Search Results (1,605)

Background: Patients undergoing open-heart surgery (OHS) are at risk of postoperative morbidity and mortality. Physical performance has been increasingly recognized as an important factor influencing postoperative outcomes. Therefore, the study aimed to investigate the associations and predictive value of physical performance on postoperative complications and duration of hospital stay. Methods: A prospective cohort study was conducted in 116 patients who were admitted to OHS. Preoperative assessment of physical performance, i.e., Short Physical Performance Battery (SPPB), Five Times Sit to Stand Test (5STS), gait speed (5 m walk test: 5MWT), Timed Up and Go (TUG), and handgrip strength. Duration of hospital stay and incidence of post-operative complications were recorded. Differences between participants with and without postoperative complications were analyzed using independent samples t-tests for continuous variables and chi-square tests for categorical variables. The associations between physical performance and postoperative outcomes were assessed using Spearman’s rank correlation coefficient. Hierarchical regression analysis was conducted to determine the predictive contribution of physical performance. Results: A total of 116 participants were submitted for OHS in two medical school hospitals; however, 108 individuals completed the pre-operative physical performance. The most common procedures were coronary artery bypass grafting and valve surgery. Fifty-one participants (47.22%) experienced postoperative complications, including five deaths, corresponding to 4.63% mortality. For the length of hospital stay analysis, five participants who died postoperatively were excluded, resulting in a final sample of 103 participants. Physical performance was significantly associated with the length of hospital stay (p < 0.05). Hierarchical regression analysis showed that the final prediction model explained 13.4% of the variance in length of hospital stay, with SPPB independently contributing an additional 6.0% to the model, followed by 5STS, 5MWT, handgrip strength, and TUG, which accounted for an additional 5.1%, 4.6%, 4.4%, and 3.7%, respectively. Conclusions: Preoperative physical performance was associated with length of hospital stay. While each measure explained a relatively small proportion of the variance in hospital stay, these assessments offer a simple, non-invasive, and clinically feasible approach to evaluating functional reserve before surgery. These findings highlight the importance of incorporating functional assessment into perioperative care to support risk stratification and guide rehabilitation strategies. Full article

Objective: To evaluate the efficacy of NADPH oxidase 4 and miR-146a-5p in current treatment planning for ascending aortic aneurysms, independent of aortic diameter, and to develop protocols that will ensure the treatment of ascending aortic aneurysms, which pose a risk for aortic dissection, without complications. Methods: Patients who met the inclusion criteria and underwent surgery at Dr. Siyami Ersek Chest, Heart, and Vascular Surgery Training and Research Hospital for ascending aortic aneurysms and coronary artery disease between 2023 and 2024 were included in the study. This study was designed as a prospective study. Demographic, biochemical, radiological, and echocardiographic data were collected, and NOX4 mRNA and miR-146a-5p expressions were examined and compared in tissue samples. Results: The study was conducted on a total of 50 patients, with 25 patients in the aneurysm group and 25 patients in the control group. miR-146a-5p expression levels were found to be significantly decreased in the patient group compared to the control group (p = 0.001). When NOX4 mRNA expression levels were examined, no significant difference was found between the control and aneurysm groups. No correlation was found between NOX4 mRNA and miR-146a-5p levels (p = 0.764). When the relationship between ascending aorta diameter and both NOX4 mRNA and miR-146a-5p was examined, it was found that miR-146a-5p expression was negatively correlated with ascending aorta diameter (p = 0.036) and did not show a significant correlation with NOX4 mRNA levels (p = 0.318). A similar correlation was also found with ascending aorta length. The correlation of NOX4 mRNA and miR-146a-5p expression levels with age, gender, and ejection fraction was investigated separately. No significant correlation was found for all three variables. The optimum cut-off value to be used to separate the patient group from the control group using miR-146a-5p expression levels, as well as the sensitivity and specificity of miR-146a-5p expression levels when this cut-off value was used, was calculated using an ROC curve. Specificity for miR-146a-5p expression was found to be 88%, and sensitivity was found to be 66%. Conclusions: The study found promising results indicating that NOX4, shown to be a determinant of vascular oxidative stress, is not involved in the development of ascending aortic aneurysms; however, miR-146a-5p, which functions in the regulation of many inflammatory responses, including the regulation of NOX4 expression, may help prevent the development of ascending aortic aneurysms. Further studies aimed at elucidating the genetic and biochemical processes involved in aneurysm development suggest that miR-146a-5p could be a therapeutic target for preventing aneurysms. Full article

Objective: This study aimed to evaluate clinical characteristics and outcomes of complete uterine rupture during pregnancy and identify factors associated with adverse neonatal outcomes. Methods: This retrospective cohort study analyzed data from a single center between January 2008 and July 2024. Complete uterine rupture was defined as full-thickness myometrial and serosal rupture confirmed during surgery. Results: Among 50,185 deliveries, 22 cases of complete uterine rupture were identified (incidence: 0.044%). Most patients (86.4%) had a scarred uterus, exclusively due to previous myomectomy (n = 19). While abdominal pain was the primary symptom (72.7%), 22.7% of patients were asymptomatic. There were no cases of maternal mortality or peripartum hysterectomy. Of the 25 neonates, 12 (48%) experienced adverse outcomes, defined as NICU admission or perinatal death. Adverse neonatal outcomes were significantly associated with preterm delivery (p = 0.030), fetal heart rate abnormalities (p = 0.040), and a prolonged symptom-to-delivery interval (p = 0.032). Univariate analysis identified preterm delivery and abdominal pain as significant predictors of poor neonatal prognosis. Conclusions: Complete uterine rupture is a rare but critical obstetric emergency. Although maternal outcomes were favorable in this study, nearly half of the neonates experienced adverse outcomes. Preterm labor and abdominal pain serve as significant prognostic indicators. These findings emphasize that early clinical suspicion and minimizing the time from symptom detection to delivery are vital for optimizing neonatal survival and health. Full article

Generative Artificial Intelligence (GenAI) in cardiac surgery refers to the integration of advanced computational models, such as Large Language Models (LLMs), to automate and enhance clinical decision-making, preoperative risk assessment, and surgical education. In the context of surgical training, it functions as a personalized pedagogical tool that supports various learning activities, ranging from information acquisition and clinical inquiry to procedural practice, while requiring rigorous human oversight to ensure patient safety and clinical accuracy. (1) Background: Generative Artificial Intelligence (GenAI) is increasingly integrated into health professions education, offering new opportunities for learning; however, its specific application and pedagogical mapping in high-stakes fields such as cardiac surgery remain underexplored. This systematic review investigates how GenAI is utilized in cardiac surgery and surgical education, aligning these uses with Laurillard’s six learning types. (2) Methods: Following the PRISMA 2020 guidelines, we searched the Web of Science Core Collection for studies on GenAI in cardiac surgery, resulting in 42 studies that met the inclusion criteria. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI). (3) Results: GenAI applications most frequently supported clinical inquiry (93.8%) and practice (68.8%), demonstrating expanding efficiency across commercial and open-source models (including ChatGPT-4o, Gemini AI, and emerging reasoning architectures such as DeepSeek) for knowledge acquisition and medical production. While it significantly improves individualized learning and preoperative assessment workflows, its practical role in Discussion and Collaboration remains heavily underutilized, highlighting a distinct shift toward individualized solo professional workflows. (4) Conclusions: GenAI provides a transformative and scalable approach to cardiac surgical training by offering personalized and accessible knowledge retrieval. However, clinical educators and governance bodies must deliberately balance these immediate productivity benefits with long-term concerns regarding structural “hallucinations,” data verifiability, and the preservation of collaborative competencies within modern multidisciplinary Heart Teams. Full article

Background/Objectives: In laparoscopic and robot-assisted surgery, bleeding may rapidly impair operative-field readability and procedural safety. In the broader Robin Heart teleoperation framework, interpretation of such events is relevant not only for scene understanding but also as a potential prerequisite for future safety-oriented supervisory functions under communication-degraded conditions. The aim of this study was to assess whether a deep learning model for blood segmentation could provide outputs suitable for preliminary image-level temporal characterization of visible blood-region behavior in laparoscopic video. Methods: A U-Net-based binary blood-segmentation model was implemented in-house in PyTorch and evaluated on three paired image–mask datasets: a simulated bleeding dataset prepared under controlled laboratory conditions, an internal operative laparoscopic dataset, and an external-domain subset derived from the public GynSurg dataset. Segmentation performance was assessed using 5-fold cross-validation and reported using the Dice coefficient and Intersection over Union (IoU). Training dynamics were analyzed using training and validation loss and Dice curves. Additional baseline comparisons were performed on the internal operative dataset using U-Net++ and DeepLabV3+. Temporal analysis was performed on selected video fragments, including a low-motion reference sequence without active bleeding progression, internal bleeding-related sequences, and external-domain sequences, using mask-derived descriptors and auxiliary optical-flow-based motion descriptors computed after camera-motion compensation within the detected blood-related ROI. Results: In 5-fold cross-validation, the U-Net-based model achieved Dice coefficient and IoU values of 0.915 ± 0.012 and 0.851 ± 0.019 on the simulated dataset, 0.856 ± 0.013 and 0.756 ± 0.025 on the internal operative dataset, and 0.707 ± 0.053 and 0.570 ± 0.056 on the external-domain GynSurg subset, respectively. On the internal operative dataset, the proposed model performed comparably to U-Net++ and slightly above DeepLabV3+ under the same cross-validation protocol. The temporal descriptor set differentiated low-motion reference behavior, more spatially coherent progression, rapid coherent expansion, and dynamic or motion-active progression profiles. Peak dA/dt reflected abrupt visible blood-area expansion, temporal IoU described mask stability over time, and optical-flow-based descriptors provided additional information on local motion activity within the detected blood-related ROI. Conclusions: The results support the feasibility of combining deep-learning-based blood segmentation with temporal and optical-flow-based descriptors for exploratory image-level characterization of visible blood-region behavior in laparoscopic video. Within the Robin Heart development pathway, such descriptors may, in the future, serve as candidate components of image-analysis support modules for safety-oriented teleoperative scenarios. At this stage, they should be interpreted as exploratory image-derived indicators rather than clinically validated markers of bleeding severity. Full article

Background: In rodent models of intracranial tumor development, evaluating the actual burden experienced by animals beyond procedural severity is essential for ethical and legal compliance. This study examined whether voluntary wheel running (VWR) could serve as a sensitive indicator of post-surgical burden following subcutaneous transmitter implantation, tumor cell injection, and tumor resection. It also assessed whether VWR supports the detection of humane endpoints. VWR outcomes were compared with body weight, clinical scores, heart rate, and activity levels recorded via telemetry. Methods: Fourteen male BDIX rats were housed individually in cages equipped with a running wheel. Under general anesthesia, telemetric devices to monitor heart rate and activity were subcutaneously implanted. After recovery, glioblastoma BT4Ca cells were stereotaxically injected into the right frontal cortex. Eight days later, the resulting tumors were microsurgically resected. Body weight, VWR, heart rate, and general activity were continuously monitored until the animals reached humane endpoint criteria, indicated by sudden weight loss and clinical deterioration. Results: On average, body weight and VWR declined significantly after all surgical procedures, with tumor resection causing the most pronounced effect. As animals approached the endpoint, a marked drop in these parameters was observed, along with an increased clinical score (p < 0.05). Activity measures supported these findings, though less consistently than weight and VWR. Conclusions: Monitoring body weight and VWR enables an effective assessment of the actual postoperative burden experienced by rats undergoing surgeries of different procedural complexity. Moreover, VWR is a valuable supplementary tool for identifying humane endpoints alongside body weight and clinical scoring. Full article

Cardiac rehabilitation (CR) is strongly recommended in secondary cardiovascular prevention; indeed, in patients after cardiac surgery or with coronary artery disease or heart failure, this intervention is recommended to decrease mortality, morbidity, and disability, and to improve quality of life and cardiorespiratory fitness. Moreover, each step of the cardiovascular continuum denotes a potential risk factor for the progression of cognitive frailty; this interaction is highly prevalent, affecting approximately one-third of all patients in cardiology settings. For these reasons, CR should consider the patient’s cognitive domain; however, cognitive assessment is still rarely integrated into standard CR protocols. Therefore, this comprehensive review presents current evidence and recent updates on the interaction between CR and cognitive impairment, focusing on physiological mechanisms, core components, benefits, and strategies for implementing CR in patients with cognitive frailty to optimize recovery and prognosis. Full article

Background: Heart transplantation (HTx) is a well-established therapy for pediatric patients with end-stage heart failure. Over the past decades, the field has considerably evolved, with noticeable changes in surgical techniques and post-transplant outcomes. This study presents our center’s experience over the past three decades. Methods: Between 1988 and 2024, we performed 256 heart transplants in pediatric patients (<18 years) with congenital heart defects (CHD) or myopathy. We divided our cohort into three periode, eras: Era1 (1988–1999), Era2 (2000–2011), and Era3 (2012–2024). We analyzed and reported baseline patient data, postoperative outcomes, and survival analysis. Results: In the first era, most HTx recipients were infants (75%), with CHD accounting for 75% of cases. In the latest era, older children and adolescents were transplanted more frequently with infants representing only 22%, and myopathies became a more predominant indication, representing 57% of patients. The use of mechanical circulatory support increased significantly (<0.001), and a complete shift towards the bi-caval surgical technique was achieved in the recent era. In terms of post-HTx outcomes, 30-day mortality and allograft vasculopathy significantly decreased in the recent era compared with previous periods (<0.001). Conversely, operative time and post-HTx hemodialysis were more frequently observed in the recent era (<0.001). Long-term survival numerically improved in the middle and recent eras compared with the early era; however, no statistically significant difference in Kaplan–Meier survival across eras was observed (log-rank p = 0.19). Conclusions: Over the past three decades, HTx in pediatric patients has evolved, with improvements in early survival and reduced allograft vasculopathy. Changes in patient demographics, surgical technique, and use of MCS in the recent era highlight the ongoing progress as well as the remaining challenges in this complex population. Full article

The aim of this study was to retrospectively compare modified Del Nido and blood-based St. Thomas cardioplegia in adult patients undergoing isolated aortic valve replacement (AVR). This retrospective study included adult patients undergoing isolated AVR because of aortic valve stenosis between 2024 and 2025. Patients were stratified into blood-based St. Thomas and modified Del Nido groups. The main modification of the Del Nido solution was the adjustment of the crystalloid-to-blood ratio to 1:4. Preoperative and perioperative variables, as well as postoperative biomarkers, including high-sensitivity troponin I, creatine kinase (CK), CK-MB, and lactate, were analyzed. A total of 93 patients were included in the study (blood-based St. Thomas: n = 22; modified Del Nido: n = 71). No significant differences were observed in cardiopulmonary bypass time [98 min (IQR 84–110) vs. 90 min (IQR 74–110); p = 0.184] or aortic cross-clamp time [75 min (IQR 67–86) vs. 73 min (IQR 62–87); p = 0.345]. High-sensitivity troponin I levels at 24 h were numerically, but not statistically significantly, lower in the blood-based St. Thomas group [1961 ng/L (IQR 1367–4423) vs. 2819 ng/L (IQR 1698–5054); p = 0.240]. CK levels at 6 h were comparable between the groups [8.4 μkat/L (IQR 6.5–10.1) vs. 8.5 μkat/L (IQR 6.0–12.7); p = 0.632], as were CK-MB and lactate levels at all evaluated time points. In exploratory multivariable analyses adjusted for age, sex, preoperative LVEF, cardiopulmonary bypass time, and aortic cross-clamp time, cardioplegia type was not independently associated with postoperative biomarker levels. The less frequent dosing and membrane-stabilizing properties of modified Del Nido cardioplegia did not translate into statistically significant clinical or biochemical advantages in the setting of relatively short, isolated AVR procedures. Full article

Congenital heart defects represent prevalent malformations requiring complex surgical interventions. Outcomes are influenced by clinical severity, inflammatory response, and complexity of care, highlighting the need for improved risk stratification tools. Objectives: To describe the behavior and distribution of perioperative sTREM-1 concentrations in a pediatric cohort undergoing cardiac surgery, exploratorily stratified by RACHS-1 and TISS-28 severity scores. Methods: A translational cross-sectional study was conducted with 32 children (aged 0–14 years) undergoing surgical correction for congenital heart disease at a Brazilian public referral hospital (2021–2022). Exclusion criteria included genetic syndromes, active infections, or previous cardiac surgeries. Clinical severity was assessed using RACHS-1 (mortality risk) and TISS-28 (care complexity) scores. Serum sTREM-1 levels were measured via ELISA preoperatively and postoperatively. Statistical analysis involved the Shapiro–Wilk normality test, descriptive statistics expressed as medians and interquartile ranges, and Spearman’s rank correlation coefficient to evaluate the relationship between sTREM-1 levels and severity scores, with significance set at p < 0.05. Results: The cohort consisted predominantly of males (56.25%), term infants (93.75%), with 50% presenting cyanosis. RACHS-1 category 3 was most common (34.37%), while TISS-28 category 2 predominated (40.62%). Most patients were discharged (93.75%). Preoperative sTREM-1 levels showed no significant correlation with RACHS-1 (r_s = 0.265; p = 0.143) or TISS-28 scores (r_s = 0.227; p = 0.212). Conversely, postoperative sTREM-1 concentrations significantly and positively correlated with both RACHS-1 (r_s = 0.356; p = 0.045) and TISS-28 categories (r_s = 0.394; p = 0.026), reflecting higher biomarker levels in more severe clinical scenarios. Conclusions: Postoperative sTREM-1 levels correlated significantly with surgical risk and clinical severity, showing higher median concentrations in more severe RACHS-1 and TISS-28 categories. Conversely, no preoperative correlation was observed, suggesting sTREM-1 primarily reflects postoperative inflammatory responses and surgical complexity. Full article

Background: Septic Charcot neuroarthropathy is a limb- and life-threatening condition characterized by the coexistence of neuropathic joint destruction and infection. In patients with severe systemic compromise, major amputation is often considered inevitable. Case Presentation: A 47-year-old man with untreated diabetes mellitus presented with progressive painless swelling of the left foot. He had morbid obesity (120 kg, 165 cm; body mass index 44.1 kg/m²), severe hypoalbuminemia, and chronic kidney disease associated with nephrotic syndrome. Laboratory tests showed marked inflammation and poor glycemic control, and blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Radiographs and computed tomography demonstrated destructive changes involving the talonavicular and subtalar joints, consistent with septic Charcot neuroarthropathy involving the midfoot. Because of sepsis, pulmonary edema, and heart failure, below-knee amputation was proposed at the referring hospital. However, limb salvage was attempted using aggressive debridement, continuous local antibiotic perfusion (CLAP; gentamicin 1200 μg/mL) administered for 14 days, and temporary circular external fixation. Serum gentamicin concentrations and renal function were regularly monitored to ensure systemic safety and avoid nephrotoxicity. Results: Repeat irrigation and final debridement were performed 20 days after the index surgery, at which time the external fixator was removed and intraoperative cultures were negative. The patient was discharged 2 months after surgery without evidence of recurrent infection. At 4-year follow-up, no recurrence had occurred, and the patient was able to walk independently. Conclusions: Limb salvage may be feasible even in severely compromised patients with septic Charcot midfoot and MRSA bacteremia when aggressive debridement, CLAP, and temporary external fixation are combined with careful systemic safety monitoring. This case suggests that limb salvage may be considered in selected high-risk patients, although further studies are required. Full article

Carcinoid heart disease is a progressive right-sided valvulopathy caused by serotonin and other vasoactive mediators released by metastatic neuroendocrine tumours. As oncological therapies have extended survival, cardiac disease has become a leading determinant of mortality. Operative mortality has decreased to 5–6% in contemporary high-volume centres, and long-term survival appears increasingly determined by tumour biology rather than cardiac disease when surgery is appropriately timed. The principal determinant of operative outcome is preoperative right ventricular function; symptom-based referral alone is insufficient because many patients remain compensated until ventricular dysfunction is advanced. This review synthesises the evidence on surgical timing, operative strategy, prosthesis selection, perioperative endocrine management, and emerging transcatheter options. Tricuspid valve replacement is required in the majority of patients, with concomitant pulmonary valve replacement advocated where concurrent disease is present. Bioprosthetic valves are preferred. Continuous perioperative octreotide infusion has substantially reduced the incidence of carcinoid crisis. Structured multidisciplinary decision-making integrating echocardiographic surveillance, biomarker monitoring, and oncological status assessment is essential. Full article

Background/Objectives: Obesity is a multifactorial chronic condition characterized by the accumulation of excess adiposity and complex interplay between intrinsic and extrinsic factors. It is an increasingly common condition, closely implicated with the incidence and progression of cardiovascular disease and its risk factors. This narrative review synthesizes and summarizes recent evidence on obesity, with a focus on the diagnosis of obesity, an exploration of both visceral and subcutaneous adipose tissue, available interventions for obesity ranging from dietary modifications to novel anti-obesity medications, and key associations with obesity and cardiovascular diseases. This review is distinct in its integrated focus on obesity definition and diagnosis, imaging modalities, the latest non-pharmacologic and pharmacologic interventions, and also the interplay between obesity and certain cardiovascular conditions as well as their risk factors. Results: The diagnosis of obesity has been evolving with the incorporation of anthropometric measurements and imaging modalities rather than simply the body mass index. There is a wide array of contributors to obesity including genetic factors, behavior, hormonal regulators, the brain–gut axis, and psychosocial stressors. Anti-obesity medications have been evolving rapidly, with current emphasis on glucagon-like peptide 1 receptor agonists. Obesity is closely implicated in cardiovascular conditions such as atherosclerotic disease, heart failure, atrial fibrillation, and hypertension as well as related risk factors such as diabetes mellitus, chronic kidney disease and sleep apnea. Conclusions: Obesity is a widely prevalent, chronic, and complex disease. The use of a variety of anthropometric measurements can help risk-stratify individuals. Imaging techniques are also helpful in evaluating body fat. Evaluating individuals from a holistic perspective is imperative to appreciate the various contributors to obesity. There are a variety of interventions available for obesity management including lifestyle interventions, bariatric surgery, and pharmacologic therapy. Notably, obesity is closely tied with cardiovascular diseases and recent pharmacologic anti-obesity agents may mitigate cardiovascular risk. Full article

Background/Objectives: Bariatric surgery is an effective treatment for severe obesity. Although physiotherapy delivered before and after surgery may support functional recovery, evidence describing real-world multidisciplinary bariatric pathways with embedded perioperative physiotherapy remains limited. This study evaluated perioperative changes in anthropometric, functional, and haemodynamic outcomes in adults who completed preoperative and postoperative physiotherapy within the multidisciplinary Polish KOS-BAR bariatric pathway. Methods: We conducted a single-centre retrospective medical-record study at the University Clinical Centre in Gdańsk. The analysis included a complete-case cohort of 91 adults who completed both supervised physiotherapy cycles and had paired outcome data available. Assessments were performed at four time points: before and after prehabilitation (T1–T2) and before and after postoperative rehabilitation (T3–T4). Outcomes included body mass, body mass index (BMI), waist and chest circumference, 6 min walk test (6MWT) distance with Borg-rated exertion, and haemodynamic measures (heart rate, blood pressure, oxygen saturation) recorded before and after the 6MWT. Results: From T1 to T4, body mass decreased by a median of 26.0 kg and BMI by 8.98 kg/m², with reductions in waist (−19.0 cm) and chest (−13.0 cm) circumference. Exercise tolerance improved (6MWT median change +30.0 m), and post-test perceived exertion decreased (median −1.0 point). Pre-6MWT resting HR, post-6MWT HR, and blood pressure decreased. The 6MWT distance increased after prehabilitation (T1 → T2) and again after postoperative rehabilitation (T3 → T4). Exploratory correlations suggested weak nominal associations between greater weight loss and larger 6MWT improvement (Spearman r = 0.251, p = 0.016) and between BMI reduction and 6MWT improvement (r = 0.226, p = 0.031), but these associations did not remain statistically significant after Bonferroni correction. Conclusions: In this retrospective cohort of programme completers, participation in the multidisciplinary KOS-BAR pathway with embedded preoperative and postoperative physiotherapy was associated with improved anthropometric, functional, perceived-exertion, and haemodynamic outcomes across follow-up. Because of the uncontrolled retrospective design, these findings cannot establish the independent effect of physiotherapy relative to surgery and other components of multidisciplinary care. Prospective controlled studies are needed to clarify causality and long-term durability. Full article

Perioperative anxiety is a common psychophysiological stress response experienced by patients before and after surgery, with a global prevalence of approximately 48%. Its occurrence is influenced by multiple factors including age, sex, type of surgery, and psychosocial determinants. The underlying pathophysiological mechanisms are complex, involving multi-system interactions such as autonomic nervous system imbalance, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, dysfunction of limbic system neural circuits, and neuroinflammation. Current assessment strategies are evolving from sole reliance on psychological scales toward multimodal approaches incorporating objective biomarkers including heart rate variability, cortisol, and electroencephalography. Management paradigms have shifted from traditional pharmacological premedication to integrated systems encompassing structured patient education, digital health tools, neuromodulation techniques, and cognitive behavioral therapy. However, significant gaps persist regarding standardized screening protocols, biomarker validation, and targeted intervention pathways for high-risk populations. Future management is likely to require more individualized risk assessment and intervention selection. Biomarker-based risk prediction, artificial intelligence-assisted intervention decision-making, and the deep integration of digital therapeutics such as virtual reality with existing enhanced recovery pathways will be key directions for improving patient outcomes and recovery quality. This structured narrative review summarizes current evidence on perioperative anxiety in adults, focusing on epidemiology, pathophysiological mechanisms, assessment tools, biomarkers, and multimodal management strategies. Full article