Authors: Cha et al.
The Daily Dose, IARS, Friday, May 8, 2026
Key Points
A late-breaking clinical trials session at the 2026 IARS and SOCCA Annual Meeting highlighted several important studies aimed at improving perioperative outcomes.
The TRACTION trial found that tranexamic acid reduced transfusion requirements in major nonorthopedic and noncardiac surgery without increasing thromboembolic complications.
The VITAL trial is evaluating whether volatile anesthesia or total intravenous anesthesia leads to better recovery after major noncardiac surgery.
The EPOCH CardioLink-10 trial showed favorable early results for superficial parasternal intercostal plane blocks after cardiac surgery with sternotomy.
The FIT After Surgery study emphasized that long-term disability after major surgery in older adults is common and should be part of perioperative counseling and risk prediction.
Summary
This IARS Daily Dose article reviewed several major studies presented during the International Clinical Trials Program late-breaking session at the 2026 IARS and SOCCA Annual Meeting. The session focused on clinical research that may help shape future perioperative practice, although some results were still pending publication at the time of the presentation.
The first study discussed was TRACTION, a phase IV randomized trial evaluating a hospital policy of tranexamic acid use in major noncardiac, nonorthopedic surgery. While tranexamic acid is already commonly used in orthopedic and cardiac surgery, it has been less frequently used in other major operations with high bleeding risk. In TRACTION, high-risk surgery was defined as procedures historically associated with more than a 5% transfusion rate. The study found that tranexamic acid reduced transfusion rates without increasing thromboembolic complications during the 3 months after surgery. Secondary outcomes such as length of stay and survival were not significantly different between groups. The article noted that TXA use in this setting could potentially save about 15 units of packed red blood cells for every 100 patients treated.
The second trial highlighted was VITAL, which compared volatile anesthesia with total intravenous anesthesia for major noncardiac surgery. This pragmatic randomized trial focused on adults 50 years and older undergoing elective major surgery in the United Kingdom. The study examined outcomes such as days alive and at home 30 days after surgery, survival, quality of recovery, longer-term recovery measures, 6-month mortality, and patient satisfaction. The article emphasized the potential system-wide impact of even small improvements in hospital length of stay, noting that a reduction of only half a day could lead to major savings for the National Health Service. The full data had not yet been published at the time of the report.
The article also described the EPOCH CardioLink-10 trial, which evaluated superficial parasternal intercostal plane blocks for patients undergoing cardiac surgery through median sternotomy. Poor pain control after sternotomy can contribute to persistent pain, opioid use, pulmonary complications, delayed mobilization, and longer hospitalization. This multicenter, double-blind, placebo-controlled randomized trial studied whether SPIP blocks could reduce opioid exposure during the first 72 hours after cardiac surgery. The detailed results were still embargoed, but the article stated that the findings were favorable for the block, without significant safety concerns or increased complication rates.
Finally, the FIT After Surgery study examined functional recovery in adults 65 years and older after major elective noncardiac surgery. This study is important because traditional perioperative outcomes often focus on survival, complications, and discharge, while older patients may be equally or more concerned with independence, mobility, cognition, and return to baseline function. The study found that new disability or death occurred in 1 in 6 patients at 6 months and 1 in 5 patients at 1 year. Risk factors included frailty, mobility limitations, cognitive impairment, open surgical procedures, smoking history, and poor social support. These findings support a more individualized approach to preoperative risk counseling, especially for older adults.
What You Should Know
This article highlights the growing importance of perioperative medicine beyond the operating room. The studies discussed focus not only on immediate anesthesia outcomes, but also on transfusion avoidance, recovery quality, opioid reduction, functional independence, and long-term disability.
For anesthesia providers, the TRACTION findings may support broader use of tranexamic acid in selected high-bleeding-risk noncardiac surgeries. The VITAL trial may help answer whether anesthetic technique meaningfully affects recovery after major surgery. The EPOCH CardioLink-10 trial adds to the growing interest in regional analgesia for sternotomy pain, while FIT After Surgery reminds clinicians that long-term disability is a major postoperative outcome, especially in older adults.
Overall, these studies reflect a shift toward measuring outcomes that matter deeply to patients: getting home, avoiding transfusion, reducing opioids, maintaining independence, and recovering function after surgery.
Thank you to IARS and The Daily Dose for allowing us to summarize and share this article.