Journal of clinical anesthesia
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There is a wide variation between hospitals with respect to rates of use of postoperative intensive care unit (ICU) after major noncardiac surgery. Whether ICU care improves patient-centered outcomes remains unknown. Days alive and out of hospital (DAH) is a novel patient-centered outcome that has been validated for surgical patients. We conducted a population-based cohort study to evaluate the association of hospital-level postoperative ICU use with DAH after select major elective noncardiac surgery. ⋯ Hospital-specific ICU admission practice showed no association with the patient-centered outcome of DAH in select elective major noncardiac surgical procedures.
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To employ systems biology-based machine learning to identify biologic processes over-represented with genetic variants (gene enrichment) implicated in post-surgical pain. ⋯ High interindividual variability in pain responses immediately after surgery and risk for CPSP suggests genetic susceptibility. Lack of large homogenous sample sizes have led to underpowered genetic association studies. Systems biology can be leveraged to integrate genetic-level data with biologic processes to generate prioritized candidate gene lists and understand novel biological pathways involved in acute postoperative pain and CPSP. Such data would be key to informing future polygenic studies with targeted genome wide profiling. This study demonstrates the utility of functional annotation - based prioritization and enrichment approaches and identifies novel genes and unique/shared biological processes involved in acute and chronic postoperative pain. Results provide framework for future targeted genetic profiling of CPSP risk, to enable preventive and therapeutic approaches.