Must Read Articles
Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial
Reference: Richards T et al. Lancet 2020; 396(10259): 1353-1361
Summary: Preoperative anaemia is common in surgical patients undergoing major abdominal surgery and is associated with worse patient outcomes. The UK’s National Institute for Health and Care Excellence (NICE) recommends that patients undergoing major surgeries be screened for anaemia and treated with iron therapy if indicated. However, the true effectiveness of iron therapy for preoperative anaemia remained uncertain. The PREVENTT trial included 487 elective abdominal surgical patients with anaemia who were randomly assigned to receive placebo or intravenous iron preoperatively, and showed no differences in outcomes between the two groups: death or blood transfusion (RR 1.03, 95% CI 0.78-1.37; p=0.84); transfusion rate (RR 0.98, 95% CI 0.68-1.43; p=0.93). These findings implied that preoperative iron therapy is not recommended in major elective abdominal surgery patients with anaemia.
Factors associated with surgical mortality and complications among patients with and without coronavirus disease 2019 (COVID-19) in Italy
Reference: Doglietto F et al. JAMA Surg. 2020; 155(8): 691-702
Summary: In this cohort study of 41 surgical patients with COVID-19 (either diagnosed before or within 1 week after surgery) and 82 matched control patients without COVID-19, who underwent mainly urgent surgery, the 30-day mortality was found to be significantly higher for those with COVID-19 compared with matched control patients without COVID-19 (OR 9.5; 95% CI, 1.77-96.53). Complications were also significantly higher (OR 4.98; 95% CI, 1.81-16.07), particularly for pulmonary complications (OR 35.62, 95% CI 9.34-205.55) and thrombotic complications (OR 13.2, 95% CI 1.48-∞). This study suggested that COVID-19 is an additional risk factor associated with very high perioperative complications and whenever possible, surgery should be postponed in patients with COVID-19.
The effect of advanced recovery room care on postoperative outcomes in moderate‐risk surgical patients: a multicentre feasibility study
Reference: Ludbrook G et al. Anaesthesia 2020; [Online ahead of print]
Summary: This study investigated the feasibility and impact on outcome of implementing advanced recovery room care (ARRC), in 166 moderate-risk patients (predicted postoperative 30-day mortality of 1-4%) undergoing non-cardiac surgery. Following baseline data collection, intervention by ARRC was implemented, after a 4-week training period using existing PACU, with extended period of patient care until morning of first postoperative day. Patient management was also based on defined assessment checklists and goals of care in the ARRC setting. The range of care available included continuous invasive cardiovascular monitoring and administration of vasopressors. The primary outcome measure – feasibility of recruitment and postoperative follow-up at 90 days, appeared to be adequate. Data collection for before and after implementation of ARRC was completed for 166 patients (target of recruitment was 120 patients), within 5-8 weeks period (varied by site) during each of the before and after stages. Follow-up rates at 90 days were 94%-100%, varied by study site. Exploratory in-hospital outcome measures were also assessed and may have been less common in the after-period, such as hospital readmission rate after discharge, MERT calls generated and re-operation rate. A definitive RCT of ARRC appears feasible and based on the hypothesis-generating exploratory outcomes, is likely warranted.
