Lulu Ma

Objective: Spinal muscular atrophy (SMA) is a rare neuromuscular disorder frequently associated with progressive scoliosis, often requiring complex surgical intervention. Perioperative management for SMA patients remains challenging due to severe respiratory compromise, difficult airway anatomy, and a high risk of perioperative complications. This study aimed to analyze perioperative strategies and outcomes in SMA patients undergoing posterior spinal fusion for scoliosis correction. Methods: We retrospectively reviewed SMA patients who underwent posterior spinal fusion at our institution from January 2018 to December 2024. Primary outcomes included intraoperative blood loss, postoperative complications, and perioperative hypokalemia; secondary outcomes included postoperative mechanical ventilation duration, length of stay in the ICU and hospital, and radiographic outcomes. Subgroup comparisons between SMA type 2 and type 3 were performed using the independent‐samples t‐test or Mann–Whitney U test for continuous variables and the chi‐square test or Fisher's exact test for categorical variables. Results: Forty‐three SMA patients (72.1% type 2, 27.9% type 3) with a mean age of 15.9 ± 4.9 years were included. Spinal deformity was severe, with a mean preoperative Cobb angle of 113.2° ± 22.8°. Pulmonary function was markedly impaired, with a median forced vital capacity (FVC) of 34.8% (IQR: 24.6%–46.4%) of the predicted value. Endotracheal intubation was challenging, with 93.0% ( n = 40) requiring video laryngoscopy or awake tracheal intubation using flexible bronchoscopy. Blood loss was substantial, with a median intraoperative blood loss of 1200 mL (IQR: 1000–1550 mL) and a postoperative drainage of 1040 mL (IQR: 723–1293 mL). An extraordinarily high incidence of perioperative hypokalemia was observed, affecting 65.1% of patients ( n = 28) intraoperatively and 79.1% ( n = 34) postoperatively. All patients successfully underwent surgery with a mean Cobb angle correction rate of 49.0% ± 13.5%. There were no cases of operative mortality, and the overall complication rate was low (2.3%, n = 1). SMA type 2 and type 3 shared similar perioperative parameters. Conclusions: This study represents the largest case series to date in Asia on the perioperative management of SMA patients undergoing scoliosis surgery. These patients present complex perioperative risks requiring meticulous multidisciplinary care. Advanced airway planning, hemodynamic support, blood management strategies, and proactive correction of electrolyte imbalances may help support safer perioperative care. With appropriate planning, scoliosis surgery can be safely performed in SMA patients, offering structural and functional benefits.

Introduction: Previous studies have indicated that exposure to anaesthetics has potential neurotoxic effects, particularly in cases of multiple and long-term general anaesthesia. However, there is currently no research exploring the relationship between early anaesthesia and neurological development in children with congenital scoliosis, who may require multiple surgical treatments. Herein, we present our design for a prospective longitudinal observational cohort study, assessing the long-term impact of general anaesthesia for surgery before school age on neurocognitive function and behaviour in children with congenital scoliosis. Methods and analysis: A dynamic cohort of children aged 6–16 years diagnosed with congenital scoliosis between July 2020 and December 2025 in the Department of Orthopaedic Surgery at a tertiary hospital will be enrolled, with an aim to include 150 patients. Detailed information about baseline characteristics, previous anaesthesia and surgery will be collected from medical records, parents or guardians. Neurodevelopment will be evaluated using the abbreviated version of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) for neurocognition, and parent-report Achenbach Child Behaviour Checklist and Strengths and Difficulties Questionnaire for neurobehaviour. Repeated measures will be performed during follow-up, with at least a 1-year interval from the previous assessment, whenever the participants are available. The primary outcome is the full-scale intelligence quotient estimated by the WISC-IV. A linear mixed effects model will be constructed, with exposure group — categorised as none, single or multiple anaesthesia exposures based on all episodes of general anaesthesia for surgery before the age of 7 years — as a fixed effect and subject-specific random effects intercept. Ethics and dissemination: The study was approved by the Institutional Review Board of Peking Union Medical College Hospital (S-K1093). Written informed consents will be obtained from the parents or guardians. The results of this research will be disseminated through peer-reviewed publications and conference presentations, and shared with paediatric surgical patients and their families who are concerned about the potential neurotoxicity of anaesthesia in clinical practice. Trial registration number: NCT06315933 .

PURPOSE: This study aimed to explore the impact of chronic kidney disease (CKD) on the prognosis of patients older than 80 years after hip fracture. METHODS: This retrospective, observational, single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital. Patients were divided into two groups based on the estimated glomerular filtration rate (eGFR): the CKD group [eGFR < 60 mL/(min·1.73m²)] and the non-CKD group. Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications, 30-day readmission, and in-hospital death. Logistic regression was used to calculate the odds ratio (OR) of CKD on these outcomes. RESULTS: A total of 498 patients were included, 165 in the CKD group and 333 in the non-CKD group. Eighty-seven CKD patients experienced 140 episodes of postoperative complications. In comparison, 114 non-CKD patients had 158 episodes of postoperative complications. CKD patients were more likely to have postoperative complications than non-CKD patients (OR = 2.143, 95% CI: 1.465-3.134, P < 0.001). CKD increased the risk of cardiovascular complications (OR = 2.044, 95% CI: 1.245-3.356, P = 0.004), acute kidney injury (OR = 3.401, 95% CI: 1.905-6.072, P < 0.001), delirium (OR = 2.276, 95% CI: 1.140-4.543, P = 0.024), and gastrointestinal bleeding (OR = 4.151, 95% CI: 1.025-16.812, P = 0.031). The transfusion rate (OR = 2.457, 95% CI: 1.668-3.618, P < 0.001) and incidence of 30-day readmission (OR = 2.426, 95% CI:1.203-4.892, P = 0.011) in CKD patients were higher than those in patients without CKD. CONCLUSION: CKD is associated with poor postoperative outcomes in geriatric hip fracture patients. Special attention should be paid to patients with CKD.

The effects of inhalation anesthesia as compared with total intravenous anesthesia (TIVA) on postoperative recovery quality in patients undergoing transsphenoidal resection of pituitary adenoma have not been well studied. This randomized clinical trial enrolled patients undergoing transsphenoidal surgery between May 2023 to April 2024. Patients were randomly assigned in a 1:1 ratio to receive inhalation anesthesia or TIVA. The primary endpoint was the 15-item Quality of Recovery Scale (QoR-15) score on the first postoperative day. Secondary endpoints included postoperative anesthesia recovery patterns, neuroendocrine stress responses, cellular immune responses, and recovery quality. Subgroup analyses were also conducted for the postoperative QoR-15 scores and neuroendocrine stress responses. Potential influence factors for QoR-15 scores and changes in counts of lymphocytes were explored. A total of 252 patients were randomized. No significant difference in postoperative QoR-15 scores was observed between groups and the between-group difference was well below the minimal clinically important difference (median difference 1.0, 95% confidence interval [CI]– 4.0 to 5.0, P = 0.647). Compared with the inhalation group, the TIVA group exhibited significantly lower Richmond agitation-sedation scale (RASS) score and reduced antiemetic drug use in the postanesthesia care unit. Subgroup analyses for postoperative QoR-15 scores revealed no significant interactions. Adrenocorticotropic hormone levels on postoperative day 1 were lower in the inhalation group, while thyroxine and serum free thyroxine levels were higher. No significant differences in these neuroendocrine indices were found in postoperative month 3. Lymphocyte subset levels did not differ between groups on postoperative day 1, although perioperative changes in immune cell counts were correlated with patient demographic and clinical characteristics. Both anesthesia methods resulted in comparable short-term postoperative recovery quality as measured by the QoR-15 scores. TIVA was associated with smoother anesthesia recovery and lower immediate antiemetic requirements. Differences in early neuroendocrine responses were observed but did not persist at 3 months postoperatively. The trial is registered with the ClinicalTrials.gov platform (registration number: NCT05822817; date of registration: March 13, 2023).

Sarcopenia, characterized by the progressive loss of muscle mass and strength, is common in the elderly and significantly increases the risk of poor postoperative outcomes. This study aims to examine the impact of sarcopenia on postoperative delirium and a range of perioperative outcomes in elderly patients. A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL. Studies investigating the association between sarcopenia and postoperative complications in elderly surgical patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized for risk-of-bias assessment. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included other postoperative complications and further recovery. Subgroup analyses were conducted based on surgery types. A total of 10,981 records were identified, with 265 studies included in the systematic review and 242 in the final meta-analysis. A significant association was found between sarcopenia and postoperative delirium in both univariable and multivariable analyses (univariable: OR 1.81, 95% confidence interval [CI] 1.31 to 2.50, P < 0.001, I2 24.0%; multivariable: OR 2.42, 95% CI 1.27 to 4.59, P = 0.007, I2 0.0%). Sarcopenia was also associated with adverse postoperative outcomes, including increased complications, mortality, delayed recovery, and reduced overall survival. However, no significant associations were observed for postoperative pancreatic fistula or recurrence. Syntheses of multivariable analyses showed significant differences in postoperative complications, mortality, overall survival, and recurrence. Subgroup analyses indicated a higher risk of reduced overall survival among sarcopenic patients undergoing head and neck or heart and chest surgeries. Sarcopenia is a strong independent predictor of postoperative delirium and poor postoperative outcomes in elderly surgical patients. PROSPERO registration number CRD42023424696 (18 May 2023)

Purpose: The efficacy and safety of four-factor prothrombin complex concentrate (4F-PCC) in managing bleeding during non-cardiac surgery are unclear. We investigated the associations of 4F-PCC with postoperative RBC transfusion and adverse events in non-cardiac surgery patients with massive intraoperative bleeding. Methods: This retrospective cohort study consecutively included non-cardiac surgery patients with massive intraoperative bleeding at a tertiary hospital (2014–2020). Administration of 4F-PCC was categorized into dose groups based on quartiles: 0 (reference), 2.8–6.7, 6.7–11.5, 11.5–19.4, and 19.4–87.5 IU/kg. Outcomes included postoperative RBC transfusion, major thromboembolic events, severe acute kidney injury, and lengths of ICU and hospital stay. Results: Of 137 patients, 89 (65.0%) received 4F-PCC. The 6.7–11.5 IU/kg group were significantly associated with reduced postoperative RBC transfusion compared to the non–4F-PCC group (adjusted mean difference, −1.29 units; 95%CI, −2.55 to −0.04 units, P = 0.044). Such findings were not observed in other dose groups. Notably, the benefits were particularly significant in patients with preoperative platelet count ≥150 × 109/l ( P = 0.031), and fibrinogen ≥3 g/l ( P = 0.025). The 6.7–11.5 IU/kg group exhibited comparable incidences of major thromboembolic events (13.0% vs 10.4%) and severe acute kidney injury (8.7% vs 8.3%) compared to the non–4F-PCC group. The lengths of ICU and hospital stay were similar across groups. Conclusion: 4F-PCC may be associated with decreased postoperative RBC transfusion in non-cardiac surgery patients experiencing massive intraoperative bleeding, without a significant increase in the risk of major thromboembolic events. Randomized trials with stratified dosing are warranted to confirm efficacy, safety, and determine optimal doses. Clinical Trial Number: ChiCTR2500096573.

The mortality and morbidity in hip fracture is a big healthcare burden. How to identify risk patients preoperatively is important. The aim of study was to evaluate the risk factors of postoperative complications and mortality in patients older than 80 years old after hip fracture surgery. Patients older than 80 years old with the diagnosis of hip fracture who had surgical treatment from February 2013 to June 2021 at a single center in China were included for analysis. The primary outcome were postoperative complications and in-hospital mortality. Binary logistic regression was used to confirm the relationship between preoperative factors and postoperative complications/mortality. 498 patients were included for analysis. 176 patients developed 265 episodes of complications and the incidence of postoperative complication was 35.3%. Postoperative pulmonary infection was the most common complication, followed by cardiovascular complications and postoperative delirium. And there were 10 postoperative in-hospital deaths (2.0%). Preoperative Charlson comorbidity index(CCI) was associated with postoperative complications (OR = 1.243, 95%CI 1.020–1.516, P = 0.031) and mortality (OR = 2.303, 95%CI 1.351–3.925, P = 0.002). However, American society of Anesthesiologists (ASA) score was not an independent risk factor for postoperative complication and mortality. CCI was the risk factor of poor postoperative outcome for patients older than 80 years old after hip fracture surgery. And CCI can be used as the potential tool of risk stratification for this group of patients. This study had been registered in www.chictr.org.cn and the registration ID was ChiCTR2400085291 on June 4th 2024.

Halo-pelvic traction is a relatively safe treatment for preoperative spinal deformity correction in patients with severe scoliosis. Common device-related complications include local infection, back discomfort, and nerve compression symptoms. However, there are potential risks of mechanical compression of bronchial structures, especially in patients with severe thoracic lordosis and scoliosis, which can lead to life-threatening airway obstruction. A 11-year-old boy diagnosed with neurofibromatosis received preoperative halo-pelvic traction for forty days with a Cobb angle reduced from 99° to 51°. On operation day, he experienced near-complete airway obstruction and hypoxemia post-anesthesia induction, which was successfully resolved by releasing the traction. The posterior correction surgery was performed as scheduled and the child was extubated uneventfully. Airway obstruction is a rare but severe complication of halo-pelvic traction, emphasizing the importance of careful airway management and continuous monitoring in pediatric patients with spinal deformities. Ensuring thorough preoperative evaluations and being prepared for potential airway emergencies are crucial steps in optimizing patient outcomes during such complex orthopedic interventions.