Realising the full potential of anaesthesiology to promote enhanced recovery after surgery programmes in China

Chen, Chaojin; Li, Xiaoyue; Luo, Gangjian; Zhou, Shaoli; Hei, Ziqing

doi:10.1016/j.bja.2021.01.016

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…The results might be important derivatives and supplements to the current perioperative prevention and management programs, which enable the surgeons and anesthesiologists to identify the elderly patients who are suspected to postoperative SIRS. In addition to screening high-risk groups, this model can also help prevent and treat postoperative SIRS in elderly patients more accurately and timely by using various of drug or non-drug means under the guideline of enhanced recovery after surgery (ERAS), so as to promote the short-term and long-term prognosis of patients [32].…”

Section: Principal Resultsmentioning

confidence: 99%

Identification of Susceptible and High-Risk Population for Postoperative Systemic Inflammatory Response Syndrome in Elderly Patients: A Machine Learning-Based Approach (Preprint)

Mai,

Lu,

et al. 2024

Preprint

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BACKGROUND Systemic inflammatory response syndrome (SIRS) is a serious postoperative complication among geriatric surgical patients which frequently develops into sepsis or even death. Notably, the incidence of SIRS and sepsis steadily increased with age. OBJECTIVE We aimed to develop and validate an individualized predictive model to identify susceptible and high-risk population of SIRS in elderly patients. METHODS Data of surgical patients aged ≥ 65years from September 2015 to September 2020 in three independent medical centers were retrieved and analyzed. The eligible patient cohort in the Third Affiliated Hospital of Sun Yat-sen University was separated into an 80% training set and a 20% internal validation set randomly. Four machine learning (ML) models were developed to predict postoperative SIRS. Area under receiver-operating curve (AUC), F1 score, Brier score, and calibration curve were used to evaluate the model performance. Model with the best performance was further validated in the other two independent datasets involving 844 and 307 cases respectively. RESULTS The incidence of SIRS in the three medical centers was 24.3%, 29.6% and 6.5%, respectively. 15 predictors were selected and applied in four ML models to predict postoperative SIRS. The Random Forest Classifier (RF) model showed the best overall performance to predict postoperative SIRS, with an AUC of 0.751, sensitivity of 0.682, specificity of 0.681 as well as F1 score of 0.508 in the internal validation set, and higher AUCs in external validation-1 set (0.759) and external validation-2 set (0.804). CONCLUSIONS We developed and validated a generalizable RF model for prediction of postoperative SIRS in elderly patients, that enables clinicians to screen susceptible and high-risk patients and implement early individualized intervention.

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Section: Principal Resultsmentioning

confidence: 99%

Identification of Susceptible and High-Risk Population for Postoperative Systemic Inflammatory Response Syndrome in Elderly Patients: A Machine Learning-Based Approach (Preprint)

Mai,

Lu,

et al. 2024

Preprint

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“…Stress-related immunity suppression, the trauma-related release of growth factors to facilitate tumor cell proliferation, attenuated inhibition of angiogenesis after primary tumor removal, and the complex effect of anesthetics have also been reported to be involved ( 2 , 21 – 24 ). The introduction of Enhanced Recovery After Surgery (ERAS) has prompted an increased focus among anesthesiologists on the impact of perioperative interventions on the long-term prognosis of cancer patients ( 25 ). There is growing evidence suggesting that perioperative care and different anesthetics can influence long-term oncological outcomes ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Association between intraoperative dexmedetomidine and all-cause mortality and recurrence after laparoscopic resection of colorectal cancer: Follow-up analysis of a previous randomized controlled trial

Gong

Xue

et al. 2023

Front. Oncol.

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BackgroundDexmedetomidine (DEX) has been widely applied in the anesthesia and sedation of patients with oncological diseases. However, the potential effect of DEX on tumor metastasis remains contradictory. This study follows up on patients who received intraoperative DEX during laparoscopic resection of colorectal cancer as part of a previous clinical trial, examining their outcomes 5 years later.MethodsBetween June 2015 and December 2015, 60 patients undergoing laparoscopic colorectal resection were randomly assigned to the DEX and control groups. The DEX group received an initial loading dose of 1μ/kg before surgery, followed by a continuous infusion of 0.3μg/kg/h during the operation and the Control group received an equivalent volume of saline. A 5-year follow-up analysis was conducted to evaluate the overall survival, disease-free survival, and tumor recurrence.ResultsThe follow-up analysis included 55 of the 60 patients. The DEX group included 28 patients, while the control group included 27 patients. Baseline characteristics were comparable between the two groups, except for vascular and/or neural invasion of the tumor in the DEX group (9/28 vs. 0/27, p = 0.002). We did not observe a statistically significant benefit but rather a trend toward an increase in overall survival and disease-free survival in the DEX group, 1-year overall survival (96.4% vs. 88.9%, p = 0.282), 2-year overall survival (89.3% vs. 74.1%, p = 0.144), 3-year overall survival (89.3% vs. 70.4%, p = 0.08), and 5-year overall survival (78.6% vs. 59.3%, p = 0.121). The total rates of mortality and recurrence between the two groups were comparable (8/28 vs. 11/27, p = 0.343).ConclusionAdministration of DEX during laparoscopic resection of colorectal cancer had a nonsignificant trend toward improved overall survival and disease-free survival.Clinical Trial Registrationhttp://www.chictr.org.cn/, identifier ChiCTRIOR-15006518.

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“…The PASS rate after preoperative education was lower in Control group, suggesting that face-to-face oral education was not always effective in communicating the medical information and the music video effectively helped to solve the patients' most worried anesthesia concerns in China. Actually, the educational video has been widely applied in several surgical centers in China to introduce anesthesia details and principle of ERAS to increase acceptance and execution by patients and their families [ 22 ]. Our results indicate that more attention should be paid to different patients’ most worried anesthesia concerns before surgery, which can finally help attenuating preoperative anxiety.…”

Section: Discussionmentioning

confidence: 99%

“…It was shown that the most significant concerns about anesthesia in surgical patients included anesthesia safety (49.5%), postoperative pain (42.6%) and anesthesia costs (42.6%). Based on the results we transformed the anesthesia precautions and ERAS principles into an educational song and made a vivid cartoon video (Video A1) [ 22 ]. In the study, we aimed to conduct a randomized controlled trial to explore whether the application of our educational video about anesthesia and ERAS could help to improve the quality of preoperative visit, reduce preoperative anxiety and enhance the patients’ recovery after surgery in China.…”

Section: Introductionmentioning

confidence: 99%

Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery

Xing,

Gong,

et al. 2023

Heliyon

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Realising the full potential of anaesthesiology to promote enhanced recovery after surgery programmes in China

Cited by 4 publications

References 9 publications

Identification of Susceptible and High-Risk Population for Postoperative Systemic Inflammatory Response Syndrome in Elderly Patients: A Machine Learning-Based Approach (Preprint)

Identification of Susceptible and High-Risk Population for Postoperative Systemic Inflammatory Response Syndrome in Elderly Patients: A Machine Learning-Based Approach (Preprint)

Association between intraoperative dexmedetomidine and all-cause mortality and recurrence after laparoscopic resection of colorectal cancer: Follow-up analysis of a previous randomized controlled trial

Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery

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