Pub Date : 2026-01-29DOI: 10.1016/j.jclinane.2026.112139
Michael G. Fitzsimons M.D. , Daniel Saddawi-Konefka M.D., M.B.A. , John Herman M.D. , Sarah Arnholz J.D. , Andy Gottlieb CNP , Keith H. Baker M.D., Ph.D.
Physicians suffer from the same medical, emotional, and psychiatric illnesses that those in non-medical careers do. These conditions may impair their performance, which could prove detrimental to the patients whose lives we are responsible for, especially in the specialty of anesthesiology. Yet, many physicians are reluctant to address their colleagues when performance appears impaired. In 2003, we implemented a substance use disorder (SUD) prevention program. Over the subsequent 20 years, the program evolved to include the critical component of professional intervention. Central to these interventions are prompt action, recognition of uncertainty, and a strong commitment to professionalism. The process emphasizes privacy, fairness, and dignity, with consistent application across all cases. Although our system arose from an effort to reduce substance use disorders, we believe that the process can be applied to other specialties even when drug testing is not involved.
{"title":"A framework for success: Compassionate interventions to support healthcare colleagues when concerns arise","authors":"Michael G. Fitzsimons M.D. , Daniel Saddawi-Konefka M.D., M.B.A. , John Herman M.D. , Sarah Arnholz J.D. , Andy Gottlieb CNP , Keith H. Baker M.D., Ph.D.","doi":"10.1016/j.jclinane.2026.112139","DOIUrl":"10.1016/j.jclinane.2026.112139","url":null,"abstract":"<div><div>Physicians suffer from the same medical, emotional, and psychiatric illnesses that those in non-medical careers do. These conditions may impair their performance, which could prove detrimental to the patients whose lives we are responsible for, especially in the specialty of anesthesiology. Yet, many physicians are reluctant to address their colleagues when performance appears impaired. In 2003, we implemented a substance use disorder (SUD) prevention program. Over the subsequent 20 years, the program evolved to include the critical component of professional intervention. Central to these interventions are prompt action, recognition of uncertainty, and a strong commitment to professionalism. The process emphasizes privacy, fairness, and dignity, with consistent application across all cases. Although our system arose from an effort to reduce substance use disorders, we believe that the process can be applied to other specialties even when drug testing is not involved.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112139"},"PeriodicalIF":5.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074537","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}
Pub Date : 2026-01-21DOI: 10.1016/j.jclinane.2026.112133
Richard D. Urman , Andreas H. Taenzer , Albert Dahan , Alparslan Turan , Basem B. Abdelmalak , Bernd Saugel , Bhargavi Gali , Robert H. Dworkin , Faisal N. Masud , Frances Chung , Ken B. Johnson , Piyush Mathur , Michael Wong , Rutger van der Schrier , Sabry Ayad , Toby N. Weingarten , Tong Joo Gan (TJ) , Ashish K. Khanna
{"title":"Improving definitions and innovations for identification and prevention of postoperative opioid-induced respiratory depression (OIRD): Proceedings of the International Consensus Conference","authors":"Richard D. Urman , Andreas H. Taenzer , Albert Dahan , Alparslan Turan , Basem B. Abdelmalak , Bernd Saugel , Bhargavi Gali , Robert H. Dworkin , Faisal N. Masud , Frances Chung , Ken B. Johnson , Piyush Mathur , Michael Wong , Rutger van der Schrier , Sabry Ayad , Toby N. Weingarten , Tong Joo Gan (TJ) , Ashish K. Khanna","doi":"10.1016/j.jclinane.2026.112133","DOIUrl":"10.1016/j.jclinane.2026.112133","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112133"},"PeriodicalIF":5.1,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023980","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}
Pub Date : 2026-01-13DOI: 10.1016/j.jclinane.2025.112108
Yanru Xiang , Mingyue Xia , Xingping Dai
{"title":"PPI and postinduction hypotension: Null association or methodological artifact?","authors":"Yanru Xiang , Mingyue Xia , Xingping Dai","doi":"10.1016/j.jclinane.2025.112108","DOIUrl":"10.1016/j.jclinane.2025.112108","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112108"},"PeriodicalIF":5.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980111","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}
Pub Date : 2026-01-09DOI: 10.1016/S0952-8180(26)00002-4
{"title":"On the Cover - King et al","authors":"","doi":"10.1016/S0952-8180(26)00002-4","DOIUrl":"10.1016/S0952-8180(26)00002-4","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112124"},"PeriodicalIF":5.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938767","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}
Pub Date : 2026-01-07DOI: 10.1016/j.jclinane.2026.112123
Chao Chen , Shengfeng Yang , Yewei Shi , Zhenyan Zhu , Xinglong Xiong , Ling Huang , Jun Lu , Guangling Tang , Xianzhou Gu , Guangdi Zhang , Yu Wan , Ruixue Zhai , Sijie Tang , Yuanyu Feng , Yusu Wang , Jielei Pan , Jing Shi
Background
Perioperative neurocognitive disorders (PND) significantly affect recovery in older adult surgical patients. However, whether untreated preoperative sleep disturbance (SD) independently contributes to postoperative cognitive dysfunction (POCD) remains unclear.
Methods
This multicenter prospective cohort study involving 535 patients aged ≥60 years undergoing major non-cardiac surgery (≥2 h) was conducted between June 30, 2024 and May 31, 2025. Patients were stratified by Pittsburgh Sleep Quality Index (PSQI): SD (PSQI>7, n = 288) or non-SD (PSQI≤7, n = 247). The primary outcome was POCD assessed on postoperative days 7, 30, 90, and 180. Secondary outcomes included postoperative delirium (days 1–3), 15-item quality of recovery (QoR-15) scores, and insomnia severity (days 30, 90, and 180). Generalized estimating equations identified independent predictors of POCD.
Results
Compared with non-SD patients, SD patients showed significantly increased POCD risk on postoperative day 7 (41.7 % vs. 27.1 %; RR = 1.44, 95 %CI 1.16–1.79; P < 0.001), day 30 (36.1 % vs. 18.2 %; RR = 1.73, 95 %CI 1.33–2.25; P < 0.001), day 90 (25.7 % vs. 13.0 %; RR = 1.66, 95 %CI 1.22–2.25; P < 0.001), and day 180 (19.4 % vs. 8.9 %; RR = 1.75, 95 %CI 1.21–2.52; P < 0.001). Preoperative SD was associated with increased delirium risk (29.9 % vs. 18.6 %; RR = 1.43, P = 0.006), poorer QoR-15 scores (difference = 8, P < 0.001), and persistent insomnia (34.7 % vs. 13.8 % at day 180, P < 0.001). PSQI≥10 optimally predicted POCD risk (sensitivity 71.8 %, specificity 69.4 %).
Conclusions
Untreated preoperative SD independently predicts both early delirium and POCD after major non-cardiac surgery. A PSQI≥10 effectively identifies high-risk older adult patients, emphasizing preoperative sleep optimization as a potential strategy to mitigate postoperative cognitive impairment.
背景围手术期神经认知障碍（PND）显著影响老年外科患者的康复。然而，术前未治疗的睡眠障碍（SD）是否会独立导致术后认知功能障碍（POCD）仍不清楚。方法本多中心前瞻性队列研究于2024年6月30日至2025年5月31日进行，纳入535例年龄≥60岁、接受重大非心脏手术（≥2小时）的患者。采用匹兹堡睡眠质量指数（PSQI）对患者进行分层：SD （PSQI>7, n = 288）和非SD （PSQI≤7,n = 247）。术后7天、30天、90天和180天评估POCD。次要结局包括术后谵妄（1-3天）、15项恢复质量（QoR-15）评分和失眠严重程度（30、90和180天）。广义估计方程确定了POCD的独立预测因子。结果与非SD患者相比，SD患者术后第7天（41.7% vs. 27.1%; RR = 1.44, 95% CI 1.16-1.79; P < 0.001）、第30天（36.1% vs. 18.2%; RR = 1.73, 95% CI 1.33-2.25; P < 0.001）、第90天（25.7% vs. 13.0%; RR = 1.66, 95% CI 1.22-2.25; P < 0.001）、第180天（19.4% vs. 8.9%; RR = 1.75, 95% CI 1.21-2.52; P < 0.001）的POCD风险显著增加。术前SD与谵妄风险增加（29.9% vs. 18.6%; RR = 1.43, P = 0.006）、较差的QoR-15评分（差异= 8,P < 0.001）和持续失眠（第180天34.7% vs. 13.8%, P < 0.001）相关。PSQI≥10最能预测POCD风险（敏感性71.8%，特异性69.4%）。结论术前经治疗的SD可独立预测重大非心脏手术后早期谵妄和POCD。PSQI≥10有效识别高危老年患者，强调术前睡眠优化是减轻术后认知障碍的潜在策略。
{"title":"Impact of preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study","authors":"Chao Chen , Shengfeng Yang , Yewei Shi , Zhenyan Zhu , Xinglong Xiong , Ling Huang , Jun Lu , Guangling Tang , Xianzhou Gu , Guangdi Zhang , Yu Wan , Ruixue Zhai , Sijie Tang , Yuanyu Feng , Yusu Wang , Jielei Pan , Jing Shi","doi":"10.1016/j.jclinane.2026.112123","DOIUrl":"10.1016/j.jclinane.2026.112123","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative neurocognitive disorders (PND) significantly affect recovery in older adult surgical patients. However, whether untreated preoperative sleep disturbance (SD) independently contributes to postoperative cognitive dysfunction (POCD) remains unclear.</div></div><div><h3>Methods</h3><div>This multicenter prospective cohort study involving 535 patients aged ≥60 years undergoing major non-cardiac surgery (≥2 h) was conducted between June 30, 2024 and May 31, 2025. Patients were stratified by Pittsburgh Sleep Quality Index (PSQI): SD (PSQI>7, <em>n</em> = 288) or non-SD (PSQI≤7, <em>n</em> = 247). The primary outcome was POCD assessed on postoperative days 7, 30, 90, and 180. Secondary outcomes included postoperative delirium (days 1–3), 15-item quality of recovery (QoR-15) scores, and insomnia severity (days 30, 90, and 180). Generalized estimating equations identified independent predictors of POCD.</div></div><div><h3>Results</h3><div>Compared with non-SD patients, SD patients showed significantly increased POCD risk on postoperative day 7 (41.7 % vs. 27.1 %; RR = 1.44, 95 %CI 1.16–1.79; <em>P</em> < 0.001), day 30 (36.1 % vs. 18.2 %; RR = 1.73, 95 %CI 1.33–2.25; <em>P</em> < 0.001), day 90 (25.7 % vs. 13.0 %; RR = 1.66, 95 %CI 1.22–2.25; <em>P</em> < 0.001), and day 180 (19.4 % vs. 8.9 %; RR = 1.75, 95 %CI 1.21–2.52; <em>P</em> < 0.001). Preoperative SD was associated with increased delirium risk (29.9 % vs. 18.6 %; RR = 1.43, <em>P</em> = 0.006), poorer QoR-15 scores (difference = 8, <em>P</em> < 0.001), and persistent insomnia (34.7 % vs. 13.8 % at day 180, <em>P</em> < 0.001). PSQI≥10 optimally predicted POCD risk (sensitivity 71.8 %, specificity 69.4 %).</div></div><div><h3>Conclusions</h3><div>Untreated preoperative SD independently predicts both early delirium and POCD after major non-cardiac surgery. A PSQI≥10 effectively identifies high-risk older adult patients, emphasizing preoperative sleep optimization as a potential strategy to mitigate postoperative cognitive impairment.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"110 ","pages":"Article 112123"},"PeriodicalIF":5.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903816","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}
Pub Date : 2026-01-03DOI: 10.1016/j.jclinane.2025.112107
Eduardo Mendez-Pino , Laura Ibanez-Pintor , Laura Mendez-Pino , Andres Zorrilla-Vaca , David L. Hepner
Background
There is increasing evidence supporting the use of intravenous (IV) iron in the perioperative setting, which has been shown to improve hemoglobin levels and reduce the need for transfusion. This study aimed to evaluate the efficacy of a single preoperative IV infusion of ferric derisomaltose administered 3 to 4 weeks prior to abdominal surgery in increasing hemoglobin (Hb) levels.
Methods
This single arm prospective trial with pos-hoc matched controls included adult patients with preoperative iron deficiency anemia (Hb ≤ 12 g/dL, and ferritin<30 ng/mL or transferrin saturation < 20 %) scheduled for abdominal surgery and treated with 1000 mg of IV ferric derisomaltose 3–4 weeks prior to surgery. The primary outcome was the change in Hb from baseline to the day of surgery. Between-group comparisons were performed using the paired t-test. A random control cohort who met our inclusion criteria but did not receive the treatment was included in a post-hoc analysis to evaluate associations with in-hospital blood transfusion.
Results
Among 36 patients treated with IV ferric derisomaltose, there was a significant improvement in hemoglobin levels after 3–4 weeks of drug administration (mean difference [MD] 1.88 g/dL, 95 % confidence interval [CI] 1.40 to 2.36) and after surgery (MD 0.67 g/dL, 95 %CI 0.16 to 1.17). Patients with moderate-to-severe pre-infusion anemia (Hb ≤ 10 g/dL) had a significantly superior improvement in Hb levels compared to patients with mild anemia (P = 0.03). In post-hoc analysis including a control group, transfusion rate was similar between the treated and control group (odds ratio 1.00, 95 %CI 0.29–3.48).
Conclusion
In this preliminary report with limited sample size, our findings suggest that a single preoperative dose of 1000 mg of IV ferric derisomaltose improves hemoglobin levels. Its ability to provide timely optimization before surgery warrants further investigation in large-scale trials to better define its role in perioperative care.
{"title":"Intravenous ferric derisomaltose for preoperative anemia in abdominal surgery","authors":"Eduardo Mendez-Pino , Laura Ibanez-Pintor , Laura Mendez-Pino , Andres Zorrilla-Vaca , David L. Hepner","doi":"10.1016/j.jclinane.2025.112107","DOIUrl":"10.1016/j.jclinane.2025.112107","url":null,"abstract":"<div><h3>Background</h3><div>There is increasing evidence supporting the use of intravenous (IV) iron in the perioperative setting, which has been shown to improve hemoglobin levels and reduce the need for transfusion. This study aimed to evaluate the efficacy of a single preoperative IV infusion of ferric derisomaltose administered 3 to 4 weeks prior to abdominal surgery in increasing hemoglobin (Hb) levels.</div></div><div><h3>Methods</h3><div>This single arm prospective trial with pos-hoc matched controls included adult patients with preoperative iron deficiency anemia (Hb ≤ 12 g/dL, and ferritin<30 ng/mL or transferrin saturation < 20 %) scheduled for abdominal surgery and treated with 1000 mg of IV ferric derisomaltose 3–4 weeks prior to surgery. The primary outcome was the change in Hb from baseline to the day of surgery. Between-group comparisons were performed using the paired <em>t-</em>test. A random control cohort who met our inclusion criteria but did not receive the treatment was included in a <em>post-hoc</em> analysis to evaluate associations with in-hospital blood transfusion.</div></div><div><h3>Results</h3><div>Among 36 patients treated with IV ferric derisomaltose, there was a significant improvement in hemoglobin levels after 3–4 weeks of drug administration (mean difference [MD] 1.88 g/dL, 95 % confidence interval [CI] 1.40 to 2.36) and after surgery (MD 0.67 g/dL, 95 %CI 0.16 to 1.17). Patients with moderate-to-severe pre-infusion anemia (Hb ≤ 10 g/dL) had a significantly superior improvement in Hb levels compared to patients with mild anemia (<em>P</em> = 0.03). In <em>post-hoc</em> analysis including a control group, transfusion rate was similar between the treated and control group (odds ratio 1.00, 95 %CI 0.29–3.48).</div></div><div><h3>Conclusion</h3><div>In this preliminary report with limited sample size, our findings suggest that a single preoperative dose of 1000 mg of IV ferric derisomaltose improves hemoglobin levels. Its ability to provide timely optimization before surgery warrants further investigation in large-scale trials to better define its role in perioperative care.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112107"},"PeriodicalIF":5.1,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880369","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}
Pub Date : 2026-01-03DOI: 10.1016/j.jclinane.2025.112112
Susana Priego-Jiménez PhD , Pablo Priego Jiménez PhD , María López-González MsC , Patricia Lorenzo-García PhD , Miguel Contreras-Molina MsC , Celia Álvarez-Bueno PhD
Background
Prehabilitation has reported improvements in exercise capacity, as measured by the six-minute walking test (6MWT), in people undergoing major abdominal and cardiothoracic surgery, although there is no evidence about which component of prehabilitation is most effective for improving exercise capacity.
Methods
A network meta-analysis (NMA) was performed to determine the effects of different components of prehabilitation on exercise capacity in people undergoing major abdominal or cardiothoracic surgery. A literature search was performed from baseline to September 2025. Randomized controlled trials on the effectiveness of prehabilitation programs on exercise capacity presurgery and recovery postsurgery were included. We assessed the risk of bias via the Cochrane risk of bias (RoB 2.0) tool and the quality of the evidence via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Pairwise meta-analyses and NMAs were performed for direct and indirect evidence.
Results
Thirty-eight studies were included in this NMA. The effects associated with improvements in exercise capacity presurgery scores were greatest for the moderate-intensity exercise group versus control group (Effect size [ES]: 0.93 95 % CI: 0.46, 1.40), followed by the multimodal group (exercise+ nutrition + psychological intervention) versus the control group (ES: 0.50, 95 % CI: 0.15, 0.86). The effects associated with 6MWT recovery postsurgery score were greatest for the exercise+ nutrition group versus the control group (ES: 1.08, 95 % CI: 0.00, 2.16), followed by the moderate-intensity exercise group versus the control group (ES: 0.55, 95 % CI: 0.08, 1.01), and the multimodal group versus the control group (ES: 0.35, 95 % CI: 0.03, 0.68).
Conclusions
Moderate-intensity exercise, followed by multimodal exercise, should be considered the most effective strategy for improving exercise capacity in people undergoing major abdominal and cardiothoracic surgery. Exercise plus nutrition is the most effective intervention to improve 6MWT recovery postsurgery, followed by moderate-intensity exercise and multimodal interventions. Owing to the importance of this outcome, as a predictor of both postsurgical complications and recovery capacity after surgery, it is essential to know the most effective intervention to improve it.
{"title":"Efficacy of prehabilitation interventions on exercise capacity of patients undergoing major abdominal and cardiothoracic surgery: A systematic review and network meta-analysis of randomized controlled trials","authors":"Susana Priego-Jiménez PhD , Pablo Priego Jiménez PhD , María López-González MsC , Patricia Lorenzo-García PhD , Miguel Contreras-Molina MsC , Celia Álvarez-Bueno PhD","doi":"10.1016/j.jclinane.2025.112112","DOIUrl":"10.1016/j.jclinane.2025.112112","url":null,"abstract":"<div><h3>Background</h3><div>Prehabilitation has reported improvements in exercise capacity, as measured by the six-minute walking test (6MWT), in people undergoing major abdominal and cardiothoracic surgery, although there is no evidence about which component of prehabilitation is most effective for improving exercise capacity.</div></div><div><h3>Methods</h3><div>A network meta-analysis (NMA) was performed to determine the effects of different components of prehabilitation on exercise capacity in people undergoing major abdominal or cardiothoracic surgery. A literature search was performed from baseline to September 2025. Randomized controlled trials on the effectiveness of prehabilitation programs on exercise capacity presurgery and recovery postsurgery were included. We assessed the risk of bias via the Cochrane risk of bias (RoB 2.0) tool and the quality of the evidence via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Pairwise meta-analyses and NMAs were performed for direct and indirect evidence.</div></div><div><h3>Results</h3><div>Thirty-eight studies were included in this NMA. The effects associated with improvements in exercise capacity presurgery scores were greatest for the moderate-intensity exercise group versus control group (Effect size [ES]: 0.93 95 % CI: 0.46, 1.40), followed by the multimodal group (exercise+ nutrition + psychological intervention) versus the control group (ES: 0.50, 95 % CI: 0.15, 0.86). The effects associated with 6MWT recovery postsurgery score were greatest for the exercise+ nutrition group versus the control group (ES: 1.08, 95 % CI: 0.00, 2.16), followed by the moderate-intensity exercise group versus the control group (ES: 0.55, 95 % CI: 0.08, 1.01), and the multimodal group versus the control group (ES: 0.35, 95 % CI: 0.03, 0.68).</div></div><div><h3>Conclusions</h3><div>Moderate-intensity exercise, followed by multimodal exercise, should be considered the most effective strategy for improving exercise capacity in people undergoing major abdominal and cardiothoracic surgery. Exercise plus nutrition is the most effective intervention to improve 6MWT recovery postsurgery, followed by moderate-intensity exercise and multimodal interventions. Owing to the importance of this outcome, as a predictor of both postsurgical complications and recovery capacity after surgery, it is essential to know the most effective intervention to improve it.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"109 ","pages":"Article 112112"},"PeriodicalIF":5.1,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880472","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}
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