Search Results (889)

Background: Abdominoplasty is associated with postoperative bleeding, drainage, and seroma. Methods: We searched four databases from inception through 16 May 2026 for randomized and non-randomized comparative studies of systemic or topical tranexamic acid (TXA). Results: Seven studies (one randomized controlled trial and six observational studies) reported 763 participants across source cohorts; treatment-arm assignment was available for 753. Random-effects meta-analysis associated TXA with lower total drainage volume (MD: −233.32 mL, 95% CI: −351.43 to −115.21), shorter drainage time (MD: −1.36 days, 95% CI: −1.75 to −0.97), shorter hospital stay (MD: −1.48 days, 95% CI: −2.16 to −0.80), smaller absolute hemoglobin drop (MD: −0.87 g/dL, 95% CI: −1.72 to −0.02), and lower seroma odds (OR: 0.51, 95% CI: 0.27 to 0.96). No significant differences were observed for 24 h drainage, relative hemoglobin drop, hematoma, surgical-site infection, wound-healing disorder, or transfusion. Rare adverse events were insufficiently reported. The absolute-hemoglobin and seroma associations were not robust to leave-one-out analysis, and major Doi-plot asymmetry affected several outcomes. Conclusions: TXA may improve selected early outcomes, but the small, mainly observational evidence base supports cautious individualized use rather than a universal regimen. Full article

Background: Hidradenitis suppurativa (HS) is a chronic disease marked by symptoms of pain, drainage, and odor. Persistent abscesses, nodules, and scarred tunnels can be resistant to pharmacologic management, with chronic lesions often requiring complex surgical intervention. Treatments include en bloc excision with primary closure, tissue flaps or skin grafts. Such procedures are associated with post-operative challenges, including pain, infection, contractures, and high recurrence rates. Methods: Herein we report use of continuous-wave carbon dioxide (CO₂) laser for HS tissue removal, during which there is an initial full-thickness excision of clinically evident lesions of hidradenitis, followed by the intra-surgical identification and staged removal of additional areas, resulting in a pocket-like (marsupialized) defect. We named the procedure staged carbon dioxide laser marsupialization (SCLM). Results: Five hundred twenty-seven patients underwent a total of 992 laser surgery sessions to manage 1846 treatment sites using SCLM. All but six patients were Hurley Stage II or III. The commonly treated sites included the groin (29.4%), axillae (27%), and buttocks (10.9%). A histomorphometry analysis of a subset of tissues revealed an average depth of HS tunnels of 3.34 mm. All post-SCLM wounds healed by secondary intention, with full healing achieved in 6–16 weeks. No instances of post-operative infection occurred. Documented surgical-site recurrence occurred in 1.4% of treated sites during available follow-up. Conclusions: Staged carbon dioxide laser marsupialization for removal of lesions of HS is an encouraging treatment approach for patients with moderate-to-severe HS, with an excellent quality of healing, no infection risk, minimal post-surgical complications, and low frequency of documented surgical-site recurrence. Full article

Objectives: We sought to evaluate CBCT-based dimensional outcomes, short-term dimensional changes, the feasibility of delayed implant placement, and complication profiles after defect-adapted guided bone regeneration of the atrophic edentulous maxilla using a PRGF-enriched autogenous bone/anorganic bovine bone mineral composite, including cases requiring simultaneous lateral-window sinus floor elevation. Materials and Methods: In this prospective, single-arm, non-randomized clinical case series, 11 patients with an atrophic edentulous maxilla requiring prosthetically guided reconstruction before implant placement were consecutively treated. Eligibility criteria included a residual ridge width < 6 mm and/or residual bone height < 10 mm, with ASA I–II status. Patients underwent defect-adapted GBR with a 60:40 mixture of autogenous bone and anorganic bovine bone mineral combined with plasma rich in growth factors (PRGF), stabilized within a defect-adapted barrier membrane system. Eight patients received combined vertical and horizontal augmentation, and three received horizontal augmentation, with simultaneous sinus floor elevation performed where anatomically indicated. Implants were placed in a delayed protocol at re-entry (6–9 months). Bone height and width were measured using standardized cone-beam computed tomography at baseline, immediately post-operatively, at 6–9 months, and at 12 months at three maxillary reference sites. Selected bone core biopsies obtained at re-entry were processed for descriptive histological evaluation. Results: Mean vertical bone dimension increased from 6.8 mm pre-surgically to 14.9 mm immediately postoperatively and measured 14.5 mm at 6–9 months and 13.9 mm at 12 months; mean horizontal bone dimension increased from 4.1 to 8.8 mm and measured 8.6 and 8.2 mm, respectively, at the corresponding follow-up time points. At 12 months, the retained mean dimensional gain was 7.1 mm vertically and 4.1 mm horizontally. Descriptive histological evaluation of selected bone core biopsies showed newly formed bone associated with residual bone-substitute particles and bone–biomaterial interface remodeling. In total, 75 implants were placed according to a delayed protocol. No intra-operative complications occurred. Three low-grade infections resolved without loss of the regenerative construct, whereas one high-grade infection caused complete graft loss at the affected site; it was excluded from the bone-gain analysis. Conclusions: Within its limitations, the PRGF-enriched autogenous bone/ABBM composite stabilized within a defect-adapted GBR compartment was associated with substantial vertical and horizontal augmentation of the severely atrophic edentulous maxilla, with limited mean linear dimensional reduction between the immediate postoperative and 12-month assessments. The approach enabled delayed implant placement in prosthetically guided positions. Controlled studies with longer follow-up are required to clarify the contribution of PRGF and validate the long-term functional performance of this multi-component regenerative biomaterial strategy. Full article

Background/Objectives: The Winograd procedure is a widely utilized surgical option for treating ingrown toenails. However, there is a lack of comparative data regarding its outcomes in the presence of active infection. The objective of this study was to compare the clinical outcomes and complication rates of the Winograd procedure for great toe ingrown toenails between patients with and without chronic severe preoperative local infection. Methods: This retrospective study included 388 great toes that underwent the Winograd procedure for ingrown toenails between 2015 and 2025 with minimum 6 months’ follow-up. Cases were categorized into two groups based on the presence (Group 1, n = 76) or absence (Group 2, n = 312) of preoperative signs of severe local infection (abscess, granulation tissue formation, and/or foul odor). Demographic factors, and clinical outcomes, including postoperative infection rates, antibiotic duration, and recurrence rates, were evaluated and compared between the two groups. Results: Patients in Group 1 were significantly younger (29.7 vs. 39.5 years; p = 0.001) and had a higher smoking prevalence (11.8% vs. 5.1%; p = 0.033) than those in Group 2. Postoperatively, the mean duration of antibiotic administration (13.9 vs. 10.6 days; p = 0.114) and the incidence of superficial operative site infection (31.6% vs. 28.2%; p = 0.561) showed no significant differences between the two groups. Persistent infection lasting more than three weeks was comparable (15.8% vs. 11.5%; p = 0.313), with similar antibiotic durations in these cases (33.0 vs. 36.6 days; p = 0.094). Most importantly, the postoperative recurrence rate did not differ significantly between the two groups, with 13.2% in Group 1 compared to 15.3% in Group 2 (p = 0.625). Conclusions: Immediate Winograd procedure with radical excision of infected granulation tissue showed no statistically significant differences in postoperative complication or recurrence rates, even in patients with chronic severe preoperative local infection. These findings suggest that immediate surgical intervention can be considered a feasible treatment option for direct source removal. Full article

Periprosthetic joint infection (PJI) remains one of the most serious complications of arthroplasty, largely due to the formation of microbial biofilms on implant surfaces. Biofilm-associated infections exhibit increased tolerance to antimicrobial therapy and host immune responses, making eradication difficult and often requiring repeated surgical interventions. Consequently, there is a growing need for effective local therapeutic strategies capable of delivering high concentrations of antimicrobial agents directly to the site of infection while minimizing systemic toxicity. Hydrogels have emerged as promising drug delivery platforms for the management of biofilm-associated PJI. Their biocompatibility, injectability, high water content, and tunable physicochemical properties enable controlled and localized release of therapeutic agents within the infected peri-implant environment. This narrative review summarizes recent advances in hydrogel-based approaches, including antibiotic-loaded hydrogels, systems incorporating anti-biofilm enzymes, bacteriophage-loaded formulations, and nanoparticle-enhanced platforms. It also highlights future research directions, with particular emphasis on the need for expanded clinical studies to facilitate the translation of emerging hydrogel-based therapies into clinical practice. Further development of these systems should focus on the incorporation of novel therapeutic agents into hydrogel platforms, aiming to enhance biofilm eradication and improve treatment outcomes in patients with PJI. Particular attention is given to stimuli-responsive (“smart”) hydrogels that release therapeutic payloads in response to infection-related triggers such as pH changes, with emphasis on the need for expanded clinical studies to facilitate the translation of emerging hydrogel-based therapies into clinical practice. Further development of these systems should focus on the incorporation of novel therapeutic agents into hydrogel platforms, aiming to enhance biofilm eradication and improve treatment outcomes in patients with PJI. 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: The radial forearm free flap (RFFF) remains one of the most reliable and widely adopted reconstructive options for head and neck defects because of its consistent vascular anatomy, long pedicle, and excellent tissue pliability. Nevertheless, donor-site morbidity continues to represent its principal drawback and may negatively affect postoperative recovery, upper-limb function, and patient satisfaction. Although numerous surgical modifications and donor-site reconstruction techniques have been proposed to reduce morbidity, the available evidence remains fragmented and heterogeneous. This systematic review and meta-analysis aimed to quantify the incidence of the principal donor-site complications following RFFF harvest and critically evaluate the current evidence regarding strategies to minimize donor-site morbidity. Methods: This systematic review and meta-analysis was conducted according to the PRISMA 2020 statement and prospectively registered in PROSPERO (CRD420261423543). PubMed/MEDLINE, Embase, and Scopus were systematically searched from inception to June 2026. Clinical studies reporting donor-site outcomes after RFFF harvest for head and neck reconstruction were eligible. Primary outcomes were tendon exposure and skin graft loss/failure. Random-effects meta-analyses were performed to estimate pooled incidence rates. Secondary complications, functional outcomes, and patient-reported outcome measures were synthesized qualitatively. Methodological quality and certainty of evidence were assessed using the Joanna Briggs Institute critical appraisal tools and the GRADE framework. Results: Twenty-two studies met the inclusion criteria for qualitative synthesis. Fourteen studies were included in the meta-analysis of tendon exposure and twelve in the meta-analysis of graft loss/failure. The pooled incidence of tendon exposure was 8% (95% CI, 7–11%; I² = 0%), whereas the pooled incidence of graft loss/failure was 11% (95% CI, 7–16%; I² = 67.1%). Delayed wound healing, infection, sensory disturbances, scar-related morbidity, and functional impairment were reported inconsistently across studies, precluding quantitative synthesis. Available studies generally reported limited long-term functional impairment, although substantial heterogeneity in assessment methods and follow-up precluded quantitative synthesis. Overall certainty of evidence was rated as low. Conclusions: Donor-site morbidity following RFFF harvest remains clinically relevant despite the excellent reconstructive reliability of the flap. Approximately one in twelve patients experiences tendon exposure and one in ten experiences graft loss or failure. Current evidence does not support the superiority of any specific donor-site reconstruction technique. Future high-quality prospective comparative studies adopting standardized outcome definitions and validated patient-reported measures are required to optimize donor-site management and improve reconstructive decision-making. Full article

Balloon valvuloplasty is a commonly performed catheter-based procedure in dogs with congenital pulmonic stenosis. Worldwide, veterinary cardiologists often administer peri- and postoperative prophylactic antimicrobials to prevent infectious complications, like bacterial endocarditis. Infective endocarditis of the pulmonary valve is, however, extremely rare in dogs, and it has never been reported after balloon valvuloplasty. The objective of this retrospective case series was to investigate the incidence of infective endocarditis, if balloon dilatation of pulmonic stenosis was performed without antimicrobial prophylaxis. Medical records of dogs operated at a university teaching hospital in a 20-year period from 2006 to 2025 were reviewed for clinical signs and echocardiographic changes that could be caused by infective endocarditis. Of the 83 dogs that were operated without peri- or postoperative antimicrobial prophylaxis, survived the surgery, and had at least three weeks of follow-up, none developed infective endocarditis. Follow-up in 68 dogs was based on medical history, physical examination and echocardiography during rechecks at the authors’ institution. Follow-up information from the remaining 15 dogs was gained from the owners and/or the referring veterinarians. Our study demonstrated zero event rate in dogs that underwent balloon dilatation of congenital pulmonic stenosis without antimicrobial prophylaxis. Full article

Background/Objectives: Postoperative infection is the leading cause of limb loss after microsurgical reconstruction of diabetic foot ulcers (DFUs), and povidone-iodine alone neither disrupts wound-bed biofilm nor penetrates hyperkeratotic debris. We assessed the feasibility of whole-field preoperative antisepsis with a pH-optimized sodium hypochlorite (NaOCl) cleanser applied before povidone-iodine draping. Methods: Consecutive patients undergoing microsurgical DFU reconstruction (January 2023–May 2024) were grouped by date of protocol introduction into pre-protocol (n = 9) and post-protocol (n = 6) cohorts. Primary outcome: technical feasibility, assessed by protocol completion, operative time, flap survival, limb salvage, and flap revision. Secondary, descriptive: postoperative infection, early (≤30 days) or late (>30 days). Results: The protocol was delivered as specified in all six post-protocol patients, without procedural modification or attributable adverse event. Operative time did not differ (388 vs. 430 min; p = 0.596); flap survival and limb salvage were 100% in both groups, with one flap revision per group. Baseline characteristics were comparable. Early infection was similar (16.7% vs. 11.1%; p = 1.000); late infection was absent post-protocol versus 33.3% pre-protocol (OR 0.14, 95% CI 0.01–3.4); and total infection was 16.7% versus 44.4% (OR 0.33, 95% CI 0.04–3.0). Follow-up was asymmetric (4.5 vs. 24.5 months); a 6-month landmark analysis showed 0 of 3 versus 3 of 6 (p = 0.464). Conclusions: Whole-field preoperative NaOCl antisepsis was technically feasible, with no adverse effect on flap survival or limb salvage. No statistically significant differences in the parameters were detected, though the sample is too small to establish comparability. An adequately powered trial is required. Full article

Background/Objectives: Frailty is increasingly recognized as a clinically relevant marker of reduced physiological reserve in surgical oncology. The modified 5-item frailty index (mFI-5) is simple and practical, but its clinical significance in oral squamous cell carcinoma (OSCC) remains incompletely defined. This study evaluated the association between mFI-5-defined frailty and postoperative complications, especially postoperative delirium, as well as survival outcomes in patients undergoing surgery for OSCC. Methods: We retrospectively analyzed 127 patients who underwent surgical resection for OSCC with postoperative high care unit (HCU) management between 2013 and 2021. Frailty was defined as an mFI-5 score of ≥2. Clinical characteristics, postoperative outcomes, HCU stay, length of hospital stay, overall survival (OS), and disease-free survival (DFS) were compared between frail and non-frail groups. Univariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative complications. An exploratory multivariable logistic regression analysis for postoperative delirium was performed using age ≥65 years and sex as covariates. Delirium was retrospectively assessed from clinical documentation considered consistent with DSM-5 criteria. Results: Twenty-one patients (16.5%) were classified as frail. Postoperative delirium occurred more frequently in frail patients than in non-frail patients (42.9% vs. 19.8%; p = 0.023). In a multivariable logistic regression model adjusted for age ≥65 years and sex, mFI-5-defined frailty was significantly associated with postoperative delirium (adjusted OR, 3.07; 95% CI, 1.08–8.60; p = 0.035). No significant association was observed for pneumonia, surgical site infection, or free-flap reoperation. Frailty was not significantly associated with HCU stay, length of hospital stay, OS, or DFS. Conclusions: mFI-5-defined frailty was associated with postoperative delirium but not with survival outcomes in this OSCC cohort. Because this retrospective study was limited by sample size, comorbidity-driven mFI-5 scoring, non-standardized delirium screening, and potential residual confounding, mFI-5 should be interpreted as a convenient screening marker rather than a stand-alone predictor. Comprehensive perioperative assessment incorporating frailty, nutrition, sarcopenia, cognition, tumor burden, and treatment-related factors may better identify patients at risk. Full article

Background/Objectives: Comparisons of abdominal Surgical-Site Infection (SSI) rates during COVID-19 often treat recorded incidence as a direct measure of biological risk, although the pandemic altered operative volume and case mix, prevention practices, and post-discharge detection. This review examines when reported SSI changes are interpretable. Methods: We conducted a critical narrative review, informed by SANRA and critical interpretive synthesis, of MEDLINE/PubMed, Embase, Scopus, and Europe PMC (January 2018–25 June 2026). Comparative SSI studies formed the core evidence set, supported by contextual studies on emergency presentation, biological risk, prevention, and surveillance. Results: Studies reported lower, unchanged, non-monotonic, and higher SSI rates. These differences became more coherent when the recorded rate was separated into operative composition, true infection probability, and detection probability. No core study measured all domains required to isolate a biological pandemic effect. Evidence from acute pancreatitis and abdominal trauma showed that disease severity, care access, inflammatory status, and prognostic relationships varied with health-system context. Conclusions: We propose the Surgical-Site Infection Signal-Validity Framework (SSI-SVF). It classifies findings as probable true improvement, apparent improvement, masked deterioration, mixed deterioration, or indeterminate and requires joint assessment of operative composition, true infection risk, and detection probability before interpreting a calendar-period change as altered surgical safety. Full article

Background: Surgical site infection (SSI) is a common complication after colorectal cancer (CRC) surgery. We evaluated routinely available perioperative biomarkers for early prediction of superficial SSI after curative CRC surgery. Methods: This retrospective study included 488 patients undergoing elective curative CRC resection. Preoperative and postoperative day (POD) 1 laboratory parameters were evaluated using receiver operating characteristic curve analysis and multivariable logistic regression. Results: Superficial SSI developed in 66 patients (13.5%). In the perioperative multivariable association model, preoperative serum albumin ≤ 3.70 g/dL (odds ratio [OR], 1.918; 95% confidence interval [CI], 1.066–3.449; p = 0.030) and WBC count ≥ 6.30 × 10³/µL (OR, 1.970; 95% CI, 1.123–3.458; p = 0.018) were independently associated with superficial SSI. On POD1, serum albumin ≤ 2.80 g/dL (OR, 3.447; 95% CI, 1.993–5.963; p < 0.001) and WBC count ≥ 10.50 × 10³/µL (OR, 2.822; 95% CI, 1.600–4.976; p < 0.001) remained independently associated with SSI. Although lower POD1 lymphocyte-to-monocyte ratio was associated with SSI in univariable analysis, it was not significant after adjustment. A combined model incorporating dichotomized preoperative and POD1 albumin and WBC counts showed modest discrimination (AUC, 0.731; 95% CI, 0.663–0.800), with 47.0% sensitivity and 89.3% specificity. Conclusions: Perioperative albumin and WBC counts were independently associated with superficial SSI. POD1 assessment may aid early risk stratification; however, the modest performance indicates that these biomarkers should complement rather than replace clinical surveillance. Prospective external validation is required. Full article

Background: Malakoplakia is a rare chronic granulomatous inflammatory disorder characterized by defective macrophage phagolysosomal activity and accumulation of Michaelis–Gutmann bodies on histopathology. It occurs predominantly in immunocompromised individuals and may mimic infectious, inflammatory, or neoplastic processes, creating significant diagnostic challenges. We describe four cases of malakoplakia occurring in distinct immunocompromised states and review the published literature to better characterize its clinical spectrum, management, and outcomes. Methods: We conducted a retrospective case series of four patients diagnosed with histologically confirmed malakoplakia at our institution. Cases occurred in the setting of liver transplantation, kidney transplantation, relapsed acute myeloid leukemia, and ulcerative colitis treated with immunosuppressive therapy. A literature review was performed using PubMed and Google Scholar to identify published cases of malakoplakia in immunocompromised hosts. Demographic, clinical, microbiological, therapeutic, and outcome data were extracted and analyzed descriptively. Results: Four patients with malakoplakia involving the gastrointestinal tract or renal allograft were identified. Clinical presentations ranged from incidental endoscopic findings and tumor-like colonic masses to recurrent bacteremia and graft dysfunction. Histopathologic examination demonstrated characteristic Michaelis–Gutmann bodies in all cases. Management included antimicrobial therapy, observation, and surgical intervention when necessary. Two patients achieved complete clinical and histologic resolution, one required transplant nephrectomy because of persistent allograft infection, and one died from progressive acute myeloid leukemia. Combined with 48 cases identified in the literature, 52 patients were analyzed. The gastrointestinal tract was the most frequently affected site (76.9%), followed by the genitourinary tract (19.2%). Malignancy (32.7%), solid-organ transplantation (26.9%), and autoimmune disease (21.2%) were the most common underlying conditions. Conclusions: Malakoplakia should be considered in the differential diagnosis of mass lesions, persistent infections, and inflammatory lesions in immunocompromised patients, particularly those with malignancy or receiving immunosuppressive therapy. Early histopathologic diagnosis is essential to distinguish malakoplakia from malignancy and guide appropriate management. Our findings highlight the heterogeneous clinical manifestations and outcomes of this uncommon condition and emphasize the importance of multidisciplinary evaluation in affected patients. Full article

Background and Objectives: Surgical-site infection remains a major complication of clean orthopedic surgery, particularly when implants or instrumentation are used. Although shorter perioperative prophylaxis is generally accepted for most clean procedures, prolonged postoperative courses continue to be used in selected high-risk orthopaedic settings. This review evaluated whether comparative evidence supports such extension. Methods: PubMed/MEDLINE, Scopus, and Cochrane CENTRAL were searched from inception to 14 May 2026. Randomized trials and non-randomized comparative studies evaluating systemic prophylaxis duration were eligible for qualitative synthesis. The primary meta-analysis was restricted to randomized controlled trials with extractable surgical-site infection data. Risk ratios were pooled using a random-effects model. Subgroup, sensitivity, and publication-bias analyses were performed. Results: Thirty-six studies were included in the qualitative synthesis, and 11 randomized trials involving 3823 participants contributed to the primary meta-analysis. After incorporating the cluster-adjusted estimate from the cluster-randomized trial, prolonged prophylaxis did not demonstrate a statistically significant additional reduction in any surgical-site infection compared with shorter prophylaxis (RR = 1.07, 95% CI 0.86–1.34; prediction interval 0.83–1.38; I² = 0.0%). A sensitivity analysis excluding the cluster-randomized trial produced a similar result (RR = 1.11, 95% CI 0.88–1.40). Exploratory procedure-based subgroup analyses did not identify a statistically significant interaction, although each subgroup contained few trials. Secondary analyses showed no statistically significant difference for superficial or non-deep infection (RR = 1.19, 95% CI 0.79–1.77) or deep or complicated infection (RR = 0.85, 95% CI 0.55–1.32). Conclusions: Prolonged systemic prophylaxis has not demonstrated a consistent additional surgical-site infection-prevention benefit compared with shorter regimens. However, sparse events, wide confidence intervals, clinical heterogeneity, and low certainty preclude conclusions of equivalence or noninferiority. Further adequately powered trials are needed in higher-risk procedures. Full article

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