The Evolution, Current Value, and Future of the American Society of Anesthesiologists Physical Status Classification System

Identification of molecular biomarkers in human serum for chronic kidney disease using attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy

Chronic kidney disease (CKD) and its progression to end-stage renal disease (ESRD) represent significant global health challenges, contributing to increased morbidity and mortality. Despite the potential diagnostic value of ATR-FTIR spectroscopic analysis of serum in CKD, research in this area remains limited. This study addressed this gap by aiming to explore the spectral profiles of sera obtained from hemodialysis patients and healthy controls. We investigated serum spectral profiles from 21 hemodialysis patients and 21 age/sex-matched controls using ATR-FTIR spectroscopy in the mid-infrared region (4000-400 cm-1). Spectroscopic analysis revealed elevated spectral intensity in ESRD samples compared to controls. Principal Component Analysis (PCA) successfully distinguished ESRD from control samples across multiple spectral regions (1480-900 cm-1, 1800-900 cm-1, and combined 3000-2800/1800-900 cm-1). Partial Least Squares Discriminant Analysis (PLS-DA) demonstrated enhanced group separation, with the optimized PLS model achieving perfect classification metrics (100% accuracy, sensitivity, and specificity). The combined spectral region models exhibited superior diagnostic performance compared to other regions. The analysis identified key molecular biomarkers associated with ESRD, including alterations in lipids, protein structures (represented by amide I and II bands), carbohydrates, nucleic acids, and immunoglobulins, which correlate with known biochemical changes in CKD pathophysiology. These findings demonstrate that ATR-FTIR spectroscopy with multivariate analysis is a rapid, cost-effective screening tool for CKD. The identified spectral biomarkers provide insights into disease-related biochemical alterations, adding valuable data to the research in this field.

Retrospective analysis of delta hemoglobin and bleeding-related risk factors in pancreaticoduodenectomy

BACKGROUND

Objective and accurate assessment of blood loss during pancreaticoduodenectomy (PD) is crucial for ensuring the safety and efficacy of the procedure. While the visual method remains the most common clinical metric, many scholars argue that it significantly differs from actual blood loss and is inherently subjective.

AIM

To assess blood loss in PD via delta hemoglobin (ΔHb) and compare it with the visual method to predict bleeding-related risk factors.

METHODS

In this retrospective analysis, 1722 patients who underwent PD from 2017 to 2022 at Shandong Provincial Hospital were divided into three groups: Open PD (OPD), laparoscopic PD (LPD), and conversion to OPD (CTOPD). Intraoperative ΔHb (IΔHb) was calculated via preoperative and 72-hour-postoperative hemoglobin concentrations, and its association with visually obtained estimated blood loss (EBL) was analyzed. Perioperative ΔHb (PΔHb) was calculated via preoperative and predischarge hemoglobin concentrations. We compared the differences in IΔHb and PΔHb among the three groups, and performed univariate and multivariate regression analyses of IΔHb and PΔHb.

RESULTS

The preoperative general information of patients showed no statistically significant difference among the three groups (P > 0.05). The IΔHb in the OPD, LPD, and CTOPD groups were 22.00 (12.00, 36.00), 21.00 (10.00, 33.00), and 33.00 (18.12, 52.24) g/L, respectively; And the PΔHb in the OPD, LPD, and CTOPD groups were 25.87 (13.51, 42.00), 25.00 (14.00, 45.00), and 37.48 (21.64, 59.65) g/L, respectively, values significantly differed (P < 0.05). IΔHb and EBL were significantly correlated (r = 0.337, P < 0.001). The results of univariate and multivariate regression analyses indicated that American Society of Anesthesiologists (ASA) classification IV [95% confidence interval (CI): 2.330-37.811, P = 0.049] and preoperative total bilirubin > 200 μmol/L (95%CI: 2.805-8.673, P < 0.001) were independent risk factors for IΔHb (P < 0.05), and ASA classification IV (95%CI: 45.934-105.485, P < 0.001), body mass index > 24 kg/m² (95%CI: 1.285-9.890, P = 0.011), and preoperative total bilirubin > 200 μmol/L (95%CI: 6.948-16.797, P < 0.001) were independent risk factors for PΔHb (P < 0.05).

CONCLUSION

There is a correlation between IΔHb and EBL in PD, so we can assess the patients’ intraoperative blood loss by the ΔHb method. ASA classification IV, body mass index > 24 kg/m², and preoperative total bilirubin > 200 μmol/L increased perioperative bleeding risk.

Intraoperative Pressure Injury Prevention

Pressure injury (PI) prevention in the operating room (OR) has unique considerations based on the patient, procedure, position for the surgical procedure, and available positioning devices. Patient-specific factors contribute to their risk of incurring an intraoperative PI from the American Society of Anesthesiologists classification, sex, body mass index, comorbidities, age, and nutritional status. Additionally, there are surgery-specific risk factors such as length of procedure, intraoperative hypotension, lack of normothermia, and intraoperative blood loss. Knowledge of intraoperative PIs and prevention is developing and continues to have room for growth due to the complexity of the OR environment.

Why are critical event checklists not always used in the perioperative setting?: A retrospective survey

INTRODUCTION

During surgery and anesthesia, life-threatening critical events, including cardiac arrest, may occur. By facilitating recall of key management steps, suggesting diagnostic possibilities, and providing dose and drug information, cognitive aids may improve clinician performance during such events. In actual clinical practice, however, cognitive aids may be available but inconsistently used. One possibility explaining aid non-use during critical events is a lack of familiarity with how cognitive aids may be helpful. We hypothesized that introduction of critical event cognitive aids along with implementation of cognitive aid resources would change the quantitative incidence of cognitive aid use and qualitative reasons for aid non-use. We surveyed members of an academic anesthesia department before and after implementation of critical event cognitive aid resources.

METHODS

All anesthesia clinicians at a single academic medical center were surveyed. Participants were surveyed both pre- and post-training with a focused program to introduce critical event cognitive aid resources. Incidences of and reasons for cognitive aid use and non-use were collected and analyzed. Survey responses were compared pre- and post-implementation.

RESULTS

The response rate was 64.5%. One-hundred eighty-five reasons for non-use were collected before the focused program and 149 after. Overall, 80% of clinicians had encountered at least one critical event during the study period and use of cognitive aids during all reported events was 7%. Six categories of reasons for non-use were identified: 'Not Available', 'Not Needed', 'No Time', 'Another Person In Charge', 'Used In Another Way', 'No Reason Given'. After implementation, a decrease in the number of respondents who cited availability and who cited 'another person running crisis,' as reasons for non-use was observed (p < 0.001).

CONCLUSIONS

Implementation of cognitive aids for critical events in an academic anesthesia environment improved the perception of cognitive aid availability and decreased the number of subjects who chose to not use the aid due to another person running the crisis response. Looking at the multiple reasons for cognitive aid non-use may guide implementation, training, and design.

Evaluation of the usefulness of platelet-rich fibrin (PRF) in mandibular third molar surgery with 3D facial swelling analysis: a split-mouth randomized clinical trial

BACKGROUND

Third molar surgery is associated with various postoperative complications (PC). Different strategies, including the application of platelet-rich fibrin (PRF), have been implemented to reduce PC. Digital technologies have proven useful in objectively assessing postoperative facial swelling. This study aimed to evaluate the effect of PRF on reducing facial swelling after lower third molar surgery using a 3D face scanner.

METHODS

A randomized split-mouth clinical trial was set up and 32 patients (18 to 32 years), requiring extraction of both mandibular third molars, were recruited at the Oral Surgery Clinic of the Magna Graecia University of Catanzaro. The primary predictive variable was the application or not of PRF plugs and membranes in the post-extraction socket. Primary outcome variable was facial swelling recorded with a face scanner preoperatively (T0), after three (T1) and seven (T2) days. Qualitative and quantitative data analysis were conducted following an automated and standardized imaging analysis workflow using the 3D Slicer software. Secondary outcome variables were trismus, recorded by measuring the maximum buccal opening with a caliper, pain, recorded using a visual analogue scale (VAS), and duration of the surgery. Descriptive and bivariate analysis were performed by setting the significance level [Formula: see text] = 0.05.

RESULTS

All patients exhibited a significant increase in facial swelling at T1, followed by a subsequent reduction from day 3 to day 7, with a slight persistence of edema observed on the seventh day. No significant data emerged from the statistical analysis conducted. Linear differences in PRF group reported improved values of postoperative swelling only in the T1-T2 and T0-T2 phases of analysis. Volumetric differences favored PRF group compared with control group in all phases. VAS was lower in PRF group only at T2, compared with control group.

CONCLUSIONS

Application of PRF in post-extraction sockets showed effectiveness in reducing facial swelling. Its advantages, including accessibility, cost-effectiveness, and absence of adverse reactions, make it an optimal treatment choice in reducing post-surgical sequelae.

The Modified Fragility Index and Perioperative Albumin as Predictors of Complications in Complex Abdominal Wall Reconstruction

BACKGROUND AND SIGNIFICANCE

Complex abdominal wall reconstruction (CAWR) is performed to restore the structure and function of the abdominal wall. These procedures carry the risk of complications such as delayed wound healing, skin necrosis, infection, recurrence, or even death. The 5-factor modified fragility index (5-mFI) has gained popularity as a concise method of evaluating preoperative risk across various surgical specialties. Additionally, perioperative hypoalbuminemia has been previously associated with delayed wound healing after surgery. The purpose of this study was to assess the utility of the 5-mFI in combination with perioperative albumin levels for assessing risk in complex abdominal wall reconstruction.

METHODS

This was a retrospective, single-institution chart review study of all patients who underwent CAWR by the senior author (A.L.) from 2002 to 2023. Demographics, comorbidities, details of surgery, perioperative albumin levels, ASA scores, and complications were collected for each patient. Five-factor modified fragility indices were calculated for each patient. Statistical analysis consisted of χ2 and Fisher exact tests for categorical variables, t tests for continuous variables, and multivariate analysis.

RESULTS

Our analysis included 437 patients. The average age of our patients was 54.3 years, the average BMI was 32.1 kg/m2, and the average length of follow-up with the plastic surgery service was 264 days. A total of 118 (27.0%) developed complications, with the most common complications being delayed wound healing (89 patients, 20.4%) and infection (78 patients, 17.8%). Other complications included skin necrosis, fistula formation, hematoma, seroma, infection, and death. Sixty patients (13.7%) experienced recurrence of their hernias within the follow-up period. An mFI of 2 or greater was significantly associated with delayed wound healing (LR, 11.42; P = 0.0436) as well as skin necrosis (LR, 4.826; P = 0.028). The presence of an mFI of 2 or greater and perioperative hypoalbuminemia was significantly associated with development of major complications (LR, 3.221; P = 0.0457), delayed wound healing (LR, 5.999; P = 0.0143), skin necrosis (LR, 9.19; P = 0.0024), and mortality (LR, 5.287; P = 0.0215). On multivariate analysis, the presence of an mFI of 2 or greater when combined with perioperative hypoalbuminemia was found to be independently associated with mortality (LR, 1524.5; P < 0.0001).

CONCLUSIONS

We found the 5-factor mFI to be significantly associated with delayed wound healing and skin necrosis in our patient population. When an mFI of 2 or greater was present along with perioperative hypoalbuminemia, patients were significantly more likely to experience complications, issues with wound healing, and mortality. Surgeons should take these findings into account when counseling patients preoperatively.

Construction and validation of a risk prediction model for postoperative frailty in older adults:a multicenter study

BACKGROUND

Postoperative frailty is an important determinant of postoperative recovery and survival outcomes. Predicting the onset of postoperative frailty is significant importance for the rehabilitation of the elderly people after surgery. Our study aims to develop and evaluate a predictive model for postoperative frailty on the 30th day in elderly patients.

METHODS

Data from seven Guangzhou hospitals were collected, encompassing 2,290 patients for analysis. This study constructed the model using LASSO regression and stepwise regression, and the optimal predictive model was selected based on comparison. Model performance was assessed through calibration curves, the area under the ROC curve (AUC), and decision curve analysis (DCA).

RESULTS

The final model included the following variables: American Society of Anesthesiologists (ASA) grade, intraoperative blood loss, economic income, caregiver status, sedentary behavior, cognitive function, Activities of Daily Living (ADL), postoperative hemoglobin (Hb) level, and postoperative ICU admission. The model demonstrated good discrimination, with an area under the curve (AUC) of 0.7431 (95% CI = 0.7073-0.7788) in the training set and 0.7285 (95% CI = 0.6671-0.7624) in the validation set.

CONCLUSIONS

According to general demographic information, lifestyle habits, and surgery-related factors, a predictive model for postoperative frailty in the elderly was constructed, which has good predictive power. This model can identify high-risk populations for postoperative frailty and provides a reference for the early detection and intervention of frailty in the elderly in clinical practice.

TRIAL REGISTRATION

This study was registered on May 17, 2023, at the Chinese Clinical Trial Registry (registration number: ChiCTR2300071535).

Clinical performance of an ormocer-based single-shade resin composite for the restoration of non-carious cervical lesions: 18-month randomized clinical trial

OBJECTIVE

This double-blind, split-mouth, randomized equivalence clinical trial aimed to evaluate the 18-month clinical performance of an ormocer-based single-shade resin composite compared with an ormocer-based multi-shade resin composite in non-carious cervical lesions (NCCLs).

METHODS

One hundred and twenty restorations were performed on NCCLs with two restorative materials (n = 60): Admira Fusion X-tra resin composite (ormocer-based single-shade), and Admira Fusion resin composite (ormocer-based multi-shade). After rubber dam isolation, a universal adhesive was applied in the selective enamel etching strategy. For both groups, restorations were inserted incrementally and light-cured. The restorations were clinically evaluated at 6, 12, and 18 months according to the updated FDI (World Dental Federation) criteria. Statistical analysis was performed using Friedman repeated measures ANOVA by rank and Mann-Whitney test for pairwise significance (α = 0.05).

RESULTS

All restorations were evaluated after 18 months, and nine restorations were lost. Fracture of the material and retention rates (95 % confidence interval [CI]) were 93 % (84-97 CI) for the ormocer-based single-shade and 91 % (82-96 CI) for the ormocer-based multi-shade, with no statistical differences between them (p > 0.05). The absolute risk (95 % CI) was 0.8 (0.2 to 3.1).

CONCLUSIONS

The updated FDI evaluation criteria showed equivalent results for ormocer-based single-shade and ormocer-based multi-shade after 18 months.

CLINICAL SIGNIFICANCE

Using an ormocer-based single-shade resin composite in NCCLs is advisable due to its convenience, ease of application, and lower cost compared to ormocer-based multi-shade composites without compromising clinical performance.

Classification Systems of Surgical Complexity: A Scoping Review of the Literature

INTRODUCTION

A robust system for classifying the technical complexity of surgical procedures has many applications, including optimization of hospital and surgeon-level surgical performance evaluations, reimbursement, and hospital resource utilization. However, little work has been done to distinguish surgical complexity from patient- and disease-associated surgical risk.

METHODS

Through a scoping review of the literature, we identified surgical subspecialty complexity classification systems which were purposed to quantify the technical complexity of a procedure and were validated with prospective or retrospective patient data.

RESULTS

We identified six validated surgical complexity classification systems and determined the methodology which most accurately determines surgical complexity is the level of training or expertise necessary to perform a procedure as determined by expert consensus. However, the existing literature largely validates complexity classification systems by their ability to predict morbidity and mortality which are measures of surgical risk.

CONCLUSIONS

A surgical complexity classification system distinct from, but used in parallel with, surgical risk has significant potential for process improvement. While the technical demands of a surgical procedure may be associated with measures of surgical risk, we propose that surgical complexity is a process measure, best represented in the literature by the level of training/expertise necessary to perform a procedure as determined through expert consensus.

Salivary attenuated total reflectance-fourier transform infrared spectroscopy combined with chemometric analysis: A potential point-of-care approach for chronic kidney disease screening

BACKGROUND

The increasing prevalence of chronic kidney disease (CKD) and its terminal stage, end-stage renal disease (ESRD), raises the importance of an accurate, early, and point-of-care method to diagnose and monitor patients. Saliva is a potential point-of-care diagnostic biofluid for its simple collection and ability to reflect systemic health status. This study investigated salivary spectral signatures in ESRD patients and their diagnostic potential compared to healthy controls.

METHODS

Saliva samples were collected from 24 ESRD patients undergoing hemodialysis and 24 age/sex-matched healthy controls. The dried saliva samples were analyzed using Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) spectroscopy in the 4000-400 cm⁻¹ range. Chemometric analyses, including Principal Component Analysis (PCA) and Partial Least Squares Discriminant Analysis (PLS-DA), were applied to preprocessed spectra to identify discriminatory spectral features and establish classification models.

RESULTS

Second derivative spectroscopic analysis of ATR-FTIR spectra revealed distinctive spectral patterns in dried ESRD saliva samples, including characteristic peak shifts observed in both the amide I secondary structures (from 1636 cm-1 in controls to 1629 cm-1 in ESRD) and carbohydrate (from 1037 cm-1 in controls to 1042 cm-1 in ESRD) regions. PCA demonstrated clear clustering patterns across key biological spectral regions, including the lipid CH stretching region (3000-2800 cm-1), the fingerprint region (1800-900 cm-1), and their combination (3000-2800 cm-1 + 1800-900 cm-1). PLS models based on the fingerprint region achieved optimal diagnostic performance (87.5-100 % accuracy, 75-100 % sensitivity, and 100 % specificity). Biochemical markers associated with ESRD revealed variations in lipids, protein, sugar moieties, carbohydrates, and nucleic acids, reflecting the underlying pathological changes in CKD, with the most prominent band at ∼1405 cm-1.

CONCLUSION

ATR-FTIR analysis of dried saliva demonstrated potential as a non-invasive diagnostic tool for ESRD. This approach could complement existing diagnostic methods, particularly in resource-limited settings or for frequent monitoring requirements.

Association of preoperative blood biomarkers with postoperative major adverse cardiac events and mortality in major orthopaedic surgery: a systematic review and meta-analysis

OBJECTIVE

The association between preoperative blood biomarkers and major adverse cardiac events (MACEs) as well as mortality after major orthopaedic surgery remains unclear. This study aimed to assess the association between preoperative blood biomarkers and postoperative MACEs as well as all-cause mortality in patients undergoing major orthopaedic surgery.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, EMBASE, the Cochrane Controlled Trials Register and Cochrane Database of Systematic Reviews from inception to 20 October 2024 were searched.

ELIGIBILITY CRITERIA

Observational or experimental studies reporting the correlation between preoperative blood biomarkers and postoperative MACEs-categorised as short-term (within 3 months) or long-term (beyond 3 months)-and all-cause mortality in patients undergoing major orthopaedic surgery.

DATA EXTRACTION AND SYNTHESIS

Data from studies reporting OR or HR and its 95% CI were pooled for analysis using random-effects model.

RESULTS

21 preoperative blood-based biomarkers from 80 studies with 226 468 patients were analysed. Elevated preoperative cardiac biomarkers were correlated with a heightened risk of MACEs within 3 months (natriuretic peptide: OR 3.37, 95% CI 2.07 to 5.47, I2=87.9%; cardiac troponin: OR 4.89, 95% CI 1.52 to 15.75, I2=69.5%) with significant heterogeneity. Only natriuretic peptide was associated with a high-risk long-term MACEs (>3 months) (OR 3.52, 95% CI 1.73 to 7.17, I2=86.2%). In contrast, cardiac biomarkers were not identified as having prognostic value for all-cause mortality in this patient cohort. Additionally, an increased risk of all-cause mortality was associated with preoperative abnormal levels of albumin (OR 1.15, 95% CI 1.06 to 1.24, I2=84.8%), creatinine (OR 1.54, 95% CI 1.12 to 1.95, I2=0), 25(OH)D (OR 1.58, 95% CI 1.01 to 2.14, I2=0) and glomerular filtration rate (GFR) (OR 1.12, 95% CI 1.06 to 1.17, I2=0), rather than cardiac biomarkers.

CONCLUSIONS

The study proposed that cardiac biomarkers assessed before surgery could offer prognostic insight into short-term MACEs, while preoperative abnormal levels of albumin, creatinine, 25 (OH)D and GFR might be prognostic valuable for all-cause mortality following major orthopaedic surgery.

PROSPERO REGISTRATION NUMBER

CRD42022352091.

Constructing a predictive model for high intraoperative excessive bleeding in patients undergoing posterior lumbar decompression and fusion internal fixation surgery during outpatient visits

OBJECTIVE

1. Construct a risk prediction model to predict the factors of high intraoperative bleeding in patients undergoing posterior lumbar decompression and fusion internal fixation surgery during outpatient visits. 2. Implement pre-hospital blood management for surgery patients, to improve clinical outcomes.

DESIGN & METHODS

We collected patients who underwent two-segment and three-segment posterior lumbar decompression and fusion internal fixation surgery in our hospital from 2016 to 2021. A total of 24 preoperative indicators were analyzed, covering medical history, demographic characteristics, segment, operator and laboratory test results. We used a logistic regression model to optimize the model's feature selection. The predictive model was constructed using the multivariable logistic regression method with all included methods, and a nomogram was created to display the model. Activated partial thromboplastin time, surgeon volume, American Society of Anesthesiologists classification, body mass index, and the number of fusion and fixation lumbar segments were used to construct the predictive model. The predictive model's discrimination, calibration, clinical applicability, and rationality were evaluated.

RESULTS

The predictive model's area under the receiver operating characteristic curve is 0.723, with a 95% confidence interval of (0.685-0.760). The training set's decision curve analysis demonstrates that applying this diagnostic curve will increase the net benefit when the threshold probability is between 5% and 40%.

CONCLUSION

This study developed a novel nomogram with relatively good accuracy to assist clinical doctors in assessing the high intraoperative bleeding risk in patients undergoing posterior lumbar decompression and fusion internal fixation surgery during outpatient visits. By evaluating individual risk, surgeons can develop an individualized treatment plan to reduce the risk of intraoperative bleeding for each patient.

Interim analysis of short-term outcomes after laparoscopic spleen-preserving distal pancreatectomy with or without preservation of splenic vessels: a randomised controlled trial

BACKGROUND

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is a widely adopted surgical approach for benign and low-grade malignant neoplasms of the distal pancreas. The Kimura and Warshaw techniques represent two principal strategies, yet it still needs to be determined which one is superior. Our investigation aimed to evaluate the clinical outcomes associated with each technique.

MATERIALS AND METHODS

This single-center, parallel-group, patient-blinded randomized controlled trial was conducted at the West China Hospital of Sichuan University. Stratified block randomization was utilized to enroll 114 patients starting in March 2022, with an interim analysis of short-term outcomes scheduled after 45-50% of participant enrollment. Patients were randomized to receive LSPDP via either the Kimura or Warshaw technique. The primary endpoint was intraoperative blood loss, while secondary endpoints included a range of outcomes from composite outcome to quality of life, as quantified by the EQ-5D-5L.

RESULTS

From March 2022 to November 2023, 53 patients were randomly allocated to the Kimura ( n =25) or Warshaw ( n =28) groups for LSPDP. Baseline characteristics and postoperative outcomes were similar between the groups, such as pancreatic fistula incidence, EQ-5D-5L index scores, and delayed gastric emptying rates. Per-protocol (PP) analysis revealed that the Kimura group experienced significantly less blood loss (52.5±51.6 ml vs. 91.7±113.5 ml, P =0.007) and a reduced rate of composite outcome (23.8 vs. 56.7%, P =0.019), but incurred higher costs in the Warshaw group (¥56 227.4±¥7027.0 vs. ¥63 513.8±¥12 944.5, P =0.013). Splenic infarction rates were higher in the Warshaw group, though not statistically significant (ITT: 39.3 vs. 12.5%, P =0.058; PP: 36.7 vs. 14.3%, P =0.113), without necessitating intervention. Neither group experienced postpancreatectomy hemorrhage, 90-day mortality, or ICU admissions, and all postoperative complications were mild (Clavien-Dindo Grade

CONCLUSIONS

The 90-day interim analysis postoperatively indicates that both Kimura and Warshaw techniques for LSPDP are safe and viable. The Kimura technique, however, confers superior in terms of reduced intraoperative blood loss and fewer complications, alongside lower costs.

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Key Words

• kimura technique
• laparoscopic spleen-preserving distal pancreatectomy
• warshaw technique

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MESH Headings

• Humans
• Pancreatectomy/methods
• Pancreatectomy/adverse effects
• Male
• Female
• Middle Aged
• Laparoscopy/methods
• Spleen/surgery
• Spleen/blood supply
• Pancreatic Neoplasms/surgery
• Adult
• Treatment Outcome
• Aged
• Organ Sparing Treatments/methods
• Blood Loss, Surgical/statistics & numerical data
• Blood Loss, Surgical/prevention & control
• Quality of Life
• Postoperative Complications/epidemiology
• Postoperative Complications/prevention & control
• Splenic Vein/surgery

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Affiliation(s)

Qiangxing Chen Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University West China School of Medicine, West China Hospital, Sichuan University Department of Pancreatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
Yangzhi Fu Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University West China School of Medicine, West China Hospital, Sichuan University
Yongbin Li Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University Department of Hepatopancreatobiliary Minimal Invasive Surgery, Shangjin Nanfu Hospital
He Cai Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
Xin Wang Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
Zhong Wu Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
Lingwei Meng Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University West China School of Medicine, West China Hospital, Sichuan University
Man Zhang Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
Zixin Chen Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University West China School of Medicine, West China Hospital, Sichuan University
Jingwen Jiang Division of Pancreatic Surgery and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; and Med-X Center for Informatics, Sichuan University
Ke Cheng Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University Division of Liver Surgery, Department of General Surgery, West China Hospital of Sichuan University
Jun Li Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University West China School of Medicine, West China Hospital, Sichuan University
Dian Zhang Department of Radiology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China, Guangzhou, China
Yu Cai Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
Jiaying You Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
Yunqiang Cai Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
Bing Peng Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University

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Low-Profile Minos TM Stent Graft System for Endovascular Abdominal Aorta Aneurysm Repair-Early and Late Outcomes in Elective and Emergent Situations

BACKGROUND

The aim of the study was to present the results of a novel abdominal stent graft for patients with abdominal aortic aneurysm (AAA), through 2-year follow-up.

METHODS

A single-center retrospective review with prospectively collected data was performed to assess the safety and effectiveness of the Minos Abdominal stent device for treating AAAs. We estimated technical success rate, in-hospital and 30-day mortality, and mortality at the end of follow-up as well as complication and reintervention rate in our study cohort. Follow-up imaging assessments consisted of computed tomography angiography at 1 and 6 months and yearly thereafter.

RESULTS

A total of 52 patients (92% males; mean age, 74 ± 6 years) were enrolled with Minos Abdominal stent device from July 2020 until September 2023. Thirty one (60%) patients were asymptomatic while 21 (40%) were symptomatic. The technical success of the endovascular aortic repair was 95% (49 of 52 patients). In 5% (3 of 52) of the cases, cannulation of the contralateral limb was unsuccessful and was converted to aorto-uni-iliac graft. Two (4%) aortic related death were recorded during the 30-day period. The major adverse event rate was 3.8%. The overall mean follow-up was 30 ± 6 months; no aorta-related deaths or graft related complications were observed. Sac shrinkage (>5 mm) has been observed in 70% of patients.

CONCLUSIONS

Minos endoprosthesis seems to be safe, effective, and durable for treating AAA either in elective or emergent situations.

Development and implementation of a home-based prehabilitation app for older patients undergoing elective colorectal cancer surgery. A Prospective Cohort Study

Background

Prehabilitation optimizes colorectal cancer patients' health during the preoperative waiting period, by increasing functional capacity, reducing postoperative complications, and speeding recovery. However, challenges in implementation include patients' willingness to attend multiple hospital visits, and hospitals needing trained personnel, facilities, and financial resources. An app-based prehabilitation program could address these issues by allowing patients to participate from home with remote support from healthcare professionals.

Objective

To develop and evaluate the feasibility of a digital application to offer multimodal home-based prehabilitation for older patients undergoing surgery for colorectal cancer.

Materials and Methods

This single-center prospective cohort study at Northwest Clinics (Alkmaar and Den Helder, The Netherlands) included patients scheduled for elective surgery for the curative treatment of colorectal cancer. The Patient Journey App was used to deliver prehabilitation. The primary outcome was the number of patients who downloaded and activated the app. Secondary outcomes included usage information, videos viewed, questionnaires answered, and signals triggered.

Results

Ninety-seven patients were included in the study (age 72.1 [SD 0.8], 62.9% male). All patients used the app daily for a median of 29 days (IQR 23-28). Exercise videos were viewed most. Ninety-five patients activated daily exercise and protein shake reminders. Patients provided 1367 answers, triggering 79 signals related to smoking cessation, nutrition, and exercise. Response rates to in-app questionnaires were high, up to 90.5%.

Conclusions

Home-based prehabilitation via an app for older colorectal cancer surgery patients is feasible. Given the effectiveness of prehabilitation programs, the scarcity of healthcare professionals, and patients' reluctance for frequent in-person visits, home-based prehabilitation programs via an app could become a valuable added modality for offering these programs.

Trial Registration

2020.0600 (VU University Medical Center).

Utility of Frailty Index in Predicting Adverse Outcomes in Patients With the Same American Society of Anesthesiologists Class in Video-assisted Thoracoscopic Surgery

OBJECTIVES

To investigate the utility of the five-item Modified Frailty Index (MFI-5) as a preoperative risk-stratification tool in video-assisted thoracoscopic surgery (VATS) for patients with the same American Society of Anesthesiologists (ASA) class.

DESIGN

This was a retrospective cohort study utilizing data from The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database from 2008 to 2021.

SETTING

The NSQIP includes 685 participating hospitals in all 50 states, the majority being large, academic medical centers.

PARTICIPANTS

All patients undergoing VATS were identified via CPT codes in the deidentified NSQIP dataset. Patients with invalid values for any variables of interest or significant covariates were excluded.

INTERVENTIONS

No interventions were applied to any patients in this retrospective cohort study.

MEASUREMENTS AND MAIN RESULTS

69,145 patients undergoing VATS were included, with the largest number having single lobectomy (32%) or unilateral wedge resection (26%). A total of 1,277 (1.8%) had unplanned reintubation, and 1,155 (1.7%) had ventilator dependence (VentDep) >48 hours after surgery. Of these patients, 66% were ASA class 3. Overall, ASA classification had a stronger correlation with both VentDep rates (adjusted R2 difference: +6.1%) and reintubation rates (adjusted R2 difference: +1.5%) than the MFI-5 score. However, combining ASA class with MFI-5 score was a stronger predictor for both primary outcomes than the ASA class alone (adjusted R2 difference: +1.5%, p < 0.001). The MFI-5 had the strongest correlation with both outcomes among ASA class 3 patients, demonstrating exponentially increasing odds of VentDep and reintubation (MFI 3 v MFI 0: odds ratio = 5.1 [3.7, 7], p = 0.002). MFI-5 also helped classify risk within ASA class 2 patients but not as reliably as for ASA class 3 (ASA class 2 reintubation: increased probability from MFI 0-1 and 1-2; VentDep: increased probability from MFI 0-1 only, p = 0.005).

CONCLUSIONS

The MFI-5 is a comorbidity-based scale that can be calculated preoperatively and considers distinct, but complementary information to the ASA class. Among VATS patients with identical ASA classes 2 and 3, the MFI-5 further stratified risk for reintubation and ventilator dependence >48 hours postsurgery.

Patient satisfaction and safety in the administration of sedation by nursing staff in the digestive endoscopy service: a cross-sectional study

BACKGROUND

The satisfaction of patients with sedation by nursing staff is an issue of interest for the quality of health care, influencing the recovery and well-being of patients as well as their confidence in and adherence to treatment. One of the most frequently performed diagnostic and therapeutic tests requiring sedation are digestive endoscopies, so it would be interesting to study satisfaction in these services.

AIM

To determine the level of patient satisfaction and safety with sedation via digestive endoscopies by nurses.

METHODS

This was a cross-sectional study in the Digestive Endoscopy Service at the University Hospital of Toledo, Spain. The sample consisted of 660 adult patients from the digestive endoscopy service who were sedated between June-September 2023. The degree of satisfaction with the service was measured by the questionnaire: Survey of patient satisfaction with the digestive endoscopy service. The study was approved by the ethics committee.

RESULTS

Patients who reported satisfaction with the treatment were very satisfied with the sedation provided by the nurses. The most valued item was the attention of the nursing professionals. The least valued items were the waiting time for the appointment and the time spent in the waiting room on the same day. The incidence of complications recorded during the test were minimal (2% of all patients).

CONCLUSIONS

Most patients are satisfied with the sedation administered by nurses via digestive endoscopies, and complications were rare, supporting the efficacy and acceptance of this practice. Clinical practice guidelines and consensus documents in Spain guarantee that nurses have autonomy to administer sedation in digestive endoscopy services, but there is a lack of national regulations to support this technique. The current consensus in Spain is that specific training is necessary for such nurses.

Association between diabetes mellitus and trochanteric bone mineral density in individuals with osteoporotic fractures: a retrospective study

Background

The relationship between diabetes mellitus (DM) and bone mineral density (BMD) in patients with osteoporotic fractures (OPFs) remains complex and heterogeneous, specifically between the genders. This study aimed to explore the association between diabetes status and trochanteric BMD in a cohort of patients with OPFs and elucidate the differences between male and female patients.

Methods

This retrospective analysis was performed on 710 admitted patients aged 50 years or older with OPFs. In this study, the exposure variable was diabetes status. Trochanteric BMD comprised the dependent variable. While controlling for covariance influences, generalized estimating equations (GEE) were applied to examine the independent link between diabetes status and trochanteric BMD in OPFs patients. Moreover, a subgroup analysis was also conducted to validate the result's stability.

Results

A substantial positive association was noted between diabetes status and trochanteric BMD in diabetic patients, as determined by the fully adjusted model (β = 0.017, 95% CI 0.001 to 0.033, p = 0.035). Furthermore, the sex-specific analysis showed a significant positive relationship between diabetes status and trochanteric BMD in male patients (β = 0.040, 95% CI 0.006 to 0.075, p = 0.022), whereas no significant relationship was observed in female patients (β = 0.010, 95% CI -0.008 to 0.028, p = 0.256).

Conclusion

This study highlighted the significant sex differences in the impact of diabetes on trochanteric BMD among patients with OPFs. The male diabetic patients had higher trochanteric BMD than their non-diabetic counterparts; however, this association was not evident in female patients. Further research is necessary to understand the underlying mechanisms that contribute to these sex-specific differences and to evaluate the clinical implications of managing fracture risk in diabetic patients.

Relevance of Preoperative Cognitive Impairment for Predicting Postoperative Delirium in Surgical Medicine: A Prospective Cohort Study

BACKGROUND

Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognition, is frequently not standardized.

METHODS

A comprehensive preoperative assessment was performed in 421 surgical patients to investigate the impact of preoperative cognitive impairment (PCI) on the risk of delirium and to evaluate appropriate screening tools (Six-item screener (SIS) and clock-drawing test (CDT)).

RESULTS

Both screening tools showed a significantly increased risk of delirium with p < 0.001 (OR 12.5, 95% [6.42; 24.4]) in SIS and p = 0.042 (OR 2.02, 95%CI [1.02; 4.03]) in CDT for existing cognitive impairment. A higher level of care (p < 0.001) and statutory care (p < 0.001, OR 5.42, 95%CI [2.34; 12.6]) also proved to be significant risk factors. The ROC curves of the two tests show AUC values of 0.741 (SIS) and 0.630 (CDT). The COP values for the SIS are 4 points with a Youden index of 0.447; for the CDT, the COP is 2 (Youden index = 0.177).

CONCLUSIONS

The recording of PCI should be a central component of the preoperative geriatric assessment. The tools used are simple yet effective and can be easily implemented in routine clinical practice. By reliably identifying patients at risk, the available resources can be personalized and used in a targeted approach.

The association between systemic immune-inflammation index (SII) and early nosocomial infections after cardiopulmonary bypass surgery in children with congenital heart disease

BACKGROUND

Infections occurring postoperatively in pediatric patients with congenital heart disease (CHD) following cardiopulmonary bypass (CPB) surgery pose a considerable challenge, affecting the duration of hospitalization, financial costs, and patient outcomes. Studies investigating the association between systemic immune-inflammation index (SII) and early infections after CHD surgery are very rare. This study seeks to delineate the link between SII and the occurrence of early nosocomial infections in pediatric patients undergoing CPB surgery for CHD.

METHODS

A cross-sectional analysis was performed on 325 pediatric patients who underwent CPB surgery for CHD between July 2020 and June 2023. The primary exposure was the SII value on the first postoperative day. The outcome was the occurrence of nosocomial infections within the first week following CPB surgery. Multivariable logistic regression models and subgroup analyses were employed to evaluate the association between SII and the risk of early nosocomial infections.

RESULTS

The median age of the study cohort was 4.4 years, with a male preponderance of 51.7%. The median SII value was recorded at 0.6 × 10^12/L. The rate of nosocomial infections within the first week post-CPB surgery was 53.5%. An inverse association was observed between SII and the incidence of early nosocomial infections. After controlling for multiple confounders, an increment of 1 × 10^12/L in SII corresponded to a 25% reduction in the likelihood of nosocomial infections (OR = 0.75; 95%CI: 0.57, 0.99; P = 0.044). Subgroup analyses substantiated the consistency of these findings.

CONCLUSIONS

The study demonstrated that an elevated SII corresponded to a reduced likelihood of early nosocomial infections after CPB surgery in children with CHD, a finding that merits additional investigation.

Correlation between admission hyperglycemia and postoperative pneumonia after hip fracture surgery: A propensity score-matched study

The association between admission hyperglycemia and postoperative pneumonia is unclear in hip fracture patients. We investigated the relationship between admission hyperglycemia and postoperative pneumonia after hip fracture surgery. This retrospective study analyzed data from 1,267 geriatric patients admitted for hip fractures. Patients were categorized into normoglycemic (< 6.10 mmol/L) and hyperglycemic (≥ 6.10 mmol/L) groups based on admission blood glucose levels. Multivariable logistic regression and propensity score matching (PSM) were used to control for potential confounding variables and estimate adjusted odds ratios and 95% confidence intervals for postoperative pneumonia (POP). We also examined the dose-dependent link between admission blood glucose and the likelihood of developing POP. Further analyses evaluated whether admission hyperglycemia has differing impacts on POP outcomes among hip fracture patients without diabetes (NDM) versus those with diabetes (DM). Additionally, subgroup analyses were conducted to assess the influence of other factors on the relationship between admission blood glucose and POP occurrence. Patients with admission hyperglycemia had significantly higher rates of POP compared to normoglycemic patients, both before (13.2% vs. 4.8%) and after (10.1% vs. 5.8%) PSM. Admission hyperglycemia is an independent risk factor of POP (OR = 2.64, 95% CI: 1.42-4.92, p = 0.002). The association persisted after PSM(OR = 2.90, 95% CI: 1.35-3.86, p = 0.016). Additionally, higher blood glucose levels correlated with a greater likelihood of developing POP. A dose-response relationship was observed between blood glucose levels and the risk of POP. Non-diabetic group patients with hyperglycemia were at higher risk of POP than diabetic group patients with hyperglycemia. Finally, the relationship between hyperglycemia and increased POP risk is modulated and influenced by the ASA classification of the patient. Admission hyperglycemia is an independent risk factor for POP after hip fracture surgery in the elderly. There is a dose-response relationship between admission blood glucose and the occurrence of POP, which is more significant in non-diabetic patients than diabetic patients.

Effects of major trauma care organisation on mortality in a European level 1 trauma centre: A retrospective analysis of 2016-2023

INTRODUCTION

The centralisation of care for trauma patients in trauma centres, alongside the creation of inclusive trauma networks, has proven to reduce mortality. In Europe, such structured trauma programs and trauma networks are in development.

OBJECTIVE

To describe the aetiology and evolution of in-hospital mortality in a developing European level 1 trauma centre, to determine the early effect of trauma care reorganisation on mortality and to identify the areas for future investments in trauma care.

MATERIALS AND METHODS

This retrospective analysis included the calculation of the standardised mortality ratio (SMR), the time to in-hospital death and the cause of in-hospital death of all primary major trauma admissions to the Antwerp University Hospital from 2016 to 2023.

RESULTS

A total of 1470 patients was included with a crude mortality of 16.4 %, a median Revised Injury Severity Classification II (RISC II) adjusted mortality of 1.47 %, and a SMR of 1.12. A limitation of care directive was registered for 18.1 % of the patients. The causes of in-hospital death were traumatic brain injury (TBI) in 60 %, haemorrhagic shock in 15 %, organ failure in 10 %, miscellaneous in 14 % and unknown in 1 %. Sixty percent died in the first 48 h of hospital admission (mainly due to TBI and haemorrhagic shock) and 27 % died after more than seven days (mainly due to organ failure and TBI). In 24 % of the deceased patients with severe TBI, a non-TBI related cause of death was found. Overall, the SMR showed a nonsignificant decreasing trend, with a significant decrease of the SMR in the highest risk group (RISCII > 75 %) and a nonsignificant increase in the lowest risk group (RISC II <15 %).

CONCLUSION

The standardised mortality ratio declined over a period of 8 years, even though the SMR increased nonsignificantly in the lowest risk-adjusted mortality group. Future analysis of this subgroup could clarify whether this trend is due to an increase of limitation of care directives and if these deaths could have been prevented with improved trauma care. There might be opportunities to increase the survival of patients with severe TBI who have a non-TBI cause of death.

Evaluation of preheating methods for bulk-fill thermoviscous composite in non-carious cervical lesions: A 24-month randomized controlled trial

OBJECTIVE

This 24-month, double-blind, split-mouth randomized equivalence clinical trial compared the clinical performance of a bulk-fill thermoviscous composite resin using two different preheating methods for the restoration of non-carious cervical lesions (NCCLs).

MATERIAL AND METHODS

A total of 120 NCCLs were randomized into two groups (n = 60 each). In one group, a bulk-fill thermoviscous composite resin (VisCalor bulk, Voco GmbH) was preheated using a dispenser heater (DH, VisCalor Caps dispenser/warmer), while in the other group, the same resin was preheated with a bench heater (BH, Caps Warmer). In the BH group, the composite underwent preheating at 68 °C using a heating bench for 3 min while in the DH group, the composite was preheated at the same temperature for 30 s using a dispenser heater. Subsequently, the preheated bulk-fill thermoviscous composite resin was directly applied to the NCCLs. The restorations were evaluated at baseline, and after 6, 12, 18, and 24 months of clinical service using the FDI criteria. The total working time was recorded. The study used TOST-P to assess groups equivalence, Kaplan-Meier analysis for retention/fracture rate, log-rank test for secondary outcomes' survival distributions, and paired t-tests for comparing time per clinical step between groups (α = 0.05).

RESULTS

After 24 months, 106 restorations were evaluated. Four restorations were lost-two from the DH group and two from the BH group-resulting in similar retention rates for both groups (96.1%, 95% CI 86.8 - 98.9, p > 0.05). The hazard ratio was 0.83 (95% CI 0.26 to 2.72), indicating no significant difference between the groups (p > 0.05). All other FDI parameters were deemed clinically acceptable. However, the total working time for the BH group was significantly longer than that for the DH group (p < 0.001).

CONCLUSIONS

Both preheating protocols employed for the bulk-fill thermoviscous composite resin demonstrated high and equivalent survival rates after 24 months, the other FDI parameters were deemed clinically acceptable over the same period.

CLINICAL SIGNIFICANCE

Clinicians can choose either method for heating the thermoviscous composite resin for restoration of non-carious cervical lesions, as they do not impact important clinical outcomes after 24 months. The total working time for the bench heater is higher than that for the dispenser heater due to the need for preheating of the bench heater.

Perioperative complications in patients aged ≥85 years undergoing spinal surgery: a retrospective comparative study of pre-old and old patients in Japan

STUDY DESIGN

A retrospective comparative study.

PURPOSE

To compare the characteristics of perioperative complications in patients aged ≥85 years with those of younger patients undergoing similar spine surgery and examine factors associated with perioperative complications and clinical outcomes among patients aged ≥85 years.

OVERVIEW OF LITERATURE

The risk factors for perioperative complications and their effect on outcomes in patients aged ≥85 years remain unclear. Furthermore, no study has compared younger patients with similar surgeries and condition with those aged ≥85 years.

METHODS

The study included patients aged ≥65 years who underwent spinal surgeries. The patients aged ≥85, 75-84, and 65-74 years were categorized into the super-old, old, and pre-old groups, respectively. The differences in perioperative age-related complications were compared among the three groups while matching for surgical procedures and general conditions (study 1). Furthermore, preoperative and intraoperative factors were examined for perioperative complications in the super-old group (study 2). Complications were categorized into surgical site and systemic complications.

RESULTS

The analysis included 44 patients from each group. In study 1, the total complication rates were 40.9%, 25%, and 18.2% of the super-old, old, and pre-old groups, respectively. Differences in complication rates were observed between the super-old and pre-old groups (p=0.011). In study 2, 58 patients from the super-old group were analyzed. Surgical site complications were significantly associated with longer surgical duration (p=0.02) and more estimated blood loss (p=0.003). Systemic complications were significantly associated with previous cerebrovascular disease (p=0.014), preoperative motor deficit (p=0.023), and emergency case (p=0.006) and negatively associated with diabetes mellitus (p=0.048).

CONCLUSIONS

Perioperative complications increased with advancing age in the super-old, old, and pre-old groups. The complication type is associated with specific background factors; therefore, determining them may help prevent perioperative complications.

Assessment of ultrasound guided erector spinae plane block for early post-operative analgesia for modified radical mastectomy: a prospective, randomized, controlled study

Erector spinae plane block is a recently introduced block with a wide range of indications. The aim of the present study was to assess the efficacy and safety of ultrasound-guided erector spinae plane block on early post-operative pain relief in patients undergoing modified radical mastectomy. We conducted a prospective, randomized, controlled study in a tertiary care institute. Sixty-five patients were enrolled. Final analysis was performed on 58 patients randomized into two groups. Ultrasound-guided erector spinae plane block with 25 mL of 0.25% bupivacaine was given using a 18 gauge needle. No block was given in the other group. All patients received general anesthesia. Primary outcome measure was 24-hour analgesic consumption. Secondary outcome measures included intra-operative fentanyl consumption, time to first analgesic request, Visual Analog Scale score, nausea score, sedation score, wound quality and patient satisfaction score. Post-operative additional analgesics and intra-operative fentanyl were significantly reduced in patients receiving erector spinae plane block. Time to rescue analgesia was significantly delayed. Visual Analog Scale score was significantly lower at all time intervals. Post-operative nausea at various time intervals was also less. Patient satisfaction score was also noted on a 5-point scale and there was a statistical significant difference. We concluded that erector spinae plane block is a safe technique and provides good analgesia in breast surgery.

Enhancing Frailty Assessments for Transcatheter Aortic Valve Replacement Patients Using Structured and Unstructured Data: Real-World Evidence Study

Background

Transcatheter aortic valve replacement (TAVR) is a commonly used treatment for severe aortic stenosis. As degenerative aortic stenosis is primarily a disease afflicting older adults, a frailty assessment is essential to patient selection and optimal periprocedural outcomes.

Objective

This study aimed to enhance frailty assessments of TAVR candidates by integrating real-world structured and unstructured data.

Methods

This study analyzed data from 14,000 patients between January 2018 and December 2019 to assess frailty in TAVR patients at the University of Florida. Frailty was identified using the Fried criteria, which includes weight loss, exhaustion, walking speed, grip strength, and physical activity. Latent Dirichlet allocation for topic modeling and Extreme Gradient Boosting for frailty prediction were applied to unstructured clinical notes and structured electronic health record (EHR) data. We also used least absolute shrinkage and selection operator regression for feature selection. Model performance was rigorously evaluated using nested cross-validation, ensuring the generalizability of the findings.

Results

Model performance was significantly improved by combining unstructured clinical notes with structured EHR data, achieving an area under the receiver operating characteristic curve of 0.82 (SD 0.07), which surpassed the EHR-only model's area under the receiver operating characteristic curve of 0.64 (SD 0.08). The Shapley Additive Explanations analysis found that congestive heart failure management, back problems, and atrial fibrillation were the top frailty predictors. Additionally, the latent Dirichlet allocation topic modeling identified 7 key topics, highlighting the role of specific medical treatments in predicting frailty.

Conclusions

Integrating unstructured clinical notes and structured EHR data led to a notable enhancement in predicting frailty. This method shows great potential for standardizing frailty assessments using real-world data and improving patient selection for TAVR.

The number of comorbidities as an important cofactor to ASA class in predicting postoperative outcome: An international multicentre cohort study

BACKGROUND

Multimorbidity is a growing burden in our ageing society and is associated with perioperative morbidity and mortality. Despite several modifications to the ASA physical status classification, multimorbidity as such is still not considered. Thus, the aim of this study was to quantify the burden of comorbidities in perioperative patients and to assess, independent of ASA class, its potential influence on perioperative outcome.

METHODS

In a subpopulation of the prospective ClassIntra® validation study from eight international centres, type and severity of anaesthesia-relevant comorbidities were additionally extracted from electronic medical records for the current study. Patients from the validation study were of all ages, undergoing any type of in-hospital surgery and were followed up until 30 days postoperatively to assess perioperative outcomes. Primary endpoint was the number of comorbidities across ASA classes. The associated postoperative length of hospital stay (pLOS) and Comprehensive Complication Index (CCI®) were secondary endpoints. On a scale from 0 (no complication) to 100 (death) the CCI® measures the severity of postoperative morbidity as a weighted sum of all postoperative complications.

RESULTS

Of 1421 enrolled patients, the mean number of comorbidities significantly increased from 1.5 in ASA I (95% CI, 1.1-1.9) to 10.5 in ASA IV (95% CI, 8.3-12.7) patients. Furthermore, independent of ASA class, postoperative complications measured by the CCI® increased per each comorbidity by 0.81 (95% CI, 0.40-1.23) and so did pLOS (geometric mean ratio, 1.03; 95% CI, 1.01-1.06).

CONCLUSIONS

These data quantify the high prevalence of multimorbidity in the surgical population and show that the number of comorbidities is predictive of negative postoperative outcomes, independent of ASA class.

The colour stability of 3D-printed, non-invasive restorations after 24 months in vivo - esthetically pleasing or not?

OBJECTIVES

The aim of the present prospective study was to evaluate the colour stability of 3D-printed non-invasive restorations after 24 months in vivo.

METHODS

The study included 29 patients, who received 3D-printed restorations made of a computer-aided design (CAD) / computer aided-manufacturing (CAM) hybrid material (n = 354). Restoration colour of 190 restorations was measured using a spectrophotometer. By applying the CIELAB system, *L (lightness), a* (red-green) and b* (blue-yellow) values were recorded. An evaluation of the colour differences (ΔE) after 6, 12 and 24 months was conducted.

RESULTS

Analysis of colour differences of 3D-printed restorations showed continuous discolouration of the restorations. After one year 34 % and after two years 18 % of the restorations were rated alpha or bravo, indicating no or hardly visible colour change. After two years, 54 % of the evaluated restorations yielded a colour difference with ΔE > 6.8 (delta). More than 82 % of the evaluated restorations showed values between ΔE 3.8 - 6.8 (charlie) and ΔE ˃ 6.8 (delta) after two years.

CONCLUSIONS

3D-printed non-invasive restorations showed an overall reduced colour stability after 24 months in vivo.

CLINICAL SIGNIFICANCE

The present study provides first clinical data regarding 3D-printed restorations. These restorations are recommended for a wearing time of about 6 months.

Influence of different viscosity and chemical composition of flowable composite resins: A 48-month split-mouth double-blind randomized clinical trial

OBJECTIVES

To evaluate the clinical performance of two flowable composites based on methacrylate and one based on ormocer in treating non-carious cervical lesions (NCCLs) after 48-month evaluation in a split-mouth double-blind clinical study design.

METHODS

A total of 183 restorations were performed on NCCLs using a universal adhesive system (Futurabond U, Voco GmbH) with selective enamel etching on 27 participants: two participants received twelve restorations each, three received nine restorations each, and 22 participants received six restorations each. Three different flowable composites were employed (n = 61): a low-viscosity methacrylate-based composite (GrandioSO Flow, LVM), a high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HVM), and an ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 48 months. Statistical analysis was conducted using Kaplan-Meier Survival analysis and Kruskal-Wallis analysis of variance rank (α = 0.05).

RESULTS

After 48 months, 17 restorations were lost: LVM 6, HVM 9, ORM 2. The retention rates (95 % confidence interval) were 89.4 % for LVM, 80.4 % for HVM, and 95.6 % for ORM, with a significant difference between HVM vs. LVM and HVM vs. ORM (p < 0.05). Minor defects were observed in 30 restorations for marginal staining criteria (LVM 12, HVM 10, ORM 8) and in 71 restorations for marginal adaptation criteria (LVM 24, HVM 20, ORM 27) without significant difference between groups (p > 0.05). No restorations showed postoperative sensitivity or recurrence of caries.

SIGNIFICANCE

The increased viscosity of flowable composites could reduce the clinical longevity in NCCLs after 48 months. Ormocer-based and low-viscosity methacrylate-based flowable composites showed a successful clinical performance in NCCLs after 48 months.

Feasibility of completion thyroidectomy via transoral endoscopic vestibular approach

Transoral endoscopic thyroidectomy is widely utilized for treating benign conditions and low-risk thyroid cancers, yet its use for completion thyroidectomy, especially when performed more than 2 weeks after an initial lobectomy, is less understood. In this retrospective study, we assessed patients who underwent endoscopic completion thyroidectomy via the transoral route, examining operative data and complications from both the initial lobectomy and the subsequent completion thyroidectomy, along with the pathological and oncologic outcomes of the latter surgery. Among the ten patients diagnosed with papillary carcinoma following an initial lobectomy who underwent a completion thyroidectomy via the same transoral approach, the median interval between surgeries was 5.4 months, with 80% of cases exceeding 3 months. All procedures were completed endoscopically without necessitating an open conversion. In 40% of these patients, additional microcarcinomas were identified in the contralateral thyroid lobe. Although the median operative time for completion thyroidectomy was longer (249 min) compared to the initial lobectomy (220 min), and postoperative pain scores on days 1 and 2 were slightly higher, and these differences were not statistically significant. Blood loss, drainage amounts, and hospital stay lengths were similar between both surgeries. The only major complication was transient hypoparathyroidism, occurring in 20% of the completion group, with 80% of patients achieving suppressed thyroglobulin levels of < 0.2 ng/mL postoperatively. Our findings demonstrate the practicality of using the transoral endoscopic vestibular approach for completion thyroidectomy, even when conducted more than 3 months after the initial lobectomy.

Is it worth using the Comprehensive Complication Index over the Clavien-Dindo classification in elderly patients who underwent percutaneous nephrolithotomy?

PURPOSE

To compare the Comprehensive Complication Index (CCI) to the Clavien-Dindo classification (CDC) in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population.

METHODS

We conducted a retrospective cohort study involving patients 60 years and older who underwent PCNL at our Institution between 2009 and 2020. Postoperative complications were considered up to 30 days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications.

RESULTS

We included 244 patients with a median age of 65 [63-69] years. 15.6% presented postoperative complications, and 2.5% multiple complications. LOS had a correlation coefficient of 0.29 (p < 0.001) and ER admissions had a coefficient of 0.27 (p < 0.001) with both CDC and CCI. Cost of hospitalization based on CDC underestimated CCI-based cost of hospitalization in 0.8% (p = 0.049). Higher American Society of Anesthesiology (ASA) physical status (p = 0.02), Charlson Comorbidity Index (p = 0.008), Guy's classification (p = 0.005), and history of urinary tract infection (UTI, p = 0.047) exhibited significant correlations with postoperative complications.

CONCLUSION

Both CDC and CCI equally correlate with LOS and ER admissions following PCNL in elderly patients. However, CDC underestimates cost of hospitalization in comparison to CCI. We found higher ASA physical status, Charlson Comorbidity Index, Guy's classification, and history of UTI as predictors of postoperative complications after this procedure in this population.

Outcome of Centenarians with Hip Fracture: An Analysis of the Registry for Geriatric Trauma (ATR-DGU)

Background/Objectives: Outcomes for hip fracture patients have improved over the years, yet the population of older patients (≥80 years) continues to grow. By 2100, the global centenarian population is projected to exceed 25 million, but data on hip fracture outcomes in this group are rare and often derived from small samples. This study aimed to analyze outcomes for centenarian hip fracture patients in specialized geriatric trauma centers and compare them with those of patients under 80. Methods: We conducted a retrospective analysis of the AltersTraumaRegister DGU® from 2016 to 2022, including all proximal femur fracture data. Patients were categorized into two groups: under 80 years and centenarians. The primary outcome was in-hospital mortality, with secondary outcomes including quality of life, walking ability on postoperative day seven, length of hospital stay, readmission rates, and changes in living situations. Results: Among 14,521 patients, 316 were over 99 years old. In-house mortality was significantly higher in centenarians (15.44% vs. 3.58%; p < 0.001), with more discharged to nursing homes. After matching by the Geriatrics at Risk (GeRi) score, mortality differences diminished. Conclusions: While age is a risk factor for mortality, centenarian hip fracture patients' outcomes do not significantly differ from those aged ≤80 when considering other risk factors.

Long-Term Comparison Safety and Outcomes of Simultaneous Bilateral, Staggered Bilateral, and Staged Bilateral Total Knee Arthroplasty

BACKGROUND

The purpose of this study was to determine the safety and the clinical outcome of simultaneous bilateral, staggered bilateral, and staged bilateral total knee arthroplasty (TKA) performed by a single surgeon at one academic institute.

METHODS

We prospectively followed and retrospectively compared the results of 7,155 patients (14,310 knees) who had simultaneous bilateral TKA, 6,671 patients (13,342 knees) who had staggered bilateral TKA, and 4,501 patients (9,002 knees) who had staged bilateral TKA. The mean age of the patients was 67, 65, and 69 years, respectively. The mean follow-up was 15.5, 15.3, and 16.1 years, respectively. The prevalence of mortality and complications were assessed in each group. In addition, patients was assessed clinically and radiographically at each follow-up.

RESULTS

The mortality rate (14 patients, 0.2%) of the patients who underwent simultaneous bilateral TKA was similar to those who underwent staggered bilateral TKA (19 patients, 0.3%) and those who underwent staged bilateral TKA (18 patients, 0.4%) (P > 0.05). The major complication (except death) rate (0.8, 0.5, and 0.4%, respectively) and the minor complication rate (20.7, 19, and 19.6%, respectively) were not significantly different among the three groups (P > 0.05). There was no significant difference in the clinical outcomes, radiographic results, revision rate, or survivorship of TKA implants among the three groups (P > 0.05). Transfusion requirements were different among the three groups (10% in the simultaneous bilateral TKA group, 12% in the staggered bilateral TKA group, and 2% in the staged bilateral TKA group).

CONCLUSIONS

We found no significant differences among the simultaneous bilateral, staggered bilateral, and staged bilateral TKA groups, with regard to the mortality, major complication, minor complication, and revision rates; the survival of TKA implants; and clinical and radiographic results after a mean follow-up of 15.5, 15.3, and 16.1 years, respectively.

Risk Factors Associated with Progression to Surgery in Patients with Ischemic Colitis

Background/Aims

Ischemic colitis (IC), the most common ischemic syndrome affecting the gastrointestinal tract, results from a decreased blood supply to the colon. Persistent symptoms can lead to complications, necessitating surgery. This study assessed the clinical characteristics and risk factors for poor outcomes in IC.

Methods

This retrospective observational study examined the medical records of 141 patients diagnosed pathologically with IC via surgery or colonoscopy at Chonnam National University Hwasun Hospital between April 2004 and August 2023.

Results

Eighteen (12.8%) and 123 (87.2%) patients were diagnosed by surgical biopsy and biopsy with colonoscopy, respectively. Multivariate analysis identified right-sided colon involvement, fever, and the absence of hematochezia as risk factors for the progression to surgery (odds ratio [OR]=5.924, 95% confidence interval [CI] 1.009-34.767, p=0.049; OR=24.139, 95% CI 5.209-111.851, p<0.001; and OR=0.076, 95% CI 0.013-0.446, p=0.004, respectively). The in-hospital mortality was 5.7% (8/141), and the patients who died exhibited higher rates of shock. The median (interquartile range) hospital stay was 11 (1-219) days. Patients who had longer hospital stays (≥14 days) had a significantly higher rate of fever but a lower rate of hematochezia.

Conclusions

A multidisciplinary approach is crucial for determining the need for surgery in patients with right-sided colon involvement, fever, or the absence of hematochezia.

Sex differences in hemoglobin levels and five-year refracture risk in patients with osteoporotic fractures: a retrospective cohort analysis

We conducted a retrospective cohort analysis to examine the association between hemoglobin (Hb) levels and refracture risk in elderly patients with osteoporotic fractures (OPFs). Our findings suggest a nonlinear relationship exists in females, and females with Hb levels below 10.7 g/dL may be at a higher risk of refracture.

INTRODUCTION

Hematopoiesis and bone health have a reciprocal influence on each other. Nevertheless, there is a scarcity of in-depth research on the association between Hb levels and the occurrence of fractures. The present research aimed to investigate the correlation between Hb levels and the rate of refracture within 5 years among individuals with OPFs.

METHODS

A retrospective cohort analysis was undertaken between 2017 and 2022. The study included 1906 individuals who were inhabitants of Kunshan and were over 60 years old. These individuals had experienced an OPF between January 1, 2017, and July 27, 2022, resulting in their hospitalization. Cox proportional hazard regression models were used to evaluate the risk of refracture within 5 years based on the Hb levels acquired during the admission examination, with consideration for sex differences. A nonlinear relationship was identified using smoothed curve fitting and threshold analysis. Kaplan-Meier curves were used to compare refracture rates between patients with low and high Hb levels.

RESULTS

Elderly female patients with OPFs and lower Hb levels exhibited a significantly higher risk of a 5-year refracture. Conversely, no significant associations were observed between the two variables in male patients. A nonlinear correlation was found between Hb levels and the probability of refracture in females, with a turning point identified at 10.7 g/dL of Hb levels. A strong negative association was observed with the five-year refracture rate when Hb levels fell below 10.7 g/dL (hazard ratio (HR) = 0.63; 95% confidence interval (CI) 0.48 to 0.83; P-value = 0.0008). This finding suggests that for every 1 g/dL increase in Hb below 10.7 g/dL, the risk of refracture reduced by 37%. However, no statistically significant association was observed when Hb levels were above 10.7 g/dL.

CONCLUSIONS

The findings demonstrated a significant negative correlation between Hb levels and the likelihood of refracture in elderly female patients with OPFs and suggested that elderly females with recent OPFs and Hb levels below 10.7 g/dL may be at a higher risk of refracture. Additionally, the Hb levels can serve as an indicator of bone fragility in elderly female patients with OPFs. These findings highlight the importance of monitoring Hb levels as a part of comprehensive management strategies to both assess skeletal health and prevent refractures in this population.

First do no harm: Predicting futility of intervention in geriatric emergency general surgery

BACKGROUND

Emergent surgical conditions are common in geriatric patients, often necessitating major operative procedures on frail patients. Understanding risk profiles is crucial for decision-making and establishing goals of care.

METHODS

We queried NSQIP 2015-2019 for patients ≥65 years undergoing open abdominal surgery for emergency general surgery conditions. Logistic regression was used to identify 30-day mortality predictors.

RESULTS

Of 41,029 patients, 5589 (13.6 ​%) died within 30 days of admission. The highest predictors of mortality were ASA status 5 (aOR 9.7, 95 ​% CI,3.5-26.8, p ​< ​0.001), septic shock (aOR 4.9, 95 ​% CI,4.5-5.4, p ​< ​0.001), and dialysis (aOR 2.1, 95 ​% CI,1.8-2.4, p ​< ​0.001). Without risk factors, mortality rates were 11.9 ​% after colectomy and 10.2 ​% after small bowel resection. Patients with all three risk factors had a mortality rate of 79.4 ​% and 100 ​% following colectomy and small bowel resection, respectively.

CONCLUSIONS

In older adults undergoing emergent open abdominal surgery, septic shock, ASA status, and dialysis were strongly associated with futility of surgical intervention. These findings can inform goals of care and informed decision-making.

Prognostic value of stress CMR and SPECT-MPI in patients undergoing intermediate-to-high-risk non-cardiac surgery

PURPOSE

The objective of this study was to investigate the role of myocardial perfusion imaging (MPI) stress tests using stress cardiac magnetic resonance (sCMR) and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in non-cardiac surgery (NCS) pre-operatory management.

MATERIALS AND METHODS

This monocentric retrospective study enrolled patients with coronary artery disease or a minimum of two cardiovascular risk factors undergoing intermediate-to-high-risk non-cardiac surgeries. The primary composite endpoint comprised cardiac death, cardiogenic shock, acute coronary syndromes (ACS), and cardiogenic pulmonary edema occurring within 30 days after surgery, while the secondary endpoint was ACS.

RESULTS

A total of 1590 patients were enrolled; among them, 669 underwent a MPI stress test strategy (sCMR: 287, SPECT-MPI: 382). The incidence of 30-day cardiac events was lower in the stress-tested group compared to the non-stress-tested group (1.2% vs. 3.4%; p 0.006). Adopting a stress test strategy showed a significant reduction in the risk of the composite endpoint (OR: 0.33, 95% CI: 0.15-0.76, p 0.009) and ACS (OR: 0.41, 95% CI: 0.17-0.98, p 0.046) at multivariable analysis, with similar cardiac events rate between stress CMR and SPECT (1.1% vs. 1.3%, p 0.756). Stress CMR showed a greater accuracy to predict coronary artery revascularizations (sCMR c-statistic: 0.95, ischemic cut-point: 5.5%; SPECT c-statistic: 0.85, ischemic cut-point: 7.5%).

CONCLUSION

Stress test strategy is related to a lower occurrence of cardiac events in high-risk patients scheduled for intermediate-to-high-risk non-cardiac surgeries. Both sCMR and SPECT-MPI comparably reduce the likelihood of cardiac complications, albeit sCMR offers greater accuracy in predicting coronary artery revascularization.

Comparison of NLP machine learning models with human physicians for ASA Physical Status classification

The American Society of Anesthesiologist's Physical Status (ASA-PS) classification system assesses comorbidities before sedation and analgesia, but inconsistencies among raters have hindered its objective use. This study aimed to develop natural language processing (NLP) models to classify ASA-PS using pre-anesthesia evaluation summaries, comparing their performance to human physicians. Data from 717,389 surgical cases in a tertiary hospital (October 2004-May 2023) was split into training, tuning, and test datasets. Board-certified anesthesiologists created reference labels for tuning and test datasets. The NLP models, including ClinicalBigBird, BioClinicalBERT, and Generative Pretrained Transformer 4, were validated against anesthesiologists. The ClinicalBigBird model achieved an area under the receiver operating characteristic curve of 0.915. It outperformed board-certified anesthesiologists with a specificity of 0.901 vs. 0.897, precision of 0.732 vs. 0.715, and F1-score of 0.716 vs. 0.713 (all p <0.01). This approach will facilitate automatic and objective ASA-PS classification, thereby streamlining the clinical workflow.

Shorter prostatic urethral length in preoperative Magnetic Resonance Imaging is associated with higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy

Climacturia is defined as the leakage of urine during orgasm and it is an adverse effect of radical prostatectomy. Our goal was to determine if various preoperative MRI pelvic floor measurements were associated with the risk of climacturia following robot-assisted laparoscopic radical prostatectomy. For this purpose, we conducted a prospective study involving 57 patients who underwent robot-assisted laparoscopic radical prostatectomy. MRI measurements were analysed by 2 urologists and 2 radiologists. Follow-up was carried out at 3, 6, and 12 months using the Parra orgasmic function questionnaire. We analysed all measurements, along with other patient, surgery, and tumour characteristics, classifying patients into two groups based on the presence or absence of climacturia. A logistic regression model was applied among statistically significant variables. STROBE recommendations were taken into consideration. Shorter prostatic urethral length was associated with higher risk of climacturia at 3 months, OR = 0.83 (95%CI 0.688-0.98) (p = 0.024). Patients with climacturia at 6 months had greater median urethral width [12.66 mm, interquartile range (IQR): 11.77-13.55 vs 12.13 mm, IQR 11.08-13.18] (p = 0.02). Patients with climacturia at 12 months had a higher proportion of preoperative lower urinary tract symptoms (57.14% vs. 20%) (p = 0.026). In the logistic regression, the history of lower urinary tract symptoms was associated with a higher risk of climacturia, OR = 6.07 (95% CI 1.342-26.03) (p = 0.023). In conclusion, shorter prostatic urethral length in preoperative MRI and a history of lower urinary tract symptoms were associated with a higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

Admission Hemoglobin Associated with Increased Mortality in Hip Fracture Surgical Patients: An Observational Study

In hip fracture patients, who are mostly elderly, preexisting anemia can be worsened when combined with trauma and surgery. To this date, there is no unequivocal approach about transfusion thresholds. We analyzed hemoglobin (Hb) and hematocrit (Hct) levels at three time points in surgical patients with proximal femoral fractures (PFF) to see which levels were triggers for transfusions and whether transfusions were related to mortality after hospital discharge. A total of 956 patients were operated on from 1 January 2021 to 31 December 2022 at the University Hospital of Split and included in the study. There were more women (74%); 47% patients had admission Hb < 120 g/L. Transfusion was given preoperatively to 88, intraoperatively to 74 and postoperatively to 309 patients. Transfusion thresholds were as follows: Hb 84 g/L preoperatively, 99 intraoperatively and 83 postoperatively. After hospital discharge, 10.79% of patients died within the 1st month and 23% within 6 months. In the group of non-survivors, 60% of patients had admission Hb ≤ 117 g/L and the proportion of patients transfused preoperatively was two times higher. Preoperative transfusion thresholds could be set to higher levels for patients with surgically treated PFF. However, that could increase mortality even more. Further investigation is necessary.

Ultrasound predictive parameters of difficult airway in thyroid surgery: a pilot study

Difficult airway is a major life-threatening complication during induction of general anesthesia. In thyroid surgery, intubation could be complicated by airway distortion because of the enlarged thyroid gland. Recently, ultrasonography has been proposed as a potential modality for airway assessment and management. The aim of the study is to evaluate ultrasound-based measurement of airway parameters in 13 selected patients with compressive goiter and tracheal deviation scheduled for thyroidectomy before induction of general anesthesia. Specifically, we detected the distance between the skin and retro-isthmic trachea (DSRIT) and the distance between the sub isthmic trachea and the carotid artery (DCSIT) at the side of the dominant lobe. We compared ultrasound measures before intubation with Cormack-Lehane laryngoscopes grades recorded during tracheal intubation.

The Effectiveness of the Gnana Laryngeal Mask Airway II (GLA-II) With Novel Suction Tubing in Gastrointestinal (GI) Cases

INTRODUCTION

The Gnana laryngeal mask airway II (GLA-II) is a supraglottic airway device similar to the classic laryngeal mask airway, except it has an additional suction port. This suction port allows for the removal of secretions and saliva. A previous version of the Gnana laryngeal airway 4 was made of silicone, while this newer version is made of polyvinyl chloride (PVC), which is more affordable. This study aimed to demonstrate the effectiveness and tolerability of this PVC-designed GLA-II and evaluate its ability to suction secretions.

METHODS

The prospective cohort study included 100 gastrointestinal (GI) cases to determine the effectiveness and toleration of the GLA-II. The American Society of Anesthesiologists (ASA) class 1-3 patients were evaluated with a Mallampati airway score for GI-related procedures. After anesthesia induction with propofol, the GLA-II was inserted, and the time for successful insertion was recorded. All cases were completed within 62 minutes. During this time, the secretion volumes were also measured.

RESULTS

One hundred patients were included in the study: 52% were males and 48% were females. Thirty-four patients were scored as ASA class 1 or 2, while 66 were scored as ASA class 3. The GLA-II insertion was successful on the first attempt in 92 patients, and a second attempt was necessary for six patients. It was unsuccessful in two patients. The average time for successful insertion was 28.3 ± 4.3 seconds. The average amount of saliva suctioned was 9.3 ± 2.6 mL. There were no intraoperative or postoperative complications during these cases.

CONCLUSION

The PVC GLA-II device is distinguished by its ability to allow suctioning during placement. With an adequate epiglottic seal, it can be safely and successfully inserted in a short period of time. More research should be conducted to explore the use of GLA-II devices in other settings, such as emergencies and life-saving scenarios.

Association between preoperative fasting time and clinical outcomes in surgical patients in a private general hospital

PURPOSE

Surgical patients are routinely subjected to long periods of fasting, a practice that can exacerbate the metabolic response to trauma and impair postoperative recovery. The aim of this study was to evaluate the association between preoperative fasting time and clinical outcomes in surgical patients.

METHODS

An observational, prospective study with a non-probabilistic sample that included patients of both sexes, aged over 18, undergoing elective surgeries. Data were extracted from electronic medical records, and a questionnaire was applied in 48 hours after surgery. Variables related to postoperative discomfort were assessed using an 11-point numeric rating scale.

RESULTS

The sample consisted of 372 patients, and the duration of the surgical event ranged from 30-680 minutes. The incidence of nausea (26.34%) was twice that of vomiting (13.17%) and showed an association with the surgical procedure's size (p = 0.018). A statistically significant difference was observed only between pain intensity and preoperative fasting times for liquids (p = 0.007) and postoperative fasting time (p = 0.08). The occurrence of postoperative complications showed no association with preoperative fasting time (p = 0.850).

CONCLUSIONS

Although no association was observed between preoperative fasting time and surgical complications, it is noteworthy that both recommended and actual fasting time exceeded the proposed on clinical guidelines.

Efficacy of Ultrasound-Guided Intercostal Nerve Block on Pain Management and Physiological Outcomes in Breast Cancer Mastectomy: A retrospective study

To evaluate the efficacy of ultrasound-guided intercostal nerve block in managing pain and physiological responses in patients undergoing radical mastectomy for breast cancer. A retrospective study analyzed 120 patients scheduled to undergo radical mastectomy in our hospital between January 2022 and December 2023. Depending on the type of anesthesia received, participants were assigned to the experimental group (60 patients) to receive ultrasound-guided intercostal nerve block and intravenous general anesthesia, or the control group (60 patients) to receive intravenous general anesthesia only. Both groups will utilize patient-controlled intravenous analgesia (PCIA) postoperatively. We will monitor and compare hemodynamic parameters, SpO2, and bispectral index (BIS) at multiple time points, and assess postoperative pain, inflammatory markers, PCIA utilization, and adverse reaction incidence. Comparative analysis showed distinct trends in heart rate, mean arterial pressure (MAP), BIS, and SpO2 across various surgical stages between groups. Notably, MAP values were consistently higher and less variable in the experimental group during surgery (P < .05). Pain assessments at 4, 12, and 24 hours postoperatively in both quiet and coughing states revealed significantly milder pain in the experimental group (P < .05). Preoperative inflammatory markers (PGE2, TNF-α, IL-6, MCP-1) were similar between groups; however, 24 hours post-surgery, the experimental group showed significantly lower levels of PGE2, IL-6, and MCP-1 (P < .05). Sufentanil consumption during surgery and PCIA use were notably lower in the experimental group (P < .05). The experimental group also experienced fewer anesthesia-related adverse reactions (8.33%) compared to the control group (25.00%) (P < .05). Ultrasound-guided intercostal nerve block significantly improves hemodynamic stability, reduces postoperative inflammatory markers, lowers the need for sufentanil, and minimizes adverse reactions in patients undergoing radical mastectomy for breast cancer.

Clinical performance of posterior restorations using a universal adhesive over moist and dry dentin: A 36-month double-blind split-mouth randomized clinical trial

OBJECTIVES

To evaluate the influence of dentin moisture on the clinical behavior of a universal adhesive on posterior teeth after 36 months of follow-up.

METHODS

Forty-five patients participated in this study. Following a split-mouth design, three operators placed 90 Class I/Class II restorations over moist dentin (MD) or dry (DD) (n = 45) with resin composite (Filtek Bulk Fill) and a universal adhesive used in the etch-and-rinse mode (Single Bond Universal). Each restoration was evaluated according to the FDI and USPHS criteria (postoperative sensitivity, fracture and retention, marginal staining, marginal adaptation, and recurrence of caries) at baseline and after 6-, 12-, and 36 months. For statistical analysis, Kruskal Wallis analysis of variance rank (α = 0.05) and Kaplan-Meier survival analysis were used.

RESULTS

No significant difference between groups was observed in each FDI criterion after 36 months of clinical evaluation (p > 0.05). The retention rates (confidence interval 95 %) were 97.37 % (86.5 - 99.5) for both MD and DD without significant difference between them (p > 0.05). Eight restorations (MD = 4; DD = 4) showed minimal marginal staining defects (p > 0.05). Two restorations were lost (MD = 1; DD = 1). Fifteen restorations (MD = 8; DD = 7) presented minor marginal discrepancies according to the FDI criteria (p > 0.05).

CONCLUSION

The clinical performance of the universal adhesive when applied in etch-and-rinse mode was not influenced by dentin moisture in posterior bulk-fill composite restorations.

CLINICAL SIGNIFICANCE

The level of dentin moisture appears not to influence the clinical efficacy of a universal adhesive when applied using the etch-and-rinse technique in posterior composite resin restorations.

Risks for prolonged mechanical ventilation and reintubation after cervical malignant tumor surgery: a nested case-control study

PURPOSE

Prolonged mechanical ventilation (PMV) and reintubation are among the most serious postoperative adverse events associated with malignant cervical tumors. In this study, we aimed to clarify the incidence, characteristics, and risk factors for PMV and reintubation in target patients.

METHODS

This retrospective nested case-control study was performed between January 2014 and January 2020 at a large spinal tumor center in China. Univariate analysis was used to identify the possible risk factors associated with PMV and reintubation. Logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) with covariates of a probability < 0.05 in univariate analysis.

RESULTS

From a cohort of 560 patients with primary malignant (n = 352) and metastatic (n = 208) cervical tumors, 27 patients required PMV and 20 patients underwent reintubation. The incidence rates of PMV and reintubation were 4.82% and 3.57%, respectively. Three variables (all p < 0.05) were independently associated with an increased risk of PMV: Karnofsky Performance Status < 50 compared to ≥ 80, operation duration ≥ 8 h compared to < 6 h, and C4 nerve root encased by the tumor. Longer operative duration and preoperative hypercapnia (all p < 0.05) were independent risk factors for postoperative reintubation, both of which led to longer length of stay (32.6 ± 30.8 vs. 10.7 ± 5.95 days, p < 0.001), with an in-hospital mortality of 17.0%.

CONCLUSION

Our results demonstrate the risk factors for PMV or reintubation after surgery for malignant cervical tumors. Adequate assessment, early detection, and prevention are necessary for this high-risk population.

Large Language Model Capabilities in Perioperative Risk Prediction and Prognostication

Importance

General-domain large language models may be able to perform risk stratification and predict postoperative outcome measures using a description of the procedure and a patient's electronic health record notes.

Objective

To examine predictive performance on 8 different tasks: prediction of American Society of Anesthesiologists Physical Status (ASA-PS), hospital admission, intensive care unit (ICU) admission, unplanned admission, hospital mortality, postanesthesia care unit (PACU) phase 1 duration, hospital duration, and ICU duration.

Design, Setting, and Participants

This prognostic study included task-specific datasets constructed from 2 years of retrospective electronic health records data collected during routine clinical care. Case and note data were formatted into prompts and given to the large language model GPT-4 Turbo (OpenAI) to generate a prediction and explanation. The setting included a quaternary care center comprising 3 academic hospitals and affiliated clinics in a single metropolitan area. Patients who had a surgery or procedure with anesthesia and at least 1 clinician-written note filed in the electronic health record before surgery were included in the study. Data were analyzed from November to December 2023.

Exposures

Compared original notes, note summaries, few-shot prompting, and chain-of-thought prompting strategies.

Main Outcomes and Measures

F1 score for binary and categorical outcomes. Mean absolute error for numerical duration outcomes.

Results

Study results were measured on task-specific datasets, each with 1000 cases with the exception of unplanned admission, which had 949 cases, and hospital mortality, which had 576 cases. The best results for each task included an F1 score of 0.50 (95% CI, 0.47-0.53) for ASA-PS, 0.64 (95% CI, 0.61-0.67) for hospital admission, 0.81 (95% CI, 0.78-0.83) for ICU admission, 0.61 (95% CI, 0.58-0.64) for unplanned admission, and 0.86 (95% CI, 0.83-0.89) for hospital mortality prediction. Performance on duration prediction tasks was universally poor across all prompt strategies for which the large language model achieved a mean absolute error of 49 minutes (95% CI, 46-51 minutes) for PACU phase 1 duration, 4.5 days (95% CI, 4.2-5.0 days) for hospital duration, and 1.1 days (95% CI, 0.9-1.3 days) for ICU duration prediction.

Conclusions and Relevance

Current general-domain large language models may assist clinicians in perioperative risk stratification on classification tasks but are inadequate for numerical duration predictions. Their ability to produce high-quality natural language explanations for the predictions may make them useful tools in clinical workflows and may be complementary to traditional risk prediction models.

Early Implant Failure in Patients Using Antihypertensive Medications: A Retrospective Cohort Study

INTRODUCTION AND AIMS

Antihypertensive medications increase osteoblasts differentiation and bone mineral formation. Osseointegration of dental implants depends on new bone formation and remodelling. Consequently, improved osseointegration may be speculated in patients receiving antihypertensive drugs. Aim - Asses the effect of antihypertensive medications on osseointegration of dental implants.

METHODS

Retrospective cohort study. All individuals (792) who received at least one dental implant during a 6-year period at a single medical centre. The cohort was divided into three groups: normotensive (74.8% - 593) patients (NT group), hypertensive (23.4% - 185) patients using antihypertensive medications (HTN +med group), and hypertensive patients not using (1.8% - 14) antihypertensive medications (HTN -med group). Interventions-Installation of dental implants by experienced oral and maxillofacial surgeons with or without bone augmentation. Main measures - Early implant failure (EIF) (≤12 months from loading) reflects lack of new bone formation or excessive bone turnover during osseointegration.

RESULTS

The study included 792 individuals, 14 in the HTN-med group, 185 in the HTN +med group and 593 in the NT group. At the patient level, the HTN -med group were most likely (P = .041) to experience EIF 28.60% (4/14 patients). Due to the small sample of the HTN -med group, an additional analysis was carried out excluding this group. EIF of 9.70% (18/185 patients) in the HTN +med group was significantly (P = .047) lower than the NT group 14.50% (86/593 patients). 2971 implants were inserted in all study groups, 71.4% (2123) in the NT group, 26.4% (784) in the HTN +med group and 2.2% (64) in the HTN -med group. Collectively, EIF was recorded for 114 (3.84%) implants. In the HTN -med group, EIF of 6.25% (4 implants), was significantly (P < .001) higher than the two other groups. The EIF rate of the HTN +med group was 2.29% (18 implants) which was significantly less than that of the NT group 4.33% (92 implants). Controlling modifying parameters, using antihypertensive medication yielded lower EIF with marginal significance (P = .059) and OR = 0.618.

CONCLUSION

Based on statistically significant lower EIF rate found in the HTN +med group, antihypertensive medications may decrease the EIF rate of dental implants.

CLINICAL RELEVANCE

Clinicians should be encouraged to treat hypertensive patients with implant-supported prostheses, provided patient compliance regarding medications intake is good.