This meta-analysis investigated the effects of intravenous magnesium sulfate on the postoperative recovery quality, as assessed using the Quality of Recovery (QoR) questionnaire, in adult surgical patients. Seven randomized controlled trials involving 622 patients were included. Compared with the placebo, magnesium sulfate significantly improved the global QoR score on postoperative day 1 (standardized mean difference [SMD]: 1.24; 95% confidence interval: 0.70—1.78; p < 0.00001). It also enhanced specific QoR dimensions, with substantial effects on pain (SMD: 1, p < 0.00001) and physical comfort (SMD: 0.85, p < 0.0001), a moderate effect on emotional state (SMD: 0.65, p = 0.002), and small improvements in physical independence (SMD: 0.43, p < 0.00001) and psychological support (SMD: 0.37, p < 0.0001). In addition, magnesium sulfate reduced the intraoperative opioid consumption (SMD: −0.66, p < 0.0001), postoperative pain severity, and the incidence of postoperative nausea and vomiting (risk ratio: 0.48, p = 0.008). The extubation times were unaffected, whereas the post-anesthesia care unit stay was slightly prolonged. These findings highlight the potential of magnesium sulfate as a valuable adjunct for multimodal analgesia and enhanced recovery. Future studies should aim to elucidate the optimal dosing strategies, timing of administration, and specific surgical populations that may derive maximum benefits.

The relationship between corrected QT (QTc) intervals and short-term clinical outcomes remains insufficiently investigated. This study examined correlations between QTc intervals and risks of arrhythmia or mortality over a 3-month follow-up period. This retrospective study analyzed de-identified electronic medical records from the TriNetX Network. Adult patients with at least 2 electrocardiogram assessments were categorized into 5 QTc interval groups: long QTc (>500 milliseconds [ms]), borderline QTc (460–500 ms), high-normal QTc (420–460 ms), control QTc (370–420 ms), and short QTc (200–370 ms). Primary outcomes were 3-month risks of new-onset atrial fibrillation (AF) or ventricular arrhythmia (VA), with secondary focus on 3-month mortality risk. Among 145,111 patients, a U-shaped pattern was observed in AF risk across QTc interval categories. The hazard ratio for AF risk was 7.384 (95% confidence interval: 5.911–9.224) in the long QTc group and 7.735 (95% confidence interval: 4.237–14.122) in the short QTc group compared to controls. Similar U-shaped correlations were observed between QTc intervals and VA or mortality risks. Sensitivity analyses confirmed the U-shaped association for AF. However, sensitivity analyses showed that the association between short QTc intervals and the risk of VA or mortality was attenuated and no longer statistically significant after excluding patients exposed to QTc-prolonging medications or in pre-pandemic cohorts. Our findings revealed a U-shaped correlation between QTc intervals and the occurrence of AF, VA, and mortality within a 3-month observation period, underscoring the potential of QTc intervals as short-term prognostic predictors.

The safety of tranexamic acid (TXA) in patients with recent coronavirus disease (COVID-19) infection undergoing major arthroplasty remains unclear. We aimed to evaluate whether TXA increases thromboembolic risk in post-COVID-19 patients undergoing major arthroplasty. Using the TriNetX database, we identified patients aged ≥50 years who underwent total knee or hip arthroplasty with documented COVID-19 within 3 months prior to surgery. Patients who received TXA on the day of surgery were compared with those who did not. The primary outcome was 6-month risk of venous thromboembolism (VTE), with secondary outcomes including cerebral infarction, mortality, intensive care unit (ICU) admission, acute kidney injury (AKI), sepsis, and pneumonia. After matching (26,366 patients for each group), analysis revealed that TXA use was not associated with an increased risk of VTE (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.90–1.32, P = .404), cerebral infarction (OR 0.86, 95% CI 0.67–1.09, P = .215), mortality (OR 0.81, 95% CI 0.60–1.10, P = .174), or other complications at 6 months. Notably, TXA was associated with a significantly reduced risk of ICU admissions (OR 0.74, 95% CI 0.62–0.89, P = .001). Sensitivity analysis showed that TXA provided additional benefits in patients with prior COVID-19 hospitalization, including reduced mortality (OR 0.53, P = .003), lower risk of AKI (OR 0.79, P = .002), and decreased incidence of sepsis (OR 0.77, P = .038). Sex-based analysis revealed more pronounced benefits in female patients, particularly for ICU admission and AKI. TXA use in post-COVID patients undergoing major arthroplasty was associated with better long-term outcomes without increasing thromboembolic risk, supporting the continued use of TXA in this patient population.