Search Results (472)

Background: Bladder cancer (BC) predominantly affects older patients, and their multidisciplinary treatment often includes surgical intervention. Frailty can influence treatment decisions and is associated with poorer outcomes. This study analyses trends in demographics, treatment patterns and frailty in a large, nationwide, real-world inpatient cohort in Germany. Methods: This retrospective observational study included a total of 49,139 consecutive patients, who received inpatient care for BC at all HELIOS hospitals in Germany between 2016 and 2022. Frailty was assessed using the Hospital Frailty Risk Score (HFRS) and categorised as low (<5), intermediate (5–15), or high (>15). Trends in HFRS, treatment modalities, and demographic variables were analysed using regression models and compared between the periods 2016–2019 and 2020–2022. Results: Of the 49,139 patients, 27,979 were treated between 2016–2019 and 21,160 between 2020–2022. Patients treated in the later period were slightly older but had a lower comorbidity index. The proportion of patients with low frailty increased (73.4% vs. 75.5%, p < 0.01), intermediate frailty decreased (23.5% vs. 21.5%, p < 0.01) and the proportion of highly frail patients remained stable at 3.0% (p = 0.95). Rates of transurethral resection declined over time, whereas rates of RC remained stable (p = 0.12). The use of systemic therapy increased (p = 0.003), particularly among low frailty elderly patients. Early intravesical chemotherapy following transurethral resection declined significantly in 2020–2022 (p < 0.001), particularly among elderly patients with high frailty. Mean length of hospital stay decreased by one day, while ICU admission rates and in-hospital mortality remained stable across time periods. Conclusions: This study shows frailty-specific changes in hospitalisation patterns and inpatient management of BC in Germany, underscoring the value of frailty assessment in population-based research. The proportion of patients classified as having low frailty increased over time. Significant changes in the use of intravesical chemotherapy and systemic therapy were associated with frailty. The decline in early intravesical chemotherapy may have implications for recurrence risk and downstream healthcare utilisation. Full article

End-stage chronic kidney disease markedly increases susceptibility to infections due to compromised immune function and other physiological alterations. Bacteremia is responsible for higher mortality rates in hemodialysis patients compared to the general population. Our study aimed to investigate the incidence and clinical outcomes among patients with end-stage CKD and associated infections. The study retrospectively analyzed admitted patients between 1 January 2023 and 31 May 2025. Among 56 hospitalized patients with CKD and infection (30 hemodialysis [HD], 26 non-HD), baseline comorbidity profiles were broadly comparable. Microbiology was frequently positive (46/56, 82.1%), dominated by Staphylococcus aureus (25/98, 25.5%), Klebsiella pneumoniae (19.98, 19.4%), and Escherichia coli (15/98, 15.3%). Crude in-hospital mortality was higher in HD (46.7% vs. 15.4%; p = 0.012; RR 3.03). In multivariable logistic regression, HD remained independently associated with death (adjusted OR 38.22, 95% CI 1.55–940.53; p = 0.026), alongside hypotension (OR 17.55, 1.46–210.92; p = 0.024) and male sex (OR 4.41, 1.29–15.11; p = 0.018); model performance was strong (AUC 0.867). In this single-center cohort of infected patients with end-stage CKD, maintenance hemodialysis was independently associated with higher in-hospital mortality, even after adjustment for age, sex, comorbidity burden, hypotension, and length of stay; hypotension and male sex were additional risk factors. LOS and most presenting features did not differ meaningfully by dialysis status. Our findings also emphasize the urgent necessity for heightened surveillance of local antimicrobial resistance patterns and underscore the profound vulnerability of hemodialysis patients to severe infectious outcomes, which is exacerbated by immunosuppressive conditions and the limited efficacy of available therapeutic options against resistant pathogens. Full article

Body mass index (BMI) has shown inconsistent associations with outcomes after transcatheter aortic valve replacement (TAVR), and evidence from the Middle Eastern population is limited. This study evaluated whether BMI independently predicts early complications, mortality, or infection following TAVR in a Saudi Arabian cohort. We conducted a retrospective analysis of 197 patients who underwent TAVR between 2015 and 2024, stratified by BMI < 25, 25–29.9, and ≥30 kg/m². The primary endpoint was the in-hospital Valve Academic Research Consortium-3 (VARC-3) composite safety outcome, with secondary outcomes including individual complications, infection, length of stay, and 30-day mortality or readmission. Overall, patients had a mean age of 74.9 ± 8.8 years and 52.3% were female; in-hospital mortality was 2.0%, technical success 99%, and 30-day readmission 12.7%. BMI category was not independently associated with in-hospital complications or mortality, while advanced age ≥ 75 years (adjusted OR 2.52, p = 0.009), moderate Society of Thoracic Surgeons (STS) risk (adjusted OR 3.75, p = 0.008), and high STS risk (adjusted OR 2.26, p = 0.033) independently predicted complications. Overweight patients had higher in-hospital infection rates (14.1% vs. ~3%, p = 0.020). These findings suggest that physiologic vulnerability and operative risk, rather than BMI alone, should guide early TAVR risk assessment. Full article

Background: Transcatheter aortic valve replacement (TAVR) is widely used in patients with severe aortic stenosis. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is an easily obtainable composite index that reflects nutritional status and systemic inflammation. Methods: In this single-center retrospective study, 140 patients who underwent TAVR between 1 April 2021, and 31 October 2024, were included. Patients were stratified according to the median HALP score (32.65) into low (<32.65)- and high (≥32.65)-HALP groups. In-hospital outcomes were mortality, bleeding requiring transfusion of >5 units of red blood cells, acute kidney injury (AKI), need for mechanical ventilation >24 h, and length of hospital stay. Associations between the HALP score and clinical outcomes were evaluated using multivariable regression analyses, and the discriminatory performance of HALP was assessed using receiver operating characteristic (ROC) curves. Results: Patients with low HALP scores had higher rates of in-hospital mortality (11.4% vs. 4.2%; p = 0.002), bleeding (28.6% vs. 5.7%; p < 0.001), AKI (11.4% vs. 2.9%; p < 0.001), and need for mechanical ventilation >24 h (25.7% vs. 14.4%; p = 0.002), as well as longer hospital stay (4.82 ± 1.50 vs. 3.62 ± 1.94 days; p = 0.001) compared with the high-HALP group. In multivariable models, a lower HALP score remained independently associated with all adverse in-hospital outcomes. ROC analysis showed good discriminatory ability of the HALP score for mortality (area under the curve [AUC] = 0.816; cut-off = 20.16), bleeding (AUC = 0.798; cut-off = 24.94), AKI (AUC = 0.737; cut-off = 26.21), and need for mechanical ventilation (AUC = 0.735; cut-off = 27.36). Conclusions: The HALP score is independently associated with adverse in-hospital clinical outcomes in patients undergoing TAVR and may serve as a simple and practical tool for early risk stratification in this population. Full article

Background: Early administration of antibiotics is commonly recommended for pneumonia in intensive care unit (ICU) patients. However, the clinical benefit of very early empirical treatment remains uncertain and may reflect differences in illness severity, baseline risk, or care pathways, particularly in non-septic or hemodynamically stable ICU populations. Methods: We performed a retrospective cohort study using the Medical Information Mart for Intensive Care IV (v2.2) database to evaluate the observational association between antibiotic timing and in-hospital mortality among adult ICU patients with pneumonia. Patients were categorized as receiving early (<3 h) or delayed (≥3 h) antibiotic therapy after ICU admission. A multivariable logistic regression model adjusted only for age and sex. Given the absence of detailed severity-of-illness measures, no causal inference was intended, and all analyses were considered hypothesis-generating. Additional analyses exploring antibiotic class, dosing frequency, and combination therapy were conducted in an exploratory manner, given substantial variation in sample sizes and a high risk of confounding by indication, misclassification, immortal-time, and survivorship bias. Results: Among 7569 ICU patients with pneumonia, 56.5% received antibiotics within three hours of ICU admission. Early antibiotic initiation was associated with higher in-hospital mortality than delayed therapy (26.1% vs. 21.5%; OR 1.30, 95% CI 1.16–1.44; p < 0.001). Because validated severity-of-illness measures were unavailable, residual confounding and confounding by indication are likely and may largely explain this association. A potential signal of increased mortality was observed in patients receiving ≥3 doses of levofloxacin (OR 4.39, 95% CI 1.13–17.02); however, this subgroup was small and the finding is highly susceptible to survivorship and indication bias. Mortality appeared lower in patients receiving two or three antibiotics compared with monotherapy, but marked group imbalances, lack of restriction or stratification, and clinical selection effects limit interpretability. Regimens involving ≥4 agents were rare and primarily associated with prolonged ICU length of stay rather than a clear mortality difference. Conclusions: In this large retrospective ICU cohort, very early antibiotic administration for pneumonia was observationally associated with higher in-hospital mortality. Causality cannot be inferred, and early treatment likely represents a marker of higher baseline risk or clinical urgency rather than a harmful exposure. These findings challenge the assumption that earlier antibiotic initiation is uniformly beneficial and underscore the importance of individualized, stewardship-aligned, and context-dependent decision-making regarding antimicrobial timing and intensity in critically ill patients. Full article

Background/Objectives: Minimally invasive coronary artery bypass grafting (MICS-CABG) offers reduced access trauma compared with conventional off-pump coronary artery bypass (OPCAB) but requires more demanding surgical and anesthetic conditions, including single-lung ventilation. Enhanced Recovery After Cardiac Surgery (ERACS) pathways—particularly those incorporating early extubation in a post-anesthesia care unit (PACU) and routine ICU bypass—may harmonize postoperative recovery across different surgical approaches. This study evaluated whether a standardized early-extubation ERACS protocol could achieve comparable short-term recovery outcomes between MICS-CABG and OPCAB. Methods: This single-center retrospective study included all adult patients who underwent off-pump MICS-CABG via mini-thoracotomy or OPCAB via sternotomy between January 2020 and December 2024 within an ERACS pathway. Propensity score matching (1:1) was applied using key demographic and clinical variables. Primary outcomes were hospital length of stay (LOS), ventilation time, and unplanned ICU transfer. Secondary outcomes included postoperative complications, transfusion requirements, pain scores, and in-hospital mortality. Results: Of 144 MICS-CABG patients, 131 met inclusion criteria and 116 were propensity-matched to 116 OPCAB patients. Operative duration was longer in MICS-CABG (238.9 ± 65 vs. 175.0 ± 48 min; p < 0.001). However, ventilation time (112.2 ± 56.9 vs. 116.9 ± 64.7 min; p = 0.59), hospital LOS (8.7 ± 4.0 vs. 8.6 ± 4.1 days; p = 0.78), and unplanned ICU transfer (0.9% vs. 2.6%; p = 0.37) were comparable. Postoperative complications, transfusion rates, pain scores, and in-hospital mortality also did not differ significantly. Conclusions: Within a structured ERACS pathway incorporating early extubation and ICU bypass, MICS-CABG and OPCAB achieved similar short-term recovery outcomes despite differences in operative complexity. These findings suggest that ERACS can provide a consistent postoperative recovery framework across both revascularization strategies. Full article

Background: Thyroid hormone dysregulation is a well-recognized consequence of cardiopulmonary bypass (CPB), particularly in neonates undergoing congenital heart surgery. Triiodothyronine (T3) plays a crucial role in maintaining cardiovascular stability, and an early decline in serum levels may adversely impact clinical outcomes. This study aimed to evaluate perioperative thyroid hormone changes and their association with morbidity and mortality. Methods: We retrospectively analyzed 132 neonates who underwent congenital cardiac surgery with CPB between January 2021 and June 2024. Serum free T3 (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were measured preoperatively and within one hour after admission to the cardiac intensive care unit. Demographic, clinical, and surgical variables were recorded. Associations between thyroid hormone levels and postoperative outcomes, including in-hospital mortality, ventilation duration, vasoactive-inotropic score (VIS), and length of stay, were assessed using correlation analyses, logistic regression, and receiver operating characteristic (ROC) analysis. Results: Postoperatively, both FT3 and TSH levels declined significantly (p < 0.01), while FT4 levels remained unchanged. Lower postoperative FT3 levels were negatively correlated with prolonged invasive mechanical ventilation (rho = −0.196, p = 0.029) and longer hospital stay (rho = −0.183, p = 0.042). Overall mortality was 7.6% (n = 10). Non-survivors had significantly lower postoperative FT3 levels compared with survivors (p = 0.001). In multivariable logistic regression, postoperative FT3 was independently associated with mortality (OR = 0.22, 95% CI 0.05–1.03, p = 0.048). ROC analysis demonstrated good predictive performance of postoperative FT3 for mortality (AUC = 0.818), with an optimal cutoff of 2.17 pg/mL (sensitivity 72%, specificity 70%). Conclusions: Early postoperative suppression of FT3 is common after CPB in neonates and is independently associated with increased mortality and adverse short-term outcomes. Early assessment of thyroid function, particularly FT3, may provide valuable prognostic information and aid in risk stratification in this high-risk population. Full article

Background/Objectives: Metabolic comorbidities and systemic inflammation are implicated in colon carcinogenesis, yet their relationship with acute obstructive presentation and early in-hospital course remains unclear. This study evaluated whether age, metabolic multimorbidity, and inflammatory–metabolic biomarkers are associated with obstruction severity and length of stay in a surgical colon cancer cohort. Methods: We analyzed 677 consecutive adults undergoing surgery for histologically confirmed colon cancer. Acute presentation was categorized as no obstruction, subocclusive syndrome, or frank obstruction. Predictors included age, comorbidity count (multimorbidity defined as ≥2), diabetes, hypertension, and preoperative biomarkers (C-reactive protein (CRP), lipids, glucose; neutrophil-to-lymphocyte ratio (NLR)/platelet-to-lymphocyte ratio (PLR)/C-reactive protein-to-albumin ratio (CAR)where available). Multivariable logistic and ordinal regression assessed obstructive presentation; linear regression assessed length of stay. Results: Subocclusion or obstruction occurred in 34.8% of patients. In multivariable logistic regression, age was independently associated with obstructive presentation (odds ratio (OR) 1.016 per year; 95% confidence interval (CI) 1.001–1.032), while comorbidity count and CRP were not. In an ordinal model, age increased the odds of more severe presentation (OR 1.018 per year), whereas diabetes was inversely associated (OR 0.573). Length of stay was independently associated only with presentation severity (β = −0.959 days per category). Correlations between inflammatory indices and length of stay were negligible. Conclusions: In this hospital-based surgical cohort, age showed a modest association with obstructive presentation, while metabolic multimorbidity and routine inflammatory markers provided limited discrimination for obstruction or early in-hospital resource use. Full article

Acellular dermal matrices (ADMs) are widely used in soft-tissue reconstruction, yet the optimal timing for split-thickness skin grafting (STSG) remains unsettled. We conducted a single-center retrospective cohort study (January 2023–August 2025) of adults undergoing ADM-based reconstruction with Integra^® Double Layer (IDL), Integra^® Single Layer (ISL), or Nevelia^®. Primary endpoints included length of stay (LOS), STSG requirement and timing, and in-hospital complications; secondary endpoints included spontaneous epithelialization. Prespecified adjusted analyses (linear/logistic models) controlled for age, sex, etiology, anatomical site, diabetes/PAOD, smoking, wound size (when available), wound contamination, and matrix type. Histology and immunohistochemistry (H&E, Masson trichrome, CD105, D2-40) assessed matrix integration and vascular/lymphatic maturation. Seventy-five patients were included (IDL n = 40; ISL n = 20; Nevelia n = 15). On multivariable analysis, matrix type was not an independent predictor of LOS (ISL vs. IDL β = +2.84 days, 95% CI −17.34 to +23.02; Nevelia vs. IDL β = −4.49 days, 95% CI −16.24 to +7.26). Complications were infrequent (6/75, 8.0%) and comparable across matrices; spontaneous epithelialization occurred in 3/75 patients (4.0%). A day-14 grafting strategy, applied only after documented clinical integration, was feasible in 30/75 (40.0%) patients without excess complications. Histology/IHC at 3–4 weeks demonstrated CD105-positive, perfused capillary networks with abundant collagen; at 4–6 weeks, D2-40-positive lymphatic structures confirmed progressive neo-dermis maturation, supporting the biological plausibility of earlier grafting once integration criteria are met. In this cohort, outcomes were broadly similar across matrices after adjustment. A criteria-based early STSG approach (~day 14) appears safe and operationally advantageous when integration is confirmed, while a minority of defects may heal without grafting. Prospective multicenter studies with standardized scar/functional measures and cost analyses are needed to refine patient selection and graft timing strategies. Full article

Background: Respiratory syncytial virus (RSV) pneumonia is an underrecognized cause of critical illness in adults. However, the influence of biological sex on intensive care unit (ICU) outcomes in this population remains unclear. Due to limited case numbers and incomplete covariate data, this study was designed as exploratory and hypothesis-generating. Methods: We conducted a retrospective exploratory cohort study using the MIMIC-IV database and identified 105 adult ICU patients with laboratory-confirmed RSV pneumonia. Clinical variables included sex, age, ICU length of stay, use of mechanical ventilation, and weaning status. Exploratory multivariable logistic regression was performed to assess associations with in-hospital mortality and weaning success, acknowledging substantial missingness of comorbidity data, severity scores, and treatment variables. This limited adjustment for confounding and statistical power. Results: Overall, in-hospital mortality was 33.3%. Mortality was significantly higher among women than men (51.6% vs. 7.0%; p < 0.001), although the absolute number of deaths in men was very small. In adjusted models, female sex (OR 14.6, 95% CI 1.58–135.3, p = 0.018), reflecting model instability due to sparse events, as well as longer ICU stay (OR 1.22 per day, p = 0.001) were independently associated with higher mortality. Female sex was also associated with lower odds of successful weaning (OR 0.07, 95% CI 0.01–0.63, p = 0.018). These effect estimates must be interpreted cautiously due to the very small number of deaths in men and the resulting wide confidence intervals. Age and ventilation duration were not significant predictors. Conclusions: In this preliminary ICU cohort, female sex and prolonged ICU stay were linked to higher mortality and lower weaning success in adults with RSV pneumonia. However, given the very small number of events—particularly among male patients—together with the modest sample size, limited covariate availability, and unstable effect estimates, the findings should be viewed as exploratory rather than confirmatory. Larger, well-powered, prospective multicenter studies are needed to validate and further characterize potential sex-related differences in outcomes of RSV-associated critical illness. Full article

Background: Endothelial dysfunction plays a critical role in ischemic stroke. The Endothelial Activation and Stress Index (EASIX), calculated from creatinine, lactate dehydrogenase (LDH), and platelet levels, reflects endothelial injury. This study aimed to investigate the relationship between EASIX and 90-day mortality in patients with posterior circulation ischemic stroke (PCIS) treated with mechanical thrombectomy. Methods: Fifty-eight patients with acute ischemic stroke who underwent mechanical thrombectomy (MT) or MT combined with intravenous thrombolysis (intravenous tissue plasminogen activator (tPA)) for posterior circulation ischemic stroke (PCIS) were included. EASIX was calculated using 24 h laboratory values of creatinine, LDH, and platelets. Its association with 90-day mortality, length of hospital stay, intubation, and parenchymal hemorrhage was analyzed. Results: In patients receiving reperfusion therapy, the Endothelial Activation and Stress Index (EASIX) showed modest ability to predict 90-day mortality (AUC = 0.583, 95% CI 0.428–0.739, p = 0.295). Higher EASIX values were linked to a 6.58-fold increase in mortality risk. Patients with elevated EASIX were generally older, had more frequent hyperlipidemia, had higher 24 h National Institutes of Health Stroke Scale (NIHSS) scores, had greater need for intubation, and had higher in-hospital mortality. Conclusions: EASIX is a simple, inexpensive, and non-invasive marker that may reflect endothelial dysfunction and help predict mortality in PCIS patients undergoing reperfusion therapy. Higher EASIX values are associated with poorer prognosis. Early identification of high-risk patients may support secondary prevention strategies. Full article

Introduction: Identification of the thoracic duct (TD) is essential during esophageal surgery to reduce the risk of complications such as chylothorax. The clinical significance of the white plane, or Morosow’s ligament—a consistent anatomical landmark along the esophagus—remains poorly defined. Methods: A total of 166 patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE) were analyzed. Intraoperative visualization of the white plane was documented. Patient demographics, tumor characteristics, postoperative complications, management strategies, hospital length of stay, and overall survival were assessed. Complication severity was graded using the Clavien–Dindo classification. The Kaplan–Meier and multivariable Cox regression analyses were used to evaluate prognostic factors, including BMI, ASA score, pneumonia, pT status, pN status, neoadjuvant and adjuvant therapy, and white plane visualization. Results: The white plane was visualized in 154 patients (92.8%). Postoperative complications, management strategies, hospital length of stay, and 30-/90-day in-hospital mortality did not differ between groups with visualized and not visualized white planes. Median overall survival was significantly longer in patients with a visible white plane (43.1 vs. 13.1 months; p = 0.0079). The multivariable analysis identified ASA classification, pT stage, pN stage, and adjuvant therapy as independent predictors of overall survival, whereas lymph node stage and adjuvant therapy were independent predictors of recurrence-free survival. Conclusions: The white plane is a distinct intraoperative anatomical structure that can be visualized in most RAMIE procedures. Its identification may assist in TD recognition and provides a framework for describing mediastinal anatomy, but further studies are needed to determine its impact on surgical standardization and patient outcomes. Full article

Background: The “weekend effect” describes the concern that patients treated on weekends experience worse outcomes due to differences in staffing, resource availability, and workflow. Evidence for a weekend effect in elective orthopedic surgery is limited and inconsistent, and most prior work does not ensure that surgery itself actually occurs on the weekend. We aimed to evaluate whether weekend admission and surgery are associated with worse in-hospital or 90-day outcomes in a contemporary nationwide cohort of elective primary total knee arthroplasty performed on hospital day 0. Methods: We conducted a retrospective cohort study using the U.S. Nationwide Readmissions Database (NRD) from 2020 to 2022. Adult patients (≥18 years) undergoing elective primary TKA with surgery on hospital day 0 were identified using ICD-10-PCS procedure codes in the primary procedure position. Weekend admissions (Saturday–Sunday) were compared with weekday admissions (Monday–Friday). Baseline demographics, comorbidities, and hospital characteristics were assessed. Outcomes included length of stay, total hospital charges, in-hospital mortality, major postoperative complications, and 90-day all-cause readmissions, time to readmission, readmission length of stay, and procedures during readmission. Continuous variables were compared using t-tests and categorical variables using chi-square or Fisher’s exact tests (two-sided α = 0.05). Results: Among 437,121 elective day-0 TKA admissions, 435,822 (99.7%) occurred on weekdays and 1299 (0.3%) on weekends. Baseline characteristics were highly similar between groups. No clinically meaningful differences were observed in in-hospital complications, mortality, or 90-day readmission outcomes. Small statistical differences in blood transfusion, blood-loss anemia, and postoperative pain did not follow a pattern consistent with a weekend effect. Conclusions: In this large contemporary national cohort of elective primary TKA with surgery on hospital day 0, weekend admission and surgery were not associated with worse in-hospital outcomes or higher 90-day readmission rates. Within standardized perioperative pathways, elective TKA appears safe when performed on weekends, without evidence of a weekend effect. Full article

Background/Objectives: Guidelines recommend combination therapy with oral vancomycin and intravenous (IV) metronidazole for fulminant Clostridioides difficile infection (CDI). Although patients with severe CDI are often managed with combination therapy, evidence supporting this practice remains limited. This study was performed to compare the clinical outcomes of vancomycin monotherapy versus combination therapy in patients with severe CDI. Methods: We conducted a multicenter, retrospective, observational cohort study including adult patients with severe CDI who received oral vancomycin between January 2017 and May 2021. Patients were classified as receiving combination therapy if IV metronidazole was administered for at least 72 h within 48 h of initiating oral vancomycin; otherwise, they were classified as receiving vancomycin monotherapy. The primary outcome was a composite of inpatient all-cause death or colectomy within 60 days after CDI diagnosis. The secondary outcomes were the clinical cure rate, CDI recurrence rate, time to discharge after CDI diagnosis, and duration of ICU admission. Results: In total, 215 patients were included, with 100 (46.5%) receiving combination therapy. There were no significant differences in in-hospital mortality or colectomy between the monotherapy and combination therapy groups (25.2% vs. 26.0%, p = 1.00). Recurrence rates (19.1% vs. 16.8%, p = 0.81), total length of stay (31.0 vs. 23.0 days, p = 0.16), and ICU stay duration (35.0 vs. 32.0 days, p = 0.89) were also similar. However, the clinical cure rate was significantly higher in the monotherapy group than in the combination therapy group (79.1% vs. 65.0%, p = 0.03). Conclusions: Combination therapy with oral vancomycin and IV metronidazole was not associated with improved clinical outcomes in patients with severe CDI. Prospective randomized studies are needed to clarify optimal management strategies for severe CDI. Full article

Background and Objectives: Diabetes mellitus (DM) is a growing global health concern linked to increased hospitalization rates, longer hospital stays, and higher mortality. Older adults with DM are particularly prone to intracranial injuries due to frailty and DM-related complications such as neuropathy and cardiovascular diseases. This study explores the impact of DM on in-hospital outcomes in patients with intracranial injuries. Material and Methods: This retrospective cohort study used data from 45 hospitals in Germany, including 12,720 patients aged ≥40 years hospitalized between January 2019 and December 2023 with a primary diagnosis of intracranial injury. Patients were categorized based on the secondary presence of DM diagnosis (ICD-10 E10-E14). Outcomes included in-hospital mortality, rehospitalization within 1 year and hospital length of stay (LOS). Multivariable logistic regression models were used to analyze associations between DM and the different outcomes, adjusting for age, sex, hospitalization year, and comorbidities. Results: Among 12,720 patients, 2394 had a known DM diagnosis. The median age was higher in DM patients (82 vs. 79 years). In-hospital mortality rates were similar for patients with and without DM (4.7% vs. 4.6%; OR: 0.98; 95% CI: 0.78–1.22). DM was not associated with rehospitalization risk (OR: 1.06; 95% CI: 0.89–1.26) but showed a trend toward longer hospital stays (≥7 days: OR: 1.13; 95% CI: 1.01–1.26). Conclusions: While DM did not significantly influence mortality or rehospitalization after intracranial injuries, it showed a non-significant trend towards extended LOS (≥7 days). These findings underscore the importance of targeted management strategies to optimize outcomes in this population. Full article