In this study, we evaluated the efficacy of the discharge Acute Physiology and Chronic Health Evaluation (APACHE) II score in predicting post-intensive care unit (ICU) mortality and ICU readmission during the same hospitalisation in a surgical ICU. Of 1190 patients who were admitted to the ICU and stayed >48 hours between October 2007 and March 2010, 23 (1.9%) died and 86 (7.2%) were readmitted after initial ICU discharge, with 26 (3.0%) admitted within 48 hours. The area under the receiver operating characteristics curve of the discharge and admission APACHE II scores in predicting in-hospital mortality was 0.631 (95% confidence interval [CI] 0.603 to 0.658) and 0.669 (95% CI 0.642 to 0.696), respectively (P=0.510). The area under the receiver operating characteristics curve of discharge and admission APACHE II scores for predicting all forms of readmission was 0.606 (95% CI 0.578 to 0.634) and 0.574 (95% CI 0.545 to 0.602), respectively (P=0.316). The area under the receiver operating characteristics curve of discharge APACHE II score in predicting early ICU readmissions was, however, higher than that of admission APACHE II score (0.688 [95% CI 0.660 to 0.714] versus 0.505 [95% CI 0.476 to 0.534], P=0.001). The discharge APACHE II score (odds ratio [OR] 1.1, 95% CI 1.01 to 1.22, P=0.024), unplanned ICU readmission (OR 20.0, 95% CI 7.6 to 53.1, P=0.001), eosinopenia at ICU discharge (OR 6.0, 95% CI 1.34 to 26.9, P=0.019), and hospital length-of-stay before ICU admission (OR 1.02, 95% CI 1.01 to 1.03, P=0.021) were significant independent factors in predicting post-ICU mortality. This study suggests that the discharge APACHE II score may be useful in predicting post-ICU mortality and is superior to the admission APACHE II score in predicting early ICU readmission in surgical ICU patients.

Background: The antiapoptotic effects of sevoflurane postconditioning are responsible for neuroprotection against cerebral ischemia-reperfusion injury. Phosphorylation of the Janus family tyrosine kinases (JAK) 2-signal transducers and activators of transcription (STAT) 3 pathway is linked to antiapoptosis. Here, we determined whether the antiapoptotic effects of sevoflurane postconditioning are associated with activation of the JAK2-STAT3 pathway after global transient cerebral ischemia in rats. Materials and Methods: Forty-five rats were randomly assigned to 5 groups: sham (n=5), control (10 min of ischemia, n=10), sevoflurane postconditioning (2 periods of sevoflurane inhalation after ischemia for 10 min, n=10), AG490 (a JAK2 selective inhibitor, intraperitoneal administration of 40 mg/kg before ischemia, n=10), and sevoflurane postconditioning plus AG490 group (n=10). The number of apoptotic cells as well as the expression of JAK2, phosphorylated JAK2 (P-JAK2), STAT3, phosphorylated STAT3 (P-STAT3), Bcl-2 (antiapoptotic protein), and Bax (proapoptotic protein) were evaluated 3 days after ischemia. Results: The apoptotic cell count was significantly lower in the sevoflurane postconditioning group than in the control, AG490, and sevoflurane postconditioning plus AG490 groups. JAK2 and STAT3 levels were comparable among all 5 groups. P-JAK2, P-STAT3, and Bcl-2 levels were higher and Bax levels were lower in the sevoflurane postconditioning group relative to the control, AG490, and sevoflurane postconditioning plus AG490 groups. Conclusions: Sevoflurane postconditioning reduced apoptosis by increasing P-JAK and P-STAT expression after transient global ischemia in rats, and AG490 reversed the beneficial antiapoptotic effects of sevoflurane postconditioning, suggesting that the JAK-STAT pathway may be involved in the antiapoptotic mechanism of sevoflurane postconditioning.

Catheter-related bladder discomfort (CRBD) due to an indwelling urinary catheter causes postoperative distress. Dexmedetomidine is used as an anaesthetic adjuvant during general anaesthesia and has an antimuscarinic effect, which may be beneficial for the prevention and treatment of CRBD. To determine the effect of intraoperative dexmedetomidine administration on the incidence of CRBD. A double-blind, placebo-controlled, randomised study. A tertiary care teaching hospital. One-hundred and nine patients undergoing transurethral bladder tumour excision (TURB). Patients were randomly allocated to two groups: control group (n = 55) received placebo and dexmedetomidine group (n = 54) received intraoperative dexmedetomidine (1 μg kg(-1) loading dose followed by 0.5 μg kg(-1) h(-1) continuous infusion). The incidence and severity (mild, moderate, severe) of CRBD assessed at 0, 1, 6 and 24 h postoperatively. The incidence of CRBD was significantly higher in the control group at 0 (78 vs. 50%; P = 0.004), 1 (86 vs. 57%; P = 0.002) and 6 h (82 vs. 63%; P = 0.047) postoperatively. The incidence of moderate to severe CRBD was higher in the control group at 0 (38 vs. 11%; P = 0.002) and 1 h (29 vs. 7%; P = 0.006) postoperatively. The number of patients having CRBD treated with tramadol was higher in the control group (24 vs. 12; P = 0.006). The mean end-tidal desflurane concentration during the surgery was higher in the control group (4.5 vs. 3.9%; P = 0.04). The postoperative pain score (numerical rating scale: 0 to 10) was higher in the control group at 0 (4.6 vs. 2.7; P = 0.002), and 1 h (3.8 vs. 2.7; P = 0.041). The number of patients treated with opioids was higher in the control group (21 vs. 8; P = 0.011). Intraoperative dexmedetomidine administration decreased the incidence and severity of early postoperative CRBD as well as intraoperative desflurane and postoperative opioid requirements in patients undergoing TURB. NCT01991223 (www.clinicaltrials.gov).

Numerous factors are associated with mortality after hip fracture surgery in elderly patients. The aim of this study was to investigate whether preoperative C-reactive protein (CRP) was an independent risk factor for 1-year mortality after hip fracture surgery in the elderly. The electronic medical records of 772 elderly patients (age ≥ 65 years) undergoing hip fracture surgery from May 2003 to November 2011 were reviewed retrospectively. The patients comprised a high CRP group (>10.0 mg/dL) and low CRP group (≤10.0 mg/dL), based upon preoperative CRP levels. The overall 1-year mortality was 14.1%; the value was significantly higher in the high CRP group than in the low CRP group (31.8% vs 12.5%; P < 0.001). On binary logistic regression, body mass index (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.88-0.99; P = 0.025), history of malignancy (OR, 2.59; 95% CI, 1.47-4.57; P = 0.001), American Society of Anesthesiologists physical status (ASA PS) class 3-4 (OR, 1.96; 95% CI, 1.25-3.07; P = 0.003), preoperative albumin (OR, 0.39; 95% CI, 0.25-0.61; P < 0.001), preoperative CRP > 10.0 mg/dL (OR, 2.04; 95% CI, 1.09-3.80; P = 0.025), postoperative intensive care unit (ICU) admission (OR, 2.29; 95% CI, 1.15-4.59; P = 0.019), and creatinine on the second postoperative day (OR, 1.20; 95% CI, 1.00-1.45; P = 0.048) were independent predictors of 1-year mortality after hip surgery. Male gender and low preoperative hemoglobin were associated with in-hospital mortality, whereas delayed surgery and femoral neck fracture were related to the 6-month mortality. Low preoperative albumin and low body mass index predicted the 6-month and 1-year mortality. An increased preoperative CRP level, particularly >10.0 mg/dL, was associated with the 1-year mortality after hip fracture surgery in the elderly. In addition, a history of malignancy, high ASA PS score, and postoperative ICU admission were related to mortality after hip fracture.