Predictive Value of ARISCAT Risk Index in the Development of Postoperative Pulmonary Complications After Major Abdominal Cancer Surgery - Journal of Ankara University Faculty of Medicine

Patient positioning (Trendelenburg vs. supine) may alter hemodynamics. This study aimed to compare the effects of position changes on cardiac parameters and vital signs in patients undergoing major abdominal cancer surgery, performed either laparoscopically or via open techniques, using esophageal Doppler monitoring (ODM) for intraoperative fluid management. After obtaining ethics committee approval, 80 patients who underwent major abdominal cancer surgery between November 2021 and November 2022 using ODM were retrospectively identified from the records of the Anesthesiology Clinic. These patients were analyzed based on whether they underwent open or laparoscopic procedures. Demographic information, vital signs, amount of blood loss, type and volume of administered fluids, as well as cardiac parameter measurements obtained with the ODM device in both the supine and Trendelenburg positions (> 45°), were examined. The ODM device recorded the following parameters: cardiac output (CO), flow time corrected (FTc), peak velocity (PV), and stroke distance (SD). The study aimed to determine whether there were significant variations in these parameters between the open and laparoscopic surgical approaches. The demographic characteristics of the patients were similar in both the supine and Trendelenburg positions. The mean duration of surgery was 163 ± 30 min in the open surgery group and 153 ± 29 min in the laparoscopic surgery group (p = 0.137). The average amount of blood loss was 495 ± 280 ml in the open surgery group and 310 ± 240 ml in the laparoscopic group (p = 0.034). There was no significant difference in net fluid balance between the two groups (open surgery: 388 ± 60 ml; laparoscopic surgery: 473 ± 21 ml; p = 0.107). Continuous fluid monitoring revealed no changes in cardiac parameters during position changes in either group. However, an increase in mean arterial pressure was observed in the Trendelenburg position, regardless of the type of surgery (p = 0.003, p = 0.014, p < 0.05). The findings of this study are consistent with the existing literature, indicating that patient positioning did not alter cardiac parameters. We conclude that preservation of intravascular volume may reduce changes in cardiac parameters that could be caused by the Trendelenburg position or pneumoperitoneum. Continuous non-invasive hemodynamic monitoring may help ensure that positional changes do not adversely affect cardiac parameters. NCT06293391 and registration on 06 November 2024.

Background: Frailty is associated with adverse surgical outcomes in older adults. We evaluated whether the Edmonton Frail Scale (EFS) is independently associated with 30-day postoperative morbidity and mortality after major colorectal cancer surgery. Methods: This prospective observational study enrolled patients aged ≥ 65 years undergoing elective oncologic colorectal resection (March–September 2025). Patients were stratified into five EFS frailty categories. The primary outcomes were 30-day postoperative complications (Clavien–Dindo; Grade I–II vs Grade III–V) and 30-day all-cause mortality. Associations were assessed using ROC analysis and multivariable logistic regression. Results: Of 205 enrolled patients, 200 were analyzed (63% male; median age 70 years). Thirty-day postoperative complications occurred in 40 patients (20%), and 30-day mortality was 5% (10/200). EFS was associated with longer hospital length of stay and higher complication and mortality rates. EFS showed excellent discrimination for postoperative complications (AUC 0.928; 95% CI 0.886–0.970), with an optimal cut-off of ~ 6.5 (sensitivity 96.2%, specificity 76.9%). In multivariable models, EFS remained independently associated with complications (OR 1.284; p = 0.006) and mortality (OR 1.323; p = 0.014). Conclusions: Preoperative EFS provides independent and clinically meaningful prediction of 30-day morbidity and mortality after major colorectal cancer surgery in older adults and may enhance perioperative risk stratification and shared decision-making. Trial registration: NCT06866678 and registration on 05 March 2025.

Purpose: The potential impact of provider-related factors, including anesthesiologist sex, on postoperative pain and analgesic requirements remains an area of ongoing investigation. While gender dynamics have been explored in various clinical settings, their role in perioperative pain outcomes has not been fully elucidated, particularly in breast surgery patients.Materials and Methods: This prospective observational study included 127 female patients undergoing elective breast surgery under standardized general anesthesia. Patients were grouped according to anesthesiologist sex. Postoperative pain scores (VAS at 0, 6, 12, and 24 hours), total opioid consumption within 24 hours (morphine equivalents), rescue analgesia requirements, and early postoperative complications were recorded. Multivariable linear regression analysis was performed to identify independent predictors of opioid consumption, including anesthesiologist years of experience as a potential confounder.Results: Patients managed by female anesthesiologists had higher postoperative opioid consumption compared with those managed by male anesthesiologists (mean difference: 2.54 mg, 95% CI [1.29 to 3.80], p<0.001). Pain scores over the first 24 hours were also higher in the female-provider group (p=0.031), and the need for rescue analgesia was more frequent (36.2% vs. 21.7%, p=0.042). No significant difference was observed in early postoperative complications (p=0.084). In multivariable analysis, anesthesiologist sex remained an independent predictor of opioid consumption after adjustment for age, BMI, operative duration, ASA status, and anesthesiologist experience (p<0.001)Conclusion: Anesthesiologist sex was independently associated with postoperative opioid consumption and pain outcomes in patients undergoing breast surgery, independent of anesthesiologist experience and other measured confounders. These findings suggest that provider-related factors may influence perioperative pain management; however, causal inference remains limited, and the results should be interpreted within the context of multidisciplinary care pathways.

Kritik travma hastalarının yönetimi elbette ki ülkemizde modern tıbbın uygulanmaya başladığından beri ve hatta geleneksel tıbbın uygulandığı dönemlerde de en iyi şekilde yapılmaktaydı. Ancak gelişen teknoloji sayesinde kritik travma hastalarına yapılan müdahaleler artmakta ve kritik travma hastalarının yaşam süreleri uzamakta ve ölüm oranları azalmaktadır. Kritik travma hastalarının bakımı için gerekli olan tıbbi bilgi, klinik beceriler ve teknolojinin anlaşılması kritik travma hastalarının bakımı için gerekli olan alt uzmanlık dallarını aşmaya devam etmekte ve bu nedenle kitabın yazımında görev alan yazarlar fizyologların yanında hemen hemen tüm cerrahi branşların ve ilgili dahili branşların bakış açısını yansıtacak şekilde dizayn edilmiştir. Her branş kendi bakış açısıyla kritik travma hastalarının takip ve tedavisindeki kilit noktaların açılımı için görüş ve önerilerini bu kitapta sunmuştur.