British journal of anaesthesia最新文献

{"title":"Preoperative anaemia and iron deficiency in Wales: a national retrospective cohort study of postsurgical outcomes after major elective surgery.","authors":"Caroline R Evans, Jasmine Rollings, Rebecca Capel, Kathleen Withers, Stephanie Ditcham","doi":"10.1016/j.bja.2026.08.038","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.038","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anaemia is common among patients undergoing major surgery and is associated with increased length of hospital stay, readmission, and mortality. Iron deficiency is the primary cause of preoperative anaemia. This study aimed to describe the prevalence of anaemia and iron deficiency across surgical specialties in Wales and their impact on postoperative outcomes during the introduction of a nationwide patient blood management model.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult patients (aged ≥18 yr) undergoing major elective surgery (gastrointestinal, cardiac, urologic, gynaecologic, orthopaedic) between January 2018 and May 2025. As part of the NHS Wales Preoperative Anaemia Pathway, anaemia was defined as a haemoglobin concentration of <130 g L^-1. Iron deficiency was defined as a serum ferritin concentration of <30 μg L^-1 or transferrin saturation of <20%, with inflammation defined as a C-reactive protein concentration of >10 mg L^-1. Data collected included patient characteristics, Charlson Comorbidity Index, laboratory results, length of hospital stay, 30-day readmission, and mortality (30-day, 90-day, 1-yr, and 5-yr).</p><p><strong>Results: </strong>Among 46 614 patients, 31% were anaemic, with 52% of anaemic patients having iron deficiency. Preoperative anaemia was independently associated with prolonged length of hospital stay (adjusted rate ratio 1.17, 95% confidence interval [CI] 1.16-1.18), increased 30-day readmission (adjusted odds ratio 1.18, 95% CI 1.09-1.27), and higher mortality at all time points (adjusted odds ratio 1.69, 95% CI 1.54-1.85). Iron deficiency and anaemia with inflammation were associated with particularly poor outcomes.</p><p><strong>Conclusions: </strong>Preoperative anaemia and iron deficiency are prevalent in the surgical population and linked to worse short-term and long-term outcomes. These findings have implications for routine screening before surgery.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073649","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":"Adherence to guidelines for neuromuscular blocking agent use in anaesthesia and intensive care: a French national survey.","authors":"Aurélie Gouel-Chéron, Skerdi Haviari, Najeh Daabek, Benoit Plaud","doi":"10.1016/j.bja.2026.08.041","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.041","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073614","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":"Beyond risk scores: artificial intelligence representations of physiological resilience in surgical patients.","authors":"John Whittle, Evangelos Mazomenos","doi":"10.1016/j.bja.2026.08.037","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.037","url":null,"abstract":"<p><p>Current perioperative risk assessment relies largely on static models that estimate the probability of adverse outcomes using indirect, population-level proxies of physiological reserve. We argue that physiological resilience is better understood as an emergent, dynamic property of interacting biological systems, expressed within the broader context of surgical stress, anaesthetic care, and perioperative management. Modern artificial intelligence and machine learning architectures offer a paradigm shift, moving perioperative medicine beyond static risk calculators toward dynamic, multimodal representations of physiological state over time. Such representations provide the substrate for prescriptive analytics, actionable clinical decision support, and mechanism-informed perioperative care.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073628","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":"The inaugural World Prehabilitation Day: a global call to action.","authors":"Kate Alexander, Gabriele Baldini, Francesco Carli, Linda Denehy, Chelsia Gillis, Sandy Jack, Cherry Koh, Ana P Drummond-Lage, Denny Levett, Graciela Martinez-Palli, Leani Pereira, Jack Reeves, Daniel Santa Mina, Raquel Sebio, Gerrit Slooter, Daniel Steffens, Tiffany Tsoukalas, Malcolm West","doi":"10.1016/j.bja.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.004","url":null,"abstract":"<p><p>The inaugural World Prehabilitation Day, marked on September 16, 2026, represents an important milestone for a rapidly evolving field. More than 2 decades of research suggest that multimodal prehabilitation can improve functional recovery and reduce postoperative complications in selected populations and settings, although uncertainty remains regarding its effectiveness when implemented broadly in routine care. Closing this gap between efficacy and effectiveness will require precision targeting of high-risk patients, tighter integration of prehabilitation with enhanced recovery after surgery and rehabilitation as a single system of surgical optimisation, and economic and implementation evidence built into research from the outset. Health policy is beginning to respond, but realising this vision at scale, equitably, and beyond cancer surgery alone is the challenge the next decade must address.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073644","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":"Frequency and duration of prolonged preoperative clear liquid fasting in children: a subgroup analysis of the Million Anesthesia Cases Study^✰.","authors":"Ethan Lowder, Gulnihal M Dalgin, Justin R Baldovino Guerra, Moustafa Abdalla, Peter Frykholm, Girish P Joshi, Alexander Nagrebetsky","doi":"10.1016/j.bja.2026.07.071","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.071","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073619","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":"Prospective validation and real-time implementation of an automated machine learning postoperative mortality prediction model. Comment on Br J Anaesth 2026; 136: 1822-32.","authors":"Mathew Lyons","doi":"10.1016/j.bja.2026.07.076","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.076","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073560","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":"Analgesia for minimal access abdominal surgery: addressing the visceral wound.","authors":"Renato Pitesa, Kaukiterangi Blair, Andrew G Hill","doi":"10.1016/j.bja.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.bja.2026.09.005","url":null,"abstract":"<p><p>Postoperative analgesia in adults undergoing minimal access abdominal surgery involves autonomic or visceral injury. Although minimal access surgery reduces somatic pain, peritoneal inflammation and consequent visceral pain remain major drivers of postoperative physiology and recovery. Nonsteroidal anti-inflammatory drugs and corticosteroids are proved, critical components of visceral analgesia and should form the foundation of any regimen addressing the visceral wound. Intraperitoneal local anaesthetic instillation offers a complementary visceral pain-targeted adjunct, reducing visceral pain scores, opioid consumption, and delays in gastrointestinal recovery. As the somatic wound continues to decrease in size, we argue for a paradigm shift in analgesic regimes toward visceral pain-targeted approaches, positioning intraperitoneal local anaesthetic instillation as a key adjunct within enhanced recovery pathways and identifying priorities for future research on the optimisation of delivery methods and patient-reported outcomes.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073563","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":"The Postponement and Cancellations in Elective Care study. Comment on Br J Anaesth 2026; 136: 1925-34.","authors":"Mahmut S Tutar, Betul Kozanhan, Munise Yildiz","doi":"10.1016/j.bja.2026.08.042","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.042","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058518","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":"Outdoor air pollution as a potentially modifiable perioperative risk factor.","authors":"Morgan L King","doi":"10.1016/j.bja.2026.08.047","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.047","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058520","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":"Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults: endobronchial intubation, an overlooked risk after difficult airway management. Comment on Br J Anaesth 2026; 136: 283-307.","authors":"Sumit Bhuyan, James H Bamber","doi":"10.1016/j.bja.2026.07.072","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.072","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058538","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}