Search Results (51,949)

Background: Body mass index (BMI) is an important consideration in perioperative evaluation. High BMI is correlated with more comorbidities and poorer operative outcomes; however, there is limited literature on the impact of BMI on patient-reported outcome measures (PROMs) after multilevel cervical disc replacement (CDR) surgery. Objective: The objective was to evaluate the relationship between BMI and PROMs in two-level CDR. Methods: A single-surgeon database was retrospectively reviewed for patients who underwent two-level CDR between August 2017 and October 2024. Patients were stratified as non-obese (BMI < 30 kg/m²; n = 44) or obese (BMI ≥ 30 kg/m²; n = 34). The final analytic cohort included 78 patients. Mean follow-up was 7.65 ± 5.53 months. Multivariable linear and logistic regression models adjusted for age, hypertension, diabetes, and Charlson Comorbidity Index. Patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) were also analyzed. Statistical analysis was conducted using Stata 18.0 (StataCorp LP, College Station, TX, USA). Results: Obese patients had a higher CCI than non-obese patients (0.90 ± 1.06, 1.87 ± 1.31, p = 0.001). Patient-reported outcomes were collected and analyzed after controlling for hypertension, diabetes, CCI scores, and age. At the final postoperative follow-up, only VR12-MCS differed, with the obese cohort having worse scores (60.7 ± 5.0 versus 53.9 ± 10.2, p = 0.040). MCID achievement rates did not differ between groups across PROMs (p > 0.183 for all). Conclusion: Patients with and without obesity demonstrated comparable early-to-midterm PROM trajectories and MCID achievement following two-level CDR. These findings suggest that obesity was not associated with substantially different patient-reported recovery during the observed follow-up period. Full article

Background: Stroke survivors often present vascular risk factors (VRFs) that are increasingly recognized as contributing to neurodegenerative diseases such as Parkinson’s disease (PD). We examined the influence of VRFs on the risk of PD in stroke survivors. Methods: Using the Korean National Health Insurance Service database, we identified 284,799 individuals with new-onset stroke and followed them for the occurrence of PD. The diagnosis of PD was confirmed using the International Classification of Diseases (ICD-10) code G20 and the rare disease registration code (V124). Results: Cox proportional hazard analyses revealed that smoking (former: Hazard ratio [HR] = 0.80; current: HR = 0.66) and alcohol consumption (moderate: HR = 0.83; heavy: HR = 0.74) were associated with a lower risk of PD. Conversely, diabetes mellitus, especially with a duration ≥ 5 years, was associated with increased PD risk (HR = 1.38). Conclusions: These findings suggest that several VRFs are associated with subsequent PD risk in stroke survivors. Further studies are warranted to determine whether modification of these risk factors influences the development of PD. Full article

Background/Objectives: This study aimed to compare the incidence, extent, and time to diagnosis of osteonecrosis of the femoral head (ONFH) between Femoral Neck System (FNS) and multiple cannulated screw (CS) fixation in patients with femoral neck fractures (FNFs) at a minimum follow-up of 24 months, as well as to identify factors associated with ONFH after FNS fixation. Methods: A retrospective cohort study was conducted at a single university hospital involving patients aged ≥18 years with isolated FNFs treated by closed reduction and internal fixation using either FNS or multiple CS. Reduction quality, fracture union, incidence and extent of ONFH (measured by Kerboul angle), and revision surgery due to ONFH or other causes were assessed as outcome measures. Logistic regression analyses were conducted to identify factors associated with ONFH after FNS fixation. Results: Eighty-seven patients were included, comprising 48 in the FNS group and 39 in the CS group. No significant differences were found between the groups in reduction quality, union rate, or time to union (p > 0.05 for all). The incidence of ONFH did not differ significantly between the FNS and CS groups (p = 0.314). However, the FNS group showed a significantly greater extent of ONFH (p = 0.031) and longer mean time to ONFH diagnosis (p = 0.001). No significant differences were observed in revision surgery rates due to ONFH (p = 1.000) or other causes (p = 0.624). Multivariate analysis identified fracture displacement (Garden classification stages III and IV) and poor reduction quality (“Broken S” by Lowell’s criteria) as significant predictors of ONFH after FNS fixation. Conclusions: ONFH following FNS fixation tended to exhibit a larger necrotic area and a delayed radiographic onset compared to CS fixation; however, the overall incidence and revision rates were comparable between implants. These differences may be due to initial fracture displacement and baseline severity, rather than the FNS implant itself. In the FNS group, the mean time to radiographic diagnosis of ONFH was 13.1 months, and initial fracture displacement and reduction quality were identified as risk factors for the development of ONFH following FNS fixation. Therefore, long-term and vigilant follow-up is essential after FNS fixation, particularly in patients with displaced fractures. Achieving optimal reduction quality and anatomical femoral neck alignment remains paramount to mitigating the risk of ONFH after FNS fixation. Full article

Background/Objectives: Frailty is increasingly recognized as an important condition in polymyalgia rheumatica (PMR), although different instruments may assess different dimensions of vulnerability. This study aimed to compare the determinants and clinical correlates of frailty measured by the Comprehensive Rheumatologic Assessment of Frailty (CRAF) and the Italian Kihon Checklist (I-KCL). Methods: Fifty-two patients with PMR were evaluated. The discriminative performance of CRAF and I-KCL was assessed against the Cardiovascular Health Study (CHS) frailty phenotype using ROC analysis. Multivariable linear regression identified the independent determinants of each frailty measure. Results: The distribution of frailty status varied across the three assessment tools. The CRAF score identified a higher proportion of non-frail patients (44.2%) and a lower proportion of frail individuals (19.2%) compared to both the I-KLC and CHS criteria. Discriminative accuracy of CRAF and I-KCL scores against the CHS/Fried phenotype reference standard was excellent for both instruments: CRAF AUC = 0.96 (95% CI 0.888–1, bootstrap, 2000 stratified resamples) and I-KCL AUC = 0.899 (95% CI 0.704–1). The difference between CRAF and I-KCL discriminative accuracy was therefore not statistically significant (z = 0.941, p = 0.3467). In multivariable linear regression models adjusted for age, disease duration, PMR-AS(CRP), comorbidity count, HAQ, and fatigue, PMR-AS(CRP) (standardized β = 0.51, p < 0.001) and comorbidity count (standardized β = 0.36, p < 0.001) were independently associated with the CRAF score (adjusted R² = 0.787, n = 51), while PMR-AS(CRP) (standardized β = 0.40, p < 0.001) and comorbidity count (standardized β = 0.46, p < 0.001) were independently associated with the I-KCL score (adjusted R² = 0.675, n = 51). A further finding was that functional impairment, measured by the HAQ, was independently associated with the CRAF score (standardized β = 0.19, p = 0.018) but not with the I-KCL score (standardized β = 0.06, p = 0.512). Conclusions: Although CRAF and I-KCL share these core determinants, they capture different dimensions of frailty: CRAF is more strongly influenced by functional impairment, whereas I-KCL appears less affected by disability. These instruments should therefore be considered complementary rather than interchangeable. Full article

Background: Risk stratification after colorectal cancer surgery remains challenging. We evaluated whether a perioperative ratio combining immediate postoperative lactate with preoperative albumin is associated with in-hospital mortality after elective colorectal resection. Methods: In this single-center retrospective cohort, 282 patients underwent open elective colorectal resection. The perioperative lactate-to-albumin ratio (LAR) was calculated as arterial lactate (mmol/L) divided by serum albumin (g/dL), and discrimination was assessed by receiver operating characteristic (ROC) analysis with age-adjusted association by Firth’s penalized logistic regression and fixed-model bootstrap validation. Results: Seventeen patients (6.0%) died in hospital, and mortality rose across LAR tertiles (2.1%, 5.3%, and 10.6%; p = 0.014). LAR showed moderate discrimination (AUC 0.73; 95% CI 0.58–0.87; optimism-corrected AUC 0.78), with no evidence of better discrimination than lactate or albumin alone. At the Youden threshold of 0.555, sensitivity was 76.5% and specificity 61.1%. The age-adjusted Firth odds ratio was 1.19 per 0.1-unit increase (95% CI 1.09–1.29). Conclusions: The perioperative lactate-to-albumin ratio was associated with in-hospital mortality after age adjustment in this single-center cohort. Given the small number of deaths and absence of external validation, LAR should be regarded as a candidate marker requiring prospective multicenter validation before clinical application. Full article

Background/Objectives: Patients with type 2 diabetes mellitus (T2DM) frequently develop diffuse and anatomically complex coronary artery disease (CAD), resulting in a substantially increased cardiovascular risk. Although both HDL-C and the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio have been associated with cardiovascular risk, their relative associations with and discriminatory performance for angiographic CAD complexity remain uncertain. This study aimed to evaluate and compare these two lipid parameters in relation to CAD complexity as assessed by the SYNTAX score. Methods: A retrospective, observational, single-center study was conducted involving 167 consecutive T2DM patients who underwent diagnostic coronary angiography. CAD complexity was quantified using the SYNTAX score, with patients categorized into low (≤22) and higher (>22) complexity groups. Statistical evaluation included correlation analyses, univariable and multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Results: Of the 167 patients, 48 (28.7%) were classified with higher SYNTAX scores. HDL-C showed a significant inverse correlation with the SYNTAX score (r = −0.339, p < 0.001), whereas the TG/HDL-C ratio showed a weak positive correlation (r = 0.159, p = 0.040). In separate multivariable models adjusted for sex, both HDL-C (OR 0.944, 95% CI 0.908–0.980; p = 0.003) and the TG/HDL-C ratio (OR 1.085, 95% CI 1.003–1.175; p = 0.041) remained associated with a higher SYNTAX score. HDL-C showed a numerically higher AUC than the TG/HDL-C ratio (0.659 vs. 0.621); however, the difference between the AUCs was not statistically significant (DeLong p = 0.268). Conclusions: Lower HDL-C and a higher TG/HDL-C ratio remained associated with a higher SYNTAX score after adjustment for sex. Although HDL-C showed numerically better discrimination, no statistically significant difference in discriminatory performance was demonstrated between the two markers. Full article

Objective: This study aimed to analyze the incidence and multifactorial causes of dislocation following primary total hip arthroplasty (THA) and to evaluate current surgical strategies for the prevention and management of this complication. Methods: This retrospective study included 1066 hips (median age 57 years; 805 females and 261 males) that underwent primary THA performed by a single surgeon between 1996 and 2025. The median follow-up duration of the patients was 46 months (min: 6, max: 357 months), and 68.9% had primary coxarthrosis, while 31.1% had secondary coxarthrosis. In this study, the effects of dislocation causes, age, gender, femoral head size, liner angle, posterior capsular repair, type of anesthesia, fixation method of the prosthesis, etiology, and surgical experience (distribution by years) on dislocation were statistically analyzed. Results: The analysis revealed that 44 of the 1066 hips (4.1%) developed a dislocation. The most common causes of dislocation were identified as femoral offset error (40.91%) and acetabular component malposition (31.82%). A statistically significant correlation was found between dislocation development and gender (p < 0.001) and femoral head diameter (p = 0.006); the dislocation rate was higher in male patients (8.0%) than in female patients (2.9%). A marked reduction in dislocation rates (1.6%) was observed following the routine use of large-diameter femoral heads (32–36 mm). The highest dislocation rate was observed during the early years of surgical experience (1996–2000, 6.8%). No statistically significant differences were found between dislocation development and age (p = 0.055), type of anesthesia, type of prosthesis, liner angle, and secondary etiological factors (p > 0.05). Conclusions: Instability developing after primary THA is a multifactorial complication. In our study, inadequate femoral offset restoration and acetabular component malposition were identified as the most common mechanical causes of dislocation. Male gender was significantly associated with an increased risk of dislocation, whereas the use of larger femoral head diameters was associated with lower dislocation rates. Our findings suggest that meticulous preoperative planning, accurate component positioning, increased surgical expertise, and the use of larger femoral head diameters may play important roles in reducing the risk of instability. Full article

Background/Objectives: Cutaneous melanoma arises de novo in the majority of cases; 20–30% develop from pre-existing nevi. Differentiating nevus-associated melanoma (NAM) from de novo melanoma (DNM) is important for understanding melanomagenesis, risk stratification, and prognostic assessment. The objective of this study was to compare the demographic, clinical, and histopathological characteristics of NAM and DNM in a large single-institution retrospective cohort. Methods: A retrospective, longitudinal, observational study was conducted at the Department of Pathological Anatomy, Cluj-Napoca County Emergency Clinical Hospital (2015–2025). Of the 729 initially identified cases, 580 patients with histopathologically confirmed cutaneous melanoma and complete clinical records were included. Analyses comprised Mann–Whitney U and chi-square tests and multivariate logistic regression (p < 0.05). Results: DNM constituted 78.6% (n = 456) and NAM 21.4% (n = 124) of cases. DNM patients were significantly older (median 66 vs. 56 years; p < 0.001). NAM was predominantly located on the trunk (63.7% vs. 45.2%; p = 0.0006), whereas DNM showed greater involvement of the head/neck and upper extremities. Superficial spreading melanoma was more frequent in NAM (79.8% vs. 62.5%; p = 0.004); nodular melanoma was more common in DNM (22.6% vs. 10.5%), and lentigo maligna was exclusive to DNM. DNM demonstrated greater Breslow thickness (median 2.0 vs. 1.25 mm; p = 0.021), more advanced Clark level (p = 0.040), and higher mitotic rate (median 3 vs. 2/mm²; p = 0.049). On multivariate logistic regression, older age (OR = 1.03; 95% CI: 1.02–1.05; p < 0.001) and head/neck localisation (OR = 2.73; 95% CI: 1.39–5.39; p = 0.004) were independent predictors of DNM; histopathological aggressiveness markers did not retain independent significance after adjustment. Conclusions: Although DNM presents with more aggressive histopathological features, these characteristics are driven primarily by patient age and anatomical location rather than an inherent de novo aggressive phenotype, suggesting that observed differences largely reflect cumulative sun-damage pathways and patient demographics. Full article

Cardiovascular ultrasound is a cornerstone of noninvasive cardiac and vascular assessment, yet conventional interpretation remains operator-dependent, variable, and limited in sensitivity for subclinical disease. Artificial intelligence (AI), particularly machine learning (ML), deep learning (DL), and, most recently, vision–language and foundation models, offers tools to automate, standardize, and extend ultrasound analysis. This narrative review examines the role of AI-enhanced cardiovascular ultrasound in the transition from descriptive imaging toward predictive and personalized medicine. We conducted a structured literature search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar (January 2016–May 2026), combining Medical Subject Headings and free-text terms related to AI and cardiovascular ultrasound. Original studies, meta-analyses, reviews, consensus documents, and seminal works were considered. AI now spans the entire echocardiographic workflow, acquisition guidance, view classification, segmentation (Dice ≈ 0.92–0.94 on public datasets), and automated quantification of ejection fraction and global longitudinal strain, achieving expert-level accuracy and improved reproducibility. Across clinical domains, AI supports ischemia detection on stress echocardiography, heart-failure phenogrouping, Doppler-independent aortic stenosis detection, and carotid plaque characterization for stroke-risk stratification. Emerging vision–language and multitask foundation models (e.g., EchoCLIP, EchoPrime, and PanEcho) point toward general-purpose interpretation, and a growing number of tools (Caption Guidance, Us2.ai, and Ultromics EchoGo) have obtained FDA clearance and/or CE marking. Increasingly, AI-derived imaging biomarkers feed multimodal models that enable individualized risk prediction and therapy selection. AI-enhanced cardiovascular ultrasound is poised to become a central tool of precision cardiology. Realizing its potential will require prospective multicenter validation, cross-vendor standardization, attention to generalizability, interpretability, and reproducibility, and evolving regulatory and ethical frameworks. Full article

Objectives: This study aimed to evaluate the diagnostic performance of preoperative ultrasonographic airway measurements for predicting difficult laryngoscopy in pediatric patients undergoing adenotonsillectomy. Methods: A total of 153 pediatric patients aged 3–8 years who were scheduled for elective otorhinolaryngologic surgery were included in this prospective observational study. Patients were divided into two groups: the adenotonsillectomy group (n = 74) and the non-adenotonsillectomy ENT surgery group (n = 79). Skin-to-epiglottis distance (SED), hyomental distance (HMD) and tongue thickness (TT) were measured using ultrasonography before anesthesia induction. Laryngoscopic view was graded according to the Cormack–Lehane classification, with grades III and IV considered indicative of difficult laryngoscopy. The diagnostic performance of ultrasonographic measurements in predicting difficult laryngoscopy was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The incidence of difficult laryngoscopy was 14.9% in the adenotonsillectomy group and 6.3% in the non-adenotonsillectomy group; however, this difference did not reach statistical significance (p = 0.085). In the adenotonsillectomy group, patients with difficult laryngoscopy had significantly greater skin-to-epiglottis distance and tongue thickness values (p = 0.002 and p = 0.015, respectively). No significant association was observed between hyomental distance and difficult laryngoscopy (p = 0.319). ROC analysis demonstrated that skin-to-epiglottis distance had the highest discriminatory performance in the adenotonsillectomy group (AUC = 0.795; 95% CI: 0.685–0.880; p = 0.004). Conclusions: Skin-to-epiglottis distance and tongue thickness were associated with difficult laryngoscopy in pediatric patients undergoing adenotonsillectomy. Among the evaluated ultrasonographic parameters, skin-to-epiglottis distance demonstrated the highest diagnostic performance. Preoperative ultrasonographic airway assessment may provide valuable information for identifying children at increased risk of difficult laryngoscopy. These findings should be confirmed in larger multicenter studies. Full article

Background/Objectives: The efficacy of two-stent implantation with iStent inject W is well established for mild-to-moderate open-angle glaucoma (OAG), whereas evidence for three-stent implantation with iStent infinite in severe OAG remains limited. We compared 12-month outcomes of a severity-based surgical strategy, using two stents in mild-to-moderate OAG and three stents in severe OAG. Methods: This retrospective study included 100 eyes with OAG that were followed for at least 12 months after trabecular micro-bypass stent implantation. Eyes with mild-to-moderate disease, defined as visual field mean deviation (MD) of −12 dB or better, received two stents (iStent inject W), whereas eyes with severe disease, defined as MD worse than −12 dB, received three stents (iStent infinite). Outcomes included intraocular pressure (IOP), glaucoma medication burden, visual field parameters, corneal endothelial cell density (ECD), surgical success, and additional glaucoma surgery. Results: Baseline IOP and the number of glaucoma medications were higher in the three-stent group. At 12 months, mean IOP was similar between groups. Although the three-stent group showed a greater unadjusted reduction in IOP, this difference was not significant after adjustment for baseline IOP using analysis of covariance. Linear mixed-model analysis also showed no significant group effect or time-by-group interaction. Glaucoma medications decreased significantly in both groups, with a similar mean reduction, although the three-stent group had a greater medication burden at 12 months. Changes in visual field parameters and corneal ECD did not differ significantly between groups. Surgical success and the need for additional glaucoma surgery were also not significantly different between groups. Conclusions: In this retrospective cohort, three-stent implantation in severe OAG was associated with 12-month IOP outcomes similar to those observed in the two-stent group with mild-to-moderate OAG, although this was achieved with a greater residual medication burden. This approach appears feasible for patients with severe OAG. Full article

Background: Gastric cancer (GC) remains a leading cause of cancer death worldwide. A subset of patients presents acutely with life-threatening complications such as perforation, obstruction, or bleeding, requiring surgery under suboptimal conditions. This multicenter Italian study aimed to explore outcomes of emergency GC surgery, identify prognostic factors, and compare survival across clinical presentations. Methods: Between 2013 and 2022, 263 GC patients presented emergently at two high-volume Italian centers. Among them, 90 patients with histologically proven adenocarcinoma who underwent emergency surgery were included. Primary outcomes were 30-day mortality and overall survival (OS). Results: Obstruction was the most frequent presentation (41.1%), followed by hemorrhage (34.4%) and perforation (24.4%). Severe complications (Clavien–Dindo ≥ 3) occurred in 28.8% of patients, and thirty-day mortality reached 13.3%. Median OS was 6.5 months. Diffuse-type GC predicted shorter OS than intestinal-type (5.5 vs. 14 months; p = 0.015). Radical surgery was performed in 63.3% of cases and was associated with superior OS compared with palliative procedures (14 vs. 4.5 months; p < 0.001). The clinical presentation did not influence survival. On exploratory multivariable analysis, advanced age and diffuse histology were associated with higher 30-day mortality, while gastric resection was associated with better OS. Conclusions: Emergency GC surgery carries high morbidity and mortality. Age, histology, and gastric resection were independent prognostic factors, whereas clinical presentation did not significantly affect survival. Early diagnosis and tailored perioperative strategies are needed to improve outcomes. Full article

Background: Pulmonary thromboembolism (PTE) may mimic or aggravate acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We evaluated the frequency of diagnosed PTE, associated factors, and D-dimer performance in hospitalized patients with AECOPD. Methods: In this single-center retrospective study, 429 consecutive patients hospitalized after presenting at the emergency department with AECOPD between 1 June 2022 and 1 June 2023 were screened; 330 met the eligibility criteria. D-dimer testing was performed at the physician’s discretion in 181 patients, who constituted the primary analysis population, and 87 underwent confirmatory imaging. PTE was confirmed by computed tomography pulmonary angiography or ventilation/perfusion scintigraphy. Results: PTE was diagnosed in 38 patients, corresponding to 21.0% of the D-dimer-tested population and an observed frequency of 11.5% in the overall eligible cohort. In the primary analysis population, D-dimer showed good discrimination for diagnosed PTE (AUC, 0.826; 95% CI, 0.754–0.898; p < 0.001). The exploratory 1053 ng/mL FEU threshold yielded 84.2% sensitivity and 73.4% specificity. In the imaging-confirmed subgroup, the AUC was 0.733 (95% CI, 0.627–0.838), and specificity at this threshold was 55.1%. D-dimer > 1053 ng/mL FEU (adjusted OR, 20.32; 95% CI, 6.80–60.66), female sex (adjusted OR, 4.40; 95% CI, 1.55–12.51), and lower C-reactive protein levels (adjusted OR per 10 mg/L increase, 0.90; 95% CI, 0.83–0.98) were independently associated with diagnosed PTE. Conclusions: Diagnosed PTE was frequent among D-dimer-tested hospitalized patients with AECOPD. Because testing and imaging were physician-directed rather than protocolized, the true prevalence in the overall cohort could not be determined. The 1053 ng/mL FEU threshold should be considered exploratory and requires external validation. Full article

Nonadherence to medications for psychosis is a major challenge in the management of schizophrenia and is associated with an increased risk of relapse, hospitalization, functional deterioration, and premature death. Although long-acting injectable (LAI) medications for psychosis improve treatment continuity, important differences exist among LAIs regarding initiation regimen, attainment of therapeutic blood level exposure, and steady state, dosing, and switching. Risperidone ISM^® is an intramuscular LAI administered every four weeks, designed to provide rapid and sustained therapeutic exposure without the need for loading doses or oral supplementation. This narrative review translates the pharmacokinetic (PK) and pharmacodynamic (PD) profile of risperidone ISM^® into expert-informed guidance for treatment initiation, dose optimization, switching, and ongoing schizophrenia management. Risperidone ISM^® achieves therapeutic exposure within hours of administration and maintains plasma concentrations and dopamine D2 receptor occupancy at levels associated with antipsychotic efficacy throughout the dosing interval, supporting continuous antipsychotic coverage and stability. Its PK profile, as characterized in clinical studies, and simplified initiation regimen may facilitate clinical decision-making across treatment settings, including transitions from oral risperidone or other medications for psychosis and continuity of care following hospitalization or relapse, while supporting symptom stability, functioning, and patient engagement. By translating PK/PD characteristics into practical clinical implications, this review aims to support clinicians in optimizing the use of risperidone ISM^® as part of individualized, recovery-oriented care in the short- and long-term management of people living with schizophrenia across settings. The recommendations presented reflect expert interpretation of the available PK/PD, clinical trial, observational, and product-label evidence, supplemented by clinical experience. Full article

Background/Objectives: Platelet-rich fibrin (PRF) and its derivatives have been proposed as biological adjuncts to enhance tissue healing following endodontic microsurgery (EMS). However, current evidence regarding their effects on postoperative recovery and long-term bone regeneration remains inconsistent. This study aimed to evaluate the efficacy of PRF and its derivatives as adjuncts in endodontic microsurgery by separately assessing patient-centered postoperative outcomes and radiographic and volumetric bone-healing outcomes through a systematic review and meta-analysis. Methods: This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261400163). Randomized controlled trials and comparative clinical studies evaluating PRF or its derivatives as adjuncts to EMS were eligible. MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and reference lists were searched from inception to April 2026. Outcomes included postoperative pain, edema, quality of life, clinical–radiographic healing, CBCT volumetric bone regeneration, bone density, and outcomes in complex defects. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses were performed where appropriate, and certainty of evidence was evaluated using the GRADE approach. Results: Seventeen clinical reports corresponding to sixteen independent datasets were included. PRF and its derivatives improved early postoperative recovery, particularly postoperative pain during the first postoperative week. Meta-analysis demonstrated a significant reduction in early postoperative pain favoring PRF-based interventions (SMD/Hedges g = −0.62; 95% CI, −1.03 to −0.21; p = 0.003). Evidence regarding long-term bone regeneration and clinical–radiographic healing remained heterogeneous and inconclusive. CBCT-based studies suggested accelerated early bone healing, although no consistent superiority was demonstrated at 6–12 months. The certainty of evidence ranged from moderate for postoperative pain to very low for volumetric bone regeneration. Interpretation of the findings is limited by clinical and methodological heterogeneity and the small number of studies available for several outcomes. Conclusions: The available evidence suggests that PRF may improve early postoperative recovery and soft-tissue healing after endodontic microsurgery. However, current evidence does not support PRF as a predictable substitute for bone grafts or regenerative biomaterials in large or non-contained defects. Well-designed CBCT-based randomized clinical trials with standardized outcome measures are needed. Full article