Search Results (1,431)

Background: Tranexamic acid (TXA) is increasingly used to reduce perioperative blood loss during scoliosis surgery; however, its effectiveness in pediatric patients with non-idiopathic scoliosis remains underexplored. Unlike adolescent idiopathic scoliosis, non-idiopathic scoliosis is frequently associated with neuromuscular, syndromic, or other underlying disorders that increase surgical complexity and may limit the generalizability of evidence from idiopathic populations. This systematic review and meta-analysis evaluated the impact of TXA on surgical outcomes in pediatric patients undergoing posterior spinal fusion for non-idiopathic scoliosis. Methods: This analysis encompassed five studies (comprising one randomized controlled trial and four observational studies) involving a total of 230 patients (TXA group: 98; control group: 132). The primary outcomes were estimated blood loss and the volume of packed red blood cells (PRBCs) transfused. Secondary outcomes included total transfusion amount, operation duration, complications, cell salvage application, preoperative hematocrit levels and blood loss percentage. A random-effects model was used. Mean difference (MD) was used for continuous outcomes, and odds ratio (OR) for dichotomous variables, both with 95% confidence intervals (CIs). Results: The use of TXA during posterior fusion surgery showed to be of benefit and was associated with significantly less estimated blood loss (p < 0.0001) and cell salvage volume transfusion (p < 0.0001). The remaining secondary outcomes did not show significant differences when compared with the control. Conclusion: Current evidence suggests that TXA is an effective blood conservation strategy in pediatric patients undergoing posterior spinal fusion for non-idiopathic scoliosis. However, the available evidence remains limited, particularly regarding perioperative complications, and further high-quality prospective studies are required to strengthen the evidence base. Clinical relevance: Exploring the use of TXA in scoliosis surgery has the potential to influence the standard of care, especially if associated with significantly more desirable post-operative and long-term outcomes. Full article

Background: Greater familiarity between surgeons and anaesthetists is associated with better teamwork and patient safety. We investigated whether the volume of major UGI cancer resections the same surgeon and anaesthetist perform together influences post-operative outcomes at our tertiary specialist cancer centre. Methods: A 10-year retrospective cohort study was conducted via propensity score matching analysis (PSM). Consecutive adults undergoing elective surgical resection for primary UGI carcinoma and colorectal liver metastases from January 2014 to December 2024 were included. Cases were performed by surgeon–anaesthetist dyads composed of five Consultant Surgeons and 34 Consultant Anaesthetists. The primary Consultant Surgeon and Consultant Anaesthetist, the Charlson co-morbidity (CCM) score, and Clavien–Dindo (CD) complications were recorded. Cases were matched for age and CCM score. Results: A total of n = 792 cases were included, which became n = 546 after PSM. The median number of cases performed per dyad was 23, and the median CCM score = 5. Dyads were stratified into high (≥23 cases/dyad) and low volume (<23 cases/dyad), and cases into high (CCM ≥ 5) and low risk (CCM < 5). High-volume dyads had a lower incidence of post-operative complications when adjusted for PSM (35.2%) compared to low-volume dyads (42.8%) (p = 0.829). Probability of CD grade III complications among low-volume dyads increased with a rise in CCM (p = 0.224), but not in high-volume dyads. Conclusions: Greater familiarity between surgeons and anaesthetists may develop by operating on more cases together. This study has highlighted a trend suggesting that high-volume dyads could safely perform UGI resections on higher-risk cases without significant increases in post-operative complications. Dyad volume should be considered in operative scheduling for UGI cancer surgery. Full article

Background and Objectives: Following the removal of the uterus, due to prolapse or other indications, disruption of the apical support structures may result in descent of the vaginal apex. As the condition progresses, the cystocele, rectocele, and/or enterocele are formed, finally creating a complex vaginal eversion that generally requires surgical multi-compartmental repair. This review aimed to provide a comprehensive overview of cur-rent surgical modalities for post-hysterectomy vaginal vault prolapse, which could sup-port personalized treatment. Materials and Methods: MEDLINE, Scopus and Google Scholar databases were searched to retrieve freely available manuscripts published in English language since the year 2000. Results: Surgical correction remains the basis of management for symptomatic post-hysterectomy vaginal vault prolapse. The primary objective of treatment is restoration of robust apical support, normalization of vaginal axis, preservation of sexual and urinary function along with minimization of operative complications and recurrence. Several reconstructive approaches have been established as safe and comparatively reliable. They are classified into native tissue vaginal repairs (sacrospinous ligament fixation, uterosacral ligament suspension), abdominal or minimally invasive sacro-colpopexy, mesh-augmented techniques, and obliterative procedures. No single surgical approach appears universally superior across anatomical, functional, and safety outcomes, and procedure selection should therefore be individualized according to patient characteristics, treatment priorities, and surgeon expertise. Consequently, procedure selection should be individualized according to patient characteristics and surgeon expertise. Conclusions: Post-hysterectomy vaginal vault prolapse remains a complex and clinically significant condition. Current evidence supports the central importance of apical suspension during all hysterectomies. Optimal treatment outcomes are achieved through patient-centered decision-making that balances durability, safety, functional recovery, and individual expectations. Full article

Endovascular aneurysm repair (EVAR) has become a widely adopted treatment for abdominal aortic aneurysms, offering lower perioperative morbidity and mortality than open surgical repair. Nevertheless, long-term imaging surveillance remains essential because procedure-related complications may occur years after treatment. Among these, endoleaks represent the most frequent and clinically relevant finding, particularly Type II endoleaks, which are sustained by retrograde collateral perfusion and may be associated with persistent aneurysm sac filling and sac enlargement. Computed tomography angiography (CTA) remains the reference standard for anatomical assessment after EVAR, providing detailed evaluation of endograft integrity, aneurysm sac morphology, and vascular anatomy. However, repeated CTA examinations involve cumulative radiation exposure and iodinated contrast administration and may be limited in the detection of low-flow or intermittent endoleaks. Contrast-enhanced ultrasound (CEUS) provides real-time hemodynamic assessment, improves detection of slow-flow endoleaks, and avoids both ionizing radiation and nephrotoxic contrast agents. Nevertheless, CEUS may be affected by operator dependency and limited anatomical overview. CT–ultrasound fusion imaging combines pre-acquired CTA datasets with real-time ultrasound through spatial co-registration and probe tracking, enabling simultaneous evaluation of vascular anatomy and flow dynamics. This narrative review critically synthesizes current evidence regarding CTA, CEUS, and CT–ultrasound fusion imaging in post-EVAR surveillance, with particular emphasis on the incremental clinical value of fusion imaging beyond standalone CTA and CEUS. Particular attention is devoted to diagnostic performance, technical implementation, clinical applicability, current limitations, and future perspectives of CT–CEUS fusion imaging. Full article

Background and Aims: Benign hepaticojejunostomy stricture (HJS) remains a challenging long-term complication after major hepatobiliary surgery. Although advanced endoscopic and interventional modalities have improved clinical outcomes, successful management is heavily constrained by anastomotic accessibility, particularly in altered post-hepatectomy anatomy. This review evaluates the clinical burden and anatomical barriers of conventional Roux-en-Y reconstruction and introduces “future-proof” biliary reconstruction strategies aimed at preserving lifelong therapeutic access. Methods: A comprehensive literature review was conducted to synthesize current evidence regarding the epidemiology, risk factors, and clinical consequences of benign HJS. We analyzed the technical limitations of contemporary interventions and critically reviewed the historical evolution of access-oriented surgical modifications, including access loops and modified enteric configurations. This narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science for studies published between January 2000 and March 2026. Search terms included “hepaticojejunostomy”, “benign hepaticojejunostomy stricture”, “Roux-en-Y”, “balloon enteroscopy”, “EUS-guided biliary drainage”, “PTBD”, “access loop”, “jejunoduodenostomy”, and “biliary reconstruction”. Original articles, systematic reviews, meta-analyses, and relevant guideline papers published in English were included. Conference abstracts, editorials, and articles lacking sufficient clinical information were excluded. Results: Anatomical factors—such as excessive Roux limb length ($ > $50–70 cm), dense postoperative adhesions, sharp intestinal angulations, and complex multi-ductal hilar reconstructions—represent the primary drivers of endoscopic failure. Conventional reactive approaches address these barriers only after complications manifest, severely impacting patient quality of life and increasing healthcare utilization. Conversely, access-oriented strategies proactively incorporate long-term accessibility into initial operative planning. Specifically, Future Access Biliary Reconstruction (FABR)—utilizing a side-to-side jejunoduodenostomy between the elevated jejunal limb and the second portion of the duodenum—creates a direct, permanent route to the biliary limb, permitting rapid and reliable intervention via standard upper gastrointestinal endoscopy without compromising the primary hepaticojejunostomy. Conclusions: Future-proof biliary reconstruction represents a pivotal paradigm shift in hepatobiliary surgery, transitioning from purely functional restoration to proactive, lifelong disease management. Incorporating FABR during the index operation may eliminate anatomical barriers before they arise, potentially reducing reliance on invasive percutaneous interventions or high-risk surgical revisions. Prospective multicenter studies are warranted to validate its long-term safety, clinical efficacy, and optimal selection criteria. Full article

Background/Objectives: Postoperative pain is one of the most frequently reported complications following endodontic treatment. Bioceramic sealers have gained widespread clinical acceptance. However, comparative clinical data on postoperative pain between specific bioceramic sealers remains limited. This double-blind randomized clinical pilot trial aimed to evaluate and compare the incidence and intensity of postoperative pain following root canal obturation using two bioceramic sealers—Bio-C Sealer (Angelus, Brazil) and TotalFill BC Sealer (FKG Dentaire, Switzerland)—over a seven-day follow-up period. Methods: A total of 30 patients requiring non-surgical root canal treatment were recruited from the dental clinics at Al-Baha University, Saudi Arabia, and randomly allocated into two equal groups (n = 15 per group). All root canals were prepared and then obturated using the tested sealers with the single-cone technique. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 24 h, 48 h, 72 h, and 7 days post-treatment. Statistical analysis was performed using Fisher’s exact test, Chi-square tests, and the independent t-test, with a significance threshold set at p < 0.05. Results: At 24 h, postoperative pain was reported by 33.3% of patients in the Bio-C Sealer group and 26.7% in the TotalFill BC Sealer group, with no statistically significant difference (p = 1.000). By 48 h, all patients in the TotalFill BC Sealer group were completely asymptomatic, whereas 13.3% of patients in the Bio-C Sealer group continued to report pain (p = 0.483). No significant associations were identified between postoperative pain and gender, tooth type, sealer extrusion, or preoperative pain status in either group (p > 0.05). Conclusions: Within the limitations of this randomized clinical pilot trial, the preliminary data suggest similar short-term clinical performance between Bio-C Sealer and TotalFill BC Sealer in terms of both the incidence and intensity of postoperative pain following non-surgical root canal treatment. Full article

Post-infarction left ventricular aneurysm is an uncommon but severe mechanical complication of transmural myocardial infarction, particularly in patients with delayed presentation or incomplete myocardial salvage. It may lead to profound distortion of left ventricular geometry, adverse remodelling, intraventricular thrombosis, mitral regurgitation, pulmonary hypertension, and advanced heart failure. We report the case of a 65-year-old male patient referred two months after a late-presenting anterior ST-segment elevation myocardial infarction caused by proximal occlusion of the left anterior descending coronary artery. At admission, the patient presented with severe decompensated heart failure, low-output status, multiorgan dysfunction, and a left ventricular ejection fraction of 12%. Transthoracic echocardiography and cardiac magnetic resonance imaging demonstrated a giant apical left ventricular aneurysm involving approximately 75% of the ventricular cavity, partial intraluminal thrombosis, extensive transmural scarring in the left anterior descending territory, and imaging features suggestive of a chronic contained free-wall rupture/pseudoaneurysmal component. Following multidisciplinary evaluation, the patient underwent surgical ventricular reconstruction using an endoventricular circular restoration technique guided by an intraventricular balloon sizer, combined with left internal thoracic artery bypass grafting to the left anterior descending artery. The early postoperative course required temporary inotropic, vasopressor, inhaled nitric oxide, and intra-aortic balloon pump support, followed by progressive haemodynamic recovery. The patient was discharged on postoperative day seven with functional improvement to NYHA class II. At six-month follow-up, he remained clinically stable without overt signs of heart failure, and echocardiography showed preserved ventricular geometry and improvement of left ventricular ejection fraction to 45%. This case highlights the potential role of carefully planned, balloon-guided surgical ventricular reconstruction in selected patients with giant post-infarction left ventricular aneurysms and end-stage heart failure when residual viable myocardium is present. Full article

Background: Septic arthritis (SA) is a serious and rapidly progressive condition that can result in significant morbidity and mortality. Current clinical guidelines endorse a combination of surgical debridement and targeted antibiotic therapy as the gold standard treatment for adults with knee SA. Despite the effectiveness of this approach, patients often experience prolonged inflammation, leading to long-term complications such as cartilage degeneration and chronic pain. Since inflammatory cytokines contribute to cartilage destruction, it is considered to be possible that mitigating their levels through the use of steroids could potentially prevent cartilage damage. Methods: This study is designed as a multicenter, open-label, randomized controlled trial aimed at evaluating the efficacy of intravenous dexamethasone as an adjunctive therapy for adults diagnosed with knee joint SA. Participants aged 18 years and older will be randomized to receive either standard treatment (surgical debridement and antibiotics) or the same regimen with the addition of dexamethasone. The primary objective is to assess pain reduction at four days post-surgery using the EQ-VAS scale and knee joint effusion, while secondary objectives will include the evaluation of additional surgical interventions, pain control over time, joint function, normalization of inflammatory markers, and overall healthcare resource utilization. Discussion: While corticosteroids have demonstrated efficacy in pediatric populations with septic arthritis, the evidence for their use in adults remains limited. This trial aims to ascertain whether the anti-inflammatory effects of corticosteroids can mitigate complications and enhance clinical outcomes in adult patients with SA. The findings from this study could provide critical insights into optimizing treatment strategies for this complex condition, ultimately improving patient quality of life. Full article

Background: Robotic-assisted spinal instrumentation is increasingly used to support implant placement, reduce radiation exposure, and improve operative workflow. However, UK NHS data describing early programme experience across elective and emergency practice remain limited. This study aimed to evaluate the feasibility, safety profile, and early learning curve of robotic-assisted spinal instrumentation in an unselected UK NHS cohort. Methods: A retrospective, single-centre, single-arm observational cohort study was conducted, including the first 50 consecutive patients treated from programme inception between June 2024 and January 2026. No exclusion criteria were applied, and each record represented one patient and one operation. Missing data were not imputed, and denominators were reported per variable. Learning curve effects were assessed using Spearman correlation and cumulative sum analysis. Wilson 95% confidence intervals were reported for complication rates. Results: The mean age was 61.9 years; 50% were male; mean body mass index was 29.0; and median Charlson Comorbidity Index was 3. Indications were degenerative disease in 74%, trauma in 24%, and deformity in 2%. Emergency admissions accounted for 18/50 cases. Robot-specific adverse events included abandonment or conversion in 2/50 cases and system malfunction in 1/50. Surgical complications occurred in 7/50 patients. On surgeon-reviewed routine post-operative imaging, no screw malpositions required revision and no durotomies or vascular injuries were recorded; this represents a clinical revision rate rather than a formal radiological measure of screw accuracy, for which blinded Gertzbein–Robbins grading was not performed. Cumulative sum analysis suggested a potential fluoroscopy change point around case 30, with the median fluoroscopy events falling from 151 to 16 thereafter. Emergency cases involved more instrumented levels, longer operative times, and more open surgery than elective cases. Conclusions: Robotic-assisted spinal instrumentation was feasible across a diverse UK NHS caseload from C1 to S2, with a low observed complication rate. The findings suggest a fluoroscopy learning curve threshold around case 30. Larger comparative studies with formal radiological accuracy assessment are required. Full article

Background and Objectives: Conversion therapy has expanded treatment options for patients with initially unresectable hepatocellular carcinoma (HCC), but the surgical literature remains focused more often on radiologic response than on the pathological, perioperative, and postoperative outcomes of patients who actually proceed to hepatectomy. This focused systematic review aimed to synthesize the available evidence on conversion hepatectomy after contemporary combination downstaging for initially unresectable HCC. Materials and Methods: A structured PubMed/MEDLINE search with backward reference-list screening was performed and last updated on 3 February 2026. The full Boolean strategy, field tags, and eligibility framework are now reported explicitly. Because the literature was observational and clinically heterogeneous, findings were synthesized narratively and complemented by structured assessments of reporting completeness, potential cohort overlap, and study-level bias. Results: Fourteen studies were included, nearly all retrospective and predominantly from East Asia. Treatment platforms clustered into systemic doublets, systemic plus HAIC strategies, and broader locoregional–systemic triplet or multimodal approaches. Across studies reporting pathological response, pathological complete response ranged from 28.0% to 50.0%, while R0 resection ranged from 85.7% to 100%, where stated. Postoperative morbidity ranged from 14.3% to 71.4%, and major complication rates from 9.5% to 16.9%; however, extent of resection, liver reserve, post-hepatectomy liver failure, transfusion, and perioperative mortality were not uniformly reported. Most studies carried moderate-to-high overall concerns for bias because of response-based surgical selection, heterogeneous denominators, incomplete perioperative reporting, and possible partial overlap among some cohorts. Conclusions: The available literature suggests that conversion hepatectomy can be feasible and oncologically meaningful in carefully selected patients treated in experienced centers, but current evidence remains hypothesis-generating rather than practice-standardizing because it is observational, heterogeneous, and incompletely reported. Full article

Objective: Airway emergencies in patients with tracheostomies are life-threatening and may arise from tube obstruction, bleeding, or accidental decannulation owing to improper handling. We describe our institutional experience with measures to prevent accidental decannulation-related emergencies, including the inferior-based tracheal flap technique combined with peri-operative care bundles and its impact on reducing accidental decannulation-related morbidity and mortality. Methods: A retrospective review was conducted on 1485 patients who underwent open tracheostomy at Ajou University Hospital between January 2011 and February 2026. In 2015, a standardized institutional protocol, incorporating the inferior-based tracheal flap as the primary incision technique and a peri-operative care bundle, was introduced following a root-cause analysis. The cohort was divided into pre-protocol (2011–2014; n = 179) and post-protocol (2015–2026; n = 1306) periods, and a long-term-followable analytic subset (Björk flap n = 363; conventional vertical-incision n = 61) was used for per-outcome comparison. These data were integrated with prior comparative studies from the literature in a random-effects meta-analysis; six literature studies plus the institutional cohort were included in the qualitative synthesis, and those with extractable arm-specific event data contributed to the quantitative synthesis. Risk of bias was assessed with ROBINS-I and the Newcastle–Ottawa Scale, and the certainty of evidence was rated using GRADE. Pre-specified sensitivity analyses, including the Hartung–Knapp–Sidik–Jonkman adjustment, were performed. All analyses were performed in R using the metafor package. Results: Pre-protocol, accidental decannulation-related emergencies occurred one to two times per year, including at least one fatal event; post-protocol, only a single event occurred over 12 years, with no associated mortality. In the analytic subset, accidental decannulation occurred in 1/363 Björk patients (0.28%) versus 3/61 conventional patients (4.92%; odds ratio [OR] 0.05, 95% confidence interval [CI] 0.01–0.52). All six pooled meta-analytic domains were directionally favorable to the Björk flap. The primary outcome (accidental decannulation/tube displacement) did not reach statistical significance in the main analysis (pooled OR 0.44, 95% CI 0.03–5.86, p = 0.531, I² = 77%, k = 3). A pre-specified sensitivity analysis excluding İnan 2025 (the heterogeneity-driving outlier) yielded an OR of 0.12 (95% CI 0.02–0.70, p = 0.019, I² = 9%, k = 2); this result is exploratory and hypothesis-generating. Secondary outcomes, including stomal infection (OR 0.26), granulation (OR 0.15), tube blockage (OR 0.21), subcutaneous emphysema (OR 0.38), and bleeding (OR 0.59), all directionally favored the Björk flap. No tracheal stenosis or decannulation failure occurred in either arm of our cohort. Under GRADE, the certainty of evidence was very low for the primary outcome and low for the secondary outcomes. Conclusions: A standardized institutional safety bundle centered on the inferior-based tracheal flap was associated with a low rate of accidental decannulation-related emergencies and no related mortality over a 12-year post-implementation period; because the flap was introduced together with concurrent peri-operative and nursing changes, its independent contribution cannot be isolated. Meta-analytic synthesis showed directionally favorable effects across all complication domains, although the primary outcome reached significance only in an exploratory sensitivity analysis and the overall certainty of evidence was low to very low. These findings are hypothesis-generating and support the inferior-based tracheal flap as a reasonable option within a structured safety bundle for elective surgical tracheostomy, particularly in patients at higher risk for accidental decannulation; prospective comparative studies are warranted. Full article

Background/Objectives: This study aims to analyze safety and effectiveness of imipenem/cilastatin sodium (IPM/CS) as an off-label embolic agent in acute lower gastrointestinal bleeding (LGIB). Methods: This is a multicentric prospective study including patients treated in emergency with endovascular embolization for acute LGIB. IPM/CS particles were prepared using one vial containing 500 mg/500 mg of IPM/CS in powder diluted with 5 mL of pure iodine contrast agent. Inclusion criteria were: acute bleeding managed with IMP/CS embolization, unfeasible/ineffective endoscopic management, availability of a pre-procedural contrast-enhanced Computed Tomography (CT) scan, pre- and post-procedural blood count, pre- and post-procedural hemodynamic balance evaluation, and follow-up to 30 days. Exclusion criteria were: patients treated in elective conditions, LGIB embolization performed without IMP/CS, IMP/CS adoption after other embolics, incomplete clinical–laboratoristic follow-up, and age < 18 years. Technical success was intended as angiographic disappearance of extravasation or significant reduction/stasis of blood flow to the target; clinical success was considered as hemoglobin values increase and/or stop transfusions and/or hemodynamic restoration. Result: Twenty-one patients were enrolled; bleeding etiologies included angiodysplasia, diverticular disease, gastrointestinal tumor-related bleeding, and post-surgical hemorrhage. Technical success rate was 100%, and clinical success rate at 30 days was 85.7%. Rebleeding occurred in three patients: two managed with surgery and one with coil re-embolization. Neither major and IPM/CS related complications occurred. Conclusions: In this study IPM/CS was a safe and feasible embolic agent in selected patients with acute LGIB; no bowel ischemia occurred during the 30 day follow-up. Future studies with larger samples are required to confirm these findings to include IPM/CS as an off-label alternative embolic agent in LGIB. Full article

Background: Warfarin remains widely used in specific clinical situations. Its management is complicated by multiple factors that affect anticoagulant response, particularly during the early period after hospital discharge. This study examined the prevalence, patterns, and factors associated with nontherapeutic international normalized ratio (INR) among patients discharged on warfarin from a tertiary-care hospital. Methods: Electronic health records of adult patients discharged home with warfarin who had at least one INR measurement within 90 days (N = 1222) were retrospectively analyzed. Nontherapeutic INR was defined as INR outside the therapeutic range: 2.5–3.5 for mitral valve replacement and 2.0–3.0 otherwise. All available INR measurements were included. Major warfarin potential drug–drug interactions (pDDIs) were defined as DDIs with major severity according to the Micromedex^® database. Factors associated with nontherapeutic INR were examined using repeated-measures generalized estimating equations (GEEs), with generalized linear mixed models (GLMMs) as confirmatory analyses. Results: Of 3704 INR measurements within 90 days after discharge, 49.4% were subtherapeutic, while 30.5% were therapeutic and 20.1% were supratherapeutic. The proportion of therapeutic INR values did not show a substantial improvement over time. In GEEs, discharge from surgical service (adjusted odds ratio (aOR) 1.24, 95%CI: 1.05–1.48, p = 0.014) and presence of major warfarin pDDIs at discharge (aOR 1.36, 95%CI: 1.11–1.67, p = 0.003) were associated with nontherapeutic INR. GLMM analyses produced consistent results with the GEE model. Conclusions: Suboptimal INR control was prevalent within 90 days post-discharge. Discharge from surgical services and presence of major warfarin pDDIs at discharge were associated with nontherapeutic INRs. Major warfarin pDDIs may serve as markers of medication complexity at discharge and may help identify patients requiring closer anticoagulation monitoring. Full article

Background/Objectives: Traumatic spinal injury (TSI) is associated with substantial morbidity, but factors contributing to in-hospital complications remain insufficiently defined. This study evaluated factors associated with in-hospital complications after TSI. Methods: We conducted a retrospective cohort study at a tertiary center (January 2018–May 2025). Among 5380 trauma patients screened by computed tomography, 413 admitted patients with TSI were included. The primary outcome was any documented in-hospital complication. Factors were assessed using multivariable logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: The median age was 28.0 years, 337 were male (81.6%), and four-wheel motorized vehicle accidents were the most common injury mechanism (57.1%). In-hospital complications occurred in 99 patients (24.0%). Pulmonary infection was most common (9.9%), followed by bloodstream infection (4.4%), urinary tract infection (3.9%), and surgical site infection (3.9%). Compared with patients without complications, those with complications had longer hospital stays, higher ICU admissions, longer ICU stays, and lower discharge home. In multivariate logistic regression, complications were associated with worse AIS grade (OR 1.690, 95% CI 1.241–2.302), inpatient physical therapy requirement (OR 4.385, 95% CI 2.494–7.711), greater number of associated non-spinal injuries (OR 1.729, 95% CI 1.463–2.042), and greater cervical vertebral injury burden (OR 1.479, 95% CI 1.061–2.062). Conclusions: Neurological severity, polytrauma burden, and cervical injury were independently associated with complications, supporting early risk stratification and multidisciplinary prevention in high-risk patients. Findings should be interpreted considering the retrospective single-center design, predominantly young male cohort, low spinal cord injury proportion, and limited post-discharge data. Full article

Background/Objectives: Thyroidectomy is widely considered a safe procedure; however, several post-operative complications can occur, including post-surgery hemorrhage, which is considered a rare but life-threatening condition. Different strategies are employed before, during, and after surgery to minimize the risks. The aim of the present study is to describe a standardized patient management and surgical technique in thyroid surgery to prevent post-operative hemorrhage. Methods: Patients undergoing a thyroidectomy between January 2024 and June 2025 in a single center were included. Pre-operative strategies included blood pressure checks and thyroid function blood exams. Surgery was performed using a standardized technique and with a surgical energy device. Following the procedure, high blood pressure was corrected pharmacologically. Results: One hundred and twenty-three patients undergoing total thyroidectomy were included. Only one patient suffered from a post-operative hemorrhage, exhibiting an asymptomatic cervical hematoma that had been spontaneously drained one day after surgery. None of the patients required further surgeries for post-operative bleeding. Conclusions: With the application of standardized patient management and surgical techniques, zero cases of re-operation for post-operative bleeding were reported. This result strongly encourages the utilization of a standardized surgical technique to improve pre- and post-operative patient management and minimize the risk of life-threatening complications such as post-operative bleeding. Full article