Abstract Background 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. Methods This retrospective cohort study analyzed data on a 20% representative sample of patients with Medicare. Patients were included if they were ≥ 66 years old, underwent colorectal surgery between October 1, 2015 and June 30, 2018, had continuous Part D enrollment during the time of operation, and were gabapentinoid naïve. Patients were excluded if they died within 180 days after surgery or were discharged to hospice or skilled nursing facility. The main outcome measure was prolonged gabapentinoid use, defined as prescription refills > 90 days after discharge, in those newly prescribed a gabapentinoid. Results Among the 979 patients who met inclusion criteria and had a new gabapentinoid prescription after colorectal surgery, 22% had prolonged gabapentinoid use. Concurrent peri-discharge opioid use was associated with reduced likelihood of prolonged gabapentinoid use (OR 0.48 [0.34, 0.66], p < 0.0001). In patients who had both opioid and gabapentinoid prescriptions at discharge, opioid use beyond 90 days was associated with prolonged gabapentinoid use (OR 3.45 [2.43, 4.89], p < 0.0001). Patients discharged home with home health services had increased likelihood of prolonged gabapentinoid use (OR 1.53 [1.08, 2.17], p = 0.047). Conclusions Factors associated with prolonged gabapentinoid use after colorectal surgery in the older adult population include initial prescription of a gabapentinoid without opioids, prolonged opioid use beyond discharge, and discharge to home with health services. Identifying these factors may reveal potentially modifiable interventions to curb prolonged gabapentinoid use in this population.
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
For thoracic surgery patients who undergo double-lumen endotracheal intubation, postoperative sore throat (POST) remains one of the most common postoperative complication. To evaluate whether preoperative ultrasound-guided stellate ganglion block (SGB) can reduce the incidence and severity of POST, and decrease the postoperative throat VAS score in patients undergoing double-lumen tube (DLT) intubation for thoracic surgery. This prospective, randomized, double-blind, controlled clinical trial enrolled 120 patients undergoing elective thoracic surgery with DLT intubation. Participants were randomized into two groups: the SGB group (n = 60) received 2–3 ml of 0.25
BACKGROUND:Perioperative red blood cell (RBC) transfusion remains common in cardiac surgery and is associated with increased morbidity and mortality. Accurate preoperative risk prediction is essential for patient blood management. The Fuwai-transfusion risk of on-pump cardiac surgery (FW-TRIC) score was previously developed and internally validated as a tool to estimate transfusion risk. This study aimed to externally validate the FW-TRIC score in a multicenter cohort. METHODS:A retrospective multicenter study was conducted across nine cardiovascular centers in China from January to December 2024. Adult patients undergoing on-pump cardiac surgery were included, while those undergoing transplantation, mechanical circulatory support, or preoperative transfusion were excluded. The discriminative performance of the FW-TRIC score was evaluated using receiver operating characteristic (ROC) curve analysis, and calibration was assessed through linear regression of observed versus predicted transfusion rates. RESULTS:A total of 3,287 patients met inclusion criteria, with an overall perioperative RBC transfusion rate of 40.1%. The FW-TRIC score demonstrated good discrimination for predicting transfusion, with an AUC of 0.713 (95% CI, 0.696-0.731) and excellent calibration. All individual predictors of FW-TRIC score, including age, sex, NYHA classification, body surface area, previous cardiac surgery, emergency surgery, and surgery type, underperformed the prediction ability of FW-TRIC score (all P < 0.05 for AUC comparison). Performance remained good across all nine centers (AUCs > 0.65). Across all transfusion risk categories in the external validation cohort, the observed transfusion rates compared well with those predicted by the FW-TRIC model. CONCLUSIONS:The FW-TRIC score was externally validated as a robust and generalizable preoperative tool for predicting perioperative RBC transfusion in on-pump cardiac surgery. Its use enables effective transfusion risk stratification and supports personalized patient blood management strategies across diverse clinical settings.
Postoperative nausea and vomiting (PONV) is a prevalent complication, occurring in approximately 30
