Sarcopenia, characterized by the progressive loss of muscle mass and strength, is common in the elderly and significantly increases the risk of poor postoperative outcomes. This study aims to examine the impact of sarcopenia on postoperative delirium and a range of perioperative outcomes in elderly patients. A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL. Studies investigating the association between sarcopenia and postoperative complications in elderly surgical patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized for risk-of-bias assessment. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included other postoperative complications and further recovery. Subgroup analyses were conducted based on surgery types. A total of 10,981 records were identified, with 265 studies included in the systematic review and 242 in the final meta-analysis. A significant association was found between sarcopenia and postoperative delirium in both univariable and multivariable analyses (univariable: OR 1.81, 95% confidence interval [CI] 1.31 to 2.50, P < 0.001, I2 24.0%; multivariable: OR 2.42, 95% CI 1.27 to 4.59, P = 0.007, I2 0.0%). Sarcopenia was also associated with adverse postoperative outcomes, including increased complications, mortality, delayed recovery, and reduced overall survival. However, no significant associations were observed for postoperative pancreatic fistula or recurrence. Syntheses of multivariable analyses showed significant differences in postoperative complications, mortality, overall survival, and recurrence. Subgroup analyses indicated a higher risk of reduced overall survival among sarcopenic patients undergoing head and neck or heart and chest surgeries. Sarcopenia is a strong independent predictor of postoperative delirium and poor postoperative outcomes in elderly surgical patients. PROSPERO registration number CRD42023424696 (18 May 2023)

The mortality and morbidity in hip fracture is a big healthcare burden. How to identify risk patients preoperatively is important. The aim of study was to evaluate the risk factors of postoperative complications and mortality in patients older than 80 years old after hip fracture surgery. Patients older than 80 years old with the diagnosis of hip fracture who had surgical treatment from February 2013 to June 2021 at a single center in China were included for analysis. The primary outcome were postoperative complications and in-hospital mortality. Binary logistic regression was used to confirm the relationship between preoperative factors and postoperative complications/mortality. 498 patients were included for analysis. 176 patients developed 265 episodes of complications and the incidence of postoperative complication was 35.3%. Postoperative pulmonary infection was the most common complication, followed by cardiovascular complications and postoperative delirium. And there were 10 postoperative in-hospital deaths (2.0%). Preoperative Charlson comorbidity index(CCI) was associated with postoperative complications (OR = 1.243, 95%CI 1.020–1.516, P = 0.031) and mortality (OR = 2.303, 95%CI 1.351–3.925, P = 0.002). However, American society of Anesthesiologists (ASA) score was not an independent risk factor for postoperative complication and mortality. CCI was the risk factor of poor postoperative outcome for patients older than 80 years old after hip fracture surgery. And CCI can be used as the potential tool of risk stratification for this group of patients. This study had been registered in www.chictr.org.cn and the registration ID was ChiCTR2400085291 on June 4th 2024.

The effects of inhalation anesthesia as compared with total intravenous anesthesia (TIVA) on postoperative recovery quality in patients undergoing transsphenoidal resection of pituitary adenoma have not been well studied. This randomized clinical trial enrolled patients undergoing transsphenoidal surgery between May 2023 to April 2024. Patients were randomly assigned in a 1:1 ratio to receive inhalation anesthesia or TIVA. The primary endpoint was the 15-item Quality of Recovery Scale (QoR-15) score on the first postoperative day. Secondary endpoints included postoperative anesthesia recovery patterns, neuroendocrine stress responses, cellular immune responses, and recovery quality. Subgroup analyses were also conducted for the postoperative QoR-15 scores and neuroendocrine stress responses. Potential influence factors for QoR-15 scores and changes in counts of lymphocytes were explored. A total of 252 patients were randomized. No significant difference in postoperative QoR-15 scores was observed between groups and the between-group difference was well below the minimal clinically important difference (median difference 1.0, 95% confidence interval [CI]– 4.0 to 5.0, P = 0.647). Compared with the inhalation group, the TIVA group exhibited significantly lower Richmond agitation-sedation scale (RASS) score and reduced antiemetic drug use in the postanesthesia care unit. Subgroup analyses for postoperative QoR-15 scores revealed no significant interactions. Adrenocorticotropic hormone levels on postoperative day 1 were lower in the inhalation group, while thyroxine and serum free thyroxine levels were higher. No significant differences in these neuroendocrine indices were found in postoperative month 3. Lymphocyte subset levels did not differ between groups on postoperative day 1, although perioperative changes in immune cell counts were correlated with patient demographic and clinical characteristics. Both anesthesia methods resulted in comparable short-term postoperative recovery quality as measured by the QoR-15 scores. TIVA was associated with smoother anesthesia recovery and lower immediate antiemetic requirements. Differences in early neuroendocrine responses were observed but did not persist at 3 months postoperatively. The trial is registered with the ClinicalTrials.gov platform (registration number: NCT05822817; date of registration: March 13, 2023).

Chronic post-thoracotomy pain (CPTP) is a debilitating postoperative complication associated with persistent hypersensitivity and neuroinflammatory changes. Here, we identify an astrocyte-neuron signaling cascade mediated by NF-κB/C3/C3aR that drives excitatory synaptic remodeling in the spinal dorsal horn during CPTP. Using a rat model, we show that the activation of astroglial NF-κB promotes C3 synthesis, which interacts with neuronal C3aR to enhance GluR1 expression and synaptic localization, thereby facilitating pain hypersensitivity. The pharmacological inhibition of NF-κB or knockdown of astroglial C3 or neuronal C3aR markedly attenuated mechanical and cold allodynia, accompanied by reduced GluR1 expression. These findings define a mechanistic link between glial NF-κB activation, complement signaling, and neuronal excitatory transmission, highlighting the NF-κB/C3/C3aR pathway as a potential therapeutic target for chronic postoperative pain.