AimUndergoing major cancer surgery is an important decision for patients. This study assessed the effectiveness of decision-making following colorectal and oesophageal cancer surgery.MethodsPatients who had undergone colorectal and oesophageal cancer surgery in two UK centres over two years were identified. Validated patient reported outcomes (PROs) were collected by cross sectional survey including perceived confidence in decision-making and effectiveness of risk communication (COMRADE scale), decision regret (Decisional Conflict Score; DCS), and quality of life (EORTC QLQ-PAL15). Uni-variable linear regression was used to explore the relationship between PRO scores and clinical and sociodemographic variables.ResultsSome 143/244 (58%) patients returned the questionnaire. Overall, decision regret was low (median 7.81, range 0–23.4), and perceived confidence in decision-making and effectiveness of risk communication was good (median 95 (75–100) and 85 (70–100) respectively). Higher education level was associated with reduced regret (−0.7; CI −1.2 to −0.1;p = 0.016) and a longer length of hospital stay was associated with higher regret (1;CI 0.2–1.9;p = 0.014).ConclusionPatients perceived decision-making to be effective in this study, but those with adverse outcomes may benefit from further support.

BackgroundEnhanced recovery after surgery (ERAS) protocols are multimodal, evidence-based pathways designed to attenuate the surgical stress response and accelerate recovery. While ERAS principles have been successfully applied in various surgeries, the impact of overall protocol compliance on outcomes after liver resection, a procedure with unique physiological demands, requires further elucidation. This study aimed to assess the effect of adherence to an ERAS protocol on short-term postoperative outcomes in patients undergoing hepatectomy.Materials and methodsThis retrospective analysis included 156 patients who underwent elective hepatectomy at a single center from 2020 to 2024. All patients were managed according to a standardized 20-item ERAS protocol. Overall compliance was calculated as the percentage of protocol elements delivered per patient. Patients were stratified into high-compliance, defined as 70% or greater, with 98 patients, and low-compliance, defined as less than 70%, with 58 patients, based on the median compliance rate. Primary outcomes were postoperative complications within 30 days, graded by the Clavien-Dindo classification, and length of postoperative hospital stay. Secondary outcomes included time to first flatus, postoperative ileus, readmission rate, and Comprehensive Complication Index.ResultsThe high-compliance group demonstrated significantly fewer overall complications, 24.5% versus 50.0%, and major complications, 6.1% versus 19.0%. The median length of stay was substantially shorter in the high-compliance group, 6 days compared to 9 days. Multivariate analysis identified high ERAS compliance as an independent protective factor against major complications, with an odds ratio of 0.32, and prolonged length of stay, with an odds ratio of 0.24. Time to gastrointestinal recovery was also faster in the high-compliance group. The overall readmission rate was similar between groups.ConclusionsHigh overall compliance with a multimodal ERAS protocol is independently associated with reduced postoperative morbidity and shorter hospital stay following hepatectomy. These findings underscore the importance of strict adherence to ERAS elements throughout the perioperative journey. Efforts should be directed towards optimizing compliance through multidisciplinary teamwork and patient engagement to maximize the benefits of ERAS pathways in liver surgery.

IntroductionPrior work has linked severe psychiatric illness (SPI) with greater postoperative mortality and complications following several elective operations. However, this relationship has not been defined in the setting of emergency general surgery (EGS).MethodsThe 2016–2021 United States Nationwide Readmissions Database was used to identify all non-elective adult EGS hospitalizations performed within 48 h of admission. SPI was defined using ICD-10 codes for bipolar disorder and schizophrenia. Patients with severe psychiatric illness comprised the SPI cohort (others: Non-SPI). Multivariable linear and logistic regression models were developed to evaluate the independent association of severe psychiatric illness with in-hospital mortality, perioperative complications, and costs.ResultsOf 2,124,284 EGS patients, 52,130 (2.5 %) were categorized as SPI. On adjusted analysis, SPI was associated with greater odds of in-hospital mortality (Adjusted Odds Ratio [AOR] 1.21; 95 % Confidence Interval [CI]:1.11–1.31), hospitalization costs (+$2304; 95 %CI: +1950, +2658), as well as a 3-fold increase in relative risk of non-home discharge (AOR 3.18, 95 % CI: 3.05–3.31).ConclusionsAmong EGS patients, severe psychiatric illness was linked with inferior clinical and financial outcomes. Improved psychiatric screening and care may allow for early intervention and targeted postoperative care, potentially mitigating complications and costs for these vulnerable patients.

Laparoscopic gastrectomy (LG) has emerged as a cornerstone in the surgical management of gastric cancer, particularly in its early stages. Compared to conventional open surgery, LG offers numerous advantages, including reduced postoperative pain, shorter hospital stays, faster recovery, and improved cosmetic outcomes, contributing to its widespread use [1]. Despite these advancements, the presence of comorbidities continues to pose significant challenges to achieving optimal outcomes in patients undergoing LG.

BackgroundThis study aims to assess the collective influence of inflammatory indicators and surgical interventions on the one-month postoperative recovery outcomes in patients with rib fractures.MethodsA retrospective analysis involved 70 surgical and 278 non - surgical rib - fracture patients. Primary outcomes were thoracic complication incidence and post - discharge oral analgesic use at one month. Secondary outcomes included hospital stay length and total costs. We collected various data and conducted propensity score matching (1:2 ratio) to control for confounders, followed by multivariate analyses.ResultsAfter PSM (60 surgical vs. 117 non-surgical patients), surgical reduced hospital stay by 10.4 days (β = −10.36 days, 95 % confidence interval [95 % CI]: −16.03 to −4.70; P < 0.001), but increase in total costs by 30,808.80 CNY (P < 0.001). Pre-existing thoracic complications independently predicted higher one-month postoperative complications (OR[95 % CI] = 4.05 [1.08, 18.15]; P = 0.048), while comorbidities lowered risk (OR[95 %CI] = 0.29 [0.08, 0.89]; P = 0.043). Elevated systemic immune-inflammation index (SII) (Coef [95 % CI] = 528.03 [28.05, 1028.00]; P = 0.039) and neutrophil-to-lymphocyte ratio (NLR) (Coef[95 % CI] = 3.50 [0.62, 6.37]; P = 0.017) were positively correlated with Injury Severity Score (ISS). In surgical patients, a higher lymphocyte-to-monocyte ratio (LMR) independently predicted a lower likelihood of ongoing analgesic use at one month (OR[95 %CI] = 0.70 [0.46, 0.95]; P = 0.046).ConclusionSurgical rib - fracture stabilization shortens hospital stay but raises treatment costs. High SII and NLR, along with thoracic complications, are linked to post - op complications. LMR and HGB levels are associated with analgesic needs, which may aid in tailored pain management.

Splenic injury (BSI) is present in nearly 45% of abdominal blunt trauma cases in the US and splenic artery embolization (SAE) has been increasingly utilized to manage BSI in recent years. However, SAE failure necessitating delayed splenectomy remains a critical concern with significant implications for patient outcomes and healthcare resource utilization. We conducted a retrospective cohort study utilizing the 2016-2021 Nationwide Readmissions Database. Adult patients (≥18years) with BSI undergoing SAE or splenectomy were included. Early embolization was defined as SAE within 48h of admission. Failure of SAE (FE) was defined as splenectomy following unsuccessful SAE during the index hospitalization or within 30days post-discharge. Multivariable regression models were developed to assess the association of FE with in-hospital mortality, length of stay (LOS), and costs. Of 44,750 included patients, 17,921 (40.0%) underwent SAE as an initial operative approach. Rates of failed embolization remained stable over the study period (2016: 8.1% vs 2021: 9.4%, nptrend=0.86), as did mortality following FE (2016: 1.9% vs 2021: 1.3%, nptrend=0.05). After risk adjustment, early embolization was associated with reduced odds of FE (AOR 0.78, 95%CI 0.64-0.95). FE was associated with significantly increased odds of mortality (AOR 2.52, 95% CI 1.86-3.41), prolonged LOS by 4.8days (95% CI 4.0-5.5), and increased hospitalization costs by $27,600 (95% CI $24,400-30,900). Despite growing SAE utilization, its failure rate remains stable with FE being associated with inferior clinical and financial outcomes. Improve patient selection, increased availability of embolization and providing early embolization in select cases may enhance SAE outcomes.

IntroductionAnastomotic leakage (AL) is a severe complication after esophagectomy. Intraluminal oxygen delivery at the anastomosis site might improve the viability of the tissue and thereby reduce the incidence of AL. We present a feasibility study of intraluminal oxygen delivery after esophagectomy.MethodsEighteen patients scheduled for robot-assisted minimally invasive esophagectomy with an intrathoracic anastomosis were selected to receive an additional manometry catheter for intraluminal oxygen delivery at the anastomosis site. The primary endpoint was the feasibility of placing the catheter in the correct position and staying in situ for five days postoperatively. Intraluminal pressure was monitored during oxygen delivery at flow rates of 0 (control group), 1, 2, or 4 ml/min. Patients were questioned on the comfort of the catheter.ResultsIn two patients, intraoperative placement of the catheter was unsuccessful. Two others replaced these patients according to the study protocol. 16 patients were analyzed. In five patients, the catheter was accidentally removed before the end of the study. The primary endpoint was successful in 11/16 patients (69 %). Intraluminal pressure in the 1 ml/min group did not differ from the control group. Intraluminal pressure in the 2 ml/min group increased substantially compared to the control group. Patients reported comfort rates that decreased over time.ConclusionThis study shows that it is feasible to administer intraluminal oxygen in the first five days after esophagectomy and that a flow rate of 1 ml/min is not associated with increased intraluminal pressure. Future studies are required to study the effectiveness of intraluminal oxygen delivery in preventing AL.