Eco-responsible and rational interval debulking surgery for high-grade ovarian carcinomas: An observational, ambispective cohort study.

Suspected anal malignancy turned out to be sarcoidosis; a case report

Peripheral arterial occlusive disease (PAOD) is afrequent manifestation of atherosclerosis associated with high morbidity and mortality. This article summarizes the current recommendations of the German S3 guidelines "Diagnostics, treatment and follow-up of PAOD" (Association of the Scientific Medical Societies in Germany, AWMF 2024) and discusses the implications of the ongoing hospital reform. Key diagnostic modalities include patient history taking, clinical examination, ankle-brachial index measurement and duplex ultrasonography. In cases of suspected chronic limb-threatening ischemia (CLTI), the WIfI score enables astructured risk assessment for amputation. Treatment management emphasizes strict secondary prevention (low-density lipoprotein, LDL < 3,1 mmol/l, smoking cessation), supervised exercise training and optimized antithrombotic therapy (clopidogrel is preferred; dual pathway inhibition for high-risk patients or after revascularization). Revascularization can be performed endovascularly or surgically and increasingly in specialized centers. The German Hospital Reform supports the centralization of complex procedures and the expansion of outpatient care, thereby underscoring the pivotal role of nonvascular surgical departments in early detection and coordinated referral.

Background: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCAIs) worldwide. Changes in the functioning of healthcare systems may affect the implementation of SSIs prevention practices, with consequent alterations in the occurrence of HCAIs. The main aims of our study were to analyze specific SSIs prevalence and proportions together with overall HCAIs prevalence in acute care hospitals (ACHs) before and after the COVID-19 pandemic. Additional aims were to identify bacterial causative agents, the use of perioperative antibiotic prophylaxis (PAP), related structural and process quality indicators, and to determine trends between two periods. Methods: The National Reference Centre for HCAIs (University Hospital Centre Zagreb) conducted point prevalence surveys in May 2017 and May 2023 in ACHs throughout Croatia, using the technical protocol developed by the European Centre for Disease Prevention and Control (ECDC). Results: The prevalence of HCAIs in ACHs in Croatia rose from 5.3% (95% CI 4.8–5.7) in 2017 to 7.2% (95% CI 6.6–7.8) in 2023 (p = 9.93 × 10−14). This trend was paralleled with the rising of the HCAIs prevalence in surgical departments from 5.1% to 6.7% (p = 0.0099). The prevalence of overall SSIs across ACHs increased from 0.9% (95% CI 0.7–1.1) in 2017 to 1.2% (95% CI 1.0–1.5) in 2023 (OR 1.36 (1.03–1.80), p = 0.032. While the prevalence of superficial incisional SSIs significantly decreased (OR 0.53 (0.30–0.95), p = 0.028), the share of deep-seated SSIs (deep incisional and organ/space SSIs) among classified SSIs shifted from 48/92 to 77/96; odds ratio (OR) 2.09 (95% CI 1.45–3.01). In 2017, Gram-positive cocci were the most frequently isolated bacterial causative agents (44.6%). By 2023, this shifted, with Enterobacterales species comprising most isolates (42.2%). In 2023, significantly a higher proportion of patients received PAP (χ2 = 25.419, df = 1, p &lt; 0.5). An increase in the positive trend of alcohol-based hand rub antiseptics use in surgical departments (+15.7 L/patient-days, p &lt; 0.001) contrasted with a decrease in infection prevention and control (IPC) nurses and medical doctors per hospital (−0.5, p = 0.041/−0.5, p = 0.003). Conclusions: Findings of the two point prevalence surveys over time indicate the changes in trends in surgical site infections burden, and highlight the need for the implementation and strengthening of preventive measures with the focus on targeted prevention of deep-seated infections.

Impact of a multimodal awareness campaign on preoperative fasting times and postoperative recovery: A prospective before-after study.

Background: Biobanks are biological repositories that collect, process, store, and distribute human biological samples. Among them, tumor banks play a central role in biomedical research. The overall goal of a tumor bank is to collect cancerous and normal samples under standardized conditions for basic, clinical, or applied research. Methods: Tumor samples from patients with endocrine neoplasms were collected from excess tissue samples not required for diagnostic purposes after surgery in the surgical department of Dr. Shariati Hospital, Tehran, Iran. In addition, relevant biological samples such as serum, plasma and DNA were collected in parallel. Prior to sampling, informed consent was obtained from the patients and a questionnaire was completed. After rapid freezing with isopentane, tissue samples were stored in a liquid nitrogen tank, while other biological materials, such as serum, were stored in a -80°C freezer. Results: Tissue, plasma, serum, and DNA samples collected from patients with endocrine neoplasms were stored in separate barcoded storage boxes in the biobank and were made available to researchers. Conclusion: The use of bioproducts in domestic research and international networks has strengthened research collaborations through supporting the collection and distribution of tissues, especially cancer tissues. This trend plays an important role in facilitating basic and applied research in various fields of cancer, including molecular biology, immunology, genetics and pharmacology, and will pave the way for scientific advances and therapeutic innovations.

Most patients end their life with general palliative care offered by healthcare providers in non-palliative care focused/specialized departments. The state of how this care is organized and adherence to the Danish board of health recommendations is largely unknown. The aim of this study is to describe the organization and clinical practice for general palliative care in Danish hospitals and to explore the association between attitudes and clinical practice. The study is a cross-sectional survey of hospital departments in Denmark with a partial comparison to a survey one decade earlier. Analyses were descriptive and logistic regression. The questionnaire was sent to one randomly assigned chief of all 360 clinical hospital departments in Denmark. The response rate was 73%. Physical symptoms were addressed by 96% and spiritual problems by 56%. The proportion of departments that prioritized resources for general palliative care increased from 24% in 2013 to 51% in 2023. Assessment of needs for general and specialized palliative care was mostly based on a general appraisal. In multivariable logistic regression analyses, the medical departments were more likely to perform needs assessment than the surgical departments, and the attitude towards systematic needs assessment was associated with the clinical practice and planning end-of-life care in the department. The responsibility for planning end-of-life care was regarded as shared among several stakeholders. General palliative care was focused on physical symptoms and assessment of target group and needs were rarely performed systematically despite national recommendations. Clinical practice was associated with specialty and attitudes.

Purpose: The World Health Organization (WHO) defined triage as the action of sorting and prioritizing patients based on the estimation of the urgency for intervention. This approach is used as the basis for identification of those patients who require immediate medical intervention and those who can safely wait. Locally triage is the process including the initial assessment followed by the prioritization of patients needing emergency care and assigns them according to their actual need or likely benefit from immediate medical treatment. To assess the compliance with triage protocols among healthcare providers managing traumatic patients attending the emergency and outpatient surgery department at University Teaching Hospital of Butare. Methodology: The total sample size were 109 but the participants enrolled in the study were 101because 8 participants voluntary did not want to participate to the study (they refused to sign consent form) a prospective cross-sectional study was conducted among health workers in the surgical department (CHUB staff 70), and the emergency department (CHUB staff 31), making a total of 101 participants across both departments. The participants ’knowledge of triage tool was assessed and their level of compliance with triaging. The training on the triage tool was provided among healthcare providers managing traumatic patients attending the emergency and outpatient surgery department at University Teaching Hospital of Butare, and after one moth of intervention the reassessment was also done about the level of compliance with triage tool following training received. Findings: A total of 101 participants were included, the majority being nurses (63.4%). Most respondents reported that the current triage protocols effectively addressed the needs of trauma patients (86.1%) and that adherence to these protocols significantly or somewhat improved patient outcomes (95%). Compliance monitoring was limited, with over one-third (36.6%) stating that outcomes were never reviewed. However, urgent cases were largely well prioritized (89.1%). About one-fifth (20.8%) acknowledged adverse outcomes due to non-compliance with triage protocols. Nearly half (49.5%) of participants reported challenges to implementation, mainly related to lack of training, monitoring, and updated tools. Training interventions were associated with improvements in outcome review practices, prioritization of urgent cases, and reduction of adverse outcomes related to non-compliance. Unique Contribution to Theory, Practice and Policy: In both department participants emphasized the need for ongoing training and to increase staffing as key strategies for further enhance level of compliance and strengthen the triage process in both the emergency and outpatient surgery departments.

Background/Objectives: Alcohol-based handrub (ABHR) consumption is commonly used as an indirect proxy for hand hygiene practices. Hand hygiene compliance increased significantly during COVID-19, but sustainability remains uncertain. This study assessed ABHR consumption trends from 2022 to 2024 and compared them with pre-pandemic and pandemic-era rates. Methods: We conducted a follow-up observational study tracking quarterly ABHR consumption in a surgical department and hospital-wide (2022–2024). Consumption was normalized as mL per patient-day and compared with 2019–2020 data. Time-series regression with Newey–West standard errors assessed temporal trends. Results: Surgical department consumption declined 27.5% (55.9 to 40.5 mL/patient-day), returning to 2019 pre-pandemic levels. Hospital-wide consumption increased 36% (36.4 to 49.6 mL/patient-day). Neither trend reached statistical significance (p > 0.05). The 2024 surgical rate remained substantially below the 2020 pandemic peak (320 mL/patient-day). Conclusions: Pandemic-era ABHR consumption gains were not sustained in the surgical department despite maintained educational infrastructure, accessible dispensers, and consistent staffing. The critical missing element was systematic monitoring and feedback. Institutions relying solely on passive education may experience erosion of hand hygiene compliance post-crisis, highlighting the need for active surveillance programs to maintain behavioral gains.

Short-Term Outcomes and 2-Year Reoperations Following Endoscopic versus Microdiscectomy for Lumbar Disc Herniation: A Propensity-Matched Analysis.

Bile leak is a recognised complication in surgery and trauma patients, often resulting in significant morbidity. While various imaging modalities play an important role in diagnosis, their accessibility and feasibility may be limited in clinical settings. Biochemical analysis of peritoneal or drain fluid bilirubin (FB) and fluid-to-serum bilirubin ratio (FSBR) have been proposed as an adjunct diagnostic tool. However, there is limited research on the use of FB or FSBR to diagnose bile leak as various FSBR cut-offs have been proposed in existing literature. We aim to assess the usefulness of FB and FSBR to diagnose bile leak in surgical and trauma patients. The study was conducted in collaboration with Pathology, Surgical and Trauma departments to comprehensively assess pre-analytical, analytical and clinical aspects. We performed a prospective study over a 21-month period (February 2023 to October 2024) at a metropolitan tertiary surgical and trauma centre. Contingency table and receiver operating characteristic area under curve (ROCAUC) analyses were made to assess the usefulness of FB and FSBR. Our study included 84 patients (38 post-operative surgical, 15 trauma and 31 medical control patients). Five patients (four surgical and one trauma) were diagnosed with bile leak based on radiological and clinical criteria. Both FB and FSBR are shown to be reliable markers to diagnose bile leak (ROCAUCs for both FB and FSBR > 0.9), with a FB cut-off of 75 μmol/L providing specificity 93.7% and sensitivity 100%, and a FSBR cut-off of 6.0 providing specificity 98.7% and sensitivity 100%. Our study demonstrates both FB and FSBR to be useful to diagnose bile leak in both surgical and trauma patients. Further validation through larger, multicentre studies may enhance the generalisability of these findings and refine the role of FB and FSBR in clinical practice.

Persistent glycemic deterioration after the COVID-19 pandemic: A large cohort analysis stratifying by care settings, specialties, and gender disparities in Chengdu, China

Problem definition: We study how clinical teams adaptively respond to real-time deviations from the planned operating room (OR) schedules and the associated consequences of these responses. Specifically, we explore whether clinical personnel adjust their service speed when they are ahead of or behind the original schedule and whether this affects patient reoperation rates. We then analyze the complicated relationships between OR schedules, patient wait times, and reoperations to offer recommendations for achieving the best speed-quality tradeoff. Methodology/results: Our empirical investigation utilizes a unique data set that includes both actual and scheduled surgery timestamps. We construct a dynamic panel model and apply the Arellano-Bond estimator to identify adaptive behavior. We use an instrumental variable approach to address potential endogeneity in estimating the effects of surgical speed and patient wait times on reoperations. The empirical study reveals that surgical and cleaning teams tend to speed up when falling behind schedule and slow down when ahead, with the slowdown effect being more pronounced. Furthermore, the findings indicate that the reoperation rate increases with patient waiting time but decreases with surgical duration. Building on these insights, we model the surgical waitlist as an M/M/1 queue, where the patient returning rate depends on both waiting time and service rate. We use this model to identify how surgery job allowance affects tradeoffs between patient wait time and surgery quality. Managerial implications: The queuing model demonstrates that increasing the average time allowance for surgeries, despite prolonging patient wait times, ultimately decreases reoperation rates under mild assumptions. By varying the time allowance, we derive Pareto curves that illustrate the tradeoffs between reoperation rates and average patient wait times. This provides actionable guidance for surgical departments to schedule their procedures. Funding: This work was supported by the Natural Sciences and Engineering Research Council of Canada [Grants RGPIN-2019-04398, RGPIN-2019-05539, and RGPIN-2025-05592]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2023.0200 .

A BSTRACT Background: With the rising demand for blood products in India, it is imperative to ensure efficient utilisation of available resources within blood banks. This study aims to assess the crossmatch-to-transfusion (C/T) ratio as a metric for evaluating and optimizing blood utilisation practices. Analysing the C/T ratio across various clinical departments will help identify inefficiencies in blood ordering protocols and support the implementation of corrective strategies to improve overall resource management. Materials and Methods: A retrospective observational study was conducted at the Blood Center of Dr. N. D. Desai Medical College &amp; Hospital. Data were collected over one year period from January 2024 to December 2024.The number of cross-matched and transfused data were collected from crossmatch request forms, crossmatch registers, issue registers, and digital medical records. The department wise utilisation of blood and its components C:T ratio were calculated. Results: During the study period, 5,402 blood units were crossmatched, of which 2,968 units were issued, yielding an overall hospital C:T ratio of 1.43 and an overall utilisation rate of 54.95%. Department-wise analysis showed substantial variation. Obstetrics and Gynaecology recorded the highest C:T ratio (2.83) with a utilisation rate of 35.3%, followed by Orthopaedics (C:T ratio 1.85; utilisation54.1%), General Surgery (C:T ratio 1.57; utilisation63.8%), ENT (C:T ratio 1.32; utilisation75.8%), and General Medicine (C:T ratio 1.14; utilisation87.8%). Conclusion: The study revealed that the overall crossmatch-to-transfusion (C/T) ratio at the hospital is within internationally accepted standards, with particularly elevated ratios observed in the surgical departments. Developing a standardized blood ordering policy, including guidelines for expected blood usage in surgical and elective procedures, can significantly reduce unnecessary blood orders, avoid redundant compatibility testing, minimize the return of unused units, and prevent wastage due to component expiry—ultimately leading to more efficient blood bank management.

Aim: We aimed to compare the number and endocrine reasons of consultations between non-surgical departments (NSDs) and surgical departments (SDs). Material and Methods: Adult inpatient endocrine consultations during working hours for 7 consecutive months in our center were retrospectively reviewed. Patients who were discharged before consultation, consulted by the coronavirus disease 2019 (COVID-19) service, or referred for consultation for thyroid ultrasound, biopsy, and prescription were excluded. The patients' age and gender, the consultation department (NSDs and SDs), the endocrine issue for consultation, and preoperative or other consultations were recorded. If the consultation recommends a new medication, discontinuation of a medication, or a change in medication dosage, or provides advice on the preoperative management of endocrine diseases, such as suggesting a glucose-insulin infusion protocol, the consultation was considered improvement management (IM). If the consulted physician did not make a new diagnosis or prescribe a new therapy other than to support the present plan, it was accepted as no improvement management (NIM). Results: A total of 361 consultations were received, but data from 46 were excluded. The remaining 315 consultations and 214 patients were analysed. The rates of consultations that NIM were significantly higher in NSDs in all endocrine issues except bone and calcium metabolism. The department with the highest consultations was dermatology. The most consulted endocrine issue was diabetes in both NSDs and SDs, the second one was thyroid in NSDs and pituitary in SDs. The mean glycated hemoglobin (HbA1c) of consultations that NIM and the mean thyroid stimulating hormone (TSH) level of patients with repeated consultations were significantly low and high, respectively. Conclusion: Since the incidence of endocrine diseases is expected to increase in the future, training to be conducted according to the related endocrine issue, especially for consultations from the NSDs, could reduce NIM consultation rates.

ResumenLa anatomía patológica (AP) es una especialidad cuya historia data de 1837. Forma parte de los procesos hospitalarios, principalmente quirúrgicos, dado que aporta un diagnóstico certero al paciente; sin embargo, continúa siendo una especialidad infravalorada, por lo que el objetivo de este estudio fue dar a conocer la importancia de la AP en los procesos hospitalarios y sus aportaciones a la medicina. Se hizo una revisión en la web de artículos médicos en español e inglés que hicieran referencia a situaciones en las que la AP aportara soluciones, evidencias o se justificara su intervención. Se encontraron artículos médicos que hacen referencia a la importancia del diagnóstico histopatológico, su intervención en los equipos multidisciplinarios, la certeza diagnóstica que ofrece, su rol en la enseñanza y su participación como evidencia en los tratamientos oncológicos. Se revisaron además los cambios con las nuevas tecnologías, principalmente la aplicación de la inteligencia artificial (IA) a los laboratorios de AP. Otra área relevante es su utilidad en el avance de las terapias inmunológicas y la radiología intervencionista. Con estos cambios se ha visto un incremento en la popularidad de la AP, disciplina que proporciona diagnósticos precisos y en muchos casos dirige la conducta quirúrgica y médica, además de favorecer la investigación. La ausencia de esta disciplina genera diagnósticos imprecisos, investigación médica limitada y disminuye las opciones de tratamiento; por lo tanto, su presencia resulta esencial en todo hospital, principalmente aquellos que cuentan con áreas quirúrgicas.

The bulk of identified waste in US health care spending is attributed to hospital-related care variance and inefficiencies from high-cost care delivery practices. Surgical procedures account for 70% to 80% of variance cost. Using a suite of artificial intelligence approaches, advanced health care analytics can process complex patient care data to identify hidden costs and variability from daily activities in the surgical services department. Electronic health record data that have been cohorted for similar surgical traits can improve efficiency and effectiveness to drive actionable changes to reduce unwarranted clinical variation and improve perioperative care quality while reducing costs. This article discusses the types of advanced health care analytics used in the surgical cohorting process and provides a clinical example that produced cost savings by reducing product variability.

The use of oxycodone, recommended as a second-line treatment after morphine, has risen strongly over the last years. Considering its addictive potential, the aim of this study was to evaluate the appropriateness of use of oxycodone for acute pain. A retrospective cross-sectional study was conducted using a university hospital clinical data warehouse and included all patients with at least one administration of oxycodone or morphine in surgery and obstetrics wards in 2022. The population was analysed using automatically collected data, and a random 100-patient sample was analysed through an extensive clinical record review. The appropriate use of oxycodone implies four cumulative conditions which are represented by the primary outcomes carried out on the random 100-patient sample. Firstly, 74% of stays received oxycodone not preceded immediately by morphine: 21% had received oxycodone immediately after morphine, but 44% received oxycodone as first strong opioid and 27% received oxycodone combined with morphine as first opioid treatment, with justification found in less than 5%. Secondly, of the 1035 oxycodone administrations recorded in our sample, 398 (38.5%) were immediate-release forms administered for mild pain or without pain assessment. Thirdly, 28% were not combined with any other analgesic (no multimodal analgesia) and 42% were combined with another opioid. Finally, 60.6% were not combined with a laxative. The majority of patients treated with oxycodone in surgery had inappropriate prescribing. Considering the known risk of developing opioid use disorder after a first administration in surgery, important educational effort seems needed.

Introduction: Triple Negative Breast Cancer (TNBC) is a subtype of breast cancer, characterised by the lack of expression of Oestrogen Receptor (ER) Progesterone Receptor (PR) and Human Epidermal growth factor Receptor (HER2). TNBC is an aggressive type of invasive breast cancer. The clinical, histopathology, and immunohistochemistry study are vital in diagnosing TNBCs. TNBC have rarely been studied in relation to rare prevalence, diagnostic difficulties, and special histological variants. Aim: To study the clinicopathological profile of TNBC pateints. Materials and Methods: The present cross-sectional study, which included all the patients undergoing lumpectomy or modified radical mastectomy received in the the Surgical Pathology Section of tertiary care hospital and department of molecular biology and genetic laboratory, at Krishna Institute of Medical Sciences, Karad, Maharashtra, India from May 2019 to April 2021. During the study period, total of 302 specimens of modified radical mastectomy or lumpectomy that met the inclusion/exclusion criteria were received in the Surgical Pathology department were included in this study. All specimens were analysed using immunohistochemistry for ER, PR, and HER2 Neu expression. Out of these, 100 (33.1%) cases were negative for all three markers, reported as TNBCs. These 100 TNBC cases were evaluated based on the clinicopathological parameters such as patient age, tumour laterality, location, tumour size, histopathological type, histologic Grade, lymphovascular invasion and lymph nodal status of TNBCs and to analyse different histomorphological type. Results: In this total of 302 specimens of modified radical mastectomy, the Invasive Breast Carcinoma No Special Type (IBC NST) (82.70%, 250 out of 302 specimens) was the commonest histopathological diagnosis, followed by medullary carcinoma seven cases (7.0%), metaplastic carcinoma two cases (2.0%), invasive lobular carcinoma two cases (2.0%), one case of apocrine carcinoma (1.0%), one case of neuroendocrine carcinoma (1.0%) and one case of each (1.0%) as malignant phyllode’s tumour, mucinous carcinoma, etc. Conclusion: Prevalence of TNBC in India is considerably higher compared with that seen in Western populations. Present study included extensive analysis of breast cancer showing increasing in incidence of TNBC and is challenging to treat due to its adverse clinicopathological profile. The TNBC is associated with younger age, larger tumour size, higher histopathological Grades, extensive tumour necrosis, more regional lymph node metastasis, advanced stage at diagnosis and aggressive nature of tumour.

ObjectiveThe objective of this study was to establish the safety and efficacy of stenting as a bridge to surgery (BTS) by comparing outcomes in patients who underwent stenting followed by surgery with those who proceeded directly to surgery.MethodologyData were collected retrospectively for all patients who presented with left-sided malignant colonic obstruction between April 1, 2021, and December 31, 2024, at the Surgical Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan. In this observational, non-randomized study, all patients of either gender aged 18 years or older with biopsy-proven left-sided colon cancer were included. Patients with metastatic disease were excluded.ResultsA total of 29 patients were included in this study, out of which 22 (75.9%) underwent stenting as a BTS, while seven (24.1%) went straight to surgery without stenting. The most frequent procedure in the stenting group was laparoscopic anterior resection with anastomosis (n = 14); while, in the non-stenting group, Hartmann’s procedure (n = 7) was predominant. Overall, seven patients (24.1%) developed perforation; however, the difference in perforation rates between the two groups was not statistically significant (p = 0.753). Stoma formation was significantly lower in the stenting group (p = 0.018). Key perioperative parameters did not show any statistically significant changes between the stented and non-stented groups.ConclusionsColonic stenting is a safe and viable option in patients with left-sided malignant colonic obstruction to decompress the bowel, which results in significantly higher rates of primary anastomosis and avoidance of stoma.