Surgeries, Volume 7, Issue 3 (September 2026) – 18 articles

Background: This study aims to evaluate the effect of postoperative posturing on graft detachment and rebubbling rates following Descemet Membrane Endothelial Keratoplasty (DMEK). Methods: This was an interventional comparative cohort study, assessing patients with and without posturing. All consecutive eyes requiring DMEK or phaco-DMEK were included in two chronological cohorts. The first cohort received strict 48 h postoperative posturing instructions, while the subsequent cohort received no posturing advice. Primary outcomes were graft detachment and rebubbling rates. Secondary outcomes were other adverse events and 6 months functionality. Results: A total of 119 eyes were included: 29 eyes in the posturing cohort (PC) and 90 eyes in the no-posturing cohort (no-PC). Forty-five eyes developed a graft detachment and rebubbling was performed in 38 eyes (37.8% resp. 31.9%). There was no significant difference in detachments (37.9% PC vs. 37.8% no-PC, p = 0.99) or rebubbling (31.0% PC vs. 32.2% no-PC, p = 0.91) between cohorts. Graft failure occurred twice in both cohorts (6.9% PC vs. 2.2% no-PC, p = 0.23). Conclusions: Abstaining from postoperative posturing did not impact the clinical outcomes of DMEK surgery. Eliminating posturing could reduce patient discomfort, health risks, and broaden eligibility for endothelial keratoplasty. Full article

Laser technology has recently gained renewed interest in hysteroscopic surgery due to advances in fiber-optic delivery systems, device miniaturization, and the growing adoption of office-based procedures. In this context, laser energy represents a potential alternative to conventional mechanical and electrosurgical techniques, particularly in settings where precision and tissue preservation are clinically relevant. This narrative review provides a comprehensive and clinically oriented overview of the role of laser technology in modern hysteroscopy. A literature search was conducted in PubMed, Scopus, and Web of Science up to December 2025, focusing on studies addressing technical aspects, clinical applications, safety, and outpatient feasibility of laser-assisted hysteroscopy. Different laser systems, including Nd:YAG, diode, CO₂, Ho:YAG, and KTP lasers, are discussed in terms of physical properties and tissue interaction. Current clinical applications include the management of intrauterine adhesions, submucous myomas, endometrial polyps, septate uterus, and selected cases of endometrial ablation. Available evidence suggests that modern diode laser platforms are particularly suited for office-based procedures due to their combined cutting and coagulative effects and compatibility with small-caliber hysteroscopes. However, most of the current literature is based on small, heterogeneous studies, and robust comparative data with standard hysteroscopic techniques remain limited. As a result, laser hysteroscopy cannot yet be considered a standard approach across indications. To move beyond a purely technical appraisal, this review also frames laser hysteroscopy as a potential translational platform in which laser–tissue interaction, biomarker-informed patient selection, endometrial repair biology, fertility outcomes, and adhesion-formation mechanisms may be integrated into future functional precision medicine pathways. In conclusion, laser technology represents a promising and evolving tool in operative hysteroscopy, with potential advantages in selected clinical scenarios. Further prospective and comparative studies are required to better define its role and to support its broader integration into routine clinical practice. Full article

Objective: Traumatic dislocation and fracture–dislocation of the hip are rare and severe injuries often associated with high-energy trauma. Early recognition and rapid, stable reduction are essential for successful treatment; otherwise, this type of injury is associated with poor functional outcomes and high rates of complications such as avascular necrosis. This retrospective study aims to describe and analyze long-term outcomes and survival rates after a hip dislocation. Methods: Between 2008 and 2021, all patients with traumatic hip dislocation who were treated in a Level I Trauma Center were retrospectively assessed and analyzed. During the follow-up examination, two experienced surgeons carried out a clinical follow-up examination and evaluated the available X-ray images. Anterior and posterior fracture–dislocations and femoral head fractures were classified according to Stewart and Milford’s and Pipkin’s classification system, respectively. All patients were followed up using the Harris Hip Score (HHS) and Lequesne score. Results: Forty-four (38 male and 6 female) patients with a mean age of 46.02 (±19.48) years were included. The average follow-up period was 45.69 (±45.69) months. Traffic accidents were the main cause of traumatic dislocation in this series, accounting for 75% of all cases. Associated injuries were noted in 28 cases. Twenty-three and 21 patients were treated with closed and open reduction, respectively. Isolated hip dislocations without bony involvement according to Stewart and Milford type 1 occurred in five cases. Type 3 injuries were most common, followed by type 4 injuries. This study found that the type of reduction and the trauma mechanism are not significant factors in long-term prognosis (p = 0.463). Thirteen patients had subjective excellent or good results in the HHS and Lequesne score. Late post-traumatic osteoarthritis of the hip developed in 10 patients (22.7%). Patients received a hip replacement at 20.7 months (1–102) months. Thus, after 2 years, implantation of a hip prosthesis due to post-traumatic coxarthrosis was necessary in 22.7% of all cases. The type of hip dislocation classified according to Stewart and Milford had no significant influence on the implantation of a hip prosthesis. Conclusions: Excellent or good results in HHS were obtained in patients with early, stable, and accurate reduction by closed or open methods. After 2 years, 22.7% of the patients needed a total hip replacement. Full article

Background/Objectives: This paper synthesizes and evaluates the potential origins of ectopic salivary gland pathologies in the human nasopharynx. By combining historical reports with an original comparative analysis, this study aims to clarify the precise anatomical and functional status of the proposed tubarial salivary-type glands. Methods: A literature search through December 2025 across major electronic databases identified 84 relevant publications on nasopharyngeal glandular pathologies. The methodological quality in the histomorphological literature was evaluated using the AQUA tool. Concurrently, histological samples were harvested from the inner Eustachian tube opening/torus tubarius region of human, canine, and rodent cadavers and analyzed using histomorphological and immunohistochemical protocols. Results: Most of the literature addressing histologically indicated nasopharyngeal glandular pathology described these findings as controversial, largely overlooking salivary gland origins. The AQUA appraisal identified significant vulnerabilities, showing a high risk of bias in the Study Design domain and yielding moderate inter-rater agreement (κ = 0.435). The empirical morphological study revealed mixed glands with strong mucous predominance in the torus tubarius region of humans and dogs, whereas rodents displayed exclusive PAS positivity within a trabecular stroma. Human samples uniquely demonstrated distinct compartmentalization, duct- and capsule-like formations, and negative α-amylase immunoreactivity. Conclusions: Our pilot empirical evidence, combined with the literature data, suggests a possible pathogenetic link between specific nasopharyngeal neoplasms and the baseline glandular structures of the human torus tubarius. Exhibiting traits of both major and minor salivary systems, the tubarial glands may represent an intermediate structural entity. Furthermore, the animal models utilized do not provide a completely reliable translational framework, highlighting the need for standardized research using fresh human biopsies. Full article

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson’s tumor, is a rare benign vascular lesion first described in 1923. Its pathogenesis involves thrombus formation influenced by stasis, trauma, hormones, or radiation, followed by endothelial proliferation and papillary formation. IPEH occurs in various anatomical locations, including the hand and wrist, with a predilection for the skin and subcutaneous tissues. Clinical presentation varies according to the site, ranging from asymptomatic slow-growing masses to syndromes caused by the compression of surrounding structures. Diagnosis relies on histopathology, supported by immunohistochemistry. Complete surgical excision remains the treatment of choice, with excellent prognosis and low recurrence rates. Full article

Background and Objectives: A number of published studies comparing transanal haemorrhoidal dearterialization (THD) and conventional haemorrhoidectomy (CH) have primarily focused on short-term outcomes, while data on long-term results remains scarce. This study aimed to compare Doppler-guided THD and CH with emphasis on both early and long-term postoperative results. Methods: This retrospective study included 336 patients who underwent CH (Group 1, n = 189) or Doppler-guided THD (Group 2, n = 147). The groups were compared according to demographic data, HD stage, symptoms, complications, duration of hospital stay, postoperative pain, patient satisfaction, and recurrence rates after 18 months of surgery. Results: There was no difference between groups regarding gender, although there were statistically significant distinctions in terms of disease stage and age (p < 0.001), with the emphasis that in CH group patients had advanced stage of disease and were older. THD was associated with significantly lower postoperative pain, with median visual analogue scale (VAS) scores on postoperative days 1, 2, and 7 of 5, 3, and 1, compared with 7, 5, and 3 after CH (p < 0.001). There was no difference in VAS on POD 30 between groups. Median hospital stay was significantly shorter after THD (1 vs. 3 days; p < 0.001). Patients undergoing CH required more analgesics, laxatives, and follow-up visits within the first postoperative month (p ≤ 0.008). Postoperative complications occurred in nine patients, without significant differences between groups. During the 18-month follow-up period, HD recurrence occurred in seven patients and was more frequent after THD. Additionally, two THD patients developed anal fissures. Conclusions: Doppler-guided THD is a safe and effective treatment for HD, providing reduced postoperative pain, faster recovery, and shorter hospitalization. Long-term outcomes were favourable in both groups, with a trend of lower recurrence rate in the CH group. Full article

Background: Chronic distal radioulnar joint (DRUJ) instability secondary to triangular fibrocartilage complex (TFCC) injury remains challenging to treat. This study describes a novel mini-open dorsal technique for TFCC reconstruction and reports preliminary clinical outcomes. Methods: Six patients with chronic symptomatic DRUJ instability underwent mini-open dorsal TFCC reconstruction using a dorsal capsular flap fixed to the ulnar fovea with a 2 mm suture anchor. Clinical outcomes included DRUJ stability, forearm range of motion, pain (VAS), QuickDASH, and PRWHE scores. Results: At final follow-up, clinical DRUJ stability was restored in all patients, with full forearm rotation. Mean QuickDASH improved from 61.0 to 6.5, mean PRWHE improved from 58.7 to 8.0, and mean VAS pain score improved from 7.5 to 0.83. No complications or recurrences were observed. Conclusions: This mini-open dorsal technique was feasible in this small case series and was associated with encouraging early clinical outcomes and restoration of clinical DRUJ stability. Larger prospective studies with longer follow-up are required before definitive conclusions can be drawn. Full article

Background/Objectives: Frontal sinus surgery remains one of the most challenging procedures in endoscopic sinus surgery due to the complex and variable anatomy of the frontal recess. While several radiological parameters have been proposed to guide surgical planning, there is no standardized anatomical classification that informs both approachability and techniques. This study aimed to develop a reproducible CT-based classification of the nasofrontal beak (NFB) and frontal ostium clearance (FOC), and to validate its surgical applicability through a two-phase design. Methods: A combined retrospective–prospective cohort study was conducted. In Phase 1, CT scans from 1383 patients (2595 sinuses) were analyzed to measure NFB and FOC lengths via a novel technique. The cutoff points were defined through histograms, kernel density estimation, and K-means clustering. In Phase 2, 100 patients (191 sinuses) who underwent frontal sinus surgery were prospectively assessed. Radiological classifications were compared with intraoperative findings, and instruments were selected on the basis of anatomical classes. Agreement between radiological and surgical classifications was analyzed, and surgical outcomes were recorded. Results: NFB and FOC were each classified into three groups: Class A (≤6 mm), Class B (6–12 mm), and Class C (≥12 mm) for NFB, and Class A (≥12 mm), Class B (6–12 mm), and Class C (≤6 mm) for FOC. There was excellent agreement between radiological and intraoperative NFB classes. Class-specific techniques included no modifications for Class A NFB, frontal sinus punches for Class B, and straight/curved drill for Class C. Only one intraoperative lamina papyracea injury and two cases of postoperative neo-ostium narrowing were reported. Significant sex-based anatomical differences and minor side-to-side asymmetries were also observed. Conclusions: This novel classification provides a reproducible, internally validated system for stratifying frontal sinus anatomy preoperatively, with good radiological–surgical concordance for the nasofrontal beak. By mapping the anatomical class onto instrument selection, it offers a practical planning adjunct. As a single-center derivation without an external cohort or comparator arm, it demonstrates anatomical–surgical concordance and feasibility rather than clinical superiority, and warrants multicenter external validation. Full article

A 52-year-old man presented with an unrepaired common canalicular laceration resulting from a traffic accident 1.5 months prior to referral. Cutaneous and conjunctival scars were identified medial to the right lower lacrimal punctum. During surgery, the skin, subcutaneous tissue, and conjunctiva were incised along the existing scar, and the plane under the orbicularis oculi muscle was dissected to expose the lacrimal sac. The anterior wall of the lacrimal sac was incised, and a pigtail probe was inserted through the internal common canalicular orifice via the lacrimal sac lumen to identify the distal end of the common canaliculus. A bicanalicular lacrimal tube was inserted into the identified distal end, followed by suturing of the Horner’s muscle surrounding the lacerated canaliculus and skin closure. At 6-month follow-up, the patient was free of epiphora, with a normal tear meniscus height. Full article

Objective: Long-term data on ejaculation-sparing transurethral surgery for primary bladder neck obstruction (PBNO) in young men remain limited. We report the extended outcomes of the ZANCLE technique—a monopolar or bipolar unilateral “Z”-shaped transurethral incision of the prostate and bladder neck (TUIP) designed to relieve obstruction while anatomically preserving the ejaculatory pathway—in the largest single-surgeon cohort published to date, with follow-up extended to 24 months. Materials and Methods: We retrospectively analyzed prospectively collected data from 186 consecutive patients who underwent the ZANCLE procedure at a single institution between December 2018 and September 2025. Eligibility required prostate volume < 30 mL and failure of alpha-blocker therapy. Voiding parameters—Qmax, post-void residual (PVR), IPSS, and IPSS-QoL—were recorded at baseline and at 1, 6, 12, and 24 months postoperatively. Ejaculatory function was evaluated at each follow-up visit. Results: Median patient age was 43 years (IQR 37–58); median prostate volume was 27 mL (IQR 20–29). Mean Qmax improved from 10.2 ± 2.5 mL/s preoperatively to 22.8 ± 3.9 mL/s at 1 month and remained at 19.8 ± 4.2 mL/s at 24 months (p < 0.001). IPSS fell from 16 ± 2.7 to 6.9 ± 1.5 at 1 month and 6.5 ± 1.6 at 24 months; IPSS-QoL from 4.3 ± 0.9 to 1.9 ± 1.6 and 1.6 ± 1.2, respectively (all p < 0.001). Mean PVR decreased from 125.5 ± 16.1 mL to 31.2 ± 8.9 mL at 24 months (p < 0.001). Anterograde ejaculation was maintained in all 186 patients (100%) at every postoperative timepoint. Minor complications (Clavien 1–2) occurred in 5 patients (2.7%); no major adverse events were recorded. Conclusions: The ZANCLE technique achieves sustained improvements in voiding function and quality of life over 24 months, with a 100% ejaculation preservation rate and an excellent safety profile. These findings support the ZANCLE technique as a clinically promising surgical option for selected young men with PBNO refractory to medical therapy, pending comparative evidence; functional outcomes were numerically consistent with those reported for laser-based approaches, without the associated cost burden, although direct comparison was not possible in this non-comparative design. Full article

Background: Despite modern technology of energy instruments, secure arterial vessel sealing remains a surgical challenge. Particularly in cases of fragile vessel walls or limited visibility, additional reinforcement techniques are potentially desirable. TachoSil^®, a collagen-based, fibrin-coated fleece, is routinely employed in clinical practice for hemostasis and suture support. Whether its external use in terms of collagen augmentation improves the burst strength of bipolarly sealed arteries is to be examined. Objective: To investigate the influence of a TachoSil^® cuff on sealing quality and burst pressures after bipolar vessel sealing in a standardized ex vivo model. Materials and Methods: Porcine carotid arteries (outer diameter 5–7 mm) were examined in two groups: native vessels (group A, n = 12) and vessels with TachoSil^® cuffs (group B, n = 12). Sealing was performed with marSeal^® 5 plus and maXium^® sealer. Burst pressures were measured by continuously increasing intraluminal pressure. Histological analyses were performed. Results: Mean burst pressures were significantly reduced in group B (805 ± 78 mbar) as compared to group A (1452 ± 275 mbar; p < 0.001). Histologically, no structural fusion between vessel walls and collagen fleece was observed. Conclusions: External collagen augmentation using TachoSil^® leads to a significant reduction in the burst strength of bipolarly sealed arteries, despite unaltered sealing duration. The combination of collagen fleece and energy sealing does not have a synergistic effect and should not be used in planned vessel sealing. Further studies are needed to evaluate the underlying mechanisms and possible alternative augmentation strategies. Full article

Low-grade myofibroblastic sarcoma is a malignant mesenchymal tumor with myofibroblastic differentiation, characterized by a high rate of local recurrence but low metastatic potential. It is commonly identified in the head and neck region, and particularly in the oral cavity. We report the diagnostic and treatment steps of a fast-growing lesion of the lower left jaw in a 22-year-old otherwise healthy woman. Based on histological and immunohistochemical features, the diagnosis of low-grade myofibroblastic sarcoma was determined. After a careful evaluation and given the absence of established protocols, our multidisciplinary tumor board recommended segmental mandibulectomy combined with a selective neck dissection. Histopathological examination of the resected specimen confirmed a low-grade mesenchymal neoplasm with focal intermediate-grade areas, resected within oncologically safe margins. In view of the histopathological findings, the case was further discussed by the multidisciplinary tumor board, which recommended adjuvant radiotherapy. No evidence of local recurrence or metastatic disease has been observed during the 10-month postoperative follow-up. Given the rarity of this tumor and the limited number of reported cases, this case report provides further insight into its diagnosis and management and contributes to the existing evidence available for the treatment of this pathology. Full article

Background/Objectives: Preoperative patient education (PPE) has been increasingly recognized as an important component of perioperative care in patients undergoing total knee arthroplasty (TKA). This study aimed to evaluate the association between preoperative education and knowledge acquisition, functional outcomes, health-related quality of life, and anxiety levels following TKA. Methods: A prospective controlled longitudinal study included 120 patients undergoing primary TKA. Participants were allocated to an intervention group receiving structured preoperative education (n = 80) and a control group receiving standard perioperative care (n = 40). Outcomes were assessed preoperatively and at one and six months postoperatively using validated instruments, including WOMAC, KOOS, Lysholm score, RAND SF-36, and the Beck Anxiety Inventory. Knowledge levels were evaluated using a structured knowledge test. Between-group comparisons and correlation analyses were performed. Results: Patients in the intervention group demonstrated significantly higher knowledge scores following education. The intervention group demonstrated more favorable postoperative functional outcomes across follow-up assessments, reflected by lower WOMAC scores and higher KOOS and Lysholm scores. Significant improvements in health-related quality of life were observed across most RAND SF-36 domains. Anxiety levels decreased over time in both groups, with consistently lower scores observed in the intervention group. Significant correlations were identified between baseline knowledge levels and selected functional and quality-of-life outcomes. Conclusions: Structured preoperative patient education was associated with improved knowledge acquisition and more favorable postoperative functional and health-related quality-of-life outcomes following TKA. Anxiety scores decreased over time in both groups; however, anxiety-related findings should be interpreted with caution because baseline BAI scores differed between groups. These findings support the integration of structured patient education into routine perioperative care pathways for individuals undergoing total knee arthroplasty. Full article

Introduction: Chronic sacroiliac joint (SIJ) pain is a frequent cause of low-back pain and remains challenging to diagnose and treat due to complex anatomy, overlapping clinical features, and limited long-term efficacy of conventional therapies. Case Presentation: We report the case of a 74-year-old woman with chronic right-sided sacroiliitis associated with spondyloarthritis, presenting with persistent gluteal pain refractory to nonsteroidal anti-inflammatory drugs, physiotherapy, and steroid injections. The patient underwent a dual imaging-guided intra-articular injection, consisting of pre-procedural ultrasound assessment and fluoroscopy-guided needle placement to confirm intra-articular access prior to injection. Autologous adipose tissue purified through mechanical filtration, without enzymatic manipulation, was administered. Pain intensity decreased from a visual analog scale (VAS) score of 8/10 at baseline to 2/10 at three months, with sustained improvement up to 12 months, functional recovery, and discontinuation of analgesic therapy, without procedure-related complications. Conclusions: This case suggests that dual imaging-guided intra-articular injection of mechanically filtered autologous adipose tissue may be feasible in selected patients with refractory SIJ pain. No causal inference can be drawn from a single case, and further studies are required to evaluate safety and clinical effectiveness. Full article

Background/Objectives: The association between gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) has been debated, with conflicting evidence regarding its magnitude and clinical significance. This systematic review and meta-analysis aimed to evaluate the epidemiological association between GERD and CRS, assess the potential pathophysiological mechanisms, and determine the impact of diagnostic methodology on the observed relationship. Methods: A literature search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science for observational studies published up to January 2026. Studies reporting the prevalence or odds of GERD in adult patients with CRS compared with controls were included. Methodological quality was assessed using ROBINS-E, JBI, and Hoy et al. Data were pooled using random-effects models with Hartung–Knapp–Sidik–Jonkman adjustment. Heterogeneity was explored using subgroup and meta-regression analyses. The certainty of the evidence was graded using the GRADE approach. Results: Twenty-two studies, involving 45,618 participants, met the inclusion criteria. Patients with CRS had significantly higher odds of having GERD than controls (OR 5.39; 95% CI: 2.06–14.11; p < 0.001). This association was corroborated by longitudinal data (aOR, 1.77; 95% CI: 1.44–2.17; p < 0.0001) and genetic evidence from Mendelian randomization. Subgroup analysis revealed that the magnitude of association was significantly stronger in studies utilizing objective diagnostic tools, such as pepsin assays (OR 15.20) and pH monitoring (OR 6.94), compared to subjective questionnaires (OR 1.43). This association was significant for CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Meta-regression analysis indicated a stronger association in younger populations (p = 0.034). Moderate-certainty evidence supports a positive epidemiological association between GERD and CRS, although substantial between-study heterogeneity (I² = 69–89%) and wide 95% prediction intervals limit the precision and generalizability of the pooled estimates. Conclusions: An association between GERD and CRS is observed in studies using objective markers of extraesophageal reflux, whereas the association is attenuated and not statistically significant when reflux is assessed by subjective questionnaires. Objective reflux assessment may be considered in selected patients with medically and surgically refractory CRS, but routine reflux testing in unselected CRS patients is not yet supported by the available evidence. Full article

Background/Objectives: Minimally invasive surgery benefits patients but places physical and cognitive demands on surgeons. While robot-assisted laparoscopic surgery (RALS) reduces musculoskeletal strain, it may increase cognitive load. This study examined whether physical and psychological preparatory protocols (warm-ups) influence surgeon strain during RALS. Methods: Ten consultant surgeons from East Lancashire Hospitals NHS Trust (UK) participated in a preregistered, randomized study. Each performed RALS under three conditions: control, physical warm-up (10 min simulation tasks on the Da Vinci system), and psychological warm-up (10 min PETTLEP-based mental imagery). Electromyography (EMG) and electroencephalography (EEG) were recorded during key surgical phases. EMG data were normalized to maximal voluntary contractions. Results: The physical warm-up significantly increased EMG activity in the right deltoid and right trapezius (p < 0.05) compared to control, with no differences observed in other muscle groups. EEG alpha power data did not significantly differ between conditions. Conclusions: These findings suggest that brief physical warm-up can enhance muscle activation in key regions involved in RALS, potentially improving motor control and reducing fatigue. Incorporating such strategies may support surgeon performance and well-being. Full article

Background: The Plantaris tendon is a viable option for tendon grafting in various reconstructive procedures. This study aimed to develop a predictive model estimating plantaris tendon length (PTL) based on lower leg length (LL) to provide a preoperative baseline reference. Methods: An investigation was conducted on 238 lower limb sides from Thai cadavers to determine the prevalence and morphometry of the plantaris muscle. Measurements included PTL, tendon width (PTW), muscle belly length (PBL), total muscle length (PML), and LL. Results: The plantaris muscle was present in 88.24% of lower limb sides. A significant correlation was observed between PTL and LL (r = 0.581, p < 0.001). The predictive equation established was: PTL (mm) = 79.167 + [0.574 × LL (mm)], with a standard error of estimate of 20.06 mm. Testing on a separate sample showed no significant difference between predicted and actual PTL values (p = 0.206). Out of the 179 sides measured, 64.80% met the criteria for tendon graft suitability. Conclusions: These findings indicate that LL serves as a practical surface measurement providing an approximate preoperative estimate of PTL in a Thai population. Due to its moderate predictive power, it should be used as a supplementary assessment rather than a sole planning tool for surgical applications. Full article

Background: Older adults undergoing non-cardiac surgery are vulnerable to perioperative complications, but the prognostic value of routine echocardiographic markers in high-acuity cohorts remains incompletely defined. Methods: This secondary analysis of a prospective cohort included 503 consecutive adults with known cardiovascular disease undergoing non-cardiac surgery, characterized by a high proportion of urgent presentations. Patients were stratified by age (geriatric, ≥65 years; non-geriatric, <65 years). The primary endpoint was major in-hospital adverse events (MIAEs), defined as a composite of in-hospital death, surgical reintervention, and postoperative acute kidney injury (AKI). Postoperative creatinine was not routinely measured in stable patients discharged early; therefore, renal outcomes were interpreted strictly as available-case analyses (n = 364). Results: MIAEs occurred more frequently in geriatric than in younger patients (45.5% vs. 30.8%). Within the geriatric cohort, patients with reduced LVEF (<50%) had lower MAPSE values and higher crude rates of AKI, death, and MIAE than those with LVEF ≥ 50%. In multivariable analyses, reduced LVEF was associated with MIAE, although this small subgroup was susceptible to statistical overfitting. MAPSE reflected longitudinal systolic dysfunction but did not retain independent prognostic value after adjustment. Conclusions: In this pilot subgroup analysis of high-acuity patients, reduced preoperative LVEF (<50%) served as a clinical flag identifying a high-risk geriatric phenotype with increased cardiorenal vulnerability. Given the event-enriched available-case denominator, these findings should be considered hypothesis-generating observations intended to increase clinical awareness. Full article