Background: Smoking is the leading single cause of preventable death in England and also increases the risk of postoperative complications. The preoperative period is a potential opportunity to introduce smoking cessation interventions to smokers to reduce the risk of postoperative complications. A systematic search was conducted to find all studies that investigated the effectiveness of preoperative smoking cessation interventions. The primary outcome was smoking cessation at surgical time to the last follow-up, and the secondary outcome was postoperative complications that required treatment or ICU admission. A random-effects meta-analysis was used to synthesize the outcomes. Sixteen studies were included in the review (3505 participants), and 14 studies were included in the meta-analysis (2940 randomized participants). The quality of evidence was moderate due to the high risk of bias and heterogeneity. We found that patients who were provided with a smoking cessation intervention had significantly increased odds of quitting smoking by the time of surgery compared with usual care, with a reported relative risk (95% CI) 1.64 (1.30-2.07) and at the longest follow-ups with RR (95% CI) 1.38 (1.12-1.70). Moreover, there was no difference found in the rate of postoperative complications between intervention and control conditions with RR (95% CI) 0.81 (0.62-1.06). The use of standardized outcome measurements is recommended to reduce heterogeneity for future studies, and further investigation focusing on patient perspectives is needed.
Trial registration: PROSPERO CRD42023423202.
Introduction: Preoperative anemia in orthopedic surgery is linked to adverse outcomes such as longer hospital stays, higher rates of blood transfusion, and increased risk of death. Effectively addressing and managing this condition is essential for improving patient outcomes and shortening the length of hospital stays. In Ethiopia and other low-income countries, studies on preoperative anemia and its impact on the length of hospital stay following orthopedic surgery are limited. Therefore, this study aimed to assess the relationship between preoperative anemia and length of hospital stay among patients who underwent orthopedic surgery in Northwest Ethiopia.
Methods: A retrospective cohort study was conducted from June 01, 2019, to June 30, 2021, at Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Data on demographic and clinical characteristics were collected using the Research Electronic Data Capture (REDCap) data collection system. Prolonged length of stay was defined as when a patient stays more than the 75th percentile of the LOS of all patients after orthopedic surgery. Multivariable logistic regression assessed the association between preoperative anemia and prolonged hospital stay length.
Results: Of 959 orthopedic patients enrolled in this study, 481 (50.16%) had preoperative anemia. The majority of patients underwent intramedullary nailing (27.63%) followed by debridement and irrigation (19.29%), and open reduction and internal fixation (17.00%) orthopedic procedures. The median length of hospital stays of all patients who underwent orthopedic surgery was 6 days (IQR 3, 13). During the follow-up, 212 patients had a prolonged length of stay following orthopedic surgery in the hospital. Of 212 patients who had prolonged hospital stays, 124 (58.49%) patients were anemic compared to 88 (41.51%) non-anemic patients. The odds of prolonged stay after orthopedic surgery were 1.77 (AOR = 1.77, 95% CI 1.25, 2.50) times higher among patients with preoperative anemia than those without preoperative anemia.
Conclusion: Preoperative anemia was independently associated with prolonged hospital stay among orthopedic surgery patients. Appropriate screening and treatment of preoperative anemia in orthopedic patients is essential.
The application of artificial intelligence (AI) in anesthesiology has become increasingly widespread. However, no previous study has analyzed this field from the bibliometric analysis dimension. The objective of this paper was to assess the global research trends in AI in anesthesiology using bibliometric software. Literatures relevant to AI and anesthesiology were retrieved from the Web of Science until 10 April 2024 and were visualized and analyzed using Excel, CiteSpace, and VOSviewer. After screening, 491 studies were included in the final bibliometric analysis. The growth rate of publications, countries, institutions, authors, journals, literature co-citations, and keyword co-occurrences was computed. The number of publications increased annually since 2018, with the most significant contributions from the USA, China, and England. The top 3 institutions were Yuan Ze University, National Taiwan University, and Brunel University London. The top three journals were Anesthesia & Analgesia, BMC Anesthesiology, and the British Journal of Anaesthesia. The researches on the application of AI in predicting hypotension have been extensive and represented a hotspot and frontier. In terms of keyword co-occurrence cluster analysis, keywords were categorized into four clusters: ultrasound-guided regional anesthesia, postoperative pain and airway management, prediction, depth of anesthesia (DoA), and intraoperative drug infusion. This analysis provides a systematic analysis on the literature regarding the AI-related research in the field of anesthesiology, which may help researchers and anesthesiologists better understand the research trend of anesthesia-related AI.
Background: This study aimed to investigate the current preoperative frailty status of elderly patients undergoing abdominal surgery and identify its associated factors. The objective of this study was to provide clinicians with valuable insights for implementing frailty intervention strategies.
Methods: A cross-sectional study was conducted with 375 elderly patients who underwent abdominal surgery at a tertiary hospital in Chengdu, Sichuan Province, between October 2021 and August 2022. The data were collected using various instruments, including a general information questionnaire, the FRAIL frailty assessment scale, the West China Mood Index, the Nutritional Risk Screening 2002, and the Barthel Index. Multivariate logistic regression analysis was conducted to investigate the factors influencing preoperative frailty in this patient population.
Results: Among the 375 elderly patients who underwent abdominal surgery, 59 were identified as having preoperative frailty, resulting in a preoperative frailty rate of 15.7%. Multivariate analysis revealed that multiple chronic diseases, malnutrition risk, and limited ability to perform daily life activities were significant associated factors for preoperative frailty in these patients (P < 0.05).
Conclusion: Clinical medical staff should prioritize the preoperative frailty assessment of elderly patients undergoing abdominal surgery, particularly those with multiple chronic diseases, malnutrition risk, and limited daily life activities.
Background: Prolonged postoperative ileus (PPOI) reportedly leads to compromised postoperative recovery and increased healthcare costs. However, the evidence for this claim was obtained from studies that included patients with both primary and secondary PPOI. How primary PPOI affects the hospital length of stay (LOS) and healthcare costs is not well documented. A multicenter cohort analysis was performed to investigate the potentially detrimental effect of primary PPOI on hospital LOS and healthcare costs.
Methods: In total, 2083 patients who underwent open abdominal surgery from 22 tertiary hospitals in China were prospectively registered in a PPOI cohort. Of these, 1863 patients without secondary PPOI were analyzed. Poisson regression for hospital LOS and log-transformed linear regression for healthcare costs were performed to identify whether primary PPOI was an independent risk factor.
Results: The incidence of primary PPOI was 13.2% (246/1863). The median LOS was significantly longer in the PPOI than non-PPOI group (12 vs. 11 days, p < 0.001). The median healthcare cost was significantly higher in the PPOI than non-PPOI group (70,672 vs. 67,597 CNY, p = 0.016). Multivariate Poisson regression and log-transformed linear regression showed that 12% of prolonged LOS and 4.6% of healthcare costs were due to primary PPOI.
Conclusions: Primary PPOI is a potential source of prolonged hospital LOS and extra healthcare costs for patients undergoing open abdominal surgery. Cost-effective approaches are needed to manage and prevent primary PPOI.
Background: Postoperative extubation is a critical phase. Various medications and different ventilation modes are employed during extubation to minimize potential issues. This study aimed to observe the early effects of the concurrent use of positive end-expiratory pressure (PEEP) and pressure support ventilation (PSV) modes during the extubation-emerge period on the respiratory system.
Methods: After laparoscopic cholecystectomy, patients were administered a remifentanil infusion following the cessation of inhalation agents. PSV and PEEP modes were used on the mechanical ventilator, and the patients were extubated upon awakening. Hemodynamic and respiratory parameters, as well as complications during intraoperative and extubation periods, were recorded.
Results: A total of 199 patients were evaluated. Patients with complications were defined as group I (n = 37), and those without complications as group 0 (n = 167). Post-extubation complications included cough (3 or more, persistent or repetitive coughing) in 12 patients (6.04%), desaturation (SPO2 < 90% for 10 s) in nine patients (4.53%), bronchospasm in eight patients (4.02%), agitation (5 and above on the agitation scale) in three patients (1.5%), need for rescue mask ventilation (SPO2 < 90% lasting longer than 10 s) in three patients (1.5%), and airway obstruction (2 and above according to laryngospasm score) in two patients (1%). Statistically significant differences were observed between the two groups for ASA III (p = 0.0365).
Conclusions: The use of PSV and PEEP modes during extubation-emergence period in laparoscopic cholecystectomy results in a low rate of respiratory system complications, which are mostly minor. These modes can be safely used during the extubation phase. However, since these complications are seen in patients with high ASA physical scores, further studies are needed for these patients.
Trial registration: NCT06356649.
Background: Patients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.
Methods: Sixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.
Results: At 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61-65 μg) compared to the TAPB group (66, 63-70 μg) (p < 0.001). Hospital stay median was 7 (6-9) days for the ESPB group and 8 (7-10) days for the TAPB group (p = 0.037).
Conclusions: Patients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.
Trial registration: https://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.
Background: Racial and ethnic disparities in the treatment of perioperative pain have not been well-studied, despite being observed in a variety of other medical settings. The goal of this investigation was to evaluate the relationship between race and ethnicity and intra- and postoperative opioid administration for patients undergoing open liver resection surgery.
Methods: In this single-center retrospective cohort study, adult patients undergoing open liver resection from January 2012 to May 2019 were identified. Demographic, intraoperative, and postoperative data were extracted from the institutional perioperative data warehouse. The primary outcome was weight-based intraoperative morphine milligram equivalents (MME/kg). Secondary outcome variables included use of neuraxial analgesia and length of stay (LOS). Multivariable regression models were used, which controlled for pertinent factors such as age and duration of surgery.
Results: There were 1294 adult open liver resections included in this study: 532 (41%) patients self-reported as White, 401 (31%) as Asian, 159 (12%) as Black, 97 (7%) as Hispanic, and 105 (8%) as Other. The risk adjusted mean intraoperative MME/kg was not different among racial groups (White: 3.25 [95% CL 3.02-3.49] mg/kg vs. Asian: 3.38 [95% CL 3.10-3.69] mg/kg, p = 0.87; Black: 2.95 [95% CL 2.70-3.23] mg/kg, p = 0.19; Hispanic: 3.36 [95% CL 3.00-3.77] mg/kg, p = 0.97). In the multivariable models for secondary outcomes, length of stay was significantly higher for Black (estimate: 1.17, CL: 1.00 to 1.35, p = 0.047) and Hispanic (1.30, CL: 1.05 to 1.65, p = 0.018) patients relative to White patients. No racial/ethnic groups were significantly associated with higher or lower odds of receiving regional anesthesia.
Conclusions: For patients undergoing liver resection surgery, no racial and ethnic disparities were observed for weight-based intraoperative MME.
Background: Postoperative atrial fibrillation (POAF) is an ordinary complication of surgery, particularly cardiac surgery. It significantly increases in-hospital mortality and costs. This study aimed to establish a nomogram prediction model for POAF in patients undergoing laparotomy. The model is expected to identify individuals at a high risk of POAF before surgery in clinical practice.
Methods: A retrospective observational case-control study involving 230 adult patients (60 patients with POAF, 120 patients in the control group, and 50 patients in the validation group) who underwent laparotomy was retrieved from two hospitals. Independent risk variables for POAF were investigated using logistic regression and the least absolute shrinkage and selection operator (LASSO) regression analysis. Subsequently, a nomogram model for POAF was constructed by multivariate logistic regression equations. The prediction model was internally validated by bootstrap method and externally validated with the validation group data. To assess the discriminative ability of the nomogram model, a receiver operating characteristic (ROC) curve was generated and a calibration curve was employed to assess the concentricity between the model's probability curve and the ideal curve. Subsequently, decision curve analysis (DCA) was performed to assess the clinical effectiveness of the model.
Results: C-reactive protein (CRP), lymphocyte-to-monocyte ratio(LMR), blood urea nitrogen (BUN), and Macruz index were independent risk variables for POAF in patients who underwent laparotomy. A user-friendly and efficient prediction nomogram was visualized using R software. This nomogram exhibited strong discrimination, as evidenced by an area under the ROC curve (AUC) of 0.90 (95% CI 0.8509-0.9488) for the training set, 0.86 (95% CI 0.7142-1) for the test set, and 0.9792 (95% CI 0.9293-1) for the validation group data. The C-index of the bootstrap nomogram model was 0.8998. Furthermore, DCA revealed that this model displayed excellent fit and calibration, as well as positive net benefits.
Conclusions: A nomogram prediction model was constructed for POAF in patients who underwent abdominal surgery. The nomogram prediction model is expected to identify individuals at high risk of POAF in clinical practice for prophylactic therapeutic intervention prior to surgery.
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