Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 69 appraisals
Surgery
Artificial intelligence to revolutionize surgical decision-making is still just around the corner.
Medical artificial intelligence, especially large language models, has engendered both excitement and unease across the medical community, promising improved surgical diagnostic accuracy, perioperative decision-making, and patient safety amidst concerns of considerable bias and its implications on the future of human expertise. The evolution of artificial intelligence clinical decision support originated in the surgical field through early systems like AAPHelp, which leveraged Bayesian reasoning to diagnose acute abdominal pain. Despite the initial promise of artificial intelligence clinical decision support, attempts to develop more robust diagnostic tools largely fell short in the 1980s, with instruments unable to adequately diagnose and manage complex presentations, a lack of transparency in their decision-making processes, and limitations in scope. It was not until the 2010s that clinical decision support began to show renewed potential as a meaningful adjunct in surgical practice, largely driven by advancements in machine learning techniques and wider access to large clinical data sets. New artificial intelligence models, particularly those utilizing large language models, now demonstrate impressive capabilities, from predicting the risk of postoperative complications for individual patients to streamlining clinical documentation and beyond. However, challenges persist regarding transparency, bias, reliability, and integration into clinical workflows. Despite these hurdles, artificial intelligence-based tools like large language models represent an exciting new chapter in surgical decision-making. Built on a long history of clinical decision support systems in surgery, these technologies hold great promise to meaningfully augment surgical practice and improve care for patients.
1 Aug 2026
Read appraisal →Neurosurgical review
Development and external validation of a machine learning model for predicting postoperative hydrocephalus in 1,073 posterior fossa tumor patients
Postoperative hydrocephalus is a common complication following posterior fossa tumor resection, affecting 7-40% of patients. Although preoperative cerebrospinal fluid (CSF) diversion may be required in selected patients with hydrocephalus, decisions remain individualized in routine neurosurgical practice. We therefore developed and externally validated a model to provide supplementary preoperative risk stratification using routinely available variables. We retrospectively analyzed 1,073 patients following resection of posterior fossa tumors (PFTs) treated at five tertiary centers between 2013 and 2024, dividing them into a development cohort (n = 854) and an external validation cohort (n = 219). We initially screened 30 perioperative variables from the multicenter dataset and then selected a clinically implementable model restricted to variables available before tumor resection. Feature importance was ranked using Shapley additive explanations (SHAP), and seven distinct machine learning (ML) algorithms were evaluated. Model performance was comprehensively measured using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision-recall curves, and decision curve analysis. The final clinically implementable model included three preoperative variables: Evans index, tumor-fourth ventricle relationship, and preoperative cerebrospinal fluid diversion status. In the external validation cohort, the support vector machine model showed good external discrimination, with an area under the receiver operating characteristic curve of 0.877, accuracy of 81.3%, sensitivity of 80.8%, and specificity of 81.7%. Logistic regression achieved comparable discrimination. Calibration assessment suggested dataset shift between the development and external validation cohorts, indicating that absolute predicted probabilities should be interpreted cautiously in populations with different baseline risks. A concise three-variable preoperative model showed good external discrimination for clinically relevant postoperative hydrocephalus after posterior fossa tumor resection. The model may support preoperative risk communication and postoperative surveillance planning, but should not be used as a stand-alone indication for cerebrospinal fluid diversion. Prospective validation and local recalibration are warranted before routine clinical implementation.
31 July 2026
Read appraisal →JBJS reviews
One-Stage or Two-Stage Revision for Infected Shoulder Arthroplasty: A Head-to-Head Meta-Analysis of Comparative Studies
BACKGROUND: Periprosthetic joint infection (PJI) following shoulder arthroplasty is a devastating complication associated with substantial morbidity and revision burden. While 2-stage revision has traditionally been regarded as the gold standard for chronic shoulder PJI, single-stage revision has emerged as a potential alternative. The aim of this systematic review was to directly compare infection-related outcomes and complications between single-stage and 2-stage revision arthroplasties for shoulder PJI. METHODS: This systematic review was prospectively registered with PROSPERO (CRD420251159566) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, and Web of Science were searched up to September 22, 2025. Comparative observational studies and randomized controlled trials (RCTs) evaluating single-stage vs. 2-stage revision for shoulder PJI in adults were eligible; no RCTs were identified. Primary outcomes were reinfection and infection control success; overall complications were secondary. Odds ratios (ORs) were calculated within each study and pooled using a random-effects model. Risk of bias was assessed with the Risk of Bias in Non-randomized Studies of Interventions tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Thirteen retrospective comparative studies involving 260 patients (127 single-stage and 133 two-stage) were included. Compared with 2-stage revision, single-stage revision showed a lower, but not statistically significant, odds of reinfection (OR 0.46, 95% confidence interval [CI] 0.21-1.04; p = 0.06; I2 = 0%) and overall complications (OR 0.52, 95% CI 0.18-1.53; p = 0.24; I2 = 0%) and a higher, but nonsignificant, odds of infection control success (OR 1.57, 95% CI 0.45-5.40; p = 0.48; I2 = 17%). CONCLUSION: Single-stage revision demonstrated infection control and complication rates comparable with 2-stage revision for shoulder PJI. Although no statistically significant differences were observed, trends favored single-stage revision. Given that the certainty of the evidence was graded as low, these findings should be interpreted with caution, and high-quality RCTs are required to define optimal patient selection and surgical strategy. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
30 July 2026
Read appraisal →Journal of the American College of Surgeons
Defining Quality Metrics for Telemedicine in Surgery: A Critical Examination
The rapid adoption of telemedicine has transformed healthcare delivery in the US, enhancing access and communication for surgical patients across wide geographic areas. However, a critical challenge persists: the need to define and standardize quality metrics specifically for telemedicine in surgery. Existing studies suggest that telemedicine can yield equivalent or improved outcomes compared with in-person visits. Nevertheless, literature remains limited in evaluating patient satisfaction, cost-effectiveness, and diagnostic accuracy. Through expert consensus within the American College of Surgeons Board of Governors Telehealth Pillar, we propose a structured framework for defining and implementing quality metrics for surgical telemedicine. This is based on the Donabedian model, addressing structure, process, and outcome, while also considering the distinct phases of surgical care: preoperative, intraoperative, and postoperative. This framework identifies unique domains of telemedicine in surgical care, emphasizing hospital and organizational structure, patient and provider readiness, and policy alignment. A comparative analysis with existing AHRQ and WHO frameworks highlights gaps in surgical applicability. Finally, we propose an implementation roadmap prioritizing immediate, feasible metrics while identifying areas for future validation. Collaboration among researchers, clinicians, and policymakers will be essential to establish these metrics and ensure that telemedicine delivers on its potential to improve surgical care delivery while addressing disparities in access and outcomes.
18 July 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Fasciotens® for abdominal wall closure: current evidence and clinical perspectives.
PURPOSE: Management of open abdomen (OA) and complex ventral hernias remains associated with high morbidity, prolonged hospitalization, and substantial healthcare costs. Vertical fascial traction has emerged as a novel approach aimed at facilitating early primary fascial closure. This study provides a narrative review and multidimensional overview of the available evidence regarding the Fasciotens® device, focusing on clinical outcomes, safety, economic considerations, and organizational aspects. METHODS: A narrative systematic literature review was performed to identify studies evaluating the use of Fasciotens® in adult patients with open abdomen or complex ventral hernias. Clinical, economic, organizational, and ethical domains were assessed. RESULTS: Available evidence, primarily derived from observational studies and case series, suggests that the use of Fasciotens® is associated with high rates of primary fascial closure, shorter time to closure, and reductions in intra‑abdominal pressure. Device‑related adverse events appear to be infrequent and mainly limited to minor skin‑related complications. Preliminary economic considerations indicate that earlier closure and avoidance of complex reconstructive procedures may reduce operative time, intensive care unit stay, and overall hospital resource utilization. CONCLUSION: Current evidence supports the clinical feasibility and potential value of Fasciotens® as an adjunctive technology for the management of open abdomen and complex ventral hernias. However, the available data are limited by small sample sizes and non‑comparative study designs. Further prospective and comparative studies are needed to better define its role within standardized treatment pathways.
16 July 2026
Read appraisal →Nutricion hospitalaria
Immunonutrition in surgical patients with colorectal cancer: a systematic review
Introduction: surgery in patients with colorectal cancer often leads to complications, affecting recovery, prolonging hospital stay, and impacting quality of life. Immunonutrition plays an important role by modulating the immune system and may contribute to the reduction of these complications. Objective: to assess the effect of immunonutrient supplementation on complications in surgical patients with colorectal cancer. Materials and methods: a literature search was conducted in PubMed, Web of Science, Embase, and Cochrane, following the PRISMA model. A total of 20 clinical trials and two observational studies published between 2000 and 2025 were selected, analyzing postoperative complications, physical or nutritional status, immune response, and length of hospital stay. Results: a reduction in postoperative complications was observed with combined immunonutrient supplementation (arginine, omega-3 fatty acids, nucleotides, L-alanine, and L-glutamine), particularly in wound infections. No benefits were found with isolated supplementation. Conclusion: combined immunonutrient administration may improve postoperative complications, especially wound infections, although results regarding hospital stay are inconsistent. Isolated supplementation with omega-3 fatty acids shows no benefit. Introducción: la cirugía en pacientes con cáncer colorrectal conlleva complicaciones, alterando la recuperación, alargando la estancia hospitalaria y afectando a la calidad de vida. La inmunonutrición ejerce una acción importante al modular el sistema inmunológico y podría mejorar estas complicaciones. Objetivo: evaluar el efecto de la suplementación con inmunonutrientes en las complicaciones en pacientes quirúrgicos por cáncer colorrectal. Material y métodos: se realizó una búsqueda bibliográfica en PubMed, Web of Science, Embase y Cochrane, siguiendo el modelo PRISMA. Se seleccionaron 20 ensayos clínicos y dos observaciones, publicados entre 2000 y 2025, que analizaron complicaciones posoperatorias, el estado físico o nutricional, la respuesta inmune y la duración de estancia hospitalaria. Resultados: se halló una reducción de las complicaciones posoperatorias con una suplementación combinada de inmunonutrientes como arginina, ácidos grasos omega-3, nucleótidos, L-alanina y L-glutamina, especialmente en infecciones de herida, sin beneficios en la administración aislada. Conclusión: la administración combinada podría mejorar las complicaciones posquirúrgicas, especialmente de la infección de la herida, con resultados contradictorios para estancia hospitalaria. La suplementación aislada de ácidos grasos n-3 no aporta beneficios.
15 July 2026
Read appraisal →BMJ open
Association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery: a systematic review and meta-analysis protocol.
INTRODUCTION: Lung cancer surgery is a cornerstone of curative treatment for resectable disease, but postoperative recovery is often prolonged and may be complicated by impaired pulmonary function, reduced physical activity, symptom burden and delayed functional restoration. Wearable devices may support perioperative physical activity through objective monitoring and activity promotion; however, existing evidence remains fragmented and has not been synthesised in a focused review. This protocol describes a systematic review and meta-analysis to evaluate the association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery. METHODS AND ANALYSIS: We will include randomised controlled trials, non-randomised interventional studies and prospective or retrospective cohort studies involving adults undergoing surgery for suspected or confirmed primary lung cancer. Eligible studies must examine wearable device-based perioperative physical activity during the preoperative period, postoperative period or both. The primary outcomes will be postoperative pulmonary complications, length of hospital stay and physical function or exercise capacity. Secondary outcomes will include overall postoperative complications, pulmonary function, symptom burden, health-related quality of life, chest tube duration, readmission and postoperative mortality. We will search PubMed, EMBASE, Web of Science, CINAHL and the Cochrane Library from inception to the final search date, supplemented by reference screening, forward citation tracking, grey literature and trial registry searches. Two reviewers will independently perform study selection, data extraction and risk-of-bias assessment. Where appropriate, meta-analysis will be performed using random-effects models; otherwise, findings will be synthesised narratively. ETHICS AND DISSEMINATION: Ethical approval is not required because this review will use data from published studies and publicly accessible sources only and will not involve individual participants or identifiable personal data. The findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic or professional conferences. PROSPERO REGISTRATION NUMBER: CRD420261375254.
11 July 2026
Read appraisal →BMJ open
Implementation determinants of a planned machine learning-enabled surgical scheduling system in a high-volume orthopaedic centre in Canada: qualitative findings.
OBJECTIVES: Elective non-emergent surgical wait times have increased across countries such as Canada, straining operating room (OR) resources and affecting patient outcomes and healthcare spending. Manual scheduling systems in Ontario orthopaedic centres create wide variations in wait times, with recent declines in meeting benchmark targets despite increased procedure volumes. Challenges stem from fragmented referral processes, outdated scheduling methods and resource constraints. Artificial intelligence and machine learning (ML) offer potential solutions for optimising scheduling; however, their implementation remains inconsistent. This study aims to identify determinants affecting the rollout of a new ML-driven automated scheduling system at a high-volume elective orthopaedic surgery centre. DESIGN: A qualitative description approach supported by implementation science frameworks. SETTING: A high-volume elective orthopaedic surgery unit at a Canadian tertiary care centre. PARTICIPANTS: 17 individuals from clinical, administrative and leadership roles who were directly involved in surgical scheduling. INTERVENTIONS: A new ML-driven automated surgical scheduling system. OUTCOMES: Perceptions of the proposed new surgical scheduling system (barriers and enablers of implementation, recommendations for improvement). RESULTS: Three main themes were identified, capturing challenges and enablers in the existing scheduling system: system functionality, process-related factors and resource constraints.Participants described substantial inefficiencies in the existing manual scheduling system, including outdated software, fragmented information systems, inconsistent communication and resource constraints. Across interest-holder groups, there was broad but variable perceived support for a planned ML-enabled scheduling system, particularly for improving duration prediction, access to scheduling data and reporting, alongside concerns about system complexity, workflow fit, training and resource implications. Interest-holders emphasised the importance of user-friendly design, interoperability, responsive training, phased implementation and ongoing feedback. CONCLUSIONS: This pre-implementation qualitative study identified significant process and resource limitations in manual orthopaedic surgical scheduling, but interest-holder support for a well-designed ML-driven system is strong. While participants anticipated potential benefits for scheduling accuracy, throughput and resource allocation, these perceived advantages will require meaningful user engagement, robust training, phased rollout and evaluation in subsequent implementation and outcome studies.
8 July 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Topography and functional connectivity analysis of heart surgery-associated brain lesions: a literature review
BACKGROUND: Cardiac surgery is a major therapeutic advancement but remains associated with neurological complications, including ischemic stroke and postoperative cognitive decline. Compared with stroke of other etiologies, ischemic brain injury following cardiac surgery may involve distinct vascular territories and functional networks, potentially influencing its characteristic cognitive profile. METHODS: We performed a systematic review of case reports describing ischemic brain lesions occurring after cardiac surgery in adults with available neuroimaging data. Lesions were manually traced onto a standard brain atlas and compared with ischemic stroke lesions from the ATLAS database, matched for hemispheric involvement. Lesion topography was analyzed at the arterial territory and voxel levels. Lesion network mapping was conducted using normative resting-state functional connectivity data to identify patterns of functional disconnection. Permutation-based statistical analyses were applied, with correction for multiple comparisons and lesion volume included as a covariate. RESULTS: Nineteen articles met the inclusion criteria, yielding 20 cases of post-cardiac surgery ischemic lesions. Compared with stroke controls, these lesions more frequently involved posterior arterial territories, particularly the occipital branches of the posterior cerebral arteries and posterior thalamic regions. Lesion network mapping revealed a distinct pattern of functional disconnection in the occipital lobes, posterior thalamus (including the pulvinar), and medial frontal cortex. CONCLUSIONS: Our results suggest that ischemia associated with cardiac surgery may preferentially involve posterior arterial territories and be associated with distinct patterns of functional disconnection involving the occipital lobe, the pulvinar, and the medial frontal cortex.
6 July 2026
Read appraisal →BMJ open
Impact of climatic variables on postoperative outcomes in various surgical disciplines: a systematic review.
OBJECTIVES: The impact of climate change on health is well recognised, yet its influence on postoperative complications remains underexplored. This systematic review examines how climatic factors-particularly temperature, humidity and seasonal variations-affect surgical outcomes. DESIGN: Systematic review with narrative synthesis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. DATA SOURCES: A comprehensive search of PubMed, Web of Science and the Cochrane Library from June 2015 to June 2025 was conducted. An additional supplementary PubMed search was performed to identify further relevant studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included were studies published in English or German that examined associations between climatic factors, including temperature, humidity, precipitation or seasonality and postoperative outcomes in surgical patients. Studies without a surgical or climatic focus, animal studies, reviews and commentaries were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies and extracted data using predefined criteria. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to methodological heterogeneity, findings were synthesised narratively. RESULTS: Fifteen studies were included. High ambient temperatures were frequently associated with increased risks of surgical site infections (SSIs). Some large studies reported that even a one-degree rise significantly elevated infection rates. Humidity was also linked to higher infection rates, with evidence suggesting an independent effect in some cases. Seasonal changes influenced complication rates across regions and surgical disciplines, with infection and pneumonia peaks in summer or winter months. A few studies reported increased risks during heavy rainfall or institutional transitions such as the 'July effect'. CONCLUSION: Overall, elevated temperature and humidity appear to be associated with increased postoperative risks, especially SSIs. Seasonal patterns may further influence outcomes depending on geography and procedure type. While the available evidence supports a link between climate and surgical complications, methodological differences and limited adjustment for confounders highlight the need for more rigorous studies.
5 July 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Advances in Remote Monitoring Technology Applications in Anesthesia: A Narrative Review
The swift progress of digital and sensor technologies is hastening the incorporation of remote monitoring into anesthesiology. While several reviews have explored telemedicine and artificial intelligence in anesthesia, most existing summaries either focus on conceptual outlook or lack systematic comparison of technical platforms and original clinical validation data. The present review provides a comprehensive, clinically oriented synthesis of remote monitoring in anesthesia, with clear focuses on technical principles, perioperative applications, platform comparisons, and evidence-based clinical outcomes. We critically assess clinical advantages and implementation hurdles, covering the full perioperative pathway - preoperative evaluation, intraoperative observation, and postoperative recovery. A head-to-head comparison of fifth generation of cellular network technology (5G), the Internet of Things (IoT), and cloud computing platforms is presented to clarify their infrastructure demands and suitability for real-world clinical scenarios. Notably, this review summarizes available clinical evidence, including evidence from the Trial of Remote Continuous versus Intermittent National Early Warning Score Monitoring after major surgery (TRaCINg) - a feasibility randomized controlled trial whose exploratory findings suggest that continuous remote monitoring may reduce unplanned intensive care unit admissions, shorten hospital stays, and facilitate earlier detection of postoperative complications. We further propose innovative solutions including multimodal data fusion and federated learning-driven predictive analytics to overcome current limitations in data interoperability, security, and clinical effectiveness. Accordingly, this paper synthesizes the latest advances in remote monitoring technology in anesthesia, clarifies its unique value relative to existing reviews, and provides practical guidance for clinical translation and future research.
2 July 2026
Read appraisal →The Orthopedic clinics of North America
Wearable Devices and Artificial Intelligence to Enhance Perioperative Care in Total Knee Arthroplasty
Rapidly evolving wearable devices have the potential to transform health care delivery and enhance outcomes. Applications of wearable smart devices range from activity and motion tracking to real-time monitoring of vital signs and biochemical markers. Recent evidence provides support for the use of wearable devices in chronic disease management, rehabilitation, and perioperative care of patients with total knee arthroplasty. Data derived from these devices may enhance treatment personalization and early identification of complications. Challenges remain regarding accuracy, standardization, privacy, and patient adherence. Future advances must overcome these limitations.
2 July 2026
Read appraisal →Current opinion in anaesthesiology
Preoperative considerations for nonoperating room anesthesia
PURPOSE OF THE REVIEW: This review aims to address the unique challenges in nonoperating room anesthesia (NORA) locations, emphasizing the importance of patient selection, risk stratification, and comprehensive preoperative evaluation to ensure safe anesthetic care for increasingly complex patients. RECENT FINDINGS: The volume of NORA procedures has risen significantly, with patients often presenting higher comorbidity burdens and advanced age. Standardized protocols and validated assessment tools, such as the STOP-Bang questionnaire and a simple frailty questionnaire (e.g., FRAIL), can aid anesthesiologists in effectively stratifying risk and tailoring anesthesia plans. Challenges in NORA include logistical constraints, personnel dynamics, and environmental factors that can compromise patient safety. The integration of telemedicine and artificial intelligence into preoperative assessments shows promise in improving efficiency and safety by allowing for remote evaluations and tailored care. SUMMARY: Adequate patient selection and preoperative optimization are essential for enhancing outcomes in NORA locations. Adherence to national safety guidelines and multidisciplinary collaboration is crucial for navigating the complexities of remote anesthesia care. Future research should focus on refining preoperative screening methods and utilizing artificial intelligence to better address the unique needs of patients undergoing procedures outside traditional operating rooms.
23 June 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Association between timing of surgery and postoperative outcomes in older adults with distal femur fractures: a systematic review and meta-analysis
INTRODUCTION: The association between surgical timing and clinical outcomes in older adults with distal femur fractures remains unclear. We conducted a systematic review and meta-analysis to evaluate whether earlier surgery is associated with improved outcomes in this population. MATERIALS AND METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent reviewers searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to October 8, 2024. The primary outcome was 30-day mortality, and secondary outcomes included longer-term mortality and postoperative complications. Risk of bias was assessed using the Quality in Prognosis Studies tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 6,101 records screened, 16 retrospective cohort studies comprising 31,213 patients met the inclusion criteria. Early surgery was not associated with reduced 30-day mortality (adjusted odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.56-1.05; low-certainty evidence) or with longer-term mortality at 90 days (crude OR: 0.91, 95% CI: 0.51-1.60), 180 days (crude OR: 0.46, 95% CI: 0.12-1.77), or 1 year (crude OR: 0.61, 95% CI: 0.34-1.09). Similar findings were observed for postoperative complications: cardiac complications (OR: 0.71, 95% CI: 0.48-1.07), pulmonary complications (OR: 1.07, 95% CI: 0.77-1.47), and pulmonary embolism (OR: 1.14, 95% CI: 0.62-2.16). Heterogeneity across outcomes was low to moderate, and definitions of early surgery varied among studies. Overall, this meta-analysis did not demonstrate a clinically meaningful association between surgical timing and short-term clinical outcomes in older adults with distal femur fractures. Sensitivity analyses consistently suggested lower mortality with earlier surgery, likely reflecting stricter definitions of early surgery and improved control of time-related bias. CONCLUSIONS: This meta-analysis did not demonstrate a clinically meaningful association between surgical timing and short-term clinical outcomes in older adults with distal femur fractures. Given the heterogeneity in definitions and study designs, high-quality prospective studies with standardized timing are warranted.
20 June 2026
Read appraisal →Journal of the American College of Surgeons
What Is Included in Pediatric Enhanced Recovery After Surgery Protocols and How to Encourage Adoption: A Systematic Review of the Literature
The present systematic review is the first to describe and analyze the breadth of enhanced recovery after surgery (ERAS) elements across various pediatric surgery procedures. The aim of the article is to provide a compendium of ERAS elements that are used in pediatric protocols to identify both gaps and variation. In response to these findings, we then propose a methodology for addressing the gaps and variation we found and furthering the use of ERAS in pediatric surgery.
14 June 2026
Read appraisal →Pediatric surgery international
Early vs. delayed feeding after pediatric gastrointestinal surgery: a systematic review and meta-analysis
BACKGROUND: The adoption of early feeding after pediatric gastrointestinal surgery remains inconsistent due to concerns regarding anastomotic safety. METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted comparing early enteral feeding (initiation within 48 h) with delayed feeding in patients < 18 years undergoing intestinal anastomosis or stoma reversal. RESULTS: Eight trials comprising 704 patients (323 early feeding, 381 delayed) were included across neonatal and pediatric elective surgical populations. Early feeding significantly shortened hospital length of stay (mean difference - 3.53 days; 95% CI - 4.35 to - 2.71) and reduced time to full feeds (mean difference - 3.15 days; 95% CI - 3.89 to - 2.40). There was no significant difference in anastomotic leakage (log risk ratio - 0.36; 95% CI - 1.23 to 0.51; I²=0%) or postoperative vomiting (log risk ratio - 0.02; 95% CI - 0.41 to 0.38). Early feeding was also associated with fewer wound infections (log risk ratio - 0.85; 95% CI - 1.48 to - 0.22). CONCLUSIONS: Overall, early enteral feeding after pediatric gastrointestinal surgery appears safe and confers clinically meaningful benefits by accelerating nutritional recovery, reducing infectious complications, and shortening hospitalization, supporting its incorporation into pediatric postoperative care pathways.
13 June 2026
Read appraisal →JMIR medical informatics
Machine Learning for Intraoperative Bleeding Prediction in Patients Undergoing Surgery: Scoping Review
BACKGROUND: Intraoperative bleeding is a critical event that impacts surgical safety and patient outcomes. Machine learning (ML) has demonstrated potential in prediction tasks, yet its methodological rigor and clinical translation face challenges. OBJECTIVE: This scoping review aims to systematically synthesize the current state of development, performance, and validation of ML models for predicting intraoperative bleeding, and to identify key barriers to their clinical implementation. METHODS: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we systematically searched 7 databases (PubMed, Web of Science, Embase, CINAHL, CNKI [China National Knowledge Infrastructure], Wanfang, and VIP [China Science and Technology Journal Database]) from their inception to April 2025. Moreover, 2 reviewers (SY and PZ) independently screened studies, extracted data using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS), and assessed the risk of bias using the Prediction Model Risk Of Bias Assessment Tool (PROBAST). A narrative synthesis was used for data analysis. RESULTS: Out of 2651 screened records, 23 studies were included (sample sizes ranging from 48 to 48,543). Tree-based ensemble models (eg, random forests and extreme gradient boosting) were the most frequently used (16/23, 70%), followed by logistic regression (13/23, 57%), and deep learning (11/23, 48%). Model discrimination varied widely (mean area under the curve [AUC] 0.82, SD 0.08, range 0.63-0.93). Integration of multimodal data (electronic health records+imaging) was associated with higher performance. However, model validation was often inadequate; only 6 studies (6/23, 26%) performed external validation, and performance often declined (eg, AUC decreased from 0.85 to 0.63 in 1 study). Reporting exhibited selective bias; AUC was commonly reported (19/23, 83%), whereas key classification metrics, such as calibration (10/23, 43%) and precision (4/23, 17%), were often omitted. PROBAST assessment indicated a high risk of bias in all included studies (23/23, 100%). CONCLUSIONS: While ML models demonstrate technical promise for predicting intraoperative bleeding, our PROBAST assessment revealed a universally high risk of bias across all included studies. This fundamental methodological limitation, coupled with a severe lack of external validation and poor transparency in reporting, severely constrains the current clinical reliability of these models. Future research must prioritize prospective multicenter validation, adherence to Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) reporting guidelines, and enhanced model interpretability to bridge the gap toward clinical utility.
13 June 2026
Read appraisal →Medicine
Effects of oxycodone and sufentanil on the quality of recovery after laparoscopic total hysterectomy: A randomized controlled trial
BACKGROUND: To compare the effects of oxycodone and sufentanil on the quality of recovery after laparoscopic total hysterectomy. METHODS: Ninety patients scheduled for laparoscopic total hysterectomy between January and December 2023 were randomly divided into 2 groups: oxycodone group (Group O) and sufentanil group (Group S), with 45 patients in each group. The primary outcome measure was postoperative recovery status recorded using the Quality of Recovery-40 questionnaire. RESULTS: At 24 hours postoperatively, the Quality of Recovery-40 scores of group O and group S were comparable (170 [156-179], 160 [146-178], P = .111). There were no statistically significant differences between the 2 groups in terms of visual analogue scale pain scores at any postoperative time points, postoperative cumulative sufentanil consumption, length of hospital stay, patient satisfaction, and incidence of postoperative nausea and vomiting, and incidence of postoperative dizziness (P > .05). CONCLUSIONS: Oxycodone and sufentanil provide comparable postoperative recovery after total laparoscopic hysterectomy.
1 June 2026
Read appraisal →Medicine
Common biomarkers of Alzheimer disease and postoperative delirium
Alzheimer disease (AD) and Postoperative delirium (POD) may share a common mechanism, but their shared genes and potential novel therapeutic targets remains unknown. We selected datasets GSE48350, GSE4226, and GSE16759 containing AD and control samples from the GEO database for AD model development, and use the GSE63061 dataset for AD model validation. The GSE163943 dataset containing PODs and controls was used to identify common genes. Differentially expressed genes (DEGs) associated with POD and AD respectively, as well as common DEGs between 2 diseases were analyzed. Shared DEGs were assessed using gene ontology and KEGG enrichment and PPI interaction networks. Machine learning algorithms, nomogram and decision tree analyses were used to interpret top 5 genes and visualize the models. 259 DEGs in POD with 148 being up-regulated and 111 down-regulated, and 199 DEGs in AD with 25 up-regulated and 174 down-regulated were found, of which 23 were common to POD and AD. Gene ontology analysis indicated that DEGs were primarily concentrated in 9 distinct biological processes, while KEGG results revealed 3 major metabolic pathways. Five hub genes emerged as potential diagnostic biomarkers for both diseases, Bruton tyrosine kinase (BTK), NCF2, CRH, FCGR3A, and SERPINA3. The LASSO model determined that the 23 common genes could serve as biomarkers for both POD and AD patients, and the Random Forest model is the the most suitable model. POD or AD decision trees showed BTK and NCF2 were sufficient to distinguish between POD or AD patients and healthy controls. BTK and NCF2 were identified common biomarkers of POD and AD. Further investigations are required to verify correlations between gene expression levels and pathological characteristics.
31 May 2026
Read appraisal →BMC surgery
Improvement of mobility and motivation in patients with elective colorectal resection using tracking devices and utilizing self-awareness (IMPETUS): a randomized controlled trial in a traditional non-ERAS clinical setting
BACKGROUND: Early postoperative mobilization is a cornerstone of modern perioperative care, including in elective colorectal surgery. Here we evaluated the effectiveness of smart wearables for improving patients' mobility and motivation during the recovery period after elective colorectal resection. METHODS: This prospective randomized two-armed clinical trial enrolled 62 patients undergoing elective colorectal resection. These patients were randomized into an intervention group that received hourly active reminders to mobilize via a smartwatch, and a control group that received only passive monitoring. All patients were given a wearable device that tracked their daily step counts. The primary end-point was the total number of steps taken within five postoperative days. Secondary end-points included complication rates, length of hospital stay, and subjective motivation, assessed using a structured questionnaire. RESULTS: Compared to the control group, the intervention group achieved significantly higher step counts (p = 0.039), and reported increased motivation for mobilization (p = 0.016). The groups did not significantly differ in overall complication rates or duration of hospital stay. CONCLUSION: Smart wearable devices with hourly active reminder functionalities effectively promoted postoperative mobility and motivation. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00039731. Registered 24.03.2026. Retrospectively registered.
29 May 2026
Read appraisal →JMIR research protocols
Virtual Reality for Preoperative Anxiety in Patients Undergoing Odontectomy Under General Anesthesia: Protocol for a Randomized Controlled Trial
BACKGROUND: Odontectomy is a common surgical procedure often associated with significant preoperative anxiety, particularly when performed under general anesthesia. Anxiety can lead to physiological changes, such as increased blood pressure and heart rate, and may affect anesthetic requirements and postoperative recovery. Virtual reality (VR) has emerged as a promising non-pharmacological intervention to reduce anxiety through immersive distraction. OBJECTIVE: This study aims to evaluate the effectiveness of VR in reducing preoperative anxiety in patients undergoing odontectomy under general anesthesia. The study will assess anxiety using both subjective measures (Amsterdam Preoperative Anxiety and Information Scale, APAIS) and objective biomarkers (salivary alpha-amylase, salivary cortisol, and vital signs). METHODS: This is a prospective, randomized controlled trial. Patients aged 17-40 years undergoing odontectomy under general anesthesia at the Dental and Oral Hospital, Universitas Padjadjaran, will be recruited. Participants (n=32) will be randomly assigned to either the intervention group (VR experience of the operating room) or the control group (standard verbal education). Data collection includes salivary samples (alpha-amylase and cortisol), vital signs (blood pressure, heart rate, respiratory rate), and APAIS scores measured at baseline, immediately post-intervention, and 15 minutes post-intervention. Data will be analyzed using independent and paired t tests or Mann-Whitney and Wilcoxon tests, depending on normality. RESULTS: The study is scheduled to be conducted between October 2026 and December 2026. The findings will provide evidence regarding the efficacy of VR as a standard anxiolytic tool in oral surgery. CONCLUSIONS: If effective, VR could serve as a non-invasive, safe alternative to pharmacological premedication for managing preoperative anxiety, potentially improving surgical outcomes and patient comfort.
29 May 2026
Read appraisal →JMIR perioperative medicine
AI-Generated Avatar Videos for Postoperative Patient Education Among Health Care Workers: Pilot Randomized Controlled Trial
BACKGROUND: Effective postoperative communication is vital for patient recovery, yet traditional text-based discharge instructions often lead to poor comprehension and adherence, particularly among patients with limited health literacy. Although educational videos improve understanding and retention, their widespread use has been hampered by high production costs. Generative artificial intelligence (AI) offers a scalable solution for creating engaging video content. OBJECTIVE: The primary objective of this pilot study was to assess the feasibility of creating and deploying AI-generated, avatar-led videos for postoperative instruction delivery. Secondary objectives included comparing knowledge retention, engagement, perceived clarity, and user experience between AI-generated video and traditional text-based handout formats among health care workers. METHODS: In this randomized pilot study, 38 health care worker volunteers were recruited as a convenience sample to pilot-test the intervention before patient implementation. Participants were assigned to either a text handout group (n=19, 50%) or an AI-generated video group (n=19, 50%). Both groups received information on 10 common postoperative topics. The primary outcome was objective knowledge, assessed via a 10-item quiz. Secondary outcomes, measured through surveys with 5-point Likert scales, included engagement time, subjective engagement, perceived clarity, usefulness, confidence in understanding, and information retention. Qualitative feedback was also collected. RESULTS: Objective knowledge quiz scores did not differ significantly between groups (mean 8.89, SD 1.20 for the AI-generated video group vs mean 8.21, SD 1.78 for the text handout group; P=.17; Cohen d=0.45). Participants in the AI-generated video group demonstrated significantly higher engagement time (mean 15.11, SD 7.78 minutes vs mean 8.84, SD 4.03 minutes; P=.004; Cohen d=1.04). They also rated instructions as significantly clearer (mean 4.63, SD 0.50 vs mean 4.00, SD 0.82; P=.007; Cohen d=0.93), more engaging (mean 4.05, SD 0.78 vs mean 3.32, SD 1.00; P=.02; Cohen d=0.81), and more effective for retention (mean 4.42, SD 0.84 vs mean 3.37, SD 0.68; P<.001; Cohen d=1.38). Qualitative feedback highlighted the engaging nature of AI-generated videos but noted areas for avatar refinement. CONCLUSIONS: In this pilot study with health care workers, AI-generated avatar videos did not improve objective knowledge scores but significantly enhanced engagement, perceived retention and perceived clarity (Cohen d=0.81-1.38). Future studies in actual patient populations with diverse health literacy levels are needed to determine whether these engagement advantages translate into improved knowledge outcomes.
28 May 2026
Read appraisal →JMIR research protocols
AI-Supported, Integrative Prediction of Postoperative Delirium: Protocol for the CONFUSED Study
BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication in older surgical patients, characterized by acute cognitive dysfunction and fluctuating levels of consciousness. POD is associated with prolonged hospitalization, long-term cognitive decline, reduced quality of life, and increased mortality. Despite its clinical relevance, the underlying pathophysiological mechanisms remain poorly understood, and reliable biomarkers for early prediction and prevention are lacking. OBJECTIVE: The CONFUSED study aims to identify molecular and clinical predictors of POD by integrating clinical data with proteomic, transcriptomic, and epigenetic analyses. The primary objective is to develop predictive models for POD using multimodal data. Secondary objectives include the identification of delirium-associated genes, proteins, and epigenetic signatures, as well as the exploration of patient subgroups at increased risk for POD. METHODS: CONFUSED is a prospective observational cohort study conducted at a German university hospital. Adult patients undergoing major surgery under general anesthesia will be enrolled until 100 cases of POD have been observed, which is expected to require a total sample size of approximately 200 to 300 patients. Blood samples are collected at 4 predefined time points: before premedication, immediately after surgery, and on postoperative days 2 and 5. Samples undergo comprehensive proteomic profiling, transcriptomic analysis using RNA microarrays, DNA methylation analysis, and genotyping of selected polymorphisms. Clinical data, including demographics, comorbidities, perioperative variables, medications, and delirium assessments using the Confusion Assessment Method (CAM) and CAM for the intensive care unit, are systematically recorded. Statistical analyses include univariate and multivariate methods, as well as machine learning approaches such as random forests and support vector machines, to identify relevant biomarkers and develop predictive models. The study protocol follows STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines and was approved by the responsible ethics committees. RESULTS: The study was registered in the German Clinical Trials Register (DRKS00033854) on March 18, 2024. Recruitment started in January 2024 and is ongoing at the time of manuscript submission. As of now, 135 patients have been enrolled. Sample collection and laboratory analyses are ongoing. Data analysis began in January 2026, with first results anticipated in July 2026. Final data lock is anticipated after the completion of recruitment. CONCLUSIONS: By integrating multimodal molecular data with clinical parameters and applying advanced machine learning techniques, the CONFUSED study aims to improve the prediction and understanding of POD. The results are expected to support the development of personalized preventive strategies and contribute to improved perioperative care for patients at risk of POD.
26 May 2026
Read appraisal →Otolaryngologia polska = The Polish otolaryngology
Leveraging large language models to audit perioperative total laryngectomy care: anesthetic, nutritional, and complication profiles in a real‑world cohort
<p><strong>Introduction: </strong>Total laryngectomy (TL) remains the standard treatment for advanced la‑ ryngeal cancer, and its perioperative management requires close collaboration within a multidisciplinary team, including anaesthesiologists and clinical nutritionists.</p><p><strong>Aim:</strong> The aim of this study was to analyse the perioperative course of patients un‑ dergoing TL from both an anaesthesiologist's and a nutritionist's perspective, with a particular focus on the feasibility and performance of structured data extraction from electronic medical records using large language models (LLMs).</p><p><strong>Material and methods:</strong> We performed a single‑centre retrospective analysis of 43 consecutive patients undergoing TL (ICD‑9 codes 30.32, 30.39, 30.41, 30.49) be‑ tween January 2024 and April 2026. Clinical data, including physician notes (n = 845), nursing notes (n = 2578), discharge summaries (n = 173), and consultations (n = 123), were subjected to structured extraction using large language models (gemma-3-31Bit/gemma-4-26B-it). Demographics, tumour stage, length of stay (LOS), periopera‑ tive nutrition, pharmacotherapy, postoperative complications, temporal laboratory trends, and rehabilitation were analysed.</p><p><strong>Results: </strong>The cohort comprised 35 men (81%) and 8 women (19%), with a mean age of 66.4 9.8 years; pT4a (49%) and pN0 (82%) predominated. Median LOS was 15.0 days (IQR 13.1-16.5). Enteral nutrition via nasogastric tube was used in 95% of patients, and oral intake was initiated at a median of postoperative day 13. Multimodal anal‑ gesia based on intravenous paracetamol (60%), ketoprofen (47%), and metamizole (40%) was routinely employed, while strong opioids were used in only 5% of pa‑ tients. Postoperative complications occurred in 22.5% of cases, with pharyngocuta‑ neous fistula (PCF) being the most frequent (12.5%). In‑hospital mortality was 0%, and overall mortality during a median 12‑month follow‑up was 2.3%. CRP peaked on postoperative day 3 (mean 114 mg/L). Pharmacologic VTE prophylaxis was admi‑ nistered in 65% of patients.</p><p><strong>Conclusions:</strong> In TL patients, enteral feeding forms the backbone of nutritional sup‑port, and multimodal analgesia provides effective pain control, whereas VTE pro‑phylaxis and other modifiable elements of perioperative care warrant optimization within prehabilitation and ERAS-based protocols.</p><p>&nbsp;</p>.
26 May 2026
Read appraisal →Journal of robotic surgery
AI-based automated bleeding monitoring in conventional and robot-assisted laparoscopic surgery: a systematic review
Artificial intelligence has emerged as a promising approach for improving the detection and management of intraoperative bleeding during conventional and robotic-assisted laparoscopic surgery, where delayed recognition of hemorrhage can lead to increased morbidity and procedural complexity. This review synthesizes current evidence on the use of artificial intelligence for intraoperative bleeding monitoring, with a particular focus on performance, feasibility, and clinical integration. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches of PubMed, Scopus, Web of Science, IEEE Xplore, Embase, and grey literature identified studies published between 2016 and 2025 that applied artificial intelligence to bleeding prediction, detection, localization, tracking, and quantitative blood-loss estimation during conventional and robotic-assisted laparoscopic surgery. Data relating to study design, model architectures, evaluation metrics, latency, and integration feasibility were extracted and summarized narratively. Across the included studies, artificial intelligence models demonstrated high detection accuracy in predominantly single-centre, retrospective, or simulation-based settings, with several approaches reporting promising real-time feasibility under controlled experimental conditions. Emerging work also explored bleeding source tracking, blood-loss estimation, and early integration into surgical workflows. However, most studies relied on small, single-center datasets and retrospective validation, limiting generalizability and clinical translation. Overall, artificial intelligence-based bleeding monitoring in conventional and robotic-assisted laparoscopic surgery shows increasing technical maturity and potential, though largely unvalidated in prospective clinical settings. Future research should prioritize large, multi-institutional datasets, prospective clinical evaluation, and optimized low-latency deployment within real surgical workflows to support safe and effective intraoperative use.
24 May 2026
Read appraisal →PloS one
Comparison between two different concentrations of ropivacaine in pericapsular nerve group block for patients undergoing total hip arthroplasty: A randomized clinical trial
Effective pain control during spinal anesthesia positioning remains a clinical challenge in elderly patients undergoing total hip arthroplasty. The pericapsular nerve group block, a novel ultrasound-guided regional anesthesia technique, has shown promise for alleviating hip pain, yet the optimal concentration of local anesthetics for this approach remains unclear. In this randomized, observer-blinded clinical trial involving 102 patients, we compared the analgesic efficacy of two concentrations of ropivacaine (0.375% vs. 0.5%) administered via pericapsular nerve group block prior to spinal anesthesia. Patients receiving 0.5% ropivacaine reported significantly lower pain scores during positioning and demonstrated prolonged postoperative analgesia up to 48 hours, without a corresponding increase in adverse events. Both concentrations improved positioning quality, reduced opioid requirements, and enhanced recovery compared to controls who received standard intravenous analgesic supplementation (including preoperative midazolam and ketorolac, and postoperative sufentanil PCA), though the higher concentration yielded modest additional benefits. These findings suggest that a 0.5% ropivacaine pericapsular nerve group block may offer superior perioperative analgesia for hip arthroplasty without compromising safety, while highlighting the need to balance analgesic potency with potential motor effects. This study informs optimization of nerve block protocols to improve perioperative outcomes in a high-risk surgical population. This study informs optimization of nerve block protocols to improve perioperative outcomes in a high-risk surgical population. The trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2400089440).
23 May 2026
Read appraisal →Neurosurgical review
The safety and efficacy of perioperative nefopam for analgesia in spine surgery: A systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: Moderate-to-severe pain is common after spine surgery. While opioids remain standard analgesia, their adverse effects have prompted opioid-sparing strategies. This systematic review evaluates the safety and efficacy of nefopam, a non-opioid and non-NSAID, as adjuvant perioperative analgesia in spine surgery. METHODS: Medline, Embase, Scopus and Cochrane databases were searched from inception to May 9, 2025. RevMan V5.4 was used to analyse mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RR) with 95% CIs for dichotomous outcomes. The GRADE framework was used to assess the certainty of evidence. RESULTS: Seven randomised controlled trials (n = 553) were included. Nefopam did not reduce 24-hour morphine use (MD -1.47 mg; 95% CI: -3.86 to 0.92 mg; GRADE moderate), 24-hour incisional pain (SMD, -0.01; 95% CI -0.22 to 0.20; GRADE moderate), 48-hour incisional pain (SMD, -0.24; 95% CI -0.50 to 0.02; GRADE low), 24-hour neuropathic pain (SMD, -0.19; 95% CI -0.49 to 0.10; GRADE low), 72-hour neuropathic pain (SMD, -0.33; 95% CI -1.02 to 0.36; GRADE very low), or length of stay (MD, 0.08days; 95% CI -0.73 to 0.88days; GRADE Low). There were no significant differences in drug-related adverse effects (sedation (RR 1.30), nausea/vomiting (RR 1.03), dizziness (RR 1.14), and urinary retention (RR 2.36)), (GRADE: very low to low). CONCLUSION: Perioperative nefopam did not reduce acute morphine use, pain scores, hospital stay, or drug-related adverse events in spine surgery, though most studies used doses below the median effective dose, limiting conclusions on its efficacy and safety.
23 May 2026
Read appraisal →PloS one
Double-cuff versus single-cuff bronchial blockers for video-assisted thoracoscopic lobectomy: A randomized controlled trial
BACKGROUND: Bronchial blockers (BBs) manage airways during thoracoscopic lobectomy and isolate lungs by occluding the bronchus at the surgical site. However, intraoperative malpositioning remains a concern. We compared the performance of a new double-cuff BB (DcBB) with an additional cuff near the end of a single-cuff BB (ScBB) with that of ScBBs during thoracoscopic lobectomy. METHODS: This single-center, randomized, parallel, controlled clinical study enrolled 80 patients undergoing thoracoscopic lobectomy for lung cancer at Nanpi People's Hospital. The patients were randomized into two groups (n = 40 each); DcBB (DcBB used during one-lung ventilation) and ScBB (ScBB used during one-lung ventilation). The primary outcomes were the incidence and number of BB malpositioning. Secondary outcomes time for BB placement and positioning, surgical duration, hypoxemia, incidence of adverse cardiovascular events, grades of lung collapse, surgeon satisfaction, tracheal wall damage assessed during bronchoscopy, contamination rates of the non-surgical lung lobe on the surgical site determined by bronchoscopy, radiographic incidence of pulmonary infiltration on postoperative day 1, and intraoperative blood gas values. RESULTS: The incidence of malpositioning was significantly lower in the DcBB than the ScBB group (7.5% vs. 30%, P = 0.02). The incidence of malposition was significantly lower in the DcBB cohort (P = 0.002). However, positioning the DcBB required more time (32.28 ± 5.37 vs. 19.90 ± 4.16 sec, P < 0.001). Other secondary outcomes did not differ significantly. CONCLUSIONS: In patients undergoing thoracoscopic lobectomy, the DcBB was associated with a lower incidence of malposition than the ScBB. The DcBB did not increase tracheal wall injury or cause significant adverse hemodynamic effects, and therefore may serve as a promising optional device for airway management during thoracoscopic lobectomy, particularly in clinical scenarios requiring high placement stability. TRIAL REGISTRATION: the Chinese Clinical Trial Registry ChiCTR2400086472.
22 May 2026
Read appraisal →Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Cephalosporins Versus Non-cephalosporin Antibiotics for Perioperative Prophylaxis in Primary Arthroplasty: A Systematic Review and Meta-Analysis
BACKGROUND: The number of arthroplasty procedures and infection-related complications, including prosthetic joint infections (PJIs) and surgical site infections (SSIs), continues to rise. Although current guidelines recommend cefazolin or cefuroxime as the first-line perioperative prophylactic antibiotic, substitutions with non-cephalosporins remain common, especially among patients with reported β-lactam allergies. These substitutions may increase infection risk and healthcare costs. Evidence comparing outcomes across antibiotic classes remains variable. METHODS: We conducted a systematic review and meta-analysis of studies comparing single-agent cephalosporin versus single-agent non-cephalosporin prophylaxis in adults undergoing primary arthroplasty. Cochrane, Embase, Medline, Scopus, and Web of Science were searched from database inception through January 2025. Random-effect or fixed-effect models were used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup analyses stratified results by cephalosporin type, study era, and risk of bias. RESULTS: Twenty-three studies (7 randomized controlled trials and 16 observational studies) were included, encompassing 191 527 arthroplasties in the cephalosporin arm and 20 058 in the non-cephalosporin arm. The odds of PJI were lower with cephalosporins (OR 0.59; 95% CI, .46-.75). No overall difference was observed for SSI (OR 0.70; 95% CI, .36-1.36), though post-2013 studies and the cefazolin subgroup demonstrated a significant protective effect. Randomized trial estimates were limited and heterogeneous and did not reach statistical significance. Certainty of evidence was graded as moderate. CONCLUSIONS: Cephalosporins, particularly cefazolin or cefuroxime, remain the preferred prophylactic agents for primary arthroplasty. This quantitative synthesis reinforces their protective association against prosthetic joint infection and supports adherence to guideline-endorsed prophylaxis.
22 May 2026
Read appraisal →Renal failure
Machine learning-based risk prediction model for postoperative acute kidney injury in surgical patients with chronic kidney disease (CKD): development, validation, and SHAP-based explainability
This study aimed to develop machine learning models to predict postoperative acute kidney injury (AKI) in surgical patients with pre-existing chronic kidney disease (CKD), a serious complication associated with high morbidity and accelerated disease progression. Using data from 3,851 surgical patients with CKD from the MIMIC-IV database, nine supervised machine learning models were developed to predict AKI, as defined by the KDIGO criteria. Postoperative AKI occurred in 24.2% (932/3,851) of the patients. The XGBoost model demonstrated the best predictive performance, achieving an AUC of 0.844, accuracy of 0.791, sensitivity of 0.79, and F1-score of 0.73, followed by Random Forest and LightGBM. The calibration curve showed a good agreement between the predicted and observed risks. For interpretability, SHAP analysis was used to identify SOFA score, estimated glomerular filtration rate (eGFR), systolic blood pressure, albumin, and phosphorus as the most influential predictors. In conclusion, machine learning models, particularly XGBoost, provide accurate and interpretable predictions of postoperative AKI in this high-risk population. The integration of explainable AI facilitates transparent risk stratification, which may support personalized perioperative care and the development of real-time clinical decision support systems.
21 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Wrist-Ankle Acupuncture on Postoperative Nausea and Vomiting Prophylaxis in High-Risk Female Patients: A Pragmatic, Randomized, Single-Blind, Sham-Controlled Trial
BACKGROUND: Postoperative nausea and vomiting (PONV) affects up to 80% of high-risk patients, compromising Enhanced Recovery After Surgery (ERAS) outcomes and prolonging hospitalization. This randomized controlled trial evaluated wrist-ankle acupuncture (WAA) efficacy for PONV prevention in high-risk female surgical patients. METHODS: This single-center, randomized, patient- and assessor-blinded, sham-controlled trial enrolled female patients (aged 18-60 years, ASA I-II) scheduled for elective surgery under general anesthesia with documented motion sickness or previous PONV. Participants received either WAA (sterile needles at four standardized acupoints, 30-minute retention) or sham acupuncture postoperatively. The primary outcome was 24-h PONV incidence using the Rhodes Index of Nausea, Vomiting, and Retching (R-INVR). RESULTS: Among 132 patients (median age 41 years), WAA significantly reduced 24-h PONV incidence versus sham (42.4% vs. 71.2%; RR 0.60, 95% CI 0.42-0.82; p = 0.002). Median R-INVR scores were lower with WAA [0 (0-5) vs. 8 (0-11); p < 0.001]. WAA patients reported significantly reduced nausea/vomiting at 30 min, 6 h, and 24 h (all p ≤ 0.006) and higher satisfaction scores (p < 0.001). Antiemetic use was comparable (9.1% vs. 16.7%; p = 0.299). No adverse events occurred. CONCLUSIONS: WAA significantly reduced PONV incidence and severity with sustained effects and improved satisfaction, offering a promising non-pharmacological prevention strategy.
21 May 2026
Read appraisal →Scientific reports
Quantum machine learning for predicting anastomotic leak: a clinical study
Anastomotic leak is a life-threatening complication following colorectal surgery. This study benchmarks Quantum Neural Networks (QNNs) against hyperparameter-tuned classical models (logistic regression, multi-layer perceptrons, boosting algorithms) for anastomotic leak prediction. Using a 200-patient clinical dataset strictly bounded by a priori medical constraints, we simulated QNNs with ZZFeatureMap encoding and EfficientSU2/RealAmplitudes ansatze under realistic hardware noise. To ensure statistical reliability, performance metrics were averaged across 10 independent optimization runs. The EfficientSU2-BFGS configuration achieved the highest mean AUC of [Formula: see text], while RealAmplitudes with CMA-ES maximized Average Precision ([Formula: see text]). Crucially, at a fixed, clinically necessary sensitivity of [Formula: see text], specific QNN configurations achieved significantly higher specificity (up to [Formula: see text]) and Negative Predictive Value (up to [Formula: see text]) compared to classical models (maximum [Formula: see text] and [Formula: see text], respectively), effectively minimizing false positives. However, classical models maintained superior probability calibration for continuous risk stratification. We conclude that QNNs offer robust discriminative performance for clinical screening, warranting further validation on larger, independent cohorts.
20 May 2026
Read appraisal →Physiological measurement
Perioperative hypoxaemia early warning based on high-frequency waveform fusion and deep learning
Objective.The accurate prediction of impending intraoperative hypoxaemia events is paramount for patient safety. Current models relying on structural parameters exhibit limitations, including low sampling frequency, weak temporal coherence, and high data attrition rates. Consequently, long-term sequence, high-frequency waveform data are utilised in this study to construct a deep learning-based hypoxaemia prediction model, by which conventional shortcomings are addressed whilst predictive accuracy and robustness are enhanced.Approach.Respiratory, blood oxygenation, and electrocardiogram waveforms were extracted from the VitalDB database. Two processing methods were employed: extraction of waveform-derived variables to construct numerical datasets; and utilisation of the Gramian Angular Summation Field (GASF) and the four-quadrant matrix method to construct image-based datasets. Through multiple dataset construction methods, five datasets were constructed. An LSTM algorithm was employed, using a 5 min learning window and prediction windows ranging from 1 to 13 min, to conduct a comprehensive performance evaluation.Main results.Optimal performance was achieved by all models within a one-minute prediction window. Highly competitive accuracy (0.932), AUC (0.953), and stability (maximum AUC variance 0.067) were demonstrated by the 'Multimodal image model', whilst the poorest performance was exhibited by the 'structured only model'. Moreover, compared to singlemodal models, multimodal models incorporating structured parameters yield only marginal improvements. Consequently, singlemodal data derived solely from raw waveforms are suggested as sufficient for prediction requirements, by which greater application potential is held due to enhanced computational efficiency.Significance.This study systematically demonstrated the significant advantages of high-frequency waveform data. Results indicate that waveform processing methods based on the GASF and the four-quadrant matrix approach can effectively enhance model stability and performance. Furthermore, the singlemodal model relying solely on waveform data, excluding structured parameters, can meet clinical prediction requirements while reducing computational costs. This study provides novel data structures and methodologies for perioperative hypoxaemia prediction.
20 May 2026
Read appraisal →Journal of robotic surgery
Comparative outcomes of da Vinci SP versus da Vinci Xi platforms in robotic cholecystectomy: a systematic review and meta-analysis
As robotic cholecystectomy adoption accelerates, the evidence comparing the perioperative outcomes of the Da Vinci Xi (DV-Xi) multiport platform to the Da Vinci Single-Port (DV-Sp) platform remains scarce. This meta-analysis provides the first systematic comparison of perioperative outcomes between these platforms. To compare perioperative safety and operative efficiency outcomes between the DV-Sp and the DV-Xi systems performing cholecystectomy. We thoroughly searched PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov from inception till December 22, 2025. The key outcomes of interest included mean operative time, console time, docking time, pain scores on the day of the operation, pain scores after 24 h, estimated blood loss, and length of hospital stay. We conducted random-effects meta-analysis and leave-one-out sensitivity analysis using RStudio v 4.5.2. The ROBINS-I was used for the risk of bias assessment. A GRADE assessment through GRADEpro was performed. Four observational studies comprising 833 patients (DV-Sp: n = 416; DV-Xi: n = 417) met the set inclusion criteria, and no RCTs were found. The DV-Sp showed significantly decreased mean operative time (MD = -2.41 min; 95% CI - 4.09 to - 0.73, p = 0.0049) and console time (MD = - 7.24; 95% CI - 9.77 to - 4.72, P < 0.0001) with no heterogeneity (I² = 0%). Two studies reported reduced pain scores in the DV-SP group. There was no significant difference found in the pooled estimates of post-operative pain scores, blood loss, docking time, and length of hospital stay between the two platforms. The DV-Sp demonstrated modest but consistent reductions in operative and console time with comparable safety to the DV-Xi system. Pain scores on the day of surgery and after 24 h of operation were reported low in the DV-SP group. While the magnitude of time differences is unlikely to impact individual patient outcomes, cumulative reductions across high-volume operating centers may translate into meaningful gains in operating room efficiency. However, substantial heterogeneity, particularly in pain-related outcomes and docking time, warrants cautious interpretation of these outcomes.
17 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of comprehensive interventions including exercise and exercise-only interventions on postoperative ileus and recovery of intestinal function in patients with colorectal cancer: a systematic review and meta-analysis
PURPOSE: This systematic review and meta-analysis aimed to evaluate the effectiveness of postoperative or preoperative comprehensive interventions including exercise and exercise-only interventions on postoperative ileus (POI) incidence and the recovery of intestinal function in patients with colorectal cancer (CRC). METHODS: Electronic searches were conducted in 6 databases. Cohort and randomized-controlled trial (RCT) studies investigating the effects of postoperative or preoperative comprehensive interventions including exercise or exercise-only interventions on POI and the recovery of intestinal function in patients with CRC were included. RESULTS: Thirty-eight studies involving 13,124 patients were included. Postoperative comprehensive interventions including exercise significantly shortened the time to first flatus (standardized mean difference [SMD] = -1.38, 95% confidence interval [CI]: -1.87 to -0.89) and time to first defecation (SMD = -1.56, 95% CI: -2.20 to -0.92), but did not reduce POI incidence (odds ratio [OR] = 1.38, 95% CI: 0.43 to 4.47). While, postoperative exercise-only interventions showed no significant effect on intestinal recovery (SMD = -0.31, 95% CI: -1.21 to 0.58). Preoperative comprehensive interventions including exercise shortened the time to first flatus (SMD = -0.41, 95% CI: -0.66 to -0.17). Also, preoperative exercise-only interventions significantly reduced the incidence of POI (OR = 0.56, 95% CI: 0.46 to 0.67). CONCLUSIONS: Postoperative comprehensive interventions effectively promote intestinal recovery; however, postoperative exercise-only interventions may not promote the recovery of intestinal function. On the other hand, preoperative comprehensive interventions or exercise-only interventions may promote the recovery of intestinal function and prevent POI onset; however, the limited number of included studies prevented definitive conclusions.
15 May 2026
Read appraisal →Antimicrobial resistance and infection control
Time-related changes in bacterial air contamination of sterile covered items in operating rooms: a systematic review and meta-analysis
BACKGROUND: There is still only limited evidence regarding how bacterial air contamination of sterile items changes over time in the operating room, even when protected by sterile covers. This review aimed to synthesize the available data to inform safe handling and preparation of sterile equipment. METHODS: A systematic search was conducted for controlled studies that assessed time-related bacterial contamination of covered sterile items in operating rooms and that reported the outcome as colony forming units (CFU) measured at two or more time points, generating distinct timelines. Six databases were searched from inception to 1 September 2025: Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, the Cochrane Database of Systematic Reviews, Embase, and Web of Science. A meta-analysis was performed using linear regression with CFU as the dependent variable and time (minutes) as the independent variable. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251018280). RESULTS: Five timelines from four studies evaluating CFU counts yielded an R2 of 0.085, indicating that time explained 8.5% of CFU variation. Similarly, analysis of eight timelines from four studies assessing mean CFU values produced an R2 of 0.070, attributing 7% of variation to time. Neither analysis demonstrated a statistically significant linear association between time and CFU count (p = 0.176, CI: -1.319 < β < 4.863) or mean CFU values (p = 0.108, CI: 0.191 < β < 0.420) when sterile covers were used. Three additional timelines excluded from the meta-analysis showed mixed results: two indicated a positive association, while one showed no relationship. CONCLUSIONS: Time has only a modest impact on bacterial contamination of sterile items when protective covers are used, with minimal increases in CFU over different waiting periods. Clinically, this confirms that properly covered sterile items can be prepared in advance without compromising microbial safety, thus supporting efficient operating room organization and workflow. These findings reinforce the effectiveness of sterile covers as a key measure to reduce the risk of surgical site infections and ensure the safe handling of sterile equipment. Although covered storage appears safe, minimizing unnecessary waiting time, even with coverage, is good clinical practice.
15 May 2026
Read appraisal →BMJ (Clinical research ed.)
Efficacy of dual antiplatelet therapy for three months versus 12 months after coronary artery bypass grafting: multicentre, double blinded, randomised controlled trial
OBJECTIVES: To evaluate the efficacy of dual antiplatelet therapy (DAPT) for three months versus 12 months in saphenous vein graft occlusion while reducing bleeding risk. DESIGN: Multicentre, non-inferiority, double blind, randomised controlled trial. SETTING: 13 cardiac surgery centres in China, with enrolment between February 2023 and July 2024. PARTICIPANTS: 2300 participants aged 18 to 80 years who underwent elective primary coronary artery bypass grafting with ≥1 saphenous vein graft. INTERVENTIONS: Participants were randomly assigned (1:1) to receive DAPT (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily) for 12 months or the same dual antiplatelet regimen for the first three months, followed by placebo plus aspirin for nine months. MAIN OUTCOME MEASURES: The primary outcomes were saphenous vein graft occlusion at one year (non-inferiority) and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding (superiority). Secondary outcomes were major adverse cardiovascular events (MACCE), saphenous vein graft failure, venous or arterial graft stenosis, and venous or arterial graft occlusion. RESULTS: 2290 patients (mean age 61.5 (standard deviation (SD) 8.4) years, 20.6% (n=472) women) were included in the modified intention-to-treat set. The mean number of saphenous vein graft segments was 2.5 (SD 0.8). 2070 patients (90.4%) with a total of 5125 saphenous vein graft segments were assessed at one year. Saphenous vein graft occlusion occurred in 280 of 2596 (10.8%) in the three month DAPT group and 283 of 2529 (11.2%) in the 12 month DAPT group (absolute difference -0.31%, 95% confidence interval (CI) -3.13% to 2.52%; P=0.008 for non-inferiority). During a median follow-up of 368 (interquartile range 358-382) days, BARC type 2, 3, or 5 bleeding occurred in 95 patients (8.3%) in the three month DAPT group and 149 patients (13.2%) in the 12 month DAPT group (absolute difference -4.67%, 95% CI -7.18% to -2.16%; P<0.001). The number needed to treat to prevent one bleeding event was 21 (95% CI 13 to 46). MACCE occurred in 26 (2.3%) patients in the three month DAPT group and 27 (2.7%) in the 12 month DAPT group (absolute difference -0.11%, 95% CI -1.48% to 1.26%). The findings for other secondary outcomes were also similar between the two groups. CONCLUSIONS: A three month DAPT strategy was non-inferior to the 12 month DAPT strategy in saphenous vein graft occlusion and was superior in reducing bleeding risk. TRIAL REGISTRATION: ClinicalTrials.gov NCT05380063.
15 May 2026
Read appraisal →BMC anesthesiology
Automated end-tidal control versus manual regulation in low-flow volatile anesthesia: a systematic review and meta-analysis
BACKGROUND: In low-flow anesthesia, automated monitoring of end-tidal oxygen (etO2) and end-tidal anesthetic agents (etAA) has been favored to reduce clinicians' cognitive workload during anesthesia maintenance. This systematic review, therefore, aimed to determine the comparative efficacy and safety of automated end-tidal controlled anesthesia (etCA) versus manually controlled anesthesia (MCA). METHODS: An electronic search was conducted across four databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus. The retrieved references were then analyzed against the studies' screening and eligibility criteria before the full articles were included in the study. The Review Manager (RevMan 5.4.1) was then used to conduct the statistical analysis of the reported outcomes. RESULTS: The electronic search retrieved 965 articles, among which 10 were included in this review. The studies included a pooled sample size of 1269 who underwent surgical procedures under low-flow anesthesia. The analyzed evidence suggests with low certainty that the type of anesthesia control may not have any significant effect on both the anesthesia duration (SMD - 0.00 min; 95% CI [-0.34, 0.34] p = 0.99) and the procedural duration MCA (SMD 0.04 min; 95% CI; 95% CI [-0.26, 0.33] p = 0.80). Moreover, we found with low certainty in the evidence that the amount of sevoflurane consumed may not be significantly different between etCA and MCA (SMD - 0.32 mLs; 95% CI [-0.94, 0.29] p = 0.31). Our narrative synthesis indicated that etCA can potentially improve anesthesia delivery by reducing the required anesthetist interventions and ensuring stable and accurately administered anesthetics. CONCLUSION: This review found very low-quality evidence suggesting that the type of anesthesia control may not significantly affect anesthesia delivery parameters, such as the amount of anesthesia consumed and procedural and anesthesia duration. The analyses, however, had significant heterogeneity, making the estimates highly unreliable. On the other hand, some studies indicate potential advantages of using etCA, such as reducing the number of interventions required during anesthesia; however, the evidence remains limited, preventing a full exploration of these advantages.
15 May 2026
Read appraisal →JMIR research protocols
Technology-Based Prehabilitation for Patients With Cancer Before Elective Treatment: Protocol for a Scoping Review
BACKGROUND: Advances in cancer treatment have improved survival rates; however, patients continue to experience significant treatment-related side effects, leading to reduced quality of life. Prehabilitation is an intervention that occurs before treatment and can improve patients' functional capacity, recovery, and well-being through exercise, nutrition, and psychological support. Typical hospital-based prehabilitation is not accessible to all patients due to geographical, socioeconomic, and time-related barriers. Technology-based approaches, including eHealth and mobile health (mHealth) interventions, may overcome these barriers by enabling remote, patient-centered delivery. However, the current evidence base is heterogeneous and lacks synthesis regarding feasibility, acceptability, and outcomes. OBJECTIVE: This protocol for a scoping review aims to outline how we will systematically map and synthesize the evidence on technology-based prehabilitation interventions for people with cancer to identify intervention designs, assess feasibility and accessibility, and highlight knowledge gaps to guide future research and practice. METHODS: The review will follow the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A 3-step search strategy will be applied across multiple databases and gray literature sources. Eligible studies will include adults (aged ≥18 years) with a cancer diagnosis who are scheduled for elective treatment (surgery, radiotherapy, chemotherapy, immunotherapy, or hormone therapy). Interventions must involve eHealth or mHealth approaches supporting unimodal or multimodal prehabilitation activities such as exercise, nutrition, psychological support, or lifestyle modification. Outcomes of interest include functional fitness, quality of life, psychological well-being, treatment preparedness, recovery, adherence, and feasibility. Two independent reviewers will conduct title, abstract, and full-text screening, with disagreements resolved through discussion or consultation with a third reviewer. Data will be charted and presented in tables and figures and as a narrative synthesis. Critical appraisal using JBI tools will contextualize methodological quality but not exclude studies. Risk of bias will be assessed using the Cochrane Risk of Bias Tool for Randomized Trials version 2 (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions version 2 (ROBINS-I V2) tool. This will not be used to exclude studies, but to determine the quality of articles included. RESULTS: The search strategy has been pilot tested and finalized. Database searches are scheduled to commence in March 2026, with study selection and screening anticipated to be completed by April 2026. Data analysis and synthesis are expected to begin in May 2026, and final results will be available by October 2026. CONCLUSIONS: This protocol outlines a rigorous and transparent approach to mapping the current evidence on technology-based prehabilitation in cancer care. By systematically characterizing intervention features, outcome domains, and evidence gaps, the review will provide an up-to-date evidence map to guide future research priorities, inform clinical implementation, and support the development of more standardized and inclusive prehabilitation pathways.
14 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Meta-Analysis of PENG+LFCN versus FICB on ERAS-Related Outcomes: Postoperative Pain, Motor Function and Recovery in Hip Surgery
OBJECTIVE: To compare pericapsular nerve group block combined with lateral femoral cutaneous nerve block (PENG+LFCN) with fascia iliaca compartment block (FICB) for postoperative analgesia and functional recovery after hip surgery within Enhanced Recovery After Surgery (ERAS) pathways. METHODS: PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and CQVIP were searched through January 2026. Comparative studies of PENG+LFCN versus FICB in hip surgery were included. Data were pooled using a random-effects model, with assessment of bias, heterogeneity, and publication bias. RESULTS: Sixteen studies were included. The PENG+LFCN group had significantly lower resting VAS (MD = -0.54; p < 0.00001) and dynamic VAS (MD = -0.98; p < 0.00001) scores. It also showed a lower incidence of postoperative muscle weakness (OR = 0.10; p = 0.0001), better preservation of quadriceps muscle strength, shorter time to first ambulation (MD = -9.22 h; p < 0.0001), and reduced length of stay (MD = -0.75 days; p < 0.00001). Additionally, morphine consumption (MD = -24.22 mg; p = 0.001) and PCA pump activations (MD = -2.46; p < 0.00001) were lower in the PENG+LFCN group. CONCLUSION: PENG+LFCN may be a more favorable regional analgesic strategy than FICB for hip surgery within ERAS pathways. PROTOCOL REGISTRATION: This systematic review and meta-analysis was registered at PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420261295309.
13 May 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Capnography With Integrated Pulmonary Index for Preventing Hypoxemia During Pediatric Urologic Surgery Under Sedation: A Randomized Controlled Trial
BACKGROUND Procedural sedation and analgesia (PSA) can relieve pain and anxiety during invasive procedures. Carbon dioxide (CO₂) monitoring or integrated pulmonary index (IPI) can reduce respiratory depression in adults with PSA, but the effect of the combination of these 2 methods on intraoperative hypoxemia in pediatric urologic surgery is unclear. This study was conducted to determine whether capnography combined with IPI could lessen intraoperative hypoxemia during pediatric urinary procedures with PSA. MATERIAL AND METHODS We conducted a randomized controlled trial (ChiCTR 2300073943). Children referred for urinary procedures with PSA were randomly assigned to either a control group with standard monitoring or an intervention group with standard monitoring combined with capnography and IPI monitoring. The primary outcome was intraoperative hypoxemia. Secondary outcomes were severe intraoperative hypoxemia, airway management, and perioperative complications. RESULTS A total of 133 patients completed the analysis (67 in the intervention group and 66 in the control group). Compared with the control group, the incidence of intraoperative oxygen saturation decline was significantly lower in the intervention group (34.33% vs 56.06%, odds ratio=0.410, 95% confidence interval: 0.203-0.825, P=0.012). Simultaneously, the incidence of severe oxygen desaturation (SpO₂ <90%) was also significantly reduced in the intervention group (19.40% vs 36.40%, odds ratio=0.421, 95% confidence interval: 0.192-0.925, P=0.034). Regarding airway management interventions, the intervention group exhibited a higher frequency of jaw thrust maneuvers (1.84±1.31 vs 1.17±1.12 times, P=0.004) and a significantly reduced need for invasive positive-pressure ventilation (1.64±1.31 vs 2.39±1.48, P=0.002). No differences in other airway management techniques or perioperative complications were observed between the 2 groups. CONCLUSIONS The addition of capnography and IPI monitoring to standard monitoring reduces the risk of intraoperative hypoxemia in pediatric urologic surgery and reduces the need for aggressive ventilation through early intervention.
12 May 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Can preoperative optimization improve abdominal wall surgery outcomes? a qualitative systematic review.
BACKGROUND: Ventral hernia repair (VHR) is commonly performed in patients with multiple modifiable risk factors. Preoperative rehabilitation programs aim to optimize these risk factors and improve surgical outcomes; however, their implementation and effectiveness remain variable. This systematic review evaluates current evidence on the role of preoperative optimization in patients undergoing VHR. MATERIALS AND METHODS: Cochrane Central, Embase, and PubMed were searched for studies comparing preoperative interventions versus standard care in patients undergoing VHR. The primary outcome was characterization of rehabilitation strategies. Secondary outcomes included surgical utilization, emergent repair, readmission, surgical site infection (SSI), surgical site occurrence (SSO), recurrence, reoperation, and mortality. RESULTS: Six studies were included, comprising a total of 3,556 patients, of whom 1,805 (50.7%) underwent preoperative optimization. Preoperative optimization interventions were highly heterogeneous and primarily consisted of multidisciplinary programs focused on exercise, weight loss, and lifestyle modification. Control groups varied widely, precluding formal meta-analysis. Studies requiring predefined optimization targets reported unsuccessful rehabilitation rates of 5.1%-45%. Emergent repair occurred in 6.8% of intervention patients in one study. SSI rates seemed lower and ranged from 4.2% to 11.8% in intervention groups versus 11.0%-16.7% in controls, SSO and reoperation rates were generally lower in optimization groups. CONCLUSION: Structured preoperative optimization pathways may be associated with improved short-term outcomes in select patients undergoing VHR. However, the current literature is heterogeneous, and standardized protocols and prospective studies are needed to better define optimal implementation strategies and long-term effectiveness.
11 May 2026
Read appraisal →Asian journal of psychiatry
Machine learning prediction model for delirium after heart valve replacement with cardiopulmonary bypass: A large-scale cohort study
OBJECTIVE: Postoperative delirium (POD) is a common and severe complication following heart valve replacement (HVR) with cardiopulmonary bypass (CPB), associated with poor outcomes. Accurate early prediction is crucial for targeted prevention. This study aimed to develop and externally validate machine learning (ML) models for predicting POD in this high-risk population. METHODS: We conducted a retrospective cohort study involving 1076 adult patients who underwent HVR with CPB between January 2018 and December 2022. POD was assessed using the CAM-ICU. Perioperative factors were analyzed to develop a traditional logistic regression-based nomogram and four ML models. The best-performing model was then tested on an independent external validation cohort of 281 patients. RESULTS: The incidence of POD was 25.1% (270/1076) and was associated with significantly increased mortality (11.9% vs. 0.2%, P < 0.001) and prolonged hospitalization. In the internal test set, the Random Forest (RF) model demonstrated the highest predictive performance with an AUROC of 0.854 (95% CI, 0.764-0.945), outperforming the traditional nomogram (AUROC: 0.754). The RF model maintained robust performance in the external validation cohort, achieving an AUROC of 0.793. Model interpretation using SHAP analysis identified postoperative awakening time (PAT), postoperative mechanical ventilation time (PMVT), and postoperative reintubation (POR) as the most influential predictors. CONCLUSIONS: Machine learning models, particularly Random Forest, provide a robust and generalizable tool for the early prediction of POD after HVR. These models outperform traditional statistical approaches and offer interpretable insights, highlighting PAT as a critical, modifiable target for perioperative management to mitigate POD risk.
9 May 2026
Read appraisal →Biomedical physics & engineering express
A novel machine learning approach for prediction of postoperative delirium using multi-domain features of high-density EEG
Background.Postoperative delirium (POD) poses a significant risk to patients, and accurate prediction of POD can provide guidance for positive interventions. Although many studies have applied machine learning (ML) to electronic health records to predict POD, there has been a lack of studies utilizing electroencephalogram (EEG) data to accurately predict POD.Methods.This retrospective study included 142 patients from two hospitals, among whom 33 developed POD. We extracted multi-domain features from high-density EEG (HD-EEG), screened 39 key features using recursive feature elimination, and analyzed the feature space structure using linear discriminant analysis (LDA). Four ML models, namely support vector machine (SVM), logistic regression (LR), random forest (RF), and gradient boosting machine, were compared. The dataset was divided using 5-fold cross-validation for model training and testing.Results.Compared to the other three models, SVM (linear kernel) performed best in predicting POD, achieving a classification accuracy of 95.71%. Alpha (8-12 Hz) and theta (4-8 Hz) powers, combined with nonlinear dynamics, critically contributed to the model. Furthermore, the performance of the linear models (SVM and LR) was significantly (p< 0.001) better than that of the nonlinear models, with LDA confirming strong feature space separability (Jensen-Shannon divergence = 0.69).Conclusions.HD-EEG data can be used to establish high-quality ML models for POD predictions. Multidomain features enable more comprehensive integration of EEG information related to delirium. The feature space structure significantly affects the performance of the prediction model, with the linear model offering distinct advantages in predicting POD.
2 May 2026
Read appraisal →BMJ open
Effect of early antiplatelet therapy on 30-day mortality after coronary artery bypass grafting: a retrospective target trial emulation using the MIMIC-IV database
OBJECTIVES: The effect of early antiplatelet therapy on 30-day mortality after coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate the association between early antiplatelet therapy initiation and clinical outcomes in post-CABG patients. DESIGN: A retrospective target trial emulation. SETTING: Single academic medical centre in Boston, Massachusetts, USA. PARTICIPANTS: We included adult patients who underwent CABG and were admitted to the intensive care unit at Beth Israel Deaconess Medical Center between 2008 and 2022. METHODS: Patients were classified into the treatment group if they initiated antiplatelet therapy within 24 hours postoperatively; otherwise, they were assigned to the control group. To address immortal-time bias for the primary outcome of 30-day mortality, we used clone-censor-weighting. For the exploratory outcome of 30-day acute kidney injury (AKI) incidence, we employed inverse probability of treatment weighting to balance baseline covariates. RESULTS: The analysis for 30-day mortality included 6887 patients. The mortality was 2.35% in the control group versus 1.44% in the treatment group, yielding an absolute risk difference of 0.90% (control group minus treatment group, 95% CI 0.09% to 1.72%). The difference in restricted mean time lost was 0.19 days (control group minus treatment group, 95% CI 0.03 to 0.36). For AKI incidence, 5543 patients were analysed. The incidence was 78.61% in the control group and 69.13% in the treatment group, with an absolute difference of 9.48% (control group minus treatment group, 95% CI 6.40% to 12.50%; p<0.001). CONCLUSIONS: In this target trial emulation, early antiplatelet therapy initiated within 24 hours after CABG was associated with lower 30-day mortality and a reduced incidence of postoperative AKI. These findings warrant confirmation in prospective randomised controlled trials.
24 Apr 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Acupoint Stimulation After Anesthesia Induction Does Not Decrease Nausea and Vomiting After Hepatectomy: A Multi-Center Double-Blinded Clinical Trial
INTRODUCTION: This study evaluated whether adding transcutaneous electrical acupoint stimulation (TEAS) to a double-antiemetic regimen during hepatectomy reduces the incidence of postoperative nausea and vomiting (PONV). METHODS: In this multicenter double-blinded randomized controlled trial conducted across three tertiary hospitals in China, patients scheduled for elective hepatectomy were randomized to either the TEAS group (stimulation at PC6 during surgery) or the control group (no stimulation). The primary outcome was the incidence of PONV within 24 h postoperatively. Key secondary outcomes included the severity of PONV and pain after surgery. RESULTS: Among 161 randomized patients, 159 completed the study. No significant difference was observed in the incidence of PONV within 24 h postoperatively between the TEAS and control groups (23.8% vs. 26.6%; OR, 95% CI: 0.86, 0.42-1.76). However, the TEAS group exhibited less patient controlled analgesia (PCA) attempts (2.7 vs 3.5) or deliveries (2.6 vs 3.5) by 24 h postoperatively. Recovery outcomes, including time to ambulation and to gastrointestinal function recovery, did not differ between groups. CONCLUSION: Intraoperative TEAS did not significantly reduce PONV incidence in hepatectomy patients receiving antiemetic therapy. Nonetheless, its potential to decrease the need for analgesics warrants further investigation to refine its role in perioperative care. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov (NCT05396716), https://clinicaltrials.gov.
21 Apr 2026
Read appraisal →BMJ open
Early mobilisation after abdominal surgery: a concept analysis
OBJECTIVE: To clarify and define the clinical practice concept of early mobilisation after abdominal surgery. DESIGN: A concept analysis guided by Walker and Avant's method. DATA SOURCES: MEDLINE (Ovid), AMED-(Ovid), Embase (Elsevier) and CINAHL (EBSCO) were searched through 5 December 2024. ELIGIBILITY CRITERIA: Relevant studies that included combinations of the terms 'early mobilisation', 'early ambulation', 'early acceleration', 'abdominal surgery' and 'surgical procedures' were selected. We restricted the search to English full-text publications involving adult patients, limited to the year 2000 and onward. Inclusion criteria were original research articles describing the timing and/or type of mobilisation. DATA EXTRACTION AND SYNTHESIS: The study derives its defining attributes, antecedents and consequences through data analysis. To enhance understanding of the model, we constructed related and contrary cases of the concept and outlined relevant empirical referents. RESULTS: In total, 140 studies were included in the analysis. Early mobilisation is characterised by the key defining attributes of initiating active physical movement, including standing, sitting in a chair or walking, within the first 24 hours of surgery. Antecedents include haemodynamic and respiratory stability, adequate pain management, and the patient's cognitive and physical readiness. Contextual antecedents include competent and adequately staffed healthcare teams. Consequences include improved physiological recovery and enhanced postoperative outcomes. CONCLUSIONS: This analysis provides a clarified, practice-focused definition of early mobilisation after abdominal surgery. By delineating its key attributes and contextual prerequisites, the study offers a conceptual foundation that can support clinical guidelines, promote consistent implementation and inform future research aimed at optimising postoperative recovery.
20 Apr 2026
Read appraisal →Journal of gastrointestinal cancer
Effect of Probiotics on the Clinical Outcome and Inflammatory Response in Gastric Cancer Surgery: A Double Blinded Randomized Control Trial
BACKGROUND AND AIM: Gut dysbiosis contributes to postoperative complications and worsens the inflammatory and immune dysfunction in gastric cancer (GC) patients. Probiotics may mitigate these effects by modulating gut microbiota. This study aimed to evaluate the effect of probiotics on the length of hospital stay, other post-operative clinical outcomes, nutritional status, inflammatory and immune markers in patients undergoing gastrectomy for gastric cancer. METHODS: This was a single-centred, prospective, double blinded, placebo-controlled trial. Participants were patients who underwent open gastrectomy for gastric cancer. Participants were randomized to receive probiotics or placebo for 10 days starting on postoperative day (POD) 1. Blood samples were collected preoperatively and POD 10 to assess haemoglobin, total counts, albumin, IL6, TNFα, and IgA. Clinical outcomes including time to first flatus, first passage of stools, oral diet resumption and length of hospital stay (LOHS). Postoperative complications were monitored for 30 days and classified using the Clavien-Dindo system. RESULTS: Of 42 participants (22 probiotic, 20 placebo), baseline characteristics were comparable. The probiotic group had a significantly shorter median LOHS (9 vs. 12 days, p<0.05), earlier time to first passage of flatus (2.6 vs. 4.3 days, p<0.05), earlier time to first passage of stools (3.6 vs. 5.7 days, p<0.05), and oral diet resumption (3.6 vs. 5.7 days, p<0.05). No significant differences were observed in inflammatory markers (TLC, IL-6, TNF-α), immune markers (IgA), nutritional status (albumin, haemoglobin), or postoperative complications (p>0.05). CONCLUSION: Postoperative probiotic supplementation reduced LOHS and improved gastrointestinal recovery in GC patients undergoing gastrectomy, but did not significantly affect inflammatory, immune, or nutritional markers.
20 Apr 2026
Read appraisal →Medicine
Effect of parecoxib on postoperative anxiety and cognitive function after pancreaticoduodenectomy: A clinical trial
BACKGROUND: After pancreaticoduodenectomy, perioperative neurocognitive disorders (PND) are a common complication. Parecoxib, a selective cyclooxygenase-2 inhibitor, is used for its analgesic and antiinflammatory effects, but its impact on postoperative anxiety and cognitive function is not clear. METHODS: The patients undergoing laparoscopic pancreaticoduodenectomy at the Second Hospital of Hebei Medical University were enrolled in the study from November 1, 2020 to September 30, 2022 in this randomized controlled trial. Patients were randomly divided into Group P who received 20 mg of parecoxib intravenously 10 minutes before anesthesia and at the end of surgery and Group C who received an equal volume of normal saline at the same times. Primary outcomes included the effect of parecoxib on anxiety, cognitive impairment, and postoperative intestinal function recovery, with the incidence of PND calculated using the Z-value method. Secondary outcomes included pain control, length of hospital stay, postoperative recovery, complication rates, and analgesic use. RESULTS: 80 patients were enrolled and randomly divided into 2 groups of 40 equally: there were no significant differences in postoperative flatus passage, defecation time, hospital stay, or complication rates (P > .05). In terms of postoperative anxiety, the experimental group had significantly lower State Anxiety Inventory scores at 24 hours postoperatively (T2) (P < .05). Cognitive function, measured by Montreal Cognitive Assessment scores, did not show significant differences; however, cognitive decline was less pronounced in the experimental group. PND rates were 5% (2/40) in the experimental group versus 12.5% (5/40) in the control group, suggesting a possible clinical tendency toward reduced incidence, although the difference did not reach statistical significance. The rates of PND at 24 hours (T2) and 7 days (T3) postoperatively were 10% (4/40) and 5% (2/40) for the experimental group, compared to 15% (6/40) and 12.5% (5/40) for the control group using the Z-value method, Although the between-group differences did not reach statistical significance, a lower incidence was observed in the parecoxib group, suggesting a possible clinical tendency. CONCLUSION: Parecoxib, when used with pancreaticoduodenectomy, alleviates postoperative anxiety and neurocognitive disorders without affecting postoperative intestinal function recovery or increasing the incidence of postoperative complications.
19 Apr 2026
Read appraisal →PloS one
High-versus conventional-volume pericapsular nerve group (PENG) block for total hip arthroplasty: A randomized, controlled trial
BACKGROUND: Currently, the optimal volume of pericapsular nerve group (PENG) block for analgesia after total hip arthroplasty (THA) has not been clarified. In this trial, we investigated whether a high-volume PENG block has a superior analgesic effect than a conventional PENG block for primary THA. METHODS: Forty patients receiving primary THA under spinal anesthesia were enrolled and randomly divided into the high-volume PENG group (40 mL of 0.375% ropivacaine) and the conventional-volume PENG group (20 mL of 0.375% ropivacaine). Dexamethasone (5 mg) was added to the local anesthetic in both groups. A blinded researcher performed pain scores and lower limb sensory and motor block assessments at 3, 6, and 24 h after surgery. The time of first walking, time of first opioid consumption, total opioid consumption within 48 h, nerve block, opioid-related complications, and length of hospital stay were recorded. The primary outcome was the dynamic pain scores at 6 h post-surgery. RESULTS: Thirty-seven patients were included in the final analysis, among whom 18 were in the high-volume group and 19 in the conventional-volume group. There were no significant differences between the two groups in dynamic pain scores at 6h after surgery [median and interquartile range (p25, p75) 5(4,6) vs 4 (4,5)] and other secondary outcomes. CONCLUSIONS: The high-volume PENG block is not superior to conventional-volume PENG block in improving post-operative analgesia in patients undergoing primary THA and does not increase the risk of quadriceps weakness. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn). Clinical trial registration number: ChiCTR2300077281.
18 Apr 2026
Read appraisal →Medicine
Publication trends of dexmedetomidine and perioperative cognitive dysfunction: A bibliometric analysis from 1995 to 2024
INTRODUCTION: Dexmedetomidine (Dex) has shown potential in mitigating perioperative cognitive dysfunction (POCD). This study aimed to systematically evaluate the research hotspots and development trends in Dex and POCD using bibliometric analysis. METHODS: A systematic search was conducted on the Web of Science Core Collection database to identify publications related to Dex and POCD from 1995 to 2024. Bibliometric analysis was performed using VOSviewer (V 1.6.20), CiteSpace (V 6.3.R1), and R V4.3.3. RESULTS: A total of 585 articles on Dex and POCD between 1995 and 2024 were analyzed. These articles involved 1688 authors from 1857 institutions across 140 countries or regions, published in 240 journals, and citing 12,881 sources. The annual growth rate of publications in this field was 16.21%, with a peak of 91 articles in 2021. China led in the number of articles (n = 379), multiple country publications (MCP = 29), and total citations = 4989). The USA ranked second with 74 articles, 18 MCPs, and 2608 citations, followed by South Korea with 29 articles and 533 citations. Harvard University published the most articles (n = 51). Wang Dong-Xin was the most influential author, with an h-index of 7. Anesthesiology led the high-impact journals with an H-index of 11. The keyword analysis identified "neuroinflammation," "risk," "injury," and "efficacy" as the latest research themes. CONCLUSION: This bibliometric analysis provides a comprehensive overview of the research trends regarding Dex and POCD. Future research should continue to explore the mechanisms, efficacy, and safety of Dex in preventing POCD.
18 Apr 2026
Read appraisal →Thorax
Cardiopulmonary exercise testing before lung resection surgery: still indicated? Evaluating predictive utility using machine learning.
RATIONALE: Despite significant advances in patient care and outcomes, criteria for cardiopulmonary exercise testing (CPET) in risk stratification guidelines for lung resection have not been updated in over a decade. We hypothesised that CPET no longer holds additional predictive value for postoperative complications. METHODS: In this secondary analysis, we included lung resection candidates from two prospective, multicentre studies eligible for CPET and assessed with preoperative pulmonary function tests (PFTs) and arterial blood gas analysis. Postoperative pulmonary (PPCs) and cardiovascular complications (PCCs) were documented during hospitalisation. We trained five types of machine learning models applying nested cross-validation to predict complications and compared predictive performance based on four metrics, including area under the receiver operating characteristic curve (AUC-ROC). RESULTS: A total of 497 patients were included. PPCs developed in 71 (14%) patients. Adding CPET parameters to PFTs and baseline clinical data did not improve the ability of models to predict PPCs in unselected patients (AUC-ROC=0.72-0.78; p=0.47), nor in those meeting American College of Chest Physicians (ACCPs) (n=236; AUC-ROC=0.64-0.78; p=0.70) or European Respiratory Society/European Society of Thoracic Surgery (ERS/ESTS) criteria (n=168; AUC-ROC=0.59-0.76; p=0.92). PCCs developed in 90 (18%) patients. CPET parameters likewise did not improve model performance for the prediction of PCCs in unselected patients (AUC-ROC=0.65-0.73; p=0.96), nor in the ACCP (AUC-ROC=0.61-0.73; p=0.82) or ERS/ESTS subgroups (AUC-ROC=0.62-0.69; p=0.87). CONCLUSIONS: In contemporary surgical practice, CPET did not improve the predictive performance of machine learning models for PPCs or PCCs in patients with an indication based on established guidelines or in those without. The role of CPET in preoperative risk stratification for lung resection should be re-evaluated. TRIAL REGISTRATION NUMBER: NCT03498352, NCT04826575.
17 Apr 2026
Read appraisal →A&A practice
Automated Identification of Cardiopulmonary Disease Cases for Preoperative Risk Stratification Using Machine Learning: A Retrospective Analysis
BACKGROUND: Preoperative chart review is time-consuming and prone to errors, particularly for cardiopulmonary conditions that impact anesthetic planning. We developed a guideline-aligned "clinical insight bot" that mines free-text documentation to surface perioperative cardiovascular risk signals relevant to the 2024 Mult Society perioperative guideline for noncardiac surgery. METHODS: We analyzed 1000 de-identified medical cases from the PhysioNet MIMIC database. Medical terminology was extracted using regex-based NLP and categorized into 13 clinical specialties. Text features were encoded using TF-IDF vectorization and 1536-dimensional semantic embeddings stored in a PostgreSQL vector database (pgvector). Four machine learning models-Logistic Regression, Random Forest, Support Vector Machine (SVM), and Naive Bayes-were trained with stratified fivefold cross-validation to classify cases as "cardiopulmonary-only" versus "mixed/other." Performance was evaluated using accuracy, precision, recall, and F1 score, with statistical comparison via McNemar's test and bootstrap confidence intervals. RESULTS: In a held-out test set of 200 notes (28 positive; 172 negatives; ~14% prevalence), a linear support vector machine achieved the best overall balance (F1 ≈ 0.71), with high precision (positive predictive value 0.94) and very low false positive rate (FPR) (1/172 ≈ 0.6%). False negatives were the dominant residual error class. The pipeline processed documents near-instantaneously and, when scaled to 1000 notes, replaced on the order of tens of clinician review hours (≈100× efficiency gain) while maintaining performance across common preoperative document types. CONCLUSIONS: A lightweight, guideline-aligned insight bot can transform unstructured preoperative notes into concise, stepwise prompts that flag cardiovascular risk signals before the day of surgery. High precision with a very low FPR supports safe integration with anesthesiology workflows by minimizing paging noise, whereas time savings create operational and financial value. Future work should emphasize multicenter validation, structured data fusion (including labs, imaging, and vitals) to improve sensitivity, and prospective evaluation of downstream clinical and operational outcomes.
17 Apr 2026
Read appraisal →A&A practice
Hypotension Prediction Index-Guided Hemodynamic Management on Postoperative Organ Outcome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Intraoperative hypotension (IOH) is a frequent occurrence during noncardiac surgery. Hypotensive episodes can compromise tissue perfusion, and cumulative exposure has been associated with adverse outcomes such as acute kidney injury (AKI), myocardial injury, and increased mortality. The Hypotension Prediction Index (HPI) is an artificial intelligence tool designed to predict hypotensive events before they occur, allowing clinicians to intervene proactively to prevent or mitigate hypotension. Although randomized trials and pooled analyses have shown its effectiveness in reducing both the incidence and duration of IOH, its impact on patient-centered outcomes remains unclear. From 1946 to August 8, 2025, we prospectively queried MEDLINE (PubMed), Embase, Cochrane Library, and Web of Science. We included randomized controlled trials in adult surgical patients with invasive arterial monitoring, comparing HPI-guided perioperative hemodynamic management to standard care. Primary outcome was postoperative AKI, and secondary outcomes were postoperative myocardial injury, pneumonia, arrhythmia, stroke, postoperative cognitive dysfunction, including delirium, surgical site infection, length of hospital stay, and mortality. Two authors independently evaluated the risk of bias according to the methods described in the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed using RevMan 5.4.1 software. Dichotomous data were presented as risk ratio, 95% confidence interval [CI]; continuous data were presented as mean difference, 95% CI. All results were pooled using random-effects models. Of 883 imported references, 14 studies (N = 2030) were included for final analysis. No significant difference in incidence of postoperative AKI was observed between HPI-guided management and standard care, RR = 0.87, 95% CI (0.71-1.07). Postoperative myocardial injury was significantly reduced in HPI-guided management group, RR = 0.61, 95% CI (0.39-0.96), although exclusion-based sensitivity analysis suggests that this finding may not be robust. No other significant differences were observed for hospital length of stay, arrhythmia, stroke, cognitive dysfunction (including delirium), surgical site infection, pneumonia, or mortality. Although HPI-guided management is associated with a reduction in postoperative myocardial injury, its significance does not withstand sensitivity analysis. All other postoperative complications, including AKI incidence, are not reduced in the intervention groups. This study has limitations inherent to the heterogeneity of included patient populations, surgical interventions performed, standard of care practices, and reporting of postoperative outcomes.
15 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of prehabilitation strategies in enhancing recovery and postoperative outcomes in laparoscopic sleeve gastrectomy patients
OBJECTIVE: This study aims to explore the application of a multimodal prehabilitation strategy in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to evaluate its impact on postoperative recovery, weight loss, and quality of life. METHODS: This was a single-center, prospective, randomized controlled trial. A total of 120 eligible patients undergoing elective LSG were enrolled and randomly assigned to either the control group (n = 60), receiving routine perioperative care, or the observation group (n = 60), receiving a structured 5-7-day prehabilitation program. RESULTS: Compared to the control group, the observation group had a significantly shorter postoperative hospital stay (mean difference [MD] -1.23 days; 95% CI -1.67 to -0.79; P < 0.001) and a lower incidence of complications (1.7% vs. 11.7%; odds ratio 0.13, 95% CI 0.02-0.89; P = 0.038). At 6 months, the prehabilitation group showed a greater reduction in BMI (MD -3.78 kg/m2; 95% CI -5.10 to -2.46; P < 0.001) and higher quality of life scores across all eight SF-36 domains (P < 0.001 for all). CONCLUSION: The application of prehabilitation strategies in patients undergoing laparoscopic sleeve gastrectomy can effectively promote faster postoperative recovery, enhance weight loss, improve quality of life, and reduce the incidence of postoperative complications. It is a safe and effective approach, worthy of clinical promotion. Furthermore, the principles of this multimodal prehabilitation framework offer valuable translational insights for optimizing perioperative supportive care in surgical oncology.
12 Apr 2026
Read appraisal →BMJ (Clinical research ed.)
Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis
OBJECTIVE: To evaluate the effectiveness of perioperative non-drug interventions in reducing postoperative pulmonary complications (PPCs) in adults undergoing abdominal surgery. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions. STUDY SELECTION: Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients developing PPCs. Secondary outcomes included the proportion of patients with PPC subtypes according to European Perioperative Clinical Outcome definitions (respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax) and hospital length of stay. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane RoB 2.0 tool. Data were synthesised using meta-analyses and trial sequential analyses, with the evidence certainty assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: 255 trials including 55 260 participants were included, evaluating 10 types of interventions with 39 subtypes for PPC prevention. PPCs occurred in 6467 (11.7%) participants across all included trials. High certainty evidence showed that low fraction of inspired oxygen (FiO2) significantly reduced PPCs (risk ratio 0.81, 95% confidence interval 0.71 to 0.92). Moderate certainty evidence showed benefit for four intervention types: lung protective ventilation (risk ratio 0.66, 0.57 to 0.76), physiotherapy (0.55, 0.46 to 0.65), analgesia (0.73, 0.64 to 0.84), and nutrition (0.74, 0.63 to 0.87), with individualised positive end expiratory pressure, composite lung protective ventilation, early mobilisation, and epidural analgesia also showing benefit at the subtype level. Trial sequential analysis confirmed sufficient cumulative evidence for all the above interventions except early mobilisation. By contrast, goal directed haemodynamic therapy, targeted blood pressure management, restrictive fluid therapy, and postoperative bi-level positive airway pressure showed no evidence of benefit, with moderate certainty. CONCLUSIONS: This synthesis establishes an evidence hierarchy for PPC prevention in abdominal surgery. Low FiO2 is the only intervention supported by high certainty evidence and should be prioritised in clinical practice. Other beneficial strategies include lung protective ventilation, physiotherapy, analgesic techniques, and nutrition interventions. Conversely, the role of goal directed haemodynamic therapy-despite its widespread use-warrants reconsideration for PPC prevention. These findings facilitate prioritisation of effective interventions and development of evidence based guidelines. STUDY REGISTRATION: PROSPERO CRD42025637449.
11 Apr 2026
Read appraisal →PloS one
An interpretable deep learning framework for predictive modeling of postoperative infections in ICU patients
A significant proportion of intensive care unit (ICU) patients undergo surgical procedures, and some may develop postoperative infections. Accurately predicting postoperative infection risk and identifying key contributing factors is crucial for improving postoperative management and understanding infection mechanisms. However, this task is challenging due to the complex interplay of multiple risk factors. While machine learning models can model these intricate associations to predict postoperative infection risk, their lack of interpretability - failing to uncover each factor's impact-hinders their adoption in clinical settings. To address this difficulty, we introduced an interpretable deep neural network (DNN) model that integrates a permutation feature importance test (PermFIT). PermFIT rigorously evaluates the impact of each feature on postoperative infection risk through a rigorous statistical inference. By using only the identified important features as inputs, the DNN's predictive performance can be further enhanced. We conducted an extensive study using electronic health records (EHRs) from the Medical Information Mart for Intensive Care (MIMIC-III), a large-scale ICU EHR database. Under the PermFIT framework, our DNN model effectively identifies significant factors associated with postoperative infections while delivering the most accurate postoperative infection risk predictions. These findings highlight the clinical utility of our proposed DNN framework in managing postoperative care for ICU surgical patients, ultimately improving their health outcomes.
10 Apr 2026
Read appraisal →Annals of medicine
Comparison of VCV and PCV-VG modes on diaphragmatic function in diabetic patients undergoing laparoscopic colorectal surgery: a prospective randomized controlled study
BACKGROUND: Diabetic patients are prone to induce diaphragmatic weakness, which can lead to postoperative pulmonary complications (PPCs). The optimal mechanical ventilation mode may potentially improve postoperative diaphragmatic function. This study evaluates the effects of two ventilation modes under driving pressure-guided ventilation strategy on diaphragmatic function, as assessed by diaphragm thickening fraction (DTF) and diaphragm excursion (DE), in diabetic patients following laparoscopic colorectal surgery. METHODS: Eighty patients diagnosed with Type II diabetes scheduled for elective laparoscopic colorectal surgery, were randomly allocated to either the pressure-controlled volume-guaranteed ventilation (PCV-VG) group (Group P) or the volume-controlled ventilation (VCV) group (Group V) during surgery. The primary outcome was diaphragmatic function assessed during both tidal breathing and maximal inspiratory effort after surgery. Secondary outcomes included intraoperative mechanical power, PPCs, and other complications. RESULTS: A total of eighty patients were included in the final analysis. The averaged area under the curve (AUC) for mechanical power during ventilation was significantly lower in Group P than in Group V (p = 0.002). PCV-VG significantly improved both DE and DTF within the first two days post-surgery (AUCDEtidal: p = 0.088, AUCDTFtidal: p = 0.004, AUCDEmax: p = 0.029, AUCDTFmax: p = 0.017). Postoperative diaphragmatic weakness was less frequent in Group P than in Group V (p = 0.019). However, there was no difference in the incidence of PPCs between the two groups (p = 0.155). CONCLUSION: PCV-VG mode can reduce intraoperative mechanical power, better preserve postoperative diaphragmatic function. However, these improvements did not translate into clinical benefits, as evidenced by the lack of reduction in the incidence of PPCs.
10 Apr 2026
Read appraisal →Scientific reports
Effects of different inflatable heater temperature settings on early postoperative recovery after hysteroscopic surgery: a randomized clinical trial
To investigate the effect of perioperative temperature settings of an inflatable warming device on postoperative recovery quality in patients undergoing hysteroscopic myomectomy, this randomized controlled trial enrolled 258 patients receiving laryngeal mask general anesthesia at Xuzhou Central Hospital, China, between March 2022 and August 2024. Patients were allocated to perioperative temperature management with an inflatable warming device set to 38 °C (Group L, n = 129) or 43 °C (Group H, n = 129). A total of 211 patients were included in the final analysis after accounting for exclusions. At 24 h postoperatively, the QoR-40 score was significantly higher in Group H compared to Group L (P < 0.05). At baseline (T0), no significant differences in core body temperature, mean arterial pressure (MAP), or heart rate (HR) were observed between groups (P > 0.05). From T1 to T6, Group H exhibited higher and more stable core body temperature, MAP, and HR compared to Group L (P < 0.05). There were no statistically significant differences in QoR-40 scores at 48 h (P > 0.05) or in the incidence of postoperative restlessness, chills, and infection between the two groups. Compared to 38 °C, the perioperative application of a 43 °C inflatable warming device improved early postoperative recovery quality at 24 h in hysteroscopic myomectomy patients without increasing complication risks.
10 Apr 2026
Read appraisal →Journal of Korean medical science
Effectiveness and Cost-Utility of Anti-Adhesion Agents in Intra-Abdominal Surgery Patients
BACKGROUND: Adhesive intestinal obstruction (AIO) is a common and critical complication of intra-abdominal surgery, often requiring preventative measures such as using anti-adhesion agents (AAA). However, despite their prevalence and significance, a notable lack of long-term and large-scale clinical evidence exists supporting the effectiveness and cost-utility of these agents. This study aimed to evaluate the effectiveness and cost-utility of applying AAA in patients undergoing intra-abdominal surgery. METHODS: This is a retrospective observational study utilizing the Korean National Health Insurance Database in combination with the data from the Clinical Data Warehouse collected from six university-affiliated hospitals in Korea. The study included patients who underwent intra-abdominal surgeries between April and December 2016, with 2-year follow-up. The effectiveness of AAA was assessed by the incidence rate of AIO, and cost-utility was evaluated through calculating quality-adjusted life years (QALYs) and direct costs. Subgroup and sensitivity analyses were conducted to confirm the consistency and robustness of the study findings. RESULTS: A total of 2,831 patients were included in the study. Among them, 1,365 (47.2%) received AAA while 1,466 (52.8%) did not. The group that received AAA exhibited a significantly lower incidence of AIO, with a rate of 12.4% compared to 18.5% in the non-user group. Utility scores were higher in the user group, averaging 1.992 QALYs versus 1.986 in the non-user group. Direct costs were significantly lower in the user group, totaling 3,794 USD, which is 1,330 USD less than those incurred by the non-user group. Subgroup and sensitivity analyses reinforced these findings, demonstrating consistent reductions in AIO incidence, increased QALYs, and decreased costs observed across various subgroups, particularly among older patients and those without chronic conditions. CONCLUSION: These findings highlight the clinical effectiveness and cost-utility of AAA in patients undergoing intra-abdominal surgery. By significantly reducing the incidence of AIO and lowering healthcare costs, these agents provide empirical evidence supporting their broader adoption in clinical practice. This study addresses critical gaps in the understanding of postoperative management and offers valuable insights that could inform future healthcare policies.
8 Apr 2026
Read appraisal →Medicine
Comparison of costoclavicular with infraclavicular block for upper limb surgeries: A meta-analysis
BACKGROUND: The influence of costoclavicular versus infraclavicular nerve block on the analgesia for upper limb surgeries remains elusive. This meta-analysis and systematic review aim to study the analgesic efficacy of costoclavicular versus infraclavicular nerve block for upper limb surgeries. METHODS: We have searched several databases, including PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases from inception to January 2024, and randomized controlled trials (RCTs) assessing the effect of costoclavicular versus infraclavicular nerve block for upper limb surgeries were included. The inclusion criteria were presented as follows: study design was RCT, patients underwent upper limb surgeries, and intervention treatments were costoclavicular nerve block versus infraclavicular nerve block. Studies without English abstracts were excluded. The methodological quality of the included studies was evaluated by the modified Jadad scale. Standard mean difference with 95% confidence interval (CI) was used to assess continuous outcomes, while odds ratio (OR) with 95% CI was applied to evaluate dichotomous outcomes. RESULTS: Six RCTs and 434 patients were included in this meta-analysis. Compared with infraclavicular nerve block for upper limb surgeries, costoclavicular nerve block was able to significantly decrease block onset time (SMD = -0.29; 95% CI = -0.53 to -0.05; P = .02), but demonstrated no influence on performance time (SMD = -0.26; 95% CI = -0.85 to 0.34; P = .40), number of passes (SMD = -0.08; 95% CI = -0.40 to 0.24; P = .61), vascular puncture (OR = 0.25; 95% CI = 0.04 to 1.56; P = .14) or Horner syndrome (OR = 1.02; 95% CI = 0.04 to 27.64; P = .99). CONCLUSION: Costoclavicular nerve block may need shorter block onset time for upper limb surgeries compared to infraclavicular nerve block, but more RCTs were needed to confirm these findings.
5 Apr 2026
Read appraisal →Open heart
Periprocedural evaluation of patients with BAV stenosis undergoing TAVR: a machine learning-based study
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has increasingly emerged as one of the primary treatments for patients with severe bicuspid aortic valve (BAV) stenosis. Nevertheless, these patients encounter multiple procedural challenges. OBJECTIVE: To develop a machine learning (ML) model for assessing the risk of periprocedural adverse events (PAEs) in TAVR population with BAV. METHODS: This multicentre study retrospectively enrolled 1266 patients with BAV stenosis. Clinical characteristics and imaging data of the patients were collected, and an ML prediction model was developed. PAE was collectively defined as all-cause death, disabling stroke, life-threatening haemorrhage, acute kidney injury (≥stage 3), major vascular complications, valve-related dysfunction necessitating reoperation and other major complications that occurred prior to discharge. RESULTS: The average age was 72.6±6.3 years, and 58.3% (n=738) of male. In the derivation dataset, five predictive factors were identified: Type 0 BAV, aortic root calcification volume, horizontal aorta, annular ellipticity and previous atrial fibrillation. A robust risk scoring model was thereby established (area under the curve=0.801 95% CI 0.768 to 0.832). A graded relationship was observed between the quartiles of the score and PAE (0.6%, 1.7%, 3.2% and 9.6%; overall p<0.001). A nomogram was constructed to enable calculation of individual scores and the corresponding PAE probabilities. Additionally, similar results were observed in the validation dataset. CONCLUSIONS: The ML model developed in this study could predict the PAEs occurrence of TAVR in patients with BAV stenosis. This is conducive to individualised procedural planning and in-hospital management.
5 Apr 2026
Read appraisal →Regional anesthesia and pain medicine
Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial
BACKGROUND: The effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA) in patients with NMIBC. METHODS: This prospective randomized controlled trial recruited 287 patients with clinical NMIBC at Seoul National University Hospital from 2018 to 2020. The patients underwent transurethral resection of the bladder tumor within 4 weeks of randomization. Intrathecal hyperbaric bupivacaine (0.5%) and a mixture of propofol (1-2 mg/kg) and fentanyl (50-100 μg/kg) were used as induction agents in the SA and GA groups, respectively, with desflurane or sevoflurane used for maintaining anesthesia. The primary and secondary outcome measures were disease recurrence and disease progression, respectively, at 2 years after resection. Cumulative incidence of outcomes was compared between the two groups using time-to-event analyses. RESULTS: 15 patients required alternative anesthesia owing to clinical needs such as SA failure or significant obturator reflex, resulting in a modified intention-to-treat (ITT) population of 272 patients. Time-to-event analysis showed a significantly lower recurrence of NMIBC in the SA group than in the GA group, in both ITT (27.4% vs 39.8%) and modified ITT populations (26.8% vs 39.6%). Disease progression occurred more frequently in the GA than in the SA group (15.2% vs 7.8%), although the difference was not statistically significant. CONCLUSIONS: A notable reduction in the 2-year recurrence rate was observed in patients who underwent SA than in those who underwent GA. Thus, SA may be considered the preferred anesthetic approach. TRIAL REGISTRATION NUMBER: NCT03597087.
4 Apr 2026
Read appraisal →Regional anesthesia and pain medicine
Efficacy and safety of intrathecal adjuvants for perioperative management of cesarean delivery: a systematic review and network meta-analysis of randomized controlled trials
BACKGROUND: Cesarean section (CS) rates have increased globally, necessitating effective anesthesia management. Single-shot spinal anesthesia has limitations due to its duration and the dose-limiting adverse effects of local anesthetics. OBJECTIVES: To evaluate the effectiveness and safety of intrathecal adjuvants combined with local anesthetics in the perioperative management of CS pain. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: PubMed, Cochrane Library for Clinical Trials, and Embase. ELIGIBILITY CRITERIA: We included women undergoing CS under single-shot spinal anesthesia with any intrathecal drug or placebo added to a long-acting local anesthetic. We selected single- or double-blind, parallel-group, randomized controlled trials (RCTs) reported in English. We excluded crossover, non-randomized, up-and-down dose-finding studies and clinical trials comparing the same drugs in all study arms. RESULTS: We included 166 RCTs with 14 925 patients assigned to 32 interventions. Buprenorphine and diamorphine were the highest-ranked treatments for reducing pain intensity at 24 hours, though not statistically significant. Morphine alone or in combination with meperidine, neostigmine, epinephrine, or nalbuphine significantly increased the duration of effective analgesia and reduced opioid consumption. Dexmedetomidine and morphine significantly prolonged the motor block duration. The safety profile of intrathecal adjuvants was generally adequate. CONCLUSIONS: While the strength of evidence, overall, was very low to low, our study suggests that while none of the interventions significantly reduced pain intensity at 24 hours, several significantly prolonged effective analgesia and reduced postoperative opioid consumption. Dexmedetomidine and morphine prolonged the duration of motor block. None of the intrathecal adjuvants evaluated significantly increased the occurrence of severe adverse events. Future large-scale RCTs are essential to provide more robust evidence. PROSPERO REGISTRATION NUMBER: CRD42024479424.
4 Apr 2026
Read appraisal →Physiological measurement
Deep learning approach for stroke volume variation estimation: retrospective modeling and prospective deployment in real-world practice
Objective. We developed stroke volume variation (SVV) Net, a deep learning-based model for estimating SVV, and validated its performance and clinical applicability through both large-scale retrospective modeling and prospective real-time deployment within intraoperative settings.Approach. A SVVNet was trained on arterial blood pressure (ABP) waveforms from 2849 patients undergoing general anesthesia at Asan Medical Center (AMC). For retrospective validation, we utilized AMC cohorts and a publicly accessible database to assess agreement, trending ability, noise robustness (quantifies via signal quality index), and inter-individual deviation against ABP-based pulse wave analysis (ABP-PWA) and other DL models. For prospective validation, the optimized model was deployed onto a tablet and prospectively evaluated in real-time during 67 surgeries.Main results. In the retrospective external validation, SVVNet achieved higher agreement mean absolute error (MAE = 0.70, Pearsonρ= 0.92), compared to ABP-PWA algorithm (MAE = 1.30, Pearsonρ= 0.80) and lower inter-individual deviation. It was more robust to signal noise (MAE = 4.33 vs 30.87). In the prospective real-time deployment, our deployed model achieved an MAE of 1.33 and a Pearson correlation of 0.87 against the ground truth.Significance. This study emphasizes the advantages of the DL-based model compared to ABP-PWA-based algorithms and presents prospective results that support the clinical applicability of SVVNet in the operating room. Our model has the potential to replace pre-existing monitoring systems and to enhance the complex surgical environment.
4 Apr 2026
Read appraisal →Current opinion in anaesthesiology
Real-time, artificial intelligence-guided intraoperative resuscitation and fluid management in trauma anesthesia
PURPOSE OF REVIEW: To synthesize recent advances in intraoperative resuscitation for trauma surgery, including fluid composition, transfusion thresholds, and coagulopathy management, and to identify emerging directions that address persistent gaps in precision. Particular attention is given to prospective evidence, as forward-looking evaluations better capture real-world performance, workflow integration, and clinical impact, culminating in the integration of artificial intelligence and machine learning as the next stage of innovation. RECENT FINDINGS: Major trials over the past 5 years have refined evidence for balanced transfusion ratios, restrictive transfusion thresholds, and the transition from crystalloid to hemostatic and physiology-guided strategies. However, outcome variability underscores the need for individualized, data-driven resuscitation. Early prospective machine learning evaluations - along with the US Food and Drug Administration-cleared point-of-care systems such as APPRAISE-HRI - demonstrate that multimodal physiologic modeling can predict hemorrhage and fluid responsiveness as accurately as expert clinicians, while offering real-time monitoring and guidance. SUMMARY: The field is shifting from protocol-based to precision-guided trauma resuscitation. Future progress will rely on randomized-controlled-trial-validated, adaptive, human-in-the-loop artificial intelligence workflows that integrate continuous physiologic data with clinical judgment to enhance the timing, composition, and safety of intraoperative fluid and transfusion therapy.
4 Apr 2026
Read appraisal →Current opinion in anaesthesiology
Data integration and systems interoperability: the prerequisite for artificial intelligence in anesthesiology
PURPOSE OF REVIEW: Anesthesiology generates large volumes of heterogeneous perioperative data, including high-resolution physiological signals, clinical documentation, and device-generated information. Despite this richness, the clinical deployment of artificial intelligence systems remains limited. This review examines how limitations in data integration and systems interoperability constrain the translation of artificial intelligence into routine practice. RECENT FINDINGS: Recent literature indicates that the principal barrier to artificial intelligence adoption in anesthesiology is not algorithmic performance but inadequate data integration. Data are distributed across anesthesia information management systems, electronic health records, and multiple medical devices, with variable data models, inconsistent semantic representations, and limited temporal synchronization. These systems were primarily designed for documentation, billing, and medicolegal purposes, rather than real-time analytics or secondary data use. In contrast, intensive care medicine has benefited from early investments in shared databases, which have facilitated reproducible artificial intelligence research and validation. Although emerging standards such as HL7 Fast Healthcare Interoperability Resources and common data models provide technical frameworks for interoperability, their implementation in anesthesiology remains partial. SUMMARY: The effective deployment of artificial intelligence in anesthesiology depends on the development of interoperable, high-quality data infrastructures. Establishing standardized data models, semantic harmonization, temporal alignment, and robust data governance is a prerequisite for scalable, trustworthy artificial intelligence-enabled perioperative care.
4 Apr 2026
Read appraisal →Yonsei medical journal
Predicting Post-Induction Hypotension in Diverse Surgical Populations: A Multiclass Classification Universal Model Using Machine Learning Techniques
PURPOSE: Our study aims to develop a machine learning model that not only predicts the occurrence of post-induction hypotension (PIH) but also assesses its severity, addressing a broader patient population than previous studies which mostly focused on a single population. MATERIALS AND METHODS: In our study, we extracted data from 71473 patients aged 18 years and older who underwent general anesthesia for non-cardiac surgery at a tertiary care hospital, using the electronic medical record system for modeling. We used patient demographics, baseline and pre-induction blood pressure, preoperative laboratory tests, surgical details, and anesthetics data, focusing on predicting PIH. The severity of hypotension was assessed by integrating and calculating the integral value of hypotensive periods. We employed several machine learning techniques and evaluated their performance using accuracy, precision, F1-scores, and macro-averaged area under the curve. Additionally, SHapley Additive exPlanation values were used to determine the key factors influencing the predictions. RESULTS: A multiclass classification model, which assesses hypotension severity through the area of hypotension, surpassed the binary model with an F1-score of 0.664. Among various machine learning techniques, the eXtreme Gradient Boosting (XGBoost) model exhibited superior prediction performance, achieving an accuracy of 0.755 and an F1-score of 0.664. Models using preoperative blood pressure and demographic data outperformed those using other datasets. CONCLUSION: We found that using the XGBoost ensemble machine learning technique aids in predicting PIH before surgery, and introducing a multiclass classification model that indicates the severity of hypotension to clinicians leads to an overall enhancement in prediction performance, thereby increasing its clinical utility for real-world applications.
4 Apr 2026
Read appraisal →Adv Anesth
The Current Use of Artificial Intelligence in Anesthesiology
Artificial intelligence (AI) applications are increasingly being used in areas of medicine such as radiology. However, within anesthesiology, there is not widespread use of AI applications at this time, though it has the potential to have a profound impact. Many applications of AI, including machine learning, deep learning, and natural language processing, are being used to create applications to enhance patient monitoring, optimize drug administration, improve decision-making, and predict postoperative complications.
1 Dec 2025
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