Prehabilitation is a process for optimizing preoperative functional capacity, yet its implementation efficiency and patient adherence remain challenging. This study aimed to develop a short home-centered multimodal prehabilitation program administered via a digital platform and to preliminarily evaluate changes in preoperative functional capacity and patient adherence among patients scheduled for major elective surgery. This prospective single-arm trial included patients who were candidates for major surgery. A web-based prehabilitation program was established using a cloud-based mobile application to deliver individualized interventions, including medical and lifestyle guidance, aerobic exercise, resistance training, respiratory training, nutritional support, and psychological support. The absolute change in the six-minute walk distance (6MWD) from the initial assessment to the immediate preoperative day was defined as the primary study endpoint. Secondary outcomes included changes in body mass index (BMI); the rate of smoking cessation; grip strength; pulmonary function; the Duke Activity Status Index (DASI); the Nutritional Risk Screening 2002 (NRS-2002); the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale (FRAIL scale); and the Hospital Anxiety and Depression Scale (HADS). Adherence was quantified using backend data from the application. The statistical association between changes in the 6MWD and adherence was tested, and multivariable linear regression was conducted to evaluate the associations between adherence and clinical characteristics. Forty patients were analyzed. Compared with the baseline, the preoperative 6MWD significantly increased (mean difference = 33.36 m, 95
The lack of a globally standardized tool for assessing patient recovery in the Post-Anesthesia Care Unit (PACU) leads to inconsistent discharge practices and complicates clinical decision-making. This narrative review synthesizes the evolution, core characteristics, advantages, and limitations of the major PACU recovery assessment tools developed worldwide. By providing a comparative analysis and linking these tools to key perioperative outcomes where evidence exists, this work offers an evidence-based framework to guide the selection of appropriate instruments in clinical practice. Furthermore, it critically appraises the current evidence base to inform the future adaptation and development of standardized recovery assessment protocols that are both scientifically rigorous and contextually feasible, with a particular emphasis on addressing the needs of perioperative care settings in China.
Hypercoagulable states (HCS) have been demonstrated to confer an elevated risk of complications such as thromboembolism following arthroplasty procedures; however, their influence on perioperative outcomes in cervical spinal fusion (CF) remains unclear. This study aims to determine the impact of hypercoagulable states on perioperative complications, healthcare resource utilization, and in-hospital mortality in patients undergoing cervical spinal fusion surgery. Adult inpatients undergoing cervical fusion between 2013 and 2022 were retrospectively identified from the National Inpatient Sample (NIS) database. Hypercoagulable states were ascertained via validated ICD-9-CM/ICD-10 diagnostic codes. Propensity-score matching (PSM) was employed to mitigate confounding factors. Primary endpoints encompassed medical and surgical complications, length of stay (LOS), total charges, and mortality. Univariate and multivariate logistic regression analyses were fitted to evaluate the association between hypercoagulable states and each outcome. All outcomes were identified using ICD codes and represent coded inpatient events from an administrative database, not clinically adjudicated complications. For pre-PSM analyses, complex-samples procedures were applied to account for NIS discharge weights and hospital-level clustering, ensuring nationally representative estimates. Post-PSM analyses were unweighted and estimate associations within the matched analytic sample, not nationally weighted population-average effects. Among 333,922 patients undergoing cervical fusion surgery, 1115 (prevalence 0.33
Intraoperative hypotension is a common occurrence during general anaesthesia that has consistently been associated with perioperative organ injury. While international consensus guidelines increasingly advocate for maintaining absolute mean arterial pressure thresholds to mitigate this risk, it remains unclear whether these safety recommendations have translated into measurable changes in routine clinical practice. This study aimed to evaluate temporal trends in the burden of hypotension exposure among adults undergoing major non-cardiac surgery. We conducted a retrospective single-centre cohort study of adults undergoing major non-cardiac surgery at a tertiary academic centre between May 2019 and December 2024. The primary outcome was the time-weighted average mean arterial pressure < 65 mm Hg (TWA MAP < 65 mm Hg), a composite metric integrating severity and duration of hypotensive exposure. Secondary outcomes included the incidence, frequency, and cumulative duration of hypotensive episodes. Temporal trends were assessed using Mann–Kendall tests, and multivariable mixed-effects regression models were constructed to quantify changes over time while adjusting for confounding variables, including patient demographics, comorbidities, and surgical specialty. A total of 5,872 patients were included in the final analysis. The primary outcome decreased by 41
Effective postoperative pain management is critical after laparoscopic radical gastrectomy. Magnesium sulfate, an N-methyl-D-aspartate receptor antagonist, may potentiate local anesthetic effects. This study evaluated whether adding magnesium sulfate to ropivacaine in a transversus abdominis plane block (TAPB) improves analgesia. In this prospective, double-blind, randomized trial, 168 patients (ASA II–III) scheduled for elective laparoscopic radical gastrectomy received bilateral TAPB, with 20 mL solution injected per side; patients were allocated to receive 0.33
Prolonged length of stay (PLOS) following anterior cervical discectomy and fusion (ACDF) is associated with increased hospital burden. While surgical and comorbidity-related factors have been widely studied, routinely documented non-surgical and social variables are less consistently reported. This study evaluated univariable associations between these factors and PLOS after ACDF. A retrospective analysis of 1,719 ACDF procedures performed between 2012 and 2022 at a single tertiary centre was conducted. Fifteen preoperative non-surgical and social variables were collected from routine records. PLOS was defined as > = 72 h. Chi-squared tests and unadjusted odds ratios (ORs) were used to evaluate associations with PLOS. No multivariable adjusted model was performed. PLOS occurred in 9.89
Armed conflict poses a growing threat to the continuity of essential health services worldwide. While preparedness frameworks often focus on trauma response and emergency medicine, considerably less attention has been given to maintaining routine and urgent surgical care during prolonged security crises. Surgical services are essential components of health systems, addressing trauma, oncologic disease, infections, obstetric emergencies, and complications of non-communicable diseases. Disruptions to surgical care, therefore, carry substantial indirect health consequences that extend beyond the immediate injuries of conflict. This perspective examines the concept of surgical system resilience- the capacity of health systems to maintain surgical services during crisis conditions. Drawing on recent experiences from hospitals operating under missile attacks in Israel, we describe operational adaptations that enabled the continuation of surgical services despite ongoing security threats. These adaptations included the rapid relocation of clinical services to protected underground hospital infrastructure, modification of surgical workflows, and strengthened multidisciplinary coordination across clinical departments. Maintaining surgical services during conflict requires balancing trauma preparedness with the ongoing treatment of urgent non-traumatic surgical conditions. The experience highlights several domains that contribute to surgical system resilience, including protected infrastructure, operational flexibility, workforce preparedness, and coordinated institutional leadership. Ensuring the continuity of surgical care during armed conflict is a critical component of health system resilience. Lessons from Israeli hospital preparedness may inform policy strategies aimed at strengthening surgical system resilience in other regions facing security threats or large-scale disruptions.
This study aimed to evaluate the effect of a combined music medicine and virtual reality intervention on the surgical anxiety and perianesthesia comfort among patients undergoing elective semi-rigid ureteroscopy under spinal anesthesia. This randomized controlled trial with blinded outcome assessment was conducted between June and December 2024 at Aydın State Hospital, Türkiye. A total of 60 patients (30 experimental, 30 control) who met the inclusion criteria were randomly assigned to two groups. The experimental group experienced a virtual reality (VR)-based music medicine intervention, while the control group received routine perioperative care. Outcomes were assessed by a researcher blinded to group allocation. Ethical approval was obtained from the Aydın Adnan Menderes University Faculty of Medicine Non-Interventional Clinical Research Ethics Committee (Decision No: 12; Protocol No: 2024/80). The study was reported in accordance with the CONSORT statement. No significant difference was found between the groups in surgery-specific anxiety scores (p = 0.285). However, the experimental group had significantly higher comfort levels than the control group (2.92 ± 0.28 vs. 2.26 ± 0.52; p < 0.001), with a moderate effect size (r = 0.63). Regression analysis confirmed that the intervention group scored, on average, 0.62 points higher in comfort (B = 0.621, p < 0.001), explaining 39
Intraoperative hemodynamic instability and hypotension commonly occur in anesthetized patients and are associated with postoperative morbidity and mortality. A growing body of evidence establishes a strong correlation between intraoperative hypotension (IOH) and adverse events such as acute kidney injury (AKI), myocardial injury, postoperative cognitive dysfunction, and mortality. Recent recommendations for mean arterial pressure (MAP) maintenance above 65 mm Hg and consensus guidelines endorsing a MAP target of 60–70 mm Hg highlight the imperative for meticulous hemodynamic management. However, achieving this goal presents challenges for anesthesia clinicians. This article reviews issues with recent trends in hemodynamic monitoring and management strategies, emphasizing the importance of avoiding unintended patient harm by looking beyond traditional blood pressure management, such as relying solely on vasopressors.
Hip fractures significantly impact the physiological and psychological well-being of elderly patients. Post-operative delirium (POD) is a common complication after hip fractures in this population, severely affecting treatment outcomes and recovery. Effective pain management during the peri-operative period is crucial for reducing POD, yet the best analgesic approach remains debated. A retrospective study (from January 2015 to December 2020) included 198 elderly hip fracture patients who received preoperative (PO-) or intraoperative (IO-) fascia iliaca compartment block (FICB) with 50 mL of 0.25
This study aimed to investigate the effectiveness of safety care and clinical nursing pathways in patients undergoing cardiovascular intervention. This single-center, single-blind, randomized controlled trial enrolled 100 patients who underwent cardiovascular intervention. Patients were randomly assigned to a control group (receiving standard nursing care) or an experimental group (receiving safety care and clinical nursing pathway interventions in addition to the standard care) (n = 50 each). The primary outcome measure included anxiety and depression symptoms assessed using the Hamilton Anxiety and Hamilton Depression (HAMA and HAMD) rating scales. Secondary outcome measures included cardiac function recovery time, surgery time, surgical vascular puncture success rate, puncture preparation time, and hospital stay, along with adverse events and complications, quality of life, and nursing satisfaction. In the experimental group, post-intervention HAMA (6.42 ± 2.41) and HAMD (6.32 ± 1.44) scores were significantly lower than those in the control group (9.24 ± 1.52, 8.76 ± 1.59) (p < 0.05). The incidence of adverse reactions was lower in the experimental group (12.0
Functional endoscopic sinus surgery (FESS) may be followed by poor early QoR-40-assessed patient-reported recovery and emergence agitation. We performed a secondary analysis to evaluate whether perioperative lidocaine plus esketamine was associated with improved early QoR-40-assessed patient-reported recovery. Inflammatory biomarkers, mood-related symptom scores, and peri-emergence neurobehavioral outcomes were assessed as supportive outcomes. This secondary analysis included 140 adults (18–65 years) from a single-center randomized four-arm study of FESS: lidocaine + esketamine (LA), lidocaine (L), esketamine (A), or saline (N), 35 per group. Study infusions were administered from 10 min before induction until the end of surgery. The primary endpoint was QoR-40 total score on postoperative day 1 (POD1), defined as the first assessment 24 ± 6 h after extubation; QoR-40 POD2 was the key secondary endpoint; SAS/SDS, emergence agitation (Riker ≥ 5), Nu-DESC-defined PACU delirium-like symptoms, and IL-6/TNF-α (T1-T4) were supportive secondary outcomes. QoR-40 POD7 total score and comparisons of the five QoR-40 domains (Physical, comfort, emotional state, self-care ability/physical independence, social support/patient support, and pain) were exploratory. QoR-40 total/domain scores and SAS/SDS were analyzed using baseline-adjusted ANCOVA. POD1 QoR-40 was available for 137/140 participants, and exploratory POD7 QoR-40 for 136/140. LA was associated with higher QoR-40 than N on POD1 (adjusted mean difference 10.5; 95
Postoperative hallucinations are underrecognized neuropsychiatric complications of cardiac surgery. Glycemic control may influence their occurrence, particularly in patients with diabetes. This study aimed to estimate the incidence of visual and auditory hallucinations in diabetic and non-diabetic patients after cardiac surgery, and to identify factors independently associated with hallucinations within each group. In this prospective multicenter cohort, hallucinations were assessed daily for 7 days using the Questionnaire for Psychotic Experiences. Cox regression identified predictors within diabetic and non-diabetic cohorts. Visual hallucinations occurred in 12.0
With the increasing prevalence of surgical centers, identifying the safest and most efficient anesthetic techniques is vital. Ultrasound-guided distal peripheral nerve block (US-DPNB) is a technique that has shown promise in published literature for blocking the ulnar, median, and radial nerves at the level of the forearm. This descriptive case series examines 50 patients who underwent hand or wrist surgery with a focus on outcomes following the application of US-DPNB. The technique used in this study was performed by an anesthesiologist, Dr. Angel Saavedra, at an outpatient surgical center. The purpose of this descriptive case series is to describe beneficial clinical outcomes and the feasibility of blocking the median, ulnar, and radial nerves at the level of the forearm in the context of hand and wrist surgeries in surgical centers. The primary outcomes included a pain scale from 1 to 5, block performance time, and postoperative complications. The secondary outcomes are tourniquet time, patient satisfaction, and return of hand movement. With IRB approval, patients were followed up for up to five days post-surgery to assess outcomes. Either a distal or proximal block was performed at the level of the forearm. Exclusion criteria included repeat surgery on the same hand, procedures expected to exceed 20 min of tourniquet time, and patients with pre-existing peripheral nerve disorders, or prior surgeries affecting nerve anatomy. Data were analyzed using descriptive statistics only; no inferential comparisons between groups were performed. The DFB group presented an average block time of 95.59s, whereas the PFB group presented a mean block time of 73.9s. The pain scores decreased in both groups over the five-day follow-up period. Notably, the only recorded complication was postoperative nausea in one patient in the PFB group. This descriptive case series demonstrates the feasibility of US-DPNB as a primary anesthetic technique for short-duration ambulatory hand and wrist procedures, with low complication rates and high patient satisfaction. As a study without a comparator group, claims regarding economic benefit cannot be formally established; however, the opioid-sparing profile and favorable outcomes observed support further investigation through controlled trials. 20245045
Postoperative pain management after pancreatectomy is challenging due to extensive tissue trauma and visceral pain. Multimodal analgesia (MMA) with continuous peripheral nerve blocks may optimize pain control while reducing opioid consumption. In this study, we aimed to evaluate the efficacy of MMA with continuous peripheral nerve blocks compared with intravenous patient-controlled analgesia (IV PCA). This single-center retrospective cohort study compared patients who underwent open pancreatectomy (pancreaticoduodenectomy or distal pancreatectomy) between March 2021 and April 2024 using either MMA with continuous peripheral nerve blocks or IV PCA. Our primary outcome was pain scores through postoperative three days. The secondary outcomes included cumulative morphine consumption, time to first mobilization, morbidity and mortality rates, length of hospital stay, and adverse events. We adjusted for confounders using univariable and multivariable regression analyses and applied generalized estimating equations. The study included 104 patients; 42 and 62 patients in the MMA and PCA groups, respectively. Patients in the MMA group had significantly lower pain scores on postoperative day 1 (P = 0.002), lower morphine consumption within 72 hours postoperatively (P < 0.001), earlier mobilization, and fewer 14-day readmissions compared to the PCA group. No significant differences were observed in morbidity, mortality, unexpected intensive care unit admission, or length of hospital stay between the groups. Patients who received MMA experienced less nausea and vomiting than those who received PCA, and no serious adverse events occurred in either group. MMA with continuous peripheral nerve blocks provides effective analgesia, reduces opioid consumption, and facilitates early mobilization compared to IV PCA in pancreatectomy patients. Further randomized controlled trials are required to confirm these findings.
Perioperative neurocognitive disorders (PNDs) are frequent and severe complications in older surgical patients, encompassing postoperative delirium, delayed neurocognitive recovery, postoperative neurocognitive disorder, and long-term cognitive impairment. These complications lead to prolonged hospital stay, elevated medical expenditure, and compromised long-term quality of life. In this 2026 narrative review, we systematically outline up-to-date evidence on the pathophysiology, risk factors, screening approaches, and evidence-based interventions for PNDs. The core mechanisms involve neuroinflammation, gut microbiota dysbiosis, blood–brain barrier disruption, cerebral hypoperfusion, oxidative stress, and tau hyperphosphorylation. Key risk factors include advanced age, preoperative cognitive impairment or frailty, intraoperative hypotension, deep anesthesia, hypothermia, cardiopulmonary bypass, and suboptimal postoperative pain and sleep control. Bedside tools (Mini-Cog, MoCA, MMSE, FRAIL scale) permit feasible risk stratification; tau-PT217, NfL, S100A12, and GFAP are emerging predictive biomarkers. Dexmedetomidine is a pharmacologic agent that has been extensively studied and has relatively strong supporting evidence. Non-pharmacological interventions and multidisciplinary care are recommended as first-line strategies. Outstanding issues include optimal intraoperative hemodynamic and anesthetic thresholds, causal links between delirium and long-term cognitive decline, and clinical validation of biomarkers. Future research demands large-scale multicenter randomized controlled trials and standardized workflows to strengthen personalized perioperative brain protection in elderly surgical patients.
Gabapentinoids are one component of multimodal analgesia in enhanced recovery programs after colorectal surgery. Long-term use can be especially harmful in older adults. This study sought to identify factors associated with prolonged gabapentinoid use in older adults following colorectal surgery. This retrospective cohort study analyzed data on a 20
Perioperative bleeding is a common surgical complication and a frequently used outcome in randomized trials; however, its definition and analysis are not straightforward and have important implications for trial design, statistical power and interpretation of treatment effect. This review aimed to summarize how perioperative bleeding was defined in randomized controlled trials, along with sample size considerations, analytic approaches, and interpretation practices. On April 9th, 2025, we systematically searched the CENTRAL database for randomized trials in surgical settings published after January 2024 that evaluated perioperative bleeding as the primary outcome. Two reviewers independently screened and extracted data. Where appropriate, we categorized findings into conceptually similar domains and applied descriptive analysis. We included 115 trials reporting 116 primary bleeding outcomes and identified 36 unique definitions, with assessment periods ranging from intraoperative to more than 30 days postoperatively. Volumetric or gravimetric measures were most common (n = 46 [39.6
To investigate the lung protective effects of individualized positive end-expiratory pressure (PEEP) titration guided by static lung compliance (Cstat) in elderly patients undergoing laparoscopic surgery in the Trendelenburg position. Seventy elderly patients aged 65–75 years scheduled for elective laparoscopic rectal cancer surgery with anticipated duration > 2 h were enrolled. Patients had ASA physical status II-III and BMI 19–28 kg/m2. Patients were equally divided into two groups: individualized PEEP guided by static lung compliance (CV group) and fixed PEEP group (DV group). Lung ultrasound scores (LUS) were performed after invasive arterial monitoring establishment (T1), immediately post-surgery (T4), before discharge from PACU (T5). Central venous blood samples were collected at T1 and T5 for ELISA determination of IL-6, CC16, and SP-A. Peak airway pressure, plateau pressure, alveolar dead space fraction (VD/VT), PaO2/FiO2 ratio, and invasive arterial pressure were recorded. Compared with the DV group, the CV group demonstrated significantly lower lung ultrasound scores at T4 (mean difference: -4.0, 95
