Preoperative Screening Research Articles

The Role of Psychosocial Screening in Patient Selection for Spine Surgery: A Review.

The purpose of this review is to provide a brief history of previous attempts at developing patient screening tools and to further examine the definitions of these psychological concepts, relevance to clinical outcomes, and implications for spine surgeons during preoperative patient assessments. A literature review was performed by 2 independent researchers to identify original manuscripts related to spine surgery and novel psychological concepts. The history of presurgical psychology screening was also studied, and definitions of frequently utilized metrics were detailed. Seven manuscripts were identified that utilized psychological metrics for preoperative risk assessments and correlated outcomes with these scores. The metrics most frequently used in the literature included resilience, patient activation, grit, and self-efficacy. Current literature favors resilience and patient activation as important metrics for preoperative patient screening. Available studies demonstrate significant associations between these character traits and patient outcomes. Further research is warranted to investigate the roles of preoperative psychological screening to optimize patient selection in spine surgery. The purpose of this review is to provide clinicians with a reference for available psychosocial screening tools and their relevance to patient selection. This review also serves to guide future research directions given the importance of this topic.

The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study

BackgroundThe Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use. MethodsThis observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery. ResultsWe chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%–90.3%) and specificity of 93.5% (91.5–95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity. ConclusionsThese findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.

Development and validation of a machine learning ASA-score to identify candidates for comprehensive preoperative screening and risk stratification

ObjectiveThe ASA physical status (ASA-PS) is determined by an anesthesia provider or surgeon to communicate co-morbidities relevant to perioperative risk. Assigning an ASA-PS is a clinical decision and there is substantial provider-dependent variability. We developed and externally validated a machine learning-derived algorithm to determine ASA-PS (ML-PS) based on data available in the medical record. DesignRetrospective multicenter hospital registry study. SettingUniversity-affiliated hospital networks. PatientsPatients who received anesthesia at Beth Israel Deaconess Medical Center (Boston, MA, training [n = 361,602] and internal validation cohorts [n = 90,400]) and Montefiore Medical Center (Bronx, NY, external validation cohort [n = 254,412]). MeasurementsThe ML-PS was created using a supervised random forest model with 35 preoperatively available variables. Its predictive ability for 30-day mortality, postoperative ICU admission, and adverse discharge were determined by logistic regression. Main resultsThe anesthesiologist ASA-PS and ML-PS were in agreement in 57.2% of the cases (moderate inter-rater agreement). Compared with anesthesiologist rating, ML-PS assigned more patients into extreme ASA-PS (I and IV), (p < 0.01), and less patients in ASA II and III (p < 0.01). ML-PS and anesthesiologist ASA-PS had excellent predictive values for 30-day mortality, and good predictive values for postoperative ICU admission and adverse discharge. Among the 3594 patients who died within 30 days after surgery, net reclassification improvement analysis revealed that using the ML-PS, 1281 (35.6%) patients were reclassified into the higher clinical risk category compared with anesthesiologist rating. However, in a subgroup of multiple co-morbidity patients, anesthesiologist ASA-PS had a better predictive accuracy than ML-PS. ConclusionsWe created and validated a machine learning physical status based on preoperatively available data. The ability to identify patients at high risk early in the preoperative process independent of the provider's decision is a part of the process we use to standardize the stratified preoperative evaluation of patients scheduled for ambulatory surgery.

Frailty: How to assess, prognostic role

Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature.A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery.This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition.Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative careshould include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.

Objective cataract grading methods and expected contrast sensitivity reestablishment with multifocal intraocular lenses.

To determine the cut-off points for age and metrics provided by cataract grading objective systems for which a reestablishment in contrast sensitivity(CS) is expected after multifocal intraocular lens(MIOL) implantation. One hundred seven subjects were included in this retrospective analysis carried out during the screening for presbyopia and cataract surgery. Monocular distance corrected contrast sensitivity defocus curve (CSDC) and visual acuity were measured, and crystalline lens sclerosis was graded with three objective metrics: Ocular Scatter Index(OSI), Dysfunctional Lens Index(DLI) and Pentacam Nucleus Staging(PNS). A CS value of 0.8 logCS at far distance, following published literature on this matter, was selected to compute the cut-off that maximized the detection of eyes exceeding this value at the preoperative screening, either for age or objective metrics. The CDCS showed a stronger correlation than CDVA with objective grading methods, whereas all objective metrics were significantly correlated between them (p < 0.05). The cut-offs for age, OSI, DLI and PNS were ≤ 62, ≤ 1.25, ≥ 7.67 and ≤ 1, respectively. The OSI provided the highest area under the receiver operating characteristic curve (0.85) followed by the age (0.84), DLI (0.74) and PNS (0.63). Surgeons conducting clear lens exchange should communicate the possible distance CS loss after surgery with MIOL implantation according to the previous described cut-offs points. Age in combination with any cataract grading objective system is recommended to detect possible inconsistencies.

The role of preoperative toxicology screening in patients undergoing bariatric surgery.

Some programs and insurers may require patients to undergo toxicology screening despite lack of evidence that this practice affects postoperative outcomes. To understand the prevalence of screening positive on toxicology testing in the bariatric surgical population and to examine the association between testing positive and important surgical outcomes. We performed a retrospective review of patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass from an academic health system from 2017-2020. We described the rate of preoperative toxicology positivity as determined by serum and urine testing. We examined the association between toxicology positivity and outcomes of preoperative length, 30-day complications (bleeding, venous thromboembolism, leak, wound infection, pneumonia, urinary tract infection, and myocardial infarction), readmissions, and 1-year weight loss using chi-square and t-test analysis. Of 1057 patients, there were 134 patients (12.7%) who had positive toxicology testing. Of these, 37 (28%) were positive for opiates and 21 (16%) were positive for cotinine. Mean preoperative length was 381.8 days (standard deviation [SD], 222.5) for patients with positive testing versus 287.8 days (SD, 151.5; P = 1.00) for negative testing. Toxicology positivity was not associated with readmissions (5.2% versus 4.3%, X2 = 0.22; P = .64). The loss to follow-up at 1 year was 32.5%. There was no association with 1-year mean change in body mass index (mean of loss 12.23kg/m2 [SD, 5.61]) versus mean of loss 12.74 (SD, 6.44; P = .20)]. Our study is the first to describe preoperative toxicology positivity rates. We found no association between toxicology positivity and preoperative length, readmissions, or weight loss. Given its lack of impact on outcomes, toxicology testing prior to bariatric surgery may be an unnecessary burden on patients and healthcare, with regard to cost and wait times.

Reducing the Risk of Spinal Cord Injury in Patients With Asymptomatic Cervical Stenosis Undergoing Cardiac and Vascular Surgery

NECK HYPEREXTENSION is used commonly during surgical positioning to provide optimal anatomic positioning and exposure. Iatrogenic tetraplegia has been reported in patients with asymptomatic cervical stenosis after prolonged neck extension during cardiac and noncardiac surgeries. Standardized protocols to screen patients for underlying degenerative cervical disease, such as cervical spondylotic myelopathy or cervical stenosis, have been shown to alter perioperative decision-making. 1 Diaz A Chin C Burks SS et al. A retrospective pilot study for preoperative screening to prevent iatrogenic cervical spinal cord injury. Cureus. 2021; 13: e12550 PubMed Google Scholar Here, the authors present the case of a patient with a significant risk of intraoperative spinal cord injury during combined cardiac and vascular surgery, which was managed successfully without complication. They discuss the pathophysiology, prevention, and treatment of this devastating complication.

How to accurately preoperative screen nipple-sparing mastectomy candidate—a nomogram for predicting nipple-areola complex involvement risk in breast cancer patients

BackgroundNipple-sparing mastectomy (NSM) offers superior cosmetic outcomes and has been gaining wide acceptance. It has always been difficult to objectively quantify the risk of nipple-areola complex involvement (NACi). The goal was to develop a prediction model for clinical application.MethodsPatients who had a total mastectomy (TM) between January 2016 and January 2020 at a single institute formed the development cohort (n = 578) and those who had NSM + immediate breast reconstruction (IBR) between January 2020 and January 2021 formed the validation cohort (n = 112). The prediction model was developed using univariate and multivariate logistic regression studies. Based on NACi risk variables identified in the development cohort, a nomogram was created and evaluated in the validation cohort. Meanwhile, stratified analysis was performed based on the model’s risk levels and was combined with intraoperative frozen pathology (IFP) to optimize the model.ResultsTumor central location, clinical tumor size (CTS) > 4.0 cm, tumor-nipple distance (TND) ≤ 1.0 cm, clinical nodal status positive (cN +), and KI-67 ≥ 20% were revealed to be good predictive indicators for NACi. A nomogram based on these major clinicopathologic variables was employed to quantify preoperative NACi risk. The accuracy was verified internally and externally. The diagnostic accuracy of IFP was 92.9%, sensitivity was 64.3%, and specificity was 96.9% in the validation group. Stratified analysis was then performed based on model risk. The diagnostic accuracy rates of IFP and NACiPM in low-risk, intermediate-risk, and high-risk respectively were 96.0%, 93.3%, 83.9%, 61.3%, 66.7%, and 83.3%.ConclusionWe created a visual nomogram to predict NACi risk in breast cancer patients. The NACiPM can be used to distinguish the low, intermediate, and high risk of NAC before surgery. Combined with IFP, we can develop a decision-making system for the implementation of NSM.

Delirium Prevention and Management in Frail Surgical Patients.

Delirium, an acute, fluctuating impairment in cognition and awareness, is one of the most common causes of postoperative brain dysfunction. It is associated with increased hospital length of stay, health care costs, and mortality. There is no FDA-approved treatment of delirium, and management relies on symptomatic control. Several preventative techniques have been proposed, including the choice of anesthetic agent, preoperative testing, and intraoperative monitoring. Frailty, a state of increased vulnerability to adverse events, is an independent and potentially modifiable risk factor for the development of delirium. Diligent preoperative screening techniques and implementation of prevention strategies could help improve outcomes in high-risk patients.

Translated article] Results of a preoperative screening and decolonization programme for Staphylococcus aureus in primary hip and knee arthroplasty

IntroductionDetection and decolonization of Staphylococcus aureus prior to surgery is postulated as an option to reduce the risk of infection in arthroplasties. The aim of this study was to evaluate the effectiveness of a screening programme for S. aureus in total knee arthroplasty (TKA) and total hip arthroplasty (THA), the incidence of infection with respect to a historical cohort, and its economic viability. Material and methodsPre-post intervention study in patients undergoing primary knee and hip prostheses in 2021, a protocol was carried out to detect nasal colonization by S. aureus and eradication if appropriate, with intranasal mupirocin, post-treatment culture with results three weeks between post-treatment culture and surgery. Efficacy measures are evaluated, costs are analyzed and the incidence of infection is compared with respect to a historical series of patients operated on between January and December 2019, performing a descriptive and comparative statistical analysis. ResultsThe groups were statistically comparable. Culture was performed in 89%, with 19 (13%) positive patients. Treatment was confirmed in 18, control culture in 14, all decolonized; none suffered infection. One culture-negative patient suffered from Staphylococcus epidermidis infection. In historical cohort: three suffered deep infection by S. epidermidis, Enterobacter cloacae, Staphylococcus aureus. The cost of the programme is €1661.85. ConclusionThe screening programme detected 89% of the patients. The prevalence of infection in the intervention group was lower than in the cohort, with S. epidermidis being the main micro-organism, different from S. aureus described in the literature and in the cohort. We believe that this programme is economically viable, as its costs are low and affordable.

Results from a type two hybrid-effectiveness study to implement a preoperative anemia and iron deficiency screening, evaluation, and management pathway.

Implementation of pathways to screen surgical patients for preoperative anemia and iron deficiency remains limited. This study sought to measure the impact of a theoretically informed, bespoke change package on improving the uptake of a Preoperative Anemia and Iron Deficiency Screening, Evaluation, and Management Pathway. Pre-post interventional study using a type two hybrid-effectiveness design evaluated implementation. Four hundred (400) patient medical record reviews provided the dataset (200 pre- and 200-post implementation). The primary outcome measure was compliance with the pathway. Secondary outcome measures (clinical outcomes) were anemia on day of surgery, exposure to a red blood cell (RBC) transfusion, and hospital length of stay. Validated surveys facilitated data collection of implementation measures. Propensity score-adjusted analyses determined the effect of the intervention on clinical outcomes, and a cost analysis determined the economic impact. For the primary outcome, compliance improved significantly post-implementation (Odds Ratio 10.6 [95% CI 4.4-25.5] p< .000). In secondary outcomes, adjusted analyses point estimates showed clinical outcomes were slightly improved for anemia on day of surgery (Odds Ratio 0.792 [95% CI 0.5-1.3] p= .32), RBC transfusion (Odds Ratio 0.86 [95% CI 0.41-1.78] p= .69) and hospital length of stay (Hazard Ratio 0.96 [95% CI 0.77-1.18] p= .67), although these were not statistically significant. Cost savings of $13,340 per patient were realized. Implementation outcomes were favorable for acceptability, appropriateness, and feasibility. The change package significantly improved compliance. The absence of a statistically significant change in clinical outcomes may be because the study was powered to detect an improvement in compliance only. Further prospective studies with larger samples are needed. Cost savings of $13,340 per patient were achieved and the change package was viewed favorably.

Association of age and spinopelvic function in patients receiving a total hip arthroplasty

Restricted spinopelvic mobility received attention as a contributing factor for total hip arthroplasty (THA) instability. However, it is still unknown, how the spinopelvic function is influenced by age. In identifying the patients at highest risk for altered spinopelvic mechanics the study aimed to determine the association of age on the individual segments of the spinopelvic complex and global spinal sagittal alignment in patients undergoing THA. 197 patients were included in the prospective observational study conducting biplanar stereoradiography (EOS) in standing and sitting position pre-and postoperatively. Two independent investigators assessed C7-sagittal vertical axis (C7-SVA), cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), anterior plane pelvic tilt (APPT), and pelvic femoral angle (PFA). Key segments of the spinopelvic complex are defined as lumbar flexibility (∆ LL = LLstanding − LLsitting), pelvic mobility (∆ SS = SSstanding − SSsitting) and hip motion (∆ PFA = PFAstanding − PFAsitting). Pelvic mobility was further defined based on ∆ SS = SSstanding − SSsitting as stiff (∆ SS < 10°), normal (∆ SS ≥ 10°–30°) and hypermobile (∆ SS > 30°). The patient collective was classified into three groups: (1) < 60 years (n = 56), (2) ≥ 60–79 years (n = 112) and (3) ≥ 80 years (n = 29). Lumbar flexibility (∆ LL) was decreased with increasing age between all groups (36.1° vs. 23.1° vs. 17.2°/p1+2 < 0.000, p2+3 = 0.020, p1+3 < 0.000) postoperatively. Pelvic mobility (∆ SS) was decreased in the groups 2 and 3 compared to group 1 (21.0° and 17.9° vs. 27.8°/p1+2 < 0.000, p2+3 = 0.371, p1+3 = 0.001). Pelvic retroversion in standing position (APPT) was higher in group 2 and 3 compared to group 1 (1.9° and − 0.5° vs 6.9°/p1+2 < 0.000, p2+3 = 0.330, p1+3 < 0.000). Global sagittal spinal balance (C7-SVA) showed more imbalance in groups 2 and 3 compared to group 1 (60.4 mm and 71.2 mm vs. 34.5 mm/p1+2 < 0.000, p2+3 = 0.376, p1+3 < 0.000) postoperatively. The preoperative proportion of patients with stiff pelvic mobility in group 1 was distinctly lower than in group 3 (23.2% vs. 35.7%) and declined in group 1 to 1.8% compared to 20.7% in group 3 after THA. Changes after THA were reported for groups 1 and 2 representing spinopelvic complex key parameter lumbar flexibility (∆ LL), pelvic mobility (∆ SS) and hip motion (∆ PFA), but not for group 3. This is the first study to present age-adjusted normative values for spinopelvic mobility. The subgroups with increased age were identified as risk cohort for altered spinopelvic mechanics and enhanced sagittal spinal imbalance and limited capacity for improvement of mobility after THA. This valuable information serves to focus in the preoperative screening on the THA candidates with the highest risk for abnormal spinopelvic function.

Comprehensive management of post-LASIK ectasia: From prevention to treatment.

Post-laser in situ keratomileusis (post-LASIK) ectasia (PLE) is one of the most serious complications after refractive surgery, mainly manifested as progressive thinning and trembling thinning of the cornea, accompanied by increased myopia and astigmatism. The mechanisms behind mainly include genetic risk factors and external environmental factors such as eye rubbing and cornea surgery. In order to achieve the goal of reducing the incidence of ectasia, preoperative screening strategies need to be continuously improved, through the collection and assessment of genetic and environmental risk factors. Although previous preoperative screening methods did not have a uniform standard, the emergence of artificial intelligence (AI) can help us process a large amount of information and make rational use of the data. By using high-fidelity finite element modelling, differences in preoperative and postoperative strain distributions can be observed, which can predict the risk of postoperative ectasia. In this review, we describe the incidence, aetiology, prevention and treatment of PLE for the purpose of comprehensive management. In terms of treatment, corneal collagen cross-linking has been widely used to treat progressive keratoconus and other ectasia disease, either as a preventive measure during surgery or as a therapeutic modality after surgery to prevent progression of corneal dilation. Although the standard Dresden protocol has been identified as the gold standard treatment for corneal dilatation, a series of refinements, investigations and long-term studies have been conducted in recent years. Thus, understanding the factors involved in delaying the onset and slowing progression of cornea ectasia will be key to reducing the incidence worldwide.

The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Association of Cognitive Impairment Screening Scores With Improvements in Speech Recognition and Quality of Life After Cochlear Implantation

Many cochlear implant centers screen patients for cognitive impairment as part of the evaluation process, but the utility of these scores in predicting cochlear implant outcomes is unknown. To determine whether there is an association between cognitive impairment screening scores and cochlear implant outcomes. Retrospective case series of adult cochlear implant recipients who underwent preoperative cognitive impairment screening with the Montreal Cognitive Assessment (MoCA) from 2018 to 2020 with 1-year follow-up at a single tertiary cochlear implant center. Data analysis was performed on data from January 2018 through December 2021. Cochlear implantation. Preoperative MoCA scores and mean (SD) improvement (aided preoperative to 12-month postoperative) in Consonant-Nucleus-Consonant phonemes (CNCp) and words (CNCw), AzBio sentences in quiet (AzBio Quiet), and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile domain and global scores. A total of 52 patients were included, 27 (52%) of whom were male and 46 (88%) were White; mean (SD) age at implantation was 68.2 (13.3) years. Twenty-three (44%) had MoCA scores suggesting mild and 1 (2%) had scores suggesting moderate cognitive impairment. None had been previously diagnosed with cognitive impairment. There were small to medium effects of the association between 12-month postoperative improvement in speech recognition measures and screening positive or not for cognitive impairment (CNCw mean [SD]: 48.4 [21.9] vs 38.5 [26.6] [d = -0.43 (95% CI, -1.02 to 0.16)]; AzBio Quiet mean [SD]: 47.5 [34.3] vs 44.7 [33.1] [d = -0.08 (95% CI, -0.64 to 0.47)]). Similarly, small to large effects of the associations between 12-month postoperative change in CIQOL-35 scores and screening positive or not for cognitive impairment were found (global: d = 0.32 [95% CI, -0.59 to 1.23]; communication: d = 0.62 [95% CI, -0.31 to 1.54]; emotional: d = 0.26 [95% CI, -0.66 to 1.16]; entertainment: d = -0.005 [95% CI, -0.91 to 0.9]; environmental: d = -0.92 [95% CI, -1.86 to 0.46]; listening effort: d = -0.79 [95% CI, -1.65 to 0.22]; social: d = -0.51 [95% CI, -1.43 to 0.42]). In this case series, screening scores were not associated with the degree of improvement of speech recognition or patient-reported outcome measures after cochlear implantation. Given the prevalence of screening positive for cognitive impairment before cochlear implantation, preoperative screening can be useful for early identification of potential cognitive decline. These findings support that screening scores may have a limited role in preoperative counseling of outcomes and should not be used to limit candidacy.

Reproducibility and validity of the Portuguese Edmonton Frail Scale version in cardiac surgery patients

IntroductionFrailty is a multidimensional syndrome characterized by the loss of functional reserve, associated with higher mortality and less functional survival in cardiac surgery patients. The Edmonton Frail Scale (EFS) is a comprehensive tool devised for brief frailty detection. To the best of our knowledge, there are no culturally adapted and validated frailty screening tools that enable the identification of vulnerability domains suited for use in the preoperative setting in Portugal. This was the motivation for this study. ObjectivesTo assess the validity and reproducibility of the Portuguese version of the EFS. MethodsProspective observational study, in a sample of elective cardiac surgery patients. The Edmonton Frail Scale (EFS) translation and backtranslation were performed. Demographic and clinical data were collected, and the translated EFS translated, Geriatric Depression Scale, and Mini Mental State Examination Portuguese versions, Katz and Clinical Frailty Scales were administered. To assess validity Mann–Whitney test, Spearman's correlation coefficient, marginal homogeneity test and Kappa coefficient were employed. Reproducibility was assessed estimating kappa coefficient for the frailty diagnosis and the 11 EFS items. Intra-class correlation coefficients and the corresponding 95% confidence interval were estimated using linear mixed effects model. ResultsThe EFS Portuguese version revealed construct validity for frailty identification, as well as criterion validity for cognition and mood domains. Reproducibility was demonstrated, with k=0.62 (95% confidence interval (CI) 0.42–0.82) and intraclass correlation (ICC)=0.94 (95% CI 0.89–0.97) in inter-observer test and k=0.48 (95% CI 0.26–0.70) and ICC=0.85 (95% CI 0.72–0.92) in intra-observer test. ConclusionsThe EFS Portuguese version is valid and reproducible for use, suiting pre-operative frailty screening in a cardiac surgery setting.

Preoperative universal screening of coronavirus disease 2019 during Omicron outbreak in patients undergoing ophthalmic surgeries: Experience from a tertiary eye care center in Saudi Arabia.

This study aims to determine the frequency of coronavirus disease 2019 (COVID-19) during Omicron outbreak among patients scheduled for elective and emergency ophthalmic surgeries in a tertiary eye care center in Saudi Arabia. This observational retrospective study was performed between December 1, 2021, and February 28, 2022, in a single tertiary eye care center in Riyadh, Saudi Arabia. All patients who were given appointments for elective or emergency surgeries were included. All patients underwent preoperative nasopharyngeal and oropharyngeal reverse transcription-polymerase chain reaction testing for the severe acute respiratory syndrome coronavirus 2. A retrospective chart review of all patients who tested positive for COVID-19 during Omicron outbreak was performed for the demographic and clinical information, presence of symptoms upon presentation, nature and urgency of the scheduled surgical intervention, and the overall outcomes. A total of 851 patients were scheduled for elective and emergency ophthalmic surgeries during the study period. The mean age of all patients was 58.2 years; 451 were males (52.9%) and 400 were females (47%). Of 851 patients tested for the COVID-19 during Omicron outbreak, the test was positive in 65 (7.6%) patients. All patients who tested positive for the COVID-19 during Omicron outbreak were asymptomatic at the time of swabbing. No patient-related perioperative complications or health-care workers' affection secondary to exposure to positive cases was documented. The study showed that almost 1 in 13 patients scheduled for elective or emergency ophthalmic surgeries may test positive for the COVID-19 during Omicron outbreak. All positive cases were asymptomatic at the time of swabbing, highlighting the importance of routine preoperative screening for COVID-19.

Preoperative coagulation screening tests in pediatric patients: Clinical relevance and hemorrhagic outcomes of abnormal results.

Coagulation screening tests in children are still frequently performed in many countries to evaluate bleeding risk. The aim of this study was to assess the management of unexpected prolongations of the activated partial thromboplastin time (APTT) and prothrombine time (PT) in children prior to elective surgery, and the perioperative hemorrhagic outcomes. Children with prolonged APTT and/or PT who attended a preoperative anesthesia consultation from January 2013 to December 2018 were included. Patients were grouped according to whether they were referred to a Hematologist or were scheduled to undergo surgery without further investigation. The primary endpoint was to compare perioperative bleeding complications. 1835 children were screened for eligibility. 102 presented abnormal results (5.6%). Of them, 45% were referred to a Hematologist. Significant bleeding disorders were associated with a positive bleeding history, odds ratio of 51 (95% CI 4.8 to 538.5, P = 0.0011). No difference in perioperative hemorrhagic outcomes were found between the groups. An additional cost of 181 euros per patient and a preoperative median delay of 43 days was observed in patients referred to Hematology. Our results suggest that hematology referral has limited value in asymptomatic children with a prolonged APTT and/or PT. Hemorrhagic complications were similar among patients referred and not referred to Hematology. A positive personal or family bleeding history can help identify patients with a higher bleeding risk, thus it should guide the need for coagulation testing and hematology referral. Further efforts should be made to standardize preoperative bleeding assessments tools in children.

Iron deficiency in patients scheduled for pancreatic resection: implications for prehabilitation practice in pancreatic surgery

Background: Preoperative anemia is a common finding in cancer patients and it is associated with postoperative allogeneic blood transfusions and increased morbidity and mortality. Iron deficiency (ID) is a frequent cause of anemia in cancer patients and constitutes a modifiable risk factor. Preoperative screening for ID and iron suppletion as part of a prehabilitation program can potentially have great impact on postoperative outcomes in pancreatic surgery.

Application of a Multi-Layer Perceptron in Preoperative Screening for Orthognathic Surgery.

Orthognathic surgery is used to treat moderate to severe occlusal discrepancies. Examinations and measurements for preoperative screening are essential procedures. A careful analysis is needed to decide whether cases require orthognathic surgery. This study developed screening software using a multi-layer perceptron to determine whether orthognathic surgery is required. In total, 538 digital lateral cephalometric radiographs were retrospectively collected from a hospital data system. The input data consisted of seven cephalometric variables. All cephalograms were analyzed by the Detectron2 detection and segmentation algorithms. A keypoint region-based convolutional neural network (R-CNN) was used for object detection, and an artificial neural network (ANN) was used for classification. This novel neural network decision support system was created and validated using Keras software. The output data are shown as a number from 0 to 1, with cases requiring orthognathic surgery being indicated by a number approaching 1. The screening software demonstrated a diagnostic agreement of 96.3% with specialists regarding the requirement for orthognathic surgery. A confusion matrix showed that only 2 out of 54 cases were misdiagnosed (accuracy = 0.963, sensitivity = 1, precision = 0.93, F-value = 0.963, area under the curve = 0.96). Orthognathic surgery screening with a keypoint R-CNN for object detection and an ANN for classification showed 96.3% diagnostic agreement in this study.