Clinically relevant postoperative nausea remains common after gynecologic laparoscopic surgery despite prophylaxis. We evaluated preoperative oral olanzapine 5 mg added to routine ondansetron prophylaxis. In this prospective, multicenter, randomized, double-blind, placebo-controlled trial, 180 adults received olanzapine 5 mg or matching placebo orally 2 h before anesthesia; all received intravenous ondansetron 8 mg. The primary outcome was nausea rated ≥ 4 on an 11-point verbal rating scale at 60 min in the post-anesthesia care unit (PACU) and at 6, 12, and 24 h. Four time-specific comparisons were assessed using two-sided Fisher’s exact tests with Holm adjustment; risk ratios (RRs) and Bonferroni-adjusted 98.75
Artificial intelligence (AI) is increasingly evaluated for risk prediction, decision support, and monitoring across surgical care, but improved model performance does not necessarily prevent patient harm. This narrative review asks whether perioperative AI reduces preventable harm, which new hazards it may introduce, and what evidence is required to establish safe clinical use. We distinguish demonstrated patient outcomes from intermediate physiological, predictive, and operational measures. A structured narrative literature search was undertaken in PubMed/MEDLINE, Scopus, Embase, and Web of Science to identify relevant perioperative AI publications. The Scale for the Assessment of Narrative Review Articles (SANRA) was used as a quality-appraisal framework for the narrative review, rather than as a study-selection or systematic-review reporting methodology. The search and selection process was descriptive rather than systematic; no formal risk-of-bias assessment or pooled effect estimation was performed. Of the 90 publications included in this narrative review, 68 (75.6
Postoperative complications significantly impact recovery and overall health in frail and older patients undergoing hip fracture surgery. This study aims to determine the predictors associated with severe complications, as classified by the Clavien-Dindo system (grade ≥ 3). A retrospective cohort study was conducted on patients aged ≥ 65 years who underwent hip fracture surgery from January 2019 to December 2024. We assessed complication severity using the Clavien-Dindo classification, categorizing cases as minor (grade < III) or severe (grade ≥ III). Logistic regression analyses were performed to identify factors independently associated with severe complications, and a corresponding risk estimation model was developed. Among 417 analyzed patients, 22 (5.3
A recent taxonomy distinguished risky surgery, the risky surgeon, and the risk-taking surgeon, separating risk arising from the procedure from risk arising from the individual performing it. We argue that an essential dimension is missing from this taxonomy: time. Surgical risk is not a fixed property of an operation or an operator; it evolves as a surgeon accumulates experience, judgment, and technical competence. We propose that the taxonomy is better understood as a developmental trajectory than a static classification, and we distinguish two surgeons who may look identical on outcomes alone: the developmental risky surgeon, a trainee on a learning curve who recognizes limitations, seeks help, and improves with feedback, and the problematic risky surgeon, who repeats preventable errors and resists feedback. We further argue that the “risk-taking surgeon” is better understood as the risk-calibrated surgeon — an expert whose distinguishing skill is not a greater appetite for risk but a superior ability to judge which risks are worth taking. We relate this individual-level calibration to the organisational principles of high-reliability healthcare and to recent evidence on surgical never-events, unnecessary surgery, and decision support for difficult operations. We outline the practical implications of this reframing for training, supervision, assessment, and credentialing.
Abstract Background Postoperative anaesthesia visits after inpatient procedures guarantee a comprehensive assessment of the patient’s status. As the number of outpatient surgical cases in hospitals increases, more patients are recovering at home. Telemedicine may provide an efficient and effective link between anaesthesiologists and patients at home without restricting their freedom and self-determination. Methods After an initial acceptance survey, a single-arm, observational pilot study piloted an optional postoperative anaesthesia visit for patients undergoing outpatient surgery under general anaesthesia. It was implemented using videochats and patient-reported outcome measure (PROM) questionnaires. Results Of the 300 people initially surveyed in the initial acceptance survey, nearly two-thirds (62.0%) expressed interest in using videochats to contact an anaesthesiologist after discharge. One hundred patients ( n = 100) were included in the subsequent observational pilot study. The offer of an optional postoperative visit was used by 65 participants ( n = 65, 65%). Videochats were considered a reliable tool for communicating medical issues and perceived as superior to telephone calls. The use of PROM questionnaires was considered meaningful by more than 80% of participants. Sixty-two of the sixty-five participants considered the postoperative anaesthesia visit a useful and beneficial part of the treatment and recovery process. Conclusions Postoperative anaesthesia visits via videochat combined with PROM questionnaires after outpatient surgery were successfully piloted and consistently perceived positively by participants. Telemedicine-assisted postoperative anaesthesia visits may be a feasible component of patient-centred care in settings with limited resources. Trial registration German Clinical Trials Register; https://drks.de/search/en; registration number: DRKS00028755, registration date: 26th January 2023.
