BACKGROUND Frailty represents a multidimensional decline in physiological reserve that increases vulnerability to surgical stress. Its peri-operative dynamics and association with outcomes across diverse surgical populations remain insufficiently characterised. OBJECTIVE This study aimed to describe the prevalence of frailty before and after surgery and to evaluate its association with postoperative complications, mortality, and hospital length of stay. METHODS We conducted a prospective, multicentre European cohort study including adults undergoing elective or emergency surgery under general or regional anaesthesia across 64 participating centres in 10 countries. Each centre contributed data from one to three predefined recruitment days between April 2021 and December 2022. Frailty was assessed preoperatively and at 30 days using the Rockwood Clinical Frailty Scale (CFS), the FRAIL questionnaire, and the Barthel Index. The primary outcome was the association between preoperative frailty and 30-day postoperative complications (Clavien–Dindo ≥ II); secondary outcomes included 30-day mortality, postoperative cognitive impairment, and new-onset frailty. RESULTS Among 1472 patients (mean age 60.9 years; 52.9% male), preoperative frailty prevalence was 14.6% (FRAIL), 10.4% (CFS), and 10.4% (Barthel). Within 30 days, 11.9% of nonfrail patients became frail, increasing overall frailty prevalence to 21.2%. Postoperative complications occurred in 19.2% and mortality in 1.7%. Preoperative frailty was independently associated with complications: adjusted odds ratio (OR) 2.35 [95% confidence interval (CI) 1.53 to 3.60], P < 0.001); 30-day mortality OR 10.9 (95% CI 1.28 to 93.0), P = 0.029). Frailty was also associated with postoperative cognitive impairment: OR 3.47 (95% CI 1.98 to 6.08), P < 0.001). CONCLUSIONS Frailty is common among surgical patients, increases after surgery, and independently predicts postoperative complications and mortality. These findings highlight frailty as a dynamic and potentially modifiable marker of surgical vulnerability that should be routinely assessed and integrated into peri-operative care. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04140370
BACKGROUND Vancomycin combined with gentamicin (VGA) is used as an alternative antibiotic prophylaxis in cardiac surgery when cephalosporins are contraindicated. However, the nephrotoxic potential of this combination raises concerns regarding postoperative acute kidney injury (AKI). OBJECTIVE This study aimed to evaluate the association between VGA prophylaxis and AKI occurrence in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), while accounting for preoperative risk factors. DESIGN Retrospective single-centre study. AKI was defined according to KDIGO criteria within 7 postoperative days. PATIENTS Of the 8895 eligible patients between April 2013 and December 2021, 8198 were included. Subgroup analyses were performed according to preoperative AKI risk status (high-risk: insulin-dependent diabetes, cirrhosis, acute endocarditis, preoperative critical state, emergency surgery, or cardiac transplantation). RESULTS In our cohort, 7469 (91%) received cephalosporins and 729 (9%) received VGA. The overall AKI incidence was 16%. AKI occurred more frequently in the VGA group (29% vs. 15%, P < 0.001). After multivariable adjustment, VGA remained independently associated with AKI [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.03 to 1.62, P = 0.024], confirmed by propensity score analysis (OR 1.32, 95% CI 1.09 to 1.60, P = 0.005). In subgroup analyses, VGA was significantly associated with AKI in high-risk patients (OR 1.53, 95% CI 1.14 to 2.04, P = 0.004), but not in low-risk patients (OR 1.19, 95% CI 0.87 to 1.64, P = 0.285). CONCLUSION In this large retrospective cohort, VGA antibiotic prophylaxis was independently associated with increased AKI risk following cardiac surgery with CPB. This association was driven primarily by patients with preoperative risk factors for AKI. Alternative prophylactic regimens should be considered in high-risk patients when possible.
BACKGROUND Accurate positioning of central venous catheter (CVC) tips is essential to avoid complications, yet consistent appropriate placement within the superior vena cava remains challenging without a simple method for depth adjustment. OBJECTIVES To develop and temporally validate a simple computed tomography-based (CT-based) body surface landmark approach for estimating optimal insertion depth (OID) and to assess its impact on appropriate catheter tip positioning. DESIGN Single-centre prospective observational cohort study. SETTING Tertiary care hospital in Japan; February 2017 to June 2019. PATIENTS Adult patients undergoing surgery requiring CVC placement via the right internal jugular vein with preoperative chest CT. After exclusions, 86 patients were included in the derivation cohort and 100 in the validation cohort. INTERVENTION In the derivation cohort, insertion depth was determined by the attending anaesthesiologist; in the validation cohort, it was determined using a model derived from the derivation cohort. MAIN OUTCOME MEASURE The primary outcome was the proportion of appropriately placed catheter tips. RESULTS The final model retained the insertion point-to-body surface landmark distance (ILD), defined using a body surface landmark corresponding to the CT-identified midpoint of Zone B, as the sole predictor: OID (cm) = 0.64 × ILD + 3.64. The proportion of appropriately placed catheter tips was higher in the validation cohort than in the derivation cohort (92.0% (95% CI, 85.0 to 95.9%) vs. 73.3% (95% CI, 63.1 to 81.5%); P < 0.001). Model-guided placement was associated with increased likelihood of appropriate positioning (adjusted odds ratio 4.68 (95% CI, 1.97 to 12.27)). Model performance showed good calibration and moderate explanatory ability ( R 2 approximately 50%) in both cohorts. CONSLUSIONS A CT-based body surface landmark approach was associated with improved consistency of appropriate CVC tip placement and enables patient-specific estimation of insertion depth. TRIAL REGISTRY UMIN Clinical Trials Registry (UMIN000026252).
BACKGROUND Vancomycin combined with gentamicin (VGA) is used as an alternative antibiotic prophylaxis in cardiac surgery when cephalosporins are contraindicated. However, the nephrotoxic potential of this combination raises concerns regarding postoperative acute kidney injury (AKI). OBJECTIVE This study aimed to evaluate the association between VGA prophylaxis and AKI occurrence in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB), while accounting for preoperative risk factors. DESIGN Retrospective single-centre study. AKI was defined according to KDIGO criteria within 7 postoperative days. PATIENTS Of the 8895 eligible patients between April 2013 and December 2021, 8198 were included. Subgroup analyses were performed according to preoperative AKI risk status (high-risk: insulin-dependent diabetes, cirrhosis, acute endocarditis, preoperative critical state, emergency surgery, or cardiac transplantation). RESULTS In our cohort, 7469 (91%) received cephalosporins and 729 (9%) received VGA. The overall AKI incidence was 16%. AKI occurred more frequently in the VGA group (29% vs. 15%, P < 0.001). After multivariable adjustment, VGA remained independently associated with AKI [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.03 to 1.62, P = 0.024], confirmed by propensity score analysis (OR 1.32, 95% CI 1.09 to 1.60, P = 0.005). In subgroup analyses, VGA was significantly associated with AKI in high-risk patients (OR 1.53, 95% CI 1.14 to 2.04, P = 0.004), but not in low-risk patients (OR 1.19, 95% CI 0.87 to 1.64, P = 0.285). CONCLUSION In this large retrospective cohort, VGA antibiotic prophylaxis was independently associated with increased AKI risk following cardiac surgery with CPB. This association was driven primarily by patients with preoperative risk factors for AKI. Alternative prophylactic regimens should be considered in high-risk patients when possible.
