Revista espanola de anestesiologia y reanimacion最新文献

英文中文

The effect of opioid-free anesthesia on postoperative pain in orthopedic surgery: A systematic review and meta-analysis of randomized controlled trial 无阿片类药物麻醉对骨科术后疼痛的影响：一项随机对照试验的系统回顾和荟萃分析。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2026.501989

A. Bachtiar Effendi , F. Cahya Ramadhan , G.D. Ica Manohara , R.M. Laksono

Background

Opioid-free anaesthesia (OFA) is increasingly recognized as a perioperative approach that may offer effective pain control with reduced risk of adverse effects. Considering that orthopaedic surgeries often lead to at least moderate postoperative pain, we assessed the effectiveness and safety of OFA in orthopaedic procedures.

Methods

We searched PubMed, ScienceDirect, ProQuest, and EuropePMC for relevant randomised controlled trials (RCT) and supplemented the data with citation tracking. Data were analysed using RevMan version 5.4. The risk of bias and the certainty of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and the GRADE approach. The study was registered on PROSPERO (CRD420251048348).

Results

Seven RCTs involving 408 patients were included. The intensity of postoperative pain measured in the post-anaesthesia care unit (mean difference [MD]: −0.08), at 24 h (MD: −0.06), and at 48 h (MD: −0.26) was not statistically significant. OFA reduced the risk of postoperative nausea and vomiting (PONV) (RR: 0.37; P = .00001) and prolonged the time to first request for analgesia (MD: 25.60 min; P = .00001). Twenty-four-hour morphine consumption was comparable across groups (MD: −0.28; P = .76). OFA reduced the incidence of intraoperative hypotension (risk ratio [RR]: 0.56; P = .02) but increased the risk of intraoperative bradycardia (RR: 1.86; P = .04).

Conclusions

In orthopaedic surgery, OFA provides comparable pain control to opioid-based anaesthesia. It also reduced the incidence of postoperative nausea and vomiting and intraoperative hypotension, and prolonged the time to the first request for analgesia (statistically, but not clinically). However, the potential risk of bradycardia should be considered when using dexmedetomidine-based anaesthesia.

背景：无阿片类药物麻醉（OFA）越来越被认为是一种围手术期的方法，可以提供有效的疼痛控制和降低不良反应的风险。考虑到骨科手术经常导致至少中度的术后疼痛，我们评估了OFA在骨科手术中的有效性和安全性。方法：检索PubMed、ScienceDirect、ProQuest和EuropePMC，查找相关的随机对照试验（RCT），并对数据进行引文跟踪。数据采用RevMan 5.4进行分析。使用Cochrane risk of bias 2.0工具和GRADE方法评估偏倚风险和证据的确定性。该研究已在PROSPERO注册（CRD420251048348）。结果：纳入7项随机对照试验，共408例患者。麻醉后护理单元测量的术后疼痛强度（平均差值[MD]: -0.08）， 24小时（MD: -0.06）和48小时（MD: -0.26）无统计学意义。OFA降低了术后恶心和呕吐（PONV）的风险（RR: 0.37; P = 0.00001），延长了首次请求镇痛的时间（MD: 25.60分钟；P = 0.00001）。两组间24小时吗啡用量具有可比性（MD: -0.28; P = 0.76）。OFA降低术中低血压的发生率（危险比[RR]: 0.56; P = 0.02），但增加术中心动过缓的风险（危险比[RR]: 1.86; P = 0.04）。结论：在骨科手术中，OFA提供了与阿片类药物麻醉相当的疼痛控制。降低了术后恶心呕吐和术中低血压的发生率，延长了第一次要求镇痛的时间（统计上，但临床上没有）。然而，当使用右美托咪定镇痛药时，应考虑心动过缓的潜在风险。

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引用次数: 0

Predictive value of muscle tone loss and perfusion index in the success of supraclavicular brachial plexus block: A pilot study 肌张力丧失和灌注指数在锁骨上臂丛阻滞成功中的预测价值：一项初步研究。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2026.501986

M.A. Hernández-Govea , G.F. Álvarez-Orenday , M. Guerra-Hernández , V.B. Kway , A.M. Castro-Alemán

Background

Currently, no standardized tool accurately predicts the success of supraclavicular brachial plexus block (SBPB) in the shortest time possible. This study aimed to evaluate the early predictive value of muscle tone loss and perfusion index in predicting SBPB success. This is the first study to report the use of this device for objective assessment of nerve block success.

Methods

A prospective observational pilot study was conducted at "Dr. Ignacio Morones Prieto" Central Hospital, Mexico, involving 33 patients (ASA 1, 2, 3) requiring surgery on the distal third of the upper limb with ultrasound-guided SBPB. Exclusion criteria included infections at the puncture site, local anaesthetic allergies, coagulopathies, restrictive pulmonary pathologies, oxygen dependency, brachial plexus radiculopathy, and uncontrolled diabetes. The motor block was assessed with a conductive ink flexion sensor (FS), and the sympathetic block was evaluated with perfusion index via pulse oximeter at 3, 5, 10, and 15 min. Block success was defined as a Numerical Rating Scale (NRS) for pain <2 during surgical stimulation. Statistical comparisons were made between successful and unsuccessful blocks, with ROC curve analysis identifying optimal cutoff points for predictive variables.

Results

Of the 33 patients, 24 had a successful block, and 9 did not. At 5 min, a PI > 196.07 showed 100% sensitivity, 87.5% specificity, and AUC 92% (p < 0.001). A 27.38% loss in muscle strength showed 100% sensitivity, 87.5% specificity, and AUC 95% (p < 0.001). Combined, these parameters had a 100% predictive value (p < 0.005).

Conclusion

PI and muscle strength loss are reliable early predictors of SBPB success, offering a valuable tool for optimizing anaesthetic strategies.

背景：目前，没有标准化的工具能准确预测锁骨上臂丛阻滞（SBPB）在最短时间内的成功。本研究旨在评价肌张力丧失和灌注指数对SBPB成功的早期预测价值。这是首次报道使用该装置客观评估神经阻滞成功的研究。方法：在墨西哥“Dr. Ignacio Morones Prieto”中心医院进行了一项前瞻性观察性先导研究，涉及33例需要在超声引导下上肢远端三分之一行SBPB手术的患者（ASA 1、2、3）。排除标准包括穿刺部位感染、局部麻醉过敏、凝血功能障碍、限制性肺病变、氧依赖、臂丛神经根病变和未控制的糖尿病。在3、5、10和15分钟时，用导电墨水挠曲传感器（FS）评估运动阻滞，用脉搏血氧仪灌注指数评估交感阻滞。阻滞成功被定义为疼痛的数值评定量表（NRS）结果：33例患者中，24例阻滞成功，9例阻滞失败。在5分钟时，PI bb0 196.07的灵敏度为100%，特异性为87.5%，AUC为92% (p)结论：PI和肌力损失是SBPB成功的可靠早期预测指标，为优化麻醉策略提供了有价值的工具。

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引用次数: 0

GLP-1 agonists: A hidden challenge for airway management GLP-1激动剂：气道管理的隐藏挑战。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2025.501991

M.A. Fernández-Vaquero , C.A. Puga-Carrasco , J.A. Sastre

引用次数: 0

GLP1 receptor analogues and perioperative management considerations: A narrative review GLP1受体类似物和围手术期处理考虑：叙述性回顾。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2026.501985

A. Vázquez Lima, M. Vidal Lopo

Glucagon-like peptide type 1 analogues (aGLP1) are a group of drugs capable of stimulating the GLP1 receptor, a key peptide in glycaemic homeostasis through its actions at the pancreatic and gastric level.

This narrative review summarises the possible implications of the perioperative use of this group of drugs. The pancreatic and extrapancreatic effects of aGLP1s determine their anaesthetic implications and perioperative management. The repercussions of their long-term suspension and their effects on the immune system have not yet been sufficiently clarified. The perioperative use of GLP1 agonists is associated with better glycaemic control without a significant increase in complications. However, their use involves a delay in gastric emptying dependent on multiple factors, which may increase the risk of bronchoaspiration.

At present, we can conclude that the perioperative maintenance of GLP1 agonists optimises glycaemic control and avoids disruptions to the potential benefits of treatment without demonstrating an increase in postoperative complications. Delayed gastric emptying and possible bronchoaspiration require measures to minimise risk and ensure patient safety.

胰高血糖素样肽1型类似物（aGLP1）是一组能够刺激GLP1受体的药物，GLP1受体是血糖稳态的关键肽，在胰腺和胃水平上起作用。这篇叙述性综述总结了围手术期使用这组药物的可能含义。aglp1的胰腺和胰腺外作用决定了其麻醉意义和围手术期处理。它们长期停用的影响及其对免疫系统的影响尚未得到充分阐明。围手术期使用GLP1激动剂与更好的血糖控制相关，而不会显著增加并发症。然而，它们的使用涉及依赖于多种因素的胃排空延迟，这可能增加支气管吸入的风险。目前，我们可以得出结论，GLP1激动剂的围手术期维持可以优化血糖控制，避免破坏治疗的潜在益处，而不会增加术后并发症。胃排空延迟和可能的支气管误吸需要采取措施将风险降至最低并确保患者安全。

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引用次数: 0

Lost in submission? Investigating publication bias in regional anaesthesia: A pilot case study of the erector spinae plane block 屈服了？调查局部麻醉的发表偏倚：竖脊肌平面阻滞的试点案例研究。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2026.501995

A. De Cassai , B. Dost , Y.E. Karapinar , M.A. Yilmaz , E.I. Turan , E. Sarikaya Ozel

Background

The Erector Spinae Plane (ESP) block is a regional anaesthesia technique with a growing range of clinical applications due to its short learning curve, low complication rate, and effectiveness. However, publication bias can distort the perceived efficacy of interventions, especially when studies with negative or inconclusive results remain unpublished. The real extent of publication bias in ESP-related clinical research currently remains unclear.

Methods

We searched ClinicalTrials.gov on 2 February 2025 using the terms «Erector Spinae Plane Block» and «ESP block», and obtained 671 records. After excluding duplicates, irrelevant, and ongoing studies, 500 records were eventually included. Study characteristics and publication status were determined using a multi-step search strategy that included PubMed®, Scopus®, Embase®, and Central®. Data were analysed using appropriate statistical tests on R (v3.4.0).

Results

Of the 500 studies included, 361 (72.2%) were complete, 102 (20.4%) had unknown status, and 37 (7.4%) had been suspended, terminated, or withdrawn. Only 211 studies (42.2%) were published, and included data from 14,374 of 32,600 intended patients. Published studies were registered significantly earlier than unpublished ones (median year 2020 vs 2021; P = .004). No significant differences were found between published and unpublished studies in terms of main outcome, continent, surgical setting, study design, or sample size.

Conclusions

A substantial proportion of ESP block studies remain unpublished, indicating potential publication bias. Although earlier registration was associated with publication, other study characteristics were not. These findings highlight the need for increased transparency and for clinical trial results to be published regardless of outcome in order to ensure that the evidence base is unbiased.

背景：竖脊平面（ESP）阻滞术是一种局部麻醉技术，由于其学习曲线短、并发症发生率低、效果好等优点，在临床应用中得到越来越广泛的应用。然而，发表偏倚会扭曲干预措施的感知效果，特别是当负面或不确定结果的研究尚未发表时。esp相关临床研究中发表偏倚的真实程度目前尚不清楚。方法：我们于2025年2月2日在ClinicalTrials.gov网站上搜索“Erector Spinae Plane Block”和“ESP Block”，获得了671条记录。在排除重复、不相关和正在进行的研究后，最终纳入了500条记录。使用包括PubMed®、Scopus®、Embase®和Central®在内的多步搜索策略确定研究特征和发表状态。使用R （v3.4.0）对数据进行适当的统计检验。结果：纳入的500项研究中，361项（72.2%）研究完成，102项（20.4%）研究状态未知，37项（7.4%）研究暂停、终止或撤回。只有211项研究（42.2%）被发表，其中包括来自32,600名预期患者中的14,374名患者的数据。已发表研究的注册时间明显早于未发表研究（中位数为2020年vs 2021年；p = 0.004）。已发表的和未发表的研究在主要结局、地区、手术环境、研究设计或样本量方面没有发现显著差异。结论：相当大比例的ESP阻滞研究仍未发表，表明潜在的发表偏倚。虽然早期注册与发表相关，但其他研究特征与发表无关。这些发现强调了提高透明度的必要性，以及无论结果如何都应公布临床试验结果的必要性，以确保证据基础的公正。

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引用次数: 0

Inter-observer reliability of gastric ultrasound and level of agreement with clinical evaluation in adult patients requiring emergency surgery 需要急诊手术的成人患者胃超声的观察者间可靠性及其与临床评价的一致程度

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2026.501994

J.C. Villalba , J.M. Quintero , C.E. Melo , D.F. Reyes , J.P. Tovar , A. Perlas

Introduction

Pulmonary aspiration of gastric contents is a major perioperative complication with a mortality rate of 75% and severe morbidity of 14%. The risk increases in emergency surgeries and gastric ultrasound may be useful to establish gastric content and inform aspiration risk assessment. In this study we describe the degree of agreement between pre-surgical clinical evaluation and gastric ultrasound, in the identification of full stomach in adult patients requiring emergency surgery.

Materials and methods

Descriptive observational cross-sectional study of diagnostic tests. The analysis included all adult patients with pathologies requiring emergency surgeries between August 2023 and May 2024 at Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia. The Kappa index was calculated between the two tests (Clinical evaluation vs. Gastric ultrasound), and the level of agreement between them was determined.

Results

A total of 57 patients were included in the study. Age, median (range): 51 (18–83), of whom 64.9% were male. The main types of surgeries were general surgery (80.7%), followed by trauma (19.3%). The majority of the population was classified as ASA 3. The most common comorbidities were Arterial Hypertension and type 2 Diabetes Mellitus. Fasting time ranged from 12 to 24 hours. There was a high level of agreement among the examiners for determining a full stomach using point-of-care (POCUS) gastric ultrasound, with a concordance level of 0.88 (p < 0.001). In contrast, there was a low level of agreement between the clinical and sonographic evaluation for gastric content assessment, with a concordance level of -0.03 (p 0.768).

Conclusion

Our results suggest that gastric ultrasound has a high level of reproducibility in the emergency surgical setting and can provide information beyond the clinical assessment.

胃内容物肺误吸是围手术期的主要并发症，死亡率为75%，严重的发病率为14%。急诊手术和胃超声可能有助于确定胃内容物并为误吸风险评估提供信息。在这项研究中，我们描述了术前临床评估和胃超声之间的一致程度，在确定成年患者的胃饱需要紧急手术。材料和方法：诊断试验的描述性观察性横断面研究。该分析包括2023年8月至2024年5月期间在哥伦比亚内华达Hernando Moncaleano Perdomo大学医院就诊的所有需要急诊手术的成年患者。计算两项试验（临床评价与胃超声）之间的Kappa指数，并确定两者之间的一致程度。结果：共纳入57例患者。年龄中位数（范围）：51岁（18-83岁），其中64.9%为男性。手术类型以普通外科为主（80.7%），其次为创伤外科（19.3%）。大多数人被归类为ASA 3。最常见的合并症是动脉高血压和2型糖尿病。禁食时间从12小时到24小时不等。在使用即时护理（POCUS）胃超声检测胃是否满的问题上，检查人员之间的一致性很高，一致性水平为0.88 (p)。结论：我们的研究结果表明，胃超声在急诊手术环境中具有很高的可重复性，可以提供临床评估之外的信息。

{"title":"Inter-observer reliability of gastric ultrasound and level of agreement with clinical evaluation in adult patients requiring emergency surgery","authors":"J.C. Villalba , J.M. Quintero , C.E. Melo , D.F. Reyes , J.P. Tovar , A. Perlas","doi":"10.1016/j.redare.2026.501994","DOIUrl":"10.1016/j.redare.2026.501994","url":null,"abstract":"<div><h3>Introduction</h3><div>Pulmonary aspiration of gastric contents is a major perioperative complication with a mortality rate of 75% and severe morbidity of 14%. The risk increases in emergency surgeries and gastric ultrasound may be useful to establish gastric content and inform aspiration risk assessment. In this study we describe the degree of agreement between pre-surgical clinical evaluation and gastric ultrasound, in the identification of full stomach in adult patients requiring emergency surgery.</div></div><div><h3>Materials and methods</h3><div>Descriptive observational cross-sectional study of diagnostic tests. The analysis included all adult patients with pathologies requiring emergency surgeries between August 2023 and May 2024 at Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia. The Kappa index was calculated between the two tests (Clinical evaluation vs. Gastric ultrasound), and the level of agreement between them was determined.</div></div><div><h3>Results</h3><div>A total of 57 patients were included in the study. Age, median (range): 51 (18–83), of whom 64.9% were male. The main types of surgeries were general surgery (80.7%), followed by trauma (19.3%). The majority of the population was classified as ASA 3. The most common comorbidities were Arterial Hypertension and type 2 Diabetes Mellitus. Fasting time ranged from 12 to 24 hours. There was a high level of agreement among the examiners for determining a full stomach using point-of-care (POCUS) gastric ultrasound, with a concordance level of 0.88 (p < 0.001). In contrast, there was a low level of agreement between the clinical and sonographic evaluation for gastric content assessment, with a concordance level of -0.03 (p 0.768).</div></div><div><h3>Conclusion</h3><div>Our results suggest that gastric ultrasound has a high level of reproducibility in the emergency surgical setting and can provide information beyond the clinical assessment.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501994"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986117","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}

引用次数: 0

Reflections on: «New-onset chronic and neuropathic pain in survivors of severe COVID-19: A secondary analysis of the PAIN-COVID Trial» 反思：“严重COVID-19幸存者的新发慢性和神经性疼痛：pain - covid试验的二次分析”。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2025.501996

A. Alcántara Montero , P.J. Ibor Vidal

引用次数: 0

Beyond compliance: Patient risk, ERAS adherence, and postoperative outcomes through explainable machine learning 超越依从性：通过可解释的机器学习，患者风险、ERAS依从性和术后结果。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2026-01-01 DOI: 10.1016/j.redare.2026.501990

J. Ripollés-Melchor , Á.V. Espinosa , A. Abad-Motos , A. Abad-Gurumeta , P. Galán-Menéndez , A. Zorrilla-Vaca , R. Navarro-Pérez , A. Ruiz-Escobar , J. Fernanz-Antón , A. Suárez-de-la-Rica , C. Aldecoa , the EuroPOWER Study Investigators Group

Background

Enhanced Recovery After Surgery (ERAS) protocols improve outcomes after colorectal surgery, but adherence remains variable and may interact with patient risk. Traditional compliance scores lack granularity to explore these dynamics. We aimed to use interpretable machine learning to quantify the contribution of individual ERAS items and clinical features to postoperative complications, and to identify data-driven ERAS phenotypes.

Methods

This was a secondary analysis of the EuroPOWER cohort (NCT04889798), a prospective European study including 2841 adults undergoing elective colorectal surgery. Two Extreme Gradient Boosting models were trained to predict in-hospital complications: a complete model (clinical variables + 23 ERAS items) and an ERAS-only model. Both were interpreted using Shapley Additive Explanations (SHAP). In the complete model, SHAP matrices were clustered to derive phenotypes. Feature importance, adherence, and complication rates were compared descriptively.

Results

The complete model achieved an AUC of 0.627. SHAP analysis identified frailty, ASA class, BMI, and age as leading predictors, followed by early mobilisation, nutritional care, and thromboprophylaxis. Three phenotypes were identified, with complication rates of 17.7%, 27.1%, and 41.1%, corresponding to robust, intermediate, and frail profiles. The ERAS-only model showed similar discrimination (area under the curve 0.642), but reduced interpretability. SHAP redundancy analysis supported inclusion of all ERAS items.

Conclusions

The clinical effect of ERAS adherence appears to be modulated by baseline vulnerability and implementation patterns. SHAP-based models enable transparent risk attribution and phenotype identification, supporting more targeted ERAS strategies and future development of automated quality monitoring tools.

背景：增强术后恢复（ERAS）方案可改善结直肠手术后的预后，但依从性仍存在差异，并可能与患者风险相互作用。传统的遵从性评分缺乏探究这些动态的粒度。我们的目标是使用可解释的机器学习来量化单个ERAS项目和临床特征对术后并发症的贡献，并确定数据驱动的ERAS表型。方法：这是对EuroPOWER队列（NCT04889798）的二次分析，这是一项前瞻性欧洲研究，包括2,841名接受选择性结直肠手术的成年人。训练两个极端梯度增强模型来预测院内并发症：一个完整模型（临床变量+ 23个ERAS项目）和一个仅ERAS模型。两者均采用Shapley加性解释（SHAP）进行解释。在完整的模型中，SHAP矩阵被聚类以获得表型。描述性地比较了特征重要性、依从性和并发症发生率。结果：完整模型的AUC为0.627。SHAP分析确定虚弱、ASA等级、BMI和年龄是主要预测因素，其次是早期活动、营养护理和血栓预防。确定了三种表型，并发症发生率分别为17.7%，27.1%和41.1%，对应于健壮，中等和虚弱的表型。ERAS-only模型具有相似的判别性（曲线下面积0.642），但可解释性降低。SHAP冗余分析支持纳入所有ERAS项目。结论：ERAS依从性的临床效果似乎受到基线脆弱性和实施模式的调节。基于shap的模型能够实现透明的风险归因和表型识别，支持更有针对性的ERAS策略和未来自动化质量监控工具的发展。

{"title":"Beyond compliance: Patient risk, ERAS adherence, and postoperative outcomes through explainable machine learning","authors":"J. Ripollés-Melchor , Á.V. Espinosa , A. Abad-Motos , A. Abad-Gurumeta , P. Galán-Menéndez , A. Zorrilla-Vaca , R. Navarro-Pérez , A. Ruiz-Escobar , J. Fernanz-Antón , A. Suárez-de-la-Rica , C. Aldecoa , the EuroPOWER Study Investigators Group","doi":"10.1016/j.redare.2026.501990","DOIUrl":"10.1016/j.redare.2026.501990","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) protocols improve outcomes after colorectal surgery, but adherence remains variable and may interact with patient risk. Traditional compliance scores lack granularity to explore these dynamics. We aimed to use interpretable machine learning to quantify the contribution of individual ERAS items and clinical features to postoperative complications, and to identify data-driven ERAS phenotypes.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the EuroPOWER cohort (NCT04889798), a prospective European study including 2841 adults undergoing elective colorectal surgery. Two Extreme Gradient Boosting models were trained to predict in-hospital complications: a complete model (clinical variables + 23 ERAS items) and an ERAS-only model. Both were interpreted using Shapley Additive Explanations (SHAP). In the complete model, SHAP matrices were clustered to derive phenotypes. Feature importance, adherence, and complication rates were compared descriptively.</div></div><div><h3>Results</h3><div>The complete model achieved an AUC of 0.627. SHAP analysis identified frailty, ASA class, BMI, and age as leading predictors, followed by early mobilisation, nutritional care, and thromboprophylaxis. Three phenotypes were identified, with complication rates of 17.7%, 27.1%, and 41.1%, corresponding to robust, intermediate, and frail profiles. The ERAS-only model showed similar discrimination (area under the curve 0.642), but reduced interpretability. SHAP redundancy analysis supported inclusion of all ERAS items.</div></div><div><h3>Conclusions</h3><div>The clinical effect of ERAS adherence appears to be modulated by baseline vulnerability and implementation patterns. SHAP-based models enable transparent risk attribution and phenotype identification, supporting more targeted ERAS strategies and future development of automated quality monitoring tools.</div></div>","PeriodicalId":94196,"journal":{"name":"Revista espanola de anestesiologia y reanimacion","volume":"73 1","pages":"Article 501990"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946955","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}

引用次数: 0

Towards universal implementation of videolaryngoscopy: A new milestone in airway management driven by SEDAR. 视频喉镜检查的普遍实施：SEDAR驱动下气道管理的新里程碑。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-20 DOI: 10.1016/j.redare.2025.501993

M Á Gómez-Ríos, A Abad-Gurumeta

引用次数: 0

Delirium in the postoperative patient. 术后患者谵妄。

Revista espanola de anestesiologia y reanimacion

Pub Date : 2025-12-20 DOI: 10.1016/j.redare.2025.501987

C Chamorro-Falero, J García-García, J J Morales-Domene

引用次数: 0

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