Daily Anesthesiology Research Analysis
Analyzed 98 papers and selected 3 impactful papers.
Summary
Across European perioperative care, practice gaps persist: a 46-center study shows preoperative clear-liquid fasting remains excessively prolonged, and a multicenter analysis links higher 24-hour positive fluid balance to postoperative acute kidney injury after colorectal surgery. A 907-hospital European survey further reveals limited around-the-clock microbiology and rapid blood culture testing capacity, delaying sepsis diagnostics.
Research Themes
- Preoperative fasting practices and patient-centered perioperative care
- Perioperative fluid balance and postoperative acute kidney injury risk
- Health system capacity for blood culture diagnostics in sepsis
Selected Articles
1. Preoperative liquid fasting practices in twelve European countries: A prospective multicentre cohort study (Thirst study).
In a 46-center, 12-country prospective cohort of 5100 adults, median preoperative clear-liquid fasting was 12 hours, with 95% fasting beyond 4 hours and only 0.8% within the recommended 2 hours. Persistent over-fasting across most countries highlights major implementation gaps in guideline-concordant care.
Impact: This large, contemporary, multicountry cohort quantifies the extent of over-fasting, a modifiable systems problem with direct patient comfort and safety consequences, and provides comparative benchmarks to drive quality improvement.
Clinical Implications: Adopt patient-centered fasting protocols allowing clear liquids up to 2 hours pre-anesthesia, implement preoperative hydration pathways, and audit fasting instructions and scheduling to reduce unnecessary fasting durations.
Key Findings
- Median preoperative clear-liquid fasting was 12 hours [IQR 10–14.6] across 5100 adults.
- Only 0.8% consumed clear liquids within 2 hours; 4% within 2–4 hours; 95% fasted beyond 4 hours.
- Prolonged fasting was widespread across countries and procedure types, with shorter durations notably in Albania.
Methodological Strengths
- Prospective, multicentre design across 46 centers in 12 countries
- Large sample size with predefined primary outcomes and subgroup analyses
Limitations
- Self-reported fasting times may be subject to recall or reporting bias
- Observational design precludes causal inference on outcomes
Future Directions: Test implementation strategies (e.g., electronic prompts, nurse-led hydration protocols) in cluster RCTs to reduce fasting times and assess effects on patient comfort, PONV, and perioperative outcomes.
BACKGROUND: International guidelines recommend preoperative clear liquid fasting for 2 h before anaesthesia. However, excessive fasting times remain widespread, potentially contributing to patient discomfort and adverse clinical outcomes. OBJECTIVE: To evaluate current preoperative liquid fasting practices among adults undergoing elective procedures across multiple European centres. DESIGN: Prospective, observational, multicentre study. SETTING: Forty-six centres in 12 European countries, conducted between November and December 2024. PATIENTS: A total of 5100 adults undergoing elective surgery or interventional procedures under general anaesthesia, regional anaesthesia or sedation. MAIN OUTCOME MEASURES: Self-reported duration of preoperative liquid fasting; incidence of prolonged fasting duration (defined as liquid fasting times of more than 4 h). Median [IQR] fasting time was calculated, with subgroup analyses by country and procedure type. RESULTS: The median [IQR] preoperative liquid fasting time was 12 [10 to 14.6] h. Only 4% of patients consumed clear liquids within 2 to 4 h, and 0.8% within 2 h. Fasting durations were consistently prolonged across most countries and procedures, except for notably shorter times in Albania. Overall, 95% of patients fasted beyond 4 h. CONCLUSIONS: Excessive preoperative liquid fasting remains highly prevalent across Europe, with poor implementation of established guidelines. These findings underscore the need for educational, institutional, and quality improvement interventions to align clinical practice with evidence-based recommendations and enhance patient-centred care. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06527703.
2. Association of perioperative fluid balance and acute kidney injury in patients undergoing elective colorectal surgery: A pre-planned secondary analysis of a multicentre prospective observational study.
In 1139 elective colorectal surgery patients, postoperative AKI occurred in 6.4%. Compared with the lowest quartile of 24-hour perioperative fluid balance, higher quartiles showed significantly increased adjusted AKI risk (e.g., Q4 RR 4.81), with a nonlinear association after multivariable adjustment.
Impact: Provides multicentre, prospective, perioperative evidence linking positive fluid balance to AKI in colorectal surgery, informing goal-directed fluid strategies within ERAS pathways.
Clinical Implications: Avoid large positive fluid balances in the first 24 hours; integrate continuous hemodynamic monitoring and individualized, goal-directed fluid therapy to minimize AKI risk.
Key Findings
- Postoperative AKI incidence was 6.4% (73/1139) after elective colorectal surgery.
- Compared to the lowest quartile of fluid balance, Q3 and Q4 had higher adjusted AKI risk (Q3 RR 4.10; Q4 RR 4.81).
- A nonlinear increase in AKI risk with more positive 24-hour fluid balance persisted after adjusting for sex, ASA, ERAS adherence, and bleeding (P<0.01).
Methodological Strengths
- Preplanned secondary analysis within a prospective multicentre cohort (POWER)
- Standardized AKI definitions incorporating KDIGO and EPCO criteria
Limitations
- Observational design limits causal inference
- Residual confounding by unmeasured perioperative factors cannot be excluded
Future Directions: Randomized trials of fluid management targets in colorectal ERAS pathways should test causal effects on AKI and other organ outcomes.
BACKGROUND: Acute kidney injury (AKI) is a common complication after surgery. Greater fluid administration has been related to an increased incidence in patients undergoing major surgery but there are no large series of patients in specific perioperative settings showing relationship between fluid balance and the occurrence of AKI. OBJECTIVE: This study tested the hypothesis that higher perioperative fluid balance was associated with an increased risk of postoperative AKI. DESIGN: Prospective observational study. Predefined secondary sub-study of the Postoperative Outcomes Within Enhanced Recovery After Surgery (POWER) study. SETTING: A pre-planned secondary analysis of a multicentre study in 80 hospitals in Spain during a single period of 2 months of recruitment between September and December 2017. PATIENTS: Patients undergoing elective primary colorectal surgery with a planned overnight stay were included if they had complete data regarding postoperative fluid balance. Patients who underwent urgent or emergency surgery or with estimated glomerular filtration rate less than 30 ml min-1 were excluded. MAIN OUTCOMES MEASURES: The primary outcome was the occurrence of AKI (mild, moderate, or severe) at 30 days following surgery. AKI was defined according to KDIGO and EPCO guidelines, incorporating serum creatinine and urine output criteria. RESULTS: A total of 1139 patients were included in the study. Of these, 73 patients (6.4%) developed acute kidney injury in the postoperative period. The adjusted relative risks (RR) that compared the quartile with the lowest perioperative fluid balance (Q1) with other quartiles were 4.10 [95% confidence interval (CI), 1.60 to 10.51] for Q3 and 4.81 (95% CI, 1.91 to 12.11) for Q4. In the Poisson loglinear model after adjusting by sex, ASA grade, Enhanced Recovery After Surgery (ERAS) adherence and intraoperative bleeding, RR for AKI were higher with a higher positive perioperative fluid balance (quadratic nonlinear P < 0.01). CONCLUSIONS: In this secondary analysis, we found that higher positive perioperative fluid balance during the first 24 h was associated with an increased risk of postoperative acute kidney injury in patients undergoing elective colorectal surgery. TRIAL REGISTRATION: Clinicaltrials.com identifier: NCT03012802.
3. Blood culture practices and microbiological capacity for sepsis diagnostics in Europe (2021-2022): a cross-sectional analysis of the European Sepsis Care Survey.
From 907 European hospitals, blood culture guidelines existed in 84.4%, but recommended practices were inconsistently followed. Only 10% had 24/7 microbiology and 7.4% had both continuous service and rapid testing, which markedly improved the probability of final results within two days (e.g., OR 4.59 for ward-collected BCs).
Impact: System-level diagnostics capacity directly influences antimicrobial timing and outcomes in sepsis; this continental snapshot identifies actionable gaps and infrastructure targets for health systems.
Clinical Implications: Prioritize investment in 24/7 microbiology and rapid identification workflows; standardize multi-set, multi-site BC collection; and streamline transport to expedite time-to-results and optimize empiric-to-targeted therapy transitions.
Key Findings
- Across 907 hospitals, 84.4% reported having blood culture guidelines, but recommended collection practices were inconsistently applied.
- Only 10.0% had around-the-clock microbiology services and 43.7% had rapid pathogen identification; just 7.4% had both.
- Hospitals with both continuous service and rapid testing had higher probability of final results within 2 days (wards: 19.6% vs 52.7%; OR 4.59; p<0.0001).
Methodological Strengths
- Large pan-European sample spanning 37 countries and 907 hospitals
- Detailed assessment of both preanalytical practices and laboratory infrastructure
Limitations
- Cross-sectional, self-reported survey susceptible to reporting bias
- Lacks patient-level outcome linkage to quantify impact of delays
Future Directions: Evaluate the clinical and economic impact of implementing 24/7 microbiology and rapid diagnostics using stepped-wedge or before–after designs across hospital networks.
BACKGROUND: Blood cultures (BCs) are key diagnostic elements for sepsis patients. Accurate preanalytical procedures are substantial, and results should be available as soon as possible to guide adequate antimicrobial treatment. This study aimed to evaluate BC collection practices and diagnostic capacity across European hospitals. METHODS: This cross-sectional survey investigated BC diagnostics in acute care hospitals across 37 European countries in the years 2021 and 2022. Analyses included BC guidelines, collection sites, number of BC sets in emergency departments (EDs), wards, and intensive care units (ICUs). We also examined transfer after collection, the use of on-site vs. external laboratories, opening hours, rapid testing capacity, and turn-around times of BCs processed in microbiology laboratories with different infrastructures. FINDINGS: Responses were collected from 907 hospitals in Europe. BC guidelines were available in 84·4% (741/878) of the hospitals. BCs were preferably collected by multiple-site sampling in EDs (62·7%, 461/735), in wards (64·0%, 513/802) and ICUs (68·5%, 518/756). One BC set was preferred in EDs in 38·4% (270/704), in wards in 40·5% (314/775), and ICUs in 34·9% (261/748). Two BC sets were preferred in EDs in 31·0% (218/704), in wards in 28·1% (218/775), and ICUs in 39·2% (293/748). 48·0% (402/838) of hospitals used on-site and 52·0% (436/838) external microbiology laboratories. Around-the-clock microbiological services were available in 10⋅0% (91/907), and rapid pathogen identification in 43·7% (396/907) of hospitals. Infrastructure with around-the-clock microbiological service and rapid testing was available in 7·4% (62/840) of hospitals, and probability of a final microbiological result within two days was highest in these hospitals compared to hospitals with limited microbiology service (for BC collected on wards: 19·6% vs. 52·7%, Odds Ratio 4·59 [95% CI 2·50-7·79], p < 0·0001). INTERPRETATION: Despite the availability of BC guidelines in many hospitals, current recommendations for BC collection were often neglected. Rapid testing capacity was limited in most microbiological laboratories, and around-the-clock service for BCs was very rare. As delay in results may have a detrimental impact on patient outcomes, strategies to improve these processes are urgently needed. FUNDING: The European Sepsis Alliance and a grant by Becton and Dickinson.