BJA open最新文献

{"title":"Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis","authors":"Kenki Matsumoto ,&nbsp;Brigitta Fazzini ,&nbsp;Hannah Malcolm ,&nbsp;Jack Eldridge ,&nbsp;Zudin Puthucheary ,&nbsp;Magda Osman ,&nbsp;Timothy J. Stephens","doi":"10.1016/j.bjao.2025.100488","DOIUrl":"10.1016/j.bjao.2025.100488","url":null,"abstract":"<div><h3>Background</h3><div>The intensive care unit (ICU) is a dynamic environment that necessitates daily clinical decisions regarding organ support treatments. The decision-making process varies significantly between clinicians (i.e. doctors, nurses, and allied healthcare practitioners), even where internationally accepted treatment guidance exists. The factors and the processes influencing clinical decision-making are poorly understood. This systematic review aims to generate a decision-making model by evaluating current evidence on the decision-making process and the factors that affect decisions on organ support treatments in the ICU.</div></div><div><h3>Methods</h3><div>We conducted a systematic search on three databases (PubMed, Embase, and CINAHL) including all papers exploring factors that influenced organ support decisions (PROSPERO: CRD42021283290). A mixed-methods meta-synthesis was performed to enable the generation of distinct themes and subthemes used to generate the decision-making model.</div></div><div><h3>Results</h3><div>After screening 8967 records, 33 studies met the inclusion criteria and were included in the analysis. The mixed-method interpretation of the data found that decision-making can be linear and primarily dictated by patient factors (i.e. patient’s clinical parameters). However, the analysis identified 11 factors that can influence and strain clinician’s decision-making. Four themes: 1) human, 2) team, 3) system, and 4) patient emerged as the potential modifiable factors to optimise the decision-making process.</div></div><div><h3>Conclusions</h3><div>Decision-making surrounding organ support treatment is complex and dynamic. However, there are four distinctive potentially modifiable themes that influence the multidisciplinary decision-making process. Further studies should focus on understanding interventions to improve decision-making and if different decision-making processes directly affect patients’ outcomes.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42021283290).</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided versus neurostimulation-guided bilateral transperineal pudendal nerve block for analgesia in outpatient haemorrhoid surgery: protocol for a multicentre, randomised, double-blind, non-inferiority trial","authors":"Thomas Giral ,&nbsp;Olivier Maupain ,&nbsp;Yoann Elmaleh ,&nbsp;Davy Huynh ,&nbsp;Floriane Ciceron ,&nbsp;Kilian Yao ,&nbsp;Pablo Devidas ,&nbsp;Albert El Metni ,&nbsp;Johannes Kutter","doi":"10.1016/j.bjao.2025.100512","DOIUrl":"10.1016/j.bjao.2025.100512","url":null,"abstract":"<div><h3>Background</h3><div>Haemorrhoid surgery is often associated with severe postoperative pain. Bilateral transperineal pudendal nerve block, performed using anatomical landmarks or nerve stimulation, is effective and currently recommended for postoperative analgesia. However, these blind techniques carry risks such as pudendal artery puncture or rectal injury and are not always routinely performed. The ultrasound-guided transperineal pudendal nerve block has shown promise in paediatric urological surgery, appearing both effective and well tolerated, but has not yet been evaluated in proctological procedures.</div></div><div><h3>Methods</h3><div>This multicentre, prospective, randomised, double-blind trial aims to compare the analgesic efficacy, adverse effects, and safety of ultrasound-guided <em>vs</em> nerve stimulator-guided bilateral transperineal pudendal nerve block in patients undergoing haemorrhoid surgery. The primary endpoint is the maximum pain score (0–10 numerical rating scale) in the post-anaesthesia care unit. Secondary outcomes include length of stay in post-anaesthesia care unit and hospital, quality of recovery score (QoR-15 score), pain and analgesic medication consumption during the first 7 days, and treatment-related adverse effects and safety. A total of 202 patients are required to test non-inferiority, based on a predefined margin of 0.7. The study received ethical approval from the Comité de Protection des Personnes Ouest IV in May 2025.</div></div><div><h3>Conclusions</h3><div>Recruitment is expected to begin in September 2025. Results will be submitted for peer-reviewed publication and conference presentation.</div></div><div><h3>Clinical trial registration</h3><div>NCT07015775.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100512"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the addition of a low-dose of ketamine to propofol anaesthesia on the phase-amplitude coupling features of an electroencephalogram","authors":"Ryusuke Tanaka,&nbsp;Masahide Kaneko,&nbsp;Masaki Takekoshi,&nbsp;Satoshi Tanaka","doi":"10.1016/j.bjao.2025.100486","DOIUrl":"10.1016/j.bjao.2025.100486","url":null,"abstract":"<div><h3>Background</h3><div>Low-dose ketamine as an adjunct to propofol-based total intravenous anaesthesia (TIVA) complicates hypnotic depth monitoring by increasing bispectral index values and altering electroencephalogram (EEG). Phase-amplitude coupling is a promising EEG marker of anaesthesia-induced unconsciousness, but its response to ketamine during TIVA remains unclear. Understanding this interaction may improve hypnotic depth monitoring under multimodal anaesthesia. This study aimed to investigate the effect of low-dose ketamine on EEG modulation index and preferred phase under propofol-based total intravenous . anaesthesia.</div></div><div><h3>Methods</h3><div>This prospective observational study analysed 19 patients (age 28–66 yr, American Society of Anesthsiology physical status 1 or 2) who underwent surgery during TIVA with propofol. After confirming the stability of propofol infusion, low-dose ketamine (0.5 mg kg⁻¹) was administered as a bolus, followed by continuous infusion at a rate of 0.125 mg kg⁻¹ h⁻¹. Frontal EEG was analysed at baseline (PreKet) and at 10 min (PostKet1) and 20 min (PostKet2) after ketamine administration.</div></div><div><h3>Results</h3><div>Analysis of delta-alpha phase-amplitude coupling revealed that the EEG modulation index (×10³) remained stable across the study period: 0.47 (95% confidence interval: 0.25–0.69) at PreKet, 0.46 (0.20–0.73) at PostKet1, and 0.35 (0.15–0.55) at PostKet2 (<em>P</em>=0.623). However, the mean preferred phase, representing the delta wave phase at which the alpha oscillation amplitude was maximal, exhibited a significant shift from 88° (95% confidence interval: 50°–126°) at PreKet to 29° (95% confidence interval: −10° to 69°) at PostKet2 (<em>P</em>=0.021).</div></div><div><h3>Conclusions</h3><div>This study demonstrates the effect of low-dose ketamine on EEG phase-amplitude coupling during total intravenous anaesthesia with propofol. Our findings provide new insights into the neural mechanisms of low-dose ketamine and support the feasibility of phase-amplitude coupling analysis as a potential tool for improving hypnotic depth monitoring in clinical practice.</div></div><div><h3>Clinical trial registration</h3><div>UMIN000050331.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100486"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative cognitive behavioural therapy compared with pain education and mindfulness for chronic postsurgical pain in breast cancer patients with high pain catastrophising characteristics: a randomised, controlled, parallel group clinical trial","authors":"Aneurin Moorthy ,&nbsp;Damien Lowry ,&nbsp;Carla Edgely ,&nbsp;Margarita Blajeva ,&nbsp;Máire-Bríd Casey ,&nbsp;Donal J. Buggy","doi":"10.1016/j.bjao.2025.100499","DOIUrl":"10.1016/j.bjao.2025.100499","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of chronic postsurgical pain (CPSP) is relatively high after breast cancer surgery. Psychological factors, especially high pain catastrophising, are predictive of CPSP. Cognitive behavioural therapy (CBT) can reduce anxiety and depression and help emotional self-regulation. We tested the hypothesis that perioperative CBT is more effective than a pain education and mindfulness (PEM) programme at reducing CPSP intensity at 3 months after breast cancer surgery in high pain catastrophising patients.</div></div><div><h3>Methods</h3><div>Women having primary breast cancer surgery were screened (<em>n</em>=208) for pain catastrophising characteristics using the pain catastrophising scale (PCS). A total of 45 patients scoring ≥24 received four 1-h sessions with the same psychologist, randomised 1:1 to receive either CBT or PEM during the perioperative period. The primary outcome was Brief Pain Inventory (BPI) average pain severity measured at 3 months. Secondary outcomes included BPI composite pain interference scores, PCS scores, and Hospital Anxiety and Depression Scale (HADS) score.</div></div><div><h3>Results</h3><div>There were no significant between group differences at 3 months with regard to the primary outcome, BPI average pain intensity score difference (median 25–75%) PEM <em>vs</em> CBT, 0 (0–1) <em>vs</em> 0 (0–1). <em>P</em>=0.45. Similarly, there were no significant between group differences at 3 months in relation to the study’s secondary outcomes: quality of recovery score at 24 h after surgery, pain interference, pain catastrophising, anxiety levels, and mood. There were within group improvements over the 3 months observation period in pain interference (PEM: <em>P</em>=0.05, CBT: <em>P</em>=0.01), catastrophising (PEM: <em>P</em>&lt;0.01, CBT: <em>P</em>&lt;0.01), anxiety (PEM: <em>P</em>&lt;0.01, CBT: <em>P</em>&lt;0.01) and mood (PEM: <em>P</em>=0.03, CBT: <em>P</em>=0.01) scores in both study arms after 3 months when compared with preoperative baseline values.</div></div><div><h3>Conclusions</h3><div>Delivery of four one-to-one, perioperative CBT or PEM sessions to patients with high pain catastrophising characteristics achieved similar reductions in pain intensity at 3 months after breast cancer surgery. Perioperative psychology might potentially help reduce the incidence of CPSP after breast cancer surgery.</div></div><div><h3>Clinical trial registration</h3><div>NCT04924010.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100499"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discharge with a smartphone application for follow-up after day care surgery: a randomised controlled trial","authors":"Bram Thiel ,&nbsp;Marc Godfried ,&nbsp;Maaike van Emst ,&nbsp;Lisette Vernooij ,&nbsp;Liesbeth van Vliet ,&nbsp;Eva Rumke ,&nbsp;Marc Snoeck ,&nbsp;Seppe Koopman ,&nbsp;Cor Kalkman","doi":"10.1016/j.bjao.2025.100489","DOIUrl":"10.1016/j.bjao.2025.100489","url":null,"abstract":"<div><h3>Background</h3><div>Day care surgery patients have limited options to communicate pain or nausea to their healthcare providers after discharge. This study evaluated the effectiveness of a smartphone application for pain and nausea follow-up as an enhancement to standard care.</div></div><div><h3>Methods</h3><div>We performed a multi center non-blinded prospective randomised controlled trial including day care surgery patients. The intervention group received a smartphone application with bidirectional messaging and standard care for postoperative follow-up. The control group received standard care. The primary outcome was measured with the Quality of Recovery-15 scale on the seventh postoperative day. Secondary endpoints included quality of recovery at postoperative day 1 and 4, satisfaction with care, trust in hospital care, and patient remarks concerning recovery and complications.</div></div><div><h3>Results</h3><div>Out of 301 included patients, 149 were randomly assigned to the smartphone application and 152 to standard care. Perioperative characteristics were comparable between the groups. On postoperative day 7, no difference was observed in quality of recovery, with median difference 0.0 (95% confidence interval: −10.0 to 7.0; <em>P</em>=0.56). Ratings of satisfaction, trust, and to recommend the hospital showed no clinically important differences.</div></div><div><h3>Conclusions</h3><div>We found no differences in patient-reported quality of recovery for day care surgical patients when adding postoperative follow-up of pain and nausea via a smartphone application compared with standard care alone.</div></div><div><h3>Clinical trial registration</h3><div>NCT05244772</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100489"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental harm from anaesthesia: the importance of clinical realism and chemical persistence","authors":"Alain F. Kalmar ,&nbsp;Laurent Zieleskiewicz ,&nbsp;David Grimaldi ,&nbsp;Jasper M. Kampman ,&nbsp;Steffen Rex","doi":"10.1016/j.bjao.2025.100490","DOIUrl":"10.1016/j.bjao.2025.100490","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100490"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between postoperative myocardial injury of unexplained aetiology after noncardiac surgery and sex and cancer on 1-yr survival: a retrospective, single-centre, observational cohort study","authors":"Eva P.C. van Schaik ,&nbsp;Lisette M. Vernooij ,&nbsp;Younes Haddou ,&nbsp;Remco B. Grobben ,&nbsp;Wilton A. van Klei ,&nbsp;Judith A.R. van Waes","doi":"10.1016/j.bjao.2025.100485","DOIUrl":"10.1016/j.bjao.2025.100485","url":null,"abstract":"<div><h3>Background</h3><div>The aetiology of postoperative myocardial injury (PMI) is often unexplained, and the effect of sex and cancer surgery on prognosis in patients with PMI is unknown. We aimed to estimate the proportion of patients developing PMI of unknown aetiology and compare their prognosis with those with explained PMI, and to investigate the interaction with sex and cancer surgery.</div></div><div><h3>Methods</h3><div>This retrospective, single-centre, observational cohort study included patients aged ≥60 yr undergoing noncardiac surgery. Patients with PMI (defined as an elevated troponin concentration &lt;72h after surgery) were categorised into five groups, based on the most likely aetiology of PMI: acute myocardial infarction (MI); extra-cardiac disease (acute or chronic renal failure, sepsis, pulmonary embolism, acute intracranial pathology, or all of the mentioned); known cardiac disease with regular follow-up; perioperative haemodynamic/respiratory events; and PMI of unexplained aetiology. The association between PMI group and 1-yr mortality, and between sex and cancer surgery, was estimated.</div></div><div><h3>Results</h3><div>Of 3885 patients, 823 (21%) had a diagnosis of PMI, of whom 32 (4%) had MI, 201 (24%) had extra-cardiac disease, 174 (21%) had known cardiac disease, 269 (33%) had haemodynamic/respiratory events, and 147 (18%) had PMI of unexplained aetiology. Like other patients with PMI, those with PMI of unexplained aetiology had an increased risk of 1-yr mortality (risk ratio 1.5, 95% confidence interval 1.1–2.1). PMI caused by MI or known cardiac disease occurred more often in men. Women more often had PMI owing to perioperative haemodynamic/respiratory factors. There was no interaction found between PMI and sex or cancer surgery on mortality risk.</div></div><div><h3>Conclusions</h3><div>In approximately half of the patients with a diagnosis of PMI, PMI aetiology was either related to perioperative haemodynamic/respiratory events or the aetiology was unexplained. These patients had an increased associated mortality risk. Women more often had PMI of likely haemodynamic/respiratory causes. Mortality risk in those with PMI was similar between sexes and between those undergoing cancer surgery <em>vs</em> non-cancer surgery.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100485"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease progression after cardiac surgery: a retrospective multicentre study","authors":"Sune Bille ,&nbsp;Rasmus B. Lindhardt ,&nbsp;Lars P. Riber ,&nbsp;Peter Juhl-Olsen ,&nbsp;Hanne B. Ravn ,&nbsp;Sebastian B. Rasmussen","doi":"10.1016/j.bjao.2025.100506","DOIUrl":"10.1016/j.bjao.2025.100506","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is a well-established risk factor for adverse outcomes after cardiac surgery. However, the long-term trajectory of kidney function in this high-risk group remains poorly characterised. This study’s primary aim was to describe CKD progression and kidney failure in patients with kidney impairment before cardiac surgery. The secondary aim was to evaluate the impact of preexisting CKD in association with known risk factors (age, sex, and postoperative acute kidney injury) on CKD disease progression after cardiac surgery.</div></div><div><h3>Methods</h3><div>This retrospective observational multicentre study included adult patients who underwent cardiac surgery at the Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, between 2000 and 2022, and the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, between 2008 and 2024. Three outcomes were assessed, according to Kidney Disease: Improving Global Outcomes (KDIGO): rapid progression (confirmed estimated glomerular filtration rate [eGFR] decline ≥5 ml min⁻¹ 1.73 m² per year), CKD stage progression (confirmed decline in eGFR ≥25% with CKD stage advancement), and kidney failure (confirmed eGFR &lt;15 ml min⁻¹ 1.73 m²). Competing risk analysis accounted for mortality during median 7-yr follow-up.</div></div><div><h3>Results</h3><div>Among 27 483 adult cardiac surgery patients, 3512 patients (12.8%) had preexisting CKD (KDIGO stages G3a–G5), based on preoperative eGFR levels. Five-year survival decreased with worsening baseline kidney function: 86.1% in stages G1–2, 70.6% in stage G3a, 61.4% in stage G3b, 45.7% in stage G4, and 51.9% in stage G5. Cumulative 5-yr incidence was 38.7% for rapid progression, 23.8% for CKD stage progression, and 5.5% for kidney failure. Events clustered early post discharge, with 43% of rapid progression, 26% of kidney failure, and 18% of CKD progression events occurring within the first year. Males aged ≤70 yr with stage G4 CKD who developed postoperative acute kidney injury faced highest risks across all outcomes.</div></div><div><h3>Conclusions</h3><div>Cardiac surgery patients with preexisting CKD face substantial kidney disease progression, especially early after discharge. These findings highlight the need for research into structured follow-up programmes and kidney-preventive interventions.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100506"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative hypotension and postoperative delirium among older high-risk patients undergoing major noncardiac surgery: a retrospective single-centre cohort study","authors":"Inaame Ettoumi ,&nbsp;Daniel Pearce ,&nbsp;Theodora Wingert ,&nbsp;Amelie Delaporte ,&nbsp;Brenton Alexander ,&nbsp;Ravi Pal ,&nbsp;Jason Tang ,&nbsp;Nancy M. Boulos ,&nbsp;Yann Gricourt ,&nbsp;Janice Boktor ,&nbsp;Maziar M. Nourian ,&nbsp;Tristan Grogan ,&nbsp;Cecila Canales ,&nbsp;Dan Cole ,&nbsp;Robert A. Whittington ,&nbsp;Maxime Cannesson ,&nbsp;Alexandre Joosten","doi":"10.1016/j.bjao.2025.100500","DOIUrl":"10.1016/j.bjao.2025.100500","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative hypotension has been associated with postoperative complications, but its relationship with postoperative delirium remains debated.</div></div><div><h3>Methods</h3><div>This single-centre retrospective cohort study included adults (≥60 yr) with ASA physical status score of 3 or 4 undergoing major noncardiac surgery, with documented Confusion Assessment Method assessments. Patients with a history of neurosurgery, stroke, dementia, or neurocognitive disorders were excluded. The primary exposure was the cumulative duration of a mean arterial pressure &lt;65 mm Hg (minutes). The primary outcome was postoperative delirium within 7 days, diagnosed via Confusion Assessment Method. Multivariable logistic regression was used to assess the association between intraoperative hypotension and delirium, adjusting for confounders.</div></div><div><h3>Results</h3><div>Among 5171 patients included from 2013–2024, 632 (11.8%) developed delirium. The median (Q1–Q3) duration of surgery and time with mean arterial pressure &lt;65 mm Hg were 281 (199–430) min and 28 (9–61) min, respectively. In models adjusted for patient characteristics and perioperative factors, intraoperative hypotension was associated with increased odds of delirium (odds ratio per 60 min, 1.12; 95% confidence interval, 1.01–1.24; <em>P</em>=0.038). However, after adjusting for year of surgery, the association was attenuated and no longer statistically significant (odds ratio, 1.06; 95% confidence interval, 0.95–1.18; <em>P</em>=0.320). Both intraoperative hypotension exposure and delirium incidence declined significantly over the study period.</div></div><div><h3>Conclusions</h3><div>Although intraoperative hypotension initially appeared to be associated with postoperative delirium, this association was no longer significant when accounting for temporal improvements in perioperative care. Intraoperative hypotension may represent a marker of historical practice patterns rather than an independent causal driver of delirium.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100500"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of total morphine milligram equivalents at hospital discharge between opioid-naive and opioid-experienced surgical patients: a single-centre retrospective cohort study","authors":"Elis Liblik ,&nbsp;Urs Pietsch ,&nbsp;Anne-Katrin Hickmann","doi":"10.1016/j.bjao.2025.100497","DOIUrl":"10.1016/j.bjao.2025.100497","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative pain management is a key concern amid the growing opioid pandemic, particularly for opioid-experienced patients. This retrospective single-centre cohort study aimed to compare morphine milligram equivalents (MME) at hospital discharge between opioid-naive and opioid-experienced adults undergoing surgery with postoperative patient-controlled analgesia (PCA). We hypothesised that opioid-experienced patients would require higher MME at discharge, and greater intraoperative remifentanil and postoperative PCA use.</div></div><div><h3>Methods</h3><div>We retrospectively analysed 406 patients from 2016 to 2023 who received intravenous PCA for acute postoperative pain management. Trauma and neuraxial/regional block cases were excluded; emergency non-trauma cases included. Opioid-experienced patients were defined as chronic use of opioids for ≥3 months before surgery. The primary outcome was opioid dose at discharge in MME. Secondary outcomes were total intraoperative remifentanil dose and total PCA use in MME, analysed using multiple linear regression with permutation testing.</div></div><div><h3>Results</h3><div>Opioid-experienced patients had a 15.4 MME day⁻¹ higher discharge opioid dose (95% confidence interval [CI] 7.4–23.4 MME day⁻¹; <em>P</em>&lt;0.001), received 6.7× more opioids at discharge than opioid-naive patients (63.5 <em>vs</em> 9.4 MME day⁻¹; <em>P</em>&lt;0.001) and nearly doubled their own preoperative use (63.5 <em>vs</em> 30 MME day⁻¹). Opioid-experienced patients also required 52.0 MME day⁻¹ more via PCA (95% CI 13.1–90.8 MME day⁻¹; <em>P</em>=0.009). Each additional preoperative MME was associated with a 0.9 MME day⁻¹ increase in PCA use during the hospitalisation (95% CI 0.2–1.6 MME day⁻¹; <em>P</em>=0.017).</div></div><div><h3>Conclusions</h3><div>Preoperative opioid experience strongly predicted postoperative opioid requirements and discharge prescribing. Early identification of opioid-experienced patients and tailored multimodal strategies may improve individualised pain management. However, the retrospective single-centre design and lack of non-opioid analgesia data limit generalisability.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}