Ayça Sultan Şahin

Background: Postoperative pain assessment relies primarily on numeric self-report tools, such as the numerical rating scale (NRS); these tools require abstract numerical cognition and may be challenging for some patients in the immediate postoperative period. Thus, in this prospective observational study, we aimed to evaluate a novel video-based pain-expression method in postoperative adults, with the primary objective of assessing patient preference for the video-based pain-expression method compared with that for the NRS.Methods: This prospective single-center observational study was conducted in a post-anesthesia care unit. Adult patients reporting postoperative pain (NRS ≥ 1) were shown five standardized artificial intelligence-generated video scenarios representing increasing pain ranges and asked to select the video best reflecting their pain. Patients also reported their NRS scores. The primary outcome was method preference. Secondary outcomes included exact and ± 1-category agreement, Spearman correlation, and decision-making time.Results: Of 240 enrolled patients, 239 were included in the final analysis. Overall, 133 patients (55.6%; 95% confidence interval [CI] 49.3–61.8) preferred the NRS, whereas 106 patients (44.4%; 95% CI 38.2–50.7) preferred the video-based method. Exact agreement between the video category and NRS was 40.6%, while ± 1-category agreement reached 80.8%. Quadratic weighted kappa demonstrated substantial agreement between the two methods (κ = 0.65). Mean decision time was longer for the video-based method than for NRS (32.87 ± 15.83 vs. 21.04 ± 8.21 s; mean difference 11.83 s, 95% CI 9.92–13.74).Conclusions: Agreement between the NRS and video-based method was strongest at pain extremes. Although NRS is more time-efficient, video-based assessment appears to be a feasible complementary tool that may enhance patient-centered postoperative pain communication.

Background: This study aims to investigate whether moderate sedation (MOAA/S 3-4) affects procedural efficiency, radiation exposure, patient–physician satisfaction, and clinical outcomes during lumbar transforaminal epidural steroid injections (L-TFESI). Patients and Methods: Between January 2021 and January 2024, a total of 201 patients with unilateral, single-root compression who underwent L-TFESI either with (Group S, n = 99) or without sedation (Group NS, n = 102) were retrospectively analyzed. In the sedation group, midazolam and fentanyl were titrated to a target Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 3-4. The primary outcomes were cumulative radiation dose (mGy), fluoroscopy time, and procedural complications. Additional outcomes included Numeric Rating Scale-11 (NRS-11) scores (baseline, Day 4, Week 4) and Likert satisfaction scales. Results: Of a total of 201 patients, 143 were male and 58 were female with a mean age of 47.22 ± 10.03 (range, 22 to 65) years. Both groups were comparable in terms of baseline demographics and pain scores. The sedation group had significantly lower cumulative radiation exposure (3.92 ± 0.30 mGy vs. 4.31 ± 0.40 mGy) and shorter fluoroscopy times (28.13 ± 2.79 sec vs. 33.13 ± 3.95 sec). Minor procedural complications (commonly vasovagal reactions and hypertension) were more frequent in the non-sedated group (21.6% vs. 2.0%). Group S reported lower pain scores on Day 4 (1.11 ± 1.29 vs. 1.88 ± 1.25), although outcomes were similar at Week 4. Patient and physician satisfaction were higher in the sedation group. Conclusion: Moderate sedation (MOAA/S 3-4) during L-TFESI is associated with lower radiation exposure, shorter procedure times and fewer minor complications, while improving both patient satisfaction and procedural conditions. These findings suggest that sedation is a potentially useful adjunct in selected patients that may contribute to improved procedural quality in interventional pain management.

Aim: Traumatic brain injury (TBI) is a vital disease entity associated with high mortality and neurological sequelae. This study seeks to evaluate the prognostic role of the Glasgow Coma Scale–Pupil score (GCS-P) and the C-reactive protein-to-albumin ratio (CAR) on mortality in patients with moderate and severe TBI.Methods: In this retrospective observational study, patients with moderate to severe TBI who were admitted to and managed in the intensive care unit (ICU) between January 2021 and June 2023 were included. The patients were classified into survivors and non-survivors. Demographic and clinical characteristics, Glasgow Coma Scale (GCS), GCS-P, and CAR were recorded. CAR was calculated by dividing the C-reactive protein (CRP) level by the albumin level obtained from routine blood tests at admission.Results: The study cohort consisted of 177 patients, with an in-hospital mortality rate of 22%. In the non-survivors, GCS and GCS-P scores were significantly lower, whereas CAR was significantly higher (all p < 0.001). In the multivariable analysis, GCS-P (odds ratio=0.425, p=0.028) and CAR (odds ratio=1.275, p=0.022) were identified as independent predictors of mortality. For the prediction of mortality, the cut-off value for GCS-P was 4.5 with an area under the curve (AUC) of 0.863, while the cut-off value for CAR was 0.07 with an AUC of 0.721.Conclusion: In patients with moderate to severe TBI admitted to the ICU, the GCS-P score and CAR are independent predictors of in-hospital mortality. The combined use of GCS-P, reflecting neurological status, and CAR, reflecting systemic inflammation and nutritional status, may provide additional prognostic value.

Acute ischemic stroke (AIS) is a major cause of functional disability and mortality in the geriatric population. This study aimed to evaluate the predictive performance of the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and the controlling nutritional status (CONUT) score for in-hospital mortality among critically ill geriatric patients. Critically ill AIS patients admitted to a tertiary hospital intensive care unit from January 2021 to January 2023 were retrospectively analyzed. Patients were classified into survivor and mortality groups. Nutritional scores were calculated: PNI = (10 × serum albumin [g/dL]) + (0.005 × total lymphocyte count); GNRI = (1.489 × albumin [g/dL]) + (41.7 × [body weight/ideal body weight]); CONUT (scored 0–12 based on serum lymphocyte count, cholesterol, and albumin). The predictive performances of the scores for in-hospital mortality were compared. A total of 142 patients were included, with 25 in the mortality group and 117 in the survivor group. The median age was 77 (range: 68–84) years, and 55.6% (n = 79) were female. Demographic characteristics (age, sex, body mass index) were similar between groups. Median PNI (36.3 vs 39.5, P = .017), GNRI (53.4 vs 56.6, P = .007), and CONUT (2 vs 2, P = .012) scores were significantly lower in the mortality group. Multivariate regression analysis showed that GNRI was an independent predictor of mortality (odds ratio = 0.935, 95% confidence interval = 0.877–0.998, P = .042). Receiver operating characteristic analyses showed a PNI cutoff value of ≤34.2 (area under curve [AUC] 0.653, 0.535–0.770), GNRI ≤56.2 (AUC 0.672, 0.577–0.767), and CONUT ≥1.5 (AUC 0.659, 0.545–0.773). Nutritional scores such as PNI, GNRI, and CONUT can predict mortality in critically ill geriatric AIS patients in the intensive care unit. Their prognostic performances were found to be similar.

Objective: Optic nerve sheath diameter (ONSD) has been increasingly recognized as a non-invasive surrogate marker for intracranial pressure (ICP) in critically ill patients. The Glasgow Coma Scale (GCS) is a widely used tool for assessing neurological status. However, the relationship between GCS and ONSD in intensive care unit (ICU) patients remains underexplored. This study aimed to investigate the association between ONSD and GCS scores in ICU patients, while also evaluating the impact of positive end-expiratory pressure (PEEP) on ONSD measurements. Methods: This prospective observational study included 66 ICU patients. ONSD measurements were obtained using ultrasonography at 24 and 48–72 hours after ICU admission. Patients were categorized into three groups based on GCS scores (3–7, 8–11, 12–15). The effect of PEEP and other clinical parameters on ONSD was analyzed using linear mixed models, with a significance level of p < 0.05. Results: ONSD was significantly higher in patients with lower GCS scores (p < 0.001). Additionally, PEEP application was strongly associated with increased ONSD (p < 0.001), whereas other factors such as mean arterial pressure, heart rate, and sepsis status did not show significant effects. Conclusion: ONSD is significantly associated with GCS scores, supporting its role as a non-invasive marker of neurological deterioration. The influence of PEEP on ONSD suggests a potential impact of mechanical ventilation on ICP dynamics, warranting further investigation.

We aimed to build a fuzzy logic preanaesthetic risk score tailored to cataract surgery. By fusing systemic comorbidities with key patient attributes in an adaptive rule base, our goal was to generate patient-specific risk estimates that move beyond the coarse granularity of traditional categorical tools. A prospective observational cohort study was conducted at Kanuni Sultan Suleyman Hospital, University of Health Sciences, Istanbul, Turkey. Two hundred fifty-one adults who were scheduled for cataract surgery under either local or general anesthesia were included in the study. Demographic information and comorbidities were gathered prior to surgery. A fuzzy inference system incorporating 5 major (pulmonary, cardiac, renal, liver disease, and diabetes) and 3 minor (age, BMI, and smoking) criteria was developed. Risk levels were generated using 270 expert-defined fuzzy rules. Postoperative transient intraocular pressure (IOP) elevations and other complications were monitored. Among the 251 patients, 70 (27.9%) developed postoperative transient IOP elevations. Fuzzy risk scores correlated strongly with the number of major comorbidities ( r = 0.954), confirming internal consistency. However, the model did not significantly differentiate between patients with and without postoperative transient intraocular pressure (IOP) elevations (AUC = 0.439; P > .05). There were no other complications found, but transient IOP elevations was significantly linked to advanced age and long-term smoking. The fuzzy logic model reliably quantified systemic risk burden but lacked predictive power for ophthalmic-specific outcomes driven by ocular factors such as transient IOP elevations. Incorporating domain-specific variables like intraocular pressure and detailed ophthalmologic assessments may improve future performance. The model remains valuable for general preanesthetic risk stratification in surgical populations.

Introduction: Pain control after proximal femoral nail surgery remains difficult, especially in older adults. The pericapsular nerve group block provides anterior hip analgesia, whereas the quadroiliac plane block may offer broader coverage. This study compared their postoperative analgesic efficacy in patients undergoing proximal femoral nail surgery under spinal anesthesia. Materials and Method: In this prospective, randomized, multicenter, non-inferiority trial, 52 patients were included. At the end of surgery, patients received either quadroiliac plane block or pericapsular nerve group block. All patients received standardized spinal anesthesia and multimodal postoperative analgesia, including intravenous patient-controlled tramadol. The primary outcome was cumulative tramadol consumption at 24 postoperative hours. Secondary outcomes were pain intensity, quality of recovery, postoperative nausea and vomiting, rescue analgesic requirement, and adverse events. Non-inferiority was assessed using the mean between-group difference in 24- hour tramadol consumption with bias-corrected and accelerated 95 percent confidence intervals. Results: Mean tramadol consumption at 24 hours was 67.7 milligrams in the quadroiliac plane block group and 81.5 milligrams in the pericapsular nerve group block group. The mean difference was minus 13.8 milligrams. Because the upper bound of the confidence interval did not exceed the prespecified non-inferiority margin of 32 milligrams, quadroiliac plane block was considered non-inferior. Overall, pain and quality of recovery were similar between groups. Postoperative nausea and vomiting occurred less frequently in the quadroiliac plane block group. No adverse events or motor weakness were observed. Conclusions: Quadroiliac plane block provided non-inferior postoperative analgesia compared with pericapsular nerve group block after proximal femoral nail surgery under spinal anesthesia. Keywords: Hip Fractures; Nerve Block; Postoperative Pain; Anesthesia, Spinal.

Objective: This study aimed to investigate the prognostic value of the Charlson comorbidity index (CCI), American Society of Anesthesiologists (ASA) status, and Acute Physiology and Chronic Disease Evaluation II (APACHE-II) score in critically ill geriatric hip fracture patients followed in the surgical intensive care unit (SICU). Materials and Methods: Critical geriatric hip fracture patients who underwent surgery and were followed in the SICU between January 2022 and December 2023 were evaluated retrospectively. The performance of CCI, ASA status, and APACHE-II scores in predicting in-hospital mortality was investigated. Results: The study included 137 patients, and 66.4% (n=91) were female. ASA IV status, APACHE-II, CCI score, and the number of patients with coronary vascular disease/heart failure were significantly higher in the mortality group (p=0.003, p<0.001, p<0.001, and 0.010, respectively). Mean Glasgow Coma Scale and serum albumin levels at SICU admission were significantly lower in the mortality group (p=0.008 and p=0.006, respectively). ASA status, APACHE-II, and CCI scores were independent predictors of mortality (p=0.002, p=0.022, and p=0.034, respectively). In ROC curve analysis, the area under the curve (AUC) for APACHE-II was 0.803 (95% CI, 0.697-0.908), AUC for CCI was 0.742 (95% CI, 0.598-0.886), and AUC for ASA status was 0.614 (0.458-0.769). Conclusions: CCI, ASA status, and APACHE-II scores independently predict in-hospital mortality in patients with critical hip fractures. It has prognostic value in predicting mortality and is listed from highest to lowest as APACHE-II, CCI, and ASA status.

Introduction Early and balanced replacement of blood products appears to be the key factor in improving outcomes of major bleeding patients including acute trauma, cardiac, obstetric and transplant surgery patients. Definitive clinical guidance regarding the optimal ratio of blood products, including those containing fibrinogen, is still lacking. Therefore, we tested the hypothesis that increasing the fibrinogen content to erythrocyte suspension ratio improves the mortality and functional outcomes of patients undergoing surgeries with expected major bleeding. Methods and analysis The Approximate Dose-Equivalent of Fibrinogen-to-Erythrocyte Suspension (ADEFES) ratio is a multicentre, prospective, observational, cohort study of patients undergoing major surgical procedures with expected major perioperative bleeding (ie, requiring packed red blood cells (PRBC)>4U/24 hours). For 5U of cryoprecipitate and 1.5 U of fresh frozen plasma (FFP), the approximate dose-equivalent for fibrinogen is considered as 1 gram of fibrinogen. Association of the ADEFES ratio at 24 hours will be assessed on the primary objective, which will consist of the composite of 30-day all-cause mortality, 30-day bleeding-specific mortality and the ‘highly-dependent scores’ of Katz index of independence in activities of daily living. Ethics and dissemination The study protocol was approved by the Ethics Committee of Ankara Bilkent City Hospital (approval no. E2-23-4265, dated 07 June 2023; Chair: Prof. Dr. F.E. Canpolat) and by the institutional review boards of all participating centres. The study will be conducted in accordance with the principles of the Declaration of Helsinki and the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, as well as in compliance with national regulations on data protection and Good Clinical Practice standards. Written informed consent will be obtained from all participants prior to inclusion in the study. The results of this study will be disseminated through peer-reviewed scientific journals, presentations at national and international conferences, and communication with relevant stakeholders including clinical practitioners and healthcare institutions. If applicable, study outcomes will also be shared via institutional newsletters and digital platforms to reach a broader audience in the medical community. Trial registration number NCT06021184.