30-Second Takeaway
- Home-based prehabilitation for frail older adults did not improve postoperative disability or complications vs usual care.
- Driving pressure–guided high PEEP with recruitment maneuvers failed to reduce pulmonary complications and increased intraoperative hypotension.
- TAP blocks reduce early pain and opioid use vs placebo or local infiltration but are generally less effective than epidural analgesia.
- Liposomal or plain bupivacaine TAP blocks showed no benefit over saline in ERAS major abdominal surgery.
- Early reintervention after EVAR/FEVAR and protocolized TBAD management strongly influence long-term aortic outcomes and surveillance needs.
Week ending December 6, 2025
New evidence reshapes perioperative pathways, analgesia choices, and vascular risk stratification
Home-based prehabilitation failed to improve outcomes in frail older elective surgery patients
In this multicenter pragmatic RCT, 847 frail adults ≥60 years undergoing elective noncardiac inpatient surgery were randomized to home-based prehabilitation vs usual care. Prehabilitation consisted of coached multimodal exercise and personalized nutrition over a median of 4 weeks, with control patients given generic public guidance. There was no meaningful reduction in 30-day postoperative disability scores or in-hospital complications with prehabilitation compared with usual care. Preoperative safety events were similar, indicating the program was safe but ineffective at improving early functional or clinical outcomes.
Driving pressure–guided high PEEP did not reduce pulmonary complications after open abdominal surgery
This 1,435-patient RCT compared driving pressure–guided high PEEP with recruitment maneuvers to standard low PEEP without recruitment during open abdominal surgery. All patients received low tidal volume ventilation; the composite 5-day pulmonary complication rate was similar between high-PEEP and low-PEEP groups (19.8% vs 17.4%). High PEEP increased intraoperative hypotension and vasoactive requirements, while low PEEP had more brief desaturation events. These findings do not support routine use of individualized high PEEP with recruitment maneuvers for abdominal cases at pulmonary risk.
TAP blocks reduce pain and opioid use but underperform epidurals for abdominal surgery
This systematic review and meta-analysis included 123 RCTs evaluating TAP blocks for abdominal surgery analgesia. Compared with placebo, TAP blocks significantly improved early postoperative pain scores and reduced 24-hour opioid consumption. Versus local infiltration, TAP blocks also produced substantial reductions in pain at 6, 12, and 24 hours and in 24-hour morphine use. Relative to epidural analgesia, TAP blocks provided less consistent benefit, with only 12-hour pain modestly improved and no advantage over intrathecal morphine. Overall, TAP blocks are effective opioid-sparing adjuncts but generally inferior to neuraxial techniques for extensive abdominal surgery.
Salaried reimbursement associated with substantially less low-value musculoskeletal surgery
This TRICARE claims cohort compared low-value elective orthopedic procedures in direct-care (largely salaried) vs private sector (fee-for-service) settings from 2016 to 2023. Among 304,908 procedures, low-value surgery comprised 20% of direct-care vs 35% of private-sector cases. After case-mix adjustment, private-sector care had higher odds of low-value surgery (OR 1.41; 95% CI, 1.38-1.45). Low-value surgery rates declined over time in both settings but remained consistently lower with salaried reimbursement. These data suggest payment structure materially shapes operative decision-making and overuse for common musculoskeletal procedures.
References
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Additional Reads
Optional additional studies from this edition.