British journal of anaesthesia最新文献

{"title":"Frailty and perioperative outcomes: SNAP-3 as a call to action","authors":"Daniel I. McIsaac ,&nbsp;Leandra Amado","doi":"10.1016/j.bja.2025.05.027","DOIUrl":"10.1016/j.bja.2025.05.027","url":null,"abstract":"<div><div>Generalisable, prospectively collected data from 7800 older UK surgical patients in the 3^rd Sprint National Anesthesia Project (SNAP-3) confirm that the presence of frailty is a key risk factor for adverse outcomes among older surgical patients. What comes next? Anaesthetists should strive to identify all patients with a Clinical Frailty Scale score ≥4 as being at elevated risk. Researchers, in collaboration with patients, clinicians and health system leaders, should move from a scientific focus on frailty as a risk factor to developing and evaluating interventions to improve outcomes for the growing population of surgical patients with frailty.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 293-295"},"PeriodicalIF":9.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504881","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":"Frailty and perioperative outcomes: SNAP-3 as a call to action","authors":"Daniel I. McIsaac, Leandra Amado","doi":"10.1016/j.bja.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.027","url":null,"abstract":"Generalisable, prospectively collected data from 7800 older UK surgical patients in the 3<ce:sup loc=\"post\">rd</ce:sup> Sprint National Anesthesia Project (SNAP-3) confirm that the presence of frailty is a key risk factor for adverse outcomes among older surgical patients. What comes next? Anaesthetists should strive to identify all patients with a Clinical Frailty Scale score ≥4 as being at elevated risk. Researchers, in collaboration with patients, clinicians and health system leaders, should move from a scientific focus on frailty as a risk factor to developing and evaluating interventions to improve outcomes for the growing population of surgical patients with frailty.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503697","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":"Description and validation of the Postoperative Discharge Recovery State outcome: a patient-partnered population-based cohort study.","authors":"Emily Hladkowicz,Gurlavine Kidd,Alana Flexman,Allan Garland,Julie Hallet,Daniel Kobewka,Matthew McGarr,Robert Talarico,Carl van Walraven,Duminda N Wijeysundera,Camilla L Wong,Daniel I McIsaac,,","doi":"10.1016/j.bja.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.020","url":null,"abstract":"BACKGROUNDOlder adults prioritise independent return home after surgery. Most discharge outcomes are binary composites that do not incorporate temporal information. We defined and validated a novel ordinal outcome, the Postoperative Discharge Recovery State, and prioritised its temporal measurement, to overcome these limitations.METHODSThis retrospective cohort study was conducted with patient partnership. Adults ≥65 yr having major, elective, noncardiac, non-orthopaedic surgery were identified from 2012 to 2022 using linked, routinely collected data in Ontario, Canada. Construct, convergent, and predictive validity were estimated. A multivariable ordinal regression model was derived and internally-externally validated.RESULTSWe included 84 422 older adult surgical patients. At the patient-prioritised postoperative day 90, the distribution of patients across Postoperative Discharge Recovery State categories was: (1) dead (2718; 3.2%); (2) hospitalised (1696; 2.0%); (3) in long-term care (179; 0.2%); (4) in rehabilitation (593; 0.7%); and (5) at home (79 236; 93.9%). Directionally expected associations with baseline characteristics supported construct validity. Consistency in associations over time supported reliability. Relationships with days alive and at home supported convergent (ρ=0.373) and predictive (fewer days at home with worse recovery state) validity. A prespecified ordinal logistic regression model had inadequate accuracy (c-statistic 0.700, poor calibration) to support its clinical use.CONCLUSIONSThe Postoperative Discharge Recovery State is a 5-level ordinal outcome that can be applied at key time points after surgery to quantify the proportion of patients in patient-prioritised discharge locations. Validity and reliability support utility, but further development will be required to maximise information gain relative to binary outcomes.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"635 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487996","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 polygenic and APOE-based genetic risk assessment for neurocognitive disorders: a biobank study of surgical patients.","authors":"Mariana Thedim,Jie Hu,Matthew Maher,Jeanine Wiener-Kronish,Richa Saxena,Susana Vacas","doi":"10.1016/j.bja.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.014","url":null,"abstract":"BACKGROUNDPreoperative risk assessment is a critical step in developing targeted preventive and therapeutic strategies. Although genetic biomarkers have shown considerable promise in assessing and stratifying dementia risk, their application in the perioperative period remains unexplored. Given the recognised effects of surgery and anaesthesia on perioperative cognitive trajectories, this study aimed to evaluate the preoperative neurocognitive genetic risk profiles of a surgical population and their influence on postoperative outcomes.METHODSData from the Mass General Brigham Biobank were analysed for male and female surgical patients aged 40-89 yr without a previous diagnosis of Alzheimer's disease. The polygenic risk score for Alzheimer's disease was calculated, and apolipoprotein E (APOE) genotypes were inferred from the study participants. Logistic regression was used to examine the associations between APOE genotype and the polygenic risk score for Alzheimer's disease with neurocognitive disorders.RESULTSThe surgical population comprised 33 526 patients, of whom 86% had European ancestry and 25% carried at least one APOE-ε4 allele. Among patients of European ancestry, the polygenic risk score for Alzheimer's disease was associated with higher risk of Alzheimer's disease (odds ratio [OR], 2.25 [95% confidence interval, 1.64-3.09]; false discovery rate [FDR] <0.001). Patients carrying APOE-ε4 alleles had an increased risk of neurocognitive disorders (e.g. delirium: OR, 1.32 [1.19-1.47], FDR <0.001; mild cognitive impairment: OR, 1.70 [1.49-1.94], FDR <0.001; and Alzheimer's disease: OR, 3.42 [2.72-4.29], FDR <0.001).CONCLUSIONSAPOE genotypes and polygenic risk scores are valuable for exploring neurocognitive genetic risk profiles in surgical populations and have the potential to enhance preoperative risk assessment strategies.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"46 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487998","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":"Frailty in the perioperative setting: lessons from SNAP-3","authors":"Simon J. Howell ,&nbsp;Jugdeep K. Dhesi","doi":"10.1016/j.bja.2025.05.024","DOIUrl":"10.1016/j.bja.2025.05.024","url":null,"abstract":"<div><div>The third Sprint National Anaesthesia Project (SNAP-3) is the largest prospective, multicentre UK study to examine the impact of frailty, multimorbidity, and delirium on postoperative outcomes in patients aged ≥60 yr. Conducted across 214 National Health Service (NHS) hospitals, SNAP-3 enrolled 7134 surgical patients over 5 days in March 2022. The investigators identified frailty in one-fifth of patients using multiple tools, including the Clinical Frailty Scale (CFS). Frailty was especially prevalent in emergency surgery and socioeconomically deprived populations. Multimorbidity was present in two-thirds of patients but only partially overlapped with frailty. Frailty was strongly associated with increased length of stay, delirium, complications, and mortality, with adverse outcomes escalating with higher CFS scores. In contrast, multimorbidity (without frailty) had limited association with most adverse outcomes. Directed acyclic graphs guided causal analysis, but by assuming frailty and multimorbidity were independent, the investigators might have underestimated the impact of multimorbidity. SNAP-3 highlights the need for routine perioperative frailty screening, comprehensive perioperative services, and workforce development. The data inform service planning and support prioritisation of frailty-focused care, especially in high-burden specialties and deprived areas.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 296-299"},"PeriodicalIF":9.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487999","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":"Geographic isolation, rurality, and outcomes after critical illness: a retrospective cohort study of emergency admissions to critical care units in Scotland 2010-2021.","authors":"Ryan D McHenry,Christopher E J Moultrie,Alasdair R Corfield,Nazir I Lone,Rich Mitchell,Daniel F Mackay,Jill P Pell","doi":"10.1016/j.bja.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.019","url":null,"abstract":"BACKGROUNDThe association between rurality, geographic isolation, and outcomes in critical care is complex, and important to the design and implementation of robust healthcare systems. We therefore conducted a retrospective cohort study of adult (≥16 yr) emergency admissions to critical care units in Scotland 2010-21.METHODSData were linked across national inpatient records, the critical care database, and mortality records. Geographic isolation was determined by modelled travel time to the intensive care unit (ICU) and emergency department, and rurality by the national eight-fold Urban Rural Classification. Standardised admission rates were calculated, alongside survival analysis for all-cause mortality by isolation and rurality with ICU and hospital length of stay, and emergency hospital readmissions in the year after critical care admission.RESULTSA total of 50 914 first emergency admissions to the ICU over the study period were included in the analyses. Age-sex standardised admissions were 24.2% (95% confidence interval 19.4-28.2%) lower for areas ≥180 min from the ICU compared with areas <30 min from the ICU. No significant associations were demonstrated between mortality and any category of isolation. Greater mortality was demonstrated in other urban areas (settlements of 10 000 to 124 999 people) compared with large urban areas (settlements of ≥125 000 people) (adjusted hazard ratio 1.05, 95% confidence interval 1.01-1.08).CONCLUSIONSAdmission rates to critical care were lower for patients in more isolated and more rural areas. Further research should explore the mechanisms for these findings and consider if strengthened access to critical care transfer and resource in remote areas might improve health outcomes.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"51 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487997","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":"Differential nerve block: axons are not all the same, nor are local anaesthetics.","authors":"John Anthony Winston Wildsmith","doi":"10.1016/j.bja.2025.05.025","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.025","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"608 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335380","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":"Peel-away nasal trumpet for fibreoptic tracheal intubation: buckle resistance and geometry of 3D-printed prototypes with high performance in airway manikin simulations.","authors":"Andre Deosaran,Jessica Winakor,Justin D Kuligowski,Gregory W Fischer,Samuel Hellman,Takeshi Irie","doi":"10.1016/j.bja.2025.05.012","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.012","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335313","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":"Sustainability assessment of perioperative patient warming devices: a comparative life cycle assessment and costing","authors":"Thais Ayres Rebello ,&nbsp;Karina Spoyalo ,&nbsp;Gyan Chhipi-Shrestha ,&nbsp;Kasun Hewage ,&nbsp;Rehan Sadiq ,&nbsp;Andrea J. MacNeill","doi":"10.1016/j.bja.2025.03.040","DOIUrl":"10.1016/j.bja.2025.03.040","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative patient warming is an integral component of quality surgical care, subject to highly variable clinical practices. We evaluated the environmental and economic impacts of currently available patient warming methods.</div></div><div><h3>Methods</h3><div>We conducted a comparative life cycle assessment (LCA) and life cycle costing (LCC) of three active warming devices (forced air warmer, resistive blanket, and circulating water garment) using a functional unit of 1 h of active patient warming. Passive warming was investigated using a singular LCA and LCC of warmed flannel blankets, with the functional unit defined as the use of one warmed flannel blanket. These results were applied to eight clinical scenarios modelling different combinations of warming devices within perioperative settings. We used multicriteria decision analysis to aggregate environmental and financial impacts into sustainability indexes.</div></div><div><h3>Results</h3><div>The resistive blanket had the lowest environmental and economic impacts. The global warming potential and cumulative energy demand of the resistive blanket were &lt;7% and 25%, respectively, of the impacts assessed for the forced air warmer. The most sustainable patient warming pathway used the resistive blanket throughout the perioperative period. Clinical scenarios using flannel blankets before and after surgery entailed the highest environmental impacts, and the highest cost was incurred with the circulating water garment.</div></div><div><h3>Conclusions</h3><div>The environmental and economic sustainability of perioperative patient warming can be optimised by minimising flannel blankets and disposable consumables in the perioperative period and by using the resistive blanket for active warming. This study presents a novel multicriteria sustainability index and simulates clinically relevant scenarios to inform practical, evidence-based recommendations for sustainable patient warming.</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"135 2","pages":"Pages 440-448"},"PeriodicalIF":9.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335312","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":"Use and effectiveness of directed, closed-loop communication in the operating theatre: mixed methods analysis of simulated clinical emergencies.","authors":"Henrietta Lee,Alan F Merry,Robyn Woodward-Krohn,Jennifer M Weller","doi":"10.1016/j.bja.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.bja.2025.05.015","url":null,"abstract":"BACKGROUNDEffective team performance requires clear communication. Closed-loop communication has improved outcome measures across a range of clinical contexts. We explored the use and effectiveness of directed, closed-loop communication in the operating theatre. We hypothesised that directed, closed-loop communication would increase the proportion of requested actions that were completed. We explored actions completed with closed-loop and directed communication, request type, communication efficiency, and professional differences.METHODSThe study involved a mixed methods conversational analysis of eight operating theatre emergency simulations.RESULTSOf 150 requests for action, 12% used closed-loop and directed communication together and were associated with higher action completion rates than when neither or one strategy alone was used (100% vs 81%, P=0.030), 19% used closed-loop (with or without directed) communication and were associated with higher action completion rate than when closed-loop was not used (97% vs 80%, P=0.023), and 45% used directed (with or without closed-loop) communication and were not associated with a significant difference in action completion rate compared with when not used (86% vs 81%, P=0.256). We identified inefficiencies in response to requested tasks, including in time-critical tasks, such as no verbal response, repetition of request, or an initial response but no action.CONCLUSIONSDirected, closed-loop communication in simulated operating theatre emergencies was associated with increased task completion but was infrequently used. Inefficiencies and dropped requests have implications for team performance and patient safety. Our findings support implementing context-specific interventions to improve task management in operating theatre emergencies through improved communication clarity.","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"14 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328636","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}