Mitsuru Ida

This study aimed to evaluate the association between antepartum hemoglobin concentration and postpartum recovery among women receiving obstetric anesthesia care. We included pregnant women aged ≥ 18 years who underwent cesarean delivery (CD) or vaginal delivery (VD) with epidural analgesia (EA). The primary outcome was the Obstetric Quality of Recovery (ObsQoR)-11 score. Associations between antepartum hemoglobin concentration and ObsQoR-11 scores were evaluated using multivariable regression analyses in the overall cohort and separately in women undergoing CD and those undergoing VD with EA. Because no validated cutoff value exists for the ObsQoR-11 score, exploratory analyses were performed to examine the association between antepartum hemoglobin concentration and poor recovery, defined as an ObsQoR-11 score one standard deviation below the mean. Among the 466 women included in the final analysis, the mean (standard deviation) ObsQoR-11 score on postpartum day 1 was 67.4 (20.8). After adjustment, antepartum hemoglobin concentration was associated with a higher ObsQoR-11 score (regression coefficient, 1.9; 95% confidence interval [CI] 0.27-3.54) and lower odds of poor recovery (odds ratio [OR], 0.74; 95% CI 0.57-0.96). These associations were observed among women undergoing CD (regression coefficient, 2.0; 95% CI 0.03-4.04; OR, 0.72; 95% CI 0.55-0.95) but not clearly demonstrated among women undergoing VD with EA (regression coefficient, 1.7; 95% CI - 1.2-4.7; OR, 0.96; 95% CI 0.41-2.25). Higher antepartum hemoglobin concentrations were associated with higher ObsQoR-11 scores and better early postpartum recovery, mainly after CD; the association was not clearly demonstrated after VD with EA.

Background: Perioperative sleep may affect surgical outcomes; however, the effects of prehabilitation on objective perioperative sleep indices remain unclear. In this randomized clinical trial, we evaluated whether a prehabilitation program could improve objective sleep indices and patient-reported outcomes in patients undergoing lung resection. Materials and methods: Patients scheduled for elective lung resection were randomized to prehabilitation or standard care. The intervention consisted of a 2-week home-based program, including exercise training, nutritional support, and relaxation strategies. Sleep parameters were assessed using actigraphy, with the primary endpoint defined as sleep efficiency on the night before surgery. The main secondary outcomes were other actigraphy-derived sleep indices, postoperative quality of recovery assessed using the Quality of Recovery-15 (QoR-15), postoperative morbidity evaluated using the Comprehensive Complication Index (CCI), and functional status at 3 months assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Results: Of 187 screened patients, 62 were randomized to prehabilitation ( n = 31) or standard care ( n = 31). After excluding dropouts, 29 patients in the intervention group and 30 in the control group were included in the analysis. Among the 59 participants (mean age: 70 years), 55% were female. Objective sleep parameters, including sleep efficiency, did not differ significantly between groups. The prehabilitation group had higher QoR-15 scores [adjusted mean difference: 12.2; 95% confidence interval (CI) 0.4–24.0] and a lower CCI (adjusted mean difference: −4.6; 95% CI: −9.2 to −0.03). WHODAS 2.0 scores did not significantly differ between groups (adjusted mean difference: 2.1; 95% CI: −4.4 to 8.8). Conclusion: A 2-week home-based trimodal prehabilitation program did not improve objective sleep indices in patients undergoing lung resection. However, the intervention was associated with improved postoperative recovery and a lower overall morbidity burden.

Labor analgesia is recommended for pain relief during childbirth. In settings with limited medical resources, elective induction with epidural analgesia is often adopted; however, this may increase healthcare costs and prolong hospitalization. The impact of different approaches to labor analgesia on delivery-related charges, epidural-to-delivery interval, and hospitalization remains unclear. This retrospective study evaluated 252 full-term pregnant women who received epidural labor analgesia at a Japanese university hospital. Parturients were categorized into elective induction (EI) and on-demand (OD) groups. Inverse probability of treatment weighting with stabilized inverse propensity scores was applied to minimize bias. After adjusting for patient data, the mean ratios of the outcomes of interest for EI and OD were estimated using a generalized estimating equation. The primary outcome was delivery-related charges, while secondary outcomes included epidural-to-delivery interval and length of hospital stay. Among eligible parturient, 62.3% (157/252) underwent EI, while 37.7% (95/252) received OD. After weighting, the mean delivery-related charges, epidural-to-delivery interval, and length of hospital stay were 621,380 yen, 37.0 h, and 7.5 days in the EI group, compared with 594,408 yen, 14.6 h, and 6.5 days in the OD group, respectively. The mean ratios (95% confidence interval) for delivery-related charges, epidural-to-delivery interval, and length of hospital stay were 1.04 (0.98, 1.10), 2.52 (1.90, 3.20), and 1.15 (1.08, 1.22), respectively. Elective induction with epidural labor analgesia was associated with longer labor duration and hospital stay, while no statistically significant difference in delivery-related charges was observed compared with the on-demand approach.

Background: Oral frailty is defined as age‐related oral function decline; however, its effect on surgical patients remains unclear. Objective: This study aimed to evaluate the effect of oral frailty index‐8 (OFI‐8) on postoperative complications. Methods: This retrospective study included patients aged ≥ 65 years who underwent elective total knee arthroplasty, total hip arthroplasty, or spinal surgery under general anaesthesia. Oral frailty was assessed using the OFI‐8, with a total score ranging from 0 to 11, and patients with an OFI‐8 score ≥ 4 were categorised as positive for oral frailty. The co‐primary outcomes were the incidence of postoperative complications, defined as Clavien–Dindo classification (CDC) grade ≥ II complications, and the Comprehensive Complication Index (CCI) score. The association between a positive result for oral frailty and co‐primary outcomes was evaluated using multiple logistic or multiple regression analyses adjusted for clinically relevant factors. Results: Of the 608 patients included in the final analysis, 314 (51.6%) had OFI‐8 scores ≥ 4. The overall incidence of complications with CDC grade ≥ II was 15%, with a mean CCI score of 15.6. After adjustment, an OFI‐8 score of ≥ 4 was associated with an increased risk of CDC grade ≥ II complications (odds ratio, 1.65; 95% confidence interval, 1.19–2.42, p = 0.01) and an increased CCI (regression coefficients, 1.7; 95% confidence interval, 0.22–3.2, p = 0.02). Conclusion: The study findings suggest that an OFI‐8 score of ≥ 4 is associated with the incidence and severity of postoperative complications.

Purpose The primary objective of this study was to estimate the prevalence of sleep quality among patients hospitalized for cesarean delivery, with a secondary objective of assessing the impact of sleep quality on postpartum outcomes. Methods This prospective observational study included patients aged ≥18 years scheduled for elective cesarean delivery under spinal anesthesia admitted a day before delivery. The incidence of poor sleep quality (Richards–Campbell Sleep Questionnaire score <50) was estimated. Mean differences in obstetric quality-of-recovery-11 (ObsQoR-11) scores on postpartum days 1, 3, and 5 and the Edinburgh Postnatal Depression Scale (EPDS) score at 1 month after childbirth between those with and without poor sleep quality were evaluated using effect sizes. Multiple linear regression adjusted for relevant factors, including the Pittsburgh Sleep Quality Index, was used to evaluate the impact of poor sleep quality on the ObsQoR-11 score on only postpartum day 1. Results Of 93 included patients, 48.3% (38.4–58.4%) met the criteria for poor sleep quality. The effect sizes for poor preoperative sleep quality and the ObsQoR-11 and EPDS scores ranged from 0.28 to 0.55. Multiple regression analyses revealed an association of preoperative poor sleep quality with the ObsQor-11 score on postoperative day 1 [Adjusted beta (95% confidence interval): − 18.8 [(− 36.5, − 1.2)]. Conclusion The prevalence of preoperative poor sleep quality in hospitalized pregnant women scheduled for elective cesarean delivery was 48%, which was significantly associated with quality of recovery on postpartum day 5 and EPDS scores at 1 month post-childbirth.