David A. Scott

Summary: Introduction: Single‐injection and continuous brachial plexus block techniques are used widely for postoperative analgesia in patients undergoing shoulder surgery. Although patient‐reported outcomes are described in individual studies, their effects have not been synthesised comprehensively using a patient‐centred framework. We sought to compare the effects of single‐injection vs. continuous brachial plexus block techniques on patient‐reported outcomes in adult patients following elective shoulder surgery. Methods: Databases were searched from inception to October 2025 and randomised controlled trials reporting patient‐reported outcomes were included. Co‐primary outcomes were postoperative patient‐reported pain intensity at rest and during movement at 12 h, 24 h and 48 h post‐surgery. Secondary outcomes included nausea and vomiting; sleep quality; patient satisfaction; opioid requests; and functional scores. Random‐effects meta‐analysis and trial sequential analysis were performed, with risk of bias and quality of patient‐reported outcome reporting assessed. Results: Twenty randomised controlled trials that included 1198 patients were analysed. Continuous brachial plexus blocks were associated with lower pain at rest at 12 h, 24 h and 48 h, with mean differences (MD) of −1.96 (95%CI −2.81 to −1.11, p < 0.001), −1.66 (95%CI −2.27 to −1.05, p < 0.001) and − 1.18 (95%CI −1.84 to −0.53, p < 0.001), respectively. Pain on movement could only be pooled at 24 h and 48 h and showed MD −2.04 (95%CI −4.26–0.19, p = 0.07) and − 1.30 (95%CI −3.67–1.07, p = 0.28) respectively. The co‐primary outcomes approached or exceeded the predefined minimal clinically important difference for pain scores after shoulder surgery, in favour of continuous techniques. Discussion: Continuous brachial plexus blocks are associated with better pain at rest and other patient‐centred outcomes following shoulder surgery, while effects on dynamic pain and long‐term functional recovery remain uncertain.

Summary: Introduction: Peri‐operative neurocognitive disorders are common among older adults presenting for surgery and anaesthesia. Cognitive screening is recommended to identify patients at risk for adverse neurocognitive outcomes, though the most appropriate peri‐operative tool remains debated. Remote assessment methods may be advantageous, but they need robust validation. We aimed to examine the feasibility and validity of the Modified Telephone Interview for Cognitive Status (TICS‐M) among older adults and provide recommended TICS‐M scores to identify those most at risk of poor postoperative cognitive outcomes. Methods: As part of a prospective longitudinal study with 215 older adults living in the community or scheduled for elective surgery, we conducted the modified, 22‐item, 50‐point version of the TICS remotely, followed by in‐person assessments using two common cognitive screening tools: the Mini‐Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale Cognition Subscale (ADAS‐Cog); and a comprehensive neuropsychological and functional assessment. Results: The TICS‐M was feasible and acceptable, with a completion rate of 86%. TICS‐M scores correlated with scores on the MMSE (r = 0.61, p < 0.001) and ADAS‐Cog (r = ‐0.55, p < 0.001) at baseline, and associations remained consistent at 12‐ and 24‐month follow‐up. After controlling for age, sex and education, baseline performance on the TICS‐M was independently associated with subsequent cognitive impairment at 12 months (OR 0.84, 95% CI 0.77–0.92, p < 0.001) and 24 months (OR 0.84, 95% CI 0.76–0.94, p = 0.001). A TICS‐M score of 32.5 was the optimal threshold to identify people with cognitive impairment (0.76, 95% CI 0.70–0.82, p < 0.001). Discussion: The TICS‐M is a feasible, valid and reliable remotely administered tool that shows utility in the peri‐operative environment. We recommend its implementation into routine clinical practice for remote pre‐operative assessment in patients aged ≥ 65 y scheduled for surgery and anaesthesia.

Background: Patients undergoing surgery deserve the best possible peri‐operative outcomes. Each stage of the peri‐operative patient journey offers opportunities to improve care delivery, with shorter lengths of stay, less complications, reduced costs and better value. Methods: These opportunities were identified through narrative review of the literature, with consultation and consensus at the hidden pandemic (of postoperative complications) summit 2, July 2023 in Adelaide, Australia Results: Before surgery: Some patients who receive timely alternative treatments may not need surgery at all. The period of waiting after listing should be a time of preparation. Risk assessment at the time of surgical listing facilitates recognition of need for comorbidity optimisation and identifies those who will most benefit from prehabilitation, particularly frail and deconditioned patients. During surgery: During the surgical admission, ERAS programs result in less postoperative complications, shorter length of stay and better patient experience but require agreement between clinicians, and coordinated monitoring of delivery of the elements in the ERAS bundle of care. After surgery: At‐risk patients need to have the appropriate levels of monitoring for cardiovascular instability, renal impairment or respiratory dysfunction, to facilitate timely, proactive management if they develop. Access to allied health in the early postoperative period is also critical for promoting mobility, and earlier discharge, particularly after joint surgery. Where appropriate, provision of rehabilitation services at home improves patient experience and adds value. The peri‐operative patient journey begins and ends with primary care so there is a need for clear communication, documentation, around sharing of responsibility between practitioners at each stage. Conclusion: Identifying and mitigating risk to reduce complications and length of stay in hospital will improve outcomes for patients and deliver the best value for the health system.

Background: Chronic post‐surgical pain (CPSP) represents a significant issue for many patients following surgery; however, the long‐term incidence and impact have not been well described following cardiac surgery. Our aim was to characterize CPSP at least 5 years following coronary artery bypass grafting (CABG) surgery.Methods: This prospective observational study investigated a cohort of patients from a larger trial investigating cognitive outcomes following CABG surgery, with 89 of 148 eligible patients (60.1%) assessed for CPSP at a mean (standard deviation [SD]) of 6.8 [1.2] years. Questionnaires interrogated pain presence, intensity, location, neuropathic characteristics, Geriatric Depression Scale scores (GDS) and instrumental activities of daily living (IADL).Results: CPSP was described in 21/89 (23.6%), with 10 rating it as moderate to severe. Six of the CPSP patients (29%) met criteria for neuropathic pain (6.7% overall). The highest rate of CPSP was associated with the leg surgical site (chest 12/89 [13.5%], arm 8/68 [11.8%] and leg (saphenous vein graft—SVG) 11/37 [29.7%]; χ² = 6.523, p = 0.038). IADL scores were significantly lower for patients with CPSP (mean [SD]: 36.7 [1.6] vs. no CPSP 40.6 [0.6]; p = 0.006). Patients had GDS scores consistent with moderate depression (GDS >8) in 3/21 (14.3%) with CPSP, versus 3/68 (4.4%) non‐CPSP patients (χ² = 3.20, p = 0.073).Conclusions: This study identified a CPSP incidence of 23.6% at a mean of 6.8 years after CABG surgery, with the highest pain proportion at SVG harvest sites. CPSP was associated with neuropathic pain symptoms and had a significant impact on IADLs. This emphasizes the need for long‐term follow‐up of CABG patients.Significance: This study highlights the impact of CPSP 7 years following cardiac surgery and highlights the effect of surgical site, neuropathic pain and the importance of including pain assessment and management in the long‐term follow‐up of cardiac surgical patients. Strategies to address and prevent chronic pain following cardiac surgery should be further explored.