Anesthesiology最新文献

{"title":"Perioperative Care of Older Adults: Comment.","authors":"Matthew B Allen, Alexander B Stone","doi":"10.1097/ALN.0000000000005483","DOIUrl":"10.1097/ALN.0000000000005483","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"228-229"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257201","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":"Perioperative Care of Older Adults: Reply.","authors":"Karen B Domino, Frederick Sieber","doi":"10.1097/ALN.0000000000005485","DOIUrl":"10.1097/ALN.0000000000005485","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"230"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257203","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":"Assisted Fluid Management for Major Liver Surgery: Comment.","authors":"Guanyu Yang, Qinjun Chu","doi":"10.1097/ALN.0000000000005469","DOIUrl":"10.1097/ALN.0000000000005469","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"221"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257183","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":"Assisted Fluid Management for Major Liver Surgery: Comment.","authors":"Jitao Wang, Shizhong Yang, Jiahong Dong","doi":"10.1097/ALN.0000000000005470","DOIUrl":"10.1097/ALN.0000000000005470","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"221-222"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257184","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":"Getting Ahead of the Clot: Precision Medicine and Prediction of Perioperative Venous Thromboembolism.","authors":"Katherine T Forkin, Bhiken I Naik, Michael A Mazzeffi","doi":"10.1097/ALN.0000000000005516","DOIUrl":"10.1097/ALN.0000000000005516","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"12-14"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257194","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":"Polygenic Risk for Postoperative Nausea and Vomiting: Comment.","authors":"Eugênio Araújo Costa, Howard Lopes Ribeiro Junior","doi":"10.1097/ALN.0000000000005490","DOIUrl":"10.1097/ALN.0000000000005490","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"143 1","pages":"231-232"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257204","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":"Association between Adherence to Patient Blood Management Recommendations and Postoperative Complications in Hip and Knee Arthroplasty.","authors":"Albert Garcia-Casanovas, Elvira Bisbe, Adria Vizoso, Eugenia Sarsanedas, Anna Garcia-Altes, Maria J Colomina, Marta Barquero, Misericordia Basora","doi":"10.1097/ALN.0000000000005450","DOIUrl":"10.1097/ALN.0000000000005450","url":null,"abstract":"<p><strong>Background: </strong>Patient blood management (PBM) is a set of evidence-based practices that reduces the need for blood transfusions. However, its impact on relevant clinical outcomes remains unclear. The authors evaluated the association between adherence to guideline-recommended PBM care and 30-day postoperative complications in patients undergoing primary total knee and hip arthroplasty. Secondary outcomes included the length of hospital stay and erythrocyte utilization.</p><p><strong>Methods: </strong>This was a retrospective, multicenter cohort study including patients from 43 hospitals. The PBM clinical pathway comprised nine major guideline-recommended interventions, and adherence was assessed using a composite quality indicator. Multilevel multivariable regression models were used to evaluate the associations between PBM adherence and outcomes at the patient level while accounting for hospital characteristics and hospital variation.</p><p><strong>Results: </strong>A total of 30,926 patients who underwent primary total knee or hip arthroplasty between 2016 and 2022 at 43 hospitals were included. Of these, 1,335 (4.3%) had 30-day postoperative complications. The median adherence to the PBM clinical pathway was 60.0%. Higher PBM adherence was associated with fewer 30-day postoperative complications (adjusted odds ratio, 0.43; 95% CI, 0.32 to 0.58; P < 0.001), including 65% lower odds of major adverse cardiac events and 45% lower odds of infection. Additionally, higher adherence was associated with shorter hospital stays (adjusted incidence rate ratio, 0.77; 95% CI, 0.76 to 0.79; P < 0.001) and reduced transfusion rates (adjusted odds ratio, 0.11; 95% CI, 0.09 to 0.14; P < 0.001). Sensitivity analyses confirmed these associations.</p><p><strong>Conclusions: </strong>Adherence to the PBM clinical pathway was associated with improved outcomes. While causality cannot be established, these findings support the potential effectiveness of PBM in reducing postoperative complications and its efficiency in shortening hospital stays, beyond minimizing blood transfusions, in patients undergoing knee and hip arthroplasty.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"24-37"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630045","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":"A Risk Assessment Model for Predicting Perioperative Venous Thromboembolism in Patients Receiving Surgery under Anesthesia Care.","authors":"Aline M Grimm, Felix Borngaesser, Fran Ganz-Lord, Annika Bald, Peter Shamamian, Michael E Kiyatkin, Maíra I Rudolph, Greta M Eikermann, Ankeeta Shukla, Ling Zhang, Simon T Schaefer, Maximilian Schaefer, Sophia Riesemann, Annika Eyth, Pooja Kumar, Matthias Eikermann, Alex C Spyropoulos, Christopher Tam, Ibraheem M Karaye","doi":"10.1097/ALN.0000000000005480","DOIUrl":"10.1097/ALN.0000000000005480","url":null,"abstract":"<p><strong>Background: </strong>Perioperative venous thromboembolism (VTE), including pulmonary embolism and deep vein thrombosis, contributes significantly to morbidity, mortality, and healthcare costs of care. A reliable risk assessment model is essential for identifying patients at risk for perioperative VTE. This study aimed to develop and validate a model to predict VTE aligned with the Agency for Healthcare Research and Quality's Patient Safety Indicator 12, which tracks VTE occurrences from hospital admission through discharge. This approach may improve early identification and targeted prevention.</p><p><strong>Methods: </strong>We retrospectively analyzed hospital registry data from surgical patients at two tertiary care hospitals in the United States: Montefiore Medical Center in the Bronx, New York, and Beth Israel Deaconess Medical Center in Boston, Massachusetts. Data from Montefiore Medical Center between 2016 and 2021 were used for prediction model creation, while data from 2021 to 2023 served for internal temporal validation. We classified perioperative VTE if patients carried a new International Classification of Diseases code for deep vein thrombosis or pulmonary embolism, and a VTE-related imaging order was documented. Stepwise backward logistic regression and bootstrap resampling were employed for model development. Model performance was evaluated using the receiver operating characteristic curves and Brier score.</p><p><strong>Results: </strong>Among 319,134 surgical patients included in the study, 2,647 (0.8%) were diagnosed with perioperative VTE after hospital admission. The model exhibited robust discriminatory performance across all cohorts, with areas under the receiver operating characteristic curve (AUC) of 0.87 (95% CI, 0.86 to 0.89) in the development cohort, 0.84 (95% CI, 0.81 to 0.87) in the internal temporal validation cohort, and 0.76 (95% CI, 0.75 to 0.77) in the external validation cohort. By contrast, the Caprini score and Rogers risk assessment model exhibited significantly lower predictive accuracies of 0.66 and 0.51, respectively. Additionally, the prediction score exhibited strong performance in predicting VTE both in patients before surgery (AUC, 0.91; 95% CI, 0.89 to 0.93) and in those after surgery (AUC, 0.84; 95% CI, 0.82 to 0.86).</p><p><strong>Conclusions: </strong>We developed a clinically intuitive risk assessment model that predicts perioperative VTE across diverse surgical populations, based on the Agency for Healthcare Research and Quality's definition. This model demonstrates superior performance compared to existing instruments, offering the potential for improved VTE prevention during hospitalization.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"71-83"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778755","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":"Predictive Value of a Novel Frailty Index for Cardiovascular Outcomes after Major Noncardiac Surgery: A Prospective Cohort Study.","authors":"Yi-Shan Xie, Shao-Hui Lei, Shi-Kun Wen, Jia-Qi Wang, Ya Zhang, Jia-Ming Liu, Wen-Chi Luo, Zhen-Lue Li, Huan-Chuan Peng, Ke-Xuan Liu, Bing-Cheng Zhao","doi":"10.1097/ALN.0000000000005426","DOIUrl":"10.1097/ALN.0000000000005426","url":null,"abstract":"<p><strong>Background: </strong>Older patients undergoing noncardiac surgery are at risk of postoperative cardiovascular events. Accurate cardiovascular risk assessment is important for informed decision-making.</p><p><strong>Methods: </strong>This prospective cohort study enrolled older patients undergoing elective major noncardiac surgery. A frailty index based on preoperative geriatric assessment (FI-PGA) was constructed using 32 health-related parameters. The primary outcome was the occurrence of any cardiovascular events within 30 days after surgery. The associations between the FI-PGA and outcomes were assessed using logistic regression models. The added predictive value was evaluated by comparing nested models using improvement in model fit, fraction of new predictive information, net reclassification improvement, and decision curve analysis. The predictive performance of the Clinical Frailty Scale was also evaluated.</p><p><strong>Results: </strong>A total of 1,808 patients were included, with 316 (17.5%) patients experiencing the primary outcome. The FI-PGA was associated with increased odds of the primary outcome after adjustment for clinical predictors (odds ratio, 1.56; 95% CI, 1.33 to 1.82 per 0.1-point increment), and clinical predictors plus preoperative N-terminal pro-B-type natriuretic peptide (odds ratio, 1.37; 95% CI, 1.16 to 1.61 per 0.1-point increment). Integration of the FI-PGA in prediction models significantly improved model fit and provided new predictive information. Net reclassification improvement analysis showed that adding the FI-PGA to risk models improved risk estimation for patients who did not develop postoperative cardiovascular events, but did not improve risk estimation for those who experienced events. Decision curves showed the models containing the FI-PGA achieved higher net benefit. Improved model performance was also observed when the Clinical Frailty Scale was used for frailty assessment, although the added predictive values appeared lower.</p><p><strong>Conclusions: </strong>A frailty index derived from preoperative multidimensional geriatric assessment can improve cardiovascular risk prediction before noncardiac surgery, primarily by improving risk estimation for patients who will not develop postoperative cardiovascular events.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"51-61"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490543","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":"Inpatient Postoperative Mortality: Comparing Patients Hospitalized Preoperatively to Those Having Elective Surgery.","authors":"Richard H Epstein, Franklin Dexter, Brenda G Fahy","doi":"10.1097/ALN.0000000000005477","DOIUrl":"10.1097/ALN.0000000000005477","url":null,"abstract":"<p><strong>Background: </strong>Perioperative death globally has been described as the third leading cause of death behind heart disease and malignant neoplasm and ahead of cerebrovascular disease. However, studies of all-cause perioperative mortality have not distinguished patients who were outpatients preoperatively (\"elective\") from patients having urgent surgery or having surgery on a day after their date of admission (\"nonelective\"). Strategies for reducing overall perioperative mortality are affected by whether most deaths occur after elective or nonelective surgery.</p><p><strong>Methods: </strong>The authors studied all adult patients undergoing major diagnostic or therapeutic surgery in Florida in 2021 and 2022 hospitalized 2 or more midnights. They compared those who survived to discharge or died between the elective and nonelective groups. Major hospital-acquired complications were considered as sensitivity analyses. The diversity of procedures (International Classification of Diseases, Tenth Revision-Procedure Coding System [ICD-10-PCS] codes) was quantified using the inverse of the internal Herfindahl.</p><p><strong>Results: </strong>Among the 1,245,537 hospitalizations studied, the nonelective group accounted for 94.5% (95% CI, 94.0 to 95.1%) of the 20,874 in-hospital deaths ( P < 0.0001 vs. 50% [\"most\"]). The nonelective group also accounted for most (70.0%) hospitalizations studied. The relative risk of death in the elective versus nonelective group was 0.13 (95% CI, 0.12 to 0.14; P < 0.0001 vs . 1.0). The relative risks of acute kidney injury, hospital-acquired pneumonia, a major adverse cardiovascular event, and infection were all less than 1.0 in the elective group. Hundreds of different ICD-10-PCS codes occurred commonly among patients who died, in both groups.</p><p><strong>Conclusions: </strong>Results of previous studies of all-cause perioperative mortality should not be applied to patients having elective major surgery because most deaths (approximately 95%) and most cases (70%) are in patients having nonelective major surgery ( i.e. , already admitted to the hospital or undergoing trauma-related surgery). From a public health perspective, interventions to reduce postoperative mortality should be primarily focused on patients who are inpatients before their first major surgical procedure.</p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"62-70"},"PeriodicalIF":9.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727518","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}