BACKGROUND: Inadequate pain management affects over half of the 230 million major surgeries performed annually. Preemptive analgesia aims to prevent peripheral and central sensitization. Dexmedetomidine (DEX) offers non-...BACKGROUND: Inadequate pain management affects over half of the 230 million major surgeries performed annually. Preemptive analgesia aims to prevent peripheral and central sensitization. Dexmedetomidine (DEX) offers non-opioid analgesia and opioid-sparing effects. This study evaluated the efficacy of preemptive DEX using the nociception index (NOX) for objective intraoperative monitoring and assessed its impact on perioperative outcomes. METHODS: In this single-center, double-blind, randomized controlled trial, 220 eligible patients were assigned to receive either intravenous DEX (1.5 µg·kg-1·h-1) (DEX group) or placebo (normal saline) (PO group) from 15 minutes before anesthesia induction until 15 minutes post-induction. The co-primary outcomes were the intraoperative NOX compliance rate (mean NOX ≤60 during nociceptive stimulation) and the incidence of moderate-to-severe postoperative pain (pNRS > 3) at 0, 24, 48 hours, and 7 days. Secondary outcomes included hemodynamic parameters, postoperative nausea and vomiting (mPONV), dizziness, analgesic consumption, and safety events. RESULTS: The DEX group demonstrated a significantly higher NOX compliance rate compared to the placebo group (98/108, 90.7% vs 14/112, 12.5%; P <.001). The incidence of NRS>3 was significantly lower in the DEX group at all postoperative time points (3/108, 2.8% vs 29/112, 25.9% at 0 hour; 6/108, 5.6% vs 33/112, 29.5% at 24 hours; 1/108, 0.9% vs 19/112, 17% at 48 hours; 0/108, 0% vs 6/112, 5.4% at 7 d; P = .000). DEX also reduced rescue opioid consumption (z = -2.428, P = .004), decreased mPONV (z = -4.901, P = .001), and improved hemodynamic stability. Safety profiles were favorable in DEX group. CONCLUSION: Preemptive analgesia with DEX significantly improves both intraoperative nociceptive control as objectively measured by the NOX and postoperative pain control. It validates the role in optimizing perioperative analgesia and enhancing recovery.
BACKGROUND: Children with severe preoperative infections are at increased risk for postoperative complications, yet the association between preoperative sepsis or systemic inflammatory response syndrome (SIRS) and subseq...BACKGROUND: Children with severe preoperative infections are at increased risk for postoperative complications, yet the association between preoperative sepsis or systemic inflammatory response syndrome (SIRS) and subsequent acute kidney injury (AKI) in pediatric surgical patients remains to be fully explored. We evaluated whether severe preoperative infections increase the risk of postoperative AKI and examined the combined impact of preoperative infections and postoperative AKI on 30-day mortality in pediatric surgical patients. METHODS: We performed a retrospective cohort study of 144,718 propensity score-matched children younger than 18 years who underwent inpatient surgery, using data from the National Surgical Quality Improvement Program-Pediatric (2012-2023). Severe preoperative infection was defined as sepsis or SIRS within 48 hours before surgery. Postoperative AKI included acute renal failure or progressive renal insufficiency occurring within 30 days. Adjusted risk ratios (aRRs) were estimated using modified Poisson regression. RESULTS: Postoperative AKI occurred in 200 children (0.14%). Severe preoperative infection was associated with more than double the risk of postoperative AKI (aRR, 2.03; 95% confidence interval [CI], 1.51-2.74; P < .001). Postoperative AKI conferred a 4.6-times associated risk of 30-day mortality (aRR, 4.64; 95% CI, 3.48-6.12; P < .001), and preoperative infection alone was associated with a 1.8-times increase in mortality risk (aRR, 1.83; 95% CI, 1.60-2.10; P < .001). When both conditions occurred, the risk of 30-day mortality was nine times higher (aRR, 9.63; 95% CI, 7.20-12.87; P < .001) on an additive interaction scale. CONCLUSIONS: Severe preoperative infection is associated with a higher risk of postoperative AKI and 30-day mortality after adjustment for measured confounders. The combination of preoperative infection and postoperative AKI produces a nine-fold higher risk of mortality, underscoring the need for targeted perioperative strategies in high-risk pediatric populations.
BACKGROUND: Fibrinogen/albumin ratio (F/A ratio) has been proposed as a prognostic factor for different outcomes in different clinical settings, including cardiovascular interventions. However, few studies address the F/...BACKGROUND: Fibrinogen/albumin ratio (F/A ratio) has been proposed as a prognostic factor for different outcomes in different clinical settings, including cardiovascular interventions. However, few studies address the F/A ratio as a possible predictor of postoperative outcome in adult cardiac surgery with cardiopulmonary bypass (CPB). The hypothesis of the present study is that by including the F/A ratio in the existing risk models for major morbidity after adult cardiac surgery may result in better discrimination, calibration, and risk reclassification of the model. METHODS: This is a retrospective study including 836 adult patients who underwent cardiac surgery with CPB. Every patient received an F/A ratio calculation, and other preoperative factors were collected (demographics, comorbidities, operation details, and EuroSCORE II). The primary outcome measure was major morbidity, defined as 1 or more of the following: surgical revision for any cardiac reason; stroke; acute kidney injury requiring renal replacement therapy; deep sternal wound infection; prolonged mechanical ventilation. The F/A ratio alone and EuroSCORE II-based predictive models with or without the F/A ratio were tested for major morbidity predictive properties. RESULTS: F/A ratio was univariately associated with major morbidity (odds ratio 1.025, 95% confidence interval 1.061-1.091, P = .004), but carried a poor discrimination for major morbidity with an area under the curve (AUC) for receiver operating characteristics (ROC) analysis of 0.606. A multivariable risk model based on the EuroSCORE II yielded a significantly (P < .001) better AUC (0.731); the inclusion of F/A ratio within this model did not significantly improve this value, which remained at 0.730. The models with or without F/A ratio had similar calibration for major morbidity prediction, and the model inclusive of F/A ratio did not significantly change the risk classification of the patients. CONCLUSIONS: The F/A ratio alone has poor predictive properties for major morbidity, and there is no added value in including the F/A ratio into the existing risk models. In the setting of adult cardiac surgery with CPB, we did not confirm the usefulness of the F/A ratio described in other settings, such as cardiac surgery without CPB. This may be due to both the consumption and sequestration of these proteins during CPB.
D'Souza RS, Klasova J, Morsi M
… +17 more, Vincent A, Mohabbat AB, Whitfield S, Radlicz C, Sheen S, Wang D, Zhitnitsky M, Saini C, Al-Hindawi A, Lopez K, To J, Chitneni A, Graca M, Gill B, Her YF, Prokop LJ, Hussain N
Estimates of fibromyalgia prevalence vary widely worldwide due to differences in diagnostic criteria, study methodology, and population characteristics. Accurate estimates are essential to inform population-level surveil...Estimates of fibromyalgia prevalence vary widely worldwide due to differences in diagnostic criteria, study methodology, and population characteristics. Accurate estimates are essential to inform population-level surveillance, guide resource allocation, and highlight disparities in disease recognition and access to care. The objective of this systematic review and meta-analysis was to determine the global prevalence of fibromyalgia in the general population, and secondarily to identify factors moderating prevalence variation and to assess prevalence in defined at-risk subpopulations. Pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using the inverse variance heterogeneity model with Freeman-Tukey transformation. Subgroup analyses were performed by sex, diagnostic criteria, country, and other study characteristics, and meta-regression assessed moderators including publication year and Human Development Index (HDI). Of 21,645 records identified, 1,728 underwent full-text review and 882 studies were included in the final analysis. Across 38 countries and 30,070,032 individuals (188 studies), the pooled fibromyalgia prevalence in the general population was 1.40% (95% CI, 0.49-2.47), with substantial heterogeneity (I2 = 100%) and very low certainty of evidence. Among at-risk subpopulations (9,771,123 participants; 768 studies), prevalence was markedly higher in autoimmune and inflammatory conditions, such as chronic urticaria (37.1%), interstitial cystitis (30.8%), systemic sclerosis (20.6%), celiac disease (20.5%), and inflammatory bowel disease (19.9%), and elevated in chronic pain, rheumatologic, and post-infection cohorts. Meta-regression identified publication year (β = 0.008, P < .001) and HDI (β = 0.725, P = .002) as significant moderators of prevalence. In conclusion, fibromyalgia affects 1% to 2% of the global population, with substantially higher rates in at-risk subpopulations. Temporal and socioeconomic trends emphasize diagnostic inconsistency and global disparities in care.
BACKGROUND: Total hip arthroplasty (THA) is one of the most frequently performed surgeries worldwide. Approximately 1% to 10% of patients experience one or multiple dislocations of their THA, a painful condition requirin...BACKGROUND: Total hip arthroplasty (THA) is one of the most frequently performed surgeries worldwide. Approximately 1% to 10% of patients experience one or multiple dislocations of their THA, a painful condition requiring urgent treatment. In Denmark, the usual treatment is closed reduction, typically performed in the operating theater under general anesthesia. However, logistical and clinical challenges can delay treatment in an often frail, elderly population. This study investigated whether time to reduction and type of anesthetics were associated with post-reduction length of stay (LOS) and complications in patients with THA dislocation. We hypothesized that longer time to reduction would be associated with increased post-reduction LOS and complications. METHODS: This retrospective observational cohort study included adults (≥18 years) with a first-time THA dislocation who underwent closed reduction in the operating theater, from 1 January 2017 to 31 January 2025 in the Capital and Zealand Regions of Denmark. Data were extracted from the Electronic Health Record "Sundhedsplatformen." The primary outcome was post-reduction LOS, assessed using linear regression adjusted for predefined confounders. Secondary outcomes were 90-day all-cause mortality, delirium, readmission, intensive care unit admission, infections, acute kidney injury, and cardiovascular complications. RESULTS: A total of 3494 reductions were included; 86.7% were performed within 12 hours of admission. Increasing time to reduction was associated with longer post-reduction LOS. In the reference group (<3 hours), median post-reduction LOS was 15.4 hours (IQR 10.5-23.4). Compared with this group, post-reduction LOS increased by 50.6 hours for reductions at 12-18 hours (95% CI 30.4-71.5¸P < .001), 197 hours at 18-24 hours (95% CI 146-249; P < .001), and 137 hours beyond 24 hours (95% CI 119-154; P < .001). Post-reduction LOS beyond 24 hours was also statistically significantly associated with increased mortality, delirium, and infection. CONCLUSIONS: Most patients underwent closed reduction within 12 hours, without increased risk of complications. Reductions exceeding 12 hours of waiting time were associated with longer post-reduction LOS, even when adjusting for known confounders. Further delays were associated with increased odds of mortality, delirium, and infections. Whether these associations were driven by system delays or patient-related factors remains unclear.