Objective: Cardiologists are the most frequently consulted specialists during pre-operative evaluations. However, unnecessary cardiology consultations (CC) can increase cardiologists' workload without impacting anaesthesia practice, resulting in delayed surgeries and additional financial burdens. We hypothesize that using Gupta during the preoperative period can reduce these adverse effects. Methods: This prospective study included patients scheduled for elective noncardiac, nonvascular surgeries who underwent pre-operative assessment. Patients who had no specific risk index used for preoperative cardiac risk evaluation were classified as Group I, and those evaluated using the Gupta scale were classified as Group II. The study compared preoperative CC, diagnostic tests, surgical delays, major adverse cardiac event (MACE), length of hospital stay and intensive care unit (ICU) stay, mortality, and costs. Results: A total of 898 patients were included in the study, with 487 in Group I and 411 in Group II. The Gupta group reduced the demand for preoperative CC (P < 0.001) and preoperative non-invasive diagnostic testing (n = 107, 21.9% vs. n = 36, 8.75%). The time from the anaesthesiology outpatient clinic to surgery was 15 days in Group I and 14 days in Group II (P=0.132). The length of ICU stay was higher in Group I (P=0.019). MACE was 15 patients (3.08%) in Group I and 9 patients (2.19%) in Group II (P=0.076). The cost of patients in Group I was higher than that in Group II (P=0.019). Conclusion: Using Gupta in preoperative evaluation may reduce unnecessary preoperative resource usage, surgical delays, ICU hospitalization rates, additional costs, and mortality.

Postoperative nausea and vomiting (PONV) is a significant issue encountered in surgical patients. This study aims to investigate the effects of dextrose infusion timing on PONV incidence. Ninety patients undergoing laparoscopic cholecystectomy were included in this randomized controlled trial. Patients were assigned to one of three equal groups. In Group I, patients received an infusion of 400 mL of 0.9% saline 2 hours before surgery. In Group D, patients received 400 mL of 5% dextrose at the same infusion rate. Both Groups I and D received 0.9% saline at 10 mL kg^-1 h^-1 during the intraoperative period. In Group DD, patients received 200 mL of 5% dextrose preoperatively and 200 mL intraoperatively. To ensure the total maintenance fluid volume was the same as in the other groups, an infusion of 0.9% saline was administered along with the 200 mL dextrose. The primary outcome in our study was PONV incidence. Secondary outcomes were postoperative pain and anxiety levels. Postoperative PONV incidence, antiemetic consumption, and anxiety levels were lowest in Group DD, while they were highest in Group I (P < 0.05). In this study, we found that dextrose infusion reduced the incidence of PONV, antiemetic consumption, and anxiety levels. We observed that administering the same volumes of dextrose in divided doses during the preoperative and intraoperative periods reduced the incidence of PONV and improved anxiety scores compared to sole preoperative dextrose infusion.

Introduction: Our study aimed to determine the impact of preoperative red blood cell distribution width on length of intensive care unit and hospital stays, and short- and long-term mortality in elderly patients undergoing hip fracture surgery. Materials and Method: This prospective cohort study included 414 patients aged 65 and older who presented with hip fractures between November 2021 and November 2022. Patients’ demographic characteristics, American Society of Anesthesiologists score, Revised Cardiac Risk Index, comorbidities, and preoperative complete blood counts (hemoglobin, red blood cell distribution width, platelet count, etc.) were recorded at the preoperative visit. Length of intensive care unit and hospital stays were documented postoperatively. Patients were followed for one year after surgery in terms of mortality. Results: Patients with high red blood cell distribution width levels (≥14.25%) were older, had more comorbidities, and had higher American Society of Anesthesiologists score and Revised Cardiac Risk Index scores (p<0.001). In the high red blood cell distribution width group, length of hospital stays was longer (p<0.001). There was no significant difference between red blood cell distribution width groups in terms of intensive care unit stay duration and readmissions (p=0.304 and p=0.664, respectively). According to the multivariate logistic regression analysis, an red blood cell distribution width of ≥14.25 was found to increase the risk of 30-day mortality by 4.7 times and 1-year mortality by 2.74 times. Conclusion: Red blood cell distribution width is a useful, practical, and cost-effective indicator of short- and long-term mortality in elderly patients undergoing hip fracture surgery. Keywords: Aged; Anemia; Hip fracture; Mortality.

Amaç: Sol ventrikül destek cihazı cerrahisi (LVAD) ile ilişkili akut böbrek hasarı (ABH), %15-45 insidans ile kalp cerrahisinin ciddi bir komplikasyonudur. Çalışma, LVAD cerrahisi sonrası erken dönemde ABH’yi Böbrek Hastalığı: Küresel Sonuçların İyileştirilmesi (KDIGO) kriterlerini kullanarak değerlendirmeyi ve ABH olan ve olmayan hastaları insidans, risk faktörleri ve klinik sonuçları belirlemek için karşılaştırmayı amaçladı. Gereç ve Yöntem: Bu retrospektif kohort çalışmada, Ocak 2011 ile Aralık 2016 arasında LVAD implantasyonu uygulanan 18-75 yaş arasındaki tüm hastaların tıbbi kayıtları gözden geçirildi. Hastalar, demografik özellikleri ve perioperatif değişkenleri analiz etmek için ABH gelişimine göre iki gruba ayrıldı. ABH, KDIGO kriterlerine göre tanımlandı. Bulgular: Elli yedi hastanın 10’u (%18) kadındı ve ortalama yaş 44,6±16,1 yıldı. Otuz altı hastada (%63) LVAD implantasyonunu takiben ABH gelişti. Lojistik regresyon analizi, ABH için bağımsız risk faktörleri olarak postoperatif birinci günde kardiyopulmoner bypass süresi, ortalama kan basıncı ve kümülatif sıvı dengesini ortaya koydu [olasılık oranı (OR): 1.013, güven aralığı (GA) %95 1,000-1,025, p=0,05; OR: 0,929, GA %95 %0,873-0,989, p=0,02; OR: 1,001, GA %95 1,000-1,001, p=0,04]. ABH’li hastalarda hastane mortalitesi (%58’e karşı %24, p=0,01) ve 30 günlük mortalite (%39’a karşı %5, p=0,01) anlamlı olarak daha yüksekti. Sonuç: Sonuçlarımız, LVAD cerrahisi sonrası hastaların %63’ünde ABH geliştiğini göstermektedir. ABH oluşumu için risk faktörleri, uzun kardiyopulmoner bypass süresini, daha düşük ortalama kan basınçlarını ve postoperatif ilk gün daha yüksek kümülatif sıvı dengesini içerir. Bu nedenle ABH, LVAD’den sonra en önemli morbidite ve mortalite nedenlerindendir.