Background/Objectives: Postoperative pulmonary complications (PPCs) are a major source of morbidity following cardiac surgery, particularly in older adults. While malnutrition is linked to adverse outcomes, the optimal screening tool for identifying patients at risk of PPCs remains uncertain. This study compared the predictive performance of the Geriatric Nutritional Risk Index (GNRI), Mini Nutritional Assessment–Short Form (MNA-SF), Prognostic Nutritional Index (PNI), and Nutrition Alert Form (NAF) for PPCs in older adults undergoing elective cardiac surgery. Methods: This prospective cohort study enrolled 217 patients aged ≥ 60 years at a tertiary university hospital. Preoperative nutritional status was assessed using the GNRI, MNA-SF, PNI, and NAF. The primary outcome was PPC development during hospitalization. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression identified independent predictors. Results: PPCs occurred in 86 patients (39.6%). Patients who developed PPCs had significantly higher NAF scores than those who did not (median [IQR]: 7.5 [3–12] vs. 5 [2–8], p < 0.001), whereas GNRI, MNA-SF, and PNI scores did not differ significantly. NAF demonstrated the highest predictive performance (AUC: 0.643, 95% CI: 0.567–0.719), followed by PNI, MNA-SF, and GNRI. However, after adjusting for clinical covariates, none of the nutritional assessment tools remained independently associated with PPCs. Conclusions: Among the four tools evaluated, NAF showed the highest predictive performance among the evaluated nutritional assessment tools; however, its discriminative ability was modest, and none of the nutritional assessment tools remained independently associated with PPCs after multivariable adjustment. Nutritional assessment should complement, rather than replace, established clinical risk factors in perioperative risk stratification.

Background: Active learning, particularly through serious and analog serious games, is effective for increasing participant engagement, fostering learners’ motivation, and promoting dynamic knowledge acquisition. In this study, we developed the “Basic Pharmacology for Anesthesia” card game to teach about anesthetic drug to first- to third-year anesthesiology residents and assessed its effectiveness and the residents’ satisfaction with game-based learning. Methods: Nineteen anesthesiology residents participated in this cross-sectional observational study conducted at the Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University. A game-based learning was introduced to the participants. The objective of the game was for participants to collect a complete set of five cards for a specific anesthetic drug. The deck comprised 55 cards representing 11 anesthetic drugs, each of which detailed the drug’s name, dosage, onset and duration, contraindications, side effects, and metabolism or pharmacology. Pre- and posttests (total score: 20 points) were administered before and after the game-based learning, respectively. Pre- and posttest knowledge scores were compared, and the participants’ satisfaction with the activity was assessed using a five-point Likert scale. Results: A comparison of the pre- and posttest scores revealed improvements across all categories: 5.00 vs. 7.47 ( p < 0.001) for induction drugs, 2.59 vs. 3.92 ( p < 0.001) for volatile anesthetics, and 6.67 vs. 7.51 ( p < 0.001) for neuromuscular agents. The total score significantly increased from 14.26 (pretest) to 18.91 (posttest) ( p < 0.001). The overall satisfaction level was 4.84 (standard deviation = 0.37). Conclusions: Game-based learning using a serious card game could effectively improve anesthesiology residents’ knowledge of anesthetic drugs and was associated with a high learner satisfaction. To achieve a more comprehensive evaluation of this educational intervention, future studies should include additional assessment methods, such as measuring learner engagement and comparing game-based learning with traditional methods used to teach anesthetic drugs to anesthesiology residents.