Pub Date : 2025-10-01DOI: 10.1213/ane.0000000000007764
Sher-Lu Pai,Sindhuja R Nimma,W Brian Beam,Beth A VanderWielen,Hari K Kalagara,Layne M Bettini,Soojie Yu,Emily E Sharpe,Monica W Harbell,
BACKGROUNDThe use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has significantly increased in recent years. GLP-1 RAs delay gastric emptying, resulting in early satiety and weight loss. This may increase the risk of pulmonary aspiration of residual gastric contents (RGC) during anesthesia delivery. Evidence is urgently needed to guide perioperative anesthesia management for patients taking GLP-1 RAs. This study evaluated preoperative factors that may be associated with high RGC.METHODSAdult patients who were taking GLP-1 RAs and scheduled to receive anesthesia at 3 hospitals between June 30, 2023, and August 15, 2024, were evaluated via preoperative point-of-care gastric ultrasonography (GUS). The primary outcome was high RGC, defined by the presence of solids food or >1.5 mL/kg of clear liquids on GUS, and its association with preoperative factors (eg, existing medical conditions, indication and route of taking GLP-1 RAs, length of taking GLP-1 RAs, days of withholding GLP-1 RAs before surgery, and preoperative fasting periods). Data are presented as median (interquartile range [IQR]).RESULTSAmong the 316 patients (60.9 years [52.1-68.9] of age; 167 [52.8%] females) included in the study, 113 (35.8%) had high RGC. A higher percentage (5.3%; 6/113) of patients in the high RGC group had an opioid prescription for pain management within 3 months of the GUS assessment compared to the low RGC group (1.0%; 2/203; P = .027). No statistical difference was found between the groups in other existing medical conditions, indication and route of taking GLP-1 RAs, and length of taking GLP-1 RAs. Of the 294 patients taking weekly injections, there were 187 (63.6%) with low RGC and 107 (36.4%) with high RGC. Patients with low RGC withheld their GLP-1 RAs for 8 days [5-10], while patients with high RGC withheld for 6 days [3-9] (P = .003). Receiver operating characteristic (ROC) analysis found ≤7.5 days of withholding the medication as cutoff for increased prevalence of high RGC in patients taking GLP-1 RA injections. Patients with low RGC fasted from solid food for 20.0 hours [14.8-40.8], and patients with high RGC fasted from solid food for 15.0 hours [12.8-19.0] (P < .001). ROC found ≤21.3 hours of fasting from solid food as the cutoff for increased prevalence of high RGC.CONCLUSIONSGLP-1 RA usage may delay gastric emptying. In preoperatively fasting adults, ≤7.5 days of withholding injections and ≤21.3 hours of fasting from solid food are associated with high RGC.
{"title":"Assessment of Gastric Content Using Gastric Ultrasound in Patients on Glucagon-Like Peptide-1 Receptor Agonists Before Anesthesia.","authors":"Sher-Lu Pai,Sindhuja R Nimma,W Brian Beam,Beth A VanderWielen,Hari K Kalagara,Layne M Bettini,Soojie Yu,Emily E Sharpe,Monica W Harbell, ","doi":"10.1213/ane.0000000000007764","DOIUrl":"https://doi.org/10.1213/ane.0000000000007764","url":null,"abstract":"BACKGROUNDThe use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has significantly increased in recent years. GLP-1 RAs delay gastric emptying, resulting in early satiety and weight loss. This may increase the risk of pulmonary aspiration of residual gastric contents (RGC) during anesthesia delivery. Evidence is urgently needed to guide perioperative anesthesia management for patients taking GLP-1 RAs. This study evaluated preoperative factors that may be associated with high RGC.METHODSAdult patients who were taking GLP-1 RAs and scheduled to receive anesthesia at 3 hospitals between June 30, 2023, and August 15, 2024, were evaluated via preoperative point-of-care gastric ultrasonography (GUS). The primary outcome was high RGC, defined by the presence of solids food or >1.5 mL/kg of clear liquids on GUS, and its association with preoperative factors (eg, existing medical conditions, indication and route of taking GLP-1 RAs, length of taking GLP-1 RAs, days of withholding GLP-1 RAs before surgery, and preoperative fasting periods). Data are presented as median (interquartile range [IQR]).RESULTSAmong the 316 patients (60.9 years [52.1-68.9] of age; 167 [52.8%] females) included in the study, 113 (35.8%) had high RGC. A higher percentage (5.3%; 6/113) of patients in the high RGC group had an opioid prescription for pain management within 3 months of the GUS assessment compared to the low RGC group (1.0%; 2/203; P = .027). No statistical difference was found between the groups in other existing medical conditions, indication and route of taking GLP-1 RAs, and length of taking GLP-1 RAs. Of the 294 patients taking weekly injections, there were 187 (63.6%) with low RGC and 107 (36.4%) with high RGC. Patients with low RGC withheld their GLP-1 RAs for 8 days [5-10], while patients with high RGC withheld for 6 days [3-9] (P = .003). Receiver operating characteristic (ROC) analysis found ≤7.5 days of withholding the medication as cutoff for increased prevalence of high RGC in patients taking GLP-1 RA injections. Patients with low RGC fasted from solid food for 20.0 hours [14.8-40.8], and patients with high RGC fasted from solid food for 15.0 hours [12.8-19.0] (P < .001). ROC found ≤21.3 hours of fasting from solid food as the cutoff for increased prevalence of high RGC.CONCLUSIONSGLP-1 RA usage may delay gastric emptying. In preoperatively fasting adults, ≤7.5 days of withholding injections and ≤21.3 hours of fasting from solid food are associated with high RGC.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203700","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 : 2025-10-01DOI: 10.1213/ane.0000000000007779
Alexander Zarbock,Jean-Louis Vincent,Daniel De Backer,Rinaldo Bellomo,Matthieu Legrand,Ashish K Khanna,Marlies Ostermann,Katarzyna Kotfis,Annoni Filippo,Patrick M Wieruszewski,Marc Leone,Massimo Girardis,Ricardo Ferrer,Yuki Kotani,Peter Pickkers,Gennaro De Pascale,Pierre Tissieres,Giovanni Landoni
{"title":"The Renin-Angiotensin-Aldosterone System in Cardiac Surgery and Angiotensin II Therapy for Vasoplegia.","authors":"Alexander Zarbock,Jean-Louis Vincent,Daniel De Backer,Rinaldo Bellomo,Matthieu Legrand,Ashish K Khanna,Marlies Ostermann,Katarzyna Kotfis,Annoni Filippo,Patrick M Wieruszewski,Marc Leone,Massimo Girardis,Ricardo Ferrer,Yuki Kotani,Peter Pickkers,Gennaro De Pascale,Pierre Tissieres,Giovanni Landoni","doi":"10.1213/ane.0000000000007779","DOIUrl":"https://doi.org/10.1213/ane.0000000000007779","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203673","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 : 2025-10-01DOI: 10.1213/ane.0000000000007762
Jennifer M Weller,Tanisha Jowsey,Rebecca D Minehart,Thomas R Vetter
{"title":"Transforming Anesthesia Practice With Qualitative Research.","authors":"Jennifer M Weller,Tanisha Jowsey,Rebecca D Minehart,Thomas R Vetter","doi":"10.1213/ane.0000000000007762","DOIUrl":"https://doi.org/10.1213/ane.0000000000007762","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203701","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 : 2025-10-01DOI: 10.1213/ane.0000000000007754
Lisa M Einhorn,Evan D Kharasch,Janice Lim,Matthew Fuller,Jennifer L Turi,Edmund H Jooste,Benjamin Y Andrew,Warwick A Ames
BACKGROUNDPrevious studies have shown that regional anesthesia (RA) use versus placebo control is associated with less postsurgical opioid requirements and improved pain scores. This trial compared a novel combination of bilateral pecto-intercostal fascial plane and unilateral rectus sheath blocks to an active comparator of surgeon-administered local anesthetic wound infiltration in children undergoing septal defect repair. The study tested the hypothesis that RA use would result in less opioid use and lower pain intensity compared to wound infiltration.METHODSThis double-blind, randomized, parallel group, single-center trial included children (<18 years) undergoing primary atrial septal defect (ASD) or ventricular septal defect (VSD) repair. Participants were randomized to RA consisting of ultrasound-guided pecto-intercostal fascial plane and rectus sheath blocks or no-block, consisting of local anesthetic wound infiltration. Both groups received 1.5 mL/kg of ropivacaine 0.2% for the intervention. The primary outcome was opioid use (oral morphine milligram equivalents [MME]/kg) 0-12 hours after surgery. Secondary outcomes were opioid use at additional time points, pain (0-10 scale) between 0 and 48 hours (area under the curve [AUC]), and hospital length of stay (LOS).RESULTSData analysis included 42 children (24 RA, 18 infiltration), age 3.3 ± 2.7 years (mean ± standard deviation [SD]; median, 3; range, 4 months-10 years). Opioid use (MME/kg mean ± SD) 0-12 hours after surgery was 0.44 ± 0.19 in the RA group compared to 0.83 ± 0.39 in the infiltration group (mean difference -0.39; 95% confidence interval [CI], -0.59 to -0.18; P = .001). Total postoperative opioid use from 0 to 48 hours after surgery was 0.95 ± 0.40 in the RA group compared to 1.57 ± 0.75 in the infiltration group (mean difference -0.64; 95% CI, -1.02 to -0.22, P = .004). Pain intensity AUC (0-48 hours) was 45.0 ± 26.8 in the RA group compared to 94.5 ± 55.7 in the infiltration group (mean difference -49.5 [-78.9 to -20.1]; P = .002). Opioid use between 12 and 48 hours and hospital LOS was not different between groups.CONCLUSIONSThis single-center study showed that the combined pecto-intercostal fascial plane and rectus sheath blocks were opioid-sparing and provided superior pain control compared to contemporary practice of local anesthetic infiltration in children following septal defect repair. This investigation strengthens the evidence to support RA use to improve postoperative pain in this population.
{"title":"Combined Pecto-intercostal Fascial Plane and Rectus Sheath Blocks Versus Local Infiltration for Pain Management Following Pediatric Cardiac Surgery: A Randomized Clinical Trial.","authors":"Lisa M Einhorn,Evan D Kharasch,Janice Lim,Matthew Fuller,Jennifer L Turi,Edmund H Jooste,Benjamin Y Andrew,Warwick A Ames","doi":"10.1213/ane.0000000000007754","DOIUrl":"https://doi.org/10.1213/ane.0000000000007754","url":null,"abstract":"BACKGROUNDPrevious studies have shown that regional anesthesia (RA) use versus placebo control is associated with less postsurgical opioid requirements and improved pain scores. This trial compared a novel combination of bilateral pecto-intercostal fascial plane and unilateral rectus sheath blocks to an active comparator of surgeon-administered local anesthetic wound infiltration in children undergoing septal defect repair. The study tested the hypothesis that RA use would result in less opioid use and lower pain intensity compared to wound infiltration.METHODSThis double-blind, randomized, parallel group, single-center trial included children (<18 years) undergoing primary atrial septal defect (ASD) or ventricular septal defect (VSD) repair. Participants were randomized to RA consisting of ultrasound-guided pecto-intercostal fascial plane and rectus sheath blocks or no-block, consisting of local anesthetic wound infiltration. Both groups received 1.5 mL/kg of ropivacaine 0.2% for the intervention. The primary outcome was opioid use (oral morphine milligram equivalents [MME]/kg) 0-12 hours after surgery. Secondary outcomes were opioid use at additional time points, pain (0-10 scale) between 0 and 48 hours (area under the curve [AUC]), and hospital length of stay (LOS).RESULTSData analysis included 42 children (24 RA, 18 infiltration), age 3.3 ± 2.7 years (mean ± standard deviation [SD]; median, 3; range, 4 months-10 years). Opioid use (MME/kg mean ± SD) 0-12 hours after surgery was 0.44 ± 0.19 in the RA group compared to 0.83 ± 0.39 in the infiltration group (mean difference -0.39; 95% confidence interval [CI], -0.59 to -0.18; P = .001). Total postoperative opioid use from 0 to 48 hours after surgery was 0.95 ± 0.40 in the RA group compared to 1.57 ± 0.75 in the infiltration group (mean difference -0.64; 95% CI, -1.02 to -0.22, P = .004). Pain intensity AUC (0-48 hours) was 45.0 ± 26.8 in the RA group compared to 94.5 ± 55.7 in the infiltration group (mean difference -49.5 [-78.9 to -20.1]; P = .002). Opioid use between 12 and 48 hours and hospital LOS was not different between groups.CONCLUSIONSThis single-center study showed that the combined pecto-intercostal fascial plane and rectus sheath blocks were opioid-sparing and provided superior pain control compared to contemporary practice of local anesthetic infiltration in children following septal defect repair. This investigation strengthens the evidence to support RA use to improve postoperative pain in this population.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203885","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 : 2025-10-01DOI: 10.1213/ane.0000000000007759
Sameer Lakha,Sharon G Huang,Cindy Wang,Eric Rome,Natalia Egorova,Yuxia Ouyang,Matthew A Levin,Samuel DeMaria
BACKGROUNDEffective teamwork is essential in high-stakes environments such as cardiac surgery, where complex procedures require coordinated efforts, particularly between surgeons and anesthesiologists. While team dynamics have been shown to affect surgical outcomes, the impact of surgeon-anesthesiologist familiarity on operative mortality in cardiac surgery remains underexplored. We aimed to assess whether increased familiarity within this dyad was associated with reduced operative mortality and improved patient outcomes.METHODSWe conducted a retrospective, single-center cohort study using data from a large academic medical center, covering cases from July 2011 to January 2024. Surgeon-anesthesiologist dyads were defined by unique pairings who worked together in each case. Familiarity was measured by the frequency of collaboration over the previous 365 days and divided into quintiles. The primary outcome was operative mortality, defined as death before discharge or within 30 days post-procedure. Secondary outcomes included operative length, hospital and intensive care length of stay, reoperation, readmission, and reported organ system complications. A logistic mixed-effects model adjusted for patient demographics, comorbidities, and procedure type, was used to examine associations.RESULTSWe identified 481 unique surgeon-anesthesiologist pairs from 16,811 cases. Higher dyad familiarity was associated with significantly lower operative mortality when analyzing the entire cohort (P < .001). Patients cared for by higher-familiarity dyads also had reduced rates of several adverse outcomes, although deep sternal wound infection showed no association with dyad familiarity. After adjusting for confounders, the odds of operative mortality were significantly higher for the lowest-familiarity dyads compared to the highest-familiarity dyads (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.29-2.81, P = .001).CONCLUSIONSIncreased surgeon-anesthesiologist familiarity was associated with lower operative mortality and improved outcomes in cardiac surgery, highlighting the importance of consistent team collaboration. Multi-center studies are warranted to validate these findings and explore familiarity's effects across diverse clinical settings.
在高风险的环境中，有效的团队合作是必不可少的，如心脏手术，复杂的程序需要协调努力，特别是在外科医生和麻醉师之间。虽然团队动态已被证明会影响手术结果，但外科麻醉师熟悉程度对心脏外科手术死亡率的影响仍未得到充分探讨。我们的目的是评估在这两个群体中增加熟悉度是否与降低手术死亡率和改善患者预后有关。方法采用回顾性、单中心队列研究，数据来自某大型学术医疗中心，涵盖2011年7月至2024年1月的病例。外科麻醉师二人组被定义为在每种情况下一起工作的独特配对。熟悉度是通过过去365天的合作频率来衡量的，并分为五分位数。主要终点为手术死亡率，定义为出院前或术后30天内死亡。次要结局包括手术时间、住院和重症监护时间、再手术、再入院和报告的器官系统并发症。采用logistic混合效应模型对患者人口统计学、合并症和手术类型进行调整，以检验相关性。结果从16,811例病例中鉴定出481对独特的外科麻醉师对。在分析整个队列时，较高的双染色体熟悉度与较低的手术死亡率相关（P < 0.001）。虽然深胸骨伤口感染与熟悉度无关，但熟悉度较高的双性恋患者的不良反应发生率也有所降低。调整混杂因素后，最低熟悉度组的手术死亡率明显高于最高熟悉度组（比值比[OR]， 1.90, 95%可信区间[CI]， 1.29-2.81, P = .001）。结论：外科麻醉师熟悉程度的提高与心脏外科手术死亡率的降低和预后的改善相关，强调了团队合作的重要性。需要多中心研究来验证这些发现，并探索熟悉度在不同临床环境中的影响。
{"title":"The Association Between Surgeon-Anesthesiologist Dyad Familiarity and Operative Mortality: A Retrospective Study at a Large Academic Cardiac Surgery Program.","authors":"Sameer Lakha,Sharon G Huang,Cindy Wang,Eric Rome,Natalia Egorova,Yuxia Ouyang,Matthew A Levin,Samuel DeMaria","doi":"10.1213/ane.0000000000007759","DOIUrl":"https://doi.org/10.1213/ane.0000000000007759","url":null,"abstract":"BACKGROUNDEffective teamwork is essential in high-stakes environments such as cardiac surgery, where complex procedures require coordinated efforts, particularly between surgeons and anesthesiologists. While team dynamics have been shown to affect surgical outcomes, the impact of surgeon-anesthesiologist familiarity on operative mortality in cardiac surgery remains underexplored. We aimed to assess whether increased familiarity within this dyad was associated with reduced operative mortality and improved patient outcomes.METHODSWe conducted a retrospective, single-center cohort study using data from a large academic medical center, covering cases from July 2011 to January 2024. Surgeon-anesthesiologist dyads were defined by unique pairings who worked together in each case. Familiarity was measured by the frequency of collaboration over the previous 365 days and divided into quintiles. The primary outcome was operative mortality, defined as death before discharge or within 30 days post-procedure. Secondary outcomes included operative length, hospital and intensive care length of stay, reoperation, readmission, and reported organ system complications. A logistic mixed-effects model adjusted for patient demographics, comorbidities, and procedure type, was used to examine associations.RESULTSWe identified 481 unique surgeon-anesthesiologist pairs from 16,811 cases. Higher dyad familiarity was associated with significantly lower operative mortality when analyzing the entire cohort (P < .001). Patients cared for by higher-familiarity dyads also had reduced rates of several adverse outcomes, although deep sternal wound infection showed no association with dyad familiarity. After adjusting for confounders, the odds of operative mortality were significantly higher for the lowest-familiarity dyads compared to the highest-familiarity dyads (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.29-2.81, P = .001).CONCLUSIONSIncreased surgeon-anesthesiologist familiarity was associated with lower operative mortality and improved outcomes in cardiac surgery, highlighting the importance of consistent team collaboration. Multi-center studies are warranted to validate these findings and explore familiarity's effects across diverse clinical settings.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203667","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 : 2025-10-01DOI: 10.1213/ane.0000000000007562
Sara Ai Lin Ang,Sherwyn Koh,Zachary Chu,Jun Xiang Tan,Ashton Yin,Yie Hui Lau
{"title":"Subjective Sleep Quality Audit in the Surgical Intensive Care Unit.","authors":"Sara Ai Lin Ang,Sherwyn Koh,Zachary Chu,Jun Xiang Tan,Ashton Yin,Yie Hui Lau","doi":"10.1213/ane.0000000000007562","DOIUrl":"https://doi.org/10.1213/ane.0000000000007562","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203670","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}
BACKGROUNDAnesthesia choice affects hip fracture surgery outcomes. However, limited evidence exists regarding the impact of neuraxial anesthesia (NA) versus general anesthesia (GA) on postoperative outcomes, specifically in hip arthroplasty for fracture. The purpose of this study was to compare 30-day readmission, in-hospital complications, hospitalization charges, and length of stay between the elderly who received NA and GA during this procedure.METHODSThe Hospital Quality Monitoring System was analyzed for patients undergoing hip arthroplasty for geriatric hip fracture (≥60 years of age) between 2013 and 2019. After adjusting for potential confounders with propensity score matching, logistic regression and linear regression analyses were conducted to compare NA with GA in terms of 30-day readmission rates and causes, in-hospital complications (including in-hospital mortality, pulmonary embolism, deep vein thrombosis, wound infection, and blood transfusion), hospitalization charges, and length of stay.RESULTSOf the 90,745 patients undergoing hip arthroplasty for geriatric hip fracture during the study period (40,551 [44.7%] for NA, 50,194 [55.3%] for GA), a total of 62,022 patients (31,011 propensity score-matched pairs) were included after study exclusions and propensity score matching. NA was significantly associated with a lower incidence of 30-day readmission (4.60% vs 4.97%, odds ratio [OR] = 0.92, 95% confidence interval [CI], 0.86-0.99, P =.032) and fewer genitourinary system complaints (0.18% vs 0.26%, OR = 0.70, 95% CI, 0.50-0.97, P =.035) for readmission compared with GA. The incidence of in-hospital mortality (0.41% vs 0.64%, OR = 0.64, 95% CI, 0.52-0.81, P <.001), deep vein thrombosis (1.84% vs 2.57%, OR = 0.71, 95% CI, 0.64-0.79, P <.001), and pulmonary embolism (0.22% vs 0.38%, OR = 0.58, 95% CI, 0.43-0.79, P <.001) was also lower for NA compared with GA. Moreover, patients with NA had decreased charges (49,851.8 Chinese Yuan [CNY] vs 54,754.8 CNY, P <.001) relative to GA. The length of stay did not differ significantly between NA and GA (13.7 days vs 13.8 days, P =.217).CONCLUSIONSIn geriatric patients undergoing hip arthroplasty for hip fracture, NA is associated with lower rates of 30-day readmission, fewer readmission caused by genitourinary system complaints, reduced complications, and decreased hospitalization charges compared to GA.
背景：麻醉选择影响髋部骨折手术结果。然而，关于神经轴麻醉（NA）与全身麻醉（GA）对术后结果的影响，特别是在骨折髋关节置换术中，证据有限。本研究的目的是比较在此过程中接受NA和GA的老年人的30天再入院、住院并发症、住院费用和住院时间。方法对2013 - 2019年接受髋关节置换术治疗老年髋部骨折（≥60岁）患者的医院质量监测系统进行分析。通过倾向评分匹配调整潜在混杂因素后，进行logistic回归和线性回归分析，比较NA和GA在30天再入院率和原因、院内并发症（包括院内死亡率、肺栓塞、深静脉血栓形成、伤口感染和输血）、住院费用和住院时间方面的差异。结果在研究期间，90,745例老年髋部骨折行髋关节置换术的患者（40,551例[44.7%],50,194例[55.3%]），经研究排除和倾向评分匹配后，共纳入62,022例患者（31,011对倾向评分匹配）。与GA相比，NA与较低的30天再入院发生率（4.60% vs 4.97%，优势比[OR] = 0.92, 95%可信区间[CI]， 0.86-0.99, P = 0.032）和较低的泌尿生殖系统再入院发生率（0.18% vs 0.26%, OR = 0.70, 95% CI, 0.50-0.97, P = 0.035）显著相关。住院死亡率（0.41% vs 0.64%, OR = 0.64, 95% CI, 0.52-0.81, P <.001）、深静脉血栓形成（1.84% vs 2.57%, OR = 0.71, 95% CI, 0.64-0.79, P <.001）和肺栓塞（0.22% vs 0.38%, OR = 0.58, 95% CI, 0.43-0.79, P <.001）的发生率也低于GA。此外，NA组患者的收费较GA组降低（49,851.8元人民币vs 54,754.8元人民币，P < 0.001）。住院时间在NA和GA之间没有显著差异（13.7天vs 13.8天，P = 0.217）。结论在髋部骨折行髋关节置换术的老年患者中，与GA相比，NA具有更低的30天再入院率、更少的泌尿生殖系统疾病引起的再入院率、更少的并发症和更低的住院费用。
{"title":"Neuraxial Compared With General Anesthesia on Postoperative Outcomes After Hip Arthroplasty for Geriatric Hip Fracture: Results From a National Database.","authors":"Fanqiang Meng,Yuqing Wang,Liusong Shen,Junzhi Sheng,Huizhong Long,Hu Chen,Xiaoxiao Li,Dongxing Xie,Xiang Ding","doi":"10.1213/ane.0000000000007758","DOIUrl":"https://doi.org/10.1213/ane.0000000000007758","url":null,"abstract":"BACKGROUNDAnesthesia choice affects hip fracture surgery outcomes. However, limited evidence exists regarding the impact of neuraxial anesthesia (NA) versus general anesthesia (GA) on postoperative outcomes, specifically in hip arthroplasty for fracture. The purpose of this study was to compare 30-day readmission, in-hospital complications, hospitalization charges, and length of stay between the elderly who received NA and GA during this procedure.METHODSThe Hospital Quality Monitoring System was analyzed for patients undergoing hip arthroplasty for geriatric hip fracture (≥60 years of age) between 2013 and 2019. After adjusting for potential confounders with propensity score matching, logistic regression and linear regression analyses were conducted to compare NA with GA in terms of 30-day readmission rates and causes, in-hospital complications (including in-hospital mortality, pulmonary embolism, deep vein thrombosis, wound infection, and blood transfusion), hospitalization charges, and length of stay.RESULTSOf the 90,745 patients undergoing hip arthroplasty for geriatric hip fracture during the study period (40,551 [44.7%] for NA, 50,194 [55.3%] for GA), a total of 62,022 patients (31,011 propensity score-matched pairs) were included after study exclusions and propensity score matching. NA was significantly associated with a lower incidence of 30-day readmission (4.60% vs 4.97%, odds ratio [OR] = 0.92, 95% confidence interval [CI], 0.86-0.99, P =.032) and fewer genitourinary system complaints (0.18% vs 0.26%, OR = 0.70, 95% CI, 0.50-0.97, P =.035) for readmission compared with GA. The incidence of in-hospital mortality (0.41% vs 0.64%, OR = 0.64, 95% CI, 0.52-0.81, P <.001), deep vein thrombosis (1.84% vs 2.57%, OR = 0.71, 95% CI, 0.64-0.79, P <.001), and pulmonary embolism (0.22% vs 0.38%, OR = 0.58, 95% CI, 0.43-0.79, P <.001) was also lower for NA compared with GA. Moreover, patients with NA had decreased charges (49,851.8 Chinese Yuan [CNY] vs 54,754.8 CNY, P <.001) relative to GA. The length of stay did not differ significantly between NA and GA (13.7 days vs 13.8 days, P =.217).CONCLUSIONSIn geriatric patients undergoing hip arthroplasty for hip fracture, NA is associated with lower rates of 30-day readmission, fewer readmission caused by genitourinary system complaints, reduced complications, and decreased hospitalization charges compared to GA.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153431","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 : 2025-09-23DOI: 10.1213/ane.0000000000007727
Shreya Khandelwal,Ravi Jasti,Abhishek Prasad,Pattrapun Wongsripuemtet,Matthew Fuller,André J Savadjian,Karthik Raghunathan,Tetsu Ohnuma,Rebecca Schroeder,Thomas M Price,Vijay Krishnamoorthy,Jamie R Privratsky
BACKGROUNDPostoperative acute kidney injury (AKI) worsens surgical outcomes. Previous studies have observed an age- and sex-dependent effect on postoperative AKI rates. The objective of our study was to determine whether preoperative exposure to male or female sex hormone therapies modified AKI risk after both noncardiac and cardiac surgery. We hypothesized that women older than 55 years on estrogen/progesterone replacement therapy and men on antiandrogen therapy would have lower odds of postoperative AKI compared to counterparts not receiving sex hormone therapies.METHODSWe conducted a retrospective cohort study, using data from Duke University Medical Center from 2013 to 2023. The study included women older than 55 years and men older than 18 years undergoing surgery. Exclusions included patients with missing creatinine values, patients with chronic kidney disease stage 5 (CKD5), transplant cases, and minor cases. The primary exposure was preoperative utilization of exogenous sex hormones, and the primary outcome was the development of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Multivariable logistic regression was used to examine the association of preoperative sex hormones with postoperative AKI.RESULTSThere were 82,557 patients in the cohort, with 68,471 undergoing noncardiac surgery and 14,086 undergoing cardiac surgery. Among men undergoing noncardiac surgery, exposure to antiandrogens was associated with lower odds of postoperative AKI (0.83, 95% confidence interval [CI], 0.72-0.96, P < .01). Among women undergoing noncardiac surgery, preoperative exposure to vaginal estrogen was associated with lower odds of postoperative AKI (adjusted odds ratio [OR], 0.61, 95% CI, 0.47-0.79, P < .001). Neither male nor female sex hormone exposures were associated with AKI risk after cardiac surgery.CONCLUSIONSPreoperative antiandrogen therapy in men and vaginal estrogen therapy in women older than 55 years were associated with reduced odds of postoperative AKI after noncardiac surgery. Our findings provide correlative evidence that sex hormones might modify postoperative AKI outcomes, while revealing complexity in drug and patient selection.
背景：术后急性肾损伤（AKI）会使手术结果恶化。先前的研究已经观察到年龄和性别对术后AKI发生率的影响。本研究的目的是确定术前接受男性或女性性激素治疗是否会改变非心脏和心脏手术后AKI的风险。我们假设55岁以上接受雌激素/孕激素替代治疗的女性和接受抗雄激素治疗的男性与未接受性激素治疗的男性相比，术后AKI的发生率较低。方法采用杜克大学医学中心2013 - 2023年的数据进行回顾性队列研究。该研究包括55岁以上的女性和18岁以上的男性接受手术。排除包括肌酐值缺失的患者、慢性肾脏疾病5期（CKD5）患者、移植病例和轻微病例。主要暴露是术前外源性性激素的使用，主要结局是术后AKI的发展，根据肾脏疾病：改善总体结局（KDIGO）血清肌酐标准定义。采用多变量logistic回归分析术前性激素与术后AKI的关系。结果该队列共有82557例患者，其中68471例接受了非心脏手术，14086例接受了心脏手术。在接受非心脏手术的男性中，暴露于抗雄激素与较低的术后AKI发生率相关（0.83,95%可信区间[CI]， 0.72-0.96, P < 0.01）。在接受非心脏手术的女性中，术前暴露于阴道雌激素与术后AKI发生率较低相关（校正优势比[OR]， 0.61, 95% CI, 0.47-0.79, P < 0.001）。男性和女性性激素暴露与心脏手术后AKI风险无关。结论男性术前抗雄激素治疗和55岁以上女性阴道雌激素治疗与非心脏手术后AKI发生率降低相关。我们的研究结果提供了性激素可能改变AKI术后预后的相关证据，同时揭示了药物和患者选择的复杂性。
{"title":"Retrospective Analysis of the Association of Preoperative Sex Hormone Therapy With the Development of Postoperative Acute Kidney Injury.","authors":"Shreya Khandelwal,Ravi Jasti,Abhishek Prasad,Pattrapun Wongsripuemtet,Matthew Fuller,André J Savadjian,Karthik Raghunathan,Tetsu Ohnuma,Rebecca Schroeder,Thomas M Price,Vijay Krishnamoorthy,Jamie R Privratsky","doi":"10.1213/ane.0000000000007727","DOIUrl":"https://doi.org/10.1213/ane.0000000000007727","url":null,"abstract":"BACKGROUNDPostoperative acute kidney injury (AKI) worsens surgical outcomes. Previous studies have observed an age- and sex-dependent effect on postoperative AKI rates. The objective of our study was to determine whether preoperative exposure to male or female sex hormone therapies modified AKI risk after both noncardiac and cardiac surgery. We hypothesized that women older than 55 years on estrogen/progesterone replacement therapy and men on antiandrogen therapy would have lower odds of postoperative AKI compared to counterparts not receiving sex hormone therapies.METHODSWe conducted a retrospective cohort study, using data from Duke University Medical Center from 2013 to 2023. The study included women older than 55 years and men older than 18 years undergoing surgery. Exclusions included patients with missing creatinine values, patients with chronic kidney disease stage 5 (CKD5), transplant cases, and minor cases. The primary exposure was preoperative utilization of exogenous sex hormones, and the primary outcome was the development of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Multivariable logistic regression was used to examine the association of preoperative sex hormones with postoperative AKI.RESULTSThere were 82,557 patients in the cohort, with 68,471 undergoing noncardiac surgery and 14,086 undergoing cardiac surgery. Among men undergoing noncardiac surgery, exposure to antiandrogens was associated with lower odds of postoperative AKI (0.83, 95% confidence interval [CI], 0.72-0.96, P < .01). Among women undergoing noncardiac surgery, preoperative exposure to vaginal estrogen was associated with lower odds of postoperative AKI (adjusted odds ratio [OR], 0.61, 95% CI, 0.47-0.79, P < .001). Neither male nor female sex hormone exposures were associated with AKI risk after cardiac surgery.CONCLUSIONSPreoperative antiandrogen therapy in men and vaginal estrogen therapy in women older than 55 years were associated with reduced odds of postoperative AKI after noncardiac surgery. Our findings provide correlative evidence that sex hormones might modify postoperative AKI outcomes, while revealing complexity in drug and patient selection.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127214","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 : 2025-09-23DOI: 10.1213/ane.0000000000007734
Zühre Uz,Iris M Jongerius,Denise P Veelo,Bülent Ergin,Thomas M van Gulik,Can Ince,
{"title":"Monitoring the Influence of Low CVP Versus Stroke Volume-Guided Fluid Therapy on Sublingual and Intestinal Microcirculatory Perfusion.","authors":"Zühre Uz,Iris M Jongerius,Denise P Veelo,Bülent Ergin,Thomas M van Gulik,Can Ince, ","doi":"10.1213/ane.0000000000007734","DOIUrl":"https://doi.org/10.1213/ane.0000000000007734","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127216","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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