Search Results (214)

Introduction: Crohn’s disease (CD) remains associated with long-term morbidity despite biologic therapies. Surgery, historically considered a last-resort option, is increasingly integrated into disease management earlier. This review examines the evolving role of surgery in the biologic era. Methods: A focused narrative review of randomized controlled trials, meta-analyses, observational studies, and international guidelines addressing contemporary surgical strategies in CD was performed. Results: The LIR!C trial demonstrated that early ileocecal resection provides durable remission and improves long-term outcomes compared with biologic therapy in selected patients. The PISA II trial supported an early combined surgical and medical approach for perianal fistulizing disease. Preoperative optimization, including nutritional support and adjustment of immunosuppressive therapy, has become a cornerstone of perioperative management. Laparoscopic surgery remains the preferred approach whenever feasible, while robotic surgery is emerging as a promising platform that is expected to play an increasingly important role in the surgical management of CD. Postoperative recurrence remains a major challenge, prompting the development of innovative surgical strategies. Although the Kono-S anastomosis initially showed promising reductions in recurrence, recent prospective studies failed to confirm superiority over conventional techniques. Similarly, extended mesenteric excision did not demonstrate improved outcomes despite increasing evidence implicating the mesentery in CD pathogenesis. Strictureplasty remains an effective option for selected fibrotic small-bowel strictures. Conclusions: Surgery remains central to multidisciplinary CD management and offers the potential to modify disease when performed early in selected patients. The impact of innovative surgical strategies on postoperative recurrence remains uncertain, and ongoing trials are expected to further help with surgical decision-making. Full article

Background: Composite immunonutritional biomarkers reflecting systemic inflammation, nutritional status, and immune competence have emerged as promising tools for perioperative risk stratification in colorectal cancer (CRC). However, their prognostic value during the perioperative period following minimally invasive CRC surgery remains unresolved. This study aimed to evaluate the association between perioperative inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), hemoglobin–albumin–lymphocyte–platelet (HALP) score, and Host Index (H-index), and short-term postoperative outcomes after minimally invasive colorectal cancer surgery. Methods: This retrospective single-center study included 105 patients who underwent minimally invasive curative-intent surgery for CRC between 2023 and 2025. Biomarkers were assessed preoperatively and during the first four postoperative days. Severe postoperative morbidity was defined as a Comprehensive Complication Index (CCI) ≥ 20.9. Results: Among all parameters, NLR measured on postoperative day 3 demonstrated the highest apparent discriminatory ability for severe complications (AUC = 0.87, 95% CI: 0.74–0.95; sensitivity 91.7%; specificity 73.7%). Preoperative HALP was the most informative preoperative marker (AUC = 0.78, 95% CI: 0.66–0.87; sensitivity 76.5%; specificity 87.7%). Conclusions: Perioperative inflammatory and immunonutritional biomarkers are associated with postoperative morbidity following CRC surgery. Preoperative HALP and postoperative day 3 NLR demonstrated the strongest apparent discrimination for CCI ≥ 20.9; however, these findings require confirmation in larger, independent prospective cohorts. Full article

Background and Objectives: Systemic inflammation, nutritional status, and host immune response play pivotal roles in cancer progression and patient prognosis. The C-reactive protein–albumin–lymphocyte (CALLY) index is a novel inflammation-based biomarker integrating these parameters. This study aimed to evaluate the prognostic value of the preoperative CALLY index in patients undergoing pancreaticoduodenectomy for pancreatic head adenocarcinoma. Materials and Methods: This retrospective study included 101 consecutive patients who underwent pancreaticoduodenectomy with curative intent for histopathologically confirmed pancreatic head adenocarcinoma at Çukurova University Faculty of Medicine between 2010 and 2021. Demographic, clinicopathological, perioperative, and survival data were analyzed. The CALLY index was calculated using preoperative serum C-reactive protein, albumin, and lymphocyte levels, and the optimal cutoff value was determined by receiver operating characteristic (ROC) curve analysis. Results: Using an optimal cutoff value of 1.38, patients were categorized into low (n = 58) and high (n = 43) CALLY index groups. Patients with a low CALLY index experienced significantly higher rates of intraoperative and postoperative complications, surgical site infection, reoperation, unplanned hospital readmissions, and 30- and 90-day mortality (all p < 0.05). Moreover, the low CALLY index group demonstrated significantly poorer overall survival than the high CALLY index group (p < 0.001). Receiver operating characteristic (ROC) analysis for overall mortality yielded an area under the curve (AUC) of 0.701 (95% CI, 0.591–0.811). On multivariable Cox regression, a low CALLY index remained an independent predictor of poorer overall survival (adjusted hazard ratio [aHR], 2.45; 95% CI, 1.47–4.08; p < 0.001) after adjustment for age, tumor size, lymph node status, resection margin, and differentiation. On multivariable logistic regression, a low CALLY index was independently associated with surgical site infection (adjusted odds ratio [aOR], 11.5; 95% CI, 3.9–34.2; p < 0.001) and overall postoperative morbidity (aOR, 5.3; 95% CI, 2.0–14.0; p < 0.001). Conclusions: The preoperative C-reactive protein–albumin–lymphocyte (CALLY) index is a simple, inexpensive, and readily available biomarker with significant prognostic value in patients undergoing pancreaticoduodenectomy for pancreatic head adenocarcinoma. A low CALLY index was associated with poorer overall survival and increased postoperative morbidity and mortality. The CALLY index may serve as a practical tool for preoperative risk stratification and prognostic assessment. However, prospective multicenter studies are warranted to validate standardized cutoff values and further establish its clinical applicability. Full article

Background/Objectives: Tuberculous constrictive pericarditis (TCP) is characterized by “backward failure” and systemic venous congestion, leading to secondary multi-organ dysfunction. The Model for End-Stage Liver Disease (MELD) 3.0 score assesses liver, renal, and nutritional status, yet its prognostic utility in TCP remains undefined. This study aimed to evaluate the preoperative MELD 3.0 score as a predictor of time to discharge in patients undergoing pericardiectomy for TCP. Methods: We analyzed 190 patients undergoing pericardiectomy for TCP between 2018 and 2024. The association between preoperative MELD 3.0 scores and time to discharge (ICU, postoperative, and total) was assessed using Fine–Gray competing risks regression to account for in-hospital mortality. Models were adjusted for age, albumin, and anti-tuberculosis therapy. Results: Each unit increase in MELD 3.0 was associated with higher operative mortality (OR 1.21, p = 0.013). In multivariable analysis, a high MELD 3.0 score (>median 9.6) was independently associated with a lower probability of discharge (i.e., delayed discharge) for total hospital stay (subdistribution hazard ratio [sHR] 0.606, 95% CI 0.453–0.811), postoperative stay (sHR 0.665), and ICU stay (sHR 0.658). Preoperative albumin was also a strong predictor of faster discharge. Conclusions: The preoperative MELD 3.0 score independently predicts delayed hospital discharge after pericardiectomy for TCP, even when accounting for mortality risk. It serves as a pragmatic tool for quantifying the systemic burden of congestion and stratifying perioperative risk. Full article

Background/Objectives: Lung metastasis (LM) is the most common type of extrahepatic metastasis after hepatectomy for hepatocellular carcinoma. However, the predictive factors for LM after hepatectomy for hepatocellular carcinoma remain incompletely characterized. This study aimed to examine the predictive factors for LM after hepatectomy for hepatocellular carcinoma and clarify the association between preoperative biomarkers and LM. Methods: We analyzed data of 644 consecutive patients with hepatocellular carcinoma who underwent primary hepatectomy between July 2003 and December 2023. Patients were divided into two groups: LM (+) and LM (−). Additionally, the association between perioperative factors and LM was investigated. Subsequently, a risk model was developed to predict LM. Results: Of the 644 patients, 43 (6.7%) experienced LM. Regarding biochemical scores, only the proportion of high Controlling Nutritional Status (CONUT) score (≥3) was significantly different (43.9% in the LM (−) group vs. 60.5% in the LM (+) group, p = 0.04). In multivariable analysis, a high CONUT score, tumor size, and microvascular invasion were identified as independent predictive factors for LM. The risk model exhibited accuracy with an area under the curve of 0.93, 0.85, and 0.83 in the 1-, 3-, and 5-year LM, respectively. Conclusions: The present study demonstrated an association between CONUT score and LM after primary hepatectomy for hepatocellular carcinoma and found that a high CONUT score is a complementary predictive factor for LM. Full article

Background: Prehabilitation has become an essential component of perioperative care in colorectal surgery, aiming to improve postoperative outcomes through multimodal interventions. However, its real-world implementation remains heterogeneous. This study aimed to evaluate the degree of implementation and variability of prehabilitation programs across colorectal surgery units in Spain. Methods: A national multicenter cross-sectional survey (VAPPER Survey) was conducted among colorectal surgery units. The questionnaire included 83 items addressing organizational structure, nutritional assessment, frailty screening, and multidisciplinary collaboration. Data were analyzed descriptively and expressed as frequencies and percentages. Results: A total of 104 hospitals participated. Prehabilitation programs were present in 79% (n = 82) of centers, while 21% (n = 22) reported no program. Nutritional screening was not performed in 21% (n = 22) of hospitals. Among those performing screening, MUST was the most frequently used tool (68%, n = 56), although considerable variability existed. Systematic use of GLIM criteria was reported in only 24% (n = 20), whereas 35% (n = 28) did not use GLIM and 41% (n = 34) applied it selectively. Frailty screening in patients ≥70 years was absent in 54% (n = 44) of centers, and geriatric involvement was limited and non-standardized. Conclusions: Prehabilitation is widely implemented in Spain but remains highly heterogeneous across all dimensions. The most relevant deficits are concentrated in systematic nutritional assessment, malnutrition diagnosis using standardized criteria, geriatric integration, and psychological support. Standardization of protocols, strengthening of multidisciplinary teams, and enhanced training in perioperative nutrition are priorities for optimizing outcomes in colorectal surgery. Full article

Background/Objectives: Patients with pre-existing chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF) are a particularly high-risk surgical population in whom postoperative pulmonary complications (PPCs) drive a disproportionate share of morbidity, prolonged stay and mortality. Prehabilitation—the structured optimization of functional reserve during the preoperative interval—has emerged as a proactive, largely non-pharmacological strategy to raise that reserve before the surgical insult. Yet the evidence base is organized predominantly by surgical procedure and enrolled in mixed populations, so the patients with the least physiological reserve—those with established COPD or CHF—remain comparatively understudied. This narrative review takes the comorbidity, rather than the incision, as its organizing axis. Methods: We summarize the pathophysiology that links chronic cardio-respiratory disease to perioperative respiratory failure; appraise the principal non-pharmacological interventions, with the respiratory components (inspiratory muscle training, pulmonary rehabilitation, breathing techniques) as the core and exercise, nutritional, psychological, and smoking-cessation elements as the multimodal context; and re-read the surgical evidence through the lens of the underlying disease. Results: A cross-surgical meta-analysis indicates that preoperative exercise training reduces PPCs (relative risk ≈ 0.52) with no significant difference in effect across surgery type or training modality, supporting a comorbidity-centered rather than procedure-centered framework. We address practical determinants of implementation—timing, patient selection, adherence, home-based and telemonitored delivery, and low-resource applicability—and highlight two cross-cutting problems: heterogeneity of intervention prescription and the lack of standardized PPC definitions. Conclusions: The scarcity of disease-specific evidence is itself the central finding, revealing a mismatch between clinical risk and research investment. Full article

Background/Objectives: Surgical treatment of colorectal cancer (CRC) is associated with a substantial risk of postoperative complications and delayed recovery of functional capacity, particularly in older patients and those with multiple comorbidities. Preoperative prehabilitation has emerged as a strategy aimed at optimizing patients’ physical, nutritional, and psychological status prior to surgery; however, its clinical effectiveness and feasibility of implementation remain subjects of ongoing debate. The aim of this narrative review was to provide a clinically oriented synthesis of current evidence regarding multimodal prehabilitation in patients undergoing CRC surgery, with particular emphasis on perioperative outcomes, functional recovery, nutritional optimization, and implementation-related considerations. Methods: A targeted narrative review of the peer-reviewed literature indexed in PubMed (2015–2025) was conducted to identify contemporary review-type publications, including narrative reviews, systematic reviews, scoping reviews, and meta-analyses, addressing prehabilitation in CRC surgery. The findings were synthesized narratively and interpreted with emphasis on clinical applicability and translational relevance. Results: Twenty contemporary review publications were included in the analysis. Across the included publications, the most frequently reported favorable effects were observed for multimodal prehabilitation, incorporating physical exercise, nutritional support, and a psychological component. These interventions were associated with improvements in functional capacity and, in some meta-analyses, with a reduction in postoperative complication rates and shorter length of hospital stay, particularly in high-risk patients. Prehabilitation was assessed as safe and well tolerated. Conclusions: The current body of evidence indicates that multimodal prehabilitation may constitute a beneficial adjunct, particularly in improving functional capacity, while its impact on hard postoperative outcomes remains closely dependent on intervention quality, appropriate patient selection, and seamless integration with established perioperative care pathways. Future meta-analyses should address underexplored components of prehabilitation, including preparation for stoma formation and targeted educational and psychological support related to sexual health. Full article

Background: Malnutrition is common among patients with cancer and is associated with poorer clinical outcomes and increased healthcare costs. However, nutritional care remains suboptimal in routine oncology practice. This study aimed to assess the implementation of nutritional screening, assessment and management across oncology centers in Lombardy (Italy) and to identify critical areas to support the development and implementation of a regional Diagnostic–Therapeutic Care Pathway (PDTA). Methods: A 21-item questionnaire developed by the Oncology Commission of the Clinical Nutrition Network of Lombardy Region was administered to all regional oncology centers. Data were collected via the Welfare General Directorate platform from 13 November 2024 to 31 December 2024, and analyzed in aggregate form. Results: In total, 55 out of 59 centers responded (93.2%). Nutritional care was available in 78% of centers. Systematic nutritional risk screening was reported by 42% of centers, while 51% performed a comprehensive nutritional assessment in all patients with a positive screening result. Nutritional assessment was scheduled at both initial and follow-up visits in 53% of centers. In the perioperative setting, prehabilitation programs were available in 49% of centers, and preoperative immunonutrition was administered in 35%. Tools for assessing patient-reported outcomes and quality of life were available in only 15% and 20% of centers, respectively. Conclusions: The survey suggests some improvements compared to previous Italian surveys but highlights persistent gaps in the organization and delivery of nutritional care for patients with cancer. Full article

Background and Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for obesity and type 2 diabetes mellitus. While these agents provide substantial metabolic benefits, concerns have emerged regarding their effects on nutritional status and potential implications for perioperative outcomes. Materials and Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. A structured literature search was conducted from 2 May 2026 to 8 June 2026 examining GLP-1RA therapy, nutritional status, body composition and surgical outcomes. Eligible studies included investigations of postoperative outcomes associated with GLP-1RA use, nutritional and body composition effects of GLP-1RAs, associations between nutritional abnormalities and surgical outcomes, and perioperative nutritional optimisation strategies. Data were extracted and synthesised narratively. Results: Twenty studies met the inclusion criteria. Four major themes were identified: (1) nutritional and body composition changes associated with GLP-1RA therapy, (2) effects of malnutrition, sarcopenia, myosteatosis and micronutrient deficiencies on surgical outcomes, (3) postoperative outcomes associated with GLP-1RA use, and (4) perioperative nutritional assessment and optimisation strategies. GLP-1RA therapy was consistently associated with reduced energy intake, inadequate protein intake, micronutrient deficiencies and loss of lean body mass. These abnormalities overlap with recognised risk factors for adverse postoperative outcomes. Despite this, clinical studies generally reported neutral or favourable postoperative outcomes among GLP-1RA users, particularly in arthroplasty and hand surgery populations, although increased wound-healing complications were reported in selected plastic surgery cohorts. Conclusions: Current evidence suggests that GLP-1RAs do not consistently worsen postoperative outcomes; however, their use is associated with nutritional and body composition changes that may influence perioperative recovery. Nutritional assessment and optimisation may therefore represent an important component of perioperative care in patients receiving GLP-1RA therapy. Full article

Background/Objectives: Lung cancer remains the leading cause of cancer-related mortality worldwide, and surgical resection is the primary curative treatment for patients with early-stage non-small cell lung cancer (NSCLC). Patients undergoing lung cancer surgery are frequently affected by malnutrition, systemic inflammation, sarcopenia, and cancer-related cachexia, which may adversely affect postoperative recovery and clinical outcomes. Perioperative immunonutrition has been proposed as a strategy to support immune and metabolic responses associated with surgical stress. This narrative review summarizes current evidence regarding the role of perioperative immunonutrition in patients undergoing lung cancer surgery. Methods: This narrative review summarizes current evidence regarding perioperative immunonutrition in patients undergoing lung cancer surgery. Relevant studies evaluating perioperative immunonutrition, including formulations enriched with arginine, omega-3 fatty acids, glutamine, and nucleotides, were analyzed. Particular attention was given to clinical studies in thoracic surgical oncology, perioperative outcomes, inflammatory response, and current nutritional guideline recommendations. Results: Available evidence suggests that perioperative immunonutrition may improve nutritional and immunological status in patients undergoing lung cancer surgery. Clinical studies have reported reductions in postoperative complications, shorter chest drainage duration, improved nutritional indices, and decreased inflammatory markers in patients receiving immunonutritional support. Experimental and translational studies also indicate potential beneficial effects on immune cell function and inflammatory regulation. However, current thoracic-specific evidence remains limited because of small study populations, heterogeneity of nutritional protocols, and variability in study design. Conclusions: Perioperative immunonutrition appears to be a promising adjunct to comprehensive perioperative care in patients undergoing lung cancer surgery. Although preliminary evidence suggests potential benefits in postoperative recovery and nutritional optimization, its implementation should be individualized according to the patient’s nutritional status, disease stage, and overall treatment strategy. As immunonutrition modulates metabolic and immune pathways that may also influence tumor biology, nutritional interventions should be evidence-based, carefully monitored, and integrated within multidisciplinary perioperative care to maximize clinical benefits while minimizing potential unintended effects. Further large, well-designed randomized clinical trials are needed to establish standardized protocols and clarify the role of immunonutrition in thoracic surgical oncology. Full article

Background/Objectives. Protein needs increase with aging to support muscle health. These needs are further increased in older adults undergoing surgery, particularly in procedures limiting acute post-operative activity, such as total joint arthroplasty (TJA). However, tools to efficiently characterize dietary protein intake in clinical settings have remained undeveloped. This report describes the initial development and preliminary validation of a novel protein screener (Protein Assessment Screening Tool, PAST) for community-dwelling adults and a clinical population undergoing elective total joint arthroplasty (TJA). Methods. Participants (n = 48; 33 female, 15 male) were aged 40–70 years in the community-dwelling group (n = 22) and aged 50–70 years in the elective TJA group (n = 26). Both groups completed a 3-day food record and the PAST at two timepoints. Descriptive statistics were performed on demographic data. Differences between male and female participants and between groups were determined using independent t-tests or Mann–Whitney U tests as appropriate. The screener and 3-day food records were compared to determine sensitivity, specificity, and negative and positive predictive values (NPVs and PPVs), with a threshold of ≥1.2 g/kg/day representing adequate protein intake. Results. The PAST had relatively high sensitivity (78–87%) and PPVs (68–79%) but lower and more variable specificity (25–57%) and NPVs (33–57%); however, the 95% confidence intervals indicated variability. Conclusions. These preliminary findings demonstrate the potential clinical utility of the PAST. However, additional research is required to validate this tool prior to broad implementation in clinical practice. Full article

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal complication that may develop in term neonates with critical congenital heart disease (CHD), despite the absence of prematurity. We aimed to evaluate the incidence of NEC and identify clinical factors associated with NEC development in term neonates with critical CHD. Methods: This retrospective cohort study included term neonates (≥37 weeks’ gestation) with critical CHD admitted to a tertiary pediatric cardiac intensive care unit between 1 January 2022, and 1 January 2026. NEC was defined as stage IIA or higher according to modified Bell’s criteria. Demographic, clinical, perioperative, and nutritional variables were analyzed. Multivariable logistic regression analysis was performed to identify factors independently associated with NEC development. Results: A total of 780 term neonates with critical CHD were included. NEC developed in 18 infants (2.3%). The median age at NEC diagnosis was 7 days (IQR 5–10), and four patients (22%) required surgical intervention. Seven NEC cases occurred preoperatively, whereas 11 developed after cardiac surgery; among postoperative cases, 64% occurred within the first 72 h after surgery. Birth weight < 2.5 kg (aOR 4.1, 95% CI 1.2–13.4; p = 0.021), gestational age < 38 weeks (aOR 3.9, 95% CI 1.3–12.0; p = 0.018), functional single-ventricle physiology (aOR 5.8, 95% CI 1.6–20.7; p = 0.007), and mechanical ventilation dependency (aOR 5.1, 95% CI 1.7–15.2; p = 0.004) were independently associated with NEC development. Mortality was significantly higher among infants with NEC compared with those without NEC (50% vs. 7.7%, p < 0.001). Conclusions: NEC remains an important complication associated with substantial mortality in term neonates with critical CHD, despite its relatively low incidence. Early-term birth, low birth weight, functional single-ventricle physiology, and dependence on mechanical ventilation were independently associated with increased NEC risk in this vulnerable population. Full article

Background/Objectives: Postoperative pulmonary complications (PPCs) are a major source of morbidity following cardiac surgery, particularly in older adults. While malnutrition is linked to adverse outcomes, the optimal screening tool for identifying patients at risk of PPCs remains uncertain. This study compared the predictive performance of the Geriatric Nutritional Risk Index (GNRI), Mini Nutritional Assessment–Short Form (MNA-SF), Prognostic Nutritional Index (PNI), and Nutrition Alert Form (NAF) for PPCs in older adults undergoing elective cardiac surgery. Methods: This prospective cohort study enrolled 217 patients aged ≥ 60 years at a tertiary university hospital. Preoperative nutritional status was assessed using the GNRI, MNA-SF, PNI, and NAF. The primary outcome was PPC development during hospitalization. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression identified independent predictors. Results: PPCs occurred in 86 patients (39.6%). Patients who developed PPCs had significantly higher NAF scores than those who did not (median [IQR]: 7.5 [3–12] vs. 5 [2–8], p < 0.001), whereas GNRI, MNA-SF, and PNI scores did not differ significantly. NAF demonstrated the highest predictive performance (AUC: 0.643, 95% CI: 0.567–0.719), followed by PNI, MNA-SF, and GNRI. However, after adjusting for clinical covariates, none of the nutritional assessment tools remained independently associated with PPCs. Conclusions: Among the four tools evaluated, NAF showed the highest predictive performance among the evaluated nutritional assessment tools; however, its discriminative ability was modest, and none of the nutritional assessment tools remained independently associated with PPCs after multivariable adjustment. Nutritional assessment should complement, rather than replace, established clinical risk factors in perioperative risk stratification. Full article

Background and Objectives: Malnutrition is highly prevalent among older adults with hip fracture and is associated with poorer surgical outcomes, yet its prognostic relevance is often under-recognized in routine orthopaedic practice. The Controlling Nutritional Status (CONUT) score is an objective laboratory-based screening tool; however, evidence regarding its value for predicting long-term mortality after hip fracture remains limited. This study aimed to evaluate whether nutritional status assessed by the CONUT score independently predicts mortality in older patients with hip fracture. Materials and Methods: This retrospective observational cohort study included consecutive patients aged ≥70 years admitted for hip fracture to a tertiary hospital between 2014 and 2021. Nutritional status was assessed at admission using the CONUT score and categorized as no, mild, moderate, or severe nutritional risk. Demographic characteristics, comorbidity burden, perioperative variables, postoperative morbidity, and mortality up to five years were recorded. Survival was evaluated using Kaplan–Meier methods, and independent predictors of mortality were identified using multivariable Cox proportional hazards models adjusted for clinically relevant confounders. Results: A total of 2798 patients were included (mean age [SD] 84.3 [6.3] years; 26.4% male), of whom 79.2% presented some degree of nutritional risk at admission. Mortality increased overall with worsening nutritional status (p < 0.001). After comprehensive multivariable adjustment, higher CONUT scores remained independently associated with mortality, with each one-point increase associated with an approximately 22% higher risk of long-term death. Poorer nutritional status was also associated with higher postoperative complication rates, greater transfusion requirements, and longer hospital stay. Conclusions: Nutritional status assessed using the CONUT score is an independent predictor of short-, mid-, and long-term mortality in older patients undergoing surgery for hip fracture. Incorporation of objective nutritional screening into orthogeriatric pathways may improve perioperative risk stratification and support targeted multidisciplinary management. Full article