Search Results (871)

Background: Enhanced Recovery After Surgery (ERAS) pathways have become the standard of care in elective colorectal surgery. However, implementation remains heterogeneous across institutions, and the relative contribution of ERAS pathways and minimally invasive surgery to improved postoperative outcomes remains uncertain. This study evaluated the association between ERAS implementation and short-term outcomes in two university-affiliated colorectal units with different levels of ERAS adoption. Methods: A retrospective bi-centre observational study was conducted, and comprised 802 consecutive patients who underwent elective colorectal resection between January 2016 and December 2024. Patients managed according to a standardized ERAS pathway (Group 1, n = 406) were compared with patients who received conventional perioperative care (Group 2, n = 396). Primary endpoints included postoperative morbidity, anastomotic leakage, and length of hospital stay (LOS). Secondary endpoints included mortality, readmission, postoperative complications, and hospitalization-related costs. Multivariable logistic regression was performed, adjusting for age, sex, ASA score, tumour stage, and tumour location. Results: Baseline demographic characteristics were largely comparable between groups, although patients in the conventional care group had a higher proportion of ASA III–IV status. Overall postoperative morbidity was significantly lower in the ERAS cohort (8.6% vs. 20.9%, p < 0.001), together with a lower incidence of anastomotic leakage (1.2% vs. 4.5%, p < 0.001). Median LOS was reduced from 9 to 8 days overall and, among patients who underwent laparoscopic surgery, from 6 to 4 days (p = 0.010). After multivariable adjustment, conventional perioperative management remained independently associated with higher postoperative morbidity (OR 2.62, 95% CI 1.60–4.09; p < 0.001) and anastomotic leakage (OR 1.92, 95% CI 1.01–4.98; p = 0.048). Mortality, surgical site infections, intra-abdominal abscesses, and other postoperative complications were comparable between groups. Based on regional reimbursement tariffs, ERAS implementation was associated with an estimated annual reduction of 567 hospital bed-days. Conclusions: Implementation of a standardized ERAS pathway was associated with reduced postoperative morbidity, lower anastomotic leakage rates, and shorter hospital stay after elective colorectal surgery. These benefits persisted after adjustment for major clinical confounders, supporting the effectiveness of standardized perioperative care. The greatest reduction in hospital stay was observed when ERAS was combined with minimally invasive surgery, emphasizing the complementary role of these strategies in optimizing postoperative recovery. Full article

Background and Objectives: Despite substantial advances in surgical techniques, anesthesia, and perioperative care, postoperative complications remain a major source of morbidity, mortality, prolonged hospitalization, and healthcare utilization following adult cardiac surgery (CS). Increasing evidence suggests that many of these complications are influenced by modifiable perioperative factors that can be addressed through multidisciplinary care. Materials and Methods: A narrative review was conducted to synthesize current evidence regarding perioperative practices associated with the prevention of postoperative complications in adult CS. A comprehensive literature search of PubMed/MEDLINE, Scopus, and Web of Science identified studies published between January 2015 and April 2026, supplemented by landmark studies and relevant clinical guidelines. Results: The identified evidence was organized into four major domains: infection prevention practices, physiological optimization strategies, protocol adherence and patient safety measures, and organizational and human factors. The strongest evidence supports timely antimicrobial prophylaxis, standardized infection prevention bundles, perioperative glycemic control, maintenance of normothermia, and patient blood management as key interventions associated with improved postoperative outcomes. Surgical safety checklists, standardized perioperative pathways, and adherence to evidence-based protocols further contributed to improved patient safety and consistency of care. Emerging evidence also highlighted the importance of communication, teamwork, safety culture, workload management, and healthcare professionals’ knowledge in facilitating successful implementation of perioperative interventions. Conclusions: Prevention of postoperative complications following CS requires a multidisciplinary, systems-based approach integrating evidence-based clinical interventions with standardized perioperative protocols and effective organizational practices that facilitate consistent implementation of evidence-based perioperative care. Future research should focus on prospective evaluation of integrated perioperative strategies, development of practical risk-stratification models, and further investigation of organizational determinants influencing implementation and postoperative outcomes. Full article

Background: Osteochondroma is the most common benign bone tumor in childhood. Although most lesions are asymptomatic, surgical treatment is indicated in patients with pain, mechanical symptoms, cosmetic concerns, restricted range of motion, or neurovascular compression. This study evaluated the clinical characteristics and surgical outcomes of osteochondromas in children and adolescents treated at a single tertiary pediatric surgery center. Methods: This retrospective study included 75 pediatric patients who underwent surgical excision of osteochondroma between January 2015 and January 2026. Demographic, clinical, radiological, operative, histopathological, and follow-up data were analyzed. Lesion-related variables were assessed at the level of individual exostoses. The primary outcome was surgical treatment outcome, while secondary outcomes included lesion localization, symptoms, hospital stay, postoperative complications, recurrence, and associations between clinical and morphological variables. Results: A total of 75 patients with 76 solitary osteochondromas were included. The median age was 13 years, and 64.0% of patients were male. Most lesions were located distally (73.7%), with the femur being the most common site (48.7%), followed by the tibia (22.4%). Pain was the most frequent symptom, present in 63.2% of exostoses, followed by cosmetic concern in 32.9%. Standard radiography was used in nearly all cases (98.7%). Radiographic measurements significantly underestimated lesion size compared with intraoperative measurements, with median diameters of 3.0 cm and 4.0 cm, respectively (p < 0.001). A strong positive correlation was observed between radiographic and intraoperative lesion diameter (ρ = 0.77; p < 0.001), while symptom duration showed a weak but significant correlation with lesion diameter (ρ = 0.28; p = 0.013). No significant association was found between lesion diameter and symptomatic presentation, and logistic regression did not identify age, sex, lesion location, or diameter as significant predictors of symptoms. Postoperative outcomes were favorable: 94.6% of patients had no complications, wound infection and hematoma occurred in 2.7% each, and no recurrences or reoperations were recorded during a median follow-up of 63 months. Histopathological examination confirmed osteochondroma in all cases. Conclusions: Surgical excision of symptomatic pediatric osteochondromas was associated with favorable postoperative outcomes, a low complication rate, and no observed recurrence during follow-up. Standard radiography correlates well with intraoperative findings but may underestimate true lesion size, likely due to limited visualization of the cartilaginous cap. Symptom development appears multifactorial and cannot be reliably predicted by lesion size or location alone. Full article

Background: Preoperative screening for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) is intended to identify patients at increased risk of surgical site infection and guide decolonization and perioperative antimicrobial prophylaxis. However, many molecular assays reduce this decision to a binary positive/negative result, potentially obscuring clinically important distinctions in organism identity, methicillin resistance attribution, and mupirocin resistance risk. Methods: This structured narrative review organized direct perioperative evidence and indirect mechanistic, implementation, and economic evidence around one question: how MRSA/MSSA screening can move from organism detection to actionable molecular triage. Results: Useful preoperative reporting depends on assigning resistance markers to the correct organism. The proposed multi-target NAAT framework organizes concordant and discordant molecular patterns into provisional reportable categories, including MSSA, MRSA, methicillin-resistant non-aureus Staphylococcus/CoNS, mixed populations, SCCmec dropout patterns, mupirocin resistance marker states, and invalid or indeterminate results. No externally validated composite score, universal molecular cutoff, or prospectively validated target-to-action decision rule currently links all of these categories to specific perioperative actions. Conclusions: Preoperative MRSA/MSSA screening may benefit from moving beyond binary reporting, but the framework presented here is a development-stage rule set rather than a validated clinical decision instrument. Assay-specific analytical thresholds, locked target combination rules, and prospective clinical and implementation validation are required before the framework can be used to assign patients reproducibly to management pathways. Until such validation is completed, the proposed categories should be interpreted as a testable reporting and validation architecture rather than as universal prophylaxis or decolonization instructions. Full article

Background and Clinical Significance: Anti–myelin-associated glycoprotein (MAG) antibody polyneuropathy is a rare, chronic IgM-mediated demyelinating peripheral neuropathy predominantly affecting sensory nerves in older adults, commonly in association with monoclonal gammopathy of undetermined significance. Reports describing anesthetic management in patients with this condition remain extremely limited, and no specific guidelines currently exist regarding neuromuscular blocking agent (NMBA) use or neuromuscular monitoring in this population. Case Presentation: A 79-year-old man with anti-MAG antibody polyneuropathy (diagnosed in 2007) and IgM monoclonal gammopathy of undetermined significance developed disproportionate progressive lower-extremity weakness and became wheelchair-dependent following COVID-19 infection in 2020. Preoperative evaluation revealed mildly reduced left ventricular function (ejection fraction 49%), mild chronic kidney disease, and marked intrinsic hand muscle atrophy with absent deep tendon reflexes. He was scheduled for robot-assisted radical cystectomy with ileal conduit diversion under combined general and thoracic epidural anesthesia. Before NMBA administration, neuromuscular monitoring was systematically attempted at the ulnar nerve (electromyography and acceleromyography, up to 60 mA/300 μs) and the corrugator supercilii; despite visible muscle contractions following peripheral nerve stimulation, neither modality produced reliable responses at either site. Given the inability to establish reliable monitoring, the administration of NMBAs was considered to carry an unacceptable risk of a prolonged, undetectable blockade. Anesthesia was maintained with deep sevoflurane (2.0–2.5% end-tidal) and remifentanil infusion without NMBAs, titrated to a bispectral index of 40–60. Tracheal intubation was accomplished via video laryngoscopy without NMBA. The 7 h and 30 min surgery was completed without patient movement or surgical compromise. Postoperatively, the patient developed transient upper airway obstruction attributed to glossoptosis, managed successfully with head elevation and nasopharyngeal airway insertion; supplemental oxygen was required until postoperative day 3, and the patient was discharged from the high-dependency unit on postoperative day 5. Conclusions: No measurable quantitative neuromuscular response could be obtained in this patient with advanced anti-MAG antibody neuropathy, despite appropriate application of electromyography- and acceleromyography-based monitoring and the presence of visible muscle contractions following peripheral nerve stimulation. In such circumstances, avoiding NMBA administration in favor of deep volatile or intravenous anesthesia with opioid supplementation may represent a reasonable, hypothesis-generating approach in carefully selected patients; this observation does not establish the general superiority of an NMBA-free strategy, and caution is warranted before generalizing it to procedures such as robotic surgery, in which profound neuromuscular blockade is often considered desirable. Full article

Background/Objectives: Traumatic spinal injury (TSI) is associated with substantial morbidity, but factors contributing to in-hospital complications remain insufficiently defined. This study evaluated factors associated with in-hospital complications after TSI. Methods: We conducted a retrospective cohort study at a tertiary center (January 2018–May 2025). Among 5380 trauma patients screened by computed tomography, 413 admitted patients with TSI were included. The primary outcome was any documented in-hospital complication. Factors were assessed using multivariable logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: The median age was 28.0 years, 337 were male (81.6%), and four-wheel motorized vehicle accidents were the most common injury mechanism (57.1%). In-hospital complications occurred in 99 patients (24.0%). Pulmonary infection was most common (9.9%), followed by bloodstream infection (4.4%), urinary tract infection (3.9%), and surgical site infection (3.9%). Compared with patients without complications, those with complications had longer hospital stays, higher ICU admissions, longer ICU stays, and lower discharge home. In multivariate logistic regression, complications were associated with worse AIS grade (OR 1.690, 95% CI 1.241–2.302), inpatient physical therapy requirement (OR 4.385, 95% CI 2.494–7.711), greater number of associated non-spinal injuries (OR 1.729, 95% CI 1.463–2.042), and greater cervical vertebral injury burden (OR 1.479, 95% CI 1.061–2.062). Conclusions: Neurological severity, polytrauma burden, and cervical injury were independently associated with complications, supporting early risk stratification and multidisciplinary prevention in high-risk patients. Findings should be interpreted considering the retrospective single-center design, predominantly young male cohort, low spinal cord injury proportion, and limited post-discharge data. Full article

Background: Acinetobacter baumannii is an important opportunistic pathogen responsible for healthcare-associated infections, particularly among critically ill, intensive care unit (ICU), and post-surgical patients. The emergence of carbapenem-resistant A. baumannii (CRAB) has become a major therapeutic challenge worldwide because of its multidrug-resistant nature and limited treatment options. Despite the increasing prevalence of CRAB in Pakistan, information regarding the molecular characterization of carbapenem resistance genes among isolates recovered from surgical site infections (SSIs) remains limited. Methods: A cross-sectional study was conducted from November 2023 to February 2024 at Khalifa Gul Nawaz Hospital, Bannu, Khyber Pakhtunkhwa, Pakistan. A total of (n = 118) surgical wound specimens were collected from patients with clinically diagnosed SSIs. A. baumannii isolates were identified using standard biochemical tests and confirmed by 16S rRNA gene sequencing. In vitro antimicrobial susceptibility was determined by Kirby–Bauer disk diffusion according to CLSI 2024 guidelines. In addition, the concentration-dependent inhibition-zone response of imipenem and meropenem against carbapenem-resistant isolates was evaluated using an agar well diffusion assay. Molecular detection of blaNDM-1 and blaOXA-23 was performed by polymerase chain reaction (PCR), and representative amplicons were subjected to Sanger sequencing for further analysis. Results: In the current study, the total number of (n = 118) wound specimens from healthcare-associated patients were processed, in which A. baumannii-positive isolates (n = 23, 19.5%) were documented. Its prevalence was higher in males (69.6%) compared to females, and was strongly associated (78.2%) with elderly patients (aged 51–68 years). In vitro susceptibility testing revealed that 91.3% of isolates harbored multidrug-resistant (MDR) attributes. Antimicrobial susceptibility profiling revealed high levels of multidrug resistance, with 82.6% of isolates resistant to imipenem and meropenem, as well as 100% resistance to aztreonam and gentamicin. Colistin showed the highest activity, with 87.0% of isolates remaining susceptible. In the agar well diffusion assay, measurable inhibition of the carbapenem-resistant isolates by imipenem and meropenem occurred only at higher concentrations. Molecular screening of resistance genes identified blaOXA-23 in 60.9% and blaNDM-1 in 30.4% of isolates. Co-expression of both genes was detected in some (n = 4) isolates. Among the selected MDR isolates included in the gene resistance analysis, imipenem and meropenem resistance were recorded in 9/14 blaOXA-23-positive isolates and 5/7 blaNDM-1-positive isolates. Conclusions: This study substantiates an escalated incidence of carbapenem-resistant, MDR A. baumannii in post-surgical infections. blaOXA-23 were documented as the predominant carbapenemase gene, with co-expression of blaNDM-1 in a substantial proportion of isolates. These findings provide an important phenotypic and molecular characterization of selected carbapenemase genes in healthcare-associated infections, highlighting the exigency for strengthened antimicrobial stewardship and infection control strategies in the hospitals of the region. Full article

Objectives: Intra-abdominal infections (IAIs) requiring surgical intervention represent a significant cause of morbidity in pediatric patients, often leading to prolonged hospitalization and increased antimicrobial exposure. This study aimed to characterize the distribution of pathogenic bacteria, antimicrobial resistance patterns, and clinical associations in pediatric intra-abdominal infections complicated by surgical site involvement. Methods: A retrospective observational study was conducted on children aged 0–16 years, who underwent surgery for intra-abdominal infections with microbiological confirmation. Peritoneal fluid, pus, and other intraoperative or postoperative specimens were analyzed using standard microbiological techniques. Infections were classified as monomicrobial or polymicrobial, and antimicrobial susceptibility was assessed phenotypically. Associations between bacterial pathogens, patient age, underlying diagnosis, surgical procedures, and antibiotic susceptibility patterns were analyzed. Results: 177 pediatric patients were included. Appendicitis was the most common diagnosis (53.53%), followed by intra-abdominal abscesses (32.94%). Gram-negative (GN) bacteria predominated (44.07%), with Escherichia coli being the most frequently isolated pathogen (83.33%). Double and triple GN and GP associations were identified in approximately 25% of cases, particularly in abscesses, complicated appendicitis, and surgical site infections. Our findings revealed that piperacillin–tazobactam and carbapenems were expected to be effective against almost all GN pathogens identified in surgical specimens of pediatric patients. Pathogen distribution and antimicrobial susceptibility varied significantly according to age group and clinical diagnosis. Conclusions: In pediatric patients, intra-abdominal infections requiring surgical management were mainly caused by Gram-negative bacteria and polymicrobial associations. Effective treatment relies on prompt surgical source control and empiric broad-spectrum antimicrobial therapy, followed by culture-guided de-escalation to support antimicrobial stewardship. Full article

Background: Acute cholecystitis affects approximately 200,000 hospitalizations annually in the United States, and emergency cholecystectomy is its definitive treatment. Whether weekend hospital admission, which is often associated with reduced staffing and diagnostic resources, adversely affects surgical outcomes in this population is unclear. We evaluated the association between weekend hospital admission and in-hospital mortality and key secondary outcomes following emergency cholecystectomy. Methods: This retrospective cohort study used the National Inpatient Sample (NIS) from January 2018 through December 2022. Adults (≥18 years) with acute cholecystitis (identified by ICD-10-CM codes) who underwent nonelective cholecystectomy (identified by ICD-10-PCS codes) were included; elective admissions, pediatric patients, and admissions with missing discharge weights were excluded. The analytic cohort comprised 194,787 unweighted admissions, representing a weighted national estimate of approximately 973,935 hospitalizations. Weekend admission was defined as admission on Saturday or Sunday (vs. Monday through Friday). The primary outcome was in-hospital mortality. Secondary outcomes, defined from secondary (not principal) diagnosis fields and interpreted as coded in-hospital diagnoses, included prolonged length of stay (>75th percentile), sepsis, surgical site infection, bile duct injury, venous thromboembolism, respiratory failure, acute kidney injury, blood transfusion, and cardiac complications. Multivariable logistic regression with hospital-year cluster-robust standard errors was used, adjusting for pre-exposure patient and hospital characteristics; the Benjamini–Hochberg false discovery rate was applied across secondary outcomes. Results: Among 194,787 admissions (weekday, 73.2%; weekend, 26.8%), in-hospital mortality was 0.62% in weekday and 0.53% in weekend patients. After adjustment, weekend admission was not associated with in-hospital mortality (aOR 0.87; 95% CI, 0.75–1.00; p = 0.06). Weekend admission was associated with modestly lower odds of prolonged length of stay (aOR 0.90; 95% CI, 0.88–0.93; p < 0.001). Weekend admission was not associated with sepsis (5.3% vs. 5.3%; aOR 1.01; 95% CI, 0.96–1.06; p = 0.65), respiratory failure (aOR 1.05; 95% CI, 1.00–1.10; p = 0.06), overall complications, or the remaining secondary outcomes after correction for multiple comparisons. Findings were consistent across design-based survey-weighted, inverse-probability-weighted, transfer-excluded, and principal-diagnosis sensitivity analyses. Conclusions: Weekend admission was not associated with higher in-hospital mortality or with a higher risk of sepsis following emergency cholecystectomy in the United States; weekend patients had modestly shorter hospital stays. These findings provide no evidence of higher coded in-hospital mortality or coded in-hospital complications among weekend admissions in contemporary US practice. Full article

Background/Objectives: This national database study compares wide-awake hand surgeries in the United States performed in the operating room and office in terms of volume, reimbursement, narcotics prescriptions, and adverse events. Methods: Patients who underwent trigger finger release, open carpal tunnel release, De Quervain’s release, and mucous cyst excision from 2010 to 2022 were identified in PearlDiver’s M170Ortho dataset. Exclusion criteria were concomitant hand surgery, inpatient setting, <30 days of follow-up, age < 18 years, general/monitored anesthesia, and nerve block. Cohorts were stratified by surgical setting then matched by age, sex, Elixhauser Comorbidity Index score, and region. Primary endpoints included total and physician reimbursement (stratified by payor: commercial, Medicaid, Medicare) and 90-day narcotic prescriptions, emergency department visits, and surgical site infections. Results: Between 2010 and 2022, all surgical cohorts demonstrated an increase in the annual proportion of surgeries performed in the office (trigger finger +36%, carpal tunnel +155%, De Quervain’s +104%, mucous cyst +22%). Office-based surgery demonstrated lower total costs for all surgical cohorts and insurance types: commercial (−34% to −43%), Medicaid (−37% to −48%), Medicare (−30% to −37%). Office-based surgery had lower physician reimbursement for all surgical cohorts with commercial insurance (−3% to −9%) and Medicare (−5% to −13%). Physician reimbursement was not significantly different by surgical setting for Medicaid patients. Following office-based surgery, patients filled fewer narcotic prescriptions and had lower rates of emergency department visits, with similar rates of surgical site infection. Conclusions: Although most wide-awake hand surgeries are still performed in the operating room, there is a nationwide increase in office-based surgery. With reduced financial burden and favorable rates of adverse events, office-based wide-awake hand surgery may offer improved economic value and comparable short-term safety for certain procedures. Future research should complement these findings with patient-reported outcomes. Full article

Background: Fibular nonunion is an uncommon but clinically relevant complication following fractures or surgical procedures, often resulting in persistent pain and functional impairment. Due to its rarity, current evidence remains limited and no standardized treatment guidelines are available. Purpose: To systematically review the literature on fibular nonunion, focusing on clinical presentation, diagnostic approaches, and treatment outcomes. Methods: A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE, Scopus, and Web of Science were searched up to July 2025. Studies including adult patients (≥18 years) with fibular nonunion treated either conservatively or surgically were included. Data regarding demographics, clinical presentation, and treatment outcomes were extracted and analyzed descriptively. Results: Nineteen studies comprising 183 patients were included. The mean patient age was 45.7 years, with a predominance of males (58.4%). The distal third of the fibula was the most frequently involved site (75.9%). The mean time to diagnosis was 28.6 weeks. Surgical treatment was performed in 65.6% of cases, most commonly using open reduction and internal fixation. Among studies reporting union outcomes, favorable radiographic healing rates were observed following surgical treatment. Conservative treatment was primarily reserved for asymptomatic or minimally symptomatic patients. The overall complication rate was low (3.8%), mainly consisting of minor infections and hardware-related issues. Conclusions: Fibular nonunion is an uncommon but clinically significant condition. Available evidence suggests that surgical management may represent the most consistently successful treatment strategy in symptomatic and mechanically unstable cases, while nonoperative treatment may remain appropriate in carefully selected asymptomatic or minimally symptomatic patients. However, the available literature is limited by retrospective study designs, heterogeneous populations, inconsistent outcome reporting, and variable definitions of nonunion, highlighting the need for prospective multicenter studies and standardized treatment protocols. Full article

Postoperative complications following colorectal surgery—including anastomotic leak (AL), surgical site infection (SSI), perioperative haemorrhage and colovesical fistula—represent major causes of patient morbidity and mortality, prolonged hospitalisation, and healthcare expenditure. This review summarises contemporary evidence across two key domains of complication management—prevention and diagnosis—applied to four major complications (AL, SSI, perioperative haemorrhage, and colovesical fistula), drawn from a comprehensive literature review of recent randomised controlled trials, systematic reviews, meta-analyses, and prospective cohort studies. Preventive strategies discussed include optimisation of surgical techniques (minimally invasive and robotic approaches, indocyanine green perfusion assessment, self-expanding metal stent bridge-to-surgery, and negative pressure wound therapy), modification of patient factors where possible (obesity, anaemia, malnutrition, and immunosuppression), and system-level interventions including Enhanced Recovery After Surgery (ERAS) protocols, perioperative beta-blockade, prehabilitation, and structured quality improvement bundles. Diagnostic strategies have evolved to incorporate biomarker surveillance (CRP and procalcitonin), drain fluid pH analysis, CT imaging (including angiography), endoscopy, and novel digital health tools including wearable monitoring and mobile health applications. Reducing the risk of postoperative complications should involve a multidisciplinary, protocolised approach combining intraoperative technique optimisation with structured perioperative care bundles and close post-discharge surveillance, and centralisation to specialist colorectal surgical units. Full article

Background and Objectives: Laparoscopic sleeve gastrectomy has emerged as the most widely adopted bariatric procedure in the management of morbid obesity. Despite its efficacy, postoperative scarring at port sites remains a significant aesthetic concern for patients. To mitigate this issue, we developed the Modified Bikini Line Sleeve Gastrectomy technique. This study aims to delineate the surgical steps of the Modified Bikini Line Sleeve Gastrectomy procedure, define the requisite anatomical landmarks, and contribute to the literature by retrospectively evaluating a patient cohort to determine the clinical applicability of this modified approach. Materials and Methods: The Modified Bikini Line Sleeve Gastrectomy procedure has been performed at our center since 2020. Stringent patient selection is paramount to the clinical success of this technique. Consequently, specific inclusion criteria necessitate meticulous evaluation during both the preoperative and intraoperative phases. This study delineates the critical aspects of patient selection, provides a comprehensive description of the Modified Bikini Line Sleeve Gastrectomy surgical technique, and analyzes the fundamental intraoperative considerations essential for its successful implementation. Results: A total of 906 patients (844 females, 62 males) with a mean Body Mass Index of 40.7 ± 6.6 kg/m² were included. Postoperative surgical site infection occurred in 6.2% of cases, and 0.8% required blood transfusion. At 12 months, the mean total body weight loss and excess weight loss were 35% ± 3% and 86.9% ± 31.2%, respectively. The mean postoperative cosmetic satisfaction score was 4 ± 0.8 (on a 5-point scale). Conclusions: These findings constitute the first study in the literature to demonstrate that the Modified Bikini Line Sleeve Gastrectomy technique is safe regarding complication profiles, effective in achieving weight loss goals, and yields high patient-reported cosmetic satisfaction. However, certain clinical presentations may preclude the use of this technique. Specifically, the Modified Bikini Line Sleeve Gastrectomy approach may not be suitable for patients with large hiatal hernias, a history of major upper abdominal surgery, or those with hepatomegaly (left lobe hypertrophy). Furthermore, anatomical constraints such as xiphoid–umbilical, xiphoid–pubic symphysis, and xiphoid–anterior superior iliac spine distances exceeding 25 cm, 36 cm, and 33 cm, respectively along with the presence of a redundant panniculus, represent limiting factors for this modified procedure. Full article

The optimal revascularization strategy for common femoral artery (CFA) atherosclerotic occlusive disease remains debated. This systematic review and meta-analysis compared perioperative and long-term outcomes of endovascular therapy (EVT) and open surgery (OS). Methods: PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched through 15 March 2026 for comparative studies of EVT versus OS in CFA atherosclerotic occlusive disease. Outcomes included perioperative morbidity, wound complications, hospital stay, patency, reintervention, major amputation, and survival. Time-to-event data were pooled as hazard ratios (HRs), reported or reconstructed from Kaplan-Meier curves. Risk of bias and evidence certainty were assessed. Results: Eleven studies with 2835 patients were included. Compared with OS, EVT reduced 30-day morbidity (OR, 0.34; 95% CI: 0.26–0.44), wound complications (OR, 0.14; 95% CI: 0.09–0.23), surgical-site infections, lymphatic complications, myocardial infarction, and hospital stay (mean difference, −4.68 days; 95% CI: −5.49 to −3.86). Distal embolization increased after EVT (OR, 2.45; 95% CI: 1.28–4.70). Follow-up major amputation was higher after EVT in event-rate analyses (OR, 2.42; 95% CI: 1.19–4.93), although amputation-free survival was similar (HR, 1.01; 95% CI: 0.83–1.23). EVT had higher hazards of loss of primary patency (HR, 1.72), loss of secondary patency (HR, 2.03), and reintervention (HR, 1.51). Conclusions: EVT offers fewer early complications and shorter hospitalization, whereas OS provides more durable patency and fewer reinterventions. Given observational, heterogeneous evidence, treatment should be individualized. Full article

Background/Objectives: Surgical site infection (SSI) remains a clinically important complication after spinal surgery. This study developed and assessed machine learning approaches for predicting postoperative SSI using routinely collected preoperative clinical variables, with emphasis on calibration and clinical applicability. Methods: In this retrospective single-center study, four prediction models were developed in patients undergoing spinal surgery: logistic regression, random forest, gradient boosting, and XGBoost. Model training used five-fold stratified cross-validation, and performance was evaluated using a hold-out internal test set. Performance was assessed using the area under the receiver operating characteristic curve (AUC), area under the precision–recall curve (AUPRC), sensitivity, precision, F1 score, Brier score, and calibration slope. SHAP analysis was performed to evaluate model interpretability. Results: The incidence of SSI was 16.6%. In cross-validation, discrimination performance was broadly comparable across models, with logistic regression showing the highest observed AUC (0.814) and AUPRC (0.484). In the hold-out test set, the same model showed the highest AUC (AUC 0.806, 95% CI 0.757–0.852) and the highest sensitivity (0.758). Calibration performance varied across models. SHAP analysis identified C-reactive protein, hemoglobin, albumin, and white blood cell count as the most influential predictors. Perioperative variables provided only modest incremental predictive value. Conclusions: Machine learning models showed acceptable performance for predicting SSI after spinal surgery. Logistic regression demonstrated performance comparable to that of the evaluated machine learning models, suggesting that conventional statistical approaches may remain clinically useful in structured datasets. Preoperative clinical and laboratory variables were the major contributors to prediction, supporting their use for routine preoperative risk stratification. Full article