Study objective Our goal is to review the outcomes of acute hypertensive/hypotensive episodes from articles published in the past 10 years that assessed the short- and long-term impact of acute hypertensive/hypotensive episodes in the perioperative setting. Methods We conducted a systematic peer review based upon PROSPERO and Cochrane Handbook protocols. The following study characteristics were collected: study type, author, year, population, sample size, their definition of acute hypertension, hypotension or other measures, and outcomes (probabilities, odds ratio, hazard ratio, and relative risk) and the p-values; and they were classified according to the type of surgery (cardiac and non-cardiac). Results A total of 3,680 articles were identified, and 66 articles fulfilled the criteria for data extraction. For the perioperative setting, the number of articles varies by outcome: 20 mortality, 16 renal outcomes, 6 stroke, 7 delirium and 34 other outcomes. Hypotension was reported to be associated with mortality (OR 1.02–20.826) as well as changes from the patient’s baseline blood pressure (BP) (OR 1.02–1.36); hypotension also had a role in the development of acute kidney injury (AKI) (OR 1.03–14.11). Postsurgical delirium was found in relation with BP lability (OR 1.018–1.038) and intra- and postsurgical hypotension (OR 1.05–1.22), and hypertension (OR 1.44–2.34). Increased OR (37.67) of intracranial hemorrhage was associated to postsurgical systolic BP >130 mmHg. There was a wide range of additional diverse outcomes related to hypo-, hypertension and BP lability. Conclusions The perioperative management of BP influences short- and long-term effects of surgical procedures in cardiac and non-cardiac interventions; these findings support the burden of BP fluctuations in this setting.

(1) Background and aim: This study aimed to investigate the impact of prehabilitation on the postoperative outcomes of heart transplantation and its cost-effectiveness. (2) Methods: This single-center, ambispective cohort study included forty-six candidates for elective heart transplantation from 2017 to 2021 attending a multimodal prehabilitation program consisting of supervised exercise training, physical activity promotion, nutritional optimization, and psychological support. The postoperative course was compared to a control cohort consisting of patients transplanted from 2014 to 2017 and those contemporaneously not involved in prehabilitation. (3) Results: A significant improvement was observed in preoperative functional capacity (endurance time 281 vs. 728 s, p < 0.001) and quality-of-life (Minnesota score 58 vs. 47, p = 0.046) after the program. No exercise-related events were registered. The prehabilitation cohort showed a lower rate and severity of postoperative complications (comprehensive complication index 37 vs. 31, p = 0.033), lower mechanical ventilation time (37 vs. 20 h, p = 0.032), ICU stay (7 vs. 5 days, p = 0.01), total hospitalization stay (23 vs. 18 days, p = 0.008) and less need for transfer to nursing/rehabilitation facilities after hospital discharge (31% vs. 3%, p = 0.009). A cost-consequence analysis showed that prehabilitation did not increase the total surgical process costs. (4) Conclusions: Multimodal prehabilitation before heart transplantation has benefits on short-term postoperative outcomes potentially attributable to enhancement of physical status, without cost-increasing.

medication administration. Analysis of the reality will serve as a base to develop suggestions leading to preventive and corrective actions with consequences for the quality of nursing care provided.One of the risk areas of nursing care is timing drug administration with food as well as food and drink composition. The partial goal was to explore this reality and identify suboptimal and potentially hazardous practices. Material and methods The research was implemented in four selected cooperating hospitals, specifically in three of their wardssurgical, internal, and follow-up wards in the form of a prospective, multicentric, observation-intervention study. In the first part of this study, all nurses administering medications to all patients hospitalised in each of the above-stated wards during the observation period (morning, noon, evening) were observed by a team of unshadowed external investigators (pharmacist and nurse) for three consecutive days. Data were recorded onto a preprepared recording sheet and subsequently typed into a web database.Results During this study, 58 nurses administrating 5330 solid oral drugs for 313 patients over 36 days were observed. We discovered that the timing of the food was suboptimal and potentially severe in 18.1% and 2.4% of cases, respectively. In order to ingst a drug, tea was used in 63% of cases, still water in 22% of cases and coffee with milk in nearly 5.8% of cases. Potentially significant drink-drug interactions were identified in nearly 1.5% of cases. Conclusion and relevanceWe found that little or no attention was paid to appropriate food, drink and drug management on the wards. These primary data will be used for interventions in this study and as the base for further research.

No abstract