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Increasing evidence suggests an association between non-steroidal anti-inflammatory drugs (NSAIDs) and atrial fibrillation in the general population. A systematic review was conducted to characterize the association of perioperative NSAIDs with atrial fibrillation after non-cardiac surgery (POAF). PubMed and Scopus were searched for relevant studies. We excluded review articles, case studies, articles not published in English, and animal studies. The primary objective was to investigate the relationship between the perioperative use of NSAIDs and POAF during the first 30 postoperative days (from the day of surgery), at hospital discharge, and at 30 and 90 days after hospital discharge. Four studies were identified, a pooled analysis of two randomized double-blind clinical trials and three observational studies. A post-hoc sensitivity analysis for acetylsalicylic acid (aspirin) vs. other NSAIDs revealed that the former seems to decrease the incidence of POAF although non-significantly (Relative Risk (RR) (95% Confidence Interval (CI)): 0.92 (0.81, 1.04); p = 0.165). After excluding acetylsalicylic acid from the analysis, NSAIDs were associated with an increased risk of POAF development (RR (95% CI): 1.15 (1.07, 1.23); p < 0.001). In conclusion, perioperative administration of non-aspirin NSAIDs may be associated with an increased risk of POAF development. Further studies investigating the role of NSAIDs and the potential protective role of aspirin in POAF are justified. [ABSTRACT FROM AUTHOR]

Summary: Surgery and general anaesthesia have deleterious effects on sleep and disrupted perioperative sleep health is a risk factor for poor surgical outcomes. The objective of this systematic review was to summarise preoperative interventions that report sleep outcomes. Studies that delivered an intervention initiated >24 h prior to surgery among an adult sample without a diagnosed sleep disorder were included. Studies were excluded if they were preclinical or were not published in English. MEDLINE, MEDLINE ePubs Ahead of Print and In‐process Citations, Embase, Cochrane Central Register of Controlled Trials, APA PsycINFO, CINAHL, and the Web of Science were searched on February 2, 2023. This review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42021260578). Risk of bias was assessed using the Cochrane Risk‐of Bias 2 tool for randomised trials and the Risk Of Bias In Non‐randomised Studies ‐ of Interventions for non‐randomised trials. Certainty of findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. The searching yielded 10,938 total citations, and after screening resulted in 28 randomised and 19 non‐randomised trials (47 total) with 4937 participants. Sleep was a primary outcome in 16 trials; a sleep outcome was significantly improved relative to comparator in 23 trials. This review demonstrates that preoperative sleep is modifiable via a variety of interventions, including pharmacological, non‐pharmacological, and nursing interventions delivered preoperatively or perioperatively. Our results should be considered with caution due to an overall intermediate to high risk of bias in the included trials, and low to very low certainty of evidence. This review supports the modifiability of sleep health among surgical patients and provides the groundwork for preoperative sleep optimisation research. [ABSTRACT FROM AUTHOR]

Purpose of Review: To examine the most recent evidence about known controversies on the effect of perioperative transfusion on cancer progression. Recent Findings: Laboratory evidence suggests that transfusion-related immunomodulation can be modified by blood management and storage practices, but it is likely of less intensity than the effect of the surgical stress response. Clinical evidence has questioned the independent effect of blood transfusion on cancer progression for some cancers but supported it for others. Despite major changes in surgery and anesthesia, cancer surgery remains a major player in perioperative blood product utilization. Prospective data is still required to strengthen or refute existing associations. Summary: Transfusion-related immunomodulation in cancer surgery is well-documented, but the extent to which it affects cancer progression is unclear. Associations between transfusion and cancer progression are disease-specific. Increasing evidence shows autologous blood transfusion may be safe in cancer surgery. [ABSTRACT FROM AUTHOR]

Objective: To explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation. Methods: We retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p0.05). Conclusion: The ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.

Abstract Background Good preoperative conditions help patients to counteract surgical injury. Prehabilitation is a multimodal preoperative management strategy, including physical, nutritional, psychological, and other interventions, which can improve the functional reserve of patients and enhance postoperative recovery. The purpose of this study is to show the evolution trend and future directions of research related to the prehabilitation of surgical patients. Methods The global literature regarding prehabilitation was identified from The Web of Science Core Collection database. Bibliometric methods of the Bibliometrix package of R (version 4.2.1) and VOSviewer were used to analyze publication trends, cooperative networks, study themes, and co-citation relationships in the field. Results A total of 638 publications were included and the number of publications increased rapidly since 2016, with an average annual growth rate of 41.0%. “Annals of Surgery”, “British Journal of Surgery” and “British Journal of Anesthesia” were the most cited journals. Experts from the USA, Canada, the UK, and the Netherlands contributed the most in this field, and an initial cooperative network among different countries and clinical teams was formed. Malnutrition, older patients, frailty, and high-risk patients were the hotspots of recent studies. However, among the top 10 cited articles, the clinical effects of prehabilitation were conflicting. Conclusion This bibliometric review summarized the most influential publications as well as the publication trends and clarified the progress and future directions of prehabilitation, which could serve as a guide for developing evidence-based practices.

Abstract Background Chronic heart failure (HF) is frequent in elderly patients undergoing non-cardiac surgery. Preoperative risk stratification is vital and can be achieved using simple clinical risk scores or preoperative N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement. This study aimed to compare the predictivity of the revised cardiac risk index (RCRI), the American University of Beirut cardiovascular risk index (AUB-HAS2), and a score proposed by Andersson et al. for postoperative 30-day morbidity to preoperative NT-proBNP. Methods Preoperative NT-proBNP was measured in 199 consecutive patients aged ≥ 65 years undergoing elective non-cardiac surgery with intermediate or high surgical risk. The areas under the receiver operating characteristic curve (AUCROC) for the composite morbidity endpoint (CME) comprising the incidence of any rehospitalisation, acute decompensated HF, acute kidney injury, and any infection at postoperative day 30 were assessed. Multivariable logistic regression analysis derived new scores from the simple risk scores and the NT-proBNP cut-off of 450 pg/mL. Results AUB-HAS2, but not RCRI or Andersson score, significantly predicted the CME (AUB-HAS2: AUCROC 0.646, p

Abstract Background Perioperative oral management contributes to the prevention of dental/systemic complications. However, a professional dental checkup before surgery is generally not performed and relies on the patient’s answer to a simple question by medical professionals other than dentists: “Do you have any concerns regarding your mouth related to undergoing surgery?” Here, we evaluated the sensitivity and specificity of this question for predicting perioperative oral health problems in patients with primary esophageal and primary lung cancer. Methods We performed an oral cavity check in all patients before scheduled surgery for primary esophageal and lung cancer. A total of 183 patients were enrolled (M, 112; F, 71; 24–88 years, median, 69 years), consisting of 61 with primary esophageal cancer (M, 46; F, 15; 24–85 years, median, 69 years) and 122 with primary lung cancer (M, 66; F; 56; 33–88 years, median, 69 years). All subjects provided a response to this question, and an oral cavity check was performed by dentists. The sensitivity and specificity of this question for detecting oral health problems were evaluated retrospectively. Results Overall sensitivity and specificity for detecting oral health problems were 0.263 and 0.898, respectively. There were no significant differences by sex or disease (primary esophageal or lung cancer). Conclusion This simple question has low sensitivity but high specificity for detecting oral health problems. Although challenging to detect surgical patients with oral health problems by simply asking questions, the results indicated that patients with oral complaints are more likely to have problems during surgery.

Purpose: The detection of congenital heart disease (CHD) before neonatal surgery is crucial for anaesthetic and perioperative management. There are no established criteria for pre-operative echocardiography in neonates. We aimed to survey current practice in the United Kingdom and evaluate the reliability of antenatal screening and postnatal clinical assessment in detecting CHD before surgery. Method: A 9-point questionnaire was sent to all paediatric surgical centres in the United Kingdom to assess their practice. Subsequently, a single-centre retrospective review of all neonatal surgery over 5 years (2015–2020) was conducted in our tertiary paediatric/neonatal hospital. Data included pre-operative clinical assessment, performance of chest radiograph and echocardiography. Indications for echocardiography were categorised and assessed using sensitivity, specificity, positive predictive value and negative predictive value. Results: All 26 paediatric surgical centres responded to our survey. 23/26 (88.5%) did not have established criteria or guidelines for pre-operative echocardiography. There was a large variation in which surgical conditions required a pre-operative scan and whether a normal clinical examination was considered sufficient to not require one. For the retrospective review, 454 patients were identified. There were 40 cases with CHDs (8.8%), 13 were classed as major or moderate. Indications for echocardiography were categorised into abnormal foetal cardiac screening, medical/surgical conditions associated with CHD and an abnormal cardiorespiratory examination. Sensitivity, specificity, positive predictive value and negative predictive value for major and moderate CHD were 46%, 99%, 67%, 98% for abnormal foetal screening, 46%, 97%, 35%, 98% for associated medical conditions, 62%, 66%, 6%, 98% for associated surgical conditions, and 100%, 66%, 9%, 100% for abnormal clinical examination. Conclusion: The use of pre-operative echocardiography in neonates is not standardised across the UK. The results from our cohort demonstrate that foetal echocardiography is not sufficient to capture all major and moderate CHDs, but the absence of abnormal clinical examination is highly reliable in ruling out them out. Specifying a list of medical/surgical of conditions associated with CHD warranting pre-operative echocardiography may improve yield, but this depends on the availability of resources and expertise. [ABSTRACT FROM AUTHOR]

This article discusses the potential role of perioperative urine biochemistry monitoring in detecting early acute kidney injury (AKI) development in elective surgical patients. AKI is a known complication of both cardiac and major non-cardiac surgeries, and early detection is important for mitigating its progression and improving patient outcomes. The article explores the use of urine electrolyte measurements as a potential tool for detecting renal impairment earlier than traditional markers like urine output and serum creatinine. The authors suggest that monitoring urine electrolyte behavior, particularly sodium and potassium levels, may provide valuable insights into the development of AKI. They also discuss the importance of accurately interpreting urine biochemistry profiles to distinguish between pathological oliguria and permissive oliguria, which is a physiological response to surgical stress. The article concludes by highlighting the need for further research in this area, particularly in low-income centers where cost-effective monitoring tools are crucial. [Extracted from the article]

Background: Good preoperative conditions help patients to counteract surgical injury. Prehabilitation is a multimodal preoperative management strategy, including physical, nutritional, psychological, and other interventions, which can improve the functional reserve of patients and enhance postoperative recovery. The purpose of this study is to show the evolution trend and future directions of research related to the prehabilitation of surgical patients. Methods: The global literature regarding prehabilitation was identified from The Web of Science Core Collection database. Bibliometric methods of the Bibliometrix package of R (version 4.2.1) and VOSviewer were used to analyze publication trends, cooperative networks, study themes, and co-citation relationships in the field. Results: A total of 638 publications were included and the number of publications increased rapidly since 2016, with an average annual growth rate of 41.0%. "Annals of Surgery", "British Journal of Surgery" and "British Journal of Anesthesia" were the most cited journals. Experts from the USA, Canada, the UK, and the Netherlands contributed the most in this field, and an initial cooperative network among different countries and clinical teams was formed. Malnutrition, older patients, frailty, and high-risk patients were the hotspots of recent studies. However, among the top 10 cited articles, the clinical effects of prehabilitation were conflicting. Conclusion: This bibliometric review summarized the most influential publications as well as the publication trends and clarified the progress and future directions of prehabilitation, which could serve as a guide for developing evidence-based practices. [ABSTRACT FROM AUTHOR]

This study assessed the quality of perioperative nursing (PON) care in selected hospitals in Osun State, Nigeria. This study adopted a concurrent mixed method design to assess the quality of perioperative nursing care in selected hospitals. The study adopted multiple sampling select surgical patients and perioperative nurses for quantitative and qualitative data. observational checklist and interview guide were used for data collection. for analysis using SPSS version 25 for quantitative data while descriptive and inferential statistical techniques were employed for quantitative data at significant level of 0.05while content and thematic analysis were used for qualitative data. Results from quantitative data showed that 52.8% of pre-operative nursing care was of good, quality, 53.2% of intra-operative nursing care was of good, 47.9%, of post-operative nursing care was of poor quality while 49.9% of overall perioperative nursing care was of good, quality. There was statistically significant difference between the level of quality of care across the three health facilities (p = 0.01). Results from the qualitative findings showed that nurses rated the quality of perioperative care as moderate while many of the patients spoke glowingly about the quality of care they receive and that perioperative nurses are doing their best. This study concluded that there is good quality of pre and intra- operative nursing but poor quality of post-operative and overall quality of perioperative nursing care. Hence, there is need for perioperative nurses to make their voices and care more visible in the care of surgical patients. Public Contribution: Perioperative nurses were involved at the data collection stage. They were the subjects for the study. [ABSTRACT FROM AUTHOR]

BACKGROUND: High-risk alcohol use is a common preventable risk factor for postoperative complications, admission to intensive care, and longer hospital stays. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications. OBJECTIVE: The study aimed to explore the acceptability and feasibility of 2 brief counseling approaches to reduce alcohol use in elective surgical patients with high-risk alcohol use in the perioperative period. METHODS: A semistructured interview study was conducted with a group of high responders (who reduced alcohol use ≥50% postbaseline) and low responders (who reduced alcohol use by ≤25% postbaseline) after their completion of a pilot trial to explore the acceptability and perceived impacts on drinking behaviors of the 2 counseling interventions delivered remotely by phone or video call. Interview transcripts were analyzed using thematic analysis. RESULTS: In total, 19 participants (10 high responders and 9 low responders) from the parent trial took part in interviews. Three main themes were identified: (1) the intervention content was novel and impactful, (2) the choice of intervention modality enhanced participant engagement in the intervention, and (3) factors external to the interventions also influenced alcohol use. CONCLUSIONS: The findings support the acceptability of both high- and low-intensity brief counseling approaches. Elective surgical patients are interested in receiving alcohol-focused education, and further research is needed to test the effectiveness of these interventions in reducing drinking before and after surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT03929562; https://clinicaltrials.gov/ct2/show/NCT03929562.

BackgroundNot everyone across the globe has access to safe surgical care. There exist stark disparities in surgical mortality between high-income and low-and middle-income countries. Quality perioperative care across the surgical care continuum can mitigate these disparities. Nurses play a vital role in providing quality perioperative care and their competency in perioperative nursing directly impacts surgical outcomes. Across Africa, formal educational opportunities for nurses in perioperative care is not well understood.MethodsThis is an informal scoping review of the existing literature investigating the current state of perioperative nursing education across the African continent. Ten articles were included in the analysis.ResultsFew programs exist across Africa that provide specialized training for nurses in perioperative medicine. Programs that have been formally evaluated show improved knowledge and clinical skills among nurses.ConclusionGreater research is necessary to establish a more robust evidence base in support of increasing access to perioperative nursing education to improve patient outcomes. Obstacles remain to designing, implementing, and evaluating new educational programs.

Abstract As patients continue to live longer from diseases that predispose them to right ventricular (RV) dysfunction or failure, many more patients will require surgery for acute or chronic health issues. Because RV dysfunction results in significant perioperative morbidity if not adequately assessed or managed, understanding appropriate assessment and treatments is important in preventing subsequent morbidity and mortality in the perioperative period. In light of the epidemiology of right heart disease, a working knowledge of right heart anatomy and physiology and an understanding of the implications of right-sided heart function for perioperative care are essential for perioperative practitioners. However, a significant knowledge gap exists concerning this topic. This manuscript is one part of a collection of papers from the PeriOperative Quality Initiative (POQI) IX Conference focusing on “Current Perspectives on the Right Heart in the Perioperative Period.” This review aims to provide perioperative clinicians with an essential understanding of right heart physiology by answering five key questions on this topic and providing an explanation of seven fundamental concepts concerning right heart physiology.

Debas Yaregal Melesse, Biruk Adie Admass, Belete Muluadam Admassie Department of Anaesthesia, University of Gondar, Gondar, Amhara, EthiopiaCorrespondence: Debas Yaregal Melesse, Email dabyyaregal82@gmail.comIntroduction: Perioperative blood transfusions are necessary during orthopaedic surgery since it is linked with significant bleeding. Remember that receiving blood transfusions containing various blood components might lead to a number of problems. In order to draw conclusions on perioperative blood transfusion methods in orthopaedic surgery, including adjuvants, this literature analysis looks at the most recent data that are currently available.Methods: Databases and other sources were searched for pertinent literature. The following databases were searched for recent evidence: MEDLINE, EMBASE, SCOPUS, PubMed, Google Scholar, the Cochrane Library, and Science Direct. Medical heading subjects (MeSH) were merged with Boolean operators such as OR, AND, and NOT, which restrict or broaden the scope of possible supporting evidence. The weight of the evidence supporting each conclusion was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.Results: The included literatures cover a wide range of topics, including fracture type, perioperative bleeding management techniques like adjuvant therapies used to reduce problems from blood transfusions, and hemoglobin thresholds for blood transfusion.Conclusion and Recommendations: Patients who are at danger of bleeding during surgery or who are anemic should be handled with medication, allogenic blood transfusions (restrictive type), adjuvants, and non-pharmacological methods such tourniquets and cell savers. Instead of relying just on one transfusion technique, healthcare personnel should consider the patient’s situation in depth and use a variety of transfusion tactics.Keywords: anemia, blood transfusion, orthopedics, perioperative, strategies

This article outlines the use of a co-design methodological approach aimed at optimizing perioperative care experiences for ethnically diverse older adults and their family carers. The research involved three phases. In Phase 1, the foundation was established with the formation of a Core Advisory Group comprising key informants, including health consumers. This initial phase focused on forming relationships and conducting a literature review to inform subsequent stages of the research. Phase 2 progressed to data collection, where a qualitative survey on perioperative experiences was conducted. Semi-structured interviews were held with patients, their family carers, and perioperative staff. Phase 3 advanced the co-design process through a workshop involving patients, family carers, perioperative staff, and key stakeholders. Workshop participants collaborated on potential practice changes, proposing strategies for future clinical implementation. While data analysis and reporting for Phases 2 and 3 are forthcoming, the continued involvement of the Core Advisory Group ensures ongoing consensus-building on health consumer needs. This methodology article adopts a prospective stance, with findings to be presented in subsequent scholarly works. Use of this methodology will help to determine how the use of a co-design approach may impact the development of culturally responsive perioperative nursing care for those from ethnically diverse communities.

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This systematic review examines the recent use of artificial intelligence, particularly machine learning, in the management of operating rooms. A total of 22 selected studies from February 2019 to September 2023 are analyzed. The review emphasizes the significant impact of AI on predicting surgical case durations, optimizing post-anesthesia care unit resource allocation, and detecting surgical case cancellations. Machine learning algorithms such as XGBoost, random forest, and neural networks have demonstrated their effectiveness in improving prediction accuracy and resource utilization. However, challenges such as data access and privacy concerns are acknowledged. The review highlights the evolving nature of artificial intelligence in perioperative medicine research and the need for continued innovation to harness artificial intelligence's transformative potential for healthcare administrators, practitioners, and patients. Ultimately, artificial intelligence integration in operative room management promises to enhance healthcare efficiency and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator from the American College of Surgeons is a widely available tool for peri‐operative risk prediction. This study investigates its predictive performance in an Australian setting. Methods: A single‐centre retrospective external validation study was conducted at a tertiary referral centre in New South Wales, Australia. Data from a general surgical cohort in a 2‐year period from 2020 to 2021 was collected from the NSQIP database and entered into the NSQIP calculator. The predictive performance of the calculator was analysed across the standard 14 NSQIP postoperative outcome measures at 30 days. Results: There were 2121 patient records analysed using tests of accuracy and in the discrimination and calibration domains. The overall predictive performance of the NSQIP calculator was reasonable. There was greater accuracy at lower‐risk predictions. At higher‐risk predictions, Readmission, Death, and Discharge to Nursing or Rehab Facility, and Length of Stay were overestimated, whilst other outcomes were underestimated. Conclusion: This study demonstrates reasonable overall performance of the NSQIP calculator in the context of this cohort and provides data to support the need for locally adapted and validated risk prediction tools for use by Australian perioperative physicians. [ABSTRACT FROM AUTHOR]

BackgroundKidney transplantation is the therapy of choice for end-stage kidney disease, and a fast-growing transplant procedure worldwide. Diverse clinical practices for recipients and donors' selection and management between transplant centers hinder the creation and dissemination of an anesthesia-surgical checklist.MethodsComponents of the anesthesia-surgical checklist were selected after a review of the English literature using PubMed search for donor, recipient and graft protocols and outcomes of existing practices in the field of kidney transplantation. Key elements of the most relevant articles were combined with our own center's experience and formulated into the proposed checklist. The checklist is intended to be used perioperatively, once patient receives an offer.ResultsThe perioperative checklist centers primarily on the following donor and recipient's factors: (i) Review of the pretransplant candidate workup; (ii) Assessment of donor/graft status; (iii) Hypothermic machine perfusion parameters; (iv) Operating room management; (v) Sign out. The proposed kidney transplant checklist was designed to ensure consistency and completeness of diverse tasks and facilitates team communication and coordination.ConclusionWe present a novel standardized combined anesthesia-surgical checklist framework for kidney transplant aimed at increasing perioperative safety and streamline the perioperative care of recipients. Future validation studies will determine its clinical feasibility and post-implementation efficacy.

Abstract Background Perioperative pediatric mortality is significantly higher in low-resource countries due to a scarcity of well-trained professionals and a lack of well-equipped pediatric perioperative services. There has been little research on pediatric mortality in low-income countries. Therefore, this study aimed to assess the incidence of perioperative pediatric mortality and its predictors in 28-day follow-up. Methods The data were collected using REDCap, an electronic data collection tool, between June 01, 2019 and July 01, 2021. This study includes pediatric patients aged 0 to 17 years who underwent surgery in Tibebe Ghion Specialized Hospital over 28 days with a total of 1171 patients. STATA version 17 software was used for data analysis. Log-rank tests were fitted to explore survival differences. After bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to declare the strength of association and statistical significance. Results There were 35 deaths in the cohort of 1171 pediatric patients. Twenty of the deaths were in neonates. The overall perioperative mortality among pediatric patients was 2.99%, with an incidence rate of 1.11 deaths per 1000 person day observation (95% CI 0.79, 1.54). The neonatal age group had an AHR = 9.59, 95% CI 3.77, 24.3), transfusion had an AHR = 2.6, 95% CI 1.11, 6.09), and the America Society of Anesthesiology physical status classification III and above had an AHR = 4.39, 95% CI 1.61, 11.9 were found the significant predictors of perioperative pediatric mortality. Conclusions In this study, the perioperative mortality of pediatric patients was high in the 28-day follow-up. Neonatal age, transfusion, and America Society of Anesthesiology physical status III and above were significant predictors of pediatric mortality. Therefore, perioperative surgical teams should give special attention to neonates, the America Society of Anesthesiology physical status III and above, and transfusion to reduce pediatric mortality.

Background: Perioperative pediatric mortality is significantly higher in low-resource countries due to a scarcity of well-trained professionals and a lack of well-equipped pediatric perioperative services. There has been little research on pediatric mortality in low-income countries. Therefore, this study aimed to assess the incidence of perioperative pediatric mortality and its predictors in 28-day follow-up. Methods: The data were collected using REDCap, an electronic data collection tool, between June 01, 2019 and July 01, 2021. This study includes pediatric patients aged 0 to 17 years who underwent surgery in Tibebe Ghion Specialized Hospital over 28 days with a total of 1171 patients. STATA version 17 software was used for data analysis. Log-rank tests were fitted to explore survival differences. After bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to declare the strength of association and statistical significance. Results: There were 35 deaths in the cohort of 1171 pediatric patients. Twenty of the deaths were in neonates. The overall perioperative mortality among pediatric patients was 2.99%, with an incidence rate of 1.11 deaths per 1000 person day observation (95% CI 0.79, 1.54). The neonatal age group had an AHR = 9.59, 95% CI 3.77, 24.3), transfusion had an AHR = 2.6, 95% CI 1.11, 6.09), and the America Society of Anesthesiology physical status classification III and above had an AHR = 4.39, 95% CI 1.61, 11.9 were found the significant predictors of perioperative pediatric mortality. Conclusions: In this study, the perioperative mortality of pediatric patients was high in the 28-day follow-up. Neonatal age, transfusion, and America Society of Anesthesiology physical status III and above were significant predictors of pediatric mortality. Therefore, perioperative surgical teams should give special attention to neonates, the America Society of Anesthesiology physical status III and above, and transfusion to reduce pediatric mortality. [ABSTRACT FROM AUTHOR]

Background: As a mind–body therapy, music may have a positive effect on patients with postoperative pain and anxiety. Objective: The aim of this systematic review and meta-analysis was to explore the effects of perioperative music therapy on postoperative pain and anxiety based on existing clinical trials. Methods: The Cochrane Library, PubMed, and Embase were searched from their inception to August 2022, selected the literature according to the inclusion and exclusion criteria, and completed the meta-analysis using RevMan 5.3. Results: A total of 19 eligible randomized controlled trials were enrolled, including 1803 patients. The results of the meta-analysis showed that the scores of pain (standardized mean difference [SMD], −0.90; 95% confidence interval [CI], −1.26 to −0.53; p < 0.00001) and anxiety (SMD, −0.75; 95% CI, −1.19 to −0.31; p = 0.0008) decreased in the music group on postoperative day 1. The blood pressure (mean difference [MD], −5.29; 95% CI, −9.53 to −1.06; p = 0.01) and heart rate (MD, −6.13; 95% CI, −11.69 to −0.58; p = 0.03) also decreased on the same day. Further, the score of change in pain (SMD, 0.35; 95% CI, 0.01 to 0.68; p = 0.04) and anxiety (SMD, 1.35; 95% CI, 0.01 to 2.69; p = 0.05) increased between preoperative and postoperative days in the music group. However, the scores of hospital satisfaction (MD, −0.07; 95% CI, −1.40 to 1.27; p = 0.92) and incidences of postoperative nausea and vomiting (risk ratio, 0.41; 95% CI, 0.13 to 1.34; p = 0.14) did not decrease in the music group. Conclusion: Perioperative music therapy can significantly reduce postoperative pain and anxiety and avoid fluctuations in blood pressure and heart rate but does not improve patient hospital satisfaction or incidences of postoperative nausea and vomiting. [ABSTRACT FROM AUTHOR]

The trauma of surgery induces systemic stress that alters homeostasis and develops postoperative complications, particularly in high-risk patients. Surgical stress is produced by an acute inflammatory process and by the imbalance between the levels of pro-oxidant molecules and the activity of antioxidant systems. This imbalance is known as oxidative stress (OS). These two mechanisms underlie perioperative complications are reduced with anaesthetic management since some anaesthetics have antioxidant capacity. OS could negatively impact all forms of major surgery, particularly in elderly patients and patients with comorbidities. This review aims to present the concept and cellular bases of OS and its relationship with the most common complications in the perioperative period of cardiac and noncardiac surgery, as well as the quantitative determination of the level of OS through serum biomarkers. Furthermore, the effect of anaesthetics on OS and the use of antioxidant therapies in preventing postoperative complications induced by OS are reviewed. [ABSTRACT FROM AUTHOR]

To describe patients, perioperative care, and outcomes undergoing supratentorial and infratentorial craniotomy for brain tumor resection in a tertiary-care hospital in Ethiopia. A retrospective cohort study of patients consecutively admitted between January 1, 2021, and December 31, 2021, was performed. We characterized patients, perioperative care, and outcomes. The final sample comprised 153 patients; 144 (94%) were 18 years and over, females (n = 48, 55%) with primarily American Society of Anesthesiologists physical class II (n = 97, 63.4%) who underwent supratentorial (n = 114, 75%), or infratentorial (n = 39, 25%) tumor resection. Patients were routinely admitted (95%) to floor/wards before craniotomy; Inhaled anesthetic (isoflurane 88%/halothane 12%) was used for maintenance of general anesthesia. Propofol (n = 93, 61%), mannitol (n = 73, 48%), and cerebrospinal fluid drain (n = 28, 18%), were used to facilitate intraoperative brain relaxation, while the use of hyperventilation was rare (n = 1). The average estimated blood loss was 1040 ± 727 ml; 37 (24%) patients received tranexamic acid, and 57 (37%) received a blood transfusion. Factors associated with extubation were a) infratentorial tumor location: relative risk (RR) 0.45 (95% confidence interval [CI] 0.29–0.69), preoperative hydrocephalus: RR 0.51, (95% CI 0.34–0.79), shorter total anesthesia duration: 277.8 + 8.8 versus 426.77 + 13.1 minutes, P < 0.0001, lower estimated blood loss: 897 + 68 ml versus 1361.7 + 100 ml, P = 0.0002, and cerebrospinal fluid drainage to facilitate brain relaxation: RR 0.52, 95% CI 0.32–0.84). Approximately one in ten patients experienced postoperative obstructive hydrocephalus, surgical site infections, or pneumonia. These findings suggest that certain factors may impact patient outcomes following craniotomy for tumor resection. By identifying these factors, health care providers may be better equipped to develop individualized treatment plans and improve patient outcomes. Additionally, the study highlights the importance of postoperative monitoring and management to prevent complications. [ABSTRACT FROM AUTHOR]

Postoperative anaemia is common among surgical patients. While often viewed as a benign condition, postoperative anaemia is neither inevitable nor harmless, being intricately linked with adverse outcomes. In this review, we summarize the prevalence, aetiology, and outcomes of postoperative anaemia and highlight prevention and management strategies. Further, we propose a novel framework to characterize postoperative anaemia as an acute organ injury (i.e., acute blood injury, anaemic subtype), thereby drawing attention to a condition that is frequently overlooked. Additionally, we discuss areas warranting further research, including risk stratification for patients at heightened risk for the development of postoperative anaemia and associated complications and determination of appropriate treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: The opioid epidemic is a public health issue in the United States. The objective of this study was to evaluate the association between naloxone coprescription mandates and postoperative outcomes. Background: Data on naloxone coprescription mandates show mixed evidence for fatal overdoses in the broader population. How these mandates have impacted surgical patients has not been fully explored. Methods: Healthcare claims data were used to identify all patients undergoing 1 of 50 common procedures between January 1, 2004, and June 30, 2019, and categorized as high risk for opioid overdose. The primary outcomes were an emergency department visit or hospital admission within 30 postoperative days. To reduce confounding, the association between this outcome and the implementation of naloxone coprescription mandates was estimated using a difference-in-differences approach. Results: The study included 429,878 surgical patients with an average age of 54.8 years (SD=15.9 years) and with 257,728 females (60.0%). There was no significant association between naloxone prescribing mandates and the primary outcomes. After adjustment for potential confounders, the incidence of hospital admission was 3.26% after implementation of a naloxone coprescription mandate compared with 3.33% before (difference change: 0.08%, 95% CI: 0.44% to 0.29%, P=0.68). The incidence of an emergency department visit was 7.06% after implementation of a naloxone coprescription mandate compared with 7.73% before (difference: 0.67%, 95% CI: -1.39% to 0.05%, P= 0.07). These results were robust to a variety of sensitivity and subgroup analyses. Conclusions: Naloxone coprescription mandates were not associated with a statistically or clinically significant change in emergency department visits or hospital admissions within 30 postoperative days. [ABSTRACT FROM AUTHOR]

Since the introduction of immune checkpoint inhibitors (ICI) a few years ago, we have witnessed unprecedented improvement in survival in hepatocellular carcinoma (HCC). Advanced stage HCC now has a median overall survival (OS) of >1.5 years compared to just a little more than 6 months a decade ago. In contrast, survival of early-stage HCC has made little progress due to the lack of effective adjuvant strategy, as recurrence after curative treatment can reach up to 70% at 5 years. Given the success of immunotherapy in advanced stage HCC, there is a growing interest in incorporating immunotherapy in the management of early-stage HCC. Recently, the IMBRAVE050 trial reported positive outcomes showing, for the first time, the use of adjuvant immunotherapy (e.g. atezolizumab), plus bevacizumab, is effective in prolonging recurrence-free survival in early-stage HCC following curative treatment. On the other end of the spectrum, there is an increasing momentum to explore neoadjuvant immunotherapy for early-stage HCC. Preclinical models have shown that neoadjuvant immunotherapy can effectively stimulate a broader range of T cells that can translate into a stronger anti-tumour immune response when the tumour is left in situ. Neoadjuvant immunotherapy has also been shown to effectively improve pathological complete response rates and prolong survival in other cancer types. Under this context, several small-scale, early phase trials have demonstrated promising results using neoadjuvant immunotherapy in early-stage HCC. In this mini review, we will discuss the rationale behind, currently available data, and considerations of study design on evaluating neoadjuvant immunotherapy in early-stage HCC.

Abstract Background Tissue injury induces inflammation and the surgical stress response, which are thought to be central to the orchestration of recovery or deterioration after surgery. Enhanced formation of reactive oxygen and nitrogen species accompanies the inflammatory response and triggers separate but integrated reduction/oxidation (redox) pathways that lead to oxidative and/or nitrosative stress (ONS). Quantitative information on ONS in the perioperative period is scarce. This single-centre exploratory study investigated the effects of major surgery on ONS and systemic redox status and their potential associations with postoperative morbidity. Methods Blood was collected from 56 patients at baseline, end of surgery (EoS) and the first postoperative day (day-1). Postoperative morbidity was recorded using the Clavien-Dindo classification and further categorised into minor, moderate and severe. Plasma/serum measures included markers of lipid oxidation (thiobarbituric acid-reactive substances; TBARS, 4-hydroxynonenal; 4-HNE, 8-iso-prostaglandin F2⍺; 8-isoprostanes). Total reducing capacity was measured using total free thiols (TFTs) and ferric-reducing ability of plasma (FRAP). Nitric oxide (NO) formation/metabolism was measured using cyclic guanosine monophosphate (cGMP), nitrite, nitrate and total nitroso-species (RxNO). Interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-⍺) were measured to evaluate inflammation. Results Both oxidative stress (TBARS) and nitrosative stress (total nitroso-species) increased from baseline to EoS (+14%, P = 0.003 and +138%, P < 0.001, respectively), along with an increase in overall reducing capacity (+9%, P = 0.03) at EoS and protein-adjusted total free thiols (+12%, P = 0.001) at day-1 after surgery. Nitrite, nitrate and cGMP concentrations declined concomitantly from baseline to day-1. Baseline nitrate was 60% higher in the minor morbidity group compared to severe (P = 0.003). The increase in intraoperative TBARS was greater in severe compared to minor morbidity (P = 0.01). The decline in intraoperative nitrate was more marked in the minor morbidity group compared to severe (P < 0.001), whereas the cGMP decline was greatest in the severe morbidity group (P = 0.006). Conclusion In patients undergoing major HPB surgery, intraoperative oxidative and nitrosative stress increased, with a concomitant increase in reductive capacity. Baseline nitrate was inversely associated with postoperative morbidity, and the hallmarks of poor postoperative outcome include changes in both oxidative stress and NO metabolism.

Abstract Background Intraoperative hypotension is a risk factor for postoperative complications. Preoperative dehydration is a major contributor, although it is difficult to estimate its severity. Point-of-care ultrasound offers several potential methods, including measurements of the inferior vena cava. The addition of lung ultrasound may offer a safety limit. We aimed to evaluate whether the implication of an ultrasound-based preoperative fluid therapy protocol can decrease the incidence of early intraoperative hypotension. Methods Randomised controlled study in a tertiary university department involves elective surgical patients of ASA 2–3 class, scheduled for elective major abdominal surgery under general anaesthesia with intubation. We randomised 40–40 patients; 38–38 were available for analysis. Conventional fluid therapy was ordered on routine preoperative visits. Ultrasound-based protocol evaluated the collapsibility index of inferior vena cava and lung ultrasound profiles. Scans were performed twice: 2 h and 30 min before surgery. A high collapsibility index (≥ 40%) indicated a standardised fluid bolus, while the anterior B-profile of the lung ultrasound contraindicated further fluid. The primary outcome was the incidence of postinduction and early intraoperative (0–10 min) hypotension (MAP

Misgan Mulatie Zewudie,1 Debas Yaregal Melesse,2 Tesera Dereje Filatie,2 Amare Belete Getahun,2 Biruk Adie Admass2 1Department of Anesthesia, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia; 2Department of Anesthesia, College of Medicine and Health Science, University of Gondar, Gondar, EthiopiaCorrespondence: Debas Yaregal Melesse, Tel +251948814731, Email dabyyaregal82@gmail.comObjective: This review of the literature’s current types of suggestions regarding perioperative nutrition support for surgical cancer patients was its primary goal.Methods: Appropriate kinds of literature were searched from the databases and other sources based on the process applied in a narrative review. The following databases like SCOPUS, PubMed, science direct, Google scholar, Cochrane library, MEDLINE, and Embase with Boolean operators including OR, AND, with medical heading subjects (MeSH) (preoperative AND nutrition AND cancer, malnutrition OR under-nutrition AND prevention AND management, cancer AND surgery AND analgesia, nutrition AND perioperative AND oncologic surgery, optimization AND perioperative AND nutrition AND cancer, oncological surgery AND frailty, sarcopenia AND perioperative malnutrition AND optimization, prehabilitation AND nutritional support AND cancer AND cachexia) were used. Endnote reference manager was used to remove duplications of extracted kinds of literature from different sources.Results: The total number of articles identified through database and website searches was 34,292. Of these references, 1030 duplicates were removed. Nine hundred literatures were excluded in the screening phase with the human and published periods. Eighty-nine (89) references were included in the final version of this review.Conclusion: Cancer-related malnutrition can be diagnosed using the criteria of the Global Leadership Initiative on Malnutrition (GLIM). A daily caloric consumption of 20– 35 kcal/kg, with glucose and lipids, as well as electrolytes, trace elements, and vitamins, is advised for malnutrition in cancer patients.Keywords: cancer, frailty, nutrition support, optimization, perioperative, sarcopenia

Background It has been confirmed in other fields that perioperative blood transfusion (PBT) will increase the incidence of complications after free-flap reconstruction and increase the risk of patients returning to the operating room within 48 hours after the initial operation. However, for head and neck tumors, whether PBT is related to postoperative complications is debatable. The aim of this study was to control the demographic and comorbidity characteristics of patients by propensity score matching (PSM) as well as to investigate the relationship between PBT and postoperative complications after oral cancer free-flap reconstruction.

Background and Aims: Sudden discontinuation of buprenorphine in the treatment of opioid use disorder can increase the risk of subsequent relapse and overdose. Little is known about buprenorphine use in the perioperative period. The aim of this study was to determine the rate of buprenorphine continuation after hospital discharge following surgery and factors associated with continuation. Design: A population‐based retrospective cohort study was conducted using administrative data from Ontario, Canada, between 2012 and 2018. The cohort included individuals on continuous buprenorphine prior to surgery. Logistic regression modeling was used to estimate the association of buprenorphine continuation with demographic, opioid agonist treatment, surgical and health service use factors. Setting: Administrative databases from Institute for Clinical Evaluative Sciences (ICES) were used, which capture the Ontario, Canada, population. The data sets describe physician billing, monitoring of controlled substances and hospital discharges. Participants: Adults (≥ 18 years, n = 2176) had received a buprenorphine/naloxone product continuously for at least 60 days for the treatment of opioid use disorder and subsequently underwent a surgical procedure. Measurements Continuation (versus discontinuation) of buprenorphine prescriptions in the 14 days after surgical discharge was recommended. Exposures included demographic, comorbidity, opioid agonist treatment, surgical and health service use characteristics. Findings About 176 (8.1%) of the 2176 patients discontinued buprenorphine after surgery. Inpatient surgery (versus ambulatory) was associated with reduced odds of continuation, with an unadjusted odds ratio (OR) of 0.17 [95% confidence interval (CI) = 0.12–0.25] and an adjusted OR of 0.16 (95% CI = 0.11–0.23) after accounting for age, sex, rural residence, neighborhood income quintile, Charlson comorbidity index, psychiatric hospitalizations in the past 5 years and recent dispensed supply of buprenorphine (number needed to harm of 6.6). Conclusions: In Ontario, Canada, from 2012 to 2018, most patients receiving continuous preoperative buprenorphine therapy continued buprenorphine use after surgery. Inpatient surgery was a strong predictor of discontinuation compared with ambulatory procedures. [ABSTRACT FROM AUTHOR]

Inguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high‐risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. Despite a large volume of literature in the area of infant inguinal hernia surgery, there remains much debate amongst anesthetists, surgeons and neonatologists regarding the optimal perioperative management of these patients. The questions asked by clinicians include; when should the surgery occur, how should the surgery be performed (open or laparoscopic), how should the anesthesia be conducted, including regional versus general anesthesia and airway devices used, and what impact does anesthesia choice have on the developing brain? There is a paucity of evidence in the literature on the concerns, priorities or goals of the parents or caregivers but clearly their opinions do and should matter. In this article we review the current clinical surgical and anesthesia practice and evidence for infants undergoing inguinal hernia surgery to help clinicians answer these questions. [ABSTRACT FROM AUTHOR]

Introduction: Hospital length of stay (LOS) is one of the measurable indicators which can be used to evaluate hospital administration, operative performance, and quality of patient care. Prolonged LOS has been associated with poor outcomes in patients and inefficient use of hospital resources. Due to the scarcity of findings in this field in Malaysia, this study aims to identify the factors affecting LOS. Methods: A single health facility-based retrospective cross-sectional study was conducted in Hospital Serdang. Data of patients admitted to the surgical ward from 2017 to 2021 were retrieved. Result: A total of 114 surgical patients' data were analysed, of which most were adults (72.8%), female (69.3%) and Malay (67.5%). The mean LOS was 5.90 ± 4.35 days. Pearson correlation revealed age (r = 0.309, p = 0.001) and preoperative albumin (r = -0.397, p <0.001) having a significant correlation with LOS. An independent samples T-test showed that males had significantly higher mean LOS than females (t = 2.653, p = 0.009). Surprisingly, having been seen by dietitians and being supplemented by oral nutrition supplements (ONS) had longer stay compared to groups who were not seen by dietitians and given ONS respectively (t = 4.278, p<0.001), (t = 3.111, p = 0.002). Furthermore, those with a moderate and high risk of malnutrition spent approximately 3.27 days longer hospitalized than low-risk patients (t = -2.868, p = 0.007). Conclusion: Factors that influence LOS are age, gender, preoperative albumin, seen by a dietitian, risk of malnutrition and oral nutrition supplementation. [ABSTRACT FROM AUTHOR]

Background: We aim to evaluate the safety and efficacy of mistletoe extract (ME) use during the oncological perioperative period. Methods: Details registered a priori on PROSPERO (CRD42018086168). Results: Seven RCTs (comprising 663 participants in nine reports) and three nonrandomized studies were included. In five RCTs, ME was evaluated as adjunctive care and the control group had no additional intervention, whereas in two RCTs, ME was compared head-to-head against common cancer treatments (i.e., etoposide or bacillus Calmette-Guérin) with the intervention groups not receiving standard care. Meta-analyses found no evidence for a difference between ME and no added therapy for mortality and recurrence (RR, 95% CI: 1.00, 0.79–1.27; and 1.03, 0.79–1.33, respectively). Two RCTs reported beneficial effects of ME on immune cells, specifically natural killer cells, in colorectal cancer, and one RCT reported quality of life improvement. Two RCTs reported ME discontinuations due to adverse events and grade 3/4 toxicities. Nevertheless, no safety signals were detected from these 10 studies. Quality appraisal revealed a substantial risk of bias. Conclusions: Preliminary data are encouraging for mistletoe extracts, particularly in the context of colorectal cancer. However, the evidence is limited by the number of studies, an evaluation of different outcomes, and methodological limitations. Further high-quality research is warranted. [ABSTRACT FROM AUTHOR]

Background: Private sector literature demonstrates an association between perioperative transfusions and poor clinical outcomes. Hemostatic agents, surgeon training, and patient blood management programs (PBMPs) may mitigate perioperative bleeding. This study attempts to identify preoperative risk factors associated with perioperative transfusions in Veterans. Study Design and Methods: This study is a retrospective review of the prospectively maintained Veterans Affairs Surgical Quality Improvement Project database. Included patients were older than 18 years and underwent noncardiac surgery between April 1, 2016, and March 31, 2021. Data collected included demographics, surgery variables, preoperative clinical variables, postoperative outcomes, and perioperative transfusions. Cohorts were created based on transfusion status. Univariate and multivariate analyses were performed to characterize the similarities, differences, and potential predictors of perioperative transfusion. Results: Of 6108 patients included, 153 patients received perioperative transfusions. The risks for transfusion included older age, male sex, black race, smoking, and low body mass index (BMI). The highest percent of transfused patients underwent vascular (43.4%), orthopedic (22%), and general surgeries (20%). Transfusion increased risk for postoperative cerebral vascular accident (P = .041) and 30-day mortality (P < .001). Multivariate regression analysis revealed American Society of Anesthesiology class, chemotherapy within 30 days, increased age, tobacco smoking, and decreased BMI were predictive of perioperative transfusions. Discussion: Perioperative transfusions are associated with increased morbidity and mortality in the Veteran population. These retrospective data describe the complex relationships between perioperative transfusions and outcomes after noncardiac surgery. These results serve as a foundation to create predictive models and PBMP within the veteran population to decrease transfusion requirements and associated complications. [ABSTRACT FROM AUTHOR]

The evidence regarding optimal crystalloid use in the perioperative period remains unclear. As the primary aim of this study, we sought to summarise the data from RCTs examining whether use of balanced crystalloids compared with 0.9% saline (saline) leads to differences in patient-important outcomes. We searched Ovid MEDLINE, Embase, the Cochrane library, and Clinicaltrials.gov, from inception until December 15, 2022, and included RCTs that intraoperatively randomised adult participants to receive either balanced fluids or saline. We pooled data using a random-effects model and present risk ratios (RRs) or mean differences (MDs), along with 95% confidence intervals (CIs). We assessed individual study risk of bias using the modified Cochrane tool, and certainty of evidence using GRADE. Of 5959 citations, we included 38 RCTs (n =3776 patients). Pooled analysis showed that intraoperative use of balanced fluids compared with saline had an uncertain effect on postoperative mortality analysed at the longest point of follow-up (RR 1.51, 95% CI: 0.42–5.36) and postoperative need for renal replacement therapy (RR 0.95, 95% CI: 0.56–1.59), both very low certainty. Furthermore, use of balanced crystalloids probably leads to a higher postoperative serum pH (MD 0.05, 95% CI: 0.04–0.06), moderate certainty. Use of balanced crystalloids, compared with saline, in the perioperative setting has an uncertain effect on mortality and need for renal replacement therapy but probably improves postoperative acid-base status. Further research is needed to determine whether balanced crystalloid use affects patient-important outcomes. CRD42022367593. [ABSTRACT FROM AUTHOR]

This study was to clarify the connection between extrinsic factors and the risk of perioperative pressure injuries (PIs) through the case–control approach, which involved making the intrinsic factors of the patients in the control group with no PIs consistent with those of the case group with PIs. We collected samples from a teaching hospital in Taiwan. We found a total of 132 patients deemed to have developed perioperative PIs. Using 1:2 frequency matching, we matched these cases with patients who had not developed PIs by gender, age, and BMI. Binary logistic regression analysis of the odds ratios of the extrinsic factors and PI risk revealed that the independent variables with statistical significance included duration of anaesthesia 3 h, amount of blood loss, use of electric blankets, diastolic blood pressure below 60 mmHg during surgery, and oxyhemoglobin saturation by pulse oximetry (SPO2) below 93% during surgery. Emphasis should be placed on cooperation among the medical team during surgery, less use of electric blankets, control over the duration of anaesthesia and blood loss, continuous monitoring of the patient during surgery for any emergencies, and the maintenance of patient diastolic blood pressure and blood oxygen levels to reduce the risk of PIs. [ABSTRACT FROM AUTHOR]

Abstract Purpose To provide an expert commentary on the impact of prior COVID-19 infection on patient’s surgical outcomes and postoperative recovery. To highlight the need for greater focus on peri-operative care of patients who have recovered from COVID-19. Methods A narrative review of the literature was conducted by searching Pubmed and EMBASE for relevant articles using keywords such as “COVID-19”, “Coronavirus”, “surgery” and “peri-operative infection”. Results Post-COVID-19 condition also known as long COVID has an estimated incidence of between 3.0 to 11.7%. COVID-19 has been shown to cause a series of short and long-term sequelae including cardiopulmonary complications, renal impairment, chronic fatigue and muscular deconditioning. Peri-operative infection with COVID-19 is associated with increased peri-operative mortality. Elective surgery patients who developed COVID-19 were 26 times more likely to die whilst in hospital compared to controls without COVID-19 infection, and for emergency surgery patients with COVID-19 infection were six times more likely to die. A large international prospective cohort study identified that patients who had surgery delayed over 7 weeks from the date of COVID-19 infection had no increased 30-day postoperative mortality, except those with ongoing symptoms. Conclusions COVID-19 infection and its complications have been shown to adversely affect surgical outcomes. Further research is required to better characterise long COVID and the long-term sequelae that develop, which should be used to guide comprehensive peri-operative assessment of patients. Graphical Abstract

Abstract Background Postoperative hypotension is common after major non-cardiac surgery, due predominantly to vasodilation. Administration of infused vasopressors postoperatively may often be considered a surrogate indicator of vasodilation. The incidence of postoperative vasopressors has never been described for non-cardiac surgery, nor have outcomes associated with their use. This paper presents a protocol for a prospective international cohort study to address these gaps in knowledge. The primary objectives are to estimate the proportion of patients who receive postoperative vasopressor infusions (PVI) and to document the variation in this proportion between hospitals and internationally. Furthermore, we will identify factors in variation of care (patient, condition, surgery, and intraoperative management) associated with receipt of PVI and investigate how PVI use is associated with patient outcomes, including organ dysfunction, length of hospital stay, and 30-day in-hospital mortality. Method This will be a prospective, international, multicentre cohort study that includes all adult (≥ 18 years) non-cardiac surgical patients in participating centres. Patients undergoing cardiac, obstetric, or day-case surgery will be excluded. We will recruit two cohorts of patients: cohort A will include all eligible patients admitted to participating hospitals for seven consecutive days. Cohort B will include 30 sequential patients per hospital, with the single additional inclusion criterion of postoperative vasopressor usage. We expect to collect data on approximately 40,000 patients for cohort A and 12,800 patients for cohort B. Discussion While in cardiac surgery, clinical trials have informed the choice of vasopressors used to treat postoperative vasoplegia; there remains equipoise over the best approach in non-cardiac surgery. Our study will represent the first large-scale assessment of the use of vasopressors after non-cardiac surgery. These data will inform future studies, including trials of different vasopressors and potential management options to improve outcomes and reduce resource use after surgery. Trial registration ClinicalTrials.gov Identifier: NCT03805230, 15 January 2019.

Abstract Background People with kidney failure often require surgery and experience worse postoperative outcomes compared to the general population, but existing risk prediction tools have excluded those with kidney failure during development or exhibit poor performance. Our objective was to derive, internally validate, and estimate the clinical utility of risk prediction models for people with kidney failure undergoing non-cardiac surgery. Design, setting, participants, and measures This study involved derivation and internal validation of prognostic risk prediction models using a retrospective, population-based cohort. We identified adults from Alberta, Canada with pre-existing kidney failure (estimated glomerular filtration rate [eGFR]

Background: Acne often worsens in transmasculine patients who are on prolonged testosterone therapy. Isotretinoin is an oral retinoid used in the treatment of severe or refractory cases of acne, but it has the potential to cause delayed wound healing. Transmasculine patients may potentially be prescribed treatment for acne with isotretinoin while also planning to undergo chest masculinization surgery. Objective: This scoping review aims to determine whether isotretinoin has a negative impact on postoperative healing in transmasculine patients undergoing chest masculinization surgery. Methods: A scoping review was performed using the PubMed and Ovid databases. A total of 16 publications were selected for inclusion. Results: Acne tends to peak in transmasculine patients six months after initiation of testosterone treatment. Severe cases can be treated with isotretinoin; however, acne may recur once treatment is discontinued, given ongoing hormone therapy. There is little-to-no evidence in the medical literature regarding perioperative use of isotretinoin specifically among transmasculine patients undergoing chest masculinization surgery. In general, however, recent studies have found no evidence of increased hypertrophic scars or keloids in patients taking isotretinoin. Conclusion: Further studies are required to strengthen the current evidence that suggests that isotretinoin does not need to be discontinued before or after incisional or excisional surgeries, including chest masculinization surgery in transmasculine patients. [ABSTRACT FROM AUTHOR]