Pub Date : 2024-09-18DOI: 10.1097/aln.0000000000005124
Jairo R Moyano A
{"title":"Perioperative Care for Spine Surgery: Comment.","authors":"Jairo R Moyano A","doi":"10.1097/aln.0000000000005124","DOIUrl":"https://doi.org/10.1097/aln.0000000000005124","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"331 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245462","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}
Pub Date : 2024-09-18DOI: 10.1097/aln.0000000000005125
Louanne M Carabini,John F Bebawy
{"title":"Perioperative Care for Spine Surgery: Reply.","authors":"Louanne M Carabini,John F Bebawy","doi":"10.1097/aln.0000000000005125","DOIUrl":"https://doi.org/10.1097/aln.0000000000005125","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"46 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245461","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":"Heart under Pressure: Intrathoracic Impact of Large Hiatal Hernia.","authors":"Youlei Li,Dahyun Kang,Michael Gonzalez,Alexander Doyal","doi":"10.1097/aln.0000000000005154","DOIUrl":"https://doi.org/10.1097/aln.0000000000005154","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"10 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245464","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}
Pub Date : 2024-09-12DOI: 10.1097/aln.0000000000005111
Mandeep Kumar,David L Hepner,Erin S Grawe,Maureen Keshock,Maleka Khambaty,Manish S Patel,BobbieJean Sweitzer
{"title":"Diagnosis and Treatment of Perioperative Anemia: A Society for Perioperative Assessment and Quality Improvement Collaborative Review.","authors":"Mandeep Kumar,David L Hepner,Erin S Grawe,Maureen Keshock,Maleka Khambaty,Manish S Patel,BobbieJean Sweitzer","doi":"10.1097/aln.0000000000005111","DOIUrl":"https://doi.org/10.1097/aln.0000000000005111","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"36 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174645","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}
Pub Date : 2024-09-09DOI: 10.1097/aln.0000000000005214
Nicholas J Douville,Lisa Bastarache,Jing He,Kuan-Han H Wu,Brett Vanderwerff,Emily Bertucci-Richter,Whitney E Hornsby,Adam Lewis,Elizabeth S Jewell,Sachin Kheterpal,Nirav Shah,Michael Mathis,Milo C Engoren,Christopher B Douville,Ida Surakka,Cristen Willer,Miklos D Kertai
BACKGROUNDPostoperative nausea and vomiting (PONV) is a key driver of unplanned admission and patient satisfaction following surgery. Because traditional risk factors do not completely explain variability in risk, we hypothesize that genetics may contribute to the overall risk for this complication. The objective of this research is to perform a genome-wide association study of PONV, derive a polygenic risk score for PONV, assess associations between the risk score and PONV in a validation cohort, and compare any genetic contributions to known clinical risks for PONV.METHODSSurgeries with integrated genetic and perioperative data performed under general anesthesia at Michigan Medicine and Vanderbilt University Medical Center were studied. PONV was defined as nausea or emesis occurring and documented in the PACU. In the Discovery Phase, genome-wide association studies were performed on each genetic cohort and the results were meta-analyzed. Next, in the Polygenic Phase, we assessed whether a polygenic score, derived from genome-wide association study in a derivation cohort from Vanderbilt University Medical Center, improved prediction within a validation cohort from Michigan Medicine, as quantified by discrimination (C-statistic) and net reclassification index.RESULTSOf 64,523 total patients, 5,703 developed PONV (8.8%). We identified 46 genetic variants exceeding P<1x10-5 threshold, occurring with minor allele frequency > 1%, and demonstrating concordant effects in both cohorts. Standardized polygenic score was associated with PONV in a basic model, controlling for age and sex, (aOR 1.027 per standard deviation increase in overall genetic risk, 95% CI 1.001-1.053, P=0.044), a model based on known clinical risks (aOR 1.029, 95% CI 1.003-1.055, P=0.030), and a full clinical regression, controlling for 21 demographic, surgical, and anesthetic factors, (aOR 1.029, 95% CI 1.002-1.056, P=0.033). The addition of polygenic score improved overall discrimination in models based on known clinical risk factors (c-statistic: 0.616 compared to 0.613, P=0.028) and improved net reclassification of 4.6% of cases.CONCLUSIONStandardized polygenic risk was associated with PONV in all three of our models, but the genetic influence was smaller than exerted by clinical risk factors. Specifically, a patient with a polygenic risk score > 1 standard deviation above the mean, has 2-3% greater odds of developing PONV when compared to the baseline population, which is at least an order of magnitude smaller than the increase associated with having prior PONV/motion sickness (55%), having a history of migraines (17%), or being female (83%), and is not clinically significant. Furthermore, the use of a polygenic risk score does not meaningfully improve discrimination compared to clinical risk factors and is not clinically useful.
{"title":"Polygenic Score for the Prediction of Postoperative Nausea and Vomiting: A Retrospective Derivation and Validation Cohort Study.","authors":"Nicholas J Douville,Lisa Bastarache,Jing He,Kuan-Han H Wu,Brett Vanderwerff,Emily Bertucci-Richter,Whitney E Hornsby,Adam Lewis,Elizabeth S Jewell,Sachin Kheterpal,Nirav Shah,Michael Mathis,Milo C Engoren,Christopher B Douville,Ida Surakka,Cristen Willer,Miklos D Kertai","doi":"10.1097/aln.0000000000005214","DOIUrl":"https://doi.org/10.1097/aln.0000000000005214","url":null,"abstract":"BACKGROUNDPostoperative nausea and vomiting (PONV) is a key driver of unplanned admission and patient satisfaction following surgery. Because traditional risk factors do not completely explain variability in risk, we hypothesize that genetics may contribute to the overall risk for this complication. The objective of this research is to perform a genome-wide association study of PONV, derive a polygenic risk score for PONV, assess associations between the risk score and PONV in a validation cohort, and compare any genetic contributions to known clinical risks for PONV.METHODSSurgeries with integrated genetic and perioperative data performed under general anesthesia at Michigan Medicine and Vanderbilt University Medical Center were studied. PONV was defined as nausea or emesis occurring and documented in the PACU. In the Discovery Phase, genome-wide association studies were performed on each genetic cohort and the results were meta-analyzed. Next, in the Polygenic Phase, we assessed whether a polygenic score, derived from genome-wide association study in a derivation cohort from Vanderbilt University Medical Center, improved prediction within a validation cohort from Michigan Medicine, as quantified by discrimination (C-statistic) and net reclassification index.RESULTSOf 64,523 total patients, 5,703 developed PONV (8.8%). We identified 46 genetic variants exceeding P<1x10-5 threshold, occurring with minor allele frequency > 1%, and demonstrating concordant effects in both cohorts. Standardized polygenic score was associated with PONV in a basic model, controlling for age and sex, (aOR 1.027 per standard deviation increase in overall genetic risk, 95% CI 1.001-1.053, P=0.044), a model based on known clinical risks (aOR 1.029, 95% CI 1.003-1.055, P=0.030), and a full clinical regression, controlling for 21 demographic, surgical, and anesthetic factors, (aOR 1.029, 95% CI 1.002-1.056, P=0.033). The addition of polygenic score improved overall discrimination in models based on known clinical risk factors (c-statistic: 0.616 compared to 0.613, P=0.028) and improved net reclassification of 4.6% of cases.CONCLUSIONStandardized polygenic risk was associated with PONV in all three of our models, but the genetic influence was smaller than exerted by clinical risk factors. Specifically, a patient with a polygenic risk score > 1 standard deviation above the mean, has 2-3% greater odds of developing PONV when compared to the baseline population, which is at least an order of magnitude smaller than the increase associated with having prior PONV/motion sickness (55%), having a history of migraines (17%), or being female (83%), and is not clinically significant. Furthermore, the use of a polygenic risk score does not meaningfully improve discrimination compared to clinical risk factors and is not clinically useful.","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"57 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165934","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}
Pub Date : 2024-09-01DOI: 10.1097/ALN.0000000000005116
Rachel Hadler, Rebecca A Aslakson
{"title":"A Required Reconsideration of \"Required Reconsideration\": Pioneering a New Paradigm for Perioperative Management of Patients Presenting with Treatment Limitations.","authors":"Rachel Hadler, Rebecca A Aslakson","doi":"10.1097/ALN.0000000000005116","DOIUrl":"10.1097/ALN.0000000000005116","url":null,"abstract":"","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":"141 3","pages":"440-442"},"PeriodicalIF":9.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970452","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}
Pub Date : 2024-09-01DOI: 10.1097/ALN.0000000000005075
Jeffrey H Silber, Paul R Rosenbaum, Joseph G Reiter, Siddharth Jain, Alexander S Hill, Sean Hashemi, Sydney Brown, Mark Olfson, Caleb Ing
Background: Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral problems. This study takes advantage of a natural experiment associated with appendicitis to determine whether anesthesia and surgery in childhood were specifically associated with subsequent neurobehavioral outcomes.
Methods: This study identified 134,388 healthy children with appendectomy and examined the incidence of subsequent externalizing or behavioral disorders (conduct, impulse control, oppositional defiant, attention-deficit hyperactivity disorder) or internalizing or mood or anxiety disorders (depression, anxiety, or bipolar disorder) when compared to 671,940 matched healthy controls as identified in Medicaid data between 2001 and 2018. For comparison, this study also examined 154,887 otherwise healthy children admitted to the hospital for pneumonia, cellulitis, and gastroenteritis, of which only 8% received anesthesia, and compared them to 774,435 matched healthy controls. In addition, this study examined the difference-in-differences between matched appendectomy patients and their controls and matched medical admission patients and their controls.
Results: Compared to controls, children with appendectomy were more likely to have subsequent behavioral disorders (hazard ratio, 1.04; 95% CI, 1.01 to 1.06; P = 0.0010) and mood or anxiety disorders (hazard ratio, 1.15; 95% CI, 1.13 to 1.17; P < 0.0001). Relative to controls, children with medical admissions were also more likely to have subsequent behavioral (hazard ratio, 1.20; 95% CI, 1.18 to 1.22; P < 0.0001) and mood or anxiety (hazard ratio, 1.25; 95% CI, 1.23 to 1.27; P < 0.0001) disorders. Comparing the difference between matched appendectomy patients and their matched controls to the difference between matched medical patients and their matched controls, medical patients had more subsequent neurobehavioral problems than appendectomy patients.
Conclusions: Although there is an association between neurobehavioral diagnoses and appendectomy, this association is not specific to anesthesia exposure and is stronger in medical admissions. Medical admissions, generally without anesthesia exposure, displayed significantly higher rates of these disorders than appendectomy-exposed patients.
Editor’s perspective:
背景：由于需要麻醉的儿童通常患有与神经行为问题相关的疾病，因此有关麻醉神经毒性的观察性研究可能存在偏差。本研究利用了与阑尾炎相关的自然实验，以确定儿童时期的麻醉和手术是否与随后的神经行为结果特别相关：我们确定了134388名接受阑尾炎手术的健康儿童，并与2001-2018年间医疗补助数据中确定的671940名匹配健康对照组相比，研究了其后外化或行为障碍（行为、冲动控制、对立违抗或注意缺陷/多动障碍）；或内化或情绪/焦虑障碍（抑郁、焦虑或躁郁症）的发生率。为了进行比较，我们还研究了 154,887 名因肺炎、蜂窝组织炎和肠胃炎入院的其他健康儿童（其中只有 8% 接受了麻醉），并将他们与 774,435 名匹配的健康对照组进行了比较。我们还研究了相匹配的阑尾切除术患者及其对照组与相匹配的内科入院患者及其对照组之间的差异：与对照组相比，接受阑尾切除术的儿童更容易出现行为障碍（危险比 (HR) 为 1.04 (95% CI 1.01, 1.06)，P = 0.0010）和情绪/焦虑障碍（HR：1.15 (95% CI 1.13, 1.17)，P < 0.0001）。与对照组相比，入院治疗的儿童随后更有可能出现行为障碍（HR：1.20 (95% CI 1.18, 1.22)，P < 0.0001）和情绪/焦虑障碍（HR：1.25 (95% CI 1.23, 1.27)，P < 0.0001）。比较配对的阑尾切除术患者及其配对对照组与配对的内科患者及其配对对照组之间的差异，内科患者比阑尾切除术患者有更多的后续神经行为问题：结论：尽管神经行为诊断与阑尾切除术之间存在关联，但这种关联并不是麻醉暴露所特有的，而且在内科住院患者中更为明显。通常没有接触过麻醉的内科住院病人患这些疾病的比例明显高于接触过阑尾切除术的病人。
{"title":"Exposure to Operative Anesthesia in Childhood and Subsequent Neurobehavioral Diagnoses: A Natural Experiment Using Appendectomy.","authors":"Jeffrey H Silber, Paul R Rosenbaum, Joseph G Reiter, Siddharth Jain, Alexander S Hill, Sean Hashemi, Sydney Brown, Mark Olfson, Caleb Ing","doi":"10.1097/ALN.0000000000005075","DOIUrl":"10.1097/ALN.0000000000005075","url":null,"abstract":"<p><strong>Background: </strong>Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral problems. This study takes advantage of a natural experiment associated with appendicitis to determine whether anesthesia and surgery in childhood were specifically associated with subsequent neurobehavioral outcomes.</p><p><strong>Methods: </strong>This study identified 134,388 healthy children with appendectomy and examined the incidence of subsequent externalizing or behavioral disorders (conduct, impulse control, oppositional defiant, attention-deficit hyperactivity disorder) or internalizing or mood or anxiety disorders (depression, anxiety, or bipolar disorder) when compared to 671,940 matched healthy controls as identified in Medicaid data between 2001 and 2018. For comparison, this study also examined 154,887 otherwise healthy children admitted to the hospital for pneumonia, cellulitis, and gastroenteritis, of which only 8% received anesthesia, and compared them to 774,435 matched healthy controls. In addition, this study examined the difference-in-differences between matched appendectomy patients and their controls and matched medical admission patients and their controls.</p><p><strong>Results: </strong>Compared to controls, children with appendectomy were more likely to have subsequent behavioral disorders (hazard ratio, 1.04; 95% CI, 1.01 to 1.06; P = 0.0010) and mood or anxiety disorders (hazard ratio, 1.15; 95% CI, 1.13 to 1.17; P < 0.0001). Relative to controls, children with medical admissions were also more likely to have subsequent behavioral (hazard ratio, 1.20; 95% CI, 1.18 to 1.22; P < 0.0001) and mood or anxiety (hazard ratio, 1.25; 95% CI, 1.23 to 1.27; P < 0.0001) disorders. Comparing the difference between matched appendectomy patients and their matched controls to the difference between matched medical patients and their matched controls, medical patients had more subsequent neurobehavioral problems than appendectomy patients.</p><p><strong>Conclusions: </strong>Although there is an association between neurobehavioral diagnoses and appendectomy, this association is not specific to anesthesia exposure and is stronger in medical admissions. Medical admissions, generally without anesthesia exposure, displayed significantly higher rates of these disorders than appendectomy-exposed patients.</p><p><strong>Editor’s perspective: </strong></p>","PeriodicalId":7970,"journal":{"name":"Anesthesiology","volume":" ","pages":"489-499"},"PeriodicalIF":9.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11361557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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