Search Results (1,076)

Postoperative endophthalmitis is a rare but severe complication of cataract surgery that may lead to significant visual impairment and can occasionally present as clusters or outbreaks linked to lapses in infection control. On 29 October 2025, three cases of postoperative endophthalmitis following cataract surgery at an ophthalmology clinic (Clinic A) in Yeongju, Republic of Korea, were reported to public health authorities. All cases were confirmed as Pseudomonas aeruginosa (P. aeruginosa). An epidemiological investigation was conducted to identify the source and transmission route; all 54 patients who underwent cataract surgery at Clinic A in October 2025 (62 procedures, including eight bilateral cases) were included. Infection control practices were assessed through on-site inspection, staff interviews, medical record review, and telephone surveys. Environmental samples were collected and cultured selectively for P. aeruginosa. Isolates were analyzed using pulsed-field gel electrophoresis (PFGE) to assess genetic relatedness. Among 54 surgical patients, three developed endophthalmitis (attack rate: 5.6%). All cases occurred in patients operated on 23 October by the same surgeon; no additional cases were identified. P. aeruginosa was isolated from all three patients. Of 45 environmental samples, three were positive: the laundry room drain, the sink drain in the local anesthesia room, and the interior of cassette No. 2 and instruments within the operating room steam sterilizer. PFGE showed 95.7% band pattern similarity between patient isolates and those from the sterilizer. This outbreak was attributed to P. aeruginosa, with the steam sterilizer identified as the most probable source. Inadequate infection control and sterilization practices likely contributed. These findings highlight the critical importance of strict sterilization monitoring and adherence to infection prevention and control practices to prevent recurrence. Full article

Previous studies on healthy controls suggest the added value of thigh-based Electrocardiography (ECG), which collects data using sensors embedded in a toilet seat for unobtrusive signal acquisition. However, further evidence regarding its clinical feasibility is needed; with this work, we investigated three complementary aspects: signal quality, morphological correlation with standard ECG leads, and the system’s potential for heart rate variability (HRV) analysis in patients undergoing aortic valve replacement. This work was divided into two main phases. In the first, 32 healthy volunteers underwent simultaneous ECG recordings using both a standard 12-lead ECG system and the thigh-based system. Signal Quality Index (SQI) analysis revealed that 56.25% of the experimental signals were classified as excellent, and over 62.5% of recordings showed a strong correlation with Lead I of the clinical ECG. These findings extend the state of the art by further characterising the quality and relevance of the captured signals. In the second phase, two patients with severe aortic stenosis were monitored before and after surgical valve replacement. HRV metrics derived from the thigh-based ECG captured distinct autonomic responses: one patient showed significant postoperative improvement in global and parasympathetic modulation (increased SDNN, RMSSD, and Sample Entropy), while the other exhibited reduced variability and complexity, potentially indicating impaired autonomic recovery. These results highlight the feasibility of thigh-based ECG data acquisition for passive, longitudinal cardiac health monitoring in everyday environments and its applicability for pre- and postoperative autonomic assessment. Full article

Background and Objectives: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed metabolic and bariatric surgeries worldwide. Marginal ulcers (MU) are a common complication following RYGB, yet their pathophysiology and the contributing risk factors to their development are not fully understood. Materials and Methods: This retrospective cohort study examined patients who underwent RYGB between January 2008 and December 2023, with 1 to 5 years of follow-up. Data collected included patient- and procedure-related risk factors, as well as postoperative MU events. Statistical analysis methods included the independent samples t-tests, multivariate regression, and Cox regression analyses. Results: Our final cohort included 2106 patients and was predominantly female (80.5%), with a mean age of 47.8 ± 12.1 years and body mass index (BMI) of 45.5 ± 7.5 kg/m². MU occurred in 241 (11.4%) patients, with a mean time to occurrence of 4.5 ± 0.02 years. History of smoking (HR = 1.87, p < 0.001) and gastroesophageal reflux disease (HR = 2.36, p < 0.001) significantly increased hazard for MU, while proton pump inhibitor use (HR = 0.18, p < 0.001) was associated with reduced hazard. Aspirin exposure, regardless of dose and chronicity, did not impact MU. Conclusions: Our findings highlight the importance of preoperative assessment and counseling in patients planning to undergo RYGB. Patient-related factors should guide postoperative monitoring and prophylaxis of MU, as this remains a debated topic amongst experts. Full article

Objectives: The aim of this study is to investigate the relationship between the lactate/albumin ratio (LAR) and 28-day mortality in gastric cancer patients undergoing monitoring in a postoperative intensive care unit due to reasons such as haemodynamic instability, need for vasopressor support, or intraoperative bleeding. Methods: This retrospective study included patients followed up at the tertiary surgical intensive care unit of Kastamonu University Faculty of Medicine between January 2020 and October 2025 who were diagnosed with histologically confirmed gastric adenocarcinoma and underwent total open surgery or subtotal gastrectomy + D2 lymphadenectomy. The patients were categorized into two groups: non-survivors within 28 days (n: 45) and survivors within 28 days (n: 139). Results: A total of 184 critically ill patients (110 males, 74 females) who underwent gastric adenocarcinoma surgery and were followed up in the surgical intensive care unit were included in this study. The mean age of the patients was 72.2 ± 11.3 years. Of these patients, 139 (75.5%) were survivors, and 45 (24.5%) were non-survivors. Albumin, the C-reactive protein (CRP)/albumin ratio, lactate, and the lactate/albumin ratio were associated with 28-day mortality. Receiver operating characteristic (ROC) analysis showed that the LAR (area under the curve (AUC): 0.839) was superior to the serum albumin (AUC: 0.736) and lactate levels (AUC: 0.796) for predicting 28-day mortality. The optimal cut-off value of the LAR was 0.82, and an LAR of ≥ 0.82 was shown to be a significant and independent prognostic factor for 28-day mortality in patients with stomach cancer in a critical postoperative condition (odds ratio (OR): 4.78, confidence interval (CI): 1.09–21.08, p = 0.0386). Conclusions: The lactate/albumin ratio is a prognostic parameter for 28-day mortality in critically ill postoperative gastric cancer patients. The optimal cut-off value for the lactate/albumin ratio is 0.82. Full article

Background and Objectives: Acute cholecystitis is a common indication for emergency surgery. While acute calculous cholecystitis (ACC) is most common, acute acalculous cholecystitis (AAC) occurs without gallstones and is often associated with severe systemic illness. We compared early postoperative outcomes after cholecystectomy for AAC versus ACC, with emphasis on complication severity and overall morbidity burden. Materials and Methods: We performed a single-center retrospective cohort study of consecutive adults undergoing urgent or emergent cholecystectomy for acute cholecystitis between December 2020 and April 2025. Patients with chronic cholecystitis, duplicate records, missing group assignment, or incomplete 30-day follow-up were excluded. The primary 30-day endpoints were postoperative complications, their severity (assessed with Clavien–Dindo scale), and cumulative morbidity assessed using the Comprehensive Complication Index. Secondary outcomes included operative approach, postoperative length of stay, 30-day readmission, and mortality. Results: A total of 221 patients were analyzed (181 ACC, 40 AAC). Patients with AAC were older and more frequently male. Any complication within 30 days occurred substantially more often in AAC patients than in ACC patients. Morbidity severity also differed markedly, with higher-grade complications occurring more frequently in the AAC group. AAC patients exhibited a substantially greater overall morbidity burden, indicating not only more frequent complications but also a heavier cumulative impact. Thirty-day mortality was considerably higher in AAC. Open surgery was more commonly required in AAC, whereas postoperative length of stay and 30-day readmission rates were similar between groups. Conclusions: In this cohort, AAC was associated with substantially worse early outcomes after cholecystectomy than ACC, characterized by a pronounced increase in clinically significant complications (Clavien–Dindo ≥ IIIa), greater cumulative morbidity (CCI), and markedly higher 30-day mortality. These findings support treating AAC as a high-risk phenotype warranting intensified perioperative optimization and vigilant postoperative monitoring. Full article

Background: Obstructive jaundice is a common clinical condition, often caused by malignant tumors such as hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCA). Percutaneous transhepatic cholangiodrainage (PTCD) is a widely used intervention method to relieve biliary obstruction in patients with obstructive jaundice; however, the impact of PTCD on hepatitis B virus (HBV) reactivation has not been thoroughly studied. Methods: A retrospective analysis was conducted from January 2016 to December 2024 on 235 patients with obstructive jaundice who underwent PTCD. Demographic, clinical, and procedural data were collected, and multivariate logistic regression was used to identify risk factors for HBV reactivation. Additionally, Cox regression was used to evaluate the time-to-reactivation variables. Results: The HBV reactivation rate in the PTCD group was 21.7%, significantly higher than the 8.9% in the non-PTCD group. Key risk factors for HBV reactivation in the PTCD group included the absence of antiviral prophylaxis, postoperative infection, elevated preoperative HBV-DNA levels, and multiple biliary punctures. Moreover, Cox regression revealed that a lack of antiviral therapy and postoperative infection were associated with earlier HBV reactivation. Conclusions: PTCD significantly increases the risk of HBV reactivation in patients with obstructive jaundice, especially in those with high preoperative HBV-DNA levels and without antiviral prophylaxis. Early detection of HBV reactivation and the initiation of antiviral therapy are critical to improving patient outcomes. These findings underscore the need for careful monitoring of HBV status in patients undergoing PTCD. Full article

Introduction: Intraoperative hypotension (IOH) is a frequent manifestation of haemodynamic instability during general anaesthesia. Advances in arterial waveform analysis have led to two distinct monitoring strategies: flow-derived platforms and predictive algorithms designed to anticipate hypotension. However, prospective comparisons and their associations with IOH and postoperative outcomes remain limited. The objective was to compare predictive haemodynamic monitoring using the Hypotension Prediction Index (HPI) with flow-derived monitoring using the Vigileo/FloTrac system and to evaluate their associations with IOH and postoperative outcomes. Methods: In this single-center prospective observational study, 101 adults undergoing elective major abdominal surgery under general anaesthesia were monitored using either the HPI system (n = 49) or the Vigileo/FloTrac system (n = 52). Primary outcomes were cumulative duration and frequency of IOH (mean arterial pressure < 65 mmHg). Secondary outcomes included postoperative complications, organ injury biomarkers (troponin, creatinine, eGFR), and hospital length of stay. Multivariable regression models adjusted for predefined confounders were used to estimate associations. Results: Vigileo/FloTrac monitoring, compared with HPI, was independently associated with a greater cumulative duration of IOH (adjusted β = 1.66; 95% CI, 0.63–2.72) and a higher number of hypotensive episodes (adjusted β = 0.53; 95% CI, 0.10–0.95). Monitoring strategy was not associated with surgical site, respiratory, or neurological complications. However, Vigileo/FloTrac monitoring was associated with higher odds of vascular complications (adjusted OR = 4.36; 95% CI, 1.13–20.41). No significant associations were observed between monitoring strategy and postoperative organ injury biomarkers or length of hospital stay. Conclusions: Predictive haemodynamic monitoring using the HPI system was associated with lower IOH burden compared with the Vigileo/FloTrac system. However, these differences were not consistently accompanied by improvements in postoperative outcomes. Haemodynamic optimisation should be considered as one component within a broader, integrated perioperative management strategy. Further large-scale, multicenter prospective studies are warranted to clarify its impact on patient-centered outcomes. Full article

Background/Objectives: Ureteral complications following oblique lumbar interbody fusion (OLIF) are uncommon and are typically attributed to direct mechanical injury. Functional ureteral obstruction without overt ureteral damage remains poorly characterized. We report two cases that provide clinical and intraoperative evidence of a previously underrecognized mechanism of ureteral obstruction associated with anterior cage positioning during OLIF. Case Presentation: Among 180 OLIF procedures performed by a single surgeon, two cases (1.1%) of postoperative or intraoperative ureteral compromise without direct structural injury were identified. In the first case, postoperative imaging revealed hydronephrosis and focal angulation of the left proximal ureter at the level of the interbody cage, without contrast extravasation. The obstruction was managed with double-J ureteral stenting, and serial renal function monitoring confirmed preserved renal function throughout the clinical course. In the second case, retroperitoneal tissue including the ureter was directly observed intraoperatively to be interposed between the anterior longitudinal ligament and the interbody cage during anterior cage placement. Release of the interposed tissue resulted in immediate ureteral decompression without structural damage. Correlation of the postoperative findings in the first case with the intraoperative observations of the second case supports a unified mechanistic explanation: anterior cage advancement may draw retroperitoneal tissue into the cage–anterior longitudinal ligament interface, subjecting the ureter to focal compression or angulation. Conclusions: Functional ureteral obstruction during OLIF may occur secondary to retroperitoneal tissue interposition rather than direct ureteral trauma. Awareness of this mechanism and meticulous protection of the anterior retroperitoneal layer during cage advancement may help prevent avoidable ureteral complications. Full article

Background: To evaluate the real-world safety and mid-term clinical performance of the Ankura™ AAA Stent Graft System in patients undergoing endovascular aneurysm repair (EVAR). Materials and Methods: This prospective, multicenter PMCF study analyzed 100 patients with abdominal aortic aneurysms (AAAs). Patients were monitored for a mean duration of 2.26 years. Primary endpoints included 30-day major adverse events and 24-month treatment success. Statistical evaluation of risk factors for reintervention was performed using univariate logistic regression. Results: The study cohort was predominantly male (97%), with a mean age of 72.01 years. Hypertension (90%) and smoking (89%) were the most prevalent comorbidities. Regarding the primary endpoints, the 30-day MAE rate was 2%. During the overall follow-up (mean 2.26 years), the primary patency rate was 97%, demonstrating high structural integrity and sustained patency. However, the overall freedom from reintervention rate was 74%, corresponding to a 26% reintervention requirement and a 27% incidence of endoleak. Reinterventions were almost exclusively driven by these post-procedural morphological complications; specifically, 26 of the 27 patients with endoleaks required a secondary procedure. No preoperative clinical or anatomical parameters were identified as significant independent predictors of reintervention in the univariate analysis (p > 0.05). The overall mortality rate was 12%, with 0% aneurysm-related mortality. Conclusions: Mid-term success and reintervention after EVAR with the Ankura™ system are primarily driven by postoperative morphological complications, such as endoleaks, rather than baseline patient risk profiles. These findings underscore the critical importance of rigorous, lifelong radiological surveillance regardless of preoperative anatomical challenges. Full article

Background: Post-bariatric hypoglycemia (PBH) is a clinically significant complication of bariatric surgery, characterized by inappropriate postprandial hyperinsulinemia and recurrent hypoglycemia. Episodes are often frequent, severe, and medically refractory, substantially impacting quality of life and potentially causing compensatory carbohydrate intake that leads to weight regain. Methods: A 50-year-old male underwent Roux-en-Y gastric bypass (RYGB) in 2009. Symptomatic postprandial hypoglycemia emerged in the second postoperative year and progressively worsened to multiple severe daily episodes. The patient developed compensatory carbohydrate intake with subsequent weight regain. Following the failure of dietary interventions and pharmacologic therapy, he underwent conversion to single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) in September 2022. Results: Following surgical conversion, the patient reported no clinically significant hypoglycemia during the follow-up period. Weight and obesity-related comorbidities improved. Gastrointestinal symptoms remained manageable, and micronutrient status was closely monitored. Conclusions: In selected patients with severe, medically refractory PBH following RYGB, conversion to an ileal-based procedure may be considered a viable therapeutic strategy. Prospective studies are needed to better define this hypothesis. Full article

Background: Gastric cancer survivors frequently encounter a “care gap” after discharge because of complex postgastrectomy syndromes. We evaluated “WECARE,” a bidirectional digital health platform designed to provide real-time symptom monitoring and multidisciplinary support. The primary goal of this study was to assess the efficacy of the platform by measuring the change in the Korean Quality of Life Questionnaire for Gastric Cancer Survivors (KOQUSS-40) total score over a six-month recovery period. Methods: This nationwide, multicenter pilot randomized controlled trial was conducted by the Korean Quality of Life in Stomach Cancer Patients Study Group (KOQUSS) across nine tertiary centers in Korea. A total of 88 patients who underwent curative gastrectomy were enrolled. Following an initial optimization phase involving 22 patients, the remaining 66 patients were randomized at a 1:1 ratio to the WECARE group or the control group. The WECARE group used a platform integrating the KOQUSS-40 algorithm for structured symptom reporting, real-time feedback on nutrition and exercise, and educational content on meal planning, symptom coping, and recovery. Assessments were performed at baseline and at 1, 3, and 6 months after discharge. Results: The WECARE group showed high feasibility and acceptability, with an adherence rate of 86.7% and an 82% satisfaction rate. At 6 months, the KOQUSS-40 total score (primary endpoint) did not differ significantly between the WECARE and control groups (85.3 ± 1.6 vs. 83.8 ± 1.6, p = 0.603). However, the WECARE group showed a numerically favorable recovery trajectory from the acute postoperative phase. Subgroup analysis revealed a positive trend in reflux symptom management in the WECARE group (p = 0.0856). In addition, more than 77% of users reported that the platform improved their self-management capabilities. Conclusions: The WECARE platform is a feasible and acceptable digital intervention for gastric cancer survivors. Although the primary endpoint was not significantly different, the favorable recovery trajectory, high adherence, and patient engagement support further evaluation in larger studies with longer follow-up and broader healthcare settings. Full article

Objective: To investigate the association between pelvic incidence (PI) and fixation failure following single-level transforaminal lumbar interbody fusion (TLIF) for low-grade spondylolisthesis and to identify risk factors for pedicle screw loosening. Methods: This retrospective study included 80 patients who underwent single-level TLIF and were divided into a high PI group (n = 40) and a normal/low PI group (n = 40). Radiographic parameters including PI, lumbar lordosis (LL), pelvic tilt (PT), sacra l slope (SS), listhesis magnitude, and PI–LL mismatch were evaluated pre- and postoperatively. Screw loosening and fusion status were assessed at 6, 12, and 24 months. Multivariate logistic regression analysis was performed to identify independent risk factors for screw loosening. Results: The high PI group demonstrated significantly higher screw loosening rates than the normal/low PI group at all follow-up time points, with a rate of 57.5% versus 28.2% at 24 months (p = 0.012). Fusion rates were comparable between groups. Multivariate analysis identified high PI and residual listhesis were independent risk factors for screw loosening (Odds ratio 1.05 and 1.35). PI–LL mismatch > 10° showed higher odds but were not statistically significant. Conclusions: High PI is associated with an increased risk of pedicle screw loosening after single-level TLIF. Careful preoperative assessment and postoperative monitoring may help reduce fixation-related complications. Full article

Background: While providing enough sedatives to avoid pain and trauma during surgery is important, studies show a link between the received sedatives and the development of postoperative delirium (POD). Therefore, predicting POD from clinical or physiological data before or during surgery is highly advantageous. This capability enables healthcare providers to proactively implement necessary measures, thereby mitigating or preventing potential complications. Methods: In this study, we focus on patients with Parkinson’s disease undergoing deep brain stimulation surgery who are particularly susceptible to POD. We investigate what aspects of EEG’s power, functional connectivity and complexity during the course of the surgery are influenced by the amount of sedative. Furthermore, we aim to determine whether and to what extent the recorded brain activity during surgery can serve as a reliable means for the prediction of POD in this group of patients. Results and Conclusions: Our results show significant correlations between various power, connectivity and complexity features of EEG and the amount of sedatives. Even though single EEG features are not significantly different between the two groups who either developed or did not develop POD, we show that a classifier based on support vector machines using the selected EEG features could predict POD. Furthermore, our results provide evidence that a classifier trained only on the amount of sedatives is unable to predict POD. Accompanying this paper, our code is published as an open-source toolbox for the analysis of the EEG signal recorded with the four-channel SEDLine Root system, which is among the widely used EEG systems in operation rooms and its recorded data come with challenges that are addressed in our toolbox. Full article

Background: Frail patients undergoing hip and knee revision surgery represent a major anesthetic challenge because of advanced age and multiple comorbidities. Continuous spinal anesthesia (CSA) with titrated low-dose levobupivacaine may offer a potentially useful alternative to general anesthesia or single-shot spinal anesthesia in this high-risk population. Methods: A retrospective review was conducted of ASA II-III patients who underwent complex hip and knee revision surgeries between February and October 2024 under CSA. The technique was performed using a 25-gauge spinal catheter with incremental boluses of 0.25% levobupivacaine (2.5 mg). Hemodynamic parameters, including mean arterial pressure (MAP), stroke volume index (SVI), and cardiac index (CI), were continuously monitored using the EV1000 hemodynamic monitoring system. Postoperative complications were recorded. Results: 37 high-risk patients were included in the study. Catheter placement was successful in all patients, with no conversions to general anesthesia. MAP decreased by a mean of 14.6% after boluses (p < 0.05); 9 patients (24.3%) experienced reductions ≥ 20%, but all remained >65 mmHg and responded to fluid therapy. CI and SVI decreased by 10.1% and 10.5%, respectively (p < 0.05), without clinical instability. No major complications (neurological injury, infection, post-dural puncture headache) were observed. Conclusions: In this retrospective single-center experience, CSA with titrated low-dose levobupivacaine was feasible and associated with stable hemodynamic profiles and a low rate of complications in frail patients undergoing complex lower-limb revision surgery. However, given the absence of a control group and the limited sample size, these findings should be interpreted cautiously. Further prospective comparative studies are needed to better define the role of CSA in high-risk orthopedic patients. Full article

Neonates undergoing surgery for congenital heart disease (CHD) are at high risk for brain function impairment. Reliable early predictors of postoperative neurological complications are lacking. We examined a retrospective cohort of 55 surgically treated CHD neonates systematically monitored by concomitant conventional electroencephalography (cEEG) and amplitude-integrated EEG (aEEG). Neonates underwent cEEG/aEEG at three time points: T0 (preoperative, duration: 90–120 min); T1 (24–48 h after cardiac surgery, duration: ≥11 h); and T2 (7–10 days post-surgery, duration: 90–120 min). For each patient, aEEG background activity was evaluated and scored, and clinical and surgical data were retrieved to establish short-term post-surgical outcomes. Patients with normal T0 monitoring had significantly higher aEEG bandwidths in T1. A lower Aristotle basic score was associated with an improvement in aEEG at T1. Inversely, a narrower aEEG bandwidth in T1 was associated with post-surgical neurological deterioration. The aEEG bandwidth accurately predicted short-term neurological outcome; in particular, a minimal aEEG amplitude above 17.5 µV excluded poor neurological outcome with a negative predictive value of 81.48%. Our results demonstrated that aEEG bandwidth and trend dynamics may be associated with surgical complexity and neurological outcomes. aEEG background trend monitoring may provide relevant prognostic information on neurological outcomes in surgically treated CHD neonates. Full article