INTRODUCTIONAs survival rates after critical illness improve, increasing numbers of ICU survivors experience post-intensive care syndrome (PICS), with physical, cognitive and psychiatric impairments. However, there is a lack of robust population-level estimates on incidence rates to guide the implementation of measures to address this issue.METHODSWe conducted a retrospective nationwide cohort study using the South Korean National Health Insurance Service database. Adults admitted to any ICU who were alive ≥ 12 months after hospital discharge were included. To estimate the incidence of PICS, we did not include patients with any PICS-related diagnosis in the year before the index ICU admission. Post-intensive care syndrome was defined as a new diagnosis in at least one domain - physical, cognitive or psychiatric - within 12 months of hospital discharge.RESULTSAmong 234,069 ICU survivors with no prior PICS diagnosis, 130,110 (55.6%) developed PICS within 12 months of hospital discharge. Risk factors included older age (odds ratio (OR) 1.01, 95%CI 1.01-1.01); female sex (OR 1.17, 95%CI 1.15-1.19); lower income, particularly among Medical Aid beneficiaries (OR 1.16, 95%CI 1.12-1.21); pre-existing disability (mild-to-moderate: OR 1.12; 95%CI 1.09-1.15; severe: OR 1.08, 95%CI 1.05-1.12); higher comorbidity burden such as cerebrovascular disease (OR 1.88, 95%CI 1.84-1.92), dementia (OR 3.11, 95%CI 2.91-3.31) or chronic pulmonary disease (OR 1.25, 95%CI 1.22-1.28); and exposure to mechanical ventilation (OR 1.40, 95%CI, 1.36-1.44) or continuous renal replacement therapy (OR 1.12, 95%CI 1.05-1.12).DISCUSSIONIn a nationwide cohort of 234,069 ICU survivors, over half developed PICS within 12 months, with physical impairment most common. These findings quantify the survivorship burden attributable to critical illness and underpin the need for structured, multidisciplinary follow-up and rehabilitation for high-risk groups.
{"title":"Post-intensive care syndrome after critical illness: incidence and predictors in a nationwide cohort.","authors":"Tak Kyu Oh,In-Ae Song","doi":"10.1111/anae.70131","DOIUrl":"https://doi.org/10.1111/anae.70131","url":null,"abstract":"INTRODUCTIONAs survival rates after critical illness improve, increasing numbers of ICU survivors experience post-intensive care syndrome (PICS), with physical, cognitive and psychiatric impairments. However, there is a lack of robust population-level estimates on incidence rates to guide the implementation of measures to address this issue.METHODSWe conducted a retrospective nationwide cohort study using the South Korean National Health Insurance Service database. Adults admitted to any ICU who were alive ≥ 12 months after hospital discharge were included. To estimate the incidence of PICS, we did not include patients with any PICS-related diagnosis in the year before the index ICU admission. Post-intensive care syndrome was defined as a new diagnosis in at least one domain - physical, cognitive or psychiatric - within 12 months of hospital discharge.RESULTSAmong 234,069 ICU survivors with no prior PICS diagnosis, 130,110 (55.6%) developed PICS within 12 months of hospital discharge. Risk factors included older age (odds ratio (OR) 1.01, 95%CI 1.01-1.01); female sex (OR 1.17, 95%CI 1.15-1.19); lower income, particularly among Medical Aid beneficiaries (OR 1.16, 95%CI 1.12-1.21); pre-existing disability (mild-to-moderate: OR 1.12; 95%CI 1.09-1.15; severe: OR 1.08, 95%CI 1.05-1.12); higher comorbidity burden such as cerebrovascular disease (OR 1.88, 95%CI 1.84-1.92), dementia (OR 3.11, 95%CI 2.91-3.31) or chronic pulmonary disease (OR 1.25, 95%CI 1.22-1.28); and exposure to mechanical ventilation (OR 1.40, 95%CI, 1.36-1.44) or continuous renal replacement therapy (OR 1.12, 95%CI 1.05-1.12).DISCUSSIONIn a nationwide cohort of 234,069 ICU survivors, over half developed PICS within 12 months, with physical impairment most common. These findings quantify the survivorship burden attributable to critical illness and underpin the need for structured, multidisciplinary follow-up and rehabilitation for high-risk groups.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"20 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021354","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}
Adele Macgregor,Andrew McCombie,Elizabeth Hall,R Ross Kennedy
INTRODUCTIONDisparities in obstetric care in Aotearoa, New Zealand, significantly impact Māori and Pacific women, resulting in higher rates of maternal and neonatal morbidity and mortality. This study investigated the relationship between ethnicity and utilisation of epidural analgesia at our hospital to identify disparities in its provision and inform future research into the contributing factors.METHODSThis population-based retrospective cohort study included all deliveries at Christchurch Hospital, Christchurch, Aotearoa New Zealand, over a 4-year period. We performed separate univariable and multivariable logistic regression analyses for primiparous and multiparous women to examine how ethnicity, maternal characteristics and obstetric factors affect epidural utilisation.RESULTSThe study included 22,970 deliveries, with an overall epidural rate for vaginal deliveries of 23.1% (n = 3449). The rate was lower among Māori (18.4%) and Pacific (9.9%) women. There was no significant difference in epidural utilisation between Māori and European women during their first birth (OR 0.87, 95%CI 0.70-1.04, p = 0.12). However, Māori women were less likely to receive an epidural in subsequent births (OR 0.75, 95%CI 0.60-0.92, p < 0.01). Pacific women showed significantly lower epidural rates compared with European women across both parity groups (primiparous OR 0.61, 95%CI 0.44-0.84, p < 0.01 and multiparous OR 0.18, 95%CI 0.09-0.31, p < 0.01), even after controlling for confounders.DISCUSSIONThis study outlines the disparities in the utilisation of epidural analgesia at our hospital across various patient demographics. It highlights the need for further qualitative research investigating potential barriers to equitable access to effective labour pain management.
新西兰奥特罗阿产科护理的差异对Māori和太平洋地区妇女产生了重大影响，导致孕产妇和新生儿发病率和死亡率较高。本研究调查了种族与我院硬膜外镇痛使用之间的关系，以确定其提供的差异，并为未来的影响因素研究提供信息。方法：这项以人群为基础的回顾性队列研究包括4年期间在新西兰基督城基督城医院分娩的所有产妇。我们对初产和多产妇女分别进行单变量和多变量logistic回归分析，以检验种族、产妇特征和产科因素如何影响硬膜外使用。结果该研究包括22970例分娩，阴道分娩的硬膜外总率为23.1% （n = 3449）。在Māori（18.4%）和太平洋地区（9.9%）的女性中，这一比例较低。Māori和欧洲妇女首次分娩时硬膜外应用无显著差异（OR 0.87, 95%CI 0.70-1.04, p = 0.12）。然而，Māori妇女在随后的分娩中接受硬膜外麻醉的可能性较低（OR 0.75, 95%CI 0.60-0.92, p < 0.01）。即使在控制混杂因素后，太平洋地区妇女与欧洲妇女相比，在两个胎次组中均表现出显著的硬膜外分娩率（初产OR 0.61, 95%CI 0.44-0.84, p < 0.01，多产OR 0.18, 95%CI 0.09-0.31, p < 0.01）。本研究概述了我院不同患者在硬膜外镇痛应用方面的差异。它强调需要进一步进行定性研究，调查公平获得有效的分娩疼痛管理的潜在障碍。
{"title":"Effect of ethnicity and parity on utilisation of labour epidural analgesia: a retrospective study.","authors":"Adele Macgregor,Andrew McCombie,Elizabeth Hall,R Ross Kennedy","doi":"10.1111/anae.70127","DOIUrl":"https://doi.org/10.1111/anae.70127","url":null,"abstract":"INTRODUCTIONDisparities in obstetric care in Aotearoa, New Zealand, significantly impact Māori and Pacific women, resulting in higher rates of maternal and neonatal morbidity and mortality. This study investigated the relationship between ethnicity and utilisation of epidural analgesia at our hospital to identify disparities in its provision and inform future research into the contributing factors.METHODSThis population-based retrospective cohort study included all deliveries at Christchurch Hospital, Christchurch, Aotearoa New Zealand, over a 4-year period. We performed separate univariable and multivariable logistic regression analyses for primiparous and multiparous women to examine how ethnicity, maternal characteristics and obstetric factors affect epidural utilisation.RESULTSThe study included 22,970 deliveries, with an overall epidural rate for vaginal deliveries of 23.1% (n = 3449). The rate was lower among Māori (18.4%) and Pacific (9.9%) women. There was no significant difference in epidural utilisation between Māori and European women during their first birth (OR 0.87, 95%CI 0.70-1.04, p = 0.12). However, Māori women were less likely to receive an epidural in subsequent births (OR 0.75, 95%CI 0.60-0.92, p < 0.01). Pacific women showed significantly lower epidural rates compared with European women across both parity groups (primiparous OR 0.61, 95%CI 0.44-0.84, p < 0.01 and multiparous OR 0.18, 95%CI 0.09-0.31, p < 0.01), even after controlling for confounders.DISCUSSIONThis study outlines the disparities in the utilisation of epidural analgesia at our hospital across various patient demographics. It highlights the need for further qualitative research investigating potential barriers to equitable access to effective labour pain management.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"22 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021297","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}
Terry McCormack,Alex Wickham,Sinéad T J McDonagh,Matthew D Wiles,Luca Faconti,Rachael Brooks,Simon G Anderson,Andrew Hartle
INTRODUCTIONMaintaining stable blood pressure during surgery is a key responsibility of anaesthetists. Peri-operative omission and reintroduction of antihypertensive drugs, general anaesthesia, neuraxial and regional techniques can all cause significant fluctuations in blood pressure, particularly in patients with hypertension. Since the first edition of this guideline there has been more literature regarding peri-operative management, but some areas still lack standardisation.METHODSThis was a planned update of the 2016 guidelines from the Association of Anaesthetists and British Hypertension Society: The measurement of adult blood pressure and management of hypertension before elective surgery. An expert working party was convened. We conducted a targeted literature review followed by a modified Delphi process to formulate recommendations.RESULTSWe make recommendations on the management of blood pressure in the peri-operative period (from time of decision to operate until 30 days after surgery) for adults having planned surgery (excluding cardiothoracic, obstetric and endocrine surgeries). These include when and how to measure blood pressure; blood pressure thresholds for postponement of planned surgery; and the peri-operative management of blood pressure. Key recommendations include: secondary care peri-operative teams should accept patient referrals that document a clinic blood pressure measurement < 160/100 mmHg, or an ambulatory or home blood pressure measurement < 155/95 mmHg in the past 12 months; and patients who attend the pre-operative assessment clinic without documentation of normotension in primary care may proceed to elective surgery if their clinic blood pressure measurement is < 180/120 mmHg or ambulatory or home blood pressure measurement < 175/115 mmHg.DISCUSSIONManaging hypertension in the peri-operative period requires a nuanced approach, balancing immediate peri-operative risks with long-term cardiovascular health. Clear communication between primary care, hospital departments and patients is essential to minimise conflicting advice and ensure safe surgical outcomes.
{"title":"Measurement and management of adult blood pressure in the peri-operative period: updated guidelines from the Association of Anaesthetists and the British and Irish Hypertension Society.","authors":"Terry McCormack,Alex Wickham,Sinéad T J McDonagh,Matthew D Wiles,Luca Faconti,Rachael Brooks,Simon G Anderson,Andrew Hartle","doi":"10.1111/anae.70082","DOIUrl":"https://doi.org/10.1111/anae.70082","url":null,"abstract":"INTRODUCTIONMaintaining stable blood pressure during surgery is a key responsibility of anaesthetists. Peri-operative omission and reintroduction of antihypertensive drugs, general anaesthesia, neuraxial and regional techniques can all cause significant fluctuations in blood pressure, particularly in patients with hypertension. Since the first edition of this guideline there has been more literature regarding peri-operative management, but some areas still lack standardisation.METHODSThis was a planned update of the 2016 guidelines from the Association of Anaesthetists and British Hypertension Society: The measurement of adult blood pressure and management of hypertension before elective surgery. An expert working party was convened. We conducted a targeted literature review followed by a modified Delphi process to formulate recommendations.RESULTSWe make recommendations on the management of blood pressure in the peri-operative period (from time of decision to operate until 30 days after surgery) for adults having planned surgery (excluding cardiothoracic, obstetric and endocrine surgeries). These include when and how to measure blood pressure; blood pressure thresholds for postponement of planned surgery; and the peri-operative management of blood pressure. Key recommendations include: secondary care peri-operative teams should accept patient referrals that document a clinic blood pressure measurement < 160/100 mmHg, or an ambulatory or home blood pressure measurement < 155/95 mmHg in the past 12 months; and patients who attend the pre-operative assessment clinic without documentation of normotension in primary care may proceed to elective surgery if their clinic blood pressure measurement is < 180/120 mmHg or ambulatory or home blood pressure measurement < 175/115 mmHg.DISCUSSIONManaging hypertension in the peri-operative period requires a nuanced approach, balancing immediate peri-operative risks with long-term cardiovascular health. Clear communication between primary care, hospital departments and patients is essential to minimise conflicting advice and ensure safe surgical outcomes.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"47 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961584","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}
INTRODUCTIONThe UK NHS is committed to reaching net zero carbon emissions by 2040. Volatile anaesthetic agents are potent greenhouse gases and alternative intravenous methods exist. We aimed to predict the cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon emissions.METHODSA general anaesthetic for a 40-year-old, 78-kg patient was modelled. Two volatile anaesthetic agents (desflurane and sevoflurane) were compared with propofol-remifentanil total intravenous anaesthesia. Total intravenous anaesthesia with and without processed electroencephalography was modelled. Cost-effectiveness was calculated as the cost per kg carbon dioxide equivalent saved by transition to total intravenous anaesthesia, benchmarked against the UK emission trading scheme carbon permit price of £41.84 (US$54.90, €47.28) per tonne carbon dioxide equivalent.RESULTSTotal intravenous anaesthesia was less carbon intensive than sevoflurane and desflurane (2.0 vs. 9.8 kg and 209.2 kg carbon dioxide equivalent, respectively). Total intravenous anaesthesia was more expensive than sevoflurane when processed electroencephalography was used (£13.03 (US$17.08, €14.72) vs. £9.76 (US$12.79, €11.03)) but cheaper when it was not (£5.31 (US$6.95, €6.00) vs. £9.76 (US$12.79, €11.03)). When processed electroencephalography was used, the incremental cost-effectiveness ratio of transitioning from sevoflurane to total intravenous anaesthesia was £416 (US$544, €470) per tonne carbon dioxide equivalent. Total intravenous anaesthesia (with and without processed electroencephalography) was cheaper than desflurane (£18.94 (US$24.77, €21.41)).DISCUSSIONUsing our model parameters and the different carbon dioxide emissions and similar cost, transitioning from desflurane anaesthesia to total intravenous anaesthesia is cost-effective. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia without processed electroencephalography is likely to be cost-effective but is not recommended due to the increased risk of awareness. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia with processed electroencephalography is unlikely to be cost-effective.
{"title":"Cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon footprint: an economic modelling study.","authors":"Daniel Leslie,Christopher J Mullington","doi":"10.1111/anae.70111","DOIUrl":"https://doi.org/10.1111/anae.70111","url":null,"abstract":"INTRODUCTIONThe UK NHS is committed to reaching net zero carbon emissions by 2040. Volatile anaesthetic agents are potent greenhouse gases and alternative intravenous methods exist. We aimed to predict the cost-effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon emissions.METHODSA general anaesthetic for a 40-year-old, 78-kg patient was modelled. Two volatile anaesthetic agents (desflurane and sevoflurane) were compared with propofol-remifentanil total intravenous anaesthesia. Total intravenous anaesthesia with and without processed electroencephalography was modelled. Cost-effectiveness was calculated as the cost per kg carbon dioxide equivalent saved by transition to total intravenous anaesthesia, benchmarked against the UK emission trading scheme carbon permit price of £41.84 (US$54.90, €47.28) per tonne carbon dioxide equivalent.RESULTSTotal intravenous anaesthesia was less carbon intensive than sevoflurane and desflurane (2.0 vs. 9.8 kg and 209.2 kg carbon dioxide equivalent, respectively). Total intravenous anaesthesia was more expensive than sevoflurane when processed electroencephalography was used (£13.03 (US$17.08, €14.72) vs. £9.76 (US$12.79, €11.03)) but cheaper when it was not (£5.31 (US$6.95, €6.00) vs. £9.76 (US$12.79, €11.03)). When processed electroencephalography was used, the incremental cost-effectiveness ratio of transitioning from sevoflurane to total intravenous anaesthesia was £416 (US$544, €470) per tonne carbon dioxide equivalent. Total intravenous anaesthesia (with and without processed electroencephalography) was cheaper than desflurane (£18.94 (US$24.77, €21.41)).DISCUSSIONUsing our model parameters and the different carbon dioxide emissions and similar cost, transitioning from desflurane anaesthesia to total intravenous anaesthesia is cost-effective. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia without processed electroencephalography is likely to be cost-effective but is not recommended due to the increased risk of awareness. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia with processed electroencephalography is unlikely to be cost-effective.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"44 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961550","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}
INTRODUCTIONBreastfeeding is acknowledged widely as one of the most effective ways to ensure the health and well-being of both child and birth parent. Historically, advice given to patients who required an anaesthetic while breastfeeding was variable and inconsistent, sometimes resulting in the interruption of feeding for ≥ 24 h, or expressing and discarding breastmilk because of concerns regarding the possible adverse effects secondary to medicines passing into the breastmilk. This can be a contributory factor in the early cessation of breastfeeding. Peri-operative decisions can normally be made on the basis of pharmacokinetic data rather than on the precautionary principle.METHODSThis multidisciplinary consensus guideline included anaesthetists, pharmacists, midwives, infant feeding advisers and people with lived experience relevant to these guidelines. Following the targeted literature review, a three-round modified Delphi process was conducted to produce and ratify recommendations.RESULTSAny patient with a child aged < 2 y should routinely be asked if they are breastfeeding or expressing breastmilk during their pre-operative assessment for a procedure involving anaesthesia or sedation. Anaesthetic, sedative and analgesic medicines are transferred to breastmilk in only very small amounts. For almost all medicines used peri-operatively, there is no evidence of adverse effects on the breastfed child. Patients should be advised that discarding of breastmilk after anaesthesia ('pumping and dumping') is not necessary and that 'sleep and keep' is now recommended.DISCUSSIONThis pragmatic, multidisciplinary guideline aims to facilitate the peri-operative management of patients who are breastfeeding. It is hoped that these will be of value to both clinicians and patients in determining the optimal anaesthetic management strategy to support breastfeeding in the peri-operative period while ensuring minimal risk to the breastfed child.
{"title":"Guidelines for anaesthesia and sedation for patients who are breastfeeding: Guidelines from the Association of Anaesthetists.","authors":"Joellene Mitchell,Wendy Jones,Samantha Morris,Merle Cohen,Fiona Breckenridge,Julie Baruah-Young,Gemma Fletcher,Sarah Edwards,Marianne White,Matthew D Wiles","doi":"10.1111/anae.70128","DOIUrl":"https://doi.org/10.1111/anae.70128","url":null,"abstract":"INTRODUCTIONBreastfeeding is acknowledged widely as one of the most effective ways to ensure the health and well-being of both child and birth parent. Historically, advice given to patients who required an anaesthetic while breastfeeding was variable and inconsistent, sometimes resulting in the interruption of feeding for ≥ 24 h, or expressing and discarding breastmilk because of concerns regarding the possible adverse effects secondary to medicines passing into the breastmilk. This can be a contributory factor in the early cessation of breastfeeding. Peri-operative decisions can normally be made on the basis of pharmacokinetic data rather than on the precautionary principle.METHODSThis multidisciplinary consensus guideline included anaesthetists, pharmacists, midwives, infant feeding advisers and people with lived experience relevant to these guidelines. Following the targeted literature review, a three-round modified Delphi process was conducted to produce and ratify recommendations.RESULTSAny patient with a child aged < 2 y should routinely be asked if they are breastfeeding or expressing breastmilk during their pre-operative assessment for a procedure involving anaesthesia or sedation. Anaesthetic, sedative and analgesic medicines are transferred to breastmilk in only very small amounts. For almost all medicines used peri-operatively, there is no evidence of adverse effects on the breastfed child. Patients should be advised that discarding of breastmilk after anaesthesia ('pumping and dumping') is not necessary and that 'sleep and keep' is now recommended.DISCUSSIONThis pragmatic, multidisciplinary guideline aims to facilitate the peri-operative management of patients who are breastfeeding. It is hoped that these will be of value to both clinicians and patients in determining the optimal anaesthetic management strategy to support breastfeeding in the peri-operative period while ensuring minimal risk to the breastfed child.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"15 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961551","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}
INTRODUCTIONInjectable medicines represent a significant proportion of the annual medicines expenditure of the NHS in England, totalling £7 billion ($9.4 billion, €8.0 billion) in 2023. This represents approximately 70% of hospital medicines spending and includes essential treatments delivered at the point of care, such as chemotherapy; clinical trial drugs; and intravenous nutrition. Licensed ready-to-administer injectable products are manufactured and labelled for immediate use, eliminating the need for preparation or dilution by clinical staff, thereby enhancing efficiency and reducing risks. Despite the recognised benefits of ready-to-administer products for safety and productivity, most NHS hospitals favour traditional vials due to lower initial acquisition costs.METHODSWe searched for studies evaluating the clinical or economic impact of ready-to-administer intravenous medications in hospital settings. Grey literature from NHS and UK government sources was also reviewed. Inclusion criteria comprised English language studies assessing cost; waste; preparation time; or medication errors associated with ready-to-administer use.RESULTSSixteen studies were included in the review. Ready-to-administer products generally reduced preparation errors, drug wastage and preparation time, but variability in outcome measures and their definitions precluded meta-analysis. Evidence suggesting fewer adverse drug events and workflow interruptions derived mainly from observational studies and surrogate outcomes. Economic evaluations indicated potential savings from avoided errors, reduced waste and staff time, though estimates were context-specific and assumption-dependent. Overall, the risk of bias varied across studies and the predominance of small, single-centre, non-randomised designs limits generalisability.DISCUSSIONLicensed ready-to-administer products are associated with fewer preparation errors, shorter preparation times and reduced drug waste, with plausible economic benefits. The certainty of this conclusion is limited by heterogeneous, largely non-randomised designs and context-specific costs. Evidence specific to the UK is sparse. Multicentre studies with standardised outcomes and robust micro-costing are needed to define clinical impact, budget impact and implementation requirements.
{"title":"Economic evidence for licensed ready-to-administer intravenous products compared with standard vials and ampoules: a systematic review.","authors":"Suzanne Al-Rawi,Matthew Greening,Sue Ladds","doi":"10.1111/anae.70122","DOIUrl":"https://doi.org/10.1111/anae.70122","url":null,"abstract":"INTRODUCTIONInjectable medicines represent a significant proportion of the annual medicines expenditure of the NHS in England, totalling £7 billion ($9.4 billion, €8.0 billion) in 2023. This represents approximately 70% of hospital medicines spending and includes essential treatments delivered at the point of care, such as chemotherapy; clinical trial drugs; and intravenous nutrition. Licensed ready-to-administer injectable products are manufactured and labelled for immediate use, eliminating the need for preparation or dilution by clinical staff, thereby enhancing efficiency and reducing risks. Despite the recognised benefits of ready-to-administer products for safety and productivity, most NHS hospitals favour traditional vials due to lower initial acquisition costs.METHODSWe searched for studies evaluating the clinical or economic impact of ready-to-administer intravenous medications in hospital settings. Grey literature from NHS and UK government sources was also reviewed. Inclusion criteria comprised English language studies assessing cost; waste; preparation time; or medication errors associated with ready-to-administer use.RESULTSSixteen studies were included in the review. Ready-to-administer products generally reduced preparation errors, drug wastage and preparation time, but variability in outcome measures and their definitions precluded meta-analysis. Evidence suggesting fewer adverse drug events and workflow interruptions derived mainly from observational studies and surrogate outcomes. Economic evaluations indicated potential savings from avoided errors, reduced waste and staff time, though estimates were context-specific and assumption-dependent. Overall, the risk of bias varied across studies and the predominance of small, single-centre, non-randomised designs limits generalisability.DISCUSSIONLicensed ready-to-administer products are associated with fewer preparation errors, shorter preparation times and reduced drug waste, with plausible economic benefits. The certainty of this conclusion is limited by heterogeneous, largely non-randomised designs and context-specific costs. Evidence specific to the UK is sparse. Multicentre studies with standardised outcomes and robust micro-costing are needed to define clinical impact, budget impact and implementation requirements.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"81 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968390","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}
Adrien Lemoine,Anna Alber,Girish P Joshi,Marc Van de Velde,Geertrui Dewinter,Esther Pogatzki-Zahn,Marie-Pierre Bonnet,
INTRODUCTIONAdequate postoperative pain control is crucial for rehabilitation after open thoracotomy. The aim of this systematic review was to update the previous procedure-specific postoperative pain management recommendations for patients undergoing open thoracotomy.METHODSUsing previously reported PROSPECT methodology, we performed a systematic review of randomised controlled trials, systematic reviews and meta-analyses evaluating pain interventions for open thoracotomy published between 2015 and 2024. Data extracted from the included studies were evaluated by an expert subgroup that considered the relevance of the studied interventions in clinical practice and their risk/benefit profile. Recommendations were finalised after review and comments by all members of the PROSPECT working group using a modified Delphi approach. The Cochrane Risk of bias tool 2 was used to grade the quality of evidence.RESULTSOverall, 100 studies were included. Based on the available evidence, either thoracic epidural analgesia or paravertebral blockade should be provided as a first-line analgesic intervention for open thoracotomy. Erector spinae plane, rhomboid intercostal or intercostal nerve blockade could be used as a second-line regional analgesia intervention. In addition, patients should receive basic analgesia consisting of paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors. Acupuncture or cryoanalgesia is recommended when regional analgesia cannot be performed, albeit with a low level of supportive evidence. The choice of surgical technique, postoperative physiotherapy and approach to patient education should be based on outcomes other than pain control.DISCUSSIONIn these updated guidelines on pain management after open thoracotomy, the main changes concern the recommendation of either thoracic epidural analgesia or paravertebral blockade as the first-line intervention according to patient and clinician preference, combined with basic systemic analgesia. The use of other regional blocks should be limited to patients who cannot receive thoracic epidural analgesia or paravertebral blockade.
{"title":"Pain management after open thoracotomy 2025: procedure-specific postoperative pain management (PROSPECT) recommendations.","authors":"Adrien Lemoine,Anna Alber,Girish P Joshi,Marc Van de Velde,Geertrui Dewinter,Esther Pogatzki-Zahn,Marie-Pierre Bonnet, ","doi":"10.1111/anae.70123","DOIUrl":"https://doi.org/10.1111/anae.70123","url":null,"abstract":"INTRODUCTIONAdequate postoperative pain control is crucial for rehabilitation after open thoracotomy. The aim of this systematic review was to update the previous procedure-specific postoperative pain management recommendations for patients undergoing open thoracotomy.METHODSUsing previously reported PROSPECT methodology, we performed a systematic review of randomised controlled trials, systematic reviews and meta-analyses evaluating pain interventions for open thoracotomy published between 2015 and 2024. Data extracted from the included studies were evaluated by an expert subgroup that considered the relevance of the studied interventions in clinical practice and their risk/benefit profile. Recommendations were finalised after review and comments by all members of the PROSPECT working group using a modified Delphi approach. The Cochrane Risk of bias tool 2 was used to grade the quality of evidence.RESULTSOverall, 100 studies were included. Based on the available evidence, either thoracic epidural analgesia or paravertebral blockade should be provided as a first-line analgesic intervention for open thoracotomy. Erector spinae plane, rhomboid intercostal or intercostal nerve blockade could be used as a second-line regional analgesia intervention. In addition, patients should receive basic analgesia consisting of paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors. Acupuncture or cryoanalgesia is recommended when regional analgesia cannot be performed, albeit with a low level of supportive evidence. The choice of surgical technique, postoperative physiotherapy and approach to patient education should be based on outcomes other than pain control.DISCUSSIONIn these updated guidelines on pain management after open thoracotomy, the main changes concern the recommendation of either thoracic epidural analgesia or paravertebral blockade as the first-line intervention according to patient and clinician preference, combined with basic systemic analgesia. The use of other regional blocks should be limited to patients who cannot receive thoracic epidural analgesia or paravertebral blockade.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"255 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949578","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}
Gareth Kitchen, Karen Thomas, Tim Felton, Hannah Durrington, John Blaikley, Stuart W. Grant, David Harrison, Peter McGuigan, Kathryn Rowan, Anthony Wilson, Danny McAuley, Paul Dark
Summary Introduction Uncertainty remains regarding whether the time of day that cardiac surgery is performed affects postoperative outcomes or if the observed variation can be explained by patient or surgical factors. Methods A secondary analysis of prospectively collected data was conducted to examine the association between time of cardiac surgery and clinical outcomes. Data were derived from four linked UK datasets: the National Adult Cardiac Surgery Audit; the Case Mix Programme; Hospital Episode Statistics; and Office for National Statistics mortality records. The primary outcomes were hazard of death due to cardiovascular disease and time to hospital readmission for myocardial infarction or acute heart failure. Secondary outcomes included duration of postoperative hospital stay; occurrence of major cardiovascular events; and all‐cause mortality. Results Linked data for 24,068 patients were identified. Surgeries performed in late morning (10:00 to 11:59) had the highest mean (SD) predicted risk of death (3.7% (4.6)), compared with 3.2% (3.7) for early morning (07:00 to 09:59), 2.8% (3.4) for early afternoon (12:00 to 13:59) and 3.1% (3.6) for late afternoon (14:00 to 19:59) surgeries, respectively. The primary outcome measures showed an increased hazard of death from cardiovascular disease in the late morning (adjusted hazard ratio 1.18, 95%CI 1.00–1.39), with no difference in hazard of readmission for myocardial infarction or acute heart failure (adjusted hazard ratio 0.97, 95%CI 0.85–1.11). There were no differences in the secondary outcome measures. Discussion Time‐of‐day variation in postoperative death due to cardiovascular disease following cardiac surgery was observed, with the highest risk seen in late morning procedures. These findings suggest that intra‐operative or organisational factors specific to this period may influence outcomes. Future research should explore whether individual circadian phenotypes or chronotypes contribute to this variation, supporting a move towards precision and personalised scheduling of cardiac surgery to optimise patient outcomes.
{"title":"Time of day of cardiac surgery and postoperative outcomes in the UK : a secondary analysis of linked national datasets","authors":"Gareth Kitchen, Karen Thomas, Tim Felton, Hannah Durrington, John Blaikley, Stuart W. Grant, David Harrison, Peter McGuigan, Kathryn Rowan, Anthony Wilson, Danny McAuley, Paul Dark","doi":"10.1111/anae.70125","DOIUrl":"https://doi.org/10.1111/anae.70125","url":null,"abstract":"Summary Introduction Uncertainty remains regarding whether the time of day that cardiac surgery is performed affects postoperative outcomes or if the observed variation can be explained by patient or surgical factors. Methods A secondary analysis of prospectively collected data was conducted to examine the association between time of cardiac surgery and clinical outcomes. Data were derived from four linked UK datasets: the National Adult Cardiac Surgery Audit; the Case Mix Programme; Hospital Episode Statistics; and Office for National Statistics mortality records. The primary outcomes were hazard of death due to cardiovascular disease and time to hospital readmission for myocardial infarction or acute heart failure. Secondary outcomes included duration of postoperative hospital stay; occurrence of major cardiovascular events; and all‐cause mortality. Results Linked data for 24,068 patients were identified. Surgeries performed in late morning (10:00 to 11:59) had the highest mean (SD) predicted risk of death (3.7% (4.6)), compared with 3.2% (3.7) for early morning (07:00 to 09:59), 2.8% (3.4) for early afternoon (12:00 to 13:59) and 3.1% (3.6) for late afternoon (14:00 to 19:59) surgeries, respectively. The primary outcome measures showed an increased hazard of death from cardiovascular disease in the late morning (adjusted hazard ratio 1.18, 95%CI 1.00–1.39), with no difference in hazard of readmission for myocardial infarction or acute heart failure (adjusted hazard ratio 0.97, 95%CI 0.85–1.11). There were no differences in the secondary outcome measures. Discussion Time‐of‐day variation in postoperative death due to cardiovascular disease following cardiac surgery was observed, with the highest risk seen in late morning procedures. These findings suggest that intra‐operative or organisational factors specific to this period may influence outcomes. Future research should explore whether individual circadian phenotypes or chronotypes contribute to this variation, supporting a move towards precision and personalised scheduling of cardiac surgery to optimise patient outcomes.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"125 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920376","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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