The effect of portable intermittent pneumatic compression devices in preventing lower limb deep vein thrombosis in patients undergoing major orthopedic surgery: A quasi-experimental multicenter study.

Quantifying preferences for watch-and-wait compared with surgery after a clinical complete response in locally advanced rectal cancer: A discrete choice experiment (PrefCoRe).

The distal vastus medialis artery - a novel recipient vessel in free flap reconstruction of the knee.

Altered gene expression associated with postoperative delirium in patients undergoing surgery and anesthesia.

The CAMUS Initiative: A Multiphase, Multicentre International Collaboration to Redefine Risk Stratification, Reporting, and Grading of Surgical Complications in Urology.

Tonsillectomy, with or without adenoidectomy, is the most common major surgical procedure performed in children. The risk and incidence of primary and secondary post-tonsillectomy hemorrhage (PTH) have been well described. The goal of this scoping review is to analyze the incidence and risk factors for recurrent PTH, and to map existing evidence to identify knowledge gaps. CINAHL, Cochrane Library, Embase, Google Scholar, and Ovid Medline. The study followed PRISMA-ScR guidelines. Three reviewers independently screened studies, including those reporting the incidence of PTH and recurrent PTH in children. There were 229 recurrent PTH episodes described in the 11 manuscripts included in this analysis, with 7.1% of initial PTH cases re-bleeding (0.33% of total tonsillectomy cases). Management of recurrent PTH involved surgical intervention and observation. Oropharyngeal findings at the time of the initial PTH and management strategy for the initial PTH were not associated with increased recurrence rates. The indication for tonsillectomy, NSAID usage, and surgical technique were not associated with recurrent PTH when reported. Across studies, there was wide heterogeneity in how recurrent bleeding was defined, and inconsistent reporting of timing and outcomes. The predictive value of laboratory screening for occult coagulopathies in children with multiple bleeds was unclear. No clear risk factors for recurrent PTH were identified from the pooled analysis. This scoping review highlights major research gaps, including the need for standardized definitions and severity grading, prospective multicenter data to clarify predictors of recurrence, and systematic evaluation of hematologic screening protocols.

Preoperative symbiotic supplementation modulates the intestinal microbiota of patients with colorectal cancer: Evidence from a randomized clinical trial.

This scoping review aims to synthesize current evidence regarding the accuracy of fitness trackers, their efficacy in improving health outcomes across diverse populations, and the barriers to their long-term adoption and clinical implementation. The review utilises 241 original studies with 645809 total participants (topic deduplicated ΣN). The mapped evidence suggests that fitness trackers have their clearest current value in measuring heart rate and step counts, with heart-rate error around 2% in one postoperative study, while also showing important limitations in low-speed walking, non-sinus rhythm, and sleep wake detection. Across clinical and community settings, tracker-supported programs were often associated with higher activity, but sustained behavior change remained inconsistent, with signals such as 68% discontinuation in adolescents with obesity and no reduction in postoperative morbidity in one randomized trial after major abdominal surgery. At the same time, the evidence map highlights a meaningful clinical role for wearable-derived activity as a monitoring and prognostic signal, including associations between low daily steps and hospital admission or death in cirrhosis and between higher activity and better cancer-related outcomes. These findings support a practical role for fitness trackers as adjuncts for remote monitoring, rehabilitation support, and personalized feedback rather than as standalone therapeutic or diagnostic tools. Future research should prioritize standardized validation across device versions and patient groups, longer-term adherence strategies, and implementation models that address privacy, workflow integration, and the digital divide.

There is increasing evidence that the addition of preoperative antibiotics (OAB) reduces infectious complications after colorectal surgery. To understand practice patterns in Australia, Australian hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) collecting targeted colectomy and proctectomy data were collated. Adult patients who had elective restorative colectomy or proctectomy between January 2015 and November 2023. Eight hundred thirty-nine patients were included. Mechanical bowel preparation (MBP) alone was the most common strategy for segmental colectomy (42.46%) and proctectomy (75%). The rate of MBP and oral antibiotics (OAB) remained low (11.7% to 25.3% between 2019 and 2023). This was associated with a decline in superficial SSI (11.7% to 4%) over this time. When the cohort was divided into three groups: MBP+/OAB+ (n = 143), MBP+/OAB- (n = 458) and MBP-/OAB- (n = 238), there were no statistical differences in infectious complications between the groups. However, the MBP+/OAB+ group had the lowest superficial surgical site infection (SSI) rate in the laparoscopic (5.3%) and open surgery (9.2%) subgroups. This was associated with a significant reduction in the odds ratio (OR) 0.52 (95% CI 0.27-1.01) of developing any SSI and a reduced length of stay in the open subgroup. Despite recommendations by several international guidelines, level 1 evidence from meta-analyses and network meta-analyses as well as a Cochrane review that MBP and OAB reduce infectious complications, there remains a low uptake of MBP and OAB in major colorectal surgery at major NSQIP hospitals in Australia, with even lower uptake in smaller non-NSQIP hospitals.

The release of serum cardiac troponins (cTn) following major non-cardiac surgery (MNCS) is associated with significant adverse postoperative outcomes. This phenomenon comprises myocardial injury after non-cardiac surgery (MINS) or perioperative myocardial infarction that may occur regardless of the presence of obstructive coronary artery disease (CAD). However, there is no consensus on its diagnostic criteria or therapeutic guidelines. The 30-day mortality following MNCS is 2%-6% and more than half of these deaths are attributable to the major adverse cardiovascular events (MACEs). Although MINS is an independent predictor of MACEs, it is not the only prognostic tool. The release of cTn may be secondary to perioperative tachycardia, hypotension, anemia, hypoxia, sepsis, inflammation, and profound stress. In the latter, an adrenergic surge, independent of underlying CAD, can cause a noticeable release of cTn. Even low levels of cTn elevation within the first three days after high-risk surgery are correlated with a significant increase in the short- and long-term mortality rates. Therefore, awareness of this phenomenon is of utmost value for better perioperative management and prognostication. The patient, surgery (type, duration, and urgency), and cTn (timing, type, and frequency) should be considered in MINS identification and interpretation. Appropriate management necessitates index of suspicion and multidisciplinary stepwise actions.

Introduction: Intraoperative hypotension (IOH) is a frequent manifestation of haemodynamic instability during general anaesthesia. Advances in arterial waveform analysis have led to two distinct monitoring strategies: flow-derived platforms and predictive algorithms designed to anticipate hypotension. However, prospective comparisons and their associations with IOH and postoperative outcomes remain limited. The objective was to compare predictive haemodynamic monitoring using the Hypotension Prediction Index (HPI) with flow-derived monitoring using the Vigileo/FloTrac system and to evaluate their associations with IOH and postoperative outcomes. Methods: In this single-center prospective observational study, 101 adults undergoing elective major abdominal surgery under general anaesthesia were monitored using either the HPI system (n = 49) or the Vigileo/FloTrac system (n = 52). Primary outcomes were cumulative duration and frequency of IOH (mean arterial pressure < 65 mmHg). Secondary outcomes included postoperative complications, organ injury biomarkers (troponin, creatinine, eGFR), and hospital length of stay. Multivariable regression models adjusted for predefined confounders were used to estimate associations. Results: Vigileo/FloTrac monitoring, compared with HPI, was independently associated with a greater cumulative duration of IOH (adjusted β = 1.66; 95% CI, 0.63–2.72) and a higher number of hypotensive episodes (adjusted β = 0.53; 95% CI, 0.10–0.95). Monitoring strategy was not associated with surgical site, respiratory, or neurological complications. However, Vigileo/FloTrac monitoring was associated with higher odds of vascular complications (adjusted OR = 4.36; 95% CI, 1.13–20.41). No significant associations were observed between monitoring strategy and postoperative organ injury biomarkers or length of hospital stay. Conclusions: Predictive haemodynamic monitoring using the HPI system was associated with lower IOH burden compared with the Vigileo/FloTrac system. However, these differences were not consistently accompanied by improvements in postoperative outcomes. Haemodynamic optimisation should be considered as one component within a broader, integrated perioperative management strategy. Further large-scale, multicenter prospective studies are warranted to clarify its impact on patient-centered outcomes.

Although regional disparities in access to surgical care have been reported across medical specialties, nationwide evaluations of variation in ophthalmic surgical services remain limited. This study examined prefecture-level differences in major ophthalmic surgeries in Japan using publicly available claims data. We analyzed the ninth release of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB Open Data) for fiscal year 2022 (April 2022-March 2023). Prefecture-level procedure counts were extracted for cataract surgery (K282), vitrectomy (K279-K281 and related codes), glaucoma surgery (relevant K-codes), and corneal transplantation. To reduce potential underestimation in non-Diagnosis Procedure Combination settings, ophthalmology-related procedures reimbursed under the Short-Stay Surgery Basic Fee 3 (A400) were identified and incorporated according to predefined mapping rules. Surgical rates per 100,000 population and per board-certified ophthalmologist were calculated. Regional inequality was quantified using population-weighted Gini coefficients. Associations between ophthalmologist density and surgical volume were assessed using Pearson's correlation coefficients. Nationwide totals were 1,777,502 cataract surgeries, 154,336 vitrectomies, 80,753 glaucoma surgeries, and 2,895 corneal transplantations. Prefecture-level surgical rates per 100,000 population varied 1.8-fold for cataract surgery, 3.3-fold for vitrectomy, and 7.8-fold for glaucoma surgery. Several prefectures reported no corneal transplantation cases. Population-weighted Gini coefficients were 0.064 for cataract surgery, 0.125 for vitrectomy, 0.190 for glaucoma surgery, and 0.351 for corneal transplantation. Similar patterns were observed after adjusting for age structure, indicating that regional disparities were not solely explained by demographic differences. Ophthalmologist density varied 2.5-fold across prefectures and was positively correlated with surgical volume for cataract surgery and vitrectomy, but not for glaucoma surgery. Using nationwide claims data, we identified substantial regional variation in major ophthalmic surgical procedures in Japan, with greater inequality observed for more specialized surgeries. These findings provide a population-level description of ophthalmic surgical distribution and may inform future evaluations of healthcare resource allocation.

This article presents a clinical case demonstrating the feasibility of using a combination of diclofenac and orphenadrine for adequate pain relief in a multimodal analgesia regimen in the early postoperative period. It also provides an overview of pain relief options used after major orthopedic and trauma surgeries in both domestic and international routine clinical practice. A unique local postoperative pain management protocol, developed taking into account the authors' capabilities and preferences, is proposed.

The perioperative management of high-risk patients undergoing major noncardiac surgery remains a significant challenge in modern healthcare. Accurate preoperative risk stratification is crucial for optimizing patient outcomes and resource allocation. This narrative review explores the emerging approach of combining natriuretic peptide measurements with the Duke Activity Status Index (DASI) to evaluate cardiac reserve in high-risk surgical patients. We examine the individual roles of natriuretic peptides (primarily B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide) and the DASI in preoperative risk assessment, highlighting their strengths and limitations. The rationale for integrating these two measures is discussed, emphasizing their complementary nature in providing both objective biomarker data and patient-reported functional status. The review synthesizes current evidence supporting this combined approach, including recent studies demonstrating improved risk discrimination compared to traditional methods. We outline a methodology for implementing this integrated assessment, addressing the timing of measurements, interpretation of results, and integration with existing risk stratification tools. Furthermore, we provide guidance on the management of identified high-risk patients, including prehabilitation and optimization strategies. The natriuretic peptide/DASI approach is also positioned within the broader context of perioperative assessment to guide appropriate clinical implementation. The integration of natriuretic peptides and DASI represents a promising strategy for enhancing preoperative cardiac risk assessment in high-risk surgical patients. While further research is needed to refine and validate this approach, it offers a practical and potentially powerful tool for improving perioperative care and patient outcomes.

Introduction: Segmental cholangiectasia is a rare cause of focal intrahepatic bile duct dilatation that can mimic congenital, inflammatory or neoplastic conditions, posing diagnostic challenges. Case Presentation: We describe a 58-year-old man with a longstanding cystic lesion in hepatic segment 8 who developed multiple cholangitic episodes. Despite exclusion of infectious, autoimmune and overt neoplastic disease, an elevated carbohydrate antigen 19-9 (CA 19-9) raised concern for intraductal papillary neoplasm of the bile duct (IPNB) and prompted anterior hepatic sectorectomy. Histopathology confirmed segmental cholangiectasia, showing ductal dilatation, bile stasis, cholesterol clefts, fibrosis, and mixed inflammation, without evidence of malignancy or IgG4-related disease. Discussion and Conclusion: Segmental cholangiectasia is a benign yet clinically significant entity that can mimic biliary tumors and prompt major surgery. This case, involving hepatic segment 8, expands the known anatomical spectrum and underscores the importance of multidisciplinary evaluation. Awareness of this condition may prevent misdiagnosis and guide appropriate management, while further studies are needed to better characterize its presentation in Western populations.

Abstract - This study provides a comprehensive analysis of global operating system (OS) trends from 2009 to 2024, leveraging Power BI to generate data-driven insights into evolving market dynamics. The research is grounded in structured datasets obtained from web-based sources and industry reports, ensuring both relevance and reliability. By applying descriptive and diagnostic analytics, the study systematically examines historical patterns, growth trajectories, and shifts in market share across major operating systems. The findings reveal a pronounced transition from desktop-centric systems, particularly Windows, toward mobile-first ecosystems dominated by Android and iOS, reflecting changing consumer behaviour and increasing reliance on portable devices. Furthermore, macOS demonstrates steady growth driven by Apple’s tightly integrated ecosystem, while Linux continues to hold a stable position within specialized and enterprise environments. The study also underscores the influence of external factors, including rapid technological advancements, cloud adoption, and global disruptions such as the COVID-19 pandemic, which have significantly impacted usage patterns and accelerated digital transformation. Despite the availability of descriptive studies, there remains a gap in predictive modeling and user-centric behavioural analysis. This research partially addresses these limitations by incorporating multi-dimensional visualization techniques, enabling deeper interpretation of complex datasets. The insights derived offer practical value for developers, businesses, and policymakers seeking to align strategies with emerging technological trends. Key Words: Operating Systems, Power BI, Data Analytics, Market Trends, OS Adoption, Visualization

Whilst guidelines recommend routine frailty screening for elderly patients with head and neck cancer (HNC), no consensus exists on the preferred tool to predict postoperative morbidity. The aim of this study was to assess the predictive capacity of three validated frailty screening tools for postoperative complications in patients undergoing major ablative and reconstructive head and neck surgery. A prospective cohort of 50 patients aged ≥ 70 years undergoing major ablative and reconstructive HNC surgery was recruited from a single institution in Sydney, Australia. Patients completed three frailty assessment tools pre-operatively: the Clinical Frailty Scale (CFS), Modified Frailty Index-5 (mFI-5) and Modified Frailty Index-11 (mFI-11). Postoperative complications were recorded using the Clavien-Dindo Classification (CDC) and the Comprehensive Complication Index (CCI). Logistic regression and ROC analysis were used to assess predictive performance. The CFS increased the odds of severe (CDC ≥ 3) complications five-fold (OR 5.16, 95% CI 1.12, 23.69; AUC 0.70; cut-off 5). Age ≥ 86 years was also a significant predictor of severe complications (OR = 9.00, 95% CI: 1.79, 45.19, p = 0.008, AUC = 0.71), though limited by prevalence. The mFI-5 and mFI-11 demonstrated limited predictive utility for severe complications (AUC = 0.30 and 0.58, respectively). CFS provided the greatest accuracy in predicting severe complications after free-flap surgery, with high specificity and negative predictive value. Age ≥ 86 years also confers high risk. Incorporating CFS into preoperative pathways may guide surgical decision-making and perioperative interventions to improve patient outcomes.

This study analyzes real-world treatment patterns among patients newly initiating treatment for painful diabetic peripheral neuropathy using a contemporary dataset in the United States. A retrospective study using the MarketScan database [1/1/2016-06/30/2023] identified adults newly prescribed pain medication(s) used to treat neuropathic pain within 60 days of a diabetic peripheral neuropathy diagnosis. Patients with prior medication, conditions with similar treatment indications, cancer, or major surgery were excluded. Treatment patterns over a 12-month period and variable-length follow-up (four sequential treatment episodes) were captured, including treatment type, dosage, adherence, discontinuation (≥90-day gap), and switching. Among 22,955 patients identified, 98.5% initiated monotherapy treatment for painful diabetic peripheral neuropathy. The majority initiated treatment with gabapentinoids (gabapentin 59.0%; pregabalin 5.3%), followed by opioids (tramadol 15.1%, oxycodone 7.0%), and antidepressants (duloxetine 5.2%). Among patients initiating gabapentin, pregabalin, or duloxetine, most were prescribed daily doses below recommended levels (79% gabapentin, 91% pregabalin, 61% duloxetine) and the majority (81%-96%) did not increase their dose. Adherence was low. Over 50% discontinued their initial treatment within 3 months and approximately 75% discontinued in the 12-month follow-up period, with fewer than 25% switching to another medication. When evaluating treatment patterns across sequential treatment episodes, almost 65% discontinued all pain medications and did not receive subsequent treatment by the fourth treatment episode. High rates of treatment discontinuation and suboptimal adherence likely indicate challenges with tolerability and insufficient pain relief associated with current therapies for painful diabetic neuropathy. These findings emphasize the limitations of existing treatment options and highlight the unmet need for more effective and better-tolerated treatments for these patients.

Delirium occurs frequently after major surgery in older adults and is associated with long-term cognitive dysfunction. While postoperative delirium (POD) shows electroencephalographic (EEG) changes during the acute phase, it remains unclear whether quantitative EEG alterations precede or persist after POD. Identifying such patterns could reveal risk markers and mechanisms of long-term cognitive dysfunction. In this prospective, multicenter cohort study, EEG recordings were obtained in patients aged 65 yr or older before and 3 months after major elective surgery without preexistent cognitive dysfunction, and in nonsurgical controls. The authors analyzed quantitative EEG measures that show alterations during acute delirium, namely relative power, phase-based and amplitude-based functional connectivity, spectral variability, and signal complexity. Linear mixed models were used to assess effects of time, surgery, and POD on these EEG measures. Of 379 enrolled surgical patients, 330 had sufficient EEG data quality, of whom 59 (18%) developed POD. Fifty-seven nonsurgical controls were included and served as a reference. At baseline, future POD patients exhibited significantly lower beta amplitude-based connectivity (β = -0.36; Pcorrected = 0.04). No other EEG measures showed significant differences between groups at baseline. Three months after surgery, no persistent changes in quantitative EEG characteristics were observed in relation to POD occurrence or surgery alone. This study identified reduced preoperative beta amplitude-based connectivity as a possible marker of neurophysiological vulnerability for POD. However, the absence of significant longitudinal changes in quantitative EEG measures suggests that resting-state EEG networks may functionally recover or compensate in this cohort at 3 months postoperative.

Implementation of a kidney protection strategy to prevent acute kidney injury after major surgery in high-risk patients identified by biomarkers: a systematic review and individual participant data meta-analysis of randomized controlled trials