Mantana Saetang

Background/Objectives: Postoperative pulmonary complications (PPCs) are a major source of morbidity following cardiac surgery, particularly in older adults. While malnutrition is linked to adverse outcomes, the optimal screening tool for identifying patients at risk of PPCs remains uncertain. This study compared the predictive performance of the Geriatric Nutritional Risk Index (GNRI), Mini Nutritional Assessment–Short Form (MNA-SF), Prognostic Nutritional Index (PNI), and Nutrition Alert Form (NAF) for PPCs in older adults undergoing elective cardiac surgery. Methods: This prospective cohort study enrolled 217 patients aged ≥ 60 years at a tertiary university hospital. Preoperative nutritional status was assessed using the GNRI, MNA-SF, PNI, and NAF. The primary outcome was PPC development during hospitalization. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression identified independent predictors. Results: PPCs occurred in 86 patients (39.6%). Patients who developed PPCs had significantly higher NAF scores than those who did not (median [IQR]: 7.5 [3–12] vs. 5 [2–8], p < 0.001), whereas GNRI, MNA-SF, and PNI scores did not differ significantly. NAF demonstrated the highest predictive performance (AUC: 0.643, 95% CI: 0.567–0.719), followed by PNI, MNA-SF, and GNRI. However, after adjusting for clinical covariates, none of the nutritional assessment tools remained independently associated with PPCs. Conclusions: Among the four tools evaluated, NAF showed the highest predictive performance among the evaluated nutritional assessment tools; however, its discriminative ability was modest, and none of the nutritional assessment tools remained independently associated with PPCs after multivariable adjustment. Nutritional assessment should complement, rather than replace, established clinical risk factors in perioperative risk stratification.

Background/Objectives: Accurate preoperative risk stratification is critical in older adults undergoing cardiac surgery, particularly for predicting postoperative cardiopulmonary complications (PCPCs). Although EuroSCORE II and the Society of Thoracic Surgeons (STS) score are widely used to estimate mortality risk, their ability to predict morbidity in older adults remains unclear. This study compared the performance of EuroSCORE II and the STS score in predicting PCPCs after on-pump cardiac surgery. Methods: This retrospective cohort study included patients aged ≥ 60 years who underwent elective on-pump cardiac surgery at Songklanagarind Hospital between January 2017 and December 2022. PCPCs included prolonged mechanical ventilation (>48 h), reintubation within 72 h, pneumonia, respiratory failure, new-onset atrial fibrillation, or low cardiac output requiring inotropic or mechanical support. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, logistic regression, calibration analysis, and overall prediction accuracy measures. Results: Among 638 patients, 273 (42.8%) developed PCPCs. Both scores were significantly associated with PCPCs. EuroSCORE II showed modest discrimination (area under the curve [AUC]: 0.581; 95% CI: 0.536–0.626); in contrast, the STS Score performed better (AUC: 0.625; 95% CI: 0.580–0.669; p = 0.017). In logistic regression, EuroSCORE II (odds ratio [OR]: 1.06; 95% CI: 1.01–1.10; p = 0.006) and the STS Score (OR: 1.05; 95% CI: 1.03–1.07; p < 0.001) were independently associated with PCPCs. Both models demonstrated acceptable calibration, although STS score showed better overall predictive performance than EuroSCORE II. Conclusions: EuroSCORE II and the STS score were both associated with postoperative cardiopulmonary complications but demonstrated only modest discriminative ability. Although the STS score performed significantly better than EuroSCORE II, neither model achieved sufficient accuracy for clinically meaningful individualized risk prediction.

Introduction: Frailty and malnutrition are closely linked to adverse surgical outcomes. However, their combined influence on post-non-cardiac surgery complications in older patients remains unclear. We aimed to evaluate the predictive value of frailty, malnutrition, and their combined effect on postoperative complications in older patients undergoing intermediate- to high-risk non-cardiac surgery.Methods: This study was a retrospective analysis of data from a prospectively collected cohort that included 637 patients aged ≥60 years. We assessed frailty using the Clinical Frailty Scale (CFS) and nutritional status using the Prognostic Nutritional Index (PNI). The primary outcome was the occurrence of postoperative complications (Clavien-Dindo classification ≥2). We used logistic regression and receiver-operating characteristic (ROC) analyses to determine the predictive accuracy of CFS, PNI, and CFS + PNI.Results: We identified frailty (CFS ≥ 5) in 38.5% of patients, with 29.8% being malnourished (PNI < 45). Multivariate analysis revealed that frailty independently predicted postoperative complications (odds ratio [OR]: 2.09, 95% confidence interval [CI]: 1.09–4.00; p = 0.026). Severe malnutrition (PNI < 40) exhibited a strong association with complications in univariate analysis (OR: 5.88, 95%CI: 3.13–11.08; p < 0.001) but not in multivariate analysis. The combined CFS + PNI model showed enhanced discriminative ability (area under the curve [AUC]: 0.694, 95%CI: 0.647–0.740) compared with CFS (AUC: 0.619, 95%CI: 0.575–0.662) or PNI (AUC: 0.665, 95%CI: 0.618–0.712) alone.Conclusion: Frailty is a strong independent predictor of postoperative complications in older patients undergoing non-cardiac surgery. Although severe malnutrition correlates with increased risk, its effect may be partially mediated by frailty. The integration of frailty and nutritional assessments enhances postoperative complication prediction, underscoring comprehensive geriatric evaluation value in preoperative risk stratification.

Background: Oxidative stress and systemic inflammation during cardiac surgery can lead to postoperative complications. Although vitamin C and thiamine (vitamin B1) have individually demonstrated protective effects, their combined effects remain underexplored. This study aimed to evaluate the efficacy of combined vitamin C and B1 therapy versus that of vitamin C alone in reducing inflammatory and cardiac biomarkers and improving postoperative outcomes in patients undergoing cardiac surgery. Methods: In this prospective, double-blind, randomized controlled trial, 64 patients scheduled for elective cardiac surgery at a tertiary care center were randomized to receive either 1000 mg vitamin C or a combination of 1000 mg vitamin C and 100 mg vitamin B1 at four perioperative time points. Primary outcomes included changes in inflammatory biomarkers [C-reactive protein, interleukin-6 (IL-6), and white blood cells], and cardiac biomarkers [creatine kinase-MB, Troponin-I, and lactate dehydrogenase]. Secondary outcomes included hemodynamic parameters and left ventricular function. Results: Compared with vitamin C alone, combined vitamin B1 and vitamin C significantly reduced postoperative cardiac biomarker levels. IL-6 levels were significantly lower immediately in the combined group; however, this effect was not sustained at 24 h post-surgery. Up to 24 h after surgery, no significant differences in hemodynamic stability or left ventricular ejection were observed between the groups. Notably, the combined therapy group demonstrated a lower incidence of postoperative arrhythmias and shorter dobutamine duration within 24 postoperatively. Conclusions: Combined vitamin C and B1 therapy significantly reduced markers of myocardial injury and early inflammatory responses (IL-6) in patients undergoing cardiac surgery, suggesting its potential as a protective agent.

Background: Frailty is increasingly being recognized as a risk factor for adverse outcomes in older surgical patients undergoing surgery. We investigated the association between frailty and intraoperative complications using multiple frailty assessment tools in older patients undergoing elective intermediate- to high-risk non-cardiac surgery. Methods: This retrospective cohort study included 637 older patients scheduled for elective non-cardiac surgery. Frailty was assessed using the Clinical Frailty Scale (CFS), FRAIL scale, and modified Frailty Index-11 (mFI-11). The predictive ability of frailty tools was analyzed and compared using the area under the receiver operating characteristic curve (AUC). Results: Frailty was significantly associated with higher intraoperative complication rates (FRAIL scale: p = 0.01; mFI-11: p = 0.046). Patients considered frail using the mFI-11 were more likely to have unplanned intensive care unit admissions (p < 0.001). Those classified as frail by the FRAIL scale and mFI-11 had significantly higher rates of vasopressor/inotrope use (p = 0.001 and p = 0.005, respectively) and mechanical ventilation (p = 0.033 and p = 0.007, respectively). In the univariate analysis, frailty measured using the FRAIL scale was significantly associated with intraoperative complications (odds ratio [OR], 2.41; 95% confidence interval [CI]: 1.33–4.38; p = 0.004); this association was not significant in the multivariate analysis (adjusted OR, 1.69; 95% CI: 0.83–3.43; p = 0.148; AUC = 0.550). Atrial fibrillation, hemoglobin levels, anesthesia type, and surgical subspecialty were stronger predictors of intraoperative complications. Conclusions: Frailty assessments demonstrate the limited predictive ability for intraoperative complications. Specific comorbidities, surgical techniques, and anesthesia types play more critical roles. Comprehensive preoperative evaluations integrating frailty with broader risk stratification methods are necessary to enhance patient outcomes and ensure safety.

Purpose: Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is a life‐saving intervention for refractory cardiopulmonary failure. Identifying factors associated with survival is essential for optimizing patient selection and management. In this study, we aimed to identify VA‐ECMO survival predictors and evaluate the associated complications, costs, and outcomes. Methods: A retrospective analysis was conducted on data from 123 adult patients who underwent VA‐ECMO at the Songklanagarind Hospital between 2017 and 2023. Clinical characteristics, ECMO‐related complications, hospital expenses, and survival outcomes were analyzed. Univariate and multivariate logistic regression analyses were used to determine independent predictors of survival. Results: Fifty (40.7%) patients survived until hospital discharge. Compared to central VA‐ECMO, peripheral VA‐ECMO was significantly associated with improved survival (adjusted OR: 26.44, 95% CI: 1.95–358.7, p = 0.014). Preexisting liver dysfunction (adjusted OR: 0.27, 95% CI: 0.09–0.79, p = 0.016) and renal dysfunction (adjusted OR: 0.29, 95% CI: 0.1–0.85, p = 0.023) were independent mortality predictors. Survival odds were significantly lower in patients with American Society of Anesthesiologists (ASA) Class 5 (adjusted OR: 0.07, 95% CI: 0.01–0.67, p = 0.022). Neurological complications were more common in nonsurvivors than in survivors (41.1% vs. 18%, p = 0.012). Survivors had significantly higher total hospital costs (997,563.5 vs. 696,191 THB, p = 0.004) and longer hospital stays (28.5 vs. 3 days, p < 0.001). The multivariate model demonstrated strong predictive performance, with an area under the curve of 0.85. Conclusions: ECMO cannulation strategy, preexisting liver and renal dysfunction, and ASA classification were key factors associated with survival. Peripheral VA‐ECMO was associated with better outcomes, and organ dysfunction significantly increased the mortality risk.

Background: To highlight the risk assessment tool associated with postoperative cardiopulmonary complications of Clavien–Dindo (CD) ≥ II in elderly patients who underwent lung cancer surgery. Methods: In patients ≥ 60 years admitted during 2020–2023 and having undergone lung cancer surgery, postoperative cardiopulmonary complications were examined using the CD classification as groups (CD grade I versus ≥ II), and the risk factors were analyzed using logistic regression and receiver operating characteristic (ROC) curves. Results: Of the 239 elderly patients, 29.3% had postoperative complications (CD ≥ II). Subgroup analysis revealed that patients aged ≥70 years had a higher rate of postoperative complications compared to those aged 60–69 years, however, this relationship was not statistically significant in the multivariable model (OR: 2.03, 95% CI: 0.95–4.36, p = 0.068). The CD grade ≥ II group had longer surgical time (p = 0.002), greater postoperative pulmonary complications (p < 0.001), and longer length of hospital stay (p < 0.001); CD grade ≥ II was more likely in patients with older age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.02–1.15, p = 0.011), COPD (OR: 4.41, 95% CI: 1.55–13.44, p = 0.005) and smoking history (OR: 2.85, 95% CI: 1.12–7.24, p = 0.028), having undergone pneumonectomy (OR: 14.89, 95% CI: 1.71–334.9, p = 0.045), and who converted to open thoracotomy (OR: 16.33, 95% CI: 2.13–169.71, p = 0.007). The area under the ROC curve was 0.81. Conclusions: Older age (≥70 years) is associated with higher rates of postoperative complications (CD classification ≥ II) but is not an independent predictor when adjusting for other factors. Comorbidities such as COPD and surgical factors, including pneumonectomy and conversion to thoracotomy, are significant contributors. These findings emphasize the need for comprehensive, multifactorial risk assessments to guide perioperative management and improve outcomes in elderly lung cancer patients.

บทคัดย่อ (Abstracts) ปัจจุบันมีผู้สูงอายุที่มีภาวะเปราะบางที่ต้องเข้ารับการผ่าตัดหัวใจจำนวนมากขึ้น ซึ่งพบว่าภาวะแทรกซ้อน อัตราการเสียชีวิต ระยะเวลาการพักรักษาตัวและระยะเวลาการนอนโรงพยาบาลในหออภิบาลผู้ป่วยผ่าตัดหัวใจเพิ่มขึ้นมากกว่าผู้สูงอายุที่ไม่มีภาวะเปราะบาง ดังนั้นการประเมินความรุนแรงของภาวะเปราะบางก่อนผ่าตัดถือว่ามีความสำคัญมาก เพื่อวินิจฉัยภาวะเปราะบางได้อย่างรวดเร็ว และนำมาสู่การวางแผนดูแลรักษาผู้ป่วยที่ครอบคลุม ซึ่งสามารถลดความรุนแรงของภาวะแทรกซ้อน และอัตราการเสียชีวิตในระหว่างและหลังผ่าตัดหัวใจได้ บทความนี้จึงได้รวบรวมความรู้การประเมินความรุนแรงของภาวะเปราะบางก่อนผ่าตัด การดูแลผู้ป่วยที่มีภาวะเปราะบางทั้งระหว่างและหลังผ่าตัด เพื่อเป็นประโยชน์ในการดูแลผู้สูงอายุที่เข้ารับการผ่าตัดหัวใจ

Introduction: The impact of medical student involvement in anesthetic procedures on operating room (OR) efficiency and patient outcomes remains understudied, despite its importance in medical education. This study aimed to quantify the effects of fifth-year medical students’ participation in anesthetic procedures on key time metrics, perceived difficulty, procedural success, and postoperative complications and to compare these effects with those of anesthetic residents and student nurse anesthetists.Methods: This prospective observational study was conducted between April and July 2022 in the OR of a tertiary university hospital in southern Thailand. We analyzed 111 elective obstetric-gynecologic and general surgery procedures under subarachnoid block or general anesthesia, equally distributed among three groups: fifth-year medical students, anesthetic residents, and student nurse anesthetists. Key time intervals, perceived difficulty, number of attempts, success rates, and postoperative complications were recorded and compared across groups.Results: Fifth-year medical students exhibited significantly prolonged anesthesia release time, anesthesia-controlled time, anesthetic preparation time, and anesthetic procedure time compared to anesthetic residents and student nurse anesthetists (p < 0.05). Medical students perceived case inductions as more challenging than the other groups did (p < 0.001), but procedural success rates were comparable across groups. Immediate postoperative airway complications were more frequent among medical students than anesthetic residents, but no significant differences were found in intraoperative or 24-h postoperative complications.Discussion: While the involvement of medical students in anesthetic procedures extends specific time metrics, it does not significantly impact overall case duration or major patient outcomes. These findings support the continued integration of medical student training in the OR, with appropriate supervision to manage the slightly increased risk of immediate postoperative complications. Further research is needed to optimize the balance between educational opportunities and OR efficiency.Clinical trial registration: https://www.thaiclinicaltrials.org/show/TCTR20220418006, identifier TCTR20220418006.