Objective:To identify the risk factors for perioperative cardiac arrest (POCA) in elderly patients undergoing general anesthesia.Methods:This case-control study enrolled elderly patients aged ≥60 yr who underwent surgery under general anesthesia at Peking Union Medical College Hospital between January 1, 2013, and November 30, 2024. The case group consisted of patients who experienced POCA, defined as cessation of cardiac mechanical activity and loss of effective circulation, requiring immediate chest compressions and/or defibrillation within 24 h from entering the operating room to the end of anesthesia. The control group consisted of elderly patients without POCA, matched to cases by sex and date of surgery in a ratio of 1∶3. Univariate analysis and multivariate logistic regression were performed to identify independent risk factors for POCA based on patients′ baseline and surgical characteristics.Results:A total of 53 POCA cases and 159 matched controls were included. The results of multivariate logistic regression analysis identified an American Society of Anesthesiologists Physical Status classification of ≥Ⅲ ( OR=4.90, 95% confidence interval [ CI] 2.21-10.89, P<0.001) and the presence of peripheral vascular disease ( OR=2.53, 95% CI 1.10-5.81, P=0.028) as independent risk factors for POCA. Higher preoperative hemoglobin concentration was found to be a protective factor ( OR=0.97, 95% CI 0.95-0.99, P<0.001). Conclusions:An American Society of Anesthesiologists Physical Status classification of ≥Ⅲ and comorbid peripheral vascular disease are independent risk factors for POCA in elderly patients undergoing general anesthesia, while higher preoperative hemoglobin concentration serves as a protective factor.

Objective:To identify the risk factors for perioperative cardiac arrest (POCA) in elderly patients undergoing general anesthesia.Methods:This case-control study enrolled elderly patients aged ≥60 yr who underwent surgery under general anesthesia at Peking Union Medical College Hospital between January 1, 2013, and November 30, 2024. The case group consisted of patients who experienced POCA, defined as cessation of cardiac mechanical activity and loss of effective circulation, requiring immediate chest compressions and/or defibrillation within 24 h from entering the operating room to the end of anesthesia. The control group consisted of elderly patients without POCA, matched to cases by sex and date of surgery in a ratio of 1∶3. Univariate analysis and multivariate logistic regression were performed to identify independent risk factors for POCA based on patients′ baseline and surgical characteristics.Results:A total of 53 POCA cases and 159 matched controls were included. The results of multivariate logistic regression analysis identified an American Society of Anesthesiologists Physical Status classification of ≥Ⅲ ( OR=4.90, 95% confidence interval [ CI] 2.21-10.89, P<0.001) and the presence of peripheral vascular disease ( OR=2.53, 95% CI 1.10-5.81, P=0.028) as independent risk factors for POCA. Higher preoperative hemoglobin concentration was found to be a protective factor ( OR=0.97, 95% CI 0.95-0.99, P<0.001). Conclusions:An American Society of Anesthesiologists Physical Status classification of ≥Ⅲ and comorbid peripheral vascular disease are independent risk factors for POCA in elderly patients undergoing general anesthesia, while higher preoperative hemoglobin concentration serves as a protective factor.

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

Background::Hepatitis B poses a heavy burden for children in China, however, the national studies on the distributional characteristics and health care costs of children with severe hepatitis B is still lacking. This study aimed to analyze the disease characteristics, health economic effects, and medical cost for children with severe hepatitis B in China.Methods::Based on patient information in the Hospital Quality Monitoring System, cases with severe hepatitis B were divided into four groups according to age, and the etiology and symptoms of each group were quantified. The cost of hospitalization was calculated for cases with different disease processes, and severity of disease. The spatial aggregation of cases and the relationship with health economic factors were analyzed by Moran’s I analysis. Results::The total number of children discharged with hepatitis B from January 2016 to April 2022 was 1603, with an average age of 10.5 years. Liver failure cases accounted for 43.48% (697/1603) of total cases and cirrhosis cases accounted for 11.23% (180/1603). According to the grouping of disease progression, there were 1292 cases without associated complications, and the median hospitalization cost was $818.12. According to the spatial analysis, the aggregation of cases was statistically significant at the prefectural and provincial levels in 2019, 2020, and 2021 (all P <0.05). The number of severe cases was negatively correlated with gross domestic product (Moran’s I <0) and percentage of urban population (Moran’s I <0), and positively correlated with the number of pediatric beds per million population (Moran’s I >0). Conclusion::The number of severe hepatitis B cases is low in areas with high gross domestic product levels and high urban population ratios, and health care costs have been declining over the years.

Background::Digestive system cancers constitute a significant number of cancer cases, but their burden is not uniform. As Global Cancer Observatory (GLOBOCAN) 2022 has recently updated its estimates of cancer burden, we aimed to investigate the burden of six major digestive system cancers both worldwide and in China, along with geographical and temporal variations in cancer-specific incidence and mortality.Methods::We extracted data on primary cancers of the esophagus, stomach, colorectum, liver, pancreas, and gallbladder from the GLOBOCAN database for 2022. Age-standardized incidence and mortality rates were calculated and stratified by sex, country, region, and human development index (HDI). We used the 2022 revision of the World Population Prospects (United Nations) to obtain demographic data for various age groups in China from 1988 to 2012 and used the joinpoint model and the average annual percentage change (AAPC) to analyze cancer incidence trends in China.Results::In 2022, the estimated global incidence of digestive system cancers reached 4,905,882, with an estimated 3,324,774 cancer-related deaths. Colorectal cancer was most prevalent in terms of incidence and mortality. There was a significant correlation between the burden of gastrointestinal cancers and country HDI. From 1988 to 2012, the incidence of esophageal, gastric, and liver cancers declined in China, whereas colorectal and pancreatic cancer incidences continued to increase. By 2050, colorectal and liver cancers are projected to remain the leading cancer types in China in terms of incidence and mortality, respectively.Conclusions::Digestive system cancers remain a significant public health challenge globally and in China. Although progress has been made in the prevention and control of some cancers, the burden of digestive system cancers persists. The implementation of tertiary prevention strategies must be intensified to reduce the incidence and mortality of digestive system cancers, mitigating their impact on public health.

Objective:To investigate the changes in image recognition ability and learning intentions after distance interactive learning, and to assess the teaching effect objectively and subjectively.Methods:A total of 61 physicians working in Department of Anesthesiology, Peking Union Medical College Hospital, were enrolled as subjects and received training with the distance interactive learning method, and a questionnaire survey was conducted to assess the changes in objective image recognition ability and subjective learning intentions after teaching. The paired t-test and the Wilcoxon paired rank test were used to perform statistical analyses. Results:A total of 48 anesthesiologists completed the learning and assessments. After training, there was a significant increase in the accuracy rate of recognizing the anatomical structures of the airway on ultrasound images from (45.98±18.57)% to (88.38±7.92)% ( t=14.74, P<0.001), and there was a significant reduction in misdiagnosis rate from (60.68±29.83)% to (8.53±4.34)% ( t=-6.00, P<0.001). After teaching, the accuracy rate of identifying tracheal intubation on ultrasound images increased from (42.50±19.62)% to (66.25±23.40)% ( t=-4.08, P<0.001). After teaching, the accuracy rate of comprehensive ultrasound airway assessment increased from (45.61±17.00)% to (85.80±7.69)% ( t=14.48, P<0.001), and the misdiagnosis rate decreased from (59.41±29.05)% to (8.46±4.27)% ( t=-6.00, P<0.001). After teaching, although there were reductions in the learning intentions for clinical application scenarios, ultrasound section and body surface landmarks, and ultrasound image features, there were no significant changes in the learning intentions for operation techniques. Conclusions:Distance interactive training helps anesthesiologists to improve their ability for recognition of ultrasound airway images and can meet their specific learning intentions.

Objective Using our team's recent research achievement"the cervical ultrasound scanning route map"as a teaching tool,to evaluate its impact on the learning effectiveness and confidence of beginners in the process of learning cervical spinal ultrasonography.Methods This study is a before and after self-control study.After recruit-ment of 40 cervical ultrasound beginners,they had completed questionnaire 1.The questionnaire was designed with three self-assessment questions on theoretical knowledge of cervical spinal ultrasound,three self-assessment ques-tions on practical skills of cervical spinal ultrasound and one question on willingness to use cervical spinal ultra-sound in the future.After traditional teaching without involving the route map,beginners completed questionnaire 2 with the same content.After a 20 min break,teacher introduced and explained the route map to the beginners,then the beginners completed questionnaire 3.Questions related to satisfaction with this learning experience had been added to questionnaire 3.The answers to all questions were scored on a scale of 1-10.In this study,the main out-come was the comprehensive learning score,calculated as(sum score of theoretical knowledge+sum score of prac-tical skills+score of willingness to use cervical ultrasound in the future)/7.Results Beginners'comprehensive learning score at the three time points were 2.9±1.3,4.8±1.8,5.7±1.8,F(2,22)= 52.11,P＜0.001,partial Eta squared=0.83.After introducing the route map,their comprehensive learning score increased 1.0(95%CI:0.46-1.49)(P＜0.001)compared to scores after traditional training.Conclusions The route map may significantly improve learning effectiveness and confidence of beginners in the field of cervical spinal ultrasonography and can be used as a routine training tool in the teaching of cervical spinal ultrasonography.

  Objective  This study aimed to investigate Chinese anesthesiologists' comprehension of palliative care and their experiences with palliative sedation for patients in the end-stage of life.  Methods  From October to December 2021, a national cross-sectional survey was conducted among anesthesiologists in China distributed by the Chinese Society of Anesthesiology, Chinese Medical Association with convenient sampling. The survey questionnaire encompassed general information, professional experience, familiarity with palliative care, emotional responses to end-stage cases, experience with sedation for critically ill or end-stage patients, and preferences for sedation medication.  Results  A total of 2536 anesthesiologists from 29 provinces in China completed valid questionnaires. Among them, 572 anesthesiologists(22.6%, 572/2536) reported familiarity with palliative medicine. Male anesthesiologists, as well as those with prior experience in caring for critically ill or end-stage patients, involved in pain management and practicing in hospitals with established institutional palliative care teams, demonstrated greater familiarity with palliative care concepts(all P<0.05). Over 40% of respondents felt powerless, helpless, and indecisive when confronted with end-stage patients. Anesthesiologists knowledgeable about palliative care exhibited greater confidence in managing critically ill or end-stage patients(9.8% vs. 4.4%, P=0.001). Among the anesthesiologists surveyed, 734 had administered sedation to end-stage patients, with 151 of them(20.6%, 151/734) inappropriately relying solely on opioids for sedation.  Conclusions  The understanding of palliative care and palliative sedation medication choice among anesthesiologists in China is still very limited. The establishment of palliative care teams, provision of education and training in palliative care, and enhancement of familiarity with palliative principles may bolster anesthesiologists' confidence when encountering critically ill or end-stage patients and subsequently enhance the quality of care for patients in the terminal stages of life.

  Objective  To investigate the occurrence of chronic postsurgical pain (CPSP) among patients with preoperative COVID-19, and further analyze the risk factors for CPSP.  Methods  This study was a ambispective cohort study, with subjects from a completed cohort study with follow-up. We included the clinical data of the patients with preoperative COVID-19 who underwent surgery at Peking Union Medical College Hospital from December 1, 2022 to February 28, 2023. Follow-up was conducted up to 6 months postoperatively, with the primary outcome being CPSP. Multivariate Logistic regression analysis was used to analyze the correlation between COVID-19-related exposure indicators and CPSP.  Results  A total of 4117 surgical patients were included, all of whom had preoperative COVID-19. Among them, 4002 cases had mild symptoms during the acute phase, 62 cases had severe symptoms, and 53 cases were critically ill. At 6th month postoperatively, 1298 cases (31.53%) had long COVID-19 syndrome, and the incidence of CPSP was 5.59% (95% CI: 4.88%-6.28%). After adjusting for confounding factors including age, gender, comorbidities, anesthesia method, and type of surgery, multivariate Logistic regression analysis revealed that critically ill COVID-19 during the acute phase (aOR=3.35, 95% CI: 1.48-7.62, P < 0.001) and presence of long COVID-19 syndrome postoperatively (aOR=2.50, 95% CI: 1.90-3.29, P < 0.001) were associated with CPSP.  Conclusions  It is clear for the first time that critically ill COVID-19 during the acute phase and the presence of long COVID-19 syndrome postoperatively are the risk factors for CPSP among patients with preoperative COVID-19.

  Objective  To identify the risk factors for postoperative nausea and vomiting (PONV) in surgical patients undergoing patient controlled intravenous analgesia (PCIA).  Methods  Our study was a retrospective cohort study, including patients who underwent surgery at Peking Union Medical College Hospital from July 1 to October 31, 2023 and received PCIA after surgery. Patient characteristics, medical history, surgical information, intraoperative medication information, postoperative analgesia follow-up information were obtained through the electronic medical record system. The patients were divided into PCIA-PONV group and non-PCIA-PONV group, depending on the occurrence of PONV during PCIA, and all patients were also divided into PCIA-POV group and non-PCIA-POV according to whether postoperative vomiting (POV) occurred. Multivariate Logistic regression analysis was used to identify the risk factors for PCIA-PONV and PCIA-POV.  Results  A total of 1373 patients were included in this study, with 676 cases in PCIA-PONV group. The incidence of PCIA-PONV was 49.2%. There were 285 patients in PCIA-POV group, and the incidence of PCIA-POV was 20.8%. The results of multivariate Logistic regression analysis showed that female (OR=2.134, 95% CI: 1.590-2.865, P < 0.001) and abdominal surgery (OR=1.655, 95% CI: 1.253-2.186, P < 0.001) were risk factors for PCIA-PONV, whereas the increase of age (OR=0.990, 95% CI: 0.982-0.998, P=0.019) and the increase of BMI (OR=0.961, 95% CI: 0.932-0.991, P=0.012) were protective factors for PCIA-PONV. Female (OR=2.646, 95% CI: 1.754-3.992, P < 0.001), history of general anesthesia (OR=1.372, 95% CI: 1.042-1.806, P=0.024), and intraoperative use of high-dose opioids (OR=1.607, 95% CI: 1.206-2.142, P=0.001) were risk factors for PCIA-POV, whereas no intraoperative use of neuromuscular blocking antagonists (OR=0.393, 95% CI: 0.237-0.651, P < 0.001) was protective factor for PCIA-POV.  Conclusions  Our study reveals the risk factors for PONV in surgical patients undergoing PCIA, and shows that comprehensive preoperative assessment and reasonable perioperative management strategies are significant in the prevention of PCIA-PONV.