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Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 3rd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 10 June 2026 | Viewed by 3073

Special Issue Editors

Dr. Dimitrios E. Magouliotis

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Guest Editor
Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
Interests: cardio-thoracic surgery; surgical oncology; bariatric surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Dimitris Zacharoulis

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Guest Editor
Department of Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece
Interests: pancreatic surgery; liver surgery; bariatric surgery; surgical oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The art and science of clinical outcome analysis, quality improvement, perioperative management of surgical patients and patient safety continue to evolve at an increasingly rapid pace. In fact, over the years, novel concepts have arisen (risk stratification, shared decision making, interdisciplinary meetings, prehabilitation, etc.), new initiatives have taken shape (e.g., state/nation-wide or international clinical databases), and new technologies and methods have been adopted across all surgical specialties (e.g., minimally invasive or robotic approaches).

In order to care for our patients, raise the standards of healthcare services, and be successful in today’s and tomorrow’s rapidly changing healthcare environment, understanding and evolving these topics represents an essential duty of all surgeons, physicians and professionals related to surgical patients. In this context, we call all surgeons, physicians and professionals from all associated disciplines involved in the perioperative pathway of surgical patients (surgeons, anesthesiologists, radiologists, intensivists, cardiologists, oncologists, pulmonologists, nurses, physiotherapists, nutritionists, etc.) to contribute to this Special Issue. Following the big success of the first and second volumes of the Special Issue: https://www.mdpi.com/journal/jcm/special_issues/0IO98MY01D, https://www.mdpi.com/journal/jcm/special_issues/7WEWDWP70I, we decided to launch a third volume to discuss a greater number of relevant topics. Our vision remains to provide the best currently available evidence in this field, thus providing all the necessary information to clinicians on core concepts in the perioperative management of surgical patients.

Dr. Dimitrios E. Magouliotis
Prof. Dr. Dimitris Zacharoulis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • clinical outcomes
  • surgery
  • quality
  • quality of life
  • quality improvement
  • postoperative
  • morbidity
  • postoperative care

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Related Special Issue

Published Papers (5 papers)

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Research

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15 pages, 1036 KB  
Article
Effectiveness of Adjunctive Measures to Limit Recurrence and Reoperation After Laparoscopic Repair of Large Paraesophageal Hernias: A Single-Institution Series
by Julia Kessel, Dimitrios N. Varvoglis, Timothy Feeney, Madeleine Higgins, Justin Hsu, Lauren M. Cook, Chris B. Agala, Maggie M. Hodges and Timothy M. Farrell
J. Clin. Med. 2026, 15(7), 2741; https://doi.org/10.3390/jcm15072741 - 4 Apr 2026
Viewed by 468
Abstract
Background: Despite surgical repair, large paraesophageal hernias (PEHs) often recur. To minimize recurrence, adjunctive measures, such as mesh and gastropexy, have been explored, but their impact on recurrence and reoperation rates remains unclear. Therefore, we analyzed our single-institution case series, where absorbable hiatal [...] Read more.
Background: Despite surgical repair, large paraesophageal hernias (PEHs) often recur. To minimize recurrence, adjunctive measures, such as mesh and gastropexy, have been explored, but their impact on recurrence and reoperation rates remains unclear. Therefore, we analyzed our single-institution case series, where absorbable hiatal overlay mesh and percutaneous endoscopic gastrostomy (PEG) placement were utilized systematically. Methods: Patients undergoing laparoscopic large PEH repair by a single surgeon between 1 January 2006 and 31 May 2021 were identified. Demographic data, hernia size, number of hiatal sutures used, use of mesh and/or PEG, fundoplication type, and complications were extracted by retrospective chart review. Hernia recurrence was assessed though postoperative radiographic and endoscopic studies or need for reoperation. Fisher’s exact, chi-square, Mood’s two-median and t-tests were used for between-group comparisons. Generalized linear models were used to assess associations between mesh and PEG placement and number of hiatal sutures and to compare risk differences for recurrence between treatment types (partial versus complete fundoplication; mesh versus no mesh; and PEG versus no PEG). Kaplan–Meier estimator with log-rank test was used to assess time to recurrence. Results: Overall, 413 patients (median age 66 years) underwent laparoscopic large PEH repair and fundoplication (51% partial and 49% complete fundoplications). Of these, 78% had overlay absorbable mesh and 51% had a PEG. With an average follow-up time of over 5 years, we found 19.9% had radiographic or endoscopic recurrence. Although cohort stratification based on mesh implementation and fundoplication type did not identify differences in recurrence rates, significantly lower recurrence rates were noted in patients with PEG compared to no-PEG (14.8% vs. 23.5%, p = 0.01). Notably, of five reoperations, all were in complete fundoplication patients, and one occurred in a patient with PEG placement at the index operation. Conclusions: PEG placement during laparoscopic PEH repair may lead to fewer recurrences in high-risk patients. Future prospective studies are warranted. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 3rd Edition)
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9 pages, 697 KB  
Article
Medication Reconciliation in the Surgical Setting: A Cross-Sectional Study in Polymedicated Patients
by Mercedes Jiménez-Heredia, Vlada Zabrodotska-Maksymyuk, Carmen Carrión-Carrión, María Galiana-Sastre, Joaquin Ortega Serrano and Diego Cano-Blanquer
J. Clin. Med. 2026, 15(1), 270; https://doi.org/10.3390/jcm15010270 - 29 Dec 2025
Viewed by 548
Abstract
Objectives: This study aimed to assess the incidence, nature, and clinical relevance of medication discrepancies identified during the perioperative period in polymedicated surgical patients, and to examine factors associated with the occurrence of real discrepancies. Methods: A cross-sectional study was conducted [...] Read more.
Objectives: This study aimed to assess the incidence, nature, and clinical relevance of medication discrepancies identified during the perioperative period in polymedicated surgical patients, and to examine factors associated with the occurrence of real discrepancies. Methods: A cross-sectional study was conducted in scheduled surgical patients admitted to the General Surgery department of a tertiary-care hospital. Eligible adults were required to be taking ≥4 chronic medications, have restored oral tolerance, and remain hospitalized for more than 48 h. Medication reconciliation was performed using hospital and primary care electronic records, complemented by a structured patient interview. Discrepancies were classified as justified or real according to SEFH criteria. Statistical analysis included descriptive methods, normality testing, correlation analyses, and generalized linear models. Results: Out of 270 assessed patients, 43 met inclusion criteria. A total of 282 medications were analyzed, with 243 (86%) showing discrepancies. 44% were real discrepancies, primarily due to unjustified omission. The average number of real discrepancies per patient was 5.7 (95% CI: 4.8–6.5). Cardiovascular (35.2%) and nervous system drugs (23.2%) were most affected. Real discrepancies with potential clinical severity accounted for 36.8%, including cases of asthma exacerbation, withdrawal syndromes, insomnia, and hypertensive crises. In 73% of pre-anesthesia reports, no specific recommendations regarding chronic medication management were provided. Conclusions: Medication reconciliation revealed frequent and clinically relevant discrepancies in this high-risk cohort of polymedicated surgical patients. Larger, more representative studies are needed to confirm these findings and to inform broader perioperative safety strategies. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 3rd Edition)
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Review

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24 pages, 1184 KB  
Review
The Legacy of the First Valve: Outcomes of Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Prior Surgical Aortic Valve Replacement—A Narrative Review
by Dimitrios E. Magouliotis, Serge Sicouri, Vasiliki Androutsopoulou, Andrew Xanthopoulos, Vanesa Brecher, Massimo Baudo and Basel Ramlawi
J. Clin. Med. 2026, 15(10), 3640; https://doi.org/10.3390/jcm15103640 - 9 May 2026
Viewed by 159
Abstract
Transcatheter Aortic Valve Replacement (TAVR) has transformed aortic stenosis management across the full risk spectrum, but expansion into younger populations makes valve failure and reintervention central to lifetime planning. There are two pathways to follow when TAVR fails: redo transcatheter implantation and surgical [...] Read more.
Transcatheter Aortic Valve Replacement (TAVR) has transformed aortic stenosis management across the full risk spectrum, but expansion into younger populations makes valve failure and reintervention central to lifetime planning. There are two pathways to follow when TAVR fails: redo transcatheter implantation and surgical explantation with surgical aortic valve replacement (SAVR), termed TAVR-SAVR. This narrative review synthesizes evidence from four studies (35,677 patients, 2011–2024) examining the association between prior valve type and redo SAVR outcomes versus redo SAVR after prior surgical prosthesis (SAVR-SAVR). TAVR-SAVR volume grew at up to 144.6% annually, projected to surpass SAVR-SAVR by approximately 2029 based on linear extrapolation from limited registry and single-center data. Operative mortality was 12.3–17% in TAVR-SAVR versus 1.1–9% in SAVR-SAVR, persisting after propensity matching in both comparative studies (11.3% vs. 6.7%, OR 1.7; and 12.0% vs. 1.1%, OR 12.5). Observed-to-expected mortality ratios exceeded 1.0 across all risk strata, including low-risk patients (O/E up to 5.48), while SAVR-SAVR demonstrated a remarkably low ratio of 0.22–0.33. Renal failure, failure to rescue, and prolonged ventilation were significantly higher following TAVR-SAVR; stroke and pacemaker rates were comparable. Paradoxically, shorter bypass and cross-clamp times in TAVR-SAVR despite worse outcomes are consistent with cumulative organ injury, rather than operative complexity, as a predominant contributor to excess mortality, though this mechanistic explanation remains hypothetical. STS risk models, developed for standard surgical populations, showed limited applicability in this population, with observed mortality consistently exceeding predicted values. These findings raise important considerations regarding TAVR-first strategies in operable patients aged 65–80 years, although causality cannot be established from observational data alone. In the era of expanding TAVR indications, the legacy of the first valve cannot be ignored. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 3rd Edition)

Other

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17 pages, 244 KB  
Study Protocol
Study of Treatment with Intensified Omeprazole to Prevent High-Output Stoma—A Protocol for a Randomized, Parallel-Group, Open-Label, Superiority Trial in Adults Undergoing Ileostomy (STOP-HOS-1)
by Tomasz Sylwestrzak, Michalina Ciosek, Katarzyna Połomska, Jarosław Kobiela and Piotr Spychalski
J. Clin. Med. 2026, 15(5), 1841; https://doi.org/10.3390/jcm15051841 - 28 Feb 2026
Viewed by 553
Abstract
Introduction: High-output stoma (HOS) is a frequent and morbid complication following ileostomy formation. Proton pump inhibitors (PPIs) may reduce intestinal secretions, but no randomized trial has yet tested whether intensified intravenous omeprazole treatment prevents or mitigates early postoperative HOS. We aim to determine [...] Read more.
Introduction: High-output stoma (HOS) is a frequent and morbid complication following ileostomy formation. Proton pump inhibitors (PPIs) may reduce intestinal secretions, but no randomized trial has yet tested whether intensified intravenous omeprazole treatment prevents or mitigates early postoperative HOS. We aim to determine whether intensified PPI dosing reduces early postoperative ileostomy output compared with standard dosing. Methods and Analysis: STOP-HOS-1 is a randomized, parallel-group, open-label, superiority trial conducted at two academic centers in Poland. The target sample size is 100 adults undergoing the formation of a loop or end ileostomy. Participants will be randomized 1:1 to receive either: intensified omeprazole group—80 mg IV loading dose, followed by 40 mg IV twice daily through postoperative day (POD) 10, or standard omeprazole group—40 mg IV once daily through POD 10. The primary outcome is mean ileostomy output (mL/24 h) across POD 1–3. A ≥250 mL/day reduction is prespecified as clinically meaningful. Key secondary outcomes include: incidence of HOS (≥1000 mL/day for ≥3 consecutive days or ≥1400 mL on any single day), time to output stabilization (<1400 mL/day for 3 consecutive days), dehydration-related complications (hyponatremia, hypokalemia, acute kidney injury), length of hospital stay and 30-day readmission rate. The primary analysis will follow the intention-to-treat principle. One interim safety analysis is planned after enrollment of the first 20 patients. Discussion: Although PPIs are commonly used to reduce ileostomy output, high-quality evidence in the early postoperative setting is lacking. STOP-HOS-1 targets the critical period when output is most variable, and complications are most frequent, using a pragmatic randomized design and an objective, clinically meaningful primary endpoint. Conclusions: STOP-HOS-1 will provide the first randomized evidence on whether intensified postoperative PPI therapy reduces early ileostomy output and HOS-related morbidity, informing future standards of care. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 3rd Edition)
17 pages, 289 KB  
Systematic Review
Biomarkers of Sarcopenia and Sarcopenic Obesity in Renal Transplant Recipients: A Systematic Review and Evidence Quality Assessment
by Ioanna Soukouli, Thomas Karagkounis, Konstantinos S. Mylonas, Theofanis Kalathas, Kalliopi-Anna Poulia, Alexander Kokkinos and Smaragdi Marinaki
J. Clin. Med. 2025, 14(24), 8943; https://doi.org/10.3390/jcm14248943 - 18 Dec 2025
Cited by 1 | Viewed by 892
Abstract
Background: Sarcopenia and sarcopenic obesity are increasingly recognized in kidney transplant recipients (KTRs), yet their molecular underpinnings remain poorly defined. We sought to synthesize current evidence on biomarker associations with muscle loss and function in the post renal transplant setting. Methods: A comprehensive [...] Read more.
Background: Sarcopenia and sarcopenic obesity are increasingly recognized in kidney transplant recipients (KTRs), yet their molecular underpinnings remain poorly defined. We sought to synthesize current evidence on biomarker associations with muscle loss and function in the post renal transplant setting. Methods: A comprehensive search of PubMed/MEDLINE and Cochrane databases was conducted according to PRISMA guidelines. Studies evaluating biomarkers related to sarcopenia or sarcopenic obesity in adult and pediatric KTRs were included. Quality assessment was performed with the NHLBI tool. Results: Seven studies were included, encompassing 548 KTRs. Myostatin levels predicted sarcopenia in KTRs (cut-off: 390 pg/mL) and inversely correlated with Metabolic equivalent of Tasks (METs), handgrip strength (HGS), and graft performance. Although adiponectin was negatively correlated with body fat, its high-molecular-weight isoform was linked to lower muscle mass and long-term graft decline. Leptin was associated with sarcopenic obesity and lower estimated Glomerular Filtration Rate (eGFR). Insulin like Growth Factor-1 (IGF-1) independently predicted HGS but not muscle mass. Brain-derived neurotrophic factor (BDNF) levels predicted sarcopenia (cut off: 17.8 ng/mL) and reflected physical activity levels. Visfatin showed no association with sarcopenia but it was positively correlated with eGFR. Lastly, certain polymorphisms of Alpha-actinin-3 (ACTN3) were shown to genetically predispose to post-transplant sarcopenia. Conclusions: These emerging candidate biomarkers provide promising mechanistic insight into post-transplant muscle decline and may ultimately support more personalized risk assessment. Further validation is needed, and functional measures remain the most reliable clinical tools at present. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 3rd Edition)
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