Pub Date : 2025-10-28DOI: 10.1016/j.jclinane.2025.112050
Paul Karim B.A. , Jiahui Chen B.S. , Isaac Huang B.A. , Marco Sanvitti , Robert Canelli M.D. , Federico Bilotta M.D.
Objective
To investigate whether elevated preoperative glycated hemoglobin (HbA1c) levels predict postoperative infections and related clinical outcomes following spinal surgery.
Design
Retrospective cohort analysis utilizing the publicly available MIMIC-IV database.
Setting
Single-center academic medical institution with intensive care capability.
Patients
A total of 246 adult patients undergoing spinal surgery with recorded preoperative HbA1c levels.
Interventions
None.
Measurements
The primary outcome was clinician-suspected postoperative infection within 24 h after surgery, defined by culture orders plus antibiotic initiation. Secondary outcomes included Sepsis-3 criteria-defined sepsis, SIRS sepsis, septic shock, and hospital length of stay.
Main results
Elevated preoperative HbA1c (≥6.5 %) was independently associated with significantly increased odds of clinician-suspected postoperative infection (OR 3.20; 95 % CI 1.22–8.36; p = 0.018), after controlling for comorbidity burden and surgical complexity. However, elevated HbA1c did not independently predict more severe outcomes such as Sepsis-3 sepsis or septic shock.
Conclusions
Elevated preoperative HbA1c substantially increases the likelihood of early clinician suspicion and empirical treatment of postoperative infections after spinal surgery. Routine HbA1c screening should therefore be considered during preoperative evaluations, especially for elective instrumented spinal procedures known for higher infection risks. While these findings support existing clinical guidelines recommending perioperative glycemic optimization, elevated HbA1c alone may not predict severe infection or septic complications once comorbidity burden is considered.
目的：探讨术前糖化血红蛋白（HbA1c）水平升高是否能预测脊柱手术后感染及相关临床结局。设计：利用公开的MIMIC-IV数据库进行回顾性队列分析。环境：具有重症监护能力的单中心学术医疗机构。患者：共有246名接受脊柱手术的成年患者，术前记录了HbA1c水平。干预措施:没有。测量：主要结果是术后24小时内临床怀疑的术后感染，由培养顺序加抗生素起始定义。次要结局包括脓毒症-3标准定义的脓毒症、SIRS脓毒症、脓毒症休克和住院时间。主要结果：在控制合并症负担和手术复杂性后，术前HbA1c升高（≥6.5%）与临床怀疑的术后感染几率显著增加独立相关（OR 3.20; 95% CI 1.22-8.36; p = 0.018）。然而，HbA1c升高并不能独立预测更严重的结果，如脓毒症-3型脓毒症或脓毒症休克。结论：术前HbA1c升高大大增加了临床医生早期怀疑和经验性治疗脊柱术后感染的可能性。因此，术前评估时应考虑常规HbA1c筛查，特别是对于已知感染风险较高的选择性脊柱固定手术。虽然这些发现支持现有的临床指南推荐围手术期血糖优化，但一旦考虑合并症负担，单独升高的HbA1c可能无法预测严重感染或脓毒性并发症。
{"title":"Preoperative glycated hemoglobin as a predictor of infection in patients undergoing spinal surgery: A retrospective analysis of MIMIC-IV database","authors":"Paul Karim B.A. , Jiahui Chen B.S. , Isaac Huang B.A. , Marco Sanvitti , Robert Canelli M.D. , Federico Bilotta M.D.","doi":"10.1016/j.jclinane.2025.112050","DOIUrl":"10.1016/j.jclinane.2025.112050","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate whether elevated preoperative glycated hemoglobin (HbA1c) levels predict postoperative infections and related clinical outcomes following spinal surgery.</div></div><div><h3>Design</h3><div>Retrospective cohort analysis utilizing the publicly available MIMIC-IV database.</div></div><div><h3>Setting</h3><div>Single-center academic medical institution with intensive care capability.</div></div><div><h3>Patients</h3><div>A total of 246 adult patients undergoing spinal surgery with recorded preoperative HbA1c levels.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements</h3><div>The primary outcome was clinician-suspected postoperative infection within 24 h after surgery, defined by culture orders plus antibiotic initiation. Secondary outcomes included Sepsis-3 criteria-defined sepsis, SIRS sepsis, septic shock, and hospital length of stay.</div></div><div><h3>Main results</h3><div>Elevated preoperative HbA1c (≥6.5 %) was independently associated with significantly increased odds of clinician-suspected postoperative infection (OR 3.20; 95 % CI 1.22–8.36; <em>p</em> = 0.018), after controlling for comorbidity burden and surgical complexity. However, elevated HbA1c did not independently predict more severe outcomes such as Sepsis-3 sepsis or septic shock.</div></div><div><h3>Conclusions</h3><div>Elevated preoperative HbA1c substantially increases the likelihood of early clinician suspicion and empirical treatment of postoperative infections after spinal surgery. Routine HbA1c screening should therefore be considered during preoperative evaluations, especially for elective instrumented spinal procedures known for higher infection risks. While these findings support existing clinical guidelines recommending perioperative glycemic optimization, elevated HbA1c alone may not predict severe infection or septic complications once comorbidity burden is considered.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112050"},"PeriodicalIF":5.1,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400988","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 : 2025-10-27DOI: 10.1016/j.jclinane.2025.112038
Qiaohong Chen , Tiantian Zhang , Shaoyong Han
{"title":"Re: Unpacking the “bundled intervention” and interpreting the outcomes in the individualized blood pressure strategy trial","authors":"Qiaohong Chen , Tiantian Zhang , Shaoyong Han","doi":"10.1016/j.jclinane.2025.112038","DOIUrl":"10.1016/j.jclinane.2025.112038","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112038"},"PeriodicalIF":5.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145389868","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 : 2025-10-25DOI: 10.1016/j.jclinane.2025.112052
Weizhi Qiu
{"title":"Letter to the editor on ‘Preoperative cognitive function and surgical outcomes under general anesthesia among older patients’","authors":"Weizhi Qiu","doi":"10.1016/j.jclinane.2025.112052","DOIUrl":"10.1016/j.jclinane.2025.112052","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112052"},"PeriodicalIF":5.1,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733427","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 : 2025-10-25DOI: 10.1016/j.jclinane.2025.112036
Maximiliano Cardozo-Panoff , Robert Blasco-Mariño , Marcos De Miguel , Míriam Basagaña-Farrés , Alfons Biarnes
Background
Cocaine use is a global concern, particularly in Europe, where it ranks as the second most commonly abused drug after cannabis. This systematic review examines perioperative outcomes in patients with positive cocaine urine tests scheduled for elective surgery.
Methods
We searched MEDLINE, Embase, Web of Science, Scopus, GlobalETD, and ClinicalTrials.gov. The study quality was assessed using the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The systematic review protocol was registered with PROSPERO.
Results
Three studies were analysed (n = 707 patients) (one retrospective cohort and two prospective cohort). No significant differences in haemodynamic event incidence were observed between positive and negative CUT groups. Two studies reported a higher use of vasopressors, and one study reported an increased use of antihypertensive administration in patients with a positive urine test for cocaine. No arrhythmias were reported. Mortality was assessed in two studies, neither of which reported any events. Two studies reported longer surgical durations in patients with a negative urine test for cocaine, without an associated increase in haemodynamic instability.
Conclusions
Asymptomatic patients with a positive cocaine urine test undergoing elective surgery have not been shown to have higher perioperative complication rates than controls. The limited number of studies and methodological shortcomings of the available evidence—such as retrospective design, small samples and potential biases—preclude definitive conclusions. Further prospective studies are needed to clarify perioperative risk and guide clinical decision-making.
可卡因的使用是一个全球关注的问题，特别是在欧洲，它是仅次于大麻的第二大滥用药物。本系统综述探讨了可卡因尿检阳性患者择期手术的围手术期预后。方法检索MEDLINE、Embase、Web of Science、Scopus、GlobalETD和ClinicalTrials.gov。研究质量采用纽卡斯尔-渥太华量表进行评估。根据系统评价和荟萃分析指南的首选报告项目综合数据。系统评价方案已在PROSPERO注册。结果共分析了3项研究（n = 707例）（1项回顾性队列研究和2项前瞻性队列研究）。CUT阳性组和阴性组的血流动力学事件发生率无显著差异。两项研究报告了更高的血管加压药物的使用，一项研究报告了可卡因尿检阳性患者抗高血压药物的使用增加。无心律失常报告。两项研究评估了死亡率，但均未报告任何事件。两项研究报告，尿检可卡因阴性的患者手术时间更长，但血流动力学不稳定性没有相应的增加。结论有症状的可卡因尿检阳性的择期手术患者围手术期并发症发生率不高于对照组。有限的研究数量和现有证据的方法学缺陷——如回顾性设计、小样本和潜在的偏倚——妨碍了明确的结论。需要进一步的前瞻性研究来明确围手术期风险，指导临床决策。
{"title":"Perioperative outcomes in patients with positive cocaine urine tests undergoing elective surgery: A systematic review","authors":"Maximiliano Cardozo-Panoff , Robert Blasco-Mariño , Marcos De Miguel , Míriam Basagaña-Farrés , Alfons Biarnes","doi":"10.1016/j.jclinane.2025.112036","DOIUrl":"10.1016/j.jclinane.2025.112036","url":null,"abstract":"<div><h3>Background</h3><div>Cocaine use is a global concern, particularly in Europe, where it ranks as the second most commonly abused drug after cannabis. This systematic review examines perioperative outcomes in patients with positive cocaine urine tests scheduled for elective surgery.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, Web of Science, Scopus, GlobalETD, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>. The study quality was assessed using the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The systematic review protocol was registered with PROSPERO.</div></div><div><h3>Results</h3><div>Three studies were analysed (<em>n</em> = 707 patients) (one retrospective cohort and two prospective cohort). No significant differences in haemodynamic event incidence were observed between positive and negative CUT groups. Two studies reported a higher use of vasopressors, and one study reported an increased use of antihypertensive administration in patients with a positive urine test for cocaine. No arrhythmias were reported. Mortality was assessed in two studies, neither of which reported any events. Two studies reported longer surgical durations in patients with a negative urine test for cocaine, without an associated increase in haemodynamic instability.</div></div><div><h3>Conclusions</h3><div>Asymptomatic patients with a positive cocaine urine test undergoing elective surgery have not been shown to have higher perioperative complication rates than controls. The limited number of studies and methodological shortcomings of the available evidence—such as retrospective design, small samples and potential biases—preclude definitive conclusions. Further prospective studies are needed to clarify perioperative risk and guide clinical decision-making.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112036"},"PeriodicalIF":5.1,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360895","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 : 2025-10-23DOI: 10.1016/j.jclinane.2025.112049
Ruijian Huang MS , Dan Cheng MD , Chen Zhang MD , Cheng Qian BS , Xuan Yin BS , Siyu Kong BS , Xinchi Li BS , Qilian Tan MD , Yali Ge MD, PhD , Xuesheng Liu MD, PhD , Hongwei Shi MD , Fan Yang BS , Xiao Ning PhD , Zhimin Zhang PhD , Lihai Chen MD, PhD , Jie Sun MD, PhD , Jifang Zhou MD, PhD, MPH
Background
Extreme temperature events (ETEs) pose increasing risks for surgical patients, who may be vulnerable to temperature fluctuations. The associations between ETEs and intraoperative hypotension (IOH) remain understudied.
Methods
We conducted a retrospective cohort analysis on patients undergoing major surgery between 2015 and 2023 at three large academic centers. ETEs were defined using percentile-based temperature thresholds and duration. Heat waves were periods of at least 3 consecutive days with daily average temperatures at or above the 95th or 97.5th percentiles of the previous 30 days, while cold spells were periods with temperatures at or below the 5th or 2.5th percentiles. The primary outcome was IOH ≥10 min, defined as a mean arterial pressure < 65 mmHg for ≥10 min. Secondary outcome was the duration of IOH ≥10 min. Logistic regression and generalized linear models were used to assess associations, adjusting for relevant covariates.
Results
Among 276,515 eligible subjects, 48,023 were exposed to heat waves, 42,615 to cold spells, and 185,877 remained unexposed. The presence of an arterial catheter was noted in 30.31 % of the patients. Heat waves were associated with a reduced risk of IOH lasting ≥10 min (adjusted odds ratio [aOR], 0.80; 95 % confidence interval [CI], 0.76–0.84; P < 0.001). The total difference in IOH duration across the range of 30-day average temperatures from 0 to 30 °C was approximately 4 min, highlighting the modest magnitude of the effect. Cold spells were associated with an increased IOH risk, with the strongest association observed for cold spells defined by the 2.5th percentile lasting 4 days (aOR, 1.31; 95 % CI, 1.24–1.39; P < 0.001). The magnitude of risk also increased with longer IOH duration. Restricted cubic spline analyses further revealed non-linear associations with the duration of IOH for mean temperature 30 days prior to admission (p-nonlinearity = 0.036).
Conclusion
ETEs were associated with IOH, with heat waves reducing risk and cold spells increasing risk. These results provide new evidence on the physiological effects of environmental temperature extremes in the perioperative setting.
极端温度事件（ETEs）对易受温度波动影响的外科患者构成越来越大的风险。ETEs与术中低血压（IOH）之间的关系仍未得到充分研究。方法对2015年至2023年在三家大型学术中心接受大手术的患者进行回顾性队列分析。使用基于百分位数的温度阈值和持续时间来定义te。热浪是指连续至少3天的日平均气温达到或高于前30天的第95或97.5%，而寒潮是指气温达到或低于前30天的第5或2.5%。主要终点为IOH≥10分钟，定义为平均动脉压≥65 mmHg≥10分钟。次要终点为IOH持续时间≥10分钟。使用逻辑回归和广义线性模型来评估关联，调整相关协变量。结果在276,515名符合条件的受试者中，48,023人暴露在热浪中，42,615人暴露在寒潮中，185,877人未暴露。30.31%的患者存在动脉导管。热浪与IOH持续≥10分钟的风险降低相关（调整优势比[aOR]， 0.80； 95%可信区间[CI]， 0.76-0.84; P < 0.001）。从0到30°C的30天平均温度范围内，IOH持续时间的总差异约为4分钟，突出了影响的适度程度。寒期与IOH风险增加相关，其中以持续4天的第2.5百分位定义的寒期相关性最强（aOR, 1.31; 95% CI, 1.24-1.39; P < 0.001）。随着IOH持续时间的延长，风险程度也随之增加。限制三次样条分析进一步揭示了入院前30天平均温度与IOH持续时间的非线性关系（p非线性= 0.036）。结论高温与IOH相关，热浪降低IOH风险，寒潮增加IOH风险。这些结果为围手术期环境极端温度的生理影响提供了新的证据。
{"title":"Impacts of extreme temperature events on intraoperative hypotension: Evidence from a multicenter cohort study of 276,515 patients","authors":"Ruijian Huang MS , Dan Cheng MD , Chen Zhang MD , Cheng Qian BS , Xuan Yin BS , Siyu Kong BS , Xinchi Li BS , Qilian Tan MD , Yali Ge MD, PhD , Xuesheng Liu MD, PhD , Hongwei Shi MD , Fan Yang BS , Xiao Ning PhD , Zhimin Zhang PhD , Lihai Chen MD, PhD , Jie Sun MD, PhD , Jifang Zhou MD, PhD, MPH","doi":"10.1016/j.jclinane.2025.112049","DOIUrl":"10.1016/j.jclinane.2025.112049","url":null,"abstract":"<div><h3>Background</h3><div>Extreme temperature events (ETEs) pose increasing risks for surgical patients, who may be vulnerable to temperature fluctuations. The associations between ETEs and intraoperative hypotension (IOH) remain understudied.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort analysis on patients undergoing major surgery between 2015 and 2023 at three large academic centers. ETEs were defined using percentile-based temperature thresholds and duration. Heat waves were periods of at least 3 consecutive days with daily average temperatures at or above the 95th or 97.5th percentiles of the previous 30 days, while cold spells were periods with temperatures at or below the 5th or 2.5th percentiles. The primary outcome was IOH ≥10 min, defined as a mean arterial pressure < 65 mmHg for ≥10 min. Secondary outcome was the duration of IOH ≥10 min. Logistic regression and generalized linear models were used to assess associations, adjusting for relevant covariates.</div></div><div><h3>Results</h3><div>Among 276,515 eligible subjects, 48,023 were exposed to heat waves, 42,615 to cold spells, and 185,877 remained unexposed. The presence of an arterial catheter was noted in 30.31 % of the patients. Heat waves were associated with a reduced risk of IOH lasting ≥10 min (adjusted odds ratio [aOR], 0.80; 95 % confidence interval [CI], 0.76–0.84; <em>P</em> < 0.001). The total difference in IOH duration across the range of 30-day average temperatures from 0 to 30 °C was approximately 4 min, highlighting the modest magnitude of the effect. Cold spells were associated with an increased IOH risk, with the strongest association observed for cold spells defined by the 2.5th percentile lasting 4 days (aOR, 1.31; 95 % CI, 1.24–1.39; <em>P</em> < 0.001). The magnitude of risk also increased with longer IOH duration. Restricted cubic spline analyses further revealed non-linear associations with the duration of IOH for mean temperature 30 days prior to admission (<em>p</em>-nonlinearity = 0.036).</div></div><div><h3>Conclusion</h3><div>ETEs were associated with IOH, with heat waves reducing risk and cold spells increasing risk. These results provide new evidence on the physiological effects of environmental temperature extremes in the perioperative setting.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112049"},"PeriodicalIF":5.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145360896","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 : 2025-10-21DOI: 10.1016/j.jclinane.2025.112035
Eva Rivas MD , Barak Cohen MD , Jacqueline Palermo MS , Daniel I. Sessler MD
{"title":"Response to “Revisiting the hypoxemia-SSI relationship”","authors":"Eva Rivas MD , Barak Cohen MD , Jacqueline Palermo MS , Daniel I. Sessler MD","doi":"10.1016/j.jclinane.2025.112035","DOIUrl":"10.1016/j.jclinane.2025.112035","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112035"},"PeriodicalIF":5.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345677","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 : 2025-10-16DOI: 10.1016/j.jclinane.2025.112033
Antonio Sánchez-Hidalgo , Iratxe Urreta Barallobre , Ignasi Bolibar Ribas , Eva Bassas Parga , Miren Arrieta Bernaras , Gaizka Gutiérrez Sánchez , David Sánchez Cirera , Francisco José González Moraga , Inigo Gorostiza , Raúl de Frutos Parra , Susana Álvarez Gómez , Pablo Manuel Keenoy , Marta Roqué Figuls , Carolina Requeijo
Background
Numerous studies have questioned the usefulness of routine preoperative tests, and several guidelines have published recommendations aimed at reducing unnecessary preoperative testing.
Study objectives
To analyze the appropriateness of preoperative test requests and interhospital variability in criteria for requesting preoperative tests.
Patients over 18 years of age undergoing elective cataract surgery, inguinal hernia, laparoscopic cholecystectomy, colon surgery or primary knee replacement, in any department of the participating hospitals during 5 working days in June 2022 (n = 1522).
Exposure
Hospitals where patients underwent surgery.
Measurements
Appropriateness of requested preoperative tests according to hospital protocols and NICE guidelines analyzed with random-intercept multilevel models considering hospital-level and patient-level variables. Hospital protocol score to determine disagreement with the NICE guidelines.
Main results
Preoperative test request inappropriateness was 12.03 % according to hospital protocols and 72.99 % according to the NICE guidelines. Inappropriateness was mostly due to excessive requests and differed by hospital and surgery type. Independent factors determining inappropriateness at the hospital-level were center complexity and availability of computerized preoperative request templates; at the patient-level were age, ASA grades and surgical complexity. Protocol criteria for requesting preoperative tests varied notably between hospitals, and most protocols showed low agreement with NICE recommendations, especially in terms of over-requested preoperative tests.
Conclusions
Inappropriateness of preoperative test requests was high according to hospital protocols and especially high according to the NICE guidelines. Appropriateness was determined by patient characteristics, surgical complexity, and institutional factors. Interhospital variability in inappropriateness was explained by differing criteria for preoperative test requests.
{"title":"Preoperative test requests for elective surgeries of different complexity: Appropriateness and interhospital variability","authors":"Antonio Sánchez-Hidalgo , Iratxe Urreta Barallobre , Ignasi Bolibar Ribas , Eva Bassas Parga , Miren Arrieta Bernaras , Gaizka Gutiérrez Sánchez , David Sánchez Cirera , Francisco José González Moraga , Inigo Gorostiza , Raúl de Frutos Parra , Susana Álvarez Gómez , Pablo Manuel Keenoy , Marta Roqué Figuls , Carolina Requeijo","doi":"10.1016/j.jclinane.2025.112033","DOIUrl":"10.1016/j.jclinane.2025.112033","url":null,"abstract":"<div><h3>Background</h3><div>Numerous studies have questioned the usefulness of routine preoperative tests, and several guidelines have published recommendations aimed at reducing unnecessary preoperative testing.</div></div><div><h3>Study objectives</h3><div>To analyze the appropriateness of preoperative test requests and interhospital variability in criteria for requesting preoperative tests.</div></div><div><h3>Design</h3><div>Cross-sectional retrospective multicenter observational study.</div></div><div><h3>Setting</h3><div>Nine Spanish National Health System hospitals.</div></div><div><h3>Patients</h3><div>Patients over 18 years of age undergoing elective cataract surgery, inguinal hernia, laparoscopic cholecystectomy, colon surgery or primary knee replacement, in any department of the participating hospitals during 5 working days in June 2022 (<em>n</em> = 1522).</div></div><div><h3>Exposure</h3><div>Hospitals where patients underwent surgery.</div></div><div><h3>Measurements</h3><div>Appropriateness of requested preoperative tests according to hospital protocols and NICE guidelines analyzed with random-intercept multilevel models considering hospital-level and patient-level variables. Hospital protocol score to determine disagreement with the NICE guidelines.</div></div><div><h3>Main results</h3><div>Preoperative test request inappropriateness was 12.03 % according to hospital protocols and 72.99 % according to the NICE guidelines. Inappropriateness was mostly due to excessive requests and differed by hospital and surgery type. Independent factors determining inappropriateness at the hospital-level were center complexity and availability of computerized preoperative request templates; at the patient-level were age, ASA grades and surgical complexity. Protocol criteria for requesting preoperative tests varied notably between hospitals, and most protocols showed low agreement with NICE recommendations, especially in terms of over-requested preoperative tests.</div></div><div><h3>Conclusions</h3><div>Inappropriateness of preoperative test requests was high according to hospital protocols and especially high according to the NICE guidelines. Appropriateness was determined by patient characteristics, surgical complexity, and institutional factors. Interhospital variability in inappropriateness was explained by differing criteria for preoperative test requests.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"108 ","pages":"Article 112033"},"PeriodicalIF":5.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312131","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 : 2025-10-14DOI: 10.1016/j.jclinane.2025.112019
Yu Jeong Bang M.D., Ph.D , Seung Yeon Yoo M.D., Ph.D , RyungA Kang M.D., Ph.D , Justin Sangwook Ko M.D., Ph.D , Ji-Hye Kwon M.D., Ph.D , Gyu-Seong Choi M.D., Ph.D , Jong Man Kim M.D., Ph.D , Tae Soo Hahm M.D., Ph.D , Gaab Soo Kim M.D., Ph.D
Introduction
This study compared the analgesic effect of single-shot erector spinae plane block (ESPB) or posterior quadratus lumborum block (QLB) versus systemic analgesia alone after laparoscopic major liver resection.
Methods
This randomized controlled trial was conducted at a single referral center between August 2022 and January 2024. 114 patients undergoing laparoscopic major liver resection were randomized to one of three groups: control, ESPB, or QLB (1:1:1). The control group received systemic analgesia without regional anesthesia, whereas both ESPB and QLB groups received an additional regional anesthesia using 40 mL of 0.5 % ropivacaine. The primary outcome was cumulative opioid consumption within 24 h post-surgery. Secondary outcomes included cumulative opioid consumption, pain intensity, and recovery parameters during 72 h post-surgery.
Results
Cumulative opioid consumption (median [IQR]) within 24 h post-surgery was not significantly different among the groups (control, 35 mg [25, 53]; ESPB, 32 mg [21, 44]; QLB, 29 mg [22, 40]; adjP > 0.99). Cumulative opioid consumption at 1 and 48 h also did not significantly differ among the three groups (adjP = 0.336 and 0.732) but was significantly lower at 72 h post-surgery (adjP = 0.032). Pain at rest during the postanesthesia care unit (PACU) stay and at 48 h post-surgery was lower in ESPB and QLB versus control, while pain when coughing in both block groups was reduced only during the PACU stay.
Conclusions
Neither ESPB nor posterior QLB resulted in a significant decrease in cumulative opioid consumption within 24 h after laparoscopic major liver resection.
{"title":"Comparison of three different methods of postoperative analgesic effects in laparoscopic major liver resection (systemic analgesia vs. erector spinae plane block vs. quadratus lumborum block): A randomized controlled trial","authors":"Yu Jeong Bang M.D., Ph.D , Seung Yeon Yoo M.D., Ph.D , RyungA Kang M.D., Ph.D , Justin Sangwook Ko M.D., Ph.D , Ji-Hye Kwon M.D., Ph.D , Gyu-Seong Choi M.D., Ph.D , Jong Man Kim M.D., Ph.D , Tae Soo Hahm M.D., Ph.D , Gaab Soo Kim M.D., Ph.D","doi":"10.1016/j.jclinane.2025.112019","DOIUrl":"10.1016/j.jclinane.2025.112019","url":null,"abstract":"<div><h3>Introduction</h3><div>This study compared the analgesic effect of single-shot erector spinae plane block (ESPB) or posterior quadratus lumborum block (QLB) versus systemic analgesia alone after laparoscopic major liver resection.</div></div><div><h3>Methods</h3><div>This randomized controlled trial was conducted at a single referral center between August 2022 and January 2024. 114 patients undergoing laparoscopic major liver resection were randomized to one of three groups: control, ESPB, or QLB (1:1:1). The control group received systemic analgesia without regional anesthesia, whereas both ESPB and QLB groups received an additional regional anesthesia using 40 mL of 0.5 % ropivacaine. The primary outcome was cumulative opioid consumption within 24 h post-surgery. Secondary outcomes included cumulative opioid consumption, pain intensity, and recovery parameters during 72 h post-surgery.</div></div><div><h3>Results</h3><div>Cumulative opioid consumption (median [IQR]) within 24 h post-surgery was not significantly different among the groups (control, 35 mg [25, 53]; ESPB, 32 mg [21, 44]; QLB, 29 mg [22, 40]; <em>adjP</em> > 0.99). Cumulative opioid consumption at 1 and 48 h also did not significantly differ among the three groups (<em>adjP</em> = 0.336 and 0.732) but was significantly lower at 72 h post-surgery (<em>adjP</em> = 0.032). Pain at rest during the postanesthesia care unit (PACU) stay and at 48 h post-surgery was lower in ESPB and QLB versus control, while pain when coughing in both block groups was reduced only during the PACU stay.</div></div><div><h3>Conclusions</h3><div>Neither ESPB nor posterior QLB resulted in a significant decrease in cumulative opioid consumption within 24 h after laparoscopic major liver resection.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112019"},"PeriodicalIF":5.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300624","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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