{"title":"Inequality in healthy lifespan after surgery: a longitudinal population study.","authors":"Yize I Wan, Rupert M Pearse, John R Prowle","doi":"10.1016/j.bja.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.009","url":null,"abstract":"<p><strong>Background: </strong>The impact of surgery on long-term disease across socioeconomic groups is unknown. We investigated the onset of long-term disease after surgery and differences between socioeconomic and ethnic groups.</p><p><strong>Methods: </strong>We conducted a longitudinal population study using linked primary and secondary care data, describing adults (≥18 yr) in England recorded in the Clinical Practice Research Datalink between January 1, 2012 and December 31, 2021. Socioeconomic deprivation was defined using the Index of Multiple Deprivation (IMD). The exposure was surgery, and the primary outcome was long-term disease.</p><p><strong>Results: </strong>Of 18 329 659 people, 8 951 145 (48.8%) underwent surgery (elective: n=7 032 475 [78.6%]; emergency: n=1 918 670 [21.4%]). Of these, 4 741 188 (52.0%) were female, 3 540 136 (39.6%) were from the most deprived deciles (IMD 1-4), and 994 595 (11.1%) were from a minority ethnic group. Age-standardised surgery rates were higher among deprived individuals (comparative rate ratio, IMD 1 vs IMD 10, elective: 1.11 [95% CI 1.11-1.11]; emergency: 1.54 [95% CI 1.54-1.54]). Rates of long-term disease increased after elective (baseline 19.6%, 3-yr 24.5%) and emergency surgery (baseline 10.3%, 3-yr 12.3%). Risk of new long-term disease after surgery increased with increasing levels of deprivation (IMD 1 vs IMD 10, elective: hazard ratio [HR] 1.45 [95% CI 1.43-1.46]; emergency: HR 1.45 [95% CI 1.42-1.48]).</p><p><strong>Conclusions: </strong>Surgical treatment is strongly associated with the onset of long-term disease and factors that limit healthy life expectancy. Surgery occurs at a younger age among socioeconomically deprived groups and could be linked to health inequalities.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944268","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}
Humphrey G M Walker, Daniel Loughnan, Nicholas Woodland, Samuel Finlayson, Ary Serpa Neto, Adam M Deane, Matthew W Semler, Alastair Brown
{"title":"Ketamine versus alternate agents to prevent postinduction haemodynamic instability during tracheal intubation of critically ill adults. Response to Br J Anaesth Advance Access published on Jul 20, 2026, doi: 10.1016/j.bja.2026.05.034.","authors":"Humphrey G M Walker, Daniel Loughnan, Nicholas Woodland, Samuel Finlayson, Ary Serpa Neto, Adam M Deane, Matthew W Semler, Alastair Brown","doi":"10.1016/j.bja.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.006","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918709","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":"Language, power, and access: large language models and equity in medicine.","authors":"Hazem Lashin","doi":"10.1016/j.bja.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.bja.2026.08.008","url":null,"abstract":"<p><p>Large language models (LLMs) are increasingly being integrated into anaesthesia, perioperative medicine, and critical care, creating new opportunities to improve communication, decision support, and access to healthcare knowledge. Realising these opportunities equitably depends not only on model capability but also on how LLMs are developed, implemented, used, and governed within healthcare systems. This editorial introduces the Bias Pyramid, a conceptual framework that explains how inequity can emerge across global knowledge ecosystems, institutional information environments, and individual clinical workflows, and identifies opportunities for equitable implementation. By incorporating reinforcing feedback, the framework conceptualises equity as an evolving property of learning healthcare systems that can either amplify existing inequities or progressively improve equity over successive learning cycles. The Bias Pyramid provides a practical implementation framework to guide governance, education, and coordinated action before LLMs become embedded in routine perioperative and critical care practice.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910848","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}
Elizabeth M O'Brien, Robert Gallop, Maya Washburn, Andrew Dumas, Nicky Como, Faith Kilungya, Steven M Willi, Elaina E Lin
{"title":"Delayed gastric emptying in adolescent patients on GLP-1 receptor agonists with standard preoperative fasting guidelines: a prospective cohort study.","authors":"Elizabeth M O'Brien, Robert Gallop, Maya Washburn, Andrew Dumas, Nicky Como, Faith Kilungya, Steven M Willi, Elaina E Lin","doi":"10.1016/j.bja.2026.07.016","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.016","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are approved in patients aged ≥10 yr for type 2 diabetes mellitus and aged ≥12 yr for obesity. We examined the effect of GLP1-RAs on the retention of gastric contents in fasting adolescents.</p><p><strong>Methods: </strong>This prospective cohort study examined adolescent patients (10-18 yr) at a single institution between June 2023 and November 2024. Three groups were compared: a GLP1-RA group; a group at-risk for delayed gastric emptying not on GLP1-RAs; and a healthy control group. All patients fasted 8 h for solids and 1 h for clears liquid. Gastric contents were examined utilising gastric ultrasound qualitatively on a 3-point scale, and quantitatively. The primary outcome was the number of adolescents on GLP1-RAs with residual gastric contents (presence of solids or gastric fluid volume ≥1.5 ml kg<sup>-1</sup>).</p><p><strong>Results: </strong>In total, 67 patients were analysed: 20 in the GLP1-RA group; 27 in the at-risk group; and 20 in the control group. The median age was 14.8 (interquartile range [IQR] 13.2-16.6) yr, and median fasting durations for solids and clears were 13 h (IQR 12-14) and 12 h (IQR 3.5-13), respectively. In the GLP1-RA group, 16/20 patients (80%) had solids present on gastric ultrasound, compared with 17/27 patients (63%) in the at-risk group and 1/20 patient (5%) in the control group (unadjusted P <0.001; adjusted P <0.02, with propensity score adjustment for age, body mass index, sex, race, and NPO time).</p><p><strong>Conclusions: </strong>We observed that 80% of adolescents on GLP1-RAs had solids on gastric ultrasound despite having fasted for over 12 h.</p>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910845","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":"Postoperative hypotension in patients recovering from noncardiac surgery: considerations on cohort selection, exploratory harm, and generalisability. Comment on Br J Anaesth 2026; 137: 66-73.","authors":"Haiyue Yu, Hang Lyu","doi":"10.1016/j.bja.2026.07.033","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.033","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910864","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":"Paediatric one-hour clear-fluid fasting: definition of the intervention and event-rate considerations. Comment on Br J Anaesth 2026; 136: 158-66.","authors":"Xi-Lin Gao","doi":"10.1016/j.bja.2026.07.040","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.040","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891025","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}
Sophia Kalanski, Tristan Grogan, Maziar M Nourian, Jacques Neelankavil, Alexandre Joosten
{"title":"Perioperative discontinuation of SGLT2-inhibitors and cardiac complications after noncardiac surgery: is postoperative treatment resumption the critical factor? Comment on Br J Anaesth 2026; 137: 440-9.","authors":"Sophia Kalanski, Tristan Grogan, Maziar M Nourian, Jacques Neelankavil, Alexandre Joosten","doi":"10.1016/j.bja.2026.07.042","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.042","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890960","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}
Louise C. Savic,Priya Dias,Jai Vairale,Salma Begum,Kamran Khan,Alexander J. Fowler,Vikas Kaura,Sarah-Louise Watson,Anna Littlejohns,Rupert M. Pearse,Tom E.F. Abbott
{"title":"Drug allergy labels and complications after surgery: a prospective multicentre cohort study","authors":"Louise C. Savic,Priya Dias,Jai Vairale,Salma Begum,Kamran Khan,Alexander J. Fowler,Vikas Kaura,Sarah-Louise Watson,Anna Littlejohns,Rupert M. Pearse,Tom E.F. Abbott","doi":"10.1016/j.bja.2026.07.035","DOIUrl":"https://doi.org/10.1016/j.bja.2026.07.035","url":null,"abstract":"","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"150 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922895","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}