R. Arthur Bouwman

Low cholesterol levels have been linked to severe illness, including sepsis. This study evaluated whether early postoperative cholesterol levels are associated with adverse outcomes in patients after elective Coronary Artery Bypass Grafting with extracorporeal circulation. This retrospective single-center study included 3280 adults who had at least one cholesterol measurement within the first five postoperative days. The lowest cholesterol value was analyzed with demographic, comorbidity, intraoperative, and laboratory variables to assess associations with 30-day mortality, cerebrovascular accident, renal replacement therapy, and respiratory dysfunction. ROC analysis with Youden’s Index identified an optimal cut-off, and logistic regression determined independent associations. A cholesterol cut-off of 2.46 mmol/L best stratified 30-day mortality (AUC 0.716; 95% CI 0.657–0.775), with patients below this threshold showing higher mortality (3.9% vs. 1.2%; p < 0.001). Cholesterol < 2.46 mmol/L was independently associated with 30-day mortality (OR 2.759 (1.675–4.544); p < 0.001), cerebrovascular accident (OR 3.661 (1.271–10.540); p = 0.016), renal replacement therapy (OR 4.785 (1.809–12.658); p = 0.002), and respiratory dysfunction (OR 3.039 (1.648–5.602); p < 0.001). Early postoperative hypocholesterolemia shows concurrent associations with adverse outcomes after CABG. Cholesterol levels < 2.46 mmol/L are concurrently associated with higher 30-day mortality.

This original work challenges the traditional view of the aorta as a passive conduit by investigating its vasoactive response to phenylephrine during cardiac surgery. Luminal area was measured by transesophageal echocardiography while simultaneously recording blood pressure. A mean pressure-independent increase in luminal area and stiffness was observed, suggesting a paradoxical vasodilative response. However, strong patient-to-patient variability in the response to phenylephrine highlights the need to measure effects patient specifically.

Early detection of clinical deterioration on surgical wards is vital to prevent adverse outcomes. Conventional ward monitoring using the Modified Early Warning Score (MEWS) relies on intermittent nurse-measured vital signs, but its role may change when continuous wearable monitoring is already available. This study evaluated the transition from mandatory to discretionary nurse-measured MEWS assessment in a continuously monitored surgical ward and compared the diagnostic performance of two wearable-derived Early Warning Scores (EWS) with conventional MEWS. In this single-center cohort study conducted between October 2024 and June 2025, postoperative patients were continuously monitored using a wearable sensor measuring heart rate, respiratory rate, and oxygen saturation. Continuous wearable monitoring was available throughout the entire study period. During Phase 1, nurse-measured MEWS assessments were mandatory according to local protocol. During Phase 2, nurse-measured MEWS assessments were performed at staff discretion. Two wearable-derived algorithms were evaluated: the Continuous Remote EWS (CREWS), based on a previously developed algorithm, and Remote 3 EWS (R3EWS), a modified version of the hospital’s standard MEWS using three parameters. The primary outcome was diagnostic accuracy for clinical deterioration, defined as postoperative complications graded Clavien–Dindo ≥ II. A total of 544 admissions (516 patients) were included, of which 98 admissions (18%) experienced clinical deterioration (comprising 154 clinical deterioration events). Following the transition from mandatory to discretionary nurse-measured MEWS assessment, intermittent nurse-measured vital signs were performed less frequently, while MEWS ≥ 3 occurred more often, resulting in higher MEWS sensitivity and lower specificity. In the separate diagnostic performance analysis, R3EWS showed slightly higher AUROC values (0.61) compared with MEWS (0.58) and CREWS (0.59), although differences were modest. Wearable-derived alarm frequency increased 6–8 h before clinical deterioration. In a surgical ward where continuous wearable monitoring was already available, transition from mandatory to discretionary nurse-measured MEWS assessment was associated with fewer intermittent observations, higher MEWS sensitivity, and lower specificity. Wearable-derived EWS algorithms showed comparable but modest discriminative performance relative to conventional MEWS. The increased number of alerts highlights the need for prospective validation and clear protocols for integrating continuous monitoring data into ward escalation workflows.

Background: The perioperative use of methadone is increasing because of its favorable effects on postoperative analgesia and opioid consumption. Methadone can cause QTc interval prolongation, increasing the risk of Torsades de Pointes. The effect of an intraoperative loading dose of methadone on intraoperative QTc interval prolongation is unknown. Methods: A retrospective observational cohort study of patients aged ≥18 years who underwent major non-cardiopulmonary surgery was conducted. Patients receiving an intraoperative loading dose of methadone were assigned to the methadone group; others formed the non-methadone group. Single-lead ECGs (II) were analyzed using a wavelet-based QTc interval algorithm to obtain 1- min average QTc interval values at baseline and intraoperatively. The outcome measure was the occurrence of any intraoperative 1- min averaged time windows that exceeded the predefined thresholds of 500 ms (primary), increase of ≥30 ms from baseline and increase of ≥60 ms from baseline (secondary). Propensity score matching was performed. Results: A total of 637 patients were included, and after propensity score matching (1:1 ratio), 244 patients were analyzed. A QTc interval >500 ms (23.8% vs 23.0%; p=0.88), an increase of ≥30 ms from baseline (67.8% vs 75.0%; p=0.22), and an increase of ≥60 ms from baseline (29.7% vs 22.4%; p=0.21) occurred equally in the non-methadone group compared with the methadone group. The percentage of intraoperative time spent above threshold was significantly higher in the non-methadone group for the>500 ms threshold (p=0.004). Conclusion: The implementation of methadone for perioperative pain management was not associated with an increased incidence of intraoperative QTc interval prolongation.

Background: Obesity and its accompanying complications have an influence on diurnal rhythm, potentially causing cardiometabolic disease. This study explores how weight loss due to bariatric surgery affects circadian rhythm disruptions measurable through wearable heart rate monitors. Methods: A single-center observational study was performed, in which patients who had undergone primary bariatric surgery 3 years ago with telemonitoring of vital parameters using a wireless accelerometer were eligible to participate. A Wilcoxon signed-rank test was conducted to evaluate the delta of, or amount of change in, circadian patterns between the baseline (before) and post-weight-loss peak, nadir, and peak–nadir heart rates. Results: In this cohort of 69 patients, 70% were female, with a median total weight loss of 31.4% towards a median BMI of 28.4 kg/m². Analysis revealed significant changes in peak–nadir excursions post-weight loss. Peak, nadir, and peak–nadir differences showed a significant reduction in values in the post-weight-loss group. No significant correlations between other clinical endpoints and change in peak–nadir excursion were found in the multivariable regression models. Conclusions: In conclusion, this study reveals significant changes in circadian heart rate patterns before and after weight loss due to metabolic surgery. The results could add to the health benefits of bariatric surgery, as it could lower the incidence of diseases associated with changes in diurnal rhythm due to obesity. However, a clear clinical explanation is lacking, as no correlation with total weight loss nor other variables was substantiated.

Objectives: An increasing number of older adults, including those with mild cognitive impairment, are undergoing cardiac surgery. Despite strong recommendations for preoperative cognitive screening and peri-operative monitoring, routine implementation faces challenges, such as limited time in busy outpatient clinics and lack of patient motivation. To address this issue, gamification and self-administration of cognitive screening using BAMCOG were explored in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: A multi-methods prospective repeated-measures within-subject cohort study was conducted between January 2021 and December 2022 to assess usability and concurrent validity. The initial part after game development focused on qualitatively examining the usability of BAMCOG in eight patients, using the System Usability Scale (SUS). The second part, with 40 patients, evaluated concurrent validity by comparing BAMCOG with the widely used Montreal Cognitive Assessment (MoCA). Results: The average SUS score was 79.7, indicating good usability. In the preoperative period, the correlation between BAMCOG and MoCA scores was r = 0.33 (p < 0.05), which increased to r = 0.59 (p < 0.001) on the first postoperative day. Conclusions: In conclusion, peri-operative self-monitoring of cognition around a TAVR procedure is feasible, but the concurrent validity of the BAMCOG and the MoCA scores is moderate to low. This warrants further research on gamified cognitive screeners to optimize their use in perioperative cognitive monitoring.

Background: Early Warning Scores (EWS) are widely implemented to identify clinical deterioration in hospitalized patients. However, their accuracy remains limited by intermittent vital sign measurements and high false-positive rates. Continuous monitoring with wearable sensors offers more timely detection, and integrating laboratory parameters may further enhance predictive precision. This study evaluated whether combining continuous vital sign monitoring with routine laboratory tests improves the prediction of postoperative complications compared with standard EWS approaches. Methods: All adult patients admitted in 2023 to the surgical oncology ward of Catharina Hospital Eindhoven who underwent monitoring with a wireless accelerometer patch were included. Continuous heart and respiratory rate data were combined with laboratory parameters, including C-reactive protein (CRP) and leukocyte count. Postoperative complications (Clavien–Dindo ≥ II) were identified by chart review. Logistic regression was used to identify significant predictors and to construct the CLUE model (Combining Labdata Upgrading Early warning scores). Model performance was compared with the Continuous Remote Early Warning Score (CREWS) using the area under the receiver operating characteristic curve (AUC). Results: The final dataset included 198 complete observations from 155 patients. Heart rate, CRP, and leukocyte count were independently associated with postoperative complications. The CLUE model achieved an AUC of 0.71 (0.60-0.80) outperforming the CREWS model (AUC 0.57 (0.50-0.63)). Conclusion: Integrating laboratory data with continuous vital sign monitoring improved the discrimination of postoperative complications compared with vital sign based EWS alone. The CLUE model represents a clinically interpretable step toward more precise, multimodal early warning systems.