Summary Published data suggest that the type of general anaesthesia used during surgical resection for cancer may impact on patient long‐term outcome. However, robust prospective clinical evidence is essential to guide a change in clinical practice. We explored the feasibility of conducting a randomised controlled trial to investigate the impact of total intravenous anaesthesia with propofol vs. inhalational volatile anaesthesia on postoperative outcomes of patients undergoing major cancer surgery. We undertook a randomised, double‐blind feasibility and pilot study of propofol total intravenous anaesthesia or volatile‐based maintenance anaesthesia during cancer resection surgery at three tertiary hospitals in Australia and the USA. Patients were randomly allocated to receive propofol total intravenous anaesthesia or volatile‐based maintenance anaesthesia. Primary outcomes for this study were successful recruitment to the study and successful delivery of the assigned anaesthetic treatment as per randomisation arm. Of the 217 eligible patients approached, 146 were recruited, a recruitment rate of 67.3% (95%CI 60.6–73.5%). One hundred and forty‐five patients adhered to the randomised treatment arm, 99.3% (95%CI 96.2–100%). Intra‐operative patient characteristics and postoperative complications were comparable between the two intervention groups. This feasibility and pilot study supports the viability of the protocol for a large, randomised controlled trial to investigate the effect of anaesthesia technique on postoperative cancer outcomes. The volatile anaesthesia and peri‐operative outcomes related to cancer (VAPOR‐C) study that is planned to follow this feasibility study is an international, multicentre trial with the aim of providing evidence‐based guidelines for the anaesthetic management of patients undergoing major cancer surgery.

Objectives “Enhanced recovery after surgery” (ERAS) protocols use a multisystem approach to target homeostatic physiology via opioid-minimizing analgesia. The aim of this study is to determine if an ERAS protocol for lower extremity bypass surgery improves pain control and decreases narcotics. Methods From July 2020 through June 2021, all patients that underwent infrainguinal lower extremity bypass procedures were subject to the ERAS protocol and compared to a “pre-ERAS” group between June 2016 through May 2020. Preoperatively, ERAS patients were given celecoxib, gabapentin, and acetaminophen while postoperatively they were given standing acetaminophen, gabapentin, ketorolac, and tramadol with as needed use of oxycodone. Pain scores were recorded using a numerical rating pain scale. Demographics, length of stay, 30-day complications, and disposition metrics were recorded. Results There were 50 patients in the ERAS group, compared to 114 before its implementation. The mean age was 70.5 (ERAS group) versus 68.7 (pre-ERAS group) and a majority were male ( P > .05). Enhanced recovery after surgery patients were less likely to have chronic kidney disease ( P = .01). Enhanced recovery after surgery patients had improved length of stay (3.6 ± 2.3 days vs 4.8 ± 3.2 days, ERAS vs pre-ERAS, P = .01). There was no significant difference between groups for the remaining demographics ( P > .05). One patient (2%) in the ERAS group used patient-controlled analgesia, compared to 30 patients (26%) in the pre-ERAS group ( P < .001). Cumulative pain control in the first 12 hours was significantly better in the ERAS group ( P = .05). Pain control at discharge was similar between the 2 groups (3 pain score vs 3 pain score, pre-ERAS vs ERAS, P > .05) Conclusion Our study utilized a multisystem approach to optimize the physiologic stress response to vascular surgery while reducing high potency narcotic use. We show that an ERAS protocol provides noninferior pain control with less potent pain medication and improves the length of stay for patients undergoing infrainguinal bypass surgery.

Objectives: COVID-19 resulted in severe disruptions to vascular surgery services across the country. Contributors to this backlog include pandemic-related restrictions in elective procedures, fewer patients presenting for care due to fear of infection, and pandemic-related diversion of health care personnel. If services are to regain normalcy, it is important to quantify the deficit of vascular care accrued during the pandemic. This will facilitate accurate anticipation and efficient planning for the required increase in vascular services in the coming months.Methods: We reviewed vascular procedures performed at all 170 Veterans Affairs Hospitals nationwide between January 1, 2018 and December 31, 2020. Procedures were divided into six categories based on Current Procedural Terminology codes: amputation, aortic, carotid, dialysis access, endovascular (diagnosis and/or intervention), and lower-extremity revascularization (open bypass and/or endarterectomy). The rates of procedures by category were calculated per month. The monthly case-backlog in each category was calculated starting January 2020 as the difference between procedures performed in 2020 and the average of procedures performed in the 2 prior years. These monthly case-backlogs were summed to calculate cumulative monthly and annual case-backlogs for 2020. The 2020 monthly case numbers were standardized relative to the 2 prior years.Results: During the study period, a total of 51,749 vascular procedures in the six selected categories were performed at a Veterans Affairs hospital: