Journal of Clinical Anesthesia最新文献

{"title":"Individual FiO2 guided by SPO2 prevents hyperoxia and reduces postoperative atelectasis in colorectal surgery: A randomized controlled trial","authors":"Xia Wei ,&nbsp;Xia Kang ,&nbsp;Lijun Zhang ,&nbsp;Jinzhu Huang ,&nbsp;Weiyu Feng ,&nbsp;Pengyu Duan ,&nbsp;Bing Zhang","doi":"10.1016/j.jclinane.2024.111732","DOIUrl":"10.1016/j.jclinane.2024.111732","url":null,"abstract":"<div><h3>Study objective</h3><div>To determine whether individualized fraction of inspired oxygen (iFiO₂) improves pulmonary atelectasis after elective laparoscopic colorectal surgery relative to 60 % FiO₂.</div></div><div><h3>Design</h3><div>This was a single-center, prospective, randomized study.</div></div><div><h3>Setting</h3><div>This study was conducted in a single tertiary care hospital in China.</div></div><div><h3>Patients</h3><div>A total of 84 eligible inpatients who underwent elective laparoscopic colorectal surgery between August 2021 and May 2022 were included in the study.</div></div><div><h3>Interventions</h3><div>The patients were randomly assigned to receive either a fixed fraction of inspiration oxygen (fFiO₂ group) or individualized FiO₂ based on physiological SpO₂ (iFiO₂ group).</div></div><div><h3>Measurements</h3><div>The primary outcome was the lung ultrasound score (LUS) at 30 min after extubation. Secondary outcomes included the length of hospital stay, admission to the intensive care unit, the length of post-anesthetic care unit stay, the ratio of lung capacity on the third day after surgery compared with before surgery, the incidence of nausea and vomiting, and surgical site infections after surgery. Additionally, the airway plate pressure, airway peak pressure, pulmonary dynamic compliance, PaO₂, oxygenation index, alveolar–arterial oxygen tension gradient (A-aDO₂), and pulmonary shunt fraction (Qs/Qt) were considered.</div></div><div><h3>Main results</h3><div>The LUS was significantly lowered in the iFiO₂ group (5 [4, 7]) compared with the fFiO₂ group (8 [4, 10]) (<em>P</em> = 0.03). Based on the criterion for determining atelectasis, 25 patients (62.5 %) in the fFiO₂ group experienced significant atelectasis compared with 15 patients (37.5 %) in the iFiO₂ group (<em>P</em> = 0.025). At the end of surgery, PaO₂, A-aDO₂, and Qs/Qt were significantly reduced in patients in the iFiO₂ group compared with those in the fFiO₂ group.</div></div><div><h3>Conclusions</h3><div>The use of iFiO₂ during operation significantly reduces the LUS and pulmonary atelectasis in patients undergoing laparoscopic colorectal surgery under general anesthesia.</div><div>Clinical trial registration: ChiCTRT2100049615.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111732"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial","authors":"Leonardo Marquez M.D. ,&nbsp;Sara Medellin M.D. ,&nbsp;Lu Wang M.S. ,&nbsp;Kamal Maheshwari M.D. ,&nbsp;Andrew Shaw M.B., F.R.C.A., F.R.C.P.C., M.M.H.C. ,&nbsp;Daniel I. Sessler M.D.","doi":"10.1016/j.jclinane.2025.111744","DOIUrl":"10.1016/j.jclinane.2025.111744","url":null,"abstract":"<div><div>Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.</div></div><div><h3>Objective</h3><div>Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.</div></div><div><h3>Design</h3><div>Secondary analysis of a single-center multiple cross-over cluster trial.</div></div><div><h3>Setting</h3><div>Intraoperative care.</div></div><div><h3>Patients</h3><div>We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.</div></div><div><h3>Interventions</h3><div>Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0–1, 1–2, 3–4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.</div></div><div><h3>Main results</h3><div>The risk of AKI did not differ significantly in patients given 0–1, 1–2, or 3–4 L saline or lactated Ringers solutions. In contrast, patients given 2–3 or &gt; 4 L of <em>lactated Ringer's</em> solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.</div></div><div><h3>Conclusions</h3><div>While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111744"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965160","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}

{"title":"Assessing the safety of tramadol use in breastfeeding women undergoing perioperative care","authors":"Betul Kozanhan,&nbsp;Munise Yildiz,&nbsp;Mahmut Sami Tutar","doi":"10.1016/j.jclinane.2024.111711","DOIUrl":"10.1016/j.jclinane.2024.111711","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111711"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824271","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}

{"title":"Artificial neural networks and machine learning in anesthesia and perioperative medicine: Reflections on the 2024 Nobel prize in physics","authors":"Yahui Xu ,&nbsp;Nie Zhang","doi":"10.1016/j.jclinane.2024.111737","DOIUrl":"10.1016/j.jclinane.2024.111737","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111737"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894686","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}

{"title":"Intertransverse process block (ITPB) at the retro-superior costotransverse ligament (retro-SCTL) space: Evaluation of local anesthetic spread using MRI and sensory blockade in healthy volunteers","authors":"Pawinee Pangthipampai MD ,&nbsp;Palanan Siriwanarangsun MD ,&nbsp;Jatuporn Pakpirom MD ,&nbsp;Ranjith Kumar Sivakumar MD ,&nbsp;Manoj Kumar Karmakar MD","doi":"10.1016/j.jclinane.2024.111718","DOIUrl":"10.1016/j.jclinane.2024.111718","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated the spread of a local anesthetic, using MRI and sensory blockade, after an intertransverse process block (ITPB) at the medial aspect of the retro-superior costotransverse ligament (retro-SCTL) space – the medial retro-SCTL space block.</div></div><div><h3>Methods</h3><div>Ten healthy volunteers received a single-injection ultrasound-guided medial retro-SCTL space block at the T4-T5 level using a mixture of 10 ml 0.5 % bupivacaine with 0.5 ml gadolinium. At 15 min, they underwent a high resolution, fat suppressed, T1 weighted MRI scan of the cervicothoracic spine. Loss of sensation to cold was assessed at 15 and 60 min, and then hourly for 5-h, after the block.</div></div><div><h3>Results</h3><div>MRI showed consistent (100 %) spread of local anesthetic to the intercostal and paravertebral spaces, anterolateral aspect of the vertebral body (sympathetic chain), costotransverse space, neural foramina, and epidural space in all participants. However, sensory blockade was variable across the ipsilateral hemithorax. Hypoesthesia was more common than anesthesia in both the anterior (median [IQR], 3.5 [2–5] vs 0 [0–1.25], <em>p</em> &lt; 0.001) and posterior (median [IQR], 6[3–7] vs 2[1–3], p &lt; 0.001) hemithorax. Additionally, more dermatomes exhibited anesthesia in the posterior compared to the anterior hemithorax (median [IQR], 2[1–3] vs 0[0–1.25], <em>p</em> = 0.01). A variable number of contralateral dermatomes were also affected in 3 (30 %) volunteers. There was no statistically significant correlation between the local anesthetic spread and the number of hypoesthetic (<em>r</em> = 0.53, <em>p</em> = 0.11) or anesthetic (<em>r</em> = 0.09, <em>p</em> = 0.78) dermatomes on the ipsilateral hemithorax.</div></div><div><h3>Conclusions</h3><div>A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111718"},"PeriodicalIF":5.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864433","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}

{"title":"Difficult airway management in 25 hospitals across China: A multicenter cross-sectional study","authors":"Zhi-hang Tang MD ,&nbsp;Qi Chen MD ,&nbsp;Wei Huang MD ,&nbsp;Jia-nan Wang MD ,&nbsp;Xiao-hua Zou PhD ,&nbsp;Yang Xiao PhD ,&nbsp;Xiao-tong Shi PhD ,&nbsp;Hai-hong Deng PhD ,&nbsp;Jing-jing Li PhD ,&nbsp;Lun Wu PhD ,&nbsp;Wen-zhi Liu PhD ,&nbsp;Si-guang Hu PhD ,&nbsp;Zheng-yang Zhou PhD ,&nbsp;Heng-ning Qi PhD ,&nbsp;Guo-hui Luan Phd ,&nbsp;Wei Luo PhD ,&nbsp;Yong Wang PhD ,&nbsp;Wu-hua Ma Phd","doi":"10.1016/j.jclinane.2025.111766","DOIUrl":"10.1016/j.jclinane.2025.111766","url":null,"abstract":"<div><h3>Study objective</h3><div>Difficult airway management is a significant challenge in clinical anesthesia, critical care, and emergency medicine. Inadequate management can lead to severe complications including organ damage and death. This study assessed the variability in difficult airway management across China and focused on how patient and operator factors influenced outcomes in operating rooms.</div></div><div><h3>Design</h3><div>A multicenter observational cross-sectional study.</div></div><div><h3>Setting</h3><div>This study was conducted from November 2022 to November 2023 and included 25 secondary and tertiary hospitals across various regions in China.</div></div><div><h3>Patients</h3><div>In the total of 181,399 general anesthesia patients, 384 (0.21 %) were identified as having difficult airways.</div></div><div><h3>Interventions</h3><div>Data were gathered from a specialized questionnaire comprising four sections with 27 questions and analyzed using logistic regression in SPSS to identify key factors that influenced effective management of difficult airways.</div></div><div><h3>Measurements</h3><div>This study focused on preoperative assessment, anesthesia selection, intubation attempts, and contingency planning for difficult airway management practices among anesthesiologists.</div></div><div><h3>Main results</h3><div>In anticipated difficult airways, rapid sequence induction was used in 51.7 % of the cases, maintaining spontaneous breathing under general anesthesia in 11.1 %, and awake intubation in 36 %. For unanticipated difficult airways, 95.9 % of the anesthesiologists opted for rapid sequence induction. Limited mouth opening was the most common cause of difficult airways and obesity and ankylosing spondylitis were identified as significant factors. The logistic regression analysis identified the type of difficult airway, anesthesiologist experience, and assessment methods as key factors influencing the first attempt intubation success.</div></div><div><h3>Conclusions</h3><div>The accuracy of difficult airway assessment and first attempt intubation success is influenced by both patient-related factors and the anesthesiologist's expertise. Regional and institutional variability in decision-making and tool selection underscores the critical need for standardized guidelines and comprehensive training to enhance airway management outcomes across diverse clinical settings in China.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111766"},"PeriodicalIF":5.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065869","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}

{"title":"Percentage contribution of anesthetic induction on total case fresh gas flow under inhalational anesthesia: A retrospective cohort study","authors":"Yael Frank ,&nbsp;Franklin Dexter ,&nbsp;Carlos E. Guerra-Londono","doi":"10.1016/j.jclinane.2025.111767","DOIUrl":"10.1016/j.jclinane.2025.111767","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111767"},"PeriodicalIF":5.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038962","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}

{"title":"Comparison of continuous non-invasive blood pressure measurement using Vitalstream™ to invasive Intraarterial pressure in pediatric surgery","authors":"Karen R. Boretsky M.D., FASA ,&nbsp;Viviane G. Nasr M.D., M.P.H ,&nbsp;Douglas Atkinson MD ,&nbsp;Martin Baruch Ph.D","doi":"10.1016/j.jclinane.2025.111763","DOIUrl":"10.1016/j.jclinane.2025.111763","url":null,"abstract":"<div><h3>Background</h3><div>Accurate blood pressure monitoring is essential in many clinical scenarios for adults and children and, when continuous measurement is critical, necessitates the insertion of an arterial line. A novel continuous non-invasive arterial pressure monitoring device using a pulse contour algorithm (Pulse Decomposition Analysis), Vitalstream™, is approved by the United States Food and Drug Administration for use in adults. In this study the performance and accuracy of the device compared to intraarterial blood pressure monitoring were assessed in children ages 2–17 undergoing major surgeries. We report the results using comparison to aspects of the recently published ISO 81060–3:2022 standard for continuous automated blood pressure measurement.</div></div><div><h3>Methods</h3><div>31 children ages 2–17 years scheduled for major surgery requiring invasive arterial blood pressure monitoring were consented to participate. Systolic, diastolic, and mean arterial blood pressure readings were obtained from both systems during at least thirty minutes of simultaneous monitoring during hemodynamically stable periods of the surgical procedure and statistically compared.</div></div><div><h3>Results</h3><div>The correlations of systolic and, diastolic, and mean arterial pressures were, respectively, 0.77, 0.68 and 0.7. The Bland-Altman comparisons yielded bias of −3.79 (9.74) mmHg, 1.72 (8.45) mmHg and 2.41 (8.75) mmHg respectively, for systolic, diastolic, and mean arterial pressures, (<em>p</em> &lt; 0.001 for all comparisons). Concordances for systole, diastole and MAP were, respectively, 0.82, 0.85 and 0.83.</div></div><div><h3>Conclusions</h3><div>Most values fell within +/−20mmhg of the corresponding arterial line values. While this meets the basic requirement for such devices published by professional societies, clinicians will need to be aware of the potential variances and make clinical decisions accordingly. The Vitalstream™ may offer low risk, accurate continuous pressure monitoring in children ages 2–17.</div><div>Clinical <span><span>trials.gov</span><svg><path></path></svg></span>: <span><span>NCT04817137</span><svg><path></path></svg></span></div><div>The trial was registered at <span><span>clinicaltrials.gov</span><svg><path></path></svg></span> (NCT048I7173).</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111763"},"PeriodicalIF":5.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038960","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}

{"title":"Implications of packed red bloods cells production and transfer on post transfusion hemoglobin increase","authors":"Heidi Ehrentraut ,&nbsp;Gregor Massoth ,&nbsp;Achilles Delis ,&nbsp;Ben Thewes ,&nbsp;Jochen Hoch ,&nbsp;Mario Majchrzak ,&nbsp;Marijke Weber-Schehl ,&nbsp;Andreas Mayr ,&nbsp;Izdar Abulizi ,&nbsp;Jan Speller ,&nbsp;Patrick Meybohm ,&nbsp;Andreas Steinisch ,&nbsp;Juergen Koessler ,&nbsp;Andreas C. Strauss ,&nbsp;Maria Wittmann ,&nbsp;Markus Velten","doi":"10.1016/j.jclinane.2025.111743","DOIUrl":"10.1016/j.jclinane.2025.111743","url":null,"abstract":"<div><h3>Background</h3><div>Blood loss resulting in severe anemia is the most common indication for postoperative allogenic red blood cell (RBC) transfusions. In high-income countries, the majority of transfusions is received by elderly patients. Preservatives extend the storage of RBCs, though concerns exist about potential harm from transfusing older RBCs. This study tested the hypothesis that RBC storage duration effects hemoglobin increase in patients older than 70 years who underwent non-cardiac surgery.</div></div><div><h3>Method</h3><div>Observations on surgical cohorts from two study sites of the LIBERAL-Trial were collected. Transfusion events and hemoglobin between 2018 and 2022 assessments in addition to manufacturing and product specific quality review information were evaluated.</div></div><div><h3>Results</h3><div>A total of 1626 transfusion events in 505 patients were analyzed. A linear mixed effects model was used to estimate the effect size of different predictors on hemoglobin increment upon red blood cell transfusion. No statistically significant effect of the RBC unit storage duration was found. Confounding variables resulting in higher hemoglobin increase included lower hemoglobin values prior to transfusion, the length of Hb measurement intervals before and after transfusion, as well as the method of RBC cell separation in line with different manufacturer hemoglobin values.</div></div><div><h3>Conclusions</h3><div>The aspired increase in hemoglobin can be achieved with red blood cell concentrates of any storage duration. In general, elderly patients exhibit a sufficient hemoglobin rise following transfusion. However, if this is associated with improved outcomes cannot be answered.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111743"},"PeriodicalIF":5.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038961","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}

{"title":"Association of the Revised Cardiac Risk Index with 1-year postoperative mortality: A single-center retrospective study","authors":"Jing Hao ,&nbsp;Yue Qian ,&nbsp;Min Hou ,&nbsp;Yan Yang,&nbsp;Luyang Zhou,&nbsp;Zhuanyun Zhang,&nbsp;Wei Zhu,&nbsp;Yu-e Sun,&nbsp;Xiaoping Gu,&nbsp;Zhengliang Ma","doi":"10.1016/j.jclinane.2025.111765","DOIUrl":"10.1016/j.jclinane.2025.111765","url":null,"abstract":"<div><h3>Objective</h3><div>To explore risk factors for 1-year postoperative mortality and to identify its association with the Revised Cardiac Risk Index (RCRI).</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study involving 54,933 patients aged 18 years and above who were surgically treated under general or regional anesthesia in a tertiary hospital in Singapore. Independent risk factors for 1-year postoperative mortality were identified by univariate Cox regression analysis. The association between the RCRI and 1-year postoperative mortality was assessed by the Kaplan-Meier estimator and multivariate Cox regression analysis and was further validated in subgroup analyses stratified by the sex, age, and type of anesthesia.</div></div><div><h3>Results</h3><div>A total of 54,933 eligible patients were enrolled in this study that included 23,922 patients classified as RCRI Class I, 25,979 as Class II, 3700 as Class III, and 1332 as Class IV. Cox regression analysis demonstrated that male sex, age, higher American Society of Anesthesiologists (ASA) physical status classification level, regional anesthesia, emergency surgery, degree of anemia, and increased RCRI were significantly associated with the increased risk of 1-year postoperative mortality (HR &gt; 1, all <em>P</em> &lt; 0.001). The significant association between RCRI and 1-year postoperative mortality still existed after adjusting for confounding factors. An RCRI Class IV was associated with a mortality risk greater than two-fold larger than that observed at an RCRI Class I (adjusted HR 2.14, 95 % CI 1.78 to 2.56, <em>p</em> &lt; 0.001). Subgroup analyses revealed that the 1-year postoperative mortality was significantly higher in patients with RCRI Class IV than that of Classes I-III regardless of the sex, age, and type of anesthesia.</div></div><div><h3>Conclusion</h3><div>RCRI is significantly correlated with 1-year postoperative mortality regardless of sex, age, and type of anesthesia. Further studies to validate these findings are warranted.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"102 ","pages":"Article 111765"},"PeriodicalIF":5.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}