Daily Anesthesiology Research Analysis
Today’s top perioperative research advances span risk modification, infection prevention, and health equity. A meta-analysis shows that quitting smoking at least 4 weeks before cancer surgery lowers postoperative complications. Updated evidence confirms triclosan-coated sutures reduce surgical site infections across procedures, and a large meta-analysis reveals racial/ethnic disparities in obstetric anesthesia utilization.
Summary
Today’s top perioperative research advances span risk modification, infection prevention, and health equity. A meta-analysis shows that quitting smoking at least 4 weeks before cancer surgery lowers postoperative complications. Updated evidence confirms triclosan-coated sutures reduce surgical site infections across procedures, and a large meta-analysis reveals racial/ethnic disparities in obstetric anesthesia utilization.
Research Themes
- Preoperative risk modification and optimization
- Evidence-based infection prevention in surgery
- Health equity in obstetric anesthesia
Selected Articles
1. Smoking and Complications After Cancer Surgery: A Systematic Review and Meta-Analysis.
Across 24 studies (n=39,499), smoking within 4 weeks before cancer surgery increased postoperative complications versus quitting ≥4 weeks and versus never smoking. No significant difference was seen between smoking within 2 weeks vs stopping 2 weeks–3 months, but smoking within 1 year remained riskier than quitting ≥1 year.
Impact: Provides actionable, time-based estimates to guide preoperative smoking cessation counseling and decisions about surgical timing for cancer patients.
Clinical Implications: Integrate intensive cessation support early and aim for ≥4 weeks of abstinence before cancer surgery when feasible; avoid unnecessary delays while prioritizing rapid initiation of cessation. Use these ORs in shared decision-making.
Key Findings
- Smoking within 4 weeks preoperatively increased complications versus ceasing ≥4 weeks (OR 1.31; 95% CI 1.10–1.55; n=14,547, 17 studies).
- Current smoking versus never smoking markedly increased complications (OR 2.83; 95% CI 2.06–3.88; n=9,726, 14 studies).
- No significant difference between smoking within 2 weeks vs stopping 2 weeks–3 months (OR 1.19; 95% CI 0.89–1.59; n=5,341, 10 studies).
- Smoking within 1 year increased complications vs quitting ≥1 year (OR 1.13; 95% CI 1.00–1.29; N=31,238, 13 studies).
Methodological Strengths
- Systematic review with MOOSE-guided methods and random-effects meta-analysis
- Adjusted analyses and multiple preoperative cessation time cutoffs evaluated
Limitations
- Predominantly observational evidence with potential residual confounding
- Heterogeneity across cancer types, surgeries, and smoking assessment
Future Directions: Pragmatic randomized or quasi-experimental cessation timing trials embedded in cancer pathways to define optimal delay vs. proceed strategies; standardized, biochemical verification of abstinence.
IMPORTANCE: Surgical cancer treatments may be delayed for patients who smoke over concerns for increased risk of complications. Quantifying risks for people who had recently smoked can inform any trade-offs of delaying surgery. OBJECTIVE: To investigate the association between smoking status or smoking cessation time and complications after cancer surgery. DATA SOURCES: Embase, CINAHL, Medline COMPLETE, and Cochrane Library were systematically searched for studies published from January 1, 2000, to August 10, 2023. STUDY SELECTION: Observational and interventional studies comparing the incidence of complications in patients undergoing cancer surgery who do and do not smoke. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened results and extracted data according to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Data were pooled with a random-effects model and adjusted analysis was performed. MAIN OUTCOMES AND MEASURES: The odds ratio (OR) of postoperative complications (of any type) for people who smoke currently vs in the past (4-week preoperative cutoff), currently smoked vs never smoked, and smoked within shorter (2-week cutoff) and longer (1-year cutoff) time frames. RESULTS: The meta-analyses across 24 studies with a pooled sample of 39 499 participants indicated that smoking within 4 weeks preoperatively was associated with higher odds of postoperative complications compared with ceasing smoking for at least 4 weeks (OR, 1.31 [95% CI, 1.10-1.55]; n = 14 547 [17 studies]) and having never smoked (OR, 2.83 [95% CI, 2.06-3.88]; n = 9726 [14 studies]). Within the shorter term, there was no statistically significant difference in postoperative complications between people who had smoked within 2 weeks preoperatively and those who had stopped between 2 weeks and 3 months in postoperative complications (OR, 1.19 [95% CI, 0.89-1.59]; n = 5341 [10 studies]), although the odds of complications among people who smoked within a year of surgery were higher compared with those who had quit smoking for at least 1 year (OR, 1.13 [95% CI, 1.00-1.29]; N = 31 238 [13 studies]). The results from adjusted analyses were consistent with the key findings. CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of smoking cessation and complications after cancer surgery, people with cancer who had stopped smoking for at least 4 weeks before surgery had fewer postoperative complications than those smoking closer to surgery. High quality, intervention-based evidence is needed to identify the optimal cessation period and inform clinicians on the trade-offs of delaying cancer surgery.
2. Triclosan-Containing Sutures for the Prevention of Surgical Site Infection: A Systematic Review and Meta-Analysis.
Pooling 31 RCTs (n=17,968), triclosan-coated sutures reduced surgical site infections versus non-coated analogs (RR 0.75, 95% CI 0.65–0.86), with moderate certainty. Trial sequential analysis indicated the accumulated evidence is robust and unlikely to be reversed by future trials.
Impact: Resolves ongoing controversy with robust accumulated evidence, supporting a low-cost, scalable intervention to reduce surgical site infections across procedures.
Clinical Implications: Adopt triclosan-coated sutures as default for wound closure in most surgeries to reduce SSI, barring specific contraindications or supply constraints. Incorporate into ERAS and infection prevention bundles.
Key Findings
- Across 31 RCTs (n=17,968), triclosan-containing sutures reduced SSI (RR 0.75; 95% CI 0.65–0.86).
- Moderate heterogeneity (I2=43%; τ2=0.04) and moderate certainty of evidence (GRADE).
- Trial sequential analysis showed the monitoring boundary for benefit was crossed, indicating robustness.
- Sensitivity analysis excluding high risk-of-bias trials preserved the benefit.
Methodological Strengths
- PRISMA-compliant meta-analysis of RCTs with GRADE assessment
- Trial sequential analysis to evaluate conclusiveness of evidence
Limitations
- Clinical heterogeneity across procedures and settings
- Moderate certainty due to heterogeneity; surgical technique and infection control practices vary
Future Directions: Cost-effectiveness analyses by specialty and setting; implementation studies integrating triclosan sutures into standardized bundles; surveillance for resistance or unforeseen adverse events.
IMPORTANCE: International guidelines recommend the use of triclosan-containing sutures for the prevention of surgical site infections. However, controversy still remains about triclosan-containing suture use in clinical practice since several new randomized clinical trials (RCTs) have shown contradicting results. OBJECTIVE: To update a previous systematic review and meta-analysis of the association of triclosan-containing sutures with surgical site infections and explore the potential added value of new RCTs. DATA SOURCES: PubMed, Embase, and Cochrane CENTRAL databases were searched from January 1, 2015, to March 14, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. STUDY SELECTION: Published RCTs comparing triclosan-containing sutures with similar sutures without triclosan for the prevention of surgical site infections in any type of surgery were included. DATA EXTRACTION AND SYNTHESIS: Two authors (H.J. and A.S.T.) independently extracted and pooled data in a random-effects (Mantel-Haenszel) model. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach, and trial sequential analysis was used to estimate whether further studies would reveal different outcomes. MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of surgical site infections, expressed as relative risk (RRs) and corresponding 95% CIs. Secondary outcomes were the incidence of surgical site infections according to depth (superficial incisional, deep incisional, and organ/space) and adverse events related to triclosan-containing sutures. RESULTS: The systematic review yielded 15 additional RCTs compared with a previous published review in 2017. A meta-analysis of 31 studies including 17 968 participants (62% male) undergoing various types of surgery was performed. Use of triclosan-containing sutures was associated with fewer surgical site infections compared with sutures without triclosan (RR, 0.75; 95% CI, 0.65-0.86). The certainty of evidence was moderate after downgrading for heterogeneity (τ2 = 0.04; I2 = 43%). In the trial sequential analysis of all trials and a sensitivity analysis excluding studies with a high risk of bias, the cumulative z curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate. CONCLUSIONS AND RELEVANCE: This updated meta-analysis found moderate-certainty evidence that wound closure with triclosan-containing sutures was associated with a lower risk of surgical site infections. The trial sequential analysis suggests that future trials that would change these findings are improbable.
3. Racial and ethnic disparity in obstetric anaesthesia: a systematic review and meta-analysis.
Meta-analysis of large observational datasets shows lower odds of neuraxial labor analgesia among Asian and Black patients versus White patients, and higher odds of general anesthesia for cesarean delivery among Black patients. Findings underscore persistent inequities in obstetric anesthesia access and practice.
Impact: Quantifies anesthesia-related inequities at scale, providing targets for quality improvement, policy, and training to reduce maternal morbidity and improve patient-centered care.
Clinical Implications: Implement targeted QI: standardized counseling for labor neuraxial analgesia, timely access to neuraxial placement, interpreter services, and audit-feedback on anesthesia modality by race/ethnicity. Address structural and implicit bias via training and system redesign.
Key Findings
- Lower odds of neuraxial labor analgesia for Asian (OR 0.80; 95% CI 0.65–0.99) and Black (OR 0.72; 95% CI 0.61–0.85) patients versus White.
- Higher odds of general anesthesia for cesarean delivery among Black patients versus White (OR 1.60; 95% CI 1.15–2.22).
- Meta-analysis pooled 19 studies (labor neuraxial n=13,398,421; cesarean GA n=2,139,763) using random-effects models.
- Risk of bias high/very high in 13 of 25 included studies, highlighting need for better controlled analyses.
Methodological Strengths
- Very large pooled populations across multiple health systems
- Clear a priori outcomes and random-effects meta-analysis
Limitations
- Predominantly observational data with high risk of bias in many studies
- Residual confounding (socioeconomic status, comorbidities, hospital factors) and heterogeneity in race/ethnicity definitions
Future Directions: Prospective equity-focused cohorts and quasi-experimental interventions (e.g., standardized neuraxial pathways) to reduce disparities; linkage with patient-reported outcomes and satisfaction.
INTRODUCTION: Racial and ethnic disparities in obstetrics persist globally despite improvements in maternal mortality rates and are related to access, experience and outcomes. We aimed to elucidate the racial and ethnic disparity in obstetric analgesia and anaesthesia. METHODS: Databases were searched and we included studies published in the English language conducted in all countries. Search terms included terminology concerning obstetric anaesthesia related to race or ethnicity. Included papers were assessed for risk of bias. Studies were included for detailed review if they described disparities relating to obstetric anaesthesia between two or more racial or ethnic groups. RESULTS: In total, 1806 abstracts were screened of which 25 articles were included and data from 19 could be pooled for meta-analysis using a random effects model. Outcome measures included disparities in labour neuraxial analgesia utilisation and general anaesthesia use for caesarean delivery. Sixteen observational studies examined labour neuraxial analgesia, representing data from 13,398,421 patients in the USA and UK. Patients categorised as Asian or Black had lower odds of receiving neuraxial analgesia when compared with those from White backgrounds (odds ratios (95%CI) 0.80 (0.65-0.99) and 0.72 (0.61-0.85), respectively). Six studies examined the use of general anaesthesia for caesarean delivery in 2,139,763 patients. Black patients were more likely to receive general anaesthesia compared with White patients (odds ratio (95%CI) 1.60 (1.15-2.22)). Risk of bias assessments showed high or very high risk of bias in 13 of the 25 included studies. DISCUSSION: Racial and ethnic disparities exist in obstetric anaesthesia. Further research to elucidate causes and ongoing action to minimise them are crucial.