Jan M. Dieleman

Electronic medical records (eMRs) could support perioperative outcomes registries, but the completeness of routinely collected data remains uncertain. This study evaluated the availability of perioperative data within a large Australian hospital eMR against the Perioperative Clinical Outcomes Registry Extended (PCOREx) dataset. A retrospective audit of all elective inpatient procedures involving anaesthetists at Westmead Hospital (Sydney, New South Wales) in June 2022 was performed. Records were reviewed in Cerner ^® PowerChart (Cerner Corporation, Kansas City, MO, USA) and completeness was defined as the presence of PCOREx variables across Baseline Risk, Intraoperative Risk, Process of Care, In-Hospital Outcomes and Post-Discharge Outcomes. A total of 405 patients met inclusion criteria. Overall completeness was 63%; excluding post-discharge variables, inpatient completeness was 77.5%. Demographic, procedural and intraoperative physiological data—mostly structured or automatically captured—were consistently recorded (>90%). Comorbidities, frailty indices, intraoperative temperature, and fluid balance were less complete (<50%). Post-discharge outcomes were recorded in only 7.9% of patients, limited to those who re-presented to hospital. Missingness reflected both structural gaps (absence of fields, siloed intensive care unit systems) and clinical behaviour (selective documentation, variable pathology ordering). While routine eMR data capture many perioperative variables, significant gaps remain, particularly for post-discharge outcomes and selectively documented fields. Mapping completeness within the Clinical Adoption Meta Model framework highlights barriers at system and clinical levels. Standardised data capture, linkage with external databases, and improved interoperability are needed to realise the potential of eMRs for perioperative outcomes registries.

Summary: In some patients, the inflammatory‐immune response to surgical injury progresses to a harmful, dysregulated state. We posit that postoperative systemic inflammatory dysregulation forms part of a pathophysiological response to surgical injury that places patients at increased risk of complications and subsequently prolongs hospital stay. In this narrative review, we have outlined the evolution, measurement and prediction of postoperative systemic inflammatory dysregulation, distinguishing it from a healthy and self‐limiting host response. We reviewed the actions of glucocorticoids and the potential for heterogeneous responses to peri‐operative corticosteroid supplementation. We have then appraised the evidence highlighting the safety of corticosteroid supplementation, and the potential benefits of high/repeated doses to reduce the risks of major complications and death. Finally, we addressed how clinical trials in the future should target patients at higher risk of peri‐operative inflammatory complications, whereby corticosteroid regimes should be tailored to modify not only the a priori risk, but also further adjusted in response to markers of an evolving pathophysiological response.

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The inflammatory response to surgery varies considerably between individual patients. Age might be a substantial factor in this variability. Our objective was to examine the association of patient age and other potential risk factors with the occurrence of a postoperative systemic inflammatory response syndrome, during the first 24 h after cardiac surgery. This was a retrospective cohort study, using linked data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) Database and the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database. Data from patients who underwent coronary artery bypass grafting and/or valve surgery were used. The association between age and postoperative SIRS was analysed using Poisson regression, and corrected for other risk factors. Restricted cubic splines were used to determine relevant age categories. Results are expressed as risk ratios (RR) with 95% confidence intervals (CI). Data from 28 513 patients were used. In both univariable and multivariable models, increased patient age was strongly associated with reduced postoperative SIRS prevalence. Using 73–83 yr as the reference category, the RRs (95% CI) for the age categories were 1.38 (1.28–1.49) for ≤43 yr, 1.15 (1.09–1.20) for 44–63 yr, 1.05 (1.00–1.09) for 64–72 yr, and 1.03 (0.94–1.12) for >83 yr, respectively. The predictive value for postoperative SIRS of the final model, however, was moderate (c-statistic: 0.61). We have demonstrated that advanced patient age is associated with a decreased risk of postoperative SIRS among cardiac surgery patients, where patients aged over 72 yr had the lowest risk.

Background: Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery; however, the exact pathogenesis remains uncertain. Identifying risk factors of PPS might help to better understand the syndrome. The aim of this study was to provide an overview of existing literature around determinants of PPS in adult cardiac surgery patients.Material and methods: Two independent investigators performed a systematic search in MEDLINE, EMBASE and the Cochrane Central Register. The search aimed to identify studies published between January 1950 and December 2015, in which determinants of PPS were reported.Results: A total of 19 studies met the selection criteria. In these studies, 14 different definitions of PPS were used. The median incidence of PPS was 16%. After quality assessment, seven studies were considered eligible for this review. Lower preoperative interleukin‐8 levels and higher postoperative complement conversion products were associated with a higher risk of PPS. Among other clinical factors, a lower age, transfusion of red blood cells and lower preoperative platelet and haemoglobin levels were associated with a higher risk of PPS. Colchicine use decreased the risk of PPS.Conclusion: We found that both the inflammatory response and perioperative bleeding and coagulation may play a role in the development of PPS, suggesting a multifactorial aetiology of the syndrome. Due to a lack of a uniform definition of PPS in the past, study comparability was poor across the studies.