AimsTo evaluate the effect of obesity on postoperative mortality after trauma laparotomies.MethodsA PRISMA-compliant meta-analysis with meta-regression using random-effects modeling was conducted (last search: August 01, 2025). All studies comparing the risk of postoperative mortality in adult patients with and without obesity (BMI ≥30) undergoing trauma laparotomies were included. The certainty of evidence was evaluated using GRADE system.ResultsNine studies comprising 19,780 patients were included (obesity group: 6474; no obesity group: 13,306). The obesity and no obesity groups were comparable in terms of male sex (RD: -0.03, 95% CI -0.06, 0.00, P = .090), injury severity score (MD: 0.96, 95% CI -0.36, 2.29, P = .160), penetrating mechanism of injury (RD: -0.01, 95% CI -0.03, 0.00, P = .150), and blunt mechanism of injury (RD: 0.01, 95% CI -0.00, 0.03, P = .150). The patients in the obesity group were older (MD: 4.18years; 95% CI 2.19, 6.18, P < .0001). The risk of postoperative mortality was higher in patients with obesity (OR: 1.33, 95% CI 1.09, 1.64. P = .006). Injury severity score (coefficient: 0.017, P = .004) and blunt mechanism (coefficient: 0.263, P = .017) were associated with an increased risk of mortality; penetrating mechanism (coefficient: -0.263, P = .017) was associated with a reduced risk of mortality; and age (coefficient: -0.004, P = .779) and male sex (coefficient: -0.055, P = .908) did not affect the mortality.ConclusionsObesity is associated with increased postoperative mortality in patients undergoing trauma laparotomies (moderate certainty). Injury severity score and blunt mechanism of injury may increase the risk of mortality in obese patients undergoing trauma laparotomies.

This umbrella review was conducted to assess the certainty and validity of all available meta-analyses for intervention trials regarding the impact of synbiotic and probiotic interventions in hospital and Intensive Care Unit (ICU) stay durations, as well as postoperative mortality risk among patients undergoing surgery. A comprehensive systematic search was performed by applying Web of Science, Scopus, PubMed, Embase and Cochrane Library until July 20, 2025. Meta-analyses were used to evaluate the effect of synbiotic and probiotic interventions among hospital and ICU stay durations, as well as the postoperative mortality risk in patients undergoing surgery. Effect sizes of synbiotic and probiotic interventions were recalculated by using a random effects model, and the GRADE tool was used to determine evidence certainty. Forty-eight clinical trials involving 6,378 participants (intervention = 3151; placebo = 3227) across thirty meta-analyses were included in this study. The findings indicated that probiotic supplementation (vs. placebo) significantly reduced the duration of hospital stay [Weighted Mean Difference (WMD): -1.00days; 95% CI: -1.37 to -0.64; I2 = 63.1%; moderate certainty of evidence; P < 0.001; n = 22] among patients undergoing surgery. Synbiotic supplementation showed even greater efficacy, reducing the length of hospital stay by a larger margin (WMD: -2.57days; 95% CI: -4.51 to -0.64; I2 = 83.2%; moderate certainty of evidence; P = 0.009; n = 19). Moreover, the results suggested that synbiotic supplementation did not affect the length of ICU stay. The results indicated that the risk of postoperative mortality did not significantly change after probiotic or synbiotic supplementation (vs. placebo) among patients undergoing surgery. The current review supports the efficacy of synbiotic and probiotic supplementation on decreasing the length of hospital stay in patients undergoing surgery. However, it is important to note that 42.3% of included systematic reviews and meta-analyses (SRMAs) were rated as 'critically low' quality using the AMSTAR2 tool, which necessitates cautious interpretation of findings.

Osmotherapy is commonly applied to postoperative patients with hemorrhagic stroke (HS) in the neuro-intensive care unit, necessitating precise monitoring of internal environment parameters such as serum osmolality. Although serum osmolality imbalances are associated with poor outcomes, definitive evidence regarding its prognostic significance in postoperative HS patients remains limited. This study analyzes the correlation between serum osmolality and in-hospital all-cause mortality in postoperative HS patients based on a large sample of postoperative HS patients from the Medical Information Mart for Intensive Care-IV database. A retrospective cohort of 342 HS patients from Medical Information Mart for Intensive Care-IV was analyzed. Consensus clustering was applied to group patients into 6 clusters, with COX proportional hazards regression models used to assess the relationship between serum osmolality and in-hospital mortality. Restricted cubic spline curves were drawn to evaluate the non-linear associations between variables and outcomes. Survival analysis was performed using the Kaplan-Meier method to estimate patient outcomes across groups, and intergroup differences were statistically compared with the log-rank test. Subgroup analyses were conducted to assess differences across various populations. The study included 342 patients, with consensus clustering identifying 6 groups. A significant difference in survival was found between Cluster 4 and the combined group (Cluster 1 + 2 + 3 + 5 + 6), with Cluster 4 showing a lower mortality rate (Log-rank P = .042). COX regression models adjusting for age, gender, comorbidities, and common clinical scores consistently showed that Cluster 4 had a lower risk of mortality. Furthermore, serum osmolality was not found to significantly influence mortality risk after adjusting for potential non-linear effects (P = .742). Serum osmolality does not appear to be a strong predictor of mortality in postoperative patients with surgically treated HS in the neuro-intensive care unit. Age (>65 years), gender, absence of hypertension, lack of hypertonic therapy, no invasive mechanical ventilation, and no diuretic use were significant factors influencing mortality risk.

Machine learning prediction of myocardial ischaemia‒reperfusion injury: Clinical features and Qishen Yiqi dripping pills mechanism.

ObjectiveThis study investigated whether blood groups are predictive factors for theseverity and postoperative mortality in patients with coronary arterydisease (CAD) undergoing bypass surgery with extracorporeal circulatorysupportMethodsA retrospective cohort study examined data from 4,002 patients who hadcoronary surgery for CAD between January 1st, 2014, and December30th, 2020. The study recorded blood groups, demographicinformation, and and SYNergy between percutaneous coronary intervention withTAXus and cardiac surgery (SYNTAX) scores for patients who died within thefirst month post-operation.ResultsMultiple regression analysis showed significant associations with the SYNTAXscore (P < 0.001). Individuals with blood group O had a 2.970 timesdecrease in their SYNTAX score, while those with blood group A showed a0.260 times increase, and those with blood group B had a 1.895 timesdecrease. Analyzing the effect of blood groups on mortality, the risk ofdeath was significantly higher compared to blood group O; in group A therisk of death was 2.65 times higher than in group O (P = 0.005, odds ratio[OR]: 2.65, 95% confidence interval [CI]: 1.35 - 5.19). In group B the riskof death was 2.29 times higher than in group O (P = 0.048, OR: 2.29, 95% CI:1.01 - 5.23). The Rh factor did not affect either mortality or CADseverity.ConclusionIn patients undergoing coronary surgery, the SYNTAX score was found to besignificantly lower in blood groups O and B. However, regarding mortality,both blood groups A and B carried a higher risk of death when compared togroup O.

Background Despite advancements in surgical techniques, coronary artery bypass grafting (CABG) for patients with recent acute myocardial infarction (AMI) remains associated with relatively high mortality. Risk prediction in these patients is essential. The aim of this study was to develop a nomogram model to predict the early postoperative mortality in patients undergoing surgical revascularization for AMI based on preoperative clinical features. Method We retrospectively analyzed the clinical data of 332 consecutive patients who underwent CABG for AMI at our center from January 2018 to December 2024. Independent predictors for early postoperative death were identified by using univariate and multivariate logistic regression models. A nomogram prediction model was developed based on all independent predictors. Discriminative ability, calibration, and clinical utility of the model were evaluated. Internal validation was performed utilizing the bootstrapping method. Results The nomogram model incorporated seven independent predictors: preoperative cardiac arrest, previous history of myocardial infarction(MI), left ventricular ejection fraction (LVEF) <50%, MI-to-CABG interval ≤ 3d, age > 75 years, serum albumin < 35g/L and serum creatinine > 2.0 mg/dL. The model achieved good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.905 (95% CI: 0.832–0.978), and showed well-fitted calibration curves with Hosmer–Lemeshow test results (χ 2 = 3.437, p = 0.944). Decision curve analysis indicated that the model can provide greater clinical net benefits compared to "operate-all" or "operate-none" strategies in a wide range of threshold probability. Conclusions The novel nomogram model combining seven preoperative clinical predictors can provide an accurate preoperative estimation of early postoperative death for AMI patients undergoing surgical revascularization, with satisfactory discrimination and calibration.

The patient's sex is an important factor affecting postoperative mortality following colorectal cancer surgery; however, this relationship is not fully understood. We searched for eligible studies evaluating the relationship between sex and postoperative mortality in patients undergoing colorectal cancer surgery. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup and sensitivity analyses were performed to assess the stability of the main findings. Sixty-four studies involving 3,364,109 participants were included. Male patients had a 22% higher risk of postoperative mortality compared with female patients (OR: 1.22, 95% CI: 1.17-1.28). This finding remained consistent and stable in most subgroup analyses, with a more significant relationship in studies with adjusted ORs (OR: 1.25, 95% CI: 1.19-1.31). Sensitivity analyses confirmed these findings, with male patients consistently showing a 23%-25% higher risk than female patients in various populations. The results were validated in sensitivity analyses using the leave-one-out method. In summary, male sex is significantly linked to an elevated risk of postoperative mortality after colorectal cancer surgery compared with female patients. Further investigations are needed to address the observed heterogeneities across studies and to explore the fundamental mechanisms underlying these sex-related differences.

Pancreatic ductal adenocarcinoma (PDAC) has a 5-year survival rate of less than 10%. Treatment with curative intent surgery still poses high rates of overall postoperative morbidity (68.7%) and mortality (5.4%). It is therefore essential to identify preoperative factors influencing early postoperative outcomes to provide better insight for improved patient selection and care. Sixty patients diagnosed with PDAC who had undergone surgical resection at Groote Schuur Hospital, Cape Town, between 2016 and 2023 were included. The patient cohort was divided into two groups, postoperative survival ≤ 90 days vs > 90 days. The groups were compared regarding demographic and preoperative assessment tools using ASA, ECOG and Codman scores, baseline clinical and imaging data, preoperative treatment and surgical related parameters. Significant differences were found in patients, with patients presenting with pancreatic duct dilation (p < 0.05), tumour location in the pancreatic head (p < 0.05), elevated gamma-glutamyl transferase (GGT) (p < 0.01) and carbohydrate antigen 19-9 (CA19-9) (p < 0.05). Using regression analysis, GGT serum levels > 500 U/L were correlated with mortality ≤ 90 days, while pancreatic duct dilatation and CA19-9 levels > 200 U/L were associated with survival > 90 days. The results of this study present important insights regarding risk factors influencing postoperative mortality and offer a potential roadmap for optimising preoperative care and judicious patient selection before pancreatic surgery.

BackgroundGastric surgery is a critical intervention for conditions, such as gastric cancer, obesity, and peptic ulcer disease. Despite advances in surgical techniques and perioperative care, postoperative complications, including elevated mortality, remain a major concern. Glycemic variability (GV), calculated as the coefficient of variation of blood glucose levels during the ICU stay, has emerged as a potential predictor of adverse outcomes in critically ill patients. This study aimed to investigate the association between GV and postoperative mortality in patients undergoing gastric surgery.MethodsData were obtained from the MIMIC-IV database, which contains anonymized health records of ICU patients admitted to Beth Israel Deaconess Medical Center. The cohort included adult patients admitted to the ICU following gastric surgery. GV was assessed using the coefficient of variation of all recorded blood glucose measurements during the ICU stay. The primary outcome was 30-day all-cause in-hospital mortality; the secondary outcome was 90-day mortality. Associations between GV and outcomes were analyzed using Cox proportional hazards models and Kaplan–Meier survival analysis. In addition, machine learning models were developed to evaluate the predictive value of GV.ResultsA total of 1099 patients were included. Higher GV was significantly associated with increased 30-day and 90-day mortality (HR 1.15, 95% CI 1.09–1.21; and HR 1.14, 95% CI 1.09–1.20, respectively). Threshold analysis identified inflection points at GV = 20.24 for 30-day mortality and GV = 33.96 for 90-day mortality. The stacking ensemble model incorporating GV achieved strong predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.83.ConclusionsGV is a significant and independent predictor of postoperative mortality in gastric surgery patients. The observed threshold effects suggest that maintaining GV below critical levels may improve early outcomes. These findings highlight the prognostic value of GV and support its potential as a target for postoperative management. Further prospective, multicenter studies are warranted to validate these results and guide clinical practice.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40001-025-03501-7.

Background: Congenital heart disease (CHD) is a leading cause of morbidity and mortality in children requiring surgical intervention. Accurate prediction of postoperative mortality remains challenging because of the limitations of traditional risk stratification systems. Artificial intelligence (AI) has emerged as a promising tool for enhancing predictive accuracy in this field. Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of AI in predicting postoperative mortality in patients with CHD. Methods: Following the PRISMA guidelines, we systematically searched four databases for relevant studies published up to July 16, 2024. Studies with retrospective, prospective, or cross-sectional designs that evaluated AI-based models for predicting mortality after CHD surgery were eligible for inclusion. Data were extracted, and study quality was assessed using the PROBAST tool. Pooled estimates for sensitivity, specificity, and the area under the curve (AUC) were calculated. Results: Six studies involving 42,536 patients and evaluating 11 distinct AI models were included. The meta-analysis yielded a pooled AUC of 0.90 (95% CI, 0.88 to 0.93), with a pooled sensitivity of 0.43 (95% CI, 0.23 to 0.65) and a pooled specificity of 0.96 (95% CI, 0.92 to 0.98). Subgroup analysis revealed that the Extreme Gradient Boosting (AUC, 0.93) and Gradient Boosting Machine (AUC, 0.91) models had the highest predictive performance. All included studies were judged to have a low risk of bias. Conclusion: The Extreme Gradient Boosting and Gradient Boosting Machine models demonstrate high specificity and promising accuracy for predicting postoperative mortality in patients with CHD, outperforming traditional scoring systems. Further multicenter, prospective studies are needed to enhance generalizability and support clinical implementation.

Background: The role of electrocardiography (ECG) has been limited in the preoperative risk evaluation in noncardiac surgery due to its low prognostic value. Recent advances in artificial intelligence (AI) have enabled the extraction of subtle features from ECG that can be used in risk prediction. Research Question: Can AI-enabled ECG predict 30-day postoperative mortality in patients undergoing non-cardiac surgery, outperforming conventional risk stratification tools? Methods: A retrospective cohort of 46,135 adults who underwent non-cardiac surgery at a tertiary center between 2020 and 2021 was analyzed. Preoperative ECG images acquired within 30 days before surgery were used as input to a previously developed CNN-based deep-learning algorithm to generate QCG-Critical score – a probability score ranging from 0 to 100 – that reflects the risk for critical conditions such as shock, respiratory failure, and cardiac arrest. The QCG-Critical score was evaluated for its ability to predict 30-day in-hospital mortality. Secondary outcomes included 7-day mortality, prolonged mechanical ventilation, unplanned percutaneous coronary intervention (PCI), and heart failure within 30 days postoperatively. Results: The overall 30-day postoperative mortality rate was 0.34%. Patients with higher QCG-Critical score showed increased mortality, with a 30-day postoperative morality rate of 11.7% among patients with scores &gt;40. The QCG-Critical score demonstrated strong predictive performance for 30-day mortality (AUROC: 0.909), outperforming the ESC guidelines (0.728) and RCRI (0.725), and was comparable to the ASA classification (0.886). The performance of QCG-Critical score remained consistent across subgroups stratified by age, sex, emergency operation, anesthesia type, and conventional risk groups. The QCG-Critical score also demonstrated good performance for predicting 7-day mortality (AUROC: 0.933), unplanned PCI (0.857), prolonged mechanical ventilation (0.829), and heart failure (0.774). Conclusion: The preoperative QCG-Critical score accurately predicted postoperative mortality and other adverse outcomes, outperforming conventional risk stratification tools. The QCG-Critical may serve as a fast, accessible, and integrable tool for perioperative risk assessments in routine surgical care.

Objective Systemic inflammation triggered by cardiopulmonary bypass (CPB) plays a critical role in postoperative complications and mortality. The Delta Neutrophil Index (DNI), which quantifies circulating immature neutrophils, is increasingly recognized as a marker of systemic inflammation. While its utility has been demonstrated in sepsis and non-cardiac surgeries, its role in cardiac procedures remains underexplored. This study aimed to evaluate the relationship between intraoperative DNI levels and postoperative mortality in patients undergoing open-heart surgery with CPB. Methods This retrospective observational study included 245 patients who underwent CPB between January 2022 and July 2023. DNI was measured at five predefined time points: induction, 5, 45, and 90 min after CPB initiation, and immediately postoperatively. Patients were categorized into two groups based on in-hospital mortality: those who experienced mortality (“Ex” group, n = 67) and those who survived (“Non-Ex” group, n = 178). Logistic regression was used to assess the association between DNI values and mortality. Results DNI levels were significantly higher in the Ex group at induction (1.22 ± 0.96 vs 0.47 ± 0.39; p = 0.002), 5 min (2.04 ± 1.07 vs 1.08 ± 0.58; p &lt; 0.001), 90 min (1.76 ± 0.84 vs 1.07 ± 0.81; p = 0.004), and postoperatively (2.14 ± 1.38 vs 0.58 ± 0.32; p &lt; 0.001). Each unit increase in postoperative DNI was associated with a 21.78-fold increase in mortality risk (95% CI: 6.12–67.92; p &lt; 0.001). CPB and cross-clamp durations were also significantly longer in Ex patients. Conclusions Elevated intraoperative and postoperative DNI levels are strongly associated with increased in-hospital mortality following CPB. DNI may serve as a dynamic and practical biomarker to aid perioperative risk stratification, pending further validation. Incorporating DNI into routine intraoperative monitoring may enhance early identification of high-risk patients and improve postoperative outcomes.

Background and Objectives: This study aimed to evaluate the factors influencing early postoperative mortality in patients undergoing cementless hemiarthroplasty for proximal femoral fractures. Materials and Methods: The medical records of 227 patients treated between January 2019 and December 2020 were retrospectively reviewed. Patients were divided into two groups: survivors (Group 1, n = 160) and non-survivors (Group 2, n = 67). The variables assessed included demographic data, neutrophil-to-lymphocyte ratio, surgical duration, hospital stay, American Society of Anesthesiologists (ASA) score, cardiac ejection fraction (EF), Charlson Comorbidity Index (CCI), osteoporosis status, and hemoglobin and albumin levels. Clinical evaluation was performed using the Harris Hip Score. Binary logistic regression was used to analyze risk factors; receiver operating characteristic (ROC) analysis was applied to determine cutoff values. Results: The mean follow-up duration was 14.03 ± 10 months. The mean ages were 80 ± 7.68 yr in Group 1 and 83.99 ± 7.42 yr in Group 2. Statistically significant differences were found between groups regarding ASA scores, intensive care unit (ICU) admission rates, and osteoporosis status (p < 0.001). Preoperative and postoperative albumin levels were also significantly different (p < 0.001). The 1-year and 6-month mortality rates were 39.6% and 29.5%, respectively. Univariate analysis identified age, EF, ASA score, preoperative and postoperative albumin levels, CCI, ICU admission, and ICU stay duration as mortality-related factors. Multivariate binary logistic regression analysis revealed that low postoperative albumin levels may have a significant effect on mortality at 1, 3, and 6 months. ROC analysis showed a significant albumin cutoff value of 2.95 g/dL. Conclusions: Higher postoperative albumin levels were inversely associated with early mortality following hemiarthroplasty in elderly patients. Perioperative monitoring of albumin levels may help improve outcomes, particularly in individuals with severe comorbidities.

Background: The Fontan procedure is a palliative surgery for patients with single-ventricle congenital heart disease (CHD), but it is associated with postoperative and long-term mortality and morbidity. Accurate, individualized risk stratification remains a challenge with traditional models. This study aimed to develop and validate a deep learning (DL) model to predict postoperative mortality after the Fontan procedure and to identify key predictive factors. Methods: We retrospectively analysed data from 230 patients who underwent the Fontan procedure between 2010 and 2024. A Deep Neural Network (DNN) model was developed using comprehensive preoperative, intraoperative, and postoperative clinical, biochemical, and hemodynamic variables. The dataset was split using five-fold cross-validation, with 80% for training and 20% for testing in each fold. The Synthetic Minority Over-sampling Technique (SMOTE) was used to fix class imbalance. Model performance was evaluated using five-fold stratified cross-validation. We assessed accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC-ROC). SHapley Additive exPlanations (SHAP) analysis was employed to enhance model interpretability and identify the importance of features. A user-friendly clinical application interface was developed using Streamlit. This study was reported in accordance with the TRIPOD + AI reporting guidelines. Results: The DNN model demonstrated superior performance in predicting postoperative mortality, achieving an overall accuracy of 91.5% (95% CI: 87.2–94.8%), precision of 83.3% (95% CI: 76.5–89.1%), recall (sensitivity) of 90.9% (95% CI: 85.2–95.1%), specificity of 92.5% (95% CI: 88.3–95.7%), F1-score of 87.0% (95% CI: 82.1–91.3%), and an AUC-ROC of 0.94 (95% CI: 0.88–0.99). SHAP analysis identified key predictors of mortality, such as pulmonary artery pressure, ventricular end-diastolic pressure, preoperative BNP levels, and severity of AV valve regurgitation. The Streamlit application offered a user-friendly interface for personalized risk evaluation. Conclusions: A deep learning model that incorporates detailed clinical data can precisely forecast postoperative mortality in patients undergoing Fontan surgeries. This AI-based method, combined with interpretability techniques, provides a valuable tool for personalized risk assessment. It has the potential to improve preoperative counseling, optimize perioperative care, and enhance patient outcomes. However, additional external validation is needed to verify its broader applicability and clinical usefulness.

Inflammatory bowel disease (IBD) is associated with elevated postoperative mortality in patients undergoing colorectal cancer (CRC) surgery. Venous thromboembolism (VTE) may partially contribute to this elevated mortality. We investigated VTE risk in patients with and without IBD undergoing their first CRC surgery. We conducted a population-based cohort study using Danish health registries (1996-2021), including all patients undergoing first-time CRC surgery (n = 83,950). Patients with a prior IBD diagnosis were defined as exposed. We calculated the 365-day cumulative risks of VTE and used Cox regression to compute adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). The 30-day VTE risk was 1.5% in patients with IBD and 0.7% in those without IBD (aHR 1.61; 95% CI 0.86-3.01). During this period, the strongest associations were observed among male patients (aHR 2.26; 95% CI 1.06-4.82), patients aged 60-69 years (aHR 4.63; 95% CI 1.88-11.39), those who had received IBD treatment before surgery (aHR 1.95; 95% CI 0.97-3.95), and patients with active disease (aHR 5.29; 95% CI 1.69-16.56). These associations were primarily driven by patients with ulcerative colitis. HRs remained elevated during 91-365 days. Patients with IBD are at elevated risk of VTE after CRC surgery compared with those without IBD. The strongest associations were observed in those who had received IBD treatment before surgery and in those with active disease, particularly patients with ulcerative colitis. These findings emphasize the need for increased VTE awareness and optimizing disease control in patients with high-risk IBD.

Abstract Aims To evaluate effect of surgeon’s seniority (trainee surgeon versus consultant surgeon) and surgeon’s sub-speciality of interest on postoperative mortality in patients undergoing emergency laparotomy (EL) Methods A systematic review was conducted and reported according to the Cochrane Handbook for Systematic Reviews and the PRISMA statement standards, respectively. We evaluated all studies comparing the risk of postoperative mortality in patients undergoing EL between a) Trainee surgeon and consultant surgeon, and b) Surgeon without and with sub-speciality of interest related to pathology. Random effects modelling was applied for the analyses. The certainty of evidence was assessed using GRADE system. Results Analysis of 256,844 patients from 13 studies showed no difference in the risk of postoperative mortality between trainee-led and consultant-led EL (OR: 0.76, p=0.12). However, EL performed by a surgeon without sub-speciality of interest related to the pathology was associated with a higher risk of postoperative mortality compared with a surgeon with sub-speciality of interest (OR: 1.38, p&amp;lt;0.00001). In lower GI pathologies, EL done by upper GI surgeons resulted in higher risk of mortality compared with lower GI surgeons (OR: 1.43, p&amp;lt;0.00001). In upper GI pathologies, EL done by lower GI surgeons resulted in higher risk of mortality compared with upper GI surgeons (OR: 1.29, P=0.05). Conclusions While confounding by indication cannot be excluded, level 2 evidence with moderate certainty suggests that trainee-led EL may not increase the risk of postoperative mortality but EL by a surgeon with sub-speciality of interest related to the pathology may reduce the risk of mortality.

Impact of Surgery Duration on Postoperative Mortality in Patients With Cirrhosis

BackgroundGastrointestinal perforation peritonitis is a life-threatening surgical emergency with high mortality. Early identification of patients at increased risk of poor outcomes is critical for optimizing care. In this study, we aimed to evaluate the prognostic value of combining serial Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and serial serum lactate levels in predicting 30-day postoperative mortality among patients undergoing emergency laparotomy for gastrointestinal perforation peritonitis.MethodsIn this prospective cohort study, 120 adult patients diagnosed with gastrointestinal perforation peritonitis and undergoing emergency laparotomy were enrolled after obtaining ethical approval and informed consent. APACHE II scores and serum lactate levels were recorded at three time points: preoperatively (baseline), 6 h postoperatively, and 24 h postoperatively. The primary objective of this study was a combination of serial APACHE II and serial serum lactate level (baseline, 6 h and 24 h post-operatively) and its correlation with post-operative mortality in emergency laparotomy for hollow viscus perforation peritonitis. Data were analysed to compare clinical variables between survivors and non-survivors. Receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were used to assess the predictive performance of individual and combined markers.ResultsThe 30-day postoperative mortality rate was 35%. Significant differences in age, serial APACHE II scores, and serial serum lactate levels were observed between survivors and non-survivors. A serum lactate level of ≥ 1.88 mmol/L had a sensitivity of 81% and specificity of 69.2% (AUC: 0.817; p = 0.0001). APACHE II scores of ≥ 11.16 yielded a sensitivity of 76.2% and specificity of 91% (AUC: 0.915; p = 0.0001). Both serial lactate levels and APACHE II scores were independent predictors of 30-day mortality. The combination of serial APACHE II scores and serum lactate (cutoff ≥ 11.95) had a sensitivity of 85%, specificity of 82%, and an AUC of 0.919 (p = 0.0001), making it the preferred predictor for 30-day post-operative mortality.ConclusionsThe combination of serial APACHE II scores and serial serum lactate levels provides superior prognostic accuracy for predicting 30-day postoperative mortality in patients undergoing emergency laparotomy for gastrointestinal perforation peritonitis. This approach may facilitate early identification of high-risk patients and guide clinical decision-making.Trial registrationNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12893-025-03099-x.

IntroductionPostoperative delirium (POD) is a commonly occurring condition in the postoperative period. Therefore, the study intends to investigate the relationship between B2M and POD and the effect of B2M levels on three-year postoperative mortality in patients with POD.MethodsPostoperatively, the Confusion Assessment Method (CAM) and the Monumental Delirium Assessment Scale (MDAS) were used to assess the incidence and severity of POD. Preoperative plasma B2M levels were measured utilizing a latex-enhanced immunoturbidimetric assay. Total tau protein (T-tau), phosphorylated tau protein (P-tau), and amyloid β plaque 42 (Aβ42) were detected in preoperative cerebrospinal fluid (CSF) by enzyme-linked immunosorbent assay. Logistic regression equations were applied to examine the risk factors linked to POD. Patients presenting with POD were grouped according to B2M level and followed up for 3 years postoperatively for their survival and Kaplan–Meier survival curves were plotted.ResultsThe prevalence of POD was 7.23%. Serum B2M levels were higher in POD patients compared to non-POD (NPOD) patients (p = 0.01). The results of the logistic regression analysis indicated that B2M (OR = 1.394, 95% CI = 1.017–1.910, p = 0.002) and T-tau (OR = 1.006, 95% CI = 1.002–1.011, p = 0.007) posed a risk for POD. B2M and POD were partially associated through the mediation of CSF T-tau (10.0%). The K-M survival curves showed that patients with high B2M who developed POD had a higher mortality rate 3 years after surgery (p = 0.031).ConclusionIn summary, B2M may be a risk factor for POD, which might be mediated in part by CSF T-tau.

To identify the postoperative mortality in patients requiring home oxygen therapy (HOT). This descriptive study used a nationwide hospital-based database constructed by JMDC Inc. (Tokyo, Japan). Patients aged ≥ 18years requiring HOT who underwent surgery between January 2014 and June 2022 were included. The study outcomes were in-hospital and 30-day postoperative mortality rates and other complications. We established a non-HOT group matched by age, sex, procedure, and surgical urgency for contrast and analyzed mortality in subgroups based on the reason for HOT, surgical department, and urgency. Among the 3349 patients receiving HOT who underwent surgery, 293 (8.7%) in-hospital mortalities and 213 (6.4%) 30-day mortalities were reported. Postoperative pulmonary complications were observed in 359 (10.7%) patients, and 227 (6.8%) had non-respiratory complications. Furthermore, 123 (3.7%) in-hospital mortalities and 74 (2.2%) 30-day mortalities were also reported in the non-HOT group (3323 patients). The subgroup analysis indicated no significant differences in mortality or complications based on the reason for HOT. Higher mortality rates were reported in gastroenterology (9.3%), dermatology (14.7%), respiratory (11.8%), otolaryngology (36.5%), and neurosurgery (16.3%) departments. In-hospital and 30-day mortalities for emergency surgeries in the HOT group were 17.3 and 13.4%, respectively. Among patients requiring HOT, in-hospital and 30-day mortalities were 8.7 and 6.4%, respectively. In addition, emergency surgeries may contribute to higher postoperative mortalities. Future research should identify specific mortality risk factors and develop perioperative management strategies to reduce these risks.