Anesthesia and analgesia最新文献

{"title":"Building Trusting Health Care Teams.","authors":"D Matthew Sherrer, Courtney B Peters, Breanne A Mertz, Andrew H Morris, Brooke R Vining, Thomas R Vetter","doi":"10.1213/ANE.0000000000007588","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007588","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intubation Setting and Mortality in Trauma Patients Undergoing Hemorrhage Control Surgery: A Propensity Score-Matched Analysis.","authors":"Tomer Talmy, Irina Radomislensky, Isaac Brzezinski Sinai, Ruth Shaylor, Eldad Katorza, Sami Gendler","doi":"10.1213/ANE.0000000000007542","DOIUrl":"10.1213/ANE.0000000000007542","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation is essential for airway management in trauma patients but may cause hemodynamic instability and delay critical resuscitation measures. Recent studies have suggested that emergency department (ED) intubation may be linked with higher mortality compared to operating room (OR) intubation in trauma patients. However, it remains unclear if these findings apply to broader trauma populations, including both civilian and military patients. This study uses a nationwide trauma registry to test the hypothesis that ED intubation is associated with higher in-hospital mortality among major trauma patients, compared to OR intubation.</p><p><strong>Methods: </strong>Registry-based analysis of the Israeli National Trauma Registry evaluating major trauma (Injury Severity Score [ISS] ≥16) patients requiring hemorrhage control surgery between 2016 and 2023. ED intubation was the main exposure variable with in-hospital mortality serving as the primary outcome. Multivariable logistic regression and propensity score matching were applied to adjust for confounders, including injury severity, ED vital signs, penetrating injury, and blood product administration.</p><p><strong>Results: </strong>The study included 975 patients, 470 (48.2%) of whom were intubated in the ED. ED-intubated patients had significantly higher ISS and higher proportion of profound shock compared to those intubated in the OR. In-hospital mortality was more common among patients intubated in the ED (22.6%) as compared with those intubated in the OR (8.5%). In the unadjusted logistic regression, ED intubation was associated with higher odds of in-hospital mortality (OR: 3.13, 95% confidence interval [CI], 2.15-4.62). However, after adjusting for several potential confounders, the association became nonsignificant and was persistent across sensitivity subgroup analyses. Propensity score matching resulted in 1:1 matching of 271 patients in each group, balancing characteristics such as ISS, profound shock, Glasgow Coma Scale, and penetrating injury. After matching, the mortality rate was similar between groups (12.5% for ED intubation vs 12.2% for OR intubation). In the matched cohort, logistic regression demonstrated no significant association between ED intubation and in-hospital mortality (OR: 0.97, 95% CI, 0.58-1.61). ED intubation was associated with a greater than 2-fold increase in odds of ICU admission in adjusted and propensity score-matched analyses.</p><p><strong>Conclusions: </strong>ED intubation was not significantly associated with increased in-hospital mortality after controlling for injury severity and shock. These findings suggest that while ED intubation may be more frequent in severely injured patients, its independent impact on mortality in patients undergoing emergent surgery remains unclear, warranting further prospective investigation.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain Health Screening in Older Surgical Patients: A Multicenter, Retrospective, Observational Analysis and Survey.","authors":"Alexander T Abess, Nirav J Shah, Elizabeth L Whitlock, Hedwig Schroeck, Donna Ron, Sandra Becker Rozek, Pablo Martinez-Camblor, Anne L Donovan, Katie J Schenning, Stacie G Deiner","doi":"10.1213/ANE.0000000000007557","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007557","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend routine screening perioperatively for cognitive impairment, frailty, and delirium for patients at risk. Capturing these 3 geriatric screening variables in multicenter databases would also enable much-needed large-scale pragmatic research. Our primary hypothesis was that the well-curated Multicenter Perioperative Outcomes Group (MPOG) database would have a low rate of retrievable geriatric screening variables. Our secondary hypothesis was that multiple barriers exist that impede clinical implementation of recommended screenings as well as the digital capture of these variables into the MPOG database.</p><p><strong>Methods: </strong>This was a 2-component study. The first component was a retrospective observational analysis using the MPOG database to identify geriatric screening variables in patients over the age of 65 undergoing nonemergent inpatient surgery. The second component was a survey sent to MPOG participant sites (49 institutions) to assess actual screening practices and perspectives.</p><p><strong>Results: </strong>Of the 908,158 relevant patient records only 8054 (0.89%) were identified as having a preoperative cognitive screen, and 123,114 (13.6%) were identified as having a postoperative delirium screening. No frailty screenings were observed. Forty-3 survey responses (88% response rate) were received. Approximately half of the respondents indicated their institutions perform cognitive screening (n=22; 51.2%), frailty screening (n=17; 44.7%), or delirium screening (n = 16; 45.7%). Only 10 institutions (23.2%) reported performing all 3, and 13 (30.2%) institutions reported performing none. Multiple barriers were identified. The most common significant barrier reported was a lack of available standard screening tools for the electronic health record.</p><p><strong>Conclusions: </strong>This study identified minimal data collection related to neurocognitive disorders which appears incongruous with clinical practice guidelines. Challenges related to capturing this data locally and in multi-center datasets were identified. Overcoming those barriers may facilitate future pragmatic research studies related to this important public health priority.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Health Care Disparities in the United States: A Systematic Review.","authors":"A Steven Bradley, Timethia J Bonner, Mohanad R Youssef, Brittany N Burton, David O Warner, Abimbola O Faloye, Paloma Toledo, Adam J Milam","doi":"10.1213/ANE.0000000000007510","DOIUrl":"https://doi.org/10.1213/ANE.0000000000007510","url":null,"abstract":"<p><p>Perioperative health inequities remain a critical issue, contributing to unequal patient outcomes and financial costs despite increasing awareness and efforts to address these disparities. This systematic review evaluated anesthesiology literature from 2010 to 2023 on perioperative health care disparities related to race, ethnicity, gender, and socioeconomic status. The review aimed to identify gaps and propose research and opportunities for intervention. A comprehensive literature search was conducted using PubMed, Embase, Scopus, and Web of Science, with studies included if they focused on perioperative disparities in the United States, were published in anesthesiology journals, and met criteria for methodological rigor. The review was registered with International Prospective Register of Systematic Reviews (PROSPERO); data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and study quality was assessed with the Newcastle-Ottawa scale. Out of 1050 abstracts screened, 116 articles were reviewed for full text, with 59 studies meeting inclusion criteria. Included studies comprised retrospective cohort studies, cross-sectional analyses, a case-control study, and a randomized controlled trial, covering various surgical procedures and sample sizes from 100 to over 21 million patients. Disparities were noted in peripartum management (n = 14), mortality (n = 12), complications (n = 8), regional anesthesia use (n = 6), and pain management (n = 3), with evidence of poorer outcomes in Black and Hispanic women, older adolescents, and patients who were uninsured or on Medicaid. This review highlights the persistence of significant perioperative disparities and identifies gaps, such as limited exploration of the causes of these disparities, limited examination of disparities during the preoperative and intraoperative period, and few interventions to address these identified disparities. Reducing these disparities requires stakeholder engagement, multifaceted approaches, culturally agile training for health care teams, enhanced decision support tools, and a more diverse health care workforce. Continued research and targeted interventions at individual, community, and societal levels are essential for improving perioperative outcomes.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Fluid Management and Intraoperative Blood Pressure and Patients' Outcome After Complex Spine Surgeries.","authors":"Ye Rin Koh, Yufei Li, Joan Koh, Elyad Ekrami, Xiaodan Liu, Maged Y Argalious, Mariel R Manlapaz, Christopher A Troianos, Michael P Steinmetz, Ehab Farag","doi":"10.1213/ANE.0000000000007358","DOIUrl":"10.1213/ANE.0000000000007358","url":null,"abstract":"<p><strong>Background: </strong>Both intraoperative hypotension and excessive fluid administration can lead to detrimental perioperative complications. However, how much fluid is considered excessive and how is intraoperative hypotension related to major postoperative complications?</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study in 6243 patients undergoing complex spine surgery at the Cleveland Clinic Foundation between 2012 and 2022 and studied the relationship between intraoperative net fluid administration and intraoperative hypotension with major postoperative complications. The primary outcome was a collapsed composite of postoperative complications including acute kidney injury (AKI), myocardial infarction (MI), stroke, and intensive care unit (ICU) admissions. Secondary outcomes were in-hospital postoperative pulmonary complications, surgical site infections (SSI), and mortality.</p><p><strong>Results: </strong>The study consisted of 6998 complex spinal surgery cases from 6243 patients. The median net fluid administration was 2100 mL (Interquartile range: 1450 to 3020 mL), and we found a change point in net fluid administration of 1865 mL (95% Confidence Interval: 1228 to 4710 mL). The odds ratio of developing postoperative complications for every 500 mL increase in net fluid administration was 1.16 (95% confidence interval [CI], 1.11-1.21; P < .0001) above and 0.87 (95% CI, 0.77-0.98; P = .026) below the change point. The odds ratio of developing postoperative pulmonary complications was 1.12 (95% CI, 1.07-1.18; P < .0001) for every 500 mL increase in net fluid administration.Intraoperative hypotension was detected in 2052 complex spine surgeries (29%). The odds ratio of developing any postoperative complication was 1.57 (95% CI, 1.37-1.80; P < .0001) and 1.30 (95% CI, 1.04-1.61; P = .019) for postoperative pulmonary complications.</p><p><strong>Conclusions: </strong>We discovered a change point in net fluid administration of 1,865mL. Above this change point, higher net fluid administration is associated with increased odds of developing postoperative complications. Intraoperative hypotension in complex spine surgeries was associated with increased postoperative complications.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1178-1187"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Underserved Populations Prescription Analgesic Use Before and After Lower Extremity Amputation in US Medicare.","authors":"Seonkyeong Yang, Debbie L Wilson, Lili Zhou, Deanna C Fernandes, Melanie Bell, Tze-Woei Tan, Chian Kent Kwoh, Ching-Yuan Chang, Pei-Lin Huang, Paige C Barker, Shunhua Yan, Wei-Hsuan Lo-Ciganic","doi":"10.1213/ANE.0000000000007160","DOIUrl":"10.1213/ANE.0000000000007160","url":null,"abstract":"<p><strong>Background: </strong>Racial disparities exist in access to health care and management of multiple health conditions including chronic pain; however, racial disparities in pre- and postoperative pain management in lower extremity amputation are not well-studied. Our objective was to examine the association between different racial and ethnic groups and prescription opioid and other analgesics use before and after lower extremity amputation. We hypothesize prescription opioid and other analgesic use among Black, Hispanic, and Native American US Medicare beneficiaries undergoing lower extremity amputations will be lower compared to White US Medicare beneficiaries.</p><p><strong>Methods: </strong>This retrospective cohort study included a 5% national sample of all Medicare beneficiaries from 2011 to 2015 and 15% national sample of fee-for-service Medicare beneficiaries from 2016 to 2018 undergoing nontraumatic, lower extremity amputations. The exposure of interest was racial and ethnic group membership (ie, Black, Hispanic, Native American, White, and others-with others being the combination of the categories Asian and other) as provided in Medicare claims data. Using multivariable generalized estimating equations with a logistic link to account for repeated measurements over time, we estimated the odds of prescription opioid use within 6 months before and after lower extremity amputation across different racial and ethnic groups separately, adjusting for sociodemographic and health status factors (eg, Elixhauser index). Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) were reported.</p><p><strong>Results: </strong>Among 16,068 eligible beneficiaries who underwent major and minor amputations (mean age = 65.1 ± 12.7 years; female = 36.1%), 10,107 (62.9%) were White, 3462 (21.5%) were Black, 1959 (12.2%) were Hispanic, 247 (1.5%) were Native American, and 151 (2.9%) were beneficiaries of other races. During the 6 months before lower extremity amputation, Hispanic beneficiaries (aOR, 0.71, 95% CI, 0.65-0.78) and beneficiaries of other races (aOR, 0.60, 95% CI, 0.47-0.76) had significantly lower odds of using prescription opioids compared to White beneficiaries. Similarly, Hispanic beneficiaries (aOR, 0.78, 95% CI, 0.71-0.84) and beneficiaries of other races (aOR, 0.63, 95% CI, 0.51-0.78) were associated with lower odds of opioid use in the 6 months after amputation compared to White beneficiaries.</p><p><strong>Conclusions: </strong>Among fee-for-service Medicare beneficiaries, Hispanic and other (eg, Asian) fee-for-service Medicare beneficiaries had lower odds of prescription opioid use than their White counterparts before and after nontraumatic, lower extremity amputations. Efforts to determine the underlying reasons are needed to ensure equitable health care access.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1205-1215"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Method for Comprehensive Analysis of Benzodiazepine, Opioid, and Propofol Interactions and Dose Selection Rationales in Gastrointestinal Endoscopy Sedation.","authors":"Jing-Yang Liou, Hsin-Yi Wang, I-Ting Kuo, Mei-Yung Tsou, Weng-Kuei Chang, Chien-Kun Ting","doi":"10.1213/ANE.0000000000007263","DOIUrl":"10.1213/ANE.0000000000007263","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to explore a new method for determining optimal dosing regimens for combinations of propofol, midazolam, and an opioid to achieve rapid on- and off-set of deep sedation.</p><p><strong>Methods: </strong>We simulated 16 published dosing regimens using a well-validated pharmacodynamic model. The study was divided into 2 parts. First, the regimen that best provided deep sedation and rapid recovery was selected. A deep sedation-time area-under-the-curve (AUC) method was used to compare published dosing regimens; a higher AUC indicated better sedation and faster recovery. Second, subgroup analysis of the best-performing dosing regimen was undertaken better to understand how each drug affected patient recovery.</p><p><strong>Results: </strong>The AUC method identified a combination of midazolam 1 mg, alfentanil 500 µg, and propofol target infusion effect-site concentration (Ce) 2 µg mL -1 as the optimal regimen ( P < .01). Propofol correlated with high probability of sedation and increased AUC (R 2 = 0.53), whereas midazolam had a significant impact on time to return of consciousness (R 2 = 0.86). Subgroup analysis indicated that regimens consisting of a fixed dose of alfentanil and either 5 µg mL -1 Ce propofol, or 1 mg midazolam with 3-5 µg mL -1 Ce of propofol, or 2 mg midazolam with 2 µg mL -1 Ce propofol provided adequate sedation and rapid recovery. Midazolam >3 mg greatly prolonged recovery.</p><p><strong>Conclusions: </strong>This study used a clinically relevant method and model simulation to determine suitable sedation regimens for use in gastrointestinal endoscopy. A balanced propofol, midazolam, and an opioid should be used. The AUC method was capable of providing objective assessments for model selection.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1168-1177"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accidental Epidural Infusion of Acetaminophen (Paracetamol) During Acute Postoperative and Labor Pain Management.","authors":"Santosh Patel","doi":"10.1213/ANE.0000000000007287","DOIUrl":"10.1213/ANE.0000000000007287","url":null,"abstract":"","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1230-1232"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"mRNA Expression of Mineralocorticoid and Glucocorticoid Receptors in Human and Mouse Sensory Neurons of the Dorsal Root Ganglia.","authors":"Katherine A Qualls, Feni K Kadakia, Elizabeth K Serafin, Debora De Nardin Lückemeyer, Steve Davidson, Judith A Strong, Jun-Ming Zhang","doi":"10.1213/ANE.0000000000007133","DOIUrl":"10.1213/ANE.0000000000007133","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroid receptors, including mineralocorticoid receptor (MR) and glucocorticoid receptor (GR), play important roles in inflammatory pain in the dorsal root ganglion (DRG). Although it is widely known that activating the GR reduces inflammatory pain, it has recently been shown that MR activation contributes to pain and neuronal excitability in rodent studies. Moreover, little is known about the translation of this work to humans, or the mechanisms through which corticosteroid receptors regulate inflammatory pain.</p><p><strong>Methods: </strong>Corticosteroid receptor expression in human and mouse DRGs was characterized. RNAscope was used to perform high-resolution in situ hybridization for GR and MR mRNAs and to examine their colocalization with markers for nociceptors ( SCN10A , Na V 1.8 mRNA) and Aβ mechanoreceptors ( KCNS1 , Kv9.1 mRNA) in human DRG and C57BL/6J mouse DRG samples.</p><p><strong>Results: </strong>GR and MR mRNAs are expressed in almost all DRG neurons across species. The 2 receptors colocalize in 99.2% of human DRG neurons and 95.9% of mouse DRG neurons ( P = .0004, Fisher exact test). In both human and mouse DRGs, the large-diameter KCNS1+ Aβ mechanoreceptors showed a significantly higher MR/GR ratio (MR-leaning) compared to KCNS1- neurons (human: 0.23 vs 0.04, P = .0002; mouse: 0.35 vs -0.24, P < .0001; log ratios, unpaired t test), whereas small-diameter SCN10A+ nociceptive neurons showed a significantly lower MR/GR ratio (GR-leaning) compared to SCN10A- neurons (human: -0.02 vs 0.18, P = .0001; mouse: -0.16 vs 0.08, P < .0001; log ratios, unpaired t test).</p><p><strong>Conclusions: </strong>These findings indicate that mouse corticosteroid receptor mRNA expression reflects human expression in the DRG, and that mice could be a suitable model for studying corticosteroid receptor involvement in pain. Additionally, this study supports the translatability of rodent data to humans for the use of more selective corticosteroids at the DRG in pain treatments.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1216-1226"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of the Simple Postoperative Acute Kidney Injury Risk Index in Patients Admitted to the Intensive Care Unit After Noncardiac Surgery.","authors":"Nan Li, Jinwei Wang, Weijie Zhou, Shuangling Li, Li Yang","doi":"10.1213/ANE.0000000000007320","DOIUrl":"10.1213/ANE.0000000000007320","url":null,"abstract":"<p><strong>Background: </strong>The Simple Postoperative AKI Risk (SPARK) index is a novel model for predicting risk of postoperative acute kidney injury (PO-AKI) among patients after noncardiac surgery. However, the performance of the index has been inconsistent partly due to heterogeneity in case mix and effects of the involved clinical features. To clarify potential reasons for poor performance, we tested the SPARK index in a cohort of high-risk patients requiring intensive care unit (ICU) care after noncardiac surgery and examined whether model modification by refitting coefficients of clinical features could optimize model performance.</p><p><strong>Methods: </strong>This was a single-center prospective cohort study. Preoperative variables of the SPARK index were extracted from electronic medical records. PO-AKI was defined by an increase in sCr ≥26.5 mmol/L within 48 hours or 150% compared with the preoperative baseline value within 7 days after surgery, whereas critical AKI was defined as AKI stage 2 or greater and/or any AKI connected to postoperative death or requiring renal replacement therapy during the hospital stay. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by the Hosmer-Lemeshow χ 2 test and calibration plot. Model modification was performed by rebuilding the model with the original variables of the SPARK index through proportional odds logistic regression among participants in the earlier study period and was validated in the later one.</p><p><strong>Results: </strong>A total of 973 patients were enrolled, among whom 79 (8.1%) PO-AKI cases and 14 (1.4%) critical AKI cases occurred. Our study participants demonstrated a higher SPARK risk score than the SPARK discovery cohort (eg, 8.02% vs 1.20% allocated in the highest risk group), and the incidence of both outcomes increased through the classes of the score (incidence proportion of PO-AKI increased from 2.56% in the lowest risk group to 25.64% in the highest risk group). The AUCs for PO-AKI and critical AKI were 0.703 (95% confidence interval [CI], 0.641-0.765) and 0.699 (95% CI, 0.550-0.848), respectively. The sensitivity, specificity, negative predictive value and positive predictive value were 68.35%, 57.49%, 95.36%, and 12.44%, respectively, when using 10% of predicted probability of PO-AKI as threshold. Calibration plots suggested acceptable consistency between the predicted and actual risk. After model modification, external validation demonstrated a significantly improved AUC for PO-AKI.</p><p><strong>Conclusions: </strong>The SPARK index showed fair discrimination and calibration among patients admitted to the ICU after noncardiac surgery. Modification of the model improved the performance of the model in terms of predicting PO-AKI.</p>","PeriodicalId":7784,"journal":{"name":"Anesthesia and analgesia","volume":" ","pages":"1140-1148"},"PeriodicalIF":4.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}