In people aged 90 and over, frailty before elective surgery was linked to two-thirds higher mortality at a year

The edition in brief

Today's anaesthesiology edition leads on frailty in the very old. An Anaesthesia analysis of the Australian and New Zealand intensive care registry matched 2699 frail and 2699 non-frail patients aged 90 and over admitted to ICU after elective surgery. ICU mortality was low and similar, but frailty was associated with higher in-hospital mortality (HR 1.66) and one-year mortality (HR 1.66, 95% CI 1.47 to 1.87), and with lower odds of returning home. A BJA meta-analysis of 58 studies (13,530 patients) found fibrinogen concentrate for acquired hypofibrinogenaemia was associated with fewer red cell (IRR 0.72), plasma (0.69) and platelet (0.56) units in adults, driven mainly by cardiac surgery, without more thrombosis or death. A US National Inpatient Sample analysis of 41.6 million surgical admissions associated HIV with higher in-hospital mortality after adjustment (OR 1.66). A triple-blind trial of 80 ACL reconstructions found IPACK and selective tibial nerve block gave similar 24-hour morphine use and function. A pragmatic trial of 7294 cognitively impaired surgical patients found an AI-driven, non-interruptive decision support tool did not change adherence to delirium best practice. The pearl covers a delirium prevention bundle that needs no software.