Search Results (2,587)

Cardiac surgery-associated acute kidney injury (CS-AKI) increases short- and long-term mortality, progression to chronic kidney disease (CKD), and healthcare costs. Its pathogenesis is multifactorial—combining renal hypoperfusion, impaired oxygen delivery, hemodilution, inflammation, ischemia–reperfusion injury, and nephrotoxin exposure—so no single intervention confers universal protection. This narrative review appraises fourteen perioperative prevention strategies, grading each by study design, reproducibility, and concordance with contemporary guidelines. The strongest actionable evidence supports the preservation of renal oxygen delivery during cardiopulmonary bypass through goal-directed perfusion, perioperative amino acid infusion, and biomarker-guided Kidney Disease: Improving Global Outcomes (KDIGO) care bundles. Remote ischemic preconditioning, pulsatile flow, minimally invasive extracorporeal circulation, dexmedetomidine, N-acetylcysteine, levosimendan, hemoadsorption with the oXiris membrane, and natriuretic peptides show variable or subgroup-dependent signals limited by heterogeneous trial design and acute kidney injury (AKI) definitions. Prevention of CS-AKI is, therefore, best conceived as a multimodal, patient-centered process integrating preoperative risk stratification, intraoperative oxygen delivery optimization, patient blood management (PBM), and postoperative nephrotoxin avoidance and surveillance. Full article

Objective: We aimed to evaluate whether deep neuromuscular blockade (DNMB) improves surgical conditions and facilitates low-pressure pneumoperitoneum compared with moderate neuromuscular blockade (MNMB) during minimally invasive surgery. Data Sources: PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, Scopus, Web of Science, and LILACS were searched from inception through May 2026. Study Selection: Randomized controlled trials comparing DNMB versus MNMB in adults undergoing laparoscopic or robot-assisted surgery were included. Data Extraction: Two reviewers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane Risk of Bias tool (RoB 2). Certainty of evidence was evaluated using the GRADE approach. Primary Outcomes: Primary outcomes were surgical workspace quality and intra-abdominal pressure requirements. Secondary Outcomes: Secondary outcomes included postoperative abdominal pain at 24 h and referred shoulder pain. Data Synthesis: Seventeen randomized controlled trials involving 1512 patients were included. DNMB consistently improved surgical workspace conditions and facilitated lower pneumoperitoneum pressures compared with MNMB. Pooled analyses additionally suggested reductions in postoperative abdominal pain and referred shoulder pain in selected studies, although postoperative outcomes demonstrated greater heterogeneity across procedures and perioperative protocols. Conclusions: Current evidence suggests that the principal clinical value of DNMB during minimally invasive surgery is optimization of surgical exposure and facilitation of low-pressure pneumoperitoneum strategies. Benefits related to postoperative abdominal pain may occur in selected settings but appear less consistent across procedures. Full article

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article

Cannabis use has increased substantially in the United States, driven by broader legalization, decriminalization, and expanding medical and recreational availability. For facial plastic surgeons, the clinical implications remain difficult to define because “cannabis use” encompasses heterogeneous products and routes, including smoked flower, vaping, concentrates, edibles, pharmaceutical cannabinoids, topical cannabidiol (CBD), and frequent co-use with tobacco or nicotine. Current evidence suggests that systemic cannabis use, particularly inhaled or heavy perioperative use, may be associated with increased surgical complications in selected populations; however, existing studies are limited by retrospective design, inconsistent exposure definitions, inadequate dose and route characterization, and confounding by tobacco use and comorbidities. Cannabinoids exert biologic effects through the endocannabinoid system, particularly CB1 and CB2 receptors, which are expressed in the central nervous system, immune cells, vasculature, and skin. These pathways influence inflammation, keratinocyte proliferation, fibroblast activity, angiogenesis, immune surveillance, pain signaling, and tissue remodeling. The net effect of cannabinoid exposure on wound healing is likely context dependent, varying based on receptor expression, wound-healing phase, route of administration, cannabinoid composition, local tissue environment, and patient-specific risk factors. Preclinical and early dermatologic literature suggests potential therapeutic roles for topical cannabinoids, especially CBD, in modulating inflammation and epithelial repair. In contrast, systemic perioperative cannabis use has been associated in several surgical cohorts with infection, delayed healing, hematoma, nonunion, and reoperation. Evidence specific to facial plastic surgery remains sparse. The most directly relevant study evaluated cannabis and tobacco use in patients undergoing operative mandibular fracture repair. Cannabis-only use was not associated with increased complications, although the cohort was small; concurrent cannabis and tobacco use was associated with higher rates of surgical site infection, facial nonunion, abscess, debridement, and malocclusion. To date, no published studies address cannabis-associated outcomes in rhinoplasty, rhytidectomy, blepharoplasty, browlift, or facial rejuvenation. This review summarizes the biologic rationale, available surgical evidence, and clinical considerations for incorporating cannabis use into individualized perioperative risk assessment in facial plastic surgery. Full article

Background: Robotic liver resections (RLRs) are rapidly expanding, yet the association between the learning curve, procedural complexity, and outcomes at intermediate-volume centers remains poorly defined. We evaluated the learning-curve trajectory and perioperative outcomes of a single surgeon’s initial RLR experience according to procedural complexity (IWATE difficulty score). Methods: We retrospectively analyzed 58 consecutive RLRs at an intermediate-volume center. We stratified outcomes by IWATE difficulty category and chronological tertile (early/middle/late). Textbook outcomes (TOs) and a composite failure endpoint (conversion, major complications [Clavien–Dindo ≥ IIIa] and 90-day mortality) were also assessed. Learning-curve behavior was examined with CUSUM and risk-adjusted CUSUM (RA-CUSUM) analyses. Results: Fifty-four procedures (93.1%) were minor resections and four were major hepatectomies; two were classified as IWATE Expert difficulty. Median estimated blood loss was 100 mL; conversion occurred in 10.3%, overall morbidity in 10.3% and severe complications (Clavien–Dindo ≥ IIIa) in 3.4%, with no mortalities within 90 days. TOs were achieved in 69.0% using the Delphi (TOLS) definition and in 46.6% using a length-of-stay-extended definition. Operative time and length of stay increased significantly with IWATE difficulty (p < 0.001 and p = 0.030), as did the composite failure endpoint (p = 0.039), whereas blood loss and complications did not. TOs decreased with difficulty under the extended definition (p = 0.016). No outcome except estimated blood loss differed across chronological tertiles (p = 0.032). Operative time was associated with the IWATE score (26.3 min per point; R² = 0.32) but not with case order (p = 0.93). CUSUM and RA-CUSUM curves showed a non-linear, multiphase pattern without an identifiable inflection point, with extremes attributable to individual high-complexity procedures. Conclusions: In this exploratory single-surgeon series, consisting predominantly of minor resections, no case-number threshold could be identified, and perioperative outcomes were more closely associated with procedural complexity than with chronological experience, supporting a complexity-adjusted interpretation of RLR outcomes rather than a fixed case-number learning threshold. Full article

Background: Acute subdural hematoma (ASDH) and chronic subdural hematoma (ChSDH) differ substantially in their pathophysiology, clinical course, and outcomes. Matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, have been implicated in blood–brain barrier disruption, extracellular matrix remodeling, and inflammatory processes involved in both traumatic brain injury and ChSDH. However, direct comparisons of perioperative MMP profiles between ASDH and ChSDH and their relationships with clinical characteristics remain limited. The aim of this study was to compare perioperative MMP-2 and MMP-9 concentrations in patients with ASDH and ChSDH and explore their associations with selected clinically relevant parameters. Methods: Thirty patients undergoing surgical treatment for subdural hematoma were prospectively enrolled, including 10 patients with ASDH and 20 with ChSDH. Serum samples were collected before surgery and on postoperative day 3, and hematoma content was obtained intraoperatively. MMP-2 and MMP-9 concentrations were measured using enzyme-linked immunosorbent assay. Results: Patients with ASDH had significantly higher MMP-9 concentrations in hematoma content (p = 0.002) and postoperative serum (p = 0.029) than patients with ChSDH, whereas MMP-2 concentrations did not differ significantly between the groups. In the ChSDH group, both MMP-2 and MMP-9 concentrations were significantly lower in hematoma content than in preoperative and postoperative serum, while no significant perioperative changes were observed in patients with ASDH. Higher MMP-2 concentrations in hematoma content were associated with lower leukocyte counts and smaller midline shift, whereas higher hematoma MMP-9 concentrations were associated with lower APTT and CRP concentrations after FDR correction. These findings suggest distinct perioperative MMP-2 and MMP-9 profiles in acute and chronic subdural hematomas. Conclusions: This study provides a direct comparison of perioperative MMP-2 and MMP-9 profiles in serum and hematoma content between patients with ASDH and ChSDH while also exploring their associations with selected clinically relevant parameters. Full article

Objective: Open surgical repair (OSR) remains an important treatment for abdominal aortic aneurysm (AAA), but its invasiveness contributes to substantial perioperative risk. Although Enhanced Recovery After Surgery (ERAS) pathways have improved outcomes across several surgical specialties, evidence supporting their use in open aortic surgery, particularly in Chinese clinical settings, remains limited. We, therefore, evaluated the association between adherence to a locally adapted ERAS pathway and early perioperative outcomes after elective OSR for AAA. Methods: This single-center retrospective cohort study included 182 patients who underwent elective OSR for AAA. Patients who received at least 70% of the 30 ERAS elements were assigned to the ERAS group (n = 93), whereas those who received less than 70% were assigned to the control group (n = 89). A total of 152 patients remained after 1:1 matching of the two groups using propensity score. Quantile regression and logistic regression models were used to evaluate the impact of the ERAS protocol on postoperative length of stay, 30-day mortality, ICU admission rate, hospital cost, major complications, and readmission. Results: After matching, baseline and aneurysm characteristics were generally comparable between groups. The ERAS group demonstrated a significantly reduced risk of major complications (OR = 0.33; 95% CI 0.16–0.71; p = 0.004) and postoperative nausea and vomiting (OR = 0.10; 95% CI 0.01–0.80; p = 0.030). The time to postoperative bowel movement was 1 day earlier in the ERAS group (p < 0.001). The incidence of postoperative cardiac complications was significantly lower in the ERAS group (2.6% vs. 11.8%; p = 0.028). Pulmonary complications were also markedly reduced in the ERAS group (1.3% vs. 19.7%; p < 0.001). The ERAS group was associated with a reduction in postoperative length of hospital stay by 2 days (p < 0.001) and a decrease in hospital cost by 8065 RMB (p < 0.001). Conclusions: Higher adherence to a locally adapted ERAS pathway was associated with fewer major complications, faster bowel recovery, shorter postoperative hospitalization, and lower hospital costs after elective open AAA repair. These findings support prospective multicenter evaluation and further context-specific implementation of ERAS in open aortic surgery. Full article

Objective: To investigate the impact of asymptomatic high-risk status for ischemic stroke on patients with abdominal aortic aneurysm undergoing endovascular aortic repair (EVAR). Methods: Eligible patients with abdominal aortic aneurysm who underwent EVAR between January 2011 and December 2021 were enrolled in this retrospective cohort study. Propensity score matching (PSM) was used to balance baseline characteristics between the cerebrovascular high-risk group and the standard control group. The impact of cerebrovascular high-risk status on short- and long-term outcomes was assessed using Cox proportional hazards regression and generalized linear models, with results presented as hazard ratios (HRs), odds ratios (ORs), and corresponding 95% confidence intervals (CIs). Results: A total of 1080 patients were included (299 high-risk, 781 standard). During the 13-year follow-up period, ischemic stroke occurred in 45 patients (15.1%) in the high-risk group (HR, 7.01; 95% CI, 4.11–11.94; p < 0.001). The high-risk group also had a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs), which occurred in 129 patients (43.1%) (HR, 1.78; 95% CI, 1.43–2.24; p < 0.001). These findings remained consistent across inverse probability of treatment weighting (IPTW) and propensity score matching combined with multivariable generalized linear model (PSM+MVA-GLM) analyses. Conclusions: Although no significant increase in perioperative cerebrovascular adverse events was observed in asymptomatic patients with a preoperative cerebrovascular high-risk status, their worse long-term prognosis appears to be associated with this risk status. This association highlights the need for rigorous cardiovascular and cerebrovascular risk management in this vulnerable population after surgery. Full article

Background: Neoadjuvant chemoimmunotherapy has emerged as a standard option for resectable stage II–III non-small cell lung cancer (NSCLC); however, its impact on surgical feasibility, operative complexity, and perioperative outcomes remains incompletely characterized. We compared surgical feasibility, complexity, and perioperative outcomes across different neoadjuvant strategies. Methods: This single-center retrospective study included patients with stage II–III NSCLC who underwent curative-intent resection following neoadjuvant chemoimmunotherapy (neo-CIT), chemotherapy alone (neo-CT), or chemoradiotherapy (neo-CRT) during the same period. Surgical complexity was assessed using a four-level empirical grading scale. Perioperative outcomes, pathological response, and complications were compared among treatment groups using appropriate nonparametric statistical methods. Results: Twenty-four patients were included in the analysis (neo-CIT, n = 8; neo-CT, n = 12; neo-CRT, n = 4). R0 resection was achieved in 100%, 66.7%, and 75% of patients in the neo-CIT, neo-CT, and neo-CRT groups, respectively. Operative time, estimated blood loss, length of hospital stay, and overall postoperative complication rates did not differ significantly among groups. Thirty-day mortality was 0% in all groups, and 90-day mortality was 12.5% in the neo-CIT group and 0% in the neo-CT and neo-CRT groups. Surgical complexity scores were high across all cohorts and, when analyzed across the entire cohort, were not significantly associated with longer operative time (p = 0.16), greater blood loss (p = 0.83), or pathological response (p = 0.55). Neo-CIT was not associated with increased objective perioperative risk compared with neoadjuvant chemotherapy or chemoradiotherapy. Conclusions: In this single-institution exploratory analysis, neoadjuvant chemoimmunotherapy appeared to be surgically feasible and did not result in an apparent increase in perioperative risk compared with other neoadjuvant strategies. Although surgeons perceived increased operative complexity, objective perioperative risk remained acceptable when procedures were performed by experienced thoracic surgeons. However, given the limited sample size and lack of statistical power, these findings should be interpreted with caution and should not be considered evidence of equivalence. Full article

Background: Intersphincteric resection (ISR) is a technically demanding sphincter-preserving procedure for low rectal cancer. While robotic surgery may offer technical advantages, evidence comparing robotic ISR (R-ISR) and laparoscopic ISR (L-ISR) remains limited. This study aimed to compare perioperative, oncologic, and functional outcomes between R-ISR and L-ISR. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. PubMed, Scopus, and Cochrane Library were searched up to 1 March 2026. Comparative studies evaluating R-ISR versus L-ISR in adult patients with low rectal cancer were included. Random-effects models were used to calculate mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I². Subgroup and sensitivity analyses were performed. Results: Seven studies were included. R-ISR was associated with a significantly longer operative duration (MD 34.53 min, 95% CI 7.48 to 61.59; p = 0.02; I² = 81%), a lower rate of overall complications (OR 0.78, 95% CI 0.61 to 0.99; p = 0.04; I² = 0%), a statistically lower Wexner score at 12 months, although the magnitude of the difference was small and its clinical significance uncertain (MD −1.53, 95% CI −2.54 to −0.51; p = 0.02; I² = 0%), and a slightly lower lymph node yield (MD −1.06, 95% CI −2.05 to −0.08; p = 0.04; I² = 65%). No significant differences were observed in blood loss (MD −8.15, 95% CI −23.03 to 6.73; p = 0.20; I² = 37%), conversion to open surgery (OR 0.35, 95% CI 0.02 to 6.02; p = 0.13; I² = 0%), anastomotic leakage (OR 0.92, 95% CI 0.61 to 1.37; p = 0.60; I² = 0%), length of hospital stay (MD −0.48, 95% CI −1.16 to 0.21; p = 0.12; I² = 0%), and CRM positivity (OR 0.93, 95% CI 0.01 to 69.04; p = 0.87; I² = 0%). Subgroup analyses in experienced surgeons and high-volume centers demonstrated no statistically significant differences across outcomes. Sensitivity analyses showed that several results were not robust. Conclusions: Evidence to date does not show superiority of robotic or laparoscopic ISR. Robotic ISR was associated with longer operative time and lower overall complication rates but most perioperative and oncologic outcomes were comparable. After robotic ISR, the 12-month Wexner scores were statistically lower, although the magnitude of this difference was small and the clinical significance uncertain. These results should be interpreted with caution given the limited non-randomized evidence base. PROSPERO Registration: CRD420261359130. Full article

Background and Objectives: Evidence regarding predictors of pathological response and long-term outcomes in older patients receiving perioperative FLOT chemotherapy for resectable gastric or gastroesophageal junction cancer remains limited. We aimed to identify factors associated with pathological response and survival in patients aged ≥65 years treated with neoadjuvant FLOT. Materials and Methods: This retrospective single-center study included 86 consecutive patients (median age, 69 years; 72.1% male) aged ≥65 years with resectable gastric or gastroesophageal junction adenocarcinoma who underwent neoadjuvant FLOT chemotherapy followed by curative-intent gastrectomy. Major pathological response was defined as College of American Pathologists tumor regression grade (CAP TRG) 0–1. Logistic regression analyses were performed to identify predictors of pathological response. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox proportional hazards regression analyses. Results: Overall, 14 patients (16.3%) achieved a major pathological response. Body mass index (BMI) ≥ 25 kg/m² (OR 5.13, p = 0.04) was independently associated with a major pathological response. During a median follow-up of 29.2 months, 39 patients (45.3%) developed recurrence and 35 (40.7%) died. ECOG performance status (ECOG PS) ≥ 1 was independently associated with both inferior DFS (HR = 2.76, p = 0.02) and OS (HR = 2.52, p = 0.045). In addition, ypN stage 2–3 (HR = 2.58, p = 0.008) was independently associated with worse DFS, whereas positive surgical margins were independently associated with worse OS (HR = 2.62, p = 0.02). Conclusions: In older patients with resectable gastric or gastroesophageal junction adenocarcinoma treated with perioperative FLOT chemotherapy, baseline BMI was independently associated with major pathological response, whereas ECOG PS and postoperative pathological factors were independently associated with survival. These findings highlight the importance of careful patient selection and individualized multimodal treatment in this population. Full article

Background: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. Results: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0–167.5] μg vs. 280.0 [IQR, 192.5–327.5] μg; p < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. Conclusions: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity. Full article

The surgical management of rectal cancer has evolved from open resection to laparoscopic and, more recently, robotic minimally invasive approaches. Laparoscopy established the short-term benefits of minimally invasive rectal surgery but is limited within the confines of the bony pelvis, prompting adoption of the robotic platform with its three-dimensional visualization, wristed instruments, and tremor filtration. Whether these refinements translate into measurable clinical benefit remains debated. This narrative review compares the two approaches across oncologic, perioperative, functional, and economic domains. Pathologic outcomes are broadly equivalent, though contemporary evidence—most notably the REAL trial—suggests a possible emerging robotic advantage, although further study is necessary in this regard. Robotic surgery offers potential advantages in conversion rates, blood loss, and postoperative urinary and sexual function, while laparoscopy retains advantages in operative time and cost. At present, platform choice should be guided by patient anatomy, tumor characteristics, and surgical expertise, with robotic surgery likely most valuable in anatomically challenging cases where laparoscopy is most limited. Full article

Background: Postoperative admission to critical care facilities is frequently employed following complex abdominal and gynecologic oncology surgery; however, the clinical value of routine short-stay (≤24 h) high-acuity care remains uncertain as the existing evidence is limited, heterogeneous and derived primarily from non-randomized studies. Consequently, the present critical narrative review aims to discuss the rationale for planned short-duration postoperative high-acuity care, summarize the contemporary evidence, and identify priorities for future research. Methods: Relevant studies evaluating planned postoperative admission to critical care facilities for ≤24 h following major abdominal surgery were identified through a targeted review of contemporary literature using a structured search of MEDLINE, Scopus, Google Scholar, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Evidence from observational studies investigating intensive care units, high-dependency units, post-anesthesia care units, and advanced recovery pathways was critically synthesized, with particular attention to clinical outcomes, healthcare utilization, and current knowledge gaps. Results: Nine primary studies were included, predominantly observational in design, with the majority lacking a comparative study design, thereby limiting direct evaluation of the clinical effectiveness of planned short-stay postoperative high-acuity care. None of the studies were designed to evaluate a gynecologic oncology population, limiting the direct applicability of the available evidence to this setting. As such, the current evidence is better suited to critical clinical interpretation of the rationale, patient selection, and potential role of postoperative high-acuity care than to drawing definitive conclusions regarding intervention effectiveness. Overall, the available data suggest that planned short-stay high-acuity postoperative care is not consistently associated with reductions in postoperative mortality or overall morbidity but may decrease unplanned intensive care unit admissions in selected patient populations. Most studies reported little or no effect on overall hospital length of stay, whereas increased healthcare costs were primarily observed in capacity-driven or unplanned postoperative critical care pathways. Interpretation of the available literature remains limited by the predominance of observational studies, heterogeneous patient populations, variability in critical care models, and inconsistent outcome reporting. Conclusions: Current evidence does not support routine postoperative admission to critical care facilities following major abdominal surgery, while evidence specifically addressing gynecologic oncology remains insufficient to establish specialty-specific effectiveness. However, planned, time-limited high-acuity postoperative care was not associated with an observed increase in adverse clinical outcomes in the available observational studies and may offer clinical and system-level benefits in selected high-risk patients; these findings should be interpreted cautiously given the limitations of the available evidence. Prospective studies with standardized outcome reporting and clearly defined populations are needed to inform evidence-based perioperative care strategies. Full article

Background: Trigeminal neuralgia is a chronic neuropathic pain disorder characterized by severe recurrent facial pain and substantial impairment in quality of life. Although microvascular decompression (MVD) is an established surgical treatment for medically refractory cases, routine clinical data integrating clinical characteristics, previous interventional treatment history, and early postoperative outcomes remain limited. This study aimed to describe the clinical profile and early postoperative outcomes of patients undergoing MVD for trigeminal neuralgia in a single-center retrospective cohort. Methods: This single-center, single-surgeon retrospective cohort study included 62 adult patients who underwent MVD at Pamukkale University Hospitals between 4 September 2019 and 9 July 2026. Demographic and clinical characteristics, previous interventional procedures, trigeminal nerve division involvement, vascular compression status, surgical opening approach, postoperative Barrow Neurological Institute (BNI) pain intensity scores, visual analog scale (VAS) pain scores, wound-related complications, and exploratory perioperative inflammatory markers were retrospectively collected. Favorable postoperative outcome was defined as BNI Grade I–II. Results: The mean age was 51.9 ± 12.8 years, 66.1% were female, and vascular compression was identified in 87.1%. A previous interventional procedure was documented in 35.5%. Favorable BNI outcomes occurred in 74.2% (95% CI, 62.1–83.4%), and complete pain relief (VAS = 0) in 88.7% (95% CI, 78.5–94.4%). Wound-related complications occurred in 9.7%. No evaluated baseline characteristic was significantly associated with either pain outcome. Paired analyses showed no significant perioperative change in CRP (p = 0.353), whereas NLR increased significantly (p = 0.001). Conclusions: MVD was associated with favorable early postoperative pain outcomes in most patients. However, the retrospective design, modest sample size, and symptom-driven longer-term follow-up limit conclusions regarding prognostic determinants and durability of pain relief. Full article