Risky lifestyle factors, including Smoking, Nutrition (malnutrition and obesity), risky Alcohol intake, and Physical inactivity (SNAP factors), are well-established predictors of postoperative complications. While advances such as Enhanced Recovery After Surgery have improved perioperative care, evidence on preoperative risk factor optimisation remains limited, particularly in hernia surgery. The aim was to map the prevalence of SNAP factors in patients undergoing ventral hernia repair and to estimate the potential impact of targeted preoperative intervention. This cross-sectional study included patients aged ≥ 18 years scheduled for primary or incisional ventral hernia repair at two Danish university hospitals (March 2024–May 2025). Data on SNAP factors were obtained through structured interviews (by telephone or at the outpatient clinic) and review of health records. The prevalence of risky lifestyle factors was analysed with 95
Due to the aging population and the high incidence of osteoarticular diseases, the demand for the future development of total hip arthroplasty (THA). Aspirin use has increased substantially owing to its multiple benefits. The aim of our study was to explore the influence of Long-Aspirin Use (L-AU) on perioperative complications in patients undergoing THA. By querying the National Inpatient Sample (NIS) database, the data of patients undergoing THA from 2019 to 2022 were acquired after removing irrelevant data. Propensity score matching (PSM) was designed to reduce the impact of demographic and comorbidity characteristics on perioperative complications. T Test, Chi-Square Test, Rank Sum Test, as well as logistic regression analysis, were used for perioperative complications risk analysis and resource consumption analysis. The proportion of ICD-coded long-term aspirin use (L-AU) among patients undergoing total hip arthroplasty in the unweighted NIS analytic sample increased from 12.13
This study aims to analyze sex differences in perioperative autonomic dysfunction in gastric cancer (GC) patients using a wearable HRV monitoring device. Additionally, we explore the relationship between HRV, sex, and postoperative recovery. A total of 160 GC patients were enrolled and divided into two sex-based groups, with 80 patients in each group. Perioperative HRV, inflammatory markers, and nutritional indices were monitored. Time to first flatus, postoperative length of stay (PLOS), and complications were compared between groups. Furthermore, the correlation between HRV indices and PLOS was analyzed. Perioperative HRV trajectories differed significantly between sexes (all sex × time interactions P < 0.001), with variable magnitude, direction and timing of across‑index sex‑related differences. Overall, females showed smaller postoperative declines and faster restoration toward preoperative HRV values. Female patients also showed lower postoperative inflammatory markers, higher cortisol (Cor) levels, shorter first flatus time. Both POD1 pNN50 and POD1 rMSSD were identified as independent predictors of prolonged PLOS. The Receiver Operating Characteristic (ROC) curve analysis revealed an apparent AUC of 0.864, and after bootstrap internal validation, the optimism-corrected AUC was 0.822, indicating good discriminative performance with expected shrinkage upon validation. Female sex was associated with more favorable autonomic recovery (as reflected by faster HRV restoration) and lower postoperative systemic inflammatory markers, although postoperative cortisol levels were higher in females. These patterns may contribute to faster gastrointestinal recovery. POD1 pNN50 and POD1 rMSSD were identified as independent predictors of prolonged PLOS. HRV indices show promise as non-invasive biomarkers for monitoring perioperative recovery, though these exploratory findings require rigorous external validation in larger, multicenter prospective studies before any clinical application can be considered.
Early mobilization is a key component of enhanced recovery after elective colorectal surgery. This pilot trial evaluated the safety and feasibility of an early supervised postoperative exercise intervention in addition to standard care. In this single-center randomized controlled pilot trial, 31 patients undergoing elective colorectal surgery were randomized to an intervention group (n = 16) or control group (n = 15). One patient withdrew after randomization, leaving 30 patients for modified intention-to-treat analysis. The intervention consisted of individualized, physiotherapist-supervised exercise sessions on postoperative days 1, 3, and 5. The control group received standard postoperative care according to the institutional ERAS protocol. The originally registered primary endpoint was time to first bowel movement; prior to final analysis, safety and feasibility were designated as the primary outcomes in accordance with the pilot nature of the study. The change was documented transparently. Secondary outcomes included physical performance (Short Physical Performance Battery [SPPB], handgrip strength), time to first bowel movement, patient-reported outcomes, and postoperative complications. Thirty patients completed the study (retention 96.8
Despite advances in medical care, the incidence of medical complications, especially delirium, remains high in patients with hip fracture. Although individual components of hip fracture pathways have been studied, the components together have not. At a tertiary academic medical center, an internal review identified a high rate of unnecessary preoperative cardiac testing and postoperative delirium among patients with hip fracture admitted to the hospital medicine service. We designed a multidisciplinary perioperative pathway aimed at reducing delirium, time to surgery, and length of stay by addressing common medical conditions in older adult patients with hip fractures. A novel pathway incorporating regional anesthesia, multimodal analgesia, preoperative anemia correction, and guideline-based cardiac evaluation was implemented at a tertiary care academic center. Led by hospitalists, this pathway was introduced in two sequential phases: Period 1 – educational initiative on evidence-based cardiac testing, regional anesthesia, and opioid-sparing analgesia, beginning July 1, 2018; Period 2 – expanded interventions targeting blood utilization, nerve blocks, carbohydrate loading, and physical therapy staffing, beginning July 1, 2023. Cardiology co-management guidelines aligned with American College of Cardiology/American Heart Association (ACC/AHA) recommendations; an order set for multimodal, opioid-sparing analgesia including a femoral nerve block within 2 h of admission; clear carbohydrate drinks; expedited operative repair targets; and preoperative anemia management with intravenous iron and epoetin alfa. Outcomes for patients admitted July 2021–December 2022 (Period 1, n = 183) were compared with those admitted January 2023–July 2024 (Period 2, n = 189). Statistical process control (SPC) charts were used to assess special-cause variation in nerve block use, carbohydrate drink consumption, delirium, and acute kidney injury (AKI). Implementation led to significant reductions in cardiology consultation time, length of stay, intra- and postoperative blood transfusions, and time to surgery. There was increased use of nerve blocks and preoperative carbohydrate drinks, with no change in delirium rates or 30-day readmissions. Statistical process control methods were used to detect special cause variation after implementation of selected interventions. Mortality remained low at 0.5
