Full author information is available at the end of the article Greet Van den Berghe, Alexander Wilmer, Rik Gosselink and Greet Hermans have equally contributed. The members of the COVID-19 consortium are listed in "Acknowledgements".

Postoperative nausea and vomiting (PONV) is one of the most unpleasant experiences after surgery. It reduces patient satisfaction and also increases hospital costs due to longer hospitalizations. The aim of this prospective study was to determine whether orthognathic surgery is associated with more PONV than less invasive maxillofacial surgery. Three hundred and eight patients aged 8-87 years who underwent maxillofacial surgery were included. The PONV score, based on the Apfel score, was calculated preoperatively. PONV occurred in 142 (46.1%) patients during the first three postoperative days; these patients were further categorized as having postoperative nausea (PON) and/or postoperative vomiting (POV). PON was most frequent after orthognathic surgery to the mandible (75%), and POV was most frequent after maxillary surgery, including bimaxillary surgery, Le Fort I osteotomy, and surgically assisted rapid palatal expansion (SARPE) (43.1%). There was a small significant relationship between the preoperative PONV score and the incidence of PONV: patients experienced more PONV when the PONV score calculated preoperatively was higher. The incidence of PONV after orthognathic surgery was very high compared with the incidence after dental extractions and other minor surgeries. Further investigation is required to establish a strategy to reduce PONV after orthognathic surgery.

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

There is no good evidence that epidural analgesia causes reduced breastfeeding success. Good lactation support is critical.

Background Pain therapy in inpatients is regularly suboptimal and might be improved by clinical pharmacy services. In our hospital, we have implemented a software‐supported ‘Check of Medication Appropriateness’ (CMA), which is a centralized pharmacist‐led service consisting of a clinical rule‐based screening for potentially inappropriate prescriptions (PIPs), and a subsequent medication review by pharmacists. We aimed to investigate the impact of the CMA on pain‐related prescribing. Methods A quasi‐experimental study was performed in a large teaching hospital, using an interrupted time series design. Pre‐implementation, patients were exposed to standard of care. Afterwards, a pain‐focused CMA comprising 12 specific clinical rules pertaining to analgesic prescribing were implemented in the post‐implementation period. A regression model was used to assess the impact of the intervention on the number of pain‐related residual PIPs between both periods. The total number of recommendations and acceptance rate was recorded for the post‐implementation period. Results At baseline, a median number of 13.1 (range: 9.5–15.8) residual PIPs per day was observed. After the CMA intervention, the number was reduced to 2.2 (range: 0–9.5) per day. Clinical rules showed an immediate relative reduction of 66% (p < .0001) in pain‐related residual PIPs. A significant decreasing time trend was observed during the post‐implementation period. Post‐implementation, 1683 recommendations were given over 1 year with an acceptance rate of 74.3%. Conclusions We proved that the CMA approach reduced the number of pain‐related residual PIPs. More pharmacist involvement and the use of clinical rules during hospital stay should be further promoted to optimize appropriate prescribing of analgesics. Significance Prescribing of analgesics should be improved in inpatients to optimize pain control and to reduce iatrogenic harm. The Check of Medication Appropriateness (CMA) approach, comprising a clinical rule‐based screening for patients at risk and a targeted medication review by pharmacists, reduced the number of pain‐related potentially inappropriate prescriptions in a highly significant and sustained manner. This study presents the opportunities of a centralized clinical pharmacy service to help clinicians to further improve analgesic prescribing.