Search Results (1,053)

Background: Pain management in patients with severe burns remains one of the most complex challenges in perioperative care. Burn-related pain is multifactorial, resulting from tissue destruction, intense inflammation, surgical procedures, and repeated dressing changes. Opioids remain the cornerstone of analgesia; however, prolonged use is associated with tolerance, dependence, adverse effects, and prolonged hospitalization. Multimodal and opioid-sparing strategies, including regional anesthesia, may improve postoperative outcomes by enhancing analgesia while reducing systemic drug exposure. This study aimed to evaluate the effectiveness of a standardized regional anesthesia protocol in reducing postoperative pain and opioid requirements in burn patients undergoing lower-limb escharectomy and autologous skin grafting. Methods: We conducted a retrospective, single-center analysis of 25 adult patients with deep thermal burns of the lower limbs who underwent escharectomy and split-thickness skin grafting. All patients received a combined ultrasound-guided sciatic popliteal block and adductor canal block on both the burned limb and the donor site. Ropivacaine 0.375% with clonidine was administered without exceeding a total dose of 3.0 mg/kg. Postoperative pain was assessed using the Numerical Rating Scale (NRS), and opioid consumption was recorded as rescue doses in intravenous morphine equivalents. Secondary outcomes included perioperative complications and 30-day hospital readmission. Results: Regional anesthesia provided effective postoperative pain control. Thirty-two percent of patients reported no pain (NRS 0), 52% reported mild pain (NRS 1–3), and 16% reported moderate pain (NRS 4–6). No patient reported severe pain (NRS 7–10). Only four patients (16%) required rescue opioids. No perioperative complications or block-related adverse events occurred, and no patient required hospital readmission within 30 days. Conclusions: In this cohort, regional anesthesia was associated with satisfactory postoperative analgesia and minimal opioid requirements. By reducing opioid exposure, this approach may help improve patient comfort and potentially limit opioid-related adverse effects. Larger prospective studies are needed to confirm these findings and to assess long-term outcomes. Full article

Respiratory infections represent one of the leading causes of pediatric consultations and hospitalizations in Chile, where rapid etiological identification is essential for clinical decision-making. We evaluated the impact of implementing the BIOFIRE^® SPOTFIRE^® Respiratory (R) Panel in the pediatric Emergency Department of a public referral hospital in Santiago, using a pre–post cross-sectional design comparing two winter periods (July 2023 vs. July 2024). Clinical records, laboratory data, and operational indicators were analyzed to assess changes in diagnostic yield, turnaround time, hospitalizations, discharges, supplementary test requests, and antimicrobial use. A total of 470 patients were included (224 in 2023; 246 in 2024). The etiological detection rate increased from 58.0% to 87.8% after the implementation of Spotfire^® (p < 0.0001), with marked increases in the identification of adenovirus, RSV, rhinovirus/enterovirus, and seasonal coronaviruses. Rapid molecular testing was associated with a significant rise in emergency department discharges (23.7% vs. 57.3%; p < 0.0001) and a reduction in hospitalizations (76.3% vs. 42.7%; p < 0.0001) and readmissions (9.2% vs. 0.5%; p < 0.0001). Requests for complete blood counts, chest X-rays, and antimicrobial prescriptions at discharge also decreased significantly. These effects persisted in key subgroups, including infants and children with comorbidities. In this high-demand winter setting, the BIOFIRE^® SPOTFIRE^® R Panel improved diagnostic performance and supported more efficient and targeted clinical management. Full article

Background/Objective: Ketorolac is an effective alternative and addition to opioids for postoperative pain control; however, there is concern of perioperative bleeding risk with its use. Within gynecology, this risk has not yet been explored in the context of hysterectomy. This study aimed to evaluate the risk of postoperative bleeding complications with ketorolac administration in the context of hysterectomy. Methods: This was a retrospective cohort study that included all patients who underwent hysterectomy for benign indications between 2015 and 2024 at a quaternary care academic hospital. Inclusion criteria were any type of hysterectomy during the study period, while exclusion criteria were malignancy and peripartum status. Complication data for up to thirty days post operation were collected. Multivariable regression analysis, including age, American Society of Anesthesiology category, use of celecoxib before surgery, anticoagulant treatment, uterus size, surgical approach, increased surgical complexity, and lysis of adhesions, was performed to identify the adjusted odds of postoperative bleeding complications. The primary outcome was a composite of any postoperative bleeding complications by use of postoperative ketorolac, including postoperative transfusion, readmission, or reoperation for bleeding. Results: In total, 4236 patients underwent hysterectomy for benign indications during our study period, of which 76% (n = 3236) received ketorolac postoperatively. The composite postoperative bleeding rate was lower in the ketorolac group (2.1% vs. 4.1%, p = 0.001). There was no association between ketorolac use and risk of postoperative bleeding in multivariable regression analysis (aOR 1.02, 95% CI 0.36–2.88). There was no difference in overall intraoperative or perioperative complications (p = 0.070 for both). Major perioperative complications were less likely in the ketorolac group (p = 0.046). Additionally, there were no differences in postoperative complications except for ileus, which was less likely in the ketorolac group (p = 0.034). Conclusions: Ketorolac administration was not associated with a higher risk of bleeding complications after hysterectomy, including when celecoxib was used preoperatively as part of an enhanced recovery protocol. It may safely be administered as an opioid-sparing pain medication in this setting. Full article

Background/Objectives: Percutaneous microwave (MW) ablation is a nephron sparing treatment for localized renal cell carcinoma (RCC). We compared perioperative, renal functional, and oncologic outcomes for clinical stage 1 RCC treated with MW ablation, PN, or RN. Methods: Adults with clinical T1 kidney masses treated with MW ablation, PN, or RN from 2001–2025 were identified. Outcomes included: 90-day overall and major complication rate, 30-day readmission rate, length of hospital stay (LOS), change in renal function, local recurrence-free survival (LRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Univariable and multivariable analyses evaluated outcomes adjusted for confounders. Results: A total of 2201 patients with renal masses ≤ 7 cm and no evidence of locally advanced or metastatic disease were treated with MW ablation (708), PN (729), or RN (764). MW ablation patients were older and more comorbid compared to both PN/RN, whereas RN patients had larger, higher-grade tumors. Ninety-day overall complications were lowest after MW ablation (8.9% vs. 20.3% PN, p < 0.001 and 8.9% vs. 19.9% RN, p < 0.001). LOS was shortest after MW ablation (median 1 day vs. 3 days PN/RN, p < 0.001 for each). Six-month eGFR decline was similar after MW ablation and PN (−5.2% and −4.7%, p = 0.84) but greater after RN (−32.9%, p < 0.001). Local recurrences were more common with MW ablation, with five-year LRFS 96.4% versus 99.7% for PN (p < 0.001). Five-year MFS (99.5% vs. 99.7%, p = 0.24) and CSS (99.3% vs. 99.7%, p = 0.71) did not differ between MW ablation and PN. Conclusions: Percutaneous MW ablation has comparable metastasis free and cancer specific survival with lower perioperative morbidity and comparable renal preservation to PN, despite worse baseline comorbidity and renal function. These findings support MW ablation as an effective nephron-sparing option for appropriately selected patients with clinical T1 RCC when performed at an experienced center. Full article

Background/Objectives: (P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery. Methods: Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis. Results: Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95% CI: 0.59–2.07; seven trials), and improvements in pain (MD = 6.12; 95% CI: 3.40–8.84; four trials), depression (MD = 2.82; 95% CI: 0.65–4.99; five trials), fatigue (MD = 10.10; 95% CI: 6.97–13.23; three trials) and distress (MD = 1.23; 95% CI: 0.30–2.16; single trial) compared with controls. Conclusions: Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies. 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

Chronic obstructive pulmonary disease (COPD) is a major health burden worldwide and in Taiwan, ranking as the third leading cause of death globally, and its prevalence in Taiwan continues to rise. Readmission within 14 days is a key indicator of disease instability and care efficiency, driven jointly by patient-level physiological vulnerability (such as reduced lung function and multiple comorbidities) and healthcare system-level deficiencies in transitional care. To mitigate the growing burden and improve quality of care, it is urgently necessary to develop an AI-based prediction model for 14-day readmission. Such a model could enable early identification of high-risk patients and trigger multidisciplinary interventions, such as pulmonary rehabilitation and remote monitoring, to effectively reduce avoidable early readmissions. However, medical data are commonly characterized by severe class imbalance, which limits the ability of conventional machine learning methods to identify minority-class cases. In this study, we used real-world clinical data from multiple hospitals in Kaohsiung City to construct a prediction framework that integrates data generation and ensemble learning to forecast readmission risk among patients with chronic obstructive pulmonary disease (COPD). CTGAN and kernel density estimation (KDE) were employed to augment the minority class, and the impact of these two generation approaches on model performance was compared across different augmentation ratios. We adopted a stacking architecture composed of six base models as the core framework and conducted systematic comparisons against the baseline models XGBoost, AdaBoost, Random Forest, and LightGBM across multiple recall thresholds, different feature configurations, and alternative data generation strategies. Overall, the results show that, under high-recall targets, KDE combined with stacking achieves the most stable and superior overall performance relative to the baseline models. We further performed ablation experiments by sequentially removing each base model to evaluate and analyze its contribution. The results indicate that removing KNN yields the greatest negative impact on the stacking classifier, particularly under high-recall settings where the declines in precision and F1-score are most pronounced, suggesting that KNN is most sensitive to the distributional changes introduced by KDE-generated data. This configuration simultaneously improves precision, F1-score, and specificity, and is therefore adopted as the final recommended model setting in this study. Full article

Background: Language barriers remain a major obstacle to equitable healthcare access for immigrants and refugees across Europe. Greece, as both a transit and host country, faces persistent challenges in providing linguistically and culturally appropriate care. Methods: This study presents a narrative literature review synthesizing international, European, and Greek evidence on the effects of limited language proficiency, professional interpretation, and intercultural mediation on healthcare access, patient safety, satisfaction, and clinical outcomes. Peer-reviewed studies and selected grey literature were identified through searches of PubMed, Scopus, Web of Science, and CINAHL. Results: The evidence consistently demonstrates that the absence of professional interpretation is associated with substantially higher rates of clinically significant communication errors, longer hospital stays, increased readmissions, and higher healthcare costs. In contrast, the use of trained medical interpreters and intercultural mediators improves comprehension, shared decision-making, patient satisfaction, and clinical outcomes. Comparative European data from Italy, Spain, Germany, and Sweden show that institutionalized interpretation systems outperform Greece’s fragmented, NGO-dependent approach. Greek studies further reveal that limited proficiency in Greek is associated with reduced service utilization, longer waiting times, and lower patient satisfaction. Conclusions: This narrative review highlights the urgent need for Greece to adopt a coordinated, professionally staffed interpretation and intercultural mediation framework. Strengthening linguistic support within the healthcare system is essential for improving patient safety, equity, efficiency, and the integration of migrant and refugee populations. Full article

Major hepatectomy (MH) has traditionally been associated with higher R0 rates in colorectal liver metastases (CRLM), but at the cost of increased morbidity. Parenchymal-sparing hepatectomy (PSH) has emerged as an alternative approach aimed at reducing perioperative complications while preserving functional liver parenchyma without compromising oncological outcomes. We retrospectively analyzed 248 consecutive patients undergoing liver resection for CRLM between 2016 and 2025, classified as PSH (n = 215, 86.7%) or MH (n = 33, 13.3%). MH was performed more frequently in patients with greater tumor burden, including larger lesions, more numerous metastases, and bilobar disease (all p < 0.001). PSH was associated with shorter hospital stay, fewer postoperative complications, and lower 30-day readmission rate. In multivariable Cox analyses, surgical strategy was not associated with recurrence-free survival or overall survival, which were primarily driven by tumor burden. Among patients who developed liver recurrence, repeat hepatectomy was more often feasible after PSH than MH (p = 0.026), emphasizing the long-term value of preserving functional parenchyma. Overall, PSH was associated with lower postoperative morbidity, enabling earlier recovery, while facilitating future liver resections when needed in this chronically evolving disease. Full article

Outpatient neurosurgical oncology has expanded with advances in anesthesia, imaging, and minimally invasive techniques, enabling safe same-day discharge for selected patients undergoing procedures such as stereotactic biopsy and craniotomy. In this review, we find that across multiple international series, same-day discharge rates in several studies ranging from 85 to 95%, with low complication (3–6%) and readmission rates when structured pathways, including standardized selection criteria, enhanced recovery protocols, and routine 4-h postoperative CT imaging, are used. Studies on economic analyses demonstrate substantial cost savings driven by reduced inpatient bed utilization, with no increase in adverse events. Key challenges identified include medicolegal concerns amongst physicians, patient education, and limitations in organization adoption. Telemedicine and remote monitoring are increasingly incorporated to streamline preoperative evaluation and postoperative follow-up, improving access and continuity of care. Emerging technologies such as laser interstitial thermal therapy and focused ultrasound may further expand the outpatient neuro-oncology repertoire. Overall, current evidence supports outpatient neurosurgical oncology as a safe, efficient, and patient-centered model when applied with structured clinical pathways and patient selection. Full article

Pulmonary hypertension associated with interstitial lung disease (PH-ILD) is a progressive condition with limited treatment options and associated with high mortality rates. Inhaled treprostinil (iTre) is the only approved therapy for PH-ILD and has been shown to improve exercise capacity and delay disease progression. However, the conventional outpatient titration schedule requires 8–16 weeks to achieve therapeutic dosing, which may delay clinical benefit in those with advanced disease. We conducted a retrospective study of six patients with severe PH-ILD admitted to a tertiary academic center for initiation of iTre using a rapid inpatient uptitration protocol. iTre was started at 3 breaths four times daily (QID) and increased by 2 additional breaths every 12–24 h as tolerated, aiming for ≥9–12 breaths QID within one week under close monitoring. All six patients achieved target dosing without dose reduction or interruption. At three-month follow-up, mean pulmonary artery pressure decreased from 42 ± 5.5 to 35.2 ± 4.5 mmHg, pulmonary vascular resistance from 8.0 ± 1.2 to 6.0 ± 0.9 WU, and cardiac index increased from 2.05 ± 0.13 to 2.15 ± 0.12 L/min/m². No readmissions occurred within 90 days. This study demonstrates that rapid inpatient uptitration of iTre in severe PH-ILD is feasible and well-tolerated, with preliminary evidence of short-term hemodynamic improvement. Full article

Background/Objectives: Tranexamic acid (TXA) is widely used to reduce bleeding in orthopedic surgery, but its safety and impact on outcomes in arthroscopic rotator cuff repair (ARCR) remain unclear. The purpose of this study was to evaluate the safety and effects of injectable TXA on short- and long-term postoperative outcomes and opioid use following ARCR. Methods: The TriNetX Research Network, an insurance claims-based database, was utilized to conduct this retrospective, propensity-matched cohort study. Patients aged ≥18 years undergoing ARCR were identified and divided into TXA (n = 5855) and non-TXA (n = 5855) groups after propensity score matching. Outcomes assessed included 30-day hospital utilization, complications (infection, thromboembolism, hemarthrosis, blood transfusion), one-year revision and shoulder surgery rates, and early, prolonged, and chronic postoperative opioid use. Results: No significant differences were observed between groups in 30-day emergency department visits (2.0% vs. 1.8%, p = 0.502), readmissions, infections, wound dehiscence, blood transfusions, hemarthrosis, or one-year revision and shoulder surgery rates. TXA use was associated with significantly lower rates of early (24.8% vs. 26.8%, p = 0.011), prolonged (9.5% vs. 12.8%, p < 0.001), and chronic opioid use (6.6% vs. 9.6%, p < 0.001). Conclusions: Injectable TXA is safe in ARCR, with no increase in postoperative complications or hospital utilization. Furthermore, TXA use is linked to reduced postoperative opioid consumption, suggesting benefits in pain management and recovery. Prospective studies are warranted to further explore these findings. Full article

Background/Objectives: Malnutrition and cognitive impairment are both common and prognostically significant in elderly patients with acute decompensated heart failure (ADHF). However, the combined impact of nutritional and cognitive status on long-term outcomes remains unclear. This study aimed to evaluate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) and Mini-Mental State Examination (MMSE) in elderly patients hospitalized for ADHF. Methods: We analyzed 414 ADHF patients aged ≥65 years from the NARA-LONGEVITY study. Patients were categorized into four groups based on GNRI (≥92 or <92) and MMSE (>23 or ≤23) values at discharge. The primary endpoint was a composite of all-cause mortality and HF-related readmission. Results: During a median follow-up of 37.4 months, 218 patients (52.7%) reached the composite endpoint, and 168 (40.6%) died. Patients with both low GNRI and low MMSE had significantly poorer outcomes than those with high GNRI and high MMSE (adjusted hazard ratio [HR] for composite outcome: 2.16; 95% CI, 1.28–3.64; p = 0.004; HR for all-cause mortality: 2.21; 95% CI, 1.22–3.99; p = 0.009). The combined prognostic impact was consistent across age subgroups. Conclusions: The combined assessment of nutritional and cognitive status using GNRI and MMSE at discharge provides additional prognostic value in elderly patients with ADHF. These findings highlight the importance of a multidimensional approach to risk stratification and personalized care planning in this population. Full article

Vulnerable populations experience higher mortality and readmission after hospital discharge. We sought to evaluate the impact of the Transitions Of Care Bundle (TOCB™) on COVID-19 patient outcomes post-discharge compared to a control cohort. This retrospective study used electronic health record data collected for 243 COVID-19 patients (65 TOCB™, 178 control) during the initial pandemic months at a large academic facility in Northeast New Jersey (NJ). Data included demographics, comorbidities, readmissions, mortality, and payor. The TOCB™ cohort had proportionally more Hispanic patients (56.92% vs. 48.3%, p = 0.0885). All TOCB™ patients were discharged home without needing additional services, compared to only 36% of the control group. The implementation of TOCB™ was associated with shorter hospital stays, a potential decrease in readmission rates, and fewer emergency department visits. These results imply that well-coordinated post-discharge services are linked to a diminished risk of mortality, possible hospital readmission, and other adverse health outcomes. Full article

Treatment of bacteremia has traditionally consisted of a 7–14-day course of intravenous (IV) antibiotics. Transitioning from IV to oral (PO) antibiotics in uncomplicated cases of Gram-negative and Gram-positive bacteremia is non-inferior to a complete course of IV antibiotics. High-dose oral amoxicillin has been used in practice for treating bacteremia but has limited safety and efficacy data. We conducted a retrospective chart review between June 2022 and June 2024 to characterize the use of high-dose amoxicillin and evaluate its efficacy and safety. A convenient sample size of 100 patients was used. Patients admitted to hospital who received at least one dose of high-dose amoxicillin (1 g PO TID) for the treatment of bacteremia were included. Patients undergoing hemodialysis and patients receiving amoxicillin for other infections were excluded. The average patient was a 60-year-old male (66% male) with a Gram-positive respiratory or skin source bacteremia. The median time to transition to oral amoxicillin was 5 days. The median duration of total treatment was 14 days. Respiratory sources were treated for a shorter duration, whereas skin sources were treated for longer. Readmission to hospital occurred in 28% of cases. The majority of readmissions were unrelated to the original infection, and 92% of patients were cured. There were no observed adverse events, bacteremia relapses, or deaths. In this observational study, transitioning to high-dose oral amoxicillin was primarily used for treatment of uncomplicated respiratory and skin infections with secondary bacteremia. A high rate of clinical success was observed with high-dose PO amoxicillin, with no adverse events reported. Full article