Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery.
{"title":"Optimisation of the patient having oncological surgical through prehabilitation: a narrative review","authors":"John Moore, Alec Beaney, Liam Humphreys, Zoe Merchant, Krishna Kholia Parmar, Denny Levett","doi":"10.1111/anae.16513","DOIUrl":"https://doi.org/10.1111/anae.16513","url":null,"abstract":"Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"80 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935820","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}
The diagnostic accuracy of gastric ultrasound in children has not been assessed thoroughly. We aimed to determine the sensitivity and specificity in children of a qualitative ultrasound examination of the gastric antrum in the supine 45° semi-recumbent position and a clinical algorithm for detecting a gastric fluid volume > 1.25 ml.kg-1, reported to represent an ‘at-risk stomach’ for pulmonary aspiration.
{"title":"Diagnostic accuracy of qualitative gastric ultrasound assessment for detecting high gastric fluid volume in children: a prospective randomised study","authors":"Eloïse Cercueil, Anaïs Henriet, Corwyn Barbe, Guinter Santos Machado, Lionel Bouvet","doi":"10.1111/anae.16539","DOIUrl":"https://doi.org/10.1111/anae.16539","url":null,"abstract":"The diagnostic accuracy of gastric ultrasound in children has not been assessed thoroughly. We aimed to determine the sensitivity and specificity in children of a qualitative ultrasound examination of the gastric antrum in the supine 45° semi-recumbent position and a clinical algorithm for detecting a gastric fluid volume > 1.25 ml.kg<sup>-1</sup>, reported to represent an ‘at-risk stomach’ for pulmonary aspiration.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935139","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}
Pooyan Sekhavati, Tristan Wild, Ingrid D. P. C. Martinez, Pierre‐Marc Dion, Michael Woo, Reva Ramlogan, Sylvain Boet, Risa Shorr, Yuqi Gu
SummaryIntroductionUltrasound‐guided regional anaesthesia enhances pain control, patient outcomes and lowers healthcare costs. However, teaching this skill effectively presents challenges with current training methods. Simulation‐based medical education offers advantages over traditional methods. However, the use of instructional design features in ultrasound‐guided regional anaesthesia simulation training has not been defined. This systematic review aimed to identify and evaluate the prevalence of various instructional design features in ultrasound‐guided regional anaesthesia simulation training and their correlation with learning outcomes using a modified Kirkpatrick model.MethodsA comprehensive literature search was conducted including studies from inception to August 2024. Eligibility criteria included randomised controlled trials; controlled before‐and‐after studies; and other experimental designs focusing on ultrasound‐guided regional anaesthesia simulation training. Data extraction included study characteristics; simulation modalities; instructional design features; and outcomes.ResultsOf the 2023 articles identified, 62 met inclusion criteria. Common simulation modalities included live‐model scanning and gel phantom models. Instructional design features such as the presence of expert instructors, repetitive practice and multiple learning strategies were prevalent, showing significant improvements across multiple outcome levels. However, fewer studies assessed behaviour (Kirkpatrick level 3) and patient outcomes (Kirkpatrick level 4).DiscussionUltrasound‐guided regional anaesthesia simulation training incorporating specific instructional design features enhances educational outcome; this was particularly evident at lower Kirkpatrick levels. Optimal combinations of instructional design features for higher‐level outcomes (Kirkpatrick levels 3 and 4) remain unclear. Future research should standardise outcome measurements and isolate individual instructional design features to better understand their impact on clinical practice and patient safety.
{"title":"Instructional design features in ultrasound‐guided regional anaesthesia simulation‐based training: a systematic review","authors":"Pooyan Sekhavati, Tristan Wild, Ingrid D. P. C. Martinez, Pierre‐Marc Dion, Michael Woo, Reva Ramlogan, Sylvain Boet, Risa Shorr, Yuqi Gu","doi":"10.1111/anae.16527","DOIUrl":"https://doi.org/10.1111/anae.16527","url":null,"abstract":"SummaryIntroductionUltrasound‐guided regional anaesthesia enhances pain control, patient outcomes and lowers healthcare costs. However, teaching this skill effectively presents challenges with current training methods. Simulation‐based medical education offers advantages over traditional methods. However, the use of instructional design features in ultrasound‐guided regional anaesthesia simulation training has not been defined. This systematic review aimed to identify and evaluate the prevalence of various instructional design features in ultrasound‐guided regional anaesthesia simulation training and their correlation with learning outcomes using a modified Kirkpatrick model.MethodsA comprehensive literature search was conducted including studies from inception to August 2024. Eligibility criteria included randomised controlled trials; controlled before‐and‐after studies; and other experimental designs focusing on ultrasound‐guided regional anaesthesia simulation training. Data extraction included study characteristics; simulation modalities; instructional design features; and outcomes.ResultsOf the 2023 articles identified, 62 met inclusion criteria. Common simulation modalities included live‐model scanning and gel phantom models. Instructional design features such as the presence of expert instructors, repetitive practice and multiple learning strategies were prevalent, showing significant improvements across multiple outcome levels. However, fewer studies assessed behaviour (Kirkpatrick level 3) and patient outcomes (Kirkpatrick level 4).DiscussionUltrasound‐guided regional anaesthesia simulation training incorporating specific instructional design features enhances educational outcome; this was particularly evident at lower Kirkpatrick levels. Optimal combinations of instructional design features for higher‐level outcomes (Kirkpatrick levels 3 and 4) remain unclear. Future research should standardise outcome measurements and isolate individual instructional design features to better understand their impact on clinical practice and patient safety.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"42 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935143","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}
<p>We read with interest the Science Letter by Dubowitz et al. [<span>1</span>]. The application of biological instead of chronological age for the prediction of postoperative complications in patients is a promising advance, and we concur with the authors' perspective on the potential association between biological ageing and postoperative complications after cancer surgery. This study helps prompt surgeons and anaesthetists to reflect on their practice and identify high-risk patients, regardless of the method used.</p> <p>However, in statistics, correlation is not a substitute for causal inference. Also, exclusive reliance on the PhenoAge model as a means of calculating biological age has considerable limitations. This model uses conventional clinical biomarkers (e.g. white blood cell count, blood glucose, lipids, creatinine, etc.) to calculate biological age [<span>2</span>]. In our opinion, these markers reflect primarily the macroscopic health of the body, but do not fully capture the ageing process at the cellular or molecular level. They are also susceptible to external factors (e.g. diet, lifestyle, environmental pollution, etc.) and, thus, may not reflect an individual's biological ageing accurately. In addition, PhenoAge modelling is based on data from specific populations, usually in the USA. In other races and regions, the performance of this model may not be the same. Therefore, when the PhenoAge model is applied in different races or regions, it may need to be re-based on a large sample size of data for optimisation or training.</p> <p>Most importantly, the PhenoAge model simplifies the ageing process, which is a multifactorial and complex process involving interactions at multiple levels, such as gene expression; telomere shortening; immune system decline; and epigenetic changes [<span>3, 4</span>]. The model focuses mainly on a few clinical markers, but it fails to account for all the biological processes involved in the ageing process and, therefore, may overlook some subtle key roles of age-related molecular targets. Indeed, one of the primary challenges in predicting the incidence of postoperative complications in older patients accurately is the absence of dedicated peri-operative databases for this specific population. Such databases are essential for researchers to obtain sufficient, high-quality raw data.</p> <p>In accordance with this objective, our research group is currently engaged in the establishment of the Perioperative Management and Outcome database, which is a large-scale, nationwide registry of older patients in China [<span>5</span>]. The prospective registry is expected to provide a rich dataset that will facilitate the evaluation of the quality of peri-operative care and, in turn, improve clinical care for older patients. Nevertheless, it has proven challenging to construct a database that encompasses multiple countries or regions and is based on participants from a diverse range of populations. It is anticipa
{"title":"Accurate prediction of postoperative complications in older patients: a long way to go","authors":"Zhendong Ding, Qin Liao, Yongzhong Tang","doi":"10.1111/anae.16540","DOIUrl":"https://doi.org/10.1111/anae.16540","url":null,"abstract":"<p>We read with interest the Science Letter by Dubowitz et al. [<span>1</span>]. The application of biological instead of chronological age for the prediction of postoperative complications in patients is a promising advance, and we concur with the authors' perspective on the potential association between biological ageing and postoperative complications after cancer surgery. This study helps prompt surgeons and anaesthetists to reflect on their practice and identify high-risk patients, regardless of the method used.</p>\u0000<p>However, in statistics, correlation is not a substitute for causal inference. Also, exclusive reliance on the PhenoAge model as a means of calculating biological age has considerable limitations. This model uses conventional clinical biomarkers (e.g. white blood cell count, blood glucose, lipids, creatinine, etc.) to calculate biological age [<span>2</span>]. In our opinion, these markers reflect primarily the macroscopic health of the body, but do not fully capture the ageing process at the cellular or molecular level. They are also susceptible to external factors (e.g. diet, lifestyle, environmental pollution, etc.) and, thus, may not reflect an individual's biological ageing accurately. In addition, PhenoAge modelling is based on data from specific populations, usually in the USA. In other races and regions, the performance of this model may not be the same. Therefore, when the PhenoAge model is applied in different races or regions, it may need to be re-based on a large sample size of data for optimisation or training.</p>\u0000<p>Most importantly, the PhenoAge model simplifies the ageing process, which is a multifactorial and complex process involving interactions at multiple levels, such as gene expression; telomere shortening; immune system decline; and epigenetic changes [<span>3, 4</span>]. The model focuses mainly on a few clinical markers, but it fails to account for all the biological processes involved in the ageing process and, therefore, may overlook some subtle key roles of age-related molecular targets. Indeed, one of the primary challenges in predicting the incidence of postoperative complications in older patients accurately is the absence of dedicated peri-operative databases for this specific population. Such databases are essential for researchers to obtain sufficient, high-quality raw data.</p>\u0000<p>In accordance with this objective, our research group is currently engaged in the establishment of the Perioperative Management and Outcome database, which is a large-scale, nationwide registry of older patients in China [<span>5</span>]. The prospective registry is expected to provide a rich dataset that will facilitate the evaluation of the quality of peri-operative care and, in turn, improve clinical care for older patients. Nevertheless, it has proven challenging to construct a database that encompasses multiple countries or regions and is based on participants from a diverse range of populations. It is anticipa","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"25 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935141","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}
Jessica Harris, Georgina Russell, Barnaby Reeves, Ben Gibbison
Approximately 1% of the UK population is prescribed oral corticosteroids at any one time. It is not known how many of these patients present for major surgery. We aimed to establish the prevalence, characteristics and outcomes of patients taking oral corticosteroids.
{"title":"Prevalence and outcomes of patients taking oral corticosteroids for over 1 month undergoing major surgery in England 2010–2020","authors":"Jessica Harris, Georgina Russell, Barnaby Reeves, Ben Gibbison","doi":"10.1111/anae.16532","DOIUrl":"https://doi.org/10.1111/anae.16532","url":null,"abstract":"Approximately 1% of the UK population is prescribed oral corticosteroids at any one time. It is not known how many of these patients present for major surgery. We aimed to establish the prevalence, characteristics and outcomes of patients taking oral corticosteroids.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"1 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935556","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}
Emma Sewart, Alexander Isted, Kitty H. F. Wong, Gudrun Kunst, Ronelle Mouton
<p>Tobacco smoking is the leading behavioural risk factor for cardiovascular disease and may double the risk of long-term mortality after coronary artery bypass grafting (CABG) [<span>1, 2</span>]. Smoking cessation interventions, which combine pharmacological treatment and behavioural support, are effective at supporting abstinence at the time of surgery and at 12 months postoperatively [<span>3</span>]. However, smoking remains more prevalent among those patients undergoing surgery (25%) than in the general UK population (13%) [<span>4, 5</span>]. There is limited contemporary evidence about the burden of smoking in cardiac surgery. This study investigated the prevalence of smoking in people undergoing CABG surgery in the UK and the impact of smoking on postoperative outcomes. This will help with risk assessment of such patients, as well as resource allocation and strategic planning for addressing smoking-related issues in surgical contexts.</p> <p>Permission was obtained for the National Institute for Cardiovascular Outcomes Research (NICOR) to release depersonalised patient data from the National Adult Cardiac Surgery Audit (NACSA) under an agreement between NHS England/GIG Cymru and King's College Hospital NHS Foundation Trust. The full process of data submission and processing by NICOR is described elsewhere [<span>6</span>]. All adults undergoing elective CABG between January 2012 and December 2022 were included. Other elective procedures were included only if performed in addition to CABG. Patients were not included if they underwent non-elective surgery, had no documented smoking status or had chosen not to have their data used for research. This study involved analysis of existing non-identifiable patient data and was, therefore, exempt from NHS ethics committee approval.</p> <p>The primary outcome was prevalence of current smoking (one or more cigarettes per day); former smoking (not smoked within the last month); and non-smoking (never smoked) at the time of surgery. The secondary outcomes were trends in smoking prevalence over time; in-hospital mortality; postoperative duration of hospital stay; and complications. Smoking status was reported by year of operation and trends in smoking prevalence over time were assessed using multivariable logistic regression, adjusted for age, sex and procedure type. The incidence of postoperative complications and duration of hospital stay were compared between smoking status groups using multivariable logistic regression and Cox proportional hazards regression, respectively, adjusted for surgical risk using the European System for Cardiac Operative Risk Evaluation 2 (EuroSCORE 2) [<span>7</span>]. Statistical analysis was performed using R version 4.2.1 (R Studio, Vienna, Austria) with a two-sided significance level set at p < 0.05. Multiple imputation was performed using the multivariate imputation by chained equations package (version 4.2.3) to account for missing data with < 50% of missing
{"title":"Prevalence of smoking and postoperative outcomes in people undergoing coronary artery bypass grafting: a UK registry analysis","authors":"Emma Sewart, Alexander Isted, Kitty H. F. Wong, Gudrun Kunst, Ronelle Mouton","doi":"10.1111/anae.16525","DOIUrl":"https://doi.org/10.1111/anae.16525","url":null,"abstract":"<p>Tobacco smoking is the leading behavioural risk factor for cardiovascular disease and may double the risk of long-term mortality after coronary artery bypass grafting (CABG) [<span>1, 2</span>]. Smoking cessation interventions, which combine pharmacological treatment and behavioural support, are effective at supporting abstinence at the time of surgery and at 12 months postoperatively [<span>3</span>]. However, smoking remains more prevalent among those patients undergoing surgery (25%) than in the general UK population (13%) [<span>4, 5</span>]. There is limited contemporary evidence about the burden of smoking in cardiac surgery. This study investigated the prevalence of smoking in people undergoing CABG surgery in the UK and the impact of smoking on postoperative outcomes. This will help with risk assessment of such patients, as well as resource allocation and strategic planning for addressing smoking-related issues in surgical contexts.</p>\u0000<p>Permission was obtained for the National Institute for Cardiovascular Outcomes Research (NICOR) to release depersonalised patient data from the National Adult Cardiac Surgery Audit (NACSA) under an agreement between NHS England/GIG Cymru and King's College Hospital NHS Foundation Trust. The full process of data submission and processing by NICOR is described elsewhere [<span>6</span>]. All adults undergoing elective CABG between January 2012 and December 2022 were included. Other elective procedures were included only if performed in addition to CABG. Patients were not included if they underwent non-elective surgery, had no documented smoking status or had chosen not to have their data used for research. This study involved analysis of existing non-identifiable patient data and was, therefore, exempt from NHS ethics committee approval.</p>\u0000<p>The primary outcome was prevalence of current smoking (one or more cigarettes per day); former smoking (not smoked within the last month); and non-smoking (never smoked) at the time of surgery. The secondary outcomes were trends in smoking prevalence over time; in-hospital mortality; postoperative duration of hospital stay; and complications. Smoking status was reported by year of operation and trends in smoking prevalence over time were assessed using multivariable logistic regression, adjusted for age, sex and procedure type. The incidence of postoperative complications and duration of hospital stay were compared between smoking status groups using multivariable logistic regression and Cox proportional hazards regression, respectively, adjusted for surgical risk using the European System for Cardiac Operative Risk Evaluation 2 (EuroSCORE 2) [<span>7</span>]. Statistical analysis was performed using R version 4.2.1 (R Studio, Vienna, Austria) with a two-sided significance level set at p < 0.05. Multiple imputation was performed using the multivariate imputation by chained equations package (version 4.2.3) to account for missing data with < 50% of missing ","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"14 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935142","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}
{"title":"Enhancing outcomes in acute type A aortic dissection through early diagnosis and access to specialist surgical care","authors":"Carlos Corredor, Aung Oo","doi":"10.1111/anae.16533","DOIUrl":"https://doi.org/10.1111/anae.16533","url":null,"abstract":"","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"5 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928978","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}
Lisa Reisinger, Crispiana Cozowicz, Jashvant Poeran, Haoyan Zhong, Alex Illescas, Periklis Giannakis, Jiabin Liu, Stavros G. Memtsoudis
SummaryBackgroundDemand for total hip and knee arthroplasty procedures continues to rise. Ongoing changes in surgical care and patient populations require continued monitoring of outcome trends. Using nationwide data from the USA, we aimed to describe updated trends in patient and peri‐operative care characteristics as well as complications among total hip and knee arthroplasty recipients.MethodsWe included patients who underwent elective primary total hip or knee arthroplasty between 2016 and 2021. Trends were reported for a variety of patient and peri‐operative care characteristics as well as complications.ResultsWe identified significant trends in patient and peri‐operative care characteristics as well as the incidence of complications. While patient median age increased, demographic composition remained consistent over the time period studied. There was a shift towards outpatient total hip and knee arthroplasty procedures, with one in five performed in the outpatient setting in 2021; the median duration of hospital stay decreased by 1 day over the time period for both procedures. Parallel increasing trends of total procedure numbers were found for patients without comorbidities and those with ≥ 3 comorbidities. Postoperative mortality increased significantly over the time period analysed for patients having total hip arthroplasty but not those having total knee arthroplasty (0.08 to 0.15 events per 1000 inpatient days, p = 0.037 and 0.09 to 0.33 events per 1000 inpatient days, p = 0.149, respectively).DiscussionCompared with previous trend analyses of patients having total hip or knee arthroplasty, the present study shows: an increasing rate of outpatient surgeries; increasing numbers of arthroplasty procedures in high comorbidity burden groups; and an increase incidence of certain serious postoperative complications.
{"title":"Trends in comorbidities and complications among patients undergoing elective total hip and knee arthroplasty in the USA","authors":"Lisa Reisinger, Crispiana Cozowicz, Jashvant Poeran, Haoyan Zhong, Alex Illescas, Periklis Giannakis, Jiabin Liu, Stavros G. Memtsoudis","doi":"10.1111/anae.16529","DOIUrl":"https://doi.org/10.1111/anae.16529","url":null,"abstract":"SummaryBackgroundDemand for total hip and knee arthroplasty procedures continues to rise. Ongoing changes in surgical care and patient populations require continued monitoring of outcome trends. Using nationwide data from the USA, we aimed to describe updated trends in patient and peri‐operative care characteristics as well as complications among total hip and knee arthroplasty recipients.MethodsWe included patients who underwent elective primary total hip or knee arthroplasty between 2016 and 2021. Trends were reported for a variety of patient and peri‐operative care characteristics as well as complications.ResultsWe identified significant trends in patient and peri‐operative care characteristics as well as the incidence of complications. While patient median age increased, demographic composition remained consistent over the time period studied. There was a shift towards outpatient total hip and knee arthroplasty procedures, with one in five performed in the outpatient setting in 2021; the median duration of hospital stay decreased by 1 day over the time period for both procedures. Parallel increasing trends of total procedure numbers were found for patients without comorbidities and those with ≥ 3 comorbidities. Postoperative mortality increased significantly over the time period analysed for patients having total hip arthroplasty but not those having total knee arthroplasty (0.08 to 0.15 events per 1000 inpatient days, p = 0.037 and 0.09 to 0.33 events per 1000 inpatient days, p = 0.149, respectively).DiscussionCompared with previous trend analyses of patients having total hip or knee arthroplasty, the present study shows: an increasing rate of outpatient surgeries; increasing numbers of arthroplasty procedures in high comorbidity burden groups; and an increase incidence of certain serious postoperative complications.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"23 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929009","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}
Angela R. Tognolini, Xin Liu, Saurabh Pandey, Jason A. Roberts, Steven C. Wallis, Dwane Jackson, Victoria A. Eley
Evidence to support intra-operative lidocaine infusion regimens in patients with obesity is lacking, risking underdosing or toxicity. We aimed to measure the plasma concentrations of lidocaine and its active metabolites to develop a pharmacokinetic model and optimised dosing regimen in patients with obesity.
{"title":"Dosing optimisation of intravenous lidocaine in patients with class 1–3 obesity by population pharmacokinetic analysis","authors":"Angela R. Tognolini, Xin Liu, Saurabh Pandey, Jason A. Roberts, Steven C. Wallis, Dwane Jackson, Victoria A. Eley","doi":"10.1111/anae.16531","DOIUrl":"https://doi.org/10.1111/anae.16531","url":null,"abstract":"Evidence to support intra-operative lidocaine infusion regimens in patients with obesity is lacking, risking underdosing or toxicity. We aimed to measure the plasma concentrations of lidocaine and its active metabolites to develop a pharmacokinetic model and optimised dosing regimen in patients with obesity.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"26 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911764","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}
Song Li, Masja K. Toneman, Judith P. M. Mangnus, Stefano Strocchi, Regina L. M. van Boekel, Kris C. P. Vissers, Richard P. G. ten Broek, Marieke J. H. Coenen
SummaryIntroductionChronic pain is one of the most common and severe complications after surgery, affecting quality of life and overall wellbeing of patients. Several risk factors have been identified but the mechanisms of chronic postsurgical pain development remain unclear. This study aimed to identify single‐nucleotide polymorphisms associated with developing chronic postsurgical pain after abdominal surgery, one of the most common types of surgery.MethodsA genome‐wide association study was performed on 27,603 patients from the UK Biobank who underwent abdominal surgery. The robustness of identified loci was validated by split‐half validation analysis. Functionally related top loci were selected for expression validation in clinical samples of adhesions from patients with and without pain.ResultsOne locus (rs185545327) reached genome‐wide significance for association with chronic postsurgical pain development, and 10 loci surpassed the suggestively significant threshold (p < 1 × 10‐6). In the robustness analysis, eight loci had at least nominal significance. The loci passing the suggestively significant threshold were mapped to 15 genes, of which two loci contained pain‐related genes (SRPK2, PDE4D). Although marginally approaching statistical significance in the expression validation of clinical samples, the detection rate and expression level of PDE4D were modestly higher in patients with pain compared with those in the control group.DiscussionThis study provides preliminary evidence for genetic risk factors implicated in chronic postsurgical pain following abdominal surgery, particularly the PDE4D gene, which has been associated with pain in previous studies. The findings add to evidence suggesting potential for the future development of a clinically applicable tool for personalised risk prediction, aiding clinicians in stratifying patients and enhancing clinical decision‐making through individualised risk assessments.
{"title":"Genome‐wide association study on chronic postsurgical pain after abdominal surgeries in the UK Biobank","authors":"Song Li, Masja K. Toneman, Judith P. M. Mangnus, Stefano Strocchi, Regina L. M. van Boekel, Kris C. P. Vissers, Richard P. G. ten Broek, Marieke J. H. Coenen","doi":"10.1111/anae.16528","DOIUrl":"https://doi.org/10.1111/anae.16528","url":null,"abstract":"SummaryIntroductionChronic pain is one of the most common and severe complications after surgery, affecting quality of life and overall wellbeing of patients. Several risk factors have been identified but the mechanisms of chronic postsurgical pain development remain unclear. This study aimed to identify single‐nucleotide polymorphisms associated with developing chronic postsurgical pain after abdominal surgery, one of the most common types of surgery.MethodsA genome‐wide association study was performed on 27,603 patients from the UK Biobank who underwent abdominal surgery. The robustness of identified loci was validated by split‐half validation analysis. Functionally related top loci were selected for expression validation in clinical samples of adhesions from patients with and without pain.ResultsOne locus (rs185545327) reached genome‐wide significance for association with chronic postsurgical pain development, and 10 loci surpassed the suggestively significant threshold (p < 1 × 10<jats:sup>‐6</jats:sup>). In the robustness analysis, eight loci had at least nominal significance. The loci passing the suggestively significant threshold were mapped to 15 genes, of which two loci contained pain‐related genes (<jats:italic>SRPK2</jats:italic>, <jats:italic>PDE4D</jats:italic>). Although marginally approaching statistical significance in the expression validation of clinical samples, the detection rate and expression level of PDE4D were modestly higher in patients with pain compared with those in the control group.DiscussionThis study provides preliminary evidence for genetic risk factors implicated in chronic postsurgical pain following abdominal surgery, particularly the <jats:italic>PDE4D</jats:italic> gene, which has been associated with pain in previous studies. The findings add to evidence suggesting potential for the future development of a clinically applicable tool for personalised risk prediction, aiding clinicians in stratifying patients and enhancing clinical decision‐making through individualised risk assessments.","PeriodicalId":7742,"journal":{"name":"Anaesthesia","volume":"30 1","pages":""},"PeriodicalIF":10.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901651","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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