Protein-energy malnutrition remains frequently unrecognised, under-reported, and undertreated in surgical populations despite being associated with a higher risk of postoperative complications. This systematic review evaluated the diagnostic agreement between the Global Leadership Initiative on Malnutrition (GLIM) operational criteria and the Subjective Global Assessment for identifying adults at risk of preoperative protein-energy malnutrition undergoing elective surgery. MEDLINE, Embase, CINAHL, and Web of Science were searched from inception to 5 May 2025. Substantial heterogeneity was observed across eight included studies (n=5834) in the definitions, cut-offs, and measurement methods for GLIM phenotypic and aetiologic criteria. In six noncardiac surgical studies (n=3999), pooled sensitivity and specificity were 76% (95% confidence interval [CI] 69–81%) and 88% (95% CI 77–94%), respectively, using a random-effects bivariate model (very low certainty of evidence). Overall diagnostic agreement was fair; thus, the GLIM criteria alone may be insufficient to make the diagnosis of malnutrition and to guide nutritional interventions without additional clinical or dietetic assessment.
Background Patient-centred care increasingly encourages patients to participate in decisions regarding their anaesthetic management. However, whether expressing a preference regarding their anaesthetic management is associated with improved postoperative recovery remains unknown. We evaluated the association between preference expression and quality of recovery after noncardiac surgery. Methods In this prospective partially randomised patient-preference study conducted at two academic hospitals, adults undergoing minimally invasive abdominal, urologic, or gynaecologic surgery received standardised information on opioid-based and opioid-free anaesthesia, co-developed with patient partners. Participants expressing a preference received their preferred strategy, whereas those without a preference were randomised 1:1 to either strategy. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 1. Results Among 220 analysed participants, 177 (80.5%) expressed a preference, and 43 (19.5%) underwent random allocation. Mean [standard deviation] QoR-15 scores on POD 1 were higher among participants expressing a preference than among randomised participants (108.8 [18.2] vs 100.8 [23.5]), with an unadjusted mean difference of 7.9 points (95% confidence interval [CI] 1.5–14.4; P=0.017). The adjusted marginal mean difference was 7.1 points (95% CI 0.3–13.9; P=0.042). Scores on the QoR-15 also remained higher on POD 2. Sensitivity analyses showed consistent effect estimates but attenuated statistical significance. Secondary outcomes, including postoperative nausea and vomiting and bradycardia, were similar between groups. Conclusions Expression of a preference regarding intraoperative opioid management was associated with better reported early postoperative patient-reported recovery. Given the non-randomised comparison and limited precision, -generating and support further investigation into the role of patient-preference expression in perioperative recovery. Trial registration The full, long-term study is pre-registered at ClinicalTrials.gov (identifier, NCT06855641; first posted, 3 March 2025; Alexandre Joosten). https://clinicaltrials.gov/study/NCT06855641.
Background It is recommended that patients receiving emergency surgery and with ‘high-risk' of morbidity and mortality should be transferred directly from theatre to critical care. Using a national, population-based cohort study, we estimated the effect of direct transfer to critical care on 90-day mortality after emergency colorectal cancer resection, and the variation amongst English NHS hospitals. Methods Patients who underwent emergency colorectal cancer resection between December 2016 and November 2019 according to Hospital Episodes Statistics, National Bowel Cancer Audit or National Emergency Laparotomy Audit were included. Patients were identified as having a direct transfer to critical care through linkage with the Intensive Care National Audit and Research Centre Case Mix Programme. Multivariable logistic regression and propensity score methods were used to measure the effect of direct transfer to critical care on 90-day mortality. Results In total, 10,441 patients underwent an emergency colorectal cancer resection. Unadjusted 90-day mortality was higher in the direct transfer to critical care cohort (10.9%) than in patients without direct transfer to critical care (3.7%) (odds ratio [OR]: 3.16, 95% confidence interval [CI]: 2.65–3.77). There was no evidence of an association after risk adjustment (adjusted OR: 1.16, 95% CI: 0.94–1.43) or after propensity score analysis (weighted OR: 0.94, 95% CI: 0.69–1.27). For patients at high risk with a predicted mortality ≥5%, the proportion of patients with a direct transfer to critical care varied widely amongst hospitals (interquartile range 68%–92%; median 83%). Conclusions Our findings suggest that apparent higher postoperative mortality in patients having direct transfer to critical care can be mostly explained by characteristics of patients, tumours, physiology and surgery. However, the extent to which direct transfer to critical care is used varies widely amongst hospitals. Further work to understand this variation has the potential to improve patient outcomes after emergency colorectal cancer resection.
Background Prehabilitation optimises patients’ physical, nutritional, and psychological readiness before major surgery, but remains largely absent from Austrian clinical practice. We aimed to identify stakeholder-perceived barriers to prehabilitation implementation and assess the readiness of the healthcare system. Methods An exploratory qualitative study using semi-structured interviews was conducted with eight purposively sampled stakeholders representing anaesthesiology (n=2), surgery (n=2), outpatient cardiology (n=1), clinical psychology (n=1), physiotherapy (n=1), and health insurance administration (n=1). Interviews conducted between February and March 2024 were analysed using descriptive thematic content analysis and mapped to the Consolidated Framework for Implementation Research. Results Six themes emerged: attitudes towards prehabilitation, work environment, healthcare system structure, economic factors, cultural factors, and politics, evidence, and guidelines. Despite unanimous recognition of clinical value, knowledge of prehabilitation varied widely. Critical barriers included the structural and financial separation between inpatient and outpatient sectors, the absence of reimbursement mechanisms, workforce shortages, organisational inertia, and limited advocacy by professional societies. Consolidated Framework for Implementation Research mapping identified barriers across all five domains, with outer setting barriers—particularly fragmented financing and the absence of national guidelines—being the most prominent. Conclusions These exploratory findings reveal conceptual, systemic, and cultural barriers to prehabilitation in Austria. The simultaneous absence of integrated financing, professional society advocacy, and coordinated governance may explain Austria’s particularly limited uptake compared to that in the UK and the Netherlands. These findings are hypothesis-generating and require validation through larger-scale qualitative studies, quantitative surveys, and pilot implementation trials that include patient perspectives and economic modelling.
Background: Patients with obesity are at an increased risk of postoperative pulmonary complications and impaired lung function after general anaesthesia. Although higher levels of PEEP combined with recruitment manoeuvres may improve intraoperative respiratory mechanics, their effect on postoperative lung function remains uncertain. We evaluated whether high PEEP with recruitment manoeuvres improves postoperative spirometry in obese patients undergoing abdominal surgery. Methods: This single-centre substudy of the Protective Ventilation in Obese Patients randomised controlled trial was conducted at Ghent University Hospital, Belgium. Adults with a BMI of ≥35 kg·m −2 undergoing abdominal surgery were randomised to high PEEP (12 cm H 2 O) with recruitment manoeuvres or low PEEP (4 cm H 2 O) without routine recruitment manoeuvres. Both groups received low tidal volume ventilation (7 mL·kg −1 predicted body weight). The primary outcome was the change in forced expiratory volume in 1 s (FEV 1 ) from baseline to postoperative day 1. Secondary outcomes included changes in spirometry variables and oxygen saturation. Results: Postoperative spirometry data were available for 44 patients (23 low PEEP, 21 high PEEP). Postoperative lung function declined in all patients. The change in FEV 1 from baseline to postoperative day 1 did not differ between the low- and high-PEEP groups (−0.90 [0.68] L vs −0.93 [0.66] L; between-group effect 0.0 L; 95% confidence interval −0.4 to 0.4 L; P =0.89). No differences were observed in secondary outcomes. Conclusions: In obese patients undergoing abdominal surgery with low tidal volume ventilation, high PEEP with recruitment manoeuvers did not improve postoperative spirometric outcomes or oxygen saturation compared with low PEEP without routine recruitment manoeuvres. Trial registration: ClinicalTrials.gov , NCT02148692.
