The role of surgical stabilization of rib fractures (SSRF) in older adults remains uncertain, particularly regarding functional recovery and long-term pain. This study examined whether chronological age influences postoperative outcomes and evaluated the performance of injury-severity scoring systems in geriatric patients undergoing SSRF. This retrospective cohort included 524 adults who underwent SSRF between 2012 and 2023. Patients were stratified into non-geriatric (< 65 years, n = 331) and geriatric (≥ 65 years, n = 193) groups. Demographics, injury characteristics, perioperative outcomes, pain trajectories, and functional recovery were compared. Predictors of postoperative complications and chronic pain were assessed using univariate and multivariate logistic regression. Correlations between clinical outcomes and RibScore, AIS-Thorax, and BPC18 were analyzed using Spearman coefficients. Geriatric patients were more often injured by low-energy falls and had higher rates of pulmonary contusion (74.6% vs. 63.9%) yet demonstrated complication rates similar to younger adults (14.0% vs. 12.7%, p = 0.696). Pain trajectories were comparable across all follow-up intervals. Functional recovery was slower in older adults, who required an additional month to return to baseline activity (median 3 vs. 2 months, p < 0.001). The number of fractured ribs on the operated side independently predicted postoperative complications (OR 1.863, 95% CI 1.396-2.487, p < 0.001), whereas age was not an independent predictor. Longer time-to-surgery (OR 1.341, p = 0.001), longer hospitalization (OR 1.059, p = 0.044), and postoperative complications (OR 1.941, p = 0.036) independently predicted chronic pain. AIS-Thorax showed the strongest correlations with clinical outcomes, while all three scoring systems demonstrated weak associations with postoperative pain. In appropriately selected patients, SSRF provides comparable safety and pain recovery across age groups. Although functional recovery is slower in older adults, overall outcomes remain favorable. These findings support shifting from age-based to physiology-based decision-making for SSRF.

The ERAS (Enhanced Recovery After Surgery) protocols are multimodal perioperative pathways that accelerate patient recovery. Despite the widespread adoption of ERAS protocols in a variety of surgical subspecialties (i.e. colorectal, bariatric, orthopedic surgery), their use in esophageal surgery is still debated. Although still not universally accepted, an increasing number of institutions are adopting the ERAS protocols for esophagectomy. In this review, we sought to provide a comprehensive summary of the components of ERAS protocols following esophagectomy, encompassing preoperative, intraoperative, and postoperative phases. Furthermore, we sought to examine variations in the most recent ERAS guidelines and identify gaps that future researchers need to address to achieve consensus on universally accepted ERAS guidelines.

Non-restorative resection (NRR) is the most common procedure for perforated diverticulitis, but frequently leads to permanent stoma and morbidity related to stoma reversal. For selected patients, primary anastomosis (PRA) is another option. Damage control surgery (DCS) may be an alternative, potentially offering a greater likelihood of stoma-free discharge. We compared DCS to conventional surgical treatment in terms of stoma-free discharge and postoperative complications. This single center trial compared patients treated before and after the introduction of a new treatment algorithm based on DCS. The prospective study group underwent surgery from 2022 to 2024, following implementation of a DCS-based treatment algorithm. The retrospective control group underwent operation from 2020 to 2022 (pre-algorithm). The primary outcome was stoma presence at 12 months. Secondary outcomes included stoma at discharge, complications, length of hospitalization, costs, and complications after stoma reversal. In the control group, 29/30 patients (97%) underwent NRR. In the study group, 22/26 (85%) underwent DCS, among these 4/22 (18%) required conversion to NRR, and 18/22 (82%) achieved anastomosis during the second-look. Demographics, length of hospitalization, post-operative complications, and complications after stoma reversal were similar. The control group exhibited higher rates of stoma at 12 months (37% vs. 8%, P = 0.003). Multivariate analysis revealed that treatment before the algorithm was independently associated with increased stoma presence at 12 months (Hazard ratio 10.65, P = 0.013). DCS appears to be a safe and effective strategy, yielding significantly lower rates of stoma at 12 months compared to conventional treatment for perforated diverticulitis.

The use of artificial intelligence (AI) for TI-RADS classification in neck sonography for the assessment of thyroid nodules has been proven beneficial. We evaluated the learning curve of such AI in a real-world setting. Between 03/2023 and 06/2024, 110 patients with 176 thyroid nodules were examined and classified according to ACR TI-RADS classification using 3D-ultrasound PIUR tUS Infinity software. After software training and update, the study was repeated examining 133 patients with 228 nodules (03/2023 until 10/2024). Every AI-based TI-RADS evaluation was compared to that of an experienced endocrine surgeon (assessor), unaware of the software results. First phase: AI-supported TI-RADS classification corresponded to the assessor's in 128/176 (73%) of examined nodules; second phase: correspondence in 210/227 (92.6%). Re-evaluating the initial 110 patients after software update, more nodules (194 vs. 176) were correctly assessed. In the first phase, AI "misinterpreted" in 36/176 (20%) cases nodules with microcalcifications or echogenic foci (leading to 1-3 points differences to accessor). After update, only 11/227 (4.8%) such nodules remained and relevant differences to the accessor were found in only 6/227 (2.6%) unusual cases (autoimmune thyroiditis, non-descended thymus, hemorrhaged cyst), compared to the initial 7%. After several rounds of deep learning, a significant improvement in correct ACR TI-RADS classification was demonstrated, especially the assessment of nodules within conglomerates. The AI-supported ultrasound is already a solid tool in the diagnosis of true thyroid nodules in non-inflamed tissue, but cannot yet replace an experienced clinician in complex or unusual cases; however, the fast learning curve is encouraging.

Schwannomas are benign nerve sheath tumors most commonly located in the posterior mediastinum. However, atypically located thoracic schwannomas are rare and may pose challenges in diagnosis and surgical management. In this retrospective case series, 14 patients who underwent surgical treatment for atypically located thoracic schwannomas between 2011 and 2025 were evaluated. Demographic, clinical, radiological, surgical, and histopathological data were analyzed. The associations between tumor location and clinical or surgical variables were assessed using Fisher’s exact test and the Chi-square test. The mean age of the patients was 51.4 years (range: 24–77), with a predominance of male cases. Tumor locations were classified as supraclavicular (n = 4), anterior/middle mediastinum (n = 4), infraclavicular (n = 2), chest wall (n = 3), and lung parenchyma (n = 1). Pain was the most common presenting symptom. All patients underwent curative (R0) surgical resection. Surgical approaches included VATS (n = 4), RATS (n = 1), thoracotomy (n = 3), and modified open techniques (n = 6). No statistically significant association was found between tumor location and complication rates, surgical method, or length of hospital stay. No recurrences were observed during a mean follow-up period of 48 months. Although rare, atypically located thoracic schwannomas should be considered in the differential diagnosis of intrathoracic masses. With accurate preoperative imaging and proper surgical planning, these lesions can be safely and completely resected, resulting in favorable clinical outcomes.