Associations between postoperative anaemia and unplanned readmission to hospital after major surgery: a retrospective cohort study†.

BACKGROUND: Anaemia following major surgery may be associated with unplanned readmission to hospital. However, the severity-response relationship between the degree of anaemia at discharge and the risk of unplanned readmission is poorly defined. We aimed to describe the severity-response relationship between haemoglobin concentration at the time of discharge and the risk of unplanned readmission in a cohort of patients undergoing different types of major surgery. METHODS: We performed a retrospective cohort study in a single tertiary health service, including all patients who underwent major surgery (orthopaedic, abdominal, cardiac or thoracic) between 1 May 2011 and 1 February 2022. The primary outcome was unplanned readmission to hospital in the 90 days following discharge after the index surgical procedure. These complex, non-linear relationships were modelled with restricted cubic splines. RESULTS: We identified 22,134 patients and included 14,635 in the primary analysis, of whom 1804 (12%) experienced at least one unplanned readmission. The odds of unplanned readmission rose when the discharge haemoglobin concentration was < 100 g.l-1 (p < 0.001). On subgroup analysis, the haemoglobin threshold below which odds of readmission began to increase appeared to be higher in patients undergoing emergency surgery (110 g.l-1; p < 0.001) compared with elective surgery. Declining discharge haemoglobin concentration was associated with increased odds ratios (95%CI) of unplanned readmission in patients undergoing orthopaedic (1.08 (1.01-1.15), p = 0.03), abdominal (1.13 (1.07-1.19), p < 0.001) and thoracic (1.12 (1.01-1.24), p = 0.03) procedures, but not cardiac surgery (1.09 (0.99-1.19), p = 0.07). CONCLUSIONS: Our findings suggest that a haemoglobin concentration < 100 g.l-1 following elective procedures and < 110 g.l-1 following emergency procedures, at the time of hospital discharge after major surgery, was associated with unplanned readmission. Future interventional trials that aim to treat postoperative anaemia and reduce unplanned readmission should include patients with discharge haemoglobin below these thresholds.

A novel therapy for intractable chronic cough.

Two cases of intractable chronic cough improved significantly with humidified high flow therapy (HHFT). A 59-year-old woman with Primary Sjogren's disease and interstitial lung disease, was trialled on a Fisher and Paykel myAIRVO™ system. She reported sustained benefits of uninterrupted sleep and increased socialization with tapering use of HHFT. A 67-year-old woman with idiopathic pulmonary fibrosis also benefited from the use of myAIRVO™. She had relentless cough with minimal movement, and nocturnal cough causing fragmented sleep. Her cough subsided considerably with continuous HHFT, but recurred without. Both patients reported significant reductions in the cough visual analogue scale. The mechanisms by which HHFT improve intractable cough may include reducing airway dryness, inhibition of neutrophil inflammation and mucus obstruction, and splinting of the airways. HHFT significantly improved cough and health-related quality of life in two patients with interstitial lung disease. Further research is warranted to explore the role of domiciliary HHFT.

Pneumorrhachis secondary to exacerbation of asthma: A case report and literature review.

Pneumorrhachis is defined by the presence of air within the spinal cord. Spontaneous pneumorrhachis secondary to exacerbation of asthma is rare, and its management is rarely discussed. We present a case of spontaneous pneumorrhachis in the context of a viral exacerbation of asthma, followed by a systematic literature review of all available cases of pneumorrhachis in asthma exacerbation. A total of 25 case studies reported pneumorrhachis in 28 asthma patients, all of whom presented with concomitant pneumomediastinum. Investigation and exclusion for other potential aetiologies of pneumorrhachis such as trauma or infection occurred to varying extents and may depend on clinical presentation and degree of suspicion. No other contributing aetiologies were demonstrated in this review, and no patients required specific intervention for pneumorrhachis. Whilst pneumorrhachis is generally benign, management should revolve around standard care of asthma exacerbation, attention to potentially life-threatening differential diagnoses, and supportive care.