Pub Date : 2026-01-30DOI: 10.1213/ane.0000000000007939
Eleni P Asimacopoulos,Meena Nathan,Kimberlee Gauvreau,James A DiNardo,John E Mayer,Kirsten C Odegard
{"title":"Optimal Size for a Pediatric Cardiac Anesthesia Team: How Many Is Too Many?","authors":"Eleni P Asimacopoulos,Meena Nathan,Kimberlee Gauvreau,James A DiNardo,John E Mayer,Kirsten C Odegard","doi":"10.1213/ane.0000000000007939","DOIUrl":"https://doi.org/10.1213/ane.0000000000007939","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1213/ane.0000000000007942
Alexander Tran,Daniel Katz,Amir Malik,Benjamin M Hyers
{"title":"A Survey of Patient Preferences for Intravenous Anxiolysis for Neuraxial Anesthesia in Elective Cesarean Delivery.","authors":"Alexander Tran,Daniel Katz,Amir Malik,Benjamin M Hyers","doi":"10.1213/ane.0000000000007942","DOIUrl":"https://doi.org/10.1213/ane.0000000000007942","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1213/ane.0000000000007864
Oliver Cafferty,Sean D Jeffries,Eric D Pelletier,Louis-Pierre Poulin,Avinash Sinha,Robert Harutyunyan,Pascal Laferrière-Langlois,Thomas M Hemmerling
BACKGROUNDAdvances in artificial intelligence (AI) have enabled large language models (LLMs) to generate complex and contextually relevant medical responses. However, their potential in clinical decision support for anesthesiology remains underexplored. This study evaluated the accuracy and clinical relevance of high-performing LLMs in response to anesthesia-related questions and compared their performance with traditional online search methods. Clinician perceptions of AI were also assessed. We hypothesized that top-performing large language models would outperform lower-tier models and traditional internet search tools by generating responses rated as more accurate, complete, and clinically relevant to anesthesiology-focused questions, as measured by higher mean evaluator scores on a 10-point Likert scale.METHODSTen LLMs: GPT-4o, Claude-Sonnet 3.5, DeepSeek R1, Llama 3.1 Instruct 70B, Gemini 2.0, GPT o1-preview, GPT o1, GPT o3-mini, NOVA Pro, and Mistral. All models were tested using ten common general anesthesia questions developed by TMH and validated by 6 physicians. Two Google search conditions served as baselines: a default search conducted in a cleared browser (unpersonalized), and a personalized Google Snippet Search performed in a browser regularly used by a clinician. Four board-certified anesthesiologists independently rated each response on a 10-point Likert scale. An ad hoc Physician Perception Questionnaire captured clinicians' use of AI, trust in its output, and reliance on traditional information sources.RESULTSLLM performance varied significantly (F = 5.89, P <.0001). DeepSeek R1 achieved the highest overall score (7.7), whereas Gemini 2.0 Flash recorded the lowest among LLMs (5.2). The Google Snippet Search scored 5.3, the lowest overall. Pairwise Welch's t tests showed that DeepSeek R1 significantly outperformed Llama, o3-mini, and Mistral (P <.001). Survey results indicated limited AI use in clinical practice; clinicians prioritized source credibility and continued to favor traditional resources.CONCLUSIONSAlthough LLM-generated responses differed in quality, DeepSeek R1 and Claude-Sonnet 3.5 produced answers most consistent with expert clinical judgment. The poor performance of several models, coupled with clinician skepticism, underscores the need for further validation before integrating AI into routine anesthesiology decision support.
{"title":"A Comparison of Ten Large Language Models and a Conventional Search Engine for Clinical Decision Support in Anesthesiology: Expert Agreement and Physician Perceptions.","authors":"Oliver Cafferty,Sean D Jeffries,Eric D Pelletier,Louis-Pierre Poulin,Avinash Sinha,Robert Harutyunyan,Pascal Laferrière-Langlois,Thomas M Hemmerling","doi":"10.1213/ane.0000000000007864","DOIUrl":"https://doi.org/10.1213/ane.0000000000007864","url":null,"abstract":"BACKGROUNDAdvances in artificial intelligence (AI) have enabled large language models (LLMs) to generate complex and contextually relevant medical responses. However, their potential in clinical decision support for anesthesiology remains underexplored. This study evaluated the accuracy and clinical relevance of high-performing LLMs in response to anesthesia-related questions and compared their performance with traditional online search methods. Clinician perceptions of AI were also assessed. We hypothesized that top-performing large language models would outperform lower-tier models and traditional internet search tools by generating responses rated as more accurate, complete, and clinically relevant to anesthesiology-focused questions, as measured by higher mean evaluator scores on a 10-point Likert scale.METHODSTen LLMs: GPT-4o, Claude-Sonnet 3.5, DeepSeek R1, Llama 3.1 Instruct 70B, Gemini 2.0, GPT o1-preview, GPT o1, GPT o3-mini, NOVA Pro, and Mistral. All models were tested using ten common general anesthesia questions developed by TMH and validated by 6 physicians. Two Google search conditions served as baselines: a default search conducted in a cleared browser (unpersonalized), and a personalized Google Snippet Search performed in a browser regularly used by a clinician. Four board-certified anesthesiologists independently rated each response on a 10-point Likert scale. An ad hoc Physician Perception Questionnaire captured clinicians' use of AI, trust in its output, and reliance on traditional information sources.RESULTSLLM performance varied significantly (F = 5.89, P <.0001). DeepSeek R1 achieved the highest overall score (7.7), whereas Gemini 2.0 Flash recorded the lowest among LLMs (5.2). The Google Snippet Search scored 5.3, the lowest overall. Pairwise Welch's t tests showed that DeepSeek R1 significantly outperformed Llama, o3-mini, and Mistral (P <.001). Survey results indicated limited AI use in clinical practice; clinicians prioritized source credibility and continued to favor traditional resources.CONCLUSIONSAlthough LLM-generated responses differed in quality, DeepSeek R1 and Claude-Sonnet 3.5 produced answers most consistent with expert clinical judgment. The poor performance of several models, coupled with clinician skepticism, underscores the need for further validation before integrating AI into routine anesthesiology decision support.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1213/ane.0000000000007957
Huizi Liu,Fang Cai
{"title":"Intraoperative Hyperkalemia in the Setting of Left Bundle Branch Block: Diagnostic Challenges and Management.","authors":"Huizi Liu,Fang Cai","doi":"10.1213/ane.0000000000007957","DOIUrl":"https://doi.org/10.1213/ane.0000000000007957","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1213/ane.0000000000007875
Peniel K Dula,Fitsum K Belachew,Katherine R Iverson,Adane B Senbeta,Tihitena Negussie,Merga Belina,Girmay Medhin,Abebaw Fekadu
INTRODUCTIONThe 76th World Health Assembly highlighted the urgent need for action to enhance surgical care. Given the postoperative complication rate of around 20% and the rapidly increasing surgical burden related to noncommunicable diseases, implementing the Enhanced Recovery After Surgery (ERAS) protocol is recommended, particularly in low- and middle-income countries (LMICs). This evidence synthesis aimed to assess the effectiveness of the ERAS protocol in improving short-term and intermediate surgical outcomes among patients in LMICs.METHODThis systematic review and meta-analysis were registered in the PROSPERO database (CRD42024524807). A systematic search for observational studies and clinical trials was conducted in PubMed, Scopus, Cochrane, and Web of Science, along with online trial registries, Google Scholar, and reference search. The search strategy included keywords related to "Enhanced Recovery After Surgery," "ERAS," "Fast-Track Surgery," "LMICs," and the names of LMICs. Risk of bias was assessed using the Cochrane risk of bias and the Newcastle-Ottawa scale. RevMan 5.4.1 software was used for data collection and reporting, Mendeley was used for reference management, and RStudio for meta-analysis. relative risk (RR) and standardized mean differences (SMDs) were used to report pooled results.RESULTSA total of 1332 studies were initially identified, and after removing duplicates, 1243 studies remained, with 56 papers eligible for full-text review. Eight studies were identified from the reference search and were added to the evidence synthesis. Thirty-five studies, 23 clinical trials, and 12 observational studies were included for review, and 33 studies were included for meta-analysis. Eighty-four percent of the publications were from South and Southeast Asia. Comparable numbers of participants were distributed in the intervention (n = 3163) and control (n = 3243) groups. The studies comprised mostly abdominal surgeries (n = 17). Each study compared ERAS protocols with routine perioperative care. Meta-analysis indicated a significant reduction of postoperative morbidity after the implementation of the ERAS protocol (RR = 0.63; 95% confidence interval [CI], 0.66-0.55 with I2 of 1.1%). Also, a significant reduction in postoperative length of hospital stay was observed when the ERAS protocol was implemented (SMD= -0.68 [95% CI, -0.47 to -0.90] with I2 = 86.7). There was no significant difference in 30-day postoperative mortality and readmission rate.CONCLUSIONSERAS protocols represent a practical approach to improving surgical outcomes in LMICs, with evidence showing reduced postoperative morbidity and hospital stay, without an increase in readmission or mortality. Although there could be an ERAS implementation cost, its role in expediting recovery could reduce hospitalization costs. Tailored implementation and improved adherence reporting are essential to guide future adoption and policy.
{"title":"Evidence on Enhanced Recovery After Surgery Protocols in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis of Postoperative Outcomes.","authors":"Peniel K Dula,Fitsum K Belachew,Katherine R Iverson,Adane B Senbeta,Tihitena Negussie,Merga Belina,Girmay Medhin,Abebaw Fekadu","doi":"10.1213/ane.0000000000007875","DOIUrl":"https://doi.org/10.1213/ane.0000000000007875","url":null,"abstract":"INTRODUCTIONThe 76th World Health Assembly highlighted the urgent need for action to enhance surgical care. Given the postoperative complication rate of around 20% and the rapidly increasing surgical burden related to noncommunicable diseases, implementing the Enhanced Recovery After Surgery (ERAS) protocol is recommended, particularly in low- and middle-income countries (LMICs). This evidence synthesis aimed to assess the effectiveness of the ERAS protocol in improving short-term and intermediate surgical outcomes among patients in LMICs.METHODThis systematic review and meta-analysis were registered in the PROSPERO database (CRD42024524807). A systematic search for observational studies and clinical trials was conducted in PubMed, Scopus, Cochrane, and Web of Science, along with online trial registries, Google Scholar, and reference search. The search strategy included keywords related to \"Enhanced Recovery After Surgery,\" \"ERAS,\" \"Fast-Track Surgery,\" \"LMICs,\" and the names of LMICs. Risk of bias was assessed using the Cochrane risk of bias and the Newcastle-Ottawa scale. RevMan 5.4.1 software was used for data collection and reporting, Mendeley was used for reference management, and RStudio for meta-analysis. relative risk (RR) and standardized mean differences (SMDs) were used to report pooled results.RESULTSA total of 1332 studies were initially identified, and after removing duplicates, 1243 studies remained, with 56 papers eligible for full-text review. Eight studies were identified from the reference search and were added to the evidence synthesis. Thirty-five studies, 23 clinical trials, and 12 observational studies were included for review, and 33 studies were included for meta-analysis. Eighty-four percent of the publications were from South and Southeast Asia. Comparable numbers of participants were distributed in the intervention (n = 3163) and control (n = 3243) groups. The studies comprised mostly abdominal surgeries (n = 17). Each study compared ERAS protocols with routine perioperative care. Meta-analysis indicated a significant reduction of postoperative morbidity after the implementation of the ERAS protocol (RR = 0.63; 95% confidence interval [CI], 0.66-0.55 with I2 of 1.1%). Also, a significant reduction in postoperative length of hospital stay was observed when the ERAS protocol was implemented (SMD= -0.68 [95% CI, -0.47 to -0.90] with I2 = 86.7). There was no significant difference in 30-day postoperative mortality and readmission rate.CONCLUSIONSERAS protocols represent a practical approach to improving surgical outcomes in LMICs, with evidence showing reduced postoperative morbidity and hospital stay, without an increase in readmission or mortality. Although there could be an ERAS implementation cost, its role in expediting recovery could reduce hospitalization costs. Tailored implementation and improved adherence reporting are essential to guide future adoption and policy.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"221 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Leveraging a 3D-Printed Spine Model to Study Medication Spread in Spinal Anesthesia.","authors":"Jaber Hanhan,Austin Zheng,Alexander Butwick,Peter Yeh,Pedram Aleshi,Jeremy Juang","doi":"10.1213/ane.0000000000007951","DOIUrl":"https://doi.org/10.1213/ane.0000000000007951","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1213/ane.0000000000007956
Elizabeth A Wilson,Evan D Kharasch
{"title":"Opioids Reconsidered: From Antinociception to Potential Organ Protection.","authors":"Elizabeth A Wilson,Evan D Kharasch","doi":"10.1213/ane.0000000000007956","DOIUrl":"https://doi.org/10.1213/ane.0000000000007956","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1213/ane.0000000000007883
Jose Rios-Monterrosa,Samuel Castro,Chance Aguiar,Ali Tanvir,Amanda Woodward,Louise Y Sun,Adam J Milam
Health care disparities, particularly among minoritized groups, pose significant challenges within health care systems, including the field of cardiac surgery. Limited English proficiency (LEP) is an often-overlooked factor contributing to these disparities. As key members of the preoperative evaluation, intraoperative management, and postoperative care of cardiac surgery patients, anesthesiologists have both ethical and economic responsibilities to understand, recognize, and address disparities to ensure equitable care for all patients. The objective of this scoping review is to summarize the literature on how LEP impacts the utilization of health services and outcomes after cardiac surgery. More specifically, the review will map how LEP is defined in the literature, summarize the patient populations that have been studied, and describe the health care outcomes in patients with LEP after cardiac surgery. A comprehensive literature search strategy was developed in collaboration with a medical librarian and was registered before conducting the search. Studies were eligible for inclusion in our current study if (i) the patient population was composed of adults (>or = 18), (ii) the study reported health care outcomes before or after cardiac surgery, and (iii) results were stratified by a patient's English proficiency. All randomized control trials, systematic reviews, observational studies, and cross-sectional studies published in English were included in our study. If conference abstracts met the inclusion criteria, they were included for full-text review. Opinion articles and case reports were excluded. The search produced 2401 articles with 13 articles meeting the inclusion criteria. All studies were conducted in either North America or Australia/New Zealand. The number of patients included in each study ranged from 204 to 21,789, with 4 studies having less than 1500 patients and 2 studies having greater than 10,000 patients. Through a systematic review of the literature on this topic, we identified 3 overarching themes that were inferred from the collective body of studies. First, a significant barrier to studying this topic is the absence of a universal definition of LEP. Second, the heterogeneity in several aspects of the available studies makes it difficult to draw conclusions from the results. Finally, there is a general scarcity of research done on the impact of LEP on cardiac surgery outcomes. Ultimately, our scoping review reveals an area of health disparity research that requires more attention. If disparities are found, then health care leaders may begin investigating which interventions can help mitigate these disparities.
{"title":"Does Language Matter? The Impact of English Proficiency on Healthcare Outcomes After Cardiac Surgery: A Scoping Review.","authors":"Jose Rios-Monterrosa,Samuel Castro,Chance Aguiar,Ali Tanvir,Amanda Woodward,Louise Y Sun,Adam J Milam","doi":"10.1213/ane.0000000000007883","DOIUrl":"https://doi.org/10.1213/ane.0000000000007883","url":null,"abstract":"Health care disparities, particularly among minoritized groups, pose significant challenges within health care systems, including the field of cardiac surgery. Limited English proficiency (LEP) is an often-overlooked factor contributing to these disparities. As key members of the preoperative evaluation, intraoperative management, and postoperative care of cardiac surgery patients, anesthesiologists have both ethical and economic responsibilities to understand, recognize, and address disparities to ensure equitable care for all patients. The objective of this scoping review is to summarize the literature on how LEP impacts the utilization of health services and outcomes after cardiac surgery. More specifically, the review will map how LEP is defined in the literature, summarize the patient populations that have been studied, and describe the health care outcomes in patients with LEP after cardiac surgery. A comprehensive literature search strategy was developed in collaboration with a medical librarian and was registered before conducting the search. Studies were eligible for inclusion in our current study if (i) the patient population was composed of adults (>or = 18), (ii) the study reported health care outcomes before or after cardiac surgery, and (iii) results were stratified by a patient's English proficiency. All randomized control trials, systematic reviews, observational studies, and cross-sectional studies published in English were included in our study. If conference abstracts met the inclusion criteria, they were included for full-text review. Opinion articles and case reports were excluded. The search produced 2401 articles with 13 articles meeting the inclusion criteria. All studies were conducted in either North America or Australia/New Zealand. The number of patients included in each study ranged from 204 to 21,789, with 4 studies having less than 1500 patients and 2 studies having greater than 10,000 patients. Through a systematic review of the literature on this topic, we identified 3 overarching themes that were inferred from the collective body of studies. First, a significant barrier to studying this topic is the absence of a universal definition of LEP. Second, the heterogeneity in several aspects of the available studies makes it difficult to draw conclusions from the results. Finally, there is a general scarcity of research done on the impact of LEP on cardiac surgery outcomes. Ultimately, our scoping review reveals an area of health disparity research that requires more attention. If disparities are found, then health care leaders may begin investigating which interventions can help mitigate these disparities.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1213/ane.0000000000007911
Nicholas V Mendez,Daniel Chan,Ty Thompson,David Chen,Sebastian Zeiner,Rishi P Kothari,Hillary J Braun,Michael P Bokoch,Kerstin Kolodzie,Dieter Adelmann
BACKGROUNDAcute kidney injury (AKI) is common after liver transplant and associated with increased morbidity and mortality. Transplantation of nonrenal organs is also associated with eventual chronic kidney disease (CKD). Development of CKD after liver transplant is known to be multifactorial; however, this study evaluates the unique contribution of AKI in this complex disease pathway.METHODSPatients were classified into 2 groups: presence or absence of severe AKI within 72 hours postoperatively. Kidney function was assessed at year 1: normal/mild (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m2); moderate (30 ≤eGFR <60 mL/min/1.73 m2); or severe (eGFR <30 mL/min/1.73m2) disease. Adjusted relative risks of both CKD and death at years 1 through 3 in the presence versus absence of severe AKI were estimated using discrete-time targeted maximum likelihood estimation.RESULTSOf 1574 patients, 769 (49%) experienced severe AKI. At year 1, 1024 (65%) patients had normal/mild, 487 (31%) had moderate, and 63 (4%) had severe CKD. The unadjusted relative risk of severe CKD was 3.66 (95% confidence interval [CI], 2.15-7.33), and the adjusted relative risk was 2.62 (95% CI, 1.61-4.28) in patients with severe AKI. In total, 66 (4%), 115 (7%), and 147 (9%) patients died in years 1, 2, and 3, respectively. Patients with severe AKI had an unadjusted relative risk of death at year 1 of 2.41 (95% CI, 1.47-4.19) compared to an adjusted relative risk of 1.15 (95% CI, 1.04-1.28); at year 2, the unadjusted relative risk of death was 1.51 (95% CI, 1.07-2.19) compared to an adjusted relative risk of 1.14 (95% CI, 1.04-1.25); and at year 3, the unadjusted relative risk of death was 1.44 (95% CI, 1.05-1.97) compared to an adjusted relative risk of 1.13 (95% CI, 1.04-1.23).CONCLUSIONSevere postoperative AKI is associated with an increased risk of severe CKD at 1 year and mortality up to 3 years after liver transplant. Postoperative AKI represents an important target for future perioperative interventions aimed at mitigating the risk of long-term morbidity and mortality for liver transplant patients.
{"title":"Contribution of Acute Kidney Injury After Liver Transplant in Development of Chronic Kidney Disease: A Single-Center Retrospective Cohort Study.","authors":"Nicholas V Mendez,Daniel Chan,Ty Thompson,David Chen,Sebastian Zeiner,Rishi P Kothari,Hillary J Braun,Michael P Bokoch,Kerstin Kolodzie,Dieter Adelmann","doi":"10.1213/ane.0000000000007911","DOIUrl":"https://doi.org/10.1213/ane.0000000000007911","url":null,"abstract":"BACKGROUNDAcute kidney injury (AKI) is common after liver transplant and associated with increased morbidity and mortality. Transplantation of nonrenal organs is also associated with eventual chronic kidney disease (CKD). Development of CKD after liver transplant is known to be multifactorial; however, this study evaluates the unique contribution of AKI in this complex disease pathway.METHODSPatients were classified into 2 groups: presence or absence of severe AKI within 72 hours postoperatively. Kidney function was assessed at year 1: normal/mild (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m2); moderate (30 ≤eGFR <60 mL/min/1.73 m2); or severe (eGFR <30 mL/min/1.73m2) disease. Adjusted relative risks of both CKD and death at years 1 through 3 in the presence versus absence of severe AKI were estimated using discrete-time targeted maximum likelihood estimation.RESULTSOf 1574 patients, 769 (49%) experienced severe AKI. At year 1, 1024 (65%) patients had normal/mild, 487 (31%) had moderate, and 63 (4%) had severe CKD. The unadjusted relative risk of severe CKD was 3.66 (95% confidence interval [CI], 2.15-7.33), and the adjusted relative risk was 2.62 (95% CI, 1.61-4.28) in patients with severe AKI. In total, 66 (4%), 115 (7%), and 147 (9%) patients died in years 1, 2, and 3, respectively. Patients with severe AKI had an unadjusted relative risk of death at year 1 of 2.41 (95% CI, 1.47-4.19) compared to an adjusted relative risk of 1.15 (95% CI, 1.04-1.28); at year 2, the unadjusted relative risk of death was 1.51 (95% CI, 1.07-2.19) compared to an adjusted relative risk of 1.14 (95% CI, 1.04-1.25); and at year 3, the unadjusted relative risk of death was 1.44 (95% CI, 1.05-1.97) compared to an adjusted relative risk of 1.13 (95% CI, 1.04-1.23).CONCLUSIONSevere postoperative AKI is associated with an increased risk of severe CKD at 1 year and mortality up to 3 years after liver transplant. Postoperative AKI represents an important target for future perioperative interventions aimed at mitigating the risk of long-term morbidity and mortality for liver transplant patients.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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