"Andrew Jackson,&nbsp;David J. Humes,&nbsp;Amir Mehrkar,&nbsp;Sebastian C. J. Bacon,&nbsp;Simon Davy,&nbsp;Ben Goldacre,&nbsp;Joe West,&nbsp;Colin J. Crooks","doi":"10.1111/anae.70091","DOIUrl":"10.1111/anae.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>SARS-CoV-2 infection is associated with an increased risk of venous thromboembolism. Data are lacking on how this risk altered during the COVID-19 pandemic and following vaccination. We aimed to evaluate the 90-day risk of postoperative venous thromboembolism during the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of patients having abdominal, obstetric, orthopaedic, cardiac, thoracic or vascular surgical procedures using the OpenSAFELY-TPP platform. Crude 90-day risks of venous thromboembolism were calculated and crude and adjusted hazard ratios were derived from individual Cox proportional hazards models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 1,800,540 procedures were performed with 15,390 individual venous thromboembolic events recorded within 90 days. The highest crude absolute risk was in the Alpha wave at 1.2%. Postoperative SARS-CoV-2 infection was associated with a 4.4-fold increase in relative risk of 90-day venous thromboembolism (adjusted hazard ratio 4.42, 95%CI 4.21–4.64) compared with those without. Recent SARS-CoV-2 infection was associated with an increased risk of venous thromboembolism (adjusted hazard ratio 4.03, 95%CI 3.78–4.30) compared with those without. Patients who were unvaccinated had the highest relative risk for 90-day venous thromboembolism. A single dose of vaccine was associated with a 20% relative risk reduction of venous thromboembolism (adjusted hazard ratio 0.80, 95%CI 0.76–0.84).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>SARS-CoV-2 infection status and vaccination history were associated with 90-day venous thromboembolism risk, with both recent and postoperative SARS-CoV-2 infection associated with an increased risk, whilst one dose of vaccine reduced the risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"637-645"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative anaemia, red blood cell transfusion and mortality after cardiac surgery: a Netherlands Heart Registration mediation analysis","authors":"Elisabeth M. Groenewegen,&nbsp;Peter G. Noordzij,&nbsp;Eline Vlot,&nbsp;Saskia Houterman,&nbsp;Toni Klok,&nbsp;Alexander J. Spanjersberg,&nbsp;Maarten Ter Horst,&nbsp;Joost M. A. A. Van Der Maaten,&nbsp;Susanne Eberl,&nbsp;Remco R. Berendsen,&nbsp;R. Arthur Bouwman,&nbsp;Bastiaan M. Gerritse,&nbsp;Thierry V. Scohy,&nbsp;Johannes S. E. Haenen,&nbsp;Jan Hofland,&nbsp;Marieke F. Kingma,&nbsp;Jan Van Klarenbosch,&nbsp;Sander Bramer,&nbsp;Marcel P. J. De Korte,&nbsp;Nicobert E. Wietsma,&nbsp;Olaf L. Cremer,&nbsp;Lizbeth Burgos Ochoa,&nbsp;Thijs C. D. Rettig,&nbsp;the NHR Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration","doi":"10.1111/anae.70100","DOIUrl":"10.1111/anae.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pre-operative anaemia is an established risk factor for mortality after cardiac surgery. The extent to which this risk is mediated by complications related to red blood cell transfusion remains uncertain, particularly across different age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This nationwide cohort study included adult cardiac surgery patients from the Netherlands Heart Registration. Pre-operative anaemia was defined according to World Health Organization criteria and red blood cell transfusion as any red blood cell transfusion during hospital stay. The main study endpoint was 120-day mortality. We used multivariable logistic regression to quantify the associations between pre-operative anaemia, red blood cell transfusion and 120-day mortality. Subsequently, a mediation analysis was conducted to quantify how much of the effect of pre-operative anaemia on postoperative mortality is because of red blood cell transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 71,053 patients, 14,452 (20.3%) had pre-operative anaemia. Of these, 7621 (52.7%) received red blood cell transfusion during hospital stay, compared with 9930 (17.5%) of patients without anaemia (p &lt; 0.001). Observed 120-day mortality was 612 (4.2%) and 901 (1.6%), respectively. In multivariable regression analysis, pre-operative anaemia remained independently associated with postoperative mortality (adjusted odds ratio 1.66, 95%CI 1.47–1.87), with consistent effects across age groups. Mediation analysis showed that red blood cell transfusion accounted for 58.9% (95%CI 41.3–76.5%) of the association between pre-operative anaemia and 120-day mortality. The proportion mediated was larger in patients aged ≥ 70 years (77.3%, 95%CI 43.1–100%) compared with younger patients (39.3%, 95%CI 21.4–57.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A substantial part of the association between pre-operative anaemia and mortality after cardiac surgery is mediated by red blood cell transfusion during hospital stay. The mediating role of red blood cell transfusion was more pronounced in older patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 5","pages":"646-654"},"PeriodicalIF":6.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145732592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}