British journal of anaesthesia
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Total hip replacement surgery is performed to improve quality of life (QoL). We explored the association between multimorbidity and change in QoL after total hip replacement. ⋯ Hip replacement surgery improves QoL. However, patients with multimorbidity are less likely to experience these benefits. Poor QoL outcomes became more frequent as the number of comorbid diseases increased. These data should inform shared decision-making conversations around joint replacement surgery.
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Deciding the optimal time for surgery in patients with pre-existing comorbid disease is complex. A careful balance of risks is required to weigh up the therapeutic benefits of surgery against an increased risk of perioperative adverse outcomes, whereas the subsequent risk of adverse events and mortality is more dependent on pre-existing conditions. A study in a recent issue of BJA shows that people with a previous cardiovascular or cerebrovascular event within 10 yr of elective surgery were at a higher risk of major adverse cardiovascular events within 1 yr from surgery and that an at-risk period existed if surgery occurred within 37 months of the preoperative event. Before this observation can be used to inform clinical decision-making, caution is needed to interpret these findings because of biases introduced by the analytical approach and potential confounding.
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Optimal composition and infusion rates of intravenous maintenance fluids for children undergoing surgery are not well defined. Avoidance of hypoglycaemia, ketosis, and hyponatraemia is important, and current guidelines recommend isotonic fluids containing 1.0-2.5% glucose. However, evidence for its safe use in infants is insufficient. The aim of this study was to investigate whether normoglycaemia is maintained in infants using a balanced electrolyte maintenance infusion with 1% glucose. ⋯ ACTRN12619000833167.