Surgical Patients Research Articles (Page 1)

Incidence of kidney toxicity of non-steroidal anti-inflammatory drugs in critically ill patients.

Circulating Extracellular Vesicle miR-150-5p as a biomarker for optimizing clinical management of sepsis and septic shock: A discovery and validation Study.

High-grade trochlear dysplasia is associated with a more negative sagittal tibial tuberosity-trochlear groove distance: A retrospective cohort study.

The Association of Opioid Prescriptions to Children after Discharge from Surgery and New Opioid Prescription Fills in Family Members.

Global prevalence of perioperative depressive symptoms among non-emergency surgical patients: An umbrella review of current evidence from systematic review and meta-analyses.

Older surgical patients' preferences for follow-up care after hospital discharge: A multi-method qualitative study into their underlying needs.

Vascular surgical patients represent one of the most complex populations in the intensive care unit, due to a combination of extensive comorbidities and high perioperative risk. Postoperative complications such as major adverse cardiovascular events, acute kidney injury, neurological complications, thromboembolism and coagulopathy are common and often intersect. We present the latest evidence on complications most encountered in critically ill patients exposed to vascular surgery and best practices for their management. Although short-term mortality rates for vascular surgical procedures are decreasing, complications continue to be challenging with some procedures incurring higher long-term complication rates. Major adverse cardiovascular events, kidney injury, infections, bleeding, thrombosis and mesenteric ischaemia are some of the most common complications requiring critical care. Optimal management requires early recognition of complications, personalized organ support, and multidisciplinary coordination. We present an updated, evidence-based overview of management strategies for critically ill vascular surgical patients, with a focus on optimizing perioperative outcomes in this high-risk population. The review highlights best practices in hemodynamic monitoring and addresses the prevention and management of common postoperative complications encountered in critical care.

Enhancing compliance and decision-making in breast cancer care for older adults: Optimising the NABCOP fitness assessment form.

Head and neck surgical patients can pose significant management challenges in the ICU postoperatively. In this review, we provide details on the common surgeries that present to the ICU, expected complications and management strategies to improve outcomes. Vital structure involved in breathing, swallowing and neurovascular control are located in the head and neck region posing unique challenges for critical care. A delayed extubation strategy can be performed in select patients and has the advantage of reducing hospital stay, early oral intake, return of speech and decreased respiratory infections compared to a tracheostomy. Recent literature highlights critical interventions to improve outcomes and the importance of a multidisciplinary approach for the management of these patients. These patients require close monitoring for airway compromise, bleeding, neurological deterioration and surgical complications postoperatively. A carefully planned delayed extubation, including a plan for reintubation of a difficult airway may be required in select patients. General management includes tracheostomy care, prevention of deep vein thrombosis, following enhanced recovery after surgery guidelines and maintaining a balance between adequate pain and preservation of airway reflexes. A thorough understanding of the surgery-specific complications and close interaction between the critical care, anesthesiology and surgical teams is paramount.

BACKGROUND Postoperative delirium (POD) is a frequent complication after surgery, associated with increased morbidity, prolonged hospital stay, long-term cognitive decline, and healthcare costs. Although evidence-based strategies to reduce POD exist, their implementation in clinical practice remains inconsistent. OBJECTIVES To assess whether structured implementation of a multicomponent perioperative care bundle is associated with a reduction in POD incidence over time, and to identify key predictors of POD in adult surgical patients. DESIGN Prospective cohort quality improvement study. SETTING Single-centre secondary-level care hospital in Switzerland; study period: 6 January 2023 to 6 January 2024. PATIENTS A total of 1419 adult patients undergoing elective and emergency surgery with postoperative recovery in the postanaesthesia care unit, were included. Patients were enrolled consecutively and included in the final analysis if at least 85% of assessments were completed at four predefined timepoints. The mean age was 58.8 years; 726 were male and 693 were female. INTERVENTIONS Structured implementation of the Safe Brain Initiative perioperative care bundle targeting known POD risk factors. MAIN OUTCOME MEASURES The primary outcome was the incidence of POD, assessed using a validated screening tool at four postoperative timepoints. Secondary outcomes included identification of independent predictors of POD using logistic regression and propensity score matching. RESULTS POD was observed in 278 patients (19.6%). An average monthly reduction in POD incidence of 3.52% was observed over the 12-month period. Independent predictors of POD included age >75 years, odds ratio (OR) 2.39 (95% confidence interval (CI), 1.58 to 3.62), surgical duration >2 h; OR 2.03 (95% CI, 1.45 to 2.85), longer PACU stay; OR 1.05 (95% CI, 1.03 to 1.07), and general anaesthesia; OR 6.50 (95% CI, 3.60 to 11.74). CONCLUSIONS The structured implementation of the care bundle was associated with a reduction in POD incidence over time. General anaesthesia was the strongest independent predictor. These findings support the use of structured perioperative interventions to mitigate POD risk and warrant confirmation in multicentre studies.

The aetiologic agents and resistance rates in community-acquired complicated intra-abdominal infections: Where are we locally?

Enhanced meningeal lymphatic drainage alleviates cognitive dysfunction induced by anesthesia and surgery in aged mice.

Background: Effective hemorrhage control is essential in managing trauma and surgical patients, with uncontrolled bleeding being a leading cause of mortality. Ankaferd Blood Stopper (ABS), a hemostatic agent historically used in Anatolia, has gained recognition for its ability to modulate red blood cell-fibrinogen interactions to form a stable protein network for rapid bleeding cessation. Objective: This review explores the multifaceted applications of ABS, evaluating its efficacy, safety, and potential therapeutic roles across various medical fields, including hemostasis, wound healing, antimicrobial activity, and antineoplastic effects. Methods: A comprehensive synthesis of clinical trials, case reports, and experimental studies was conducted to assess the performance and implications of ABS. This narrative review highlights its application in trauma, surgery, dental procedures, and other clinical contexts, and compares its efficacy with that of established hemostatic agents. Results: ABS demonstrates significant efficacy in achieving hemostasis in diverse clinical settings, particularly in patients with coagulopathies. Its wound healing and antimicrobial properties enhance its therapeutic versatility. Neurotoxic effects of ABS are also reported, with recent studies providing mixed evidence on nerve safety in animal models. Emerging evidence suggests potential antineoplastic effects, with studies reporting apoptosis induction in cancer cells and protective effects in experimental models. Conclusion: ABS is a promising hemostatic agent with applications in bleeding control, wound healing, and infection management. While it has shown efficacy in various clinical settings, its safety profile remains a subject of debate, with some studies confirming its biocompatibility and others reporting potential neurotoxic effects. Further large-scale human studies are needed to clarify its long-term safety and establish standardized clinical guidelines for its use.

Background: Identifying surgical patients through administrative and clinical data can inform the quality and demand for surgical care. In South Africa, a database exists that comprises data from the public health sector. However, algorithms are lacking to identify surgical procedures like appendectomy in these systems in our setting. Aim: To develop and validate an appendectomy algorithm for use in a South African database. Setting: Data from public hospitals in South Africa were the reference standard and comprised appendectomy and other general surgery procedure controls. The index test was the appendectomy algorithm developed and validated using the provincial database in the country. Methods: A diagnostic test accuracy study was done. The algorithm was developed using four phases: exploration and selection, development, refinement and validation. Data analyses were performed using STATA version 18. Results: The final algorithm comprised two procedures and nine diagnostic codes and reached a sensitivity of 91.3% and a specificity of 96%. Conclusion: Our study is the first to validate an appendectomy algorithm in a low-and middle-income country setting. While not the first globally, it addresses a critical gap in the literature by demonstrating that robust, high-specificity algorithms can be developed in resource-constrained settings. Future research should focus on applying the algorithm to evaluate median delays in accessing care within the public health system. Contribution: This study demonstrates that surgical procedure algorithms can be developed and validated with sufficient sensitivity and specificity using diagnostic and procedure codes for application in a low- and middle-income country setting.

BACKGROUND: In-hospital ischemic stroke is a severe competing condition associated with a high rate of adverse outcomes. AIM: This work aimed to compare the effectiveness of medical care for patients with in-hospital ischemic stroke in facilities with a primary stroke unit versus a regional comprehensive stroke center. METHODS: A retrospective analysis was performed, evaluating quality of care and outcomes in 389 patients with in-hospital ischemic stroke across 12 healthcare facilities in Saint Petersburg during 2015–2024: eight hospitals with a regional comprehensive stroke center and one federal medical organization providing 24/7 endovascular care for in-hospital ischemic stroke (n = 268); and three multidisciplinary hospitals with a primary stroke unit (n = 121). RESULTS: In-hospital ischemic stroke occurred more frequently in internal medicine patients in primary stroke units (66.9% vs 33.1%), whereas in regional comprehensive stroke centers it was more common in surgical patients (56.7% vs 43.3%; p 0.001). Patients with in-hospital ischemic stroke treated in primary stroke units were older (77.0 ± 13.0 vs 69.0 ± 12.0 years; p 0.001), had higher comorbidity burden by Charlson Comorbidity Index (8.9 ± 3.7 vs 7.1 ± 2.8; p 0.001), and were more often admitted urgently (85% vs 57%; p 0.001). In-hospital ischemic stroke in primary stroke units was associated with more severe neurological deficits (13 ± 7 vs 12 ± 8; p = 0.025), poorer functional outcomes (p 0.001), and higher in-hospital mortality (53% vs 29%; p 0.001) compared with regional comprehensive stroke centers. At diagnosis of in-hospital ischemic stroke, angiographic (11% vs 57%; p 0.001) and perfusion (0.8% vs 5.4%; p 0.001) neuroimaging studies were performed less frequently in hospitals with primary stroke units than in regional comprehensive vascular centers; emergency reperfusion methods were also used less often (0.8% vs 16.4%; p 0.001). CONCLUSION: Differences in functional capacity between primary stroke units and regional comprehensive stroke centers with regard to reperfusion treatment approaches should not adversely influence the timeliness and completeness of diagnostic work-up in patients with in-hospital ischemic stroke. Angiographic and perfusion neuroimaging allows for the use of systemic thrombolytic therapy under expanded indications in primary stroke units, and also enables determination of indications for endovascular interventions to facilitate transfer to the nearest regional comprehensive stroke center in accordance with routing protocols.

Abstract Background Post-induction hypotension is a common complications in surgical patients under general anesthesia. Previous evidence indicated preoperative fluid bolus infusion might improve hemodynamic stability after anesthesia induction. But the reported results regarding the postoperative clinical outcomes remains controversary. Methods Colloids infusion for Optimal outcomes In Non-cardiac surgery (COIN) trial is a multicenter, double-blinded, parallel-group, randomized controlled trial being conducted in seven tertiary hospitals in China. The trial will enroll and randomize 2,020 adult participants scheduled to undergo noncardiac surgery under general anesthesia with tracheal intubation. Participants will receive either 5 ml/kg of 6% hydroxyethyl starch 130/0.4 electrolyte solution (colloid group) or balanced multiple electrolyte solution (crystalloid group) prior to anesthesia induction. The primary endpoint is the incidence of postoperative complications within 30 days after surgery, defined as Clavien-Dindo classification Grade I or higher (any deviation from the normal postoperative course, including those requiring pharmacological treatment). The primary analysis will be an unadjusted, modified intention-to-treat comparison between patients randomized to colloids group and crystalloids group using chi-square test. The first patient was enrolled on July 12, 2023, and the trial is expected to be completed in June 2025. Conclusion The study aims to provide evidence-based insights into reducing postoperative complications in non-cardiac surgery patients undergoing general anesthesia, by comparing the effects of preoperative colloid versus crystalloid solution infusion prior to anesthetic induction. Should the findings demonstrate that colloid solution infusion effectively reduces the 30-day postoperative complication rate, this protocol may contribute to an optimized perioperative management strategy and further promote the clinical adoption of standardized preoperative hemodynamic management. Trial registration This study was registered at ClinicalTrials.gov under the identifier NCT05728645 on July 9, 2023, prior to its initiation ( http://clinicaltrials.gov ).

This meta-analysis aimed to systematically evaluate the impact of intraoperative dexmedetomidine (DEX) on postoperative mortality and clinical outcomes in surgical patients, addressing existing controversies in the literature. We conducted a systematic review of randomized controlled trials (RCTs) from PubMed, Embase and Cochrane Library (inception to October 8, 2024; PROSPERO: CRD42024583524). Included studies compared intraoperative DEX against controls (placebo/active comparators) in adults undergoing general anesthesia. Primary outcome was mortality; secondary outcomes included postoperative delirium (POD), ICU/hospital stay, mechanical ventilation duration, and safety endpoints. Risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were pooled using fixed/random-effects models. This meta-analysis included 17 randomized controlled trials (RCTs). In cardiac surgery patients, DEX significantly reduced all-cause mortality (RR 0.39, 95% CI 0.18-0.85; P = 0.02) and in-hospital mortality (RR 0.23, 95% CI 0.08-0.70; P = 0.01), but not 30-day mortality. In non-cardiac surgery patients, DEX did not significantly reduce all-cause, 30-day, or in-hospital mortality. DEX decreased the incidence of POD in both cardiac (RR 0.61, 95% CI 0.46-0.82; P = 0.001) and non-cardiac surgery patients (RR 0.56, 95% CI 0.36-0.87; P = 0.01). For other outcomes, significant reductions in hospital stay, ICU stay, and mechanical ventilation duration were primarily observed in the cardiac surgery subgroup. Safety analysis indicated there was no significant difference in intraoperative bradycardia or hypotension between groups. Dexmedetomidine use in cardiac surgery significantly reduces all-cause and in-hospital mortality, shortens hospital length of stay, decreases ICU stay duration, and reduces mechanical ventilation requirements. However, its impact on 30-day mortality is not significant. Additionally, the drug consistently demonstrates a preventive effect on postoperative delirium across different surgical types.Clinicians must carefully weigh the benefits of this medication against the potential risk of transient hemodynamic instability.

To evaluate the real-world safety and efficacy for standard surgical risk patients with extracranial internal carotid artery disease undergoing transcarotid artery revascularization. ROADSTER 3 is a prospective, multicenter, single-arm post-approval study. Patients <80 years old without anatomic or physiologic high-risk factors were included. Thirty-day incidence of major adverse events (stroke, death, or myocardial infarction) and cranial nerve injury were assessed. An independent clinical events committee adjudicated events, and independent certified health care personnel performed neurological assessments. Between 2022 and 2024, 344 patients (intent to treat population) were enrolled at 48 sites in the United States. Because of 24 major protocol deviations, 320 patients remained in the Food and Drug Administration's analysis population (per protocol). In the per protocol population, there were 136 (42.5%) females and 49 (15.3%) symptomatic patients. Among symptomatic patients, 12 (24.5%) were treated within 2 weeks of the prior event. Technical success was 100%. For the entire study population, there were strokes in 3 patients with no instances of death or myocardial infarction. The 2 instances of cranial nerve injury (0.6%; 95% CI, 0.1-2.2% in the per protocol population) both resolved within 6 months. The composite 30-day stroke/death/myocardial infarction rate was 0.6% (95% CI, 0.1-2.2%) for the per protocol population and 0.9% (95% CI, 0.2-2.5%) for the intent to treat population. The 30-day results of the ROADSTER 3 study confirm that transcarotid artery revascularization is safe and effective in the standard-risk population. Longer-term follow-up is pending to confirm durable stroke prevention for these patients. ANN NEUROL 2025.

Validation of recorded diagnoses of acute kidney injury among surgical patients in the Japanese Diagnosis Procedure Combination database.

Acute kidney injury (AKI) is a critical concern in intensive care unit (ICU) patients, especially those treated with colistin. However, existing research often includes mixed patient populations, including non-ICU patients, and lacks stratification of factors associated with varying severities of AKI. The AKI prevalence and predicting variables should be further explored due to the diversity in AKI development and outcomes in colistin-treated ICU patients. This study analyzed electronic medical records of 174 surgical and medical ICU patients treated with intravenous colistin at a tertiary university hospital. Multinomial regression analysis was used to analyze the prevalence of AKI stages using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and identify predictive factors across different stages of AKI. Among 174 colistin-treated ICU patients, 83.9% developed AKI with a median stage of 3. The presence of AKI did not significantly influence the mortality rates. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score was a consistent predictor across AKI stages (P < 0.05). Colistin dosage was as a significant predictor when distinguishing Stage 1 AKI from no AKI (adjusted OR 1.46, 95% CI: 1.09-1.94), but was not identified as a significant predictor for the progression to Stages 2 to 3 AKI. The impact of colistin-associated nephrotoxicity in ICU patients is primarily at the initial stage of AKI and does not extend to more advanced stages. Patient safety may be enhanced by using the APACHE II score as one of the deciding variables when deciding between colistin and other antibiotic treatments, particularly for vulnerable critically ill patients.