Preoperative frailty and postoperative complications after non-cardiac surgery: a systematic review.

OBJECTIVE: Many tools have been used to assess frailty in the perioperative setting. However, no single scale has been shown to be the most effective in predicting postoperative complications. We evaluated the relationship between several frailty scales and the occurrence of complications following different non-cardiac surgeries. METHODS: This systematic review was registered in PROSPERO (CRD42023473401). The search strategy included PubMed, Google Scholar, and Embase, covering manuscripts published from January 2000 to July 2023. We included prospective and retrospective studies that evaluated frailty using specific scales and tracked patients postoperatively. Studies on cardiac, neurosurgical, and thoracic surgery were excluded because of the impact of underlying diseases on patients' functional status. Narrative reviews, conference abstracts, and articles lacking a comprehensive definition of frailty were excluded. RESULTS: Of the 2204 articles identified, 145 were included in the review: 7 on non-cardiac surgery, 36 on general and digestive surgery, 19 on urology, 22 on vascular surgery, 36 on spinal surgery, and 25 on orthopedic/trauma surgery. The reviewed manuscripts confirmed that various frailty scales had been used to predict postoperative complications, mortality, and hospital stay across these surgical disciplines. CONCLUSION: Despite differences among surgical populations, preoperative frailty assessment consistently predicts postoperative outcomes in non-cardiac surgeries.

Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study.

High-dose-rate brachytherapy (HDR) is part of the main treatment for locally advanced uterine cervical cancer. Our aim was to evaluate the incidence and intensity of pain and patients' satisfaction during HDR. Risk factors for suffering pain were also analyzed. A retrospective study was carried out by extracting data from patients who had received HDR treatment for five years. Postoperative analgesia had been administered using pre-established analgesic protocols for 48 h. Pain assessment was collected according to a protocol by the acute pain unit. Analgesic assessment was compared according to analgesic protocol administered, number of needles implanted, and type of anesthesia performed during the procedure. From 172 patients treated, data from 247 treatments were analyzed. Pain was considered moderate in 18.2% of the patients, and 43.3% of the patients required at least one analgesic rescue. Patients receiving major opioids reported worse pain control. No differences were found regarding the analgesic management according to the intraprocedural anesthesia used or the patients' characteristics. The number of inserted needles did not influence the postoperative analgesic assessment. Continuous intravenous infusion of tramadol and metamizole made peri-procedural pain during HDR mild in most cases. Many patients still suffered from moderate pain.

Identification of the haemoglobin level associated with a lower risk of complications after total hip and knee arthroplasty.

BACKGROUND: Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut-off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. METHODS: Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2-month recruitment period. Anaemia was defined as haemoglobin <12 g dl-1 for females and < 13 g dl-1 for males. The primary outcome was the number of patients with 30-day in-hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications. Secondary outcomes included the number of patients with 30-day moderate-to-severe complications, red blood cell transfusion, mortality, and length of hospital stay. Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred. RESULTS: A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate-to-severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl-1 was associated with fewer postoperative complications. CONCLUSION: Preoperative haemoglobin ≥14 g dl-1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.

Dispositivos de insuflación-exsuflación en el fracaso respiratorio postoperatorio: informe de caso / Insufflation-exsufflation devices in post-operative respiratory failure: Case report

Introduction: Patients suffering from a neuromuscular disease have a greater likelihood of postoperative respiratory failure. Sometimes, this complication does not respond to noninvasive mechanical ventilation. Case report: Perioperative management of a patient with Werdnig-Hoffmann disease who underwent bilateral coronoidectomy due to trismus. The postoperative period was hampered by the patient's poor respiratory mechanics, inducing the appearance of atelectasis. Despite the application of preventive non-invasive mechanical ventilation, the patient suffered respiratory failure and required endotracheal intubation. Finally, the respiratory weaning was achieved after the application of insufflation-exsufflation devices associated with non-invasive mechanical ventilation. Conclusion: The application of insufflations-exsufflation devices in the immediate postoperative period of patients with neuromuscular diseases promotes the proper respiratory evolution of a patient considered impossible to extubate.

Introducción: El padecimiento de una enfermedad neuromusculares un factor predictor independiente de insuficiencia respiratoria postoperatoria. Esta complicación en ocasiones no responde al tratamiento con ventilación mecánica no invasiva. Presentación del caso: Manejo perioperatorio de un paciente con enfermedad de Werdnig-Hoffmann que fue intervenido de coronoidectomía bilateral por trismus. Su evolución postoperatoria se vio dificultada por la mala mecánica respiratoria del paciente que favoreció la aparición de atelectasias. A pesar de la aplicación de ventilación mecánica no invasiva de forma preventiva, el paciente terminó sufriendo insuficiencia respiratoria y requiriendo intubación orotraqueal. Finalmente se logra el destete respiratorio tras la aplicación de dispositivos de insuflación-exsuflación asociados a la ventilación mecánica no invasiva. Conclusión: La aplicación de los dispositivos de insuflación-exsuflación en el postoperatorio inmediato de pacientes con enfermedades neuromusculares favorece la adecuada evolución respiratoria de un paciente considerado inicialmente como imposible de extubar.