Akshay Shah, Andrew A. Klein, Seema Agarwal, Andrew Lindley, Aamer Ahmed, Kerry Dowling, Emma Jackson, Sumit Das, Divya Raviraj, Rachel Collis, Anna Sharrock, Simon J. Stanworth, Paul Moor
SummaryBackgroundThe administration of blood components and their alternatives can be lifesaving. Anaemia, bleeding and transfusion are all associated with poor peri‐operative outcomes. Considerable changes in the approaches to optimal use of blood components and their alternatives, driven by the findings of large randomised controlled trials and improved haemovigilance, have become apparent over the past decade. The aim of these updated guidelines is to provide an evidence‐based set of recommendations so that anaesthetists and peri‐operative physicians might provide high‐quality care.MethodsAn expert multidisciplinary, multi‐society working party conducted targeted literature reviews, followed by a three‐round Delphi process to produce these guidelines.ResultsWe agreed on 12 key recommendations. Overall, these highlight the importance of organisational factors for safe transfusion and timely provision of blood components; the need for protocols that are targeted to different clinical contexts of major bleeding; and strategies to avoid the need for transfusion, minimise bleeding and manage anticoagulant therapy.ConclusionsAll anaesthetists involved in the care of patients at risk of major bleeding and peri‐operative transfusion should be aware of the treatment options and approaches that are available to them. These contemporary guidelines aim to provide recommendations across a range of clinical situations.
{"title":"Association of Anaesthetists guidelines: the use of blood components and their alternatives 2024","authors":"Akshay Shah, Andrew A. Klein, Seema Agarwal, Andrew Lindley, Aamer Ahmed, Kerry Dowling, Emma Jackson, Sumit Das, Divya Raviraj, Rachel Collis, Anna Sharrock, Simon J. Stanworth, Paul Moor","doi":"10.1111/anae.16542","DOIUrl":"https://doi.org/10.1111/anae.16542","url":null,"abstract":"SummaryBackgroundThe administration of blood components and their alternatives can be lifesaving. Anaemia, bleeding and transfusion are all associated with poor peri‐operative outcomes. Considerable changes in the approaches to optimal use of blood components and their alternatives, driven by the findings of large randomised controlled trials and improved haemovigilance, have become apparent over the past decade. The aim of these updated guidelines is to provide an evidence‐based set of recommendations so that anaesthetists and peri‐operative physicians might provide high‐quality care.MethodsAn expert multidisciplinary, multi‐society working party conducted targeted literature reviews, followed by a three‐round Delphi process to produce these guidelines.ResultsWe agreed on 12 key recommendations. Overall, these highlight the importance of organisational factors for safe transfusion and timely provision of blood components; the need for protocols that are targeted to different clinical contexts of major bleeding; and strategies to avoid the need for transfusion, minimise bleeding and manage anticoagulant therapy.ConclusionsAll anaesthetists involved in the care of patients at risk of major bleeding and peri‐operative transfusion should be aware of the treatment options and approaches that are available to them. These contemporary guidelines aim to provide recommendations across a range of clinical situations.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"2 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pietro Arina, Davide Ferrari, Nicholas Tetlow, Amy Dewar, Robert Stephens, Daniel Martin, Ramani Moonesinghe, Vasa Curcin, Mervyn Singer, John Whittle, Evangelos B. Mazomenos
SummaryIntroductionUnderstanding 1‐year mortality following major surgery offers valuable insights into patient outcomes and the quality of peri‐operative care. Few models exist that predict 1‐year mortality accurately. This study aimed to develop a predictive model for 1‐year mortality in patients undergoing complex non‐cardiac surgery using a novel machine‐learning technique called multi‐objective symbolic regression.MethodsA single‐institution database of patients undergoing major elective surgery with previous cardiopulmonary exercise testing was divided into three datasets: pre‐operative clinical data; cardiorespiratory and physiological data; and combined. A multi‐objective symbolic regression model was developed and compared against existing models. Model performance was evaluated using the F1 score. Shapley additive explanations analysis was used to identify the major contributors to model performance.ResultsFrom 2145 patients in the database, 1190 were included, with 952 in the training dataset and 238 in the test dataset. Median (IQR [range]) age was 71 (61–79 [45–89]) years and 825 (69%) were male. The multi‐objective symbolic regression model demonstrated robust consistency with an F1 score of 0.712. Shapley additive explanations analysis indicated that ventilatory equivalents for carbon dioxide, oxygen at peak exercise and BMI influenced model performance most significantly, surpassing surgery type and named comorbidities.DiscussionThis study confirms the feasibility of developing a multi‐objective symbolic regression‐based model for predicting 1‐year postoperative mortality in a mixed non‐cardiac surgical population. The model's strong performance underscores the critical role of physiological data, particularly cardiorespiratory fitness, in surgical risk assessment and emphasises the importance of pre‐operative optimisation to identify and manage high‐risk patients. The multi‐objective symbolic regression model demonstrated high sensitivity and a good F1 score, highlighting its potential as an effective tool for peri‐operative risk prediction.
{"title":"Mortality prediction after major surgery in a mixed population through machine learning: a multi‐objective symbolic regression approach","authors":"Pietro Arina, Davide Ferrari, Nicholas Tetlow, Amy Dewar, Robert Stephens, Daniel Martin, Ramani Moonesinghe, Vasa Curcin, Mervyn Singer, John Whittle, Evangelos B. Mazomenos","doi":"10.1111/anae.16538","DOIUrl":"https://doi.org/10.1111/anae.16538","url":null,"abstract":"SummaryIntroductionUnderstanding 1‐year mortality following major surgery offers valuable insights into patient outcomes and the quality of peri‐operative care. Few models exist that predict 1‐year mortality accurately. This study aimed to develop a predictive model for 1‐year mortality in patients undergoing complex non‐cardiac surgery using a novel machine‐learning technique called multi‐objective symbolic regression.MethodsA single‐institution database of patients undergoing major elective surgery with previous cardiopulmonary exercise testing was divided into three datasets: pre‐operative clinical data; cardiorespiratory and physiological data; and combined. A multi‐objective symbolic regression model was developed and compared against existing models. Model performance was evaluated using the F1 score. Shapley additive explanations analysis was used to identify the major contributors to model performance.ResultsFrom 2145 patients in the database, 1190 were included, with 952 in the training dataset and 238 in the test dataset. Median (IQR [range]) age was 71 (61–79 [45–89]) years and 825 (69%) were male. The multi‐objective symbolic regression model demonstrated robust consistency with an F1 score of 0.712. Shapley additive explanations analysis indicated that ventilatory equivalents for carbon dioxide, oxygen at peak exercise and BMI influenced model performance most significantly, surpassing surgery type and named comorbidities.DiscussionThis study confirms the feasibility of developing a multi‐objective symbolic regression‐based model for predicting 1‐year postoperative mortality in a mixed non‐cardiac surgical population. The model's strong performance underscores the critical role of physiological data, particularly cardiorespiratory fitness, in surgical risk assessment and emphasises the importance of pre‐operative optimisation to identify and manage high‐risk patients. The multi‐objective symbolic regression model demonstrated high sensitivity and a good F1 score, highlighting its potential as an effective tool for peri‐operative risk prediction.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"28 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ka Yu Tse, Mandy Man Yee Chu, Jessie Wan Kam Chiu, Shuk Tak Kwok, Michael G. Irwin, Aaron Hey Yin Chan, Polly Ho, Calvin Pak Wing Cheng, Siew Fei Ngu, Karen Kar Loen Chan
Patients with advanced ovarian cancer often require radical cytoreductive surgery and chemotherapy, with or without targeted therapy. Return to intended oncological therapy after surgery is a crucial metric, as delay can worsen survival. The concept of return to intended oncological therapy is important because it highlights the need for not just successful surgical outcomes, but also the ability to continue with the comprehensive cancer treatment plan.
{"title":"Return to intended oncological therapy following advanced ovarian cancer surgery: a narrative review","authors":"Ka Yu Tse, Mandy Man Yee Chu, Jessie Wan Kam Chiu, Shuk Tak Kwok, Michael G. Irwin, Aaron Hey Yin Chan, Polly Ho, Calvin Pak Wing Cheng, Siew Fei Ngu, Karen Kar Loen Chan","doi":"10.1111/anae.16521","DOIUrl":"https://doi.org/10.1111/anae.16521","url":null,"abstract":"Patients with advanced ovarian cancer often require radical cytoreductive surgery and chemotherapy, with or without targeted therapy. Return to intended oncological therapy after surgery is a crucial metric, as delay can worsen survival. The concept of return to intended oncological therapy is important because it highlights the need for not just successful surgical outcomes, but also the ability to continue with the comprehensive cancer treatment plan.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hilary Stewart, Sophie Stanley, Xiubin Zhang, Lisa Ashmore, Christopher Gaffney, Jo Rycroft-Malone, Andrew F. Smith, Laura Wareing, Cliff Shelton
Prehabilitation seeks to enhance functional capacity and preparedness before surgery with the aim of improving outcomes; it is generally based on exercise, diet and psychological interventions. While there is obvious appeal to this approach in terms of patient experience and resource use, the interventions are complex and the evidence base for prehabilitation before cancer surgery is heterogeneous. Prehabilitation requires patient understanding and motivation as well as commitment of resources. Programmes are challenging to design and implement, and can generate ‘intervention-based inequalities’ based on the capacity of patients to engage. We present a narrative review on the inequalities and challenges of prehabilitation before cancer surgery.
{"title":"The inequalities and challenges of prehabilitation before cancer surgery: a narrative review","authors":"Hilary Stewart, Sophie Stanley, Xiubin Zhang, Lisa Ashmore, Christopher Gaffney, Jo Rycroft-Malone, Andrew F. Smith, Laura Wareing, Cliff Shelton","doi":"10.1111/anae.16502","DOIUrl":"https://doi.org/10.1111/anae.16502","url":null,"abstract":"Prehabilitation seeks to enhance functional capacity and preparedness before surgery with the aim of improving outcomes; it is generally based on exercise, diet and psychological interventions. While there is obvious appeal to this approach in terms of patient experience and resource use, the interventions are complex and the evidence base for prehabilitation before cancer surgery is heterogeneous. Prehabilitation requires patient understanding and motivation as well as commitment of resources. Programmes are challenging to design and implement, and can generate ‘intervention-based inequalities’ based on the capacity of patients to engage. We present a narrative review on the inequalities and challenges of prehabilitation before cancer surgery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos E. Guerra-Londono, Santiago Uribe-Marquez, Rupen Shah, Vijaya Gottumukkala
Most patients with cancer will require surgery at some point in their lifetime. As the global burden of cancer continues to increase, changes and challenges in cancer epidemiology and care are also borne peri-operatively.
{"title":"The increasing global burden of cancer: implications for anaesthesia and peri-operative medicine","authors":"Carlos E. Guerra-Londono, Santiago Uribe-Marquez, Rupen Shah, Vijaya Gottumukkala","doi":"10.1111/anae.16514","DOIUrl":"https://doi.org/10.1111/anae.16514","url":null,"abstract":"Most patients with cancer will require surgery at some point in their lifetime. As the global burden of cancer continues to increase, changes and challenges in cancer epidemiology and care are also borne peri-operatively.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"44 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanna Abraham, Katherine J. Holzer, Lavanya Pedamallu, Benjamin D. Kozower, Michael S. Avidan, Eric J. Lenze
Oncologic surgeries are common and rates of depression and anxiety are high in the peri-operative period, potentially interfering with successful recovery.
肿瘤手术很常见，围手术期抑郁和焦虑的发生率很高，可能会干扰成功的康复。
{"title":"Peri-operative mental health interventions for surgical oncology patients: a narrative synthesis and meta-analysis","authors":"Joanna Abraham, Katherine J. Holzer, Lavanya Pedamallu, Benjamin D. Kozower, Michael S. Avidan, Eric J. Lenze","doi":"10.1111/anae.16471","DOIUrl":"https://doi.org/10.1111/anae.16471","url":null,"abstract":"Oncologic surgeries are common and rates of depression and anxiety are high in the peri-operative period, potentially interfering with successful recovery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andy Georgiou, David Cain, Martin Schuster Bruce, Denise Axelsen, Tom Woodward, Tom Baumer, Katie Preston, James Ward, Jack Ingham, Alun Roberts
The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%–< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care.
{"title":"Emergency and postoperative access to critical and enhanced care: a multicentre prospective observational study*","authors":"Andy Georgiou, David Cain, Martin Schuster Bruce, Denise Axelsen, Tom Woodward, Tom Baumer, Katie Preston, James Ward, Jack Ingham, Alun Roberts","doi":"10.1111/anae.16536","DOIUrl":"https://doi.org/10.1111/anae.16536","url":null,"abstract":"The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%–< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"17 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ben Sharif, Melanie Nana, Rachel Kearns, Queenie Lo, Yavor Metodiev
Cancer complicates approximately 1 in 2000 pregnancies, with increasing incidence due to factors such as increased maternal age, obesity and advancements in antenatal testing. Anaesthetists play a crucial role in managing pregnant patients with cancer, both during delivery and in providing anaesthesia for oncological treatments. This review explores the challenges in anaesthetic management and specific considerations for common cancers encountered in pregnant patients.
{"title":"Anaesthetic management of oncological disease in pregnancy: a narrative review","authors":"Ben Sharif, Melanie Nana, Rachel Kearns, Queenie Lo, Yavor Metodiev","doi":"10.1111/anae.16489","DOIUrl":"https://doi.org/10.1111/anae.16489","url":null,"abstract":"Cancer complicates approximately 1 in 2000 pregnancies, with increasing incidence due to factors such as increased maternal age, obesity and advancements in antenatal testing. Anaesthetists play a crucial role in managing pregnant patients with cancer, both during delivery and in providing anaesthesia for oncological treatments. This review explores the challenges in anaesthetic management and specific considerations for common cancers encountered in pregnant patients.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"48 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiotherapy is currently used in approximately one-third of children with cancer. Treatments are typically received as weekday outpatient appointments over 3–6 weeks. The treatment is painless but requires a still, co-operative patient who can lie alone in set positions, facilitated by the use of immobilisation devices, for up to 1 h.
{"title":"Anaesthesia for paediatric radiotherapy: A narrative review","authors":"Lauren Oswald, Sam Al-Kadhimi, Nicola Thorp","doi":"10.1111/anae.16499","DOIUrl":"https://doi.org/10.1111/anae.16499","url":null,"abstract":"Radiotherapy is currently used in approximately one-third of children with cancer. Treatments are typically received as weekday outpatient appointments over 3–6 weeks. The treatment is painless but requires a still, co-operative patient who can lie alone in set positions, facilitated by the use of immobilisation devices, for up to 1 h.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"56 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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