Daily Anesthesiology Research Analysis

This retrospective comparative-effectiveness study emulated a target trial among 17,027 adults with ASA physical status III or higher undergoing moderate- to high-risk elective noncardiac surgery. Noninferiority of virtual consultation for 90-day major morbidity or mortality was inconclusive, whereas length of stay, costs, and days alive and at home were noninferior, with lower carbon emissions associated with virtual care.

Impact: This is one of the largest real-world evaluations of virtual preoperative anesthesiology consultation and directly addresses whether rapid expansion of telemedicine compromises perioperative safety. Its inconclusive primary result is clinically informative because it supports selective implementation rather than universal substitution of in-person assessment.

Clinical Implications: Virtual consultations may be appropriate for selected patients and healthcare pathways, particularly when access, travel burden, or sustainability is important. High-risk patients should not automatically be shifted to virtual assessment until triage criteria and additional safety data are established.

Future Directions: Future studies should prospectively evaluate risk-stratified triage algorithms, assess patient subgroups that require physical examination, and determine whether hybrid consultation pathways can preserve safety while maximizing access and environmental benefits.

This systematic review and modified Delphi consensus study evaluated 122 acute kidney injury biomarker diagnostic-accuracy studies. Reporting quality was poor: only 16 studies were judged high quality by QUADAS-2, and compliance with STARD was insufficient for meta-analysis. The international expert panel developed STARDaki, extending STARD guidance with criteria for patient selection, reference standards, and test-retest reliability.

Impact: Rather than promoting another biomarker, this paper addresses a foundational problem: unreliable and non-comparable evidence generation. STARDaki could improve reproducibility, reduce exaggerated diagnostic estimates, and make future acute kidney injury biomarker studies more clinically actionable.

Clinical Implications: Clinicians and investigators should require transparent reporting of patient selection, timing of sampling, reference standards, and test-retest reliability before adopting AKI biomarkers. Regulatory, guideline, and journal processes may use STARDaki to improve evidence appraisal.

Future Directions: Prospective multicenter studies should apply STARDaki from protocol development through publication, with standardized reference standards, prespecified sampling windows, external validation, and test-retest assessments.

This multicenter randomized factorial feasibility trial included 483 ASA physical status III to V patients undergoing major surgery under general anesthesia. The study achieved separation between ventilatory interventions but did not meet its feasibility targets. Most postoperative outcomes did not differ, while higher PEEP levels were associated with more arrhythmias and lower inspired-oxygen targets were associated with more intraoperative hypoxemia.

Impact: The study challenges the assumption that higher PEEP or lower oxygen exposure is automatically beneficial in high-risk surgical patients. Its negative and feasibility findings are valuable for designing definitive trials and caution against routine escalation of ventilatory settings without patient-specific justification.

Clinical Implications: Routine use of higher PEEP should be approached cautiously in high-risk patients because of a possible arrhythmia signal. Oxygen targets should be individualized, with close monitoring for hypoxemia when lower inspired-oxygen concentrations are used.

Future Directions: A larger definitive multicenter trial should use the observed feasibility data to refine protocol adherence, stratify patients by pulmonary and cardiovascular risk, and prospectively assess clinically important pulmonary, cardiac, and patient-centered outcomes.