Surgical Outcomes Research Articles

Enhancing the outcomes of diabetic vitrectomy with pharmacological adjuvants

This editorial offers insights from a minireview by Venkatesh et al , who explored pharmacological adjuvants for diabetic vitrectomy. Specifically, they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications. Herein, we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques, minimizing intraoperative challenges, and enhancing postoperative recovery. We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field. Overall, this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’ quality of life.

External Validation of an AI-based Preoperative Frailty Index using Real-World Data

Abstract Background Preoperative frailty assessment is crucial for surgical risk stratification in older adults. Traditional frailty measurements are often too time-consuming and resource-intensive in preoperative settings. This study aimed to externally validate an artificial intelligence (AI)-based frailty index developed using electronic health records (EHR). Methods We externally validated an AI-based frailty index, previously developed by our team, on a cohort of 152,364 surgical patients aged 65+ years from the OneFlorida+ Clinical Research Consortium. We examined the association between the predicted frailty and three postoperative outcomes: 30-day mortality, length of hospital stay, and discharge disposition. We also compared the predictive performance of general and service-specific frailty indices (the latter developed using data from patients undergoing specific surgeries) in predicting postoperative outcomes. Results The AI-based frailty index demonstrated a strong and stepwise association with adverse postoperative outcomes. Patients in the highest frailty level (top 20%) had significantly higher odds of 30-day mortality (OR 4.33, 95% CI 3.91-4.80), longer hospital stays (2.53 times longer, 95% CI 2.47-2.60), and a higher likelihood of unfavorable discharge dispositions compared to the lowest frailty level, after adjusting for demographics and comorbidities. The general frailty index performed comparably to or slightly better than service-specific indices across surgical specialties. Conclusion The developed preoperative frailty index effectively predicts postoperative outcomes in a large and diverse external cohort. The index’s efficiency and predictive performance in stratifying surgical risk can potentially improve surgical care and outcomes.

An antibody-photosensitiser bioconjugate overcomes trastuzumab resistance in HER2-positive breast cancer.

An antibody-photosensitiser bioconjugate overcomes trastuzumab resistance in HER2-positive breast cancer.

A meta-analysis of percutaneous endoscopic discectomy and microdiscectomy for lumbar disc herniation: assessing surgical efficacy and clinical outcomes

ABSTRACT Background Lumbar disc herniation is one of the commonest conditions affecting the lumbar spine, with disc fragments migrating in 35–72% of patients. It can be treated with either microdiscectomy or percutaneous endoscopic lumbar discectomy (PELD) surgeries. Materials and Methods We searched these databases; Web of Science, PubMed, Cochrane Library, and SCOPUS. Overall, 26 studies, both randomized controlled trials and observational studies, were included. We analyzed different efficacy, safety, and functional outcomes including operation time, estimated blood loss (EBL), length of hospital stay, return to work period, pain scores, functional outcomes (Oswestry Disability Index (ODI) index, MacNab classification), and rates of complications, recurrence, and reoperation. Results Our results revealed that PELD was superior to MD in different studied outcomes including operation times (mean difference (MD) = -7.97 minutes, p = 0.004), I2 = 69%, return to work (MD = -3.21 weeks, p = 0.001), I2 = 52%, complication rates (OR = 0.70, p = 0.02), I2 = 23%, back pain (OR = −0.30, p = 0.001), and ODI scores (MD = -1.64%, p = 0.002). Both cohorts showed similar outcomes for leg pain (p = 0.31) and recurrence rates (p = 0.87). The rates of reoperation were higher in the PELD cohort compared to MD (OR = 1.47, p = 0.04). Conclusion PELD had better results than the MD group in most of our efficacy, safety, and clinical outcomes including ODI score, surgical time, blood loss, overall complications, and hospital stay while being comparable in the rest of the parameters assessed.

Quantitative and Qualitative Symmetry Analysis of Open Reduction and Fixation of Zygomatic Complex Fractures.

Zygomatic complex (ZMC) fractures are among the most common craniofacial injuries, impacting both function and esthetics. This study evaluates the effectiveness of open reduction and internal fixation (ORIF) in restoring facial symmetry following ZMC fractures. Sixteen patients with unilateral ZMC fractures underwent a retrospective analysis comparing preoperative and postoperative computed tomography (CT) scans to a control group of ten individuals without facial fractures. Quantitative metrics, including root mean square distance (RMSD) and heatmap analysis, were used alongside a qualitative zygoma fracture scale to assess outcomes. Postoperative results showed significant improvements in facial symmetry, with RMSD values approaching those of the control group. Heatmap analysis revealed that 50% of patients achieved deviations within 2-4 mm and 31% within 2 mm, highlighting the effectiveness of ORIF. More complex fractures exhibited higher residual asymmetry, emphasizing the influence of fracture severity on surgical outcomes. The zygoma fracture scale correlated with heatmap results, supporting its value as a complementary assessment tool. These findings demonstrate ORIF's capability to restore symmetry while identifying areas for improvement in managing complex fractures. The study underscores the need for enhanced imaging and standardized evaluation methods to optimize surgical precision and outcomes in craniofacial trauma care.

Impact of adding the immune checkpoint inhibitor atezolizumab to first-line chemotherapy on progression-free survival in poor-prognosis ovarian cancer: A retrospective analysis from the IMagyn050 trial.

Impact of adding the immune checkpoint inhibitor atezolizumab to first-line chemotherapy on progression-free survival in poor-prognosis ovarian cancer: A retrospective analysis from the IMagyn050 trial.

Trisomy 21 Children With Duodenal Atresia or Anorectal Malformation: NSQIP-P Surgical Outcomes Study.

Trisomy 21 Children With Duodenal Atresia or Anorectal Malformation: NSQIP-P Surgical Outcomes Study.

Effect of hospital systems on surgical outcomes in cancer patients.

e16449 Background: Individual hospitals are rapidly consolidating into large healthcare systems. While evidence exists on volume-outcome relationships for individual hospitals for the Whipple procedure, evidence on healthcare systems is lacking. We aim to compare outcomes for patients undergoing Whipple procedures between flagship and non-flagship hospitals to examine how hospital systems impact surgical quality for highly specialized surgical care. Methods: Utilizing New York State’s (NYS) Statewide Planning and Research Cooperative System, we identified adult patients who underwent Whipple’s procedure between 2016 and 2019. Patients were categorized into two cohorts: those treated in a flagship (highest volume hospital in a system) or non-flagship hospital. Free-standing hospitals and systems with fewer than 5 Whipple procedures annually at their flagship hospital were excluded (n = x). Patients with a non-pancreatic cancer that metastasized to the pancreases and patients with concomitant surgeries performed same-day were excluded (n = x). 1:1 propensity score matching was performed to balance cohorts for analysis. Patient characteristics and outcomes (30-day and 90-day) were analyzed between cohorts in unmatched and matched (on sex, race and insurance) samples using bivariate and multivariate analysis with alpha set at 0.05. Results: Overall, 1633 patients were included: 1126 (68.6%) received care at flagship hospitals and 515 (31.4%) at non-flagship hospitals. Whipple procedures were performed in X% of NYS hospitals including Y systems (Median hospitals per system: X). Patients treated at flagship hospitals were more often White (65% vs. 41%, p < 0.01) and less often Medicaid recipients (17% vs 30%, p < 0.01) versus non-flagship hospitals. After propensity-score-matching, patients at flagship hospitals had lower 30-day transfusion requirements (18% vs. 27%, p < 0.01), and overall fewer postoperative complications at 30-days (47% ) and 90-days (49% vs. 56%, p = 0.03) compared to patients in non-flagship hospitals in the same system; there was no difference in 90-day readmission (18% vs. 17%, p = 0.49) or mortality (2% vs 1%, p = 0.23). Conclusions: When planning a Whipple procedure, patients should be referred to the highest volume Whipple procedure hospital within their healthcare system to optimize post-operative outcomes. To facilitate access to high quality surgical services, providers should screen patients for social determinants or health and help connect patients with appropriate services to minimize patients burden and financial toxicities.

Splenectomy as an indicator for ovarian cancer spread and complete cytoreduction.

Splenectomy as an indicator for ovarian cancer spread and complete cytoreduction.

Nutritional assessment in gynecological cancers: Experience from an Indian tertiary care center.

Nutritional assessment in gynecological cancers: Experience from an Indian tertiary care center.

Exploring the relationship between the level of facial nerve injury and surgical outcome: Application of a new anatomical classification system in a limited cohort undergoing marginal mandibular nerve reconstruction.

Reconstruction of the marginal mandibular nerve (MMN) is important for achieving optimal outcomes in the treatment of facial paralysis. However, the heterogeneity of injuries, ranging from extensive proximal facial nerve injuries to isolated distal MMN injuries, complicates meaningful outcome comparisons. This study assessed a new anatomical classification system for stratifying facial nerve injuries by injury location. The aim was to study MMN outcomes in proximal versus distal injuries and determine whether this system could provide a more reliable way to compare surgical results. A retrospective, single-center study of MMN reconstructions (either independent MMN reconstructions or as part of a broader facial nerve reconstruction) was conducted over a 12-year period. Clinical outcomes were assessed using a classification system for facial nerve injuries (Levels 1-3, based on facial nerve injury location: Level 1 = proximal, Level 2 = parotid area, Level 3 = distal). Outcome measures included the Terzis' Lower Lip Grading Scale, photogrammetry, Sunnybrook, and quality-of-life assessments (Facial Disability Index, Facial Clinimetric Evaluation Scale). Sixteen patients (7 female; mean age 46.5 ± 20.6 years) underwent MMN reconstruction. Across all outcome measures, distal Level 3 injuries yielded the best outcomes, followed by Level 2, with proximal Level 1 injuries showing the least favourable results. Proximal facial nerve injuries demonstrated inferior MMN outcomes compared with distal injuries, highlighting the importance of considering injury location when comparing results. The proposed classification system may provide a practical method for grouping patients according to anatomical injury location, enabling more meaningful and standardized comparisons of surgical outcomes among patients with similar characteristics and treatment protocols.

Evaluating AI-generated patient education materials for spinal surgeries: Comparative analysis of readability and DISCERN quality across ChatGPT and deepseek models.

Access to patient-centered health information is essential for informed decision-making. However, online medical resources vary in quality and often fail to accommodate differing degrees of health literacy. This issue is particularly evident in surgical contexts, where complex terminology obstructs patient comprehension. With the increasing reliance on AI models for supplementary medical information, the reliability and readability of AI-generated content require thorough evaluation. This study aimed to evaluate four natural language processing models-ChatGPT-4o, ChatGPT-o3 mini, DeepSeek-V3, and DeepSeek-R1-in generating patient education materials for three common spinal surgeries: lumbar discectomy, spinal fusion, and decompressive laminectomy. Information quality was evaluated using the DISCERN score, and readability was assessed through Flesch-Kincaid indices. DeepSeek-R1 produced the most readable responses, with Flesch-Kincaid Grade Level (FKGL) scores ranging from 7.2 to 9.0, succeeded by ChatGPT-4o. In contrast, ChatGPT-o3 exhibited the lowest readability (FKGL>10.4). The DISCERN scores for all AI models were below 60, classifying the information quality as "fair," primarily due to insufficient cited references. All models achieved merely a "fair" quality rating, underscoring the necessity for improvements in citation practices, and personalization. Nonetheless, DeepSeek-R1 and ChatGPT-4o generated more readable surgical information than ChatGPT-o3. Given that enhanced readability can improve patient engagement, reduce anxiety, and contribute to better surgical outcomes, these two models should be prioritized for assisting patients in the clinical. This study is limited by the rapid evolution of AI models, its exclusive focus on spinal surgery education, and the absence of real-world patient feedback, which may affect the generalizability and long-term applicability of the findings. Future research ought to explore interactive, multimodal approaches and incorporate patient feedback to ensure that AI-generated health information is accurate, accessible, and facilitates informed healthcare decisions.

Adenomyosis Patterns on Transvaginal Sonography Could Predict the Obstetrical Outcomes of Fertility-Sparing Surgeries: A Retrospective Cohort Study.

Adenomyosis Patterns on Transvaginal Sonography Could Predict the Obstetrical Outcomes of Fertility-Sparing Surgeries: A Retrospective Cohort Study.

Surgical Outcomes among Individuals Experiencing Homelessness with Gastrointestinal Cancer.

Surgical Outcomes among Individuals Experiencing Homelessness with Gastrointestinal Cancer.

Impact of Extended Versus Limited Lymph Node Dissection on Surgical Outcome, Recurrence Patterns and Survival After Radical Cystectomy.

Impact of Extended Versus Limited Lymph Node Dissection on Surgical Outcome, Recurrence Patterns and Survival After Radical Cystectomy.

Preoperative cognitive function and surgical outcomes under general anesthesia among older patients.

Preoperative cognitive function and surgical outcomes under general anesthesia among older patients.

VNOTES hysterectomy for patients with large uteri: Initial experience in the largest Tertiary Centre in Singapore.

vNOTES hysterectomy for patients with large uteri: Initial experience in the largest Tertiary Centre in Singapore.

Effect of romosozumab administration on proximal junctional kyphosis in corrective spinal fusion surgery.

Effect of romosozumab administration on proximal junctional kyphosis in corrective spinal fusion surgery.

Anti-Osteoporotic Treatment Reduces Risk of Revision Following Total Shoulder Arthroplasty in Patients with Osteoporosis

Anti-Osteoporotic Treatment Reduces Risk of Revision Following Total Shoulder Arthroplasty in Patients with Osteoporosis

Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study.

Salvageable locoregional recurrence and stoma rate after local excision of pT1-2 rectal cancer - A nationwide cross-sectional cohort study.