BMC Surgery最新文献

{"title":"Incidence rates of post-pancreatectomy complications are similar between octogenarians and non-octogenarians and decrease after minimally invasive pancreatic surgery : a retrospective cohort study.","authors":"Ryo Saito, Hidetake Amemiya, Wataru Izumo, Yuuki Nakata, Takashi Nakayama, Kazunori Takahashi, Suguru Maruyama, Koichi Takiguchi, Katsutoshi Shoda, Kensuke Shiraishi, Shinji Furuya, Yoshihiko Kawaguchi, Hiromichi Kawaida, Daisuke Ichikawa","doi":"10.1186/s12893-025-03184-1","DOIUrl":"10.1186/s12893-025-03184-1","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the incidence of postoperative complications following pancreatectomy in octogenarians.</p><p><strong>Methods: </strong>This study included 291 patients who underwent pancreatic surgery (pancreatoduodenectomy [PD] or distal pancreatectomy [DP]) between 2019 and 2024 in a Japanese University Hospital. Perioperative outcomes were compared between octogenarians and non-octogenarians. The primary outcomes included the risk factors (including age) and incidence rates for postoperative complications. In addition, 1:3 propensity score matching (PSM) was conducted with standardized patient and perioperative factors, and the incidence of postoperative complications was compared. Finally, the clinical characteristics of octogenarians and non-octogenarians in open surgery and minimally invasive pancreatic surgery (MIPS) were compared.</p><p><strong>Results: </strong>The median age was 82.0 and 71.0 years for octogenarians (n = 33) and non-octogenarians (n = 258). We found that a high body mass index (BMI) value, PD, laparotomy, high intraoperative blood loss (IBL) (≥ 320mL), and long operative times were associated with the incidence of postoperative complications in univariate analysis, although patient age (octogenarians) was not significantly correlated. PSM showed that the incidence of postoperative complications was similar between octogenarians and non-octogenarians. MIPS led to similar or lower postoperative complication rates in octogenarians compared with non-octogenarians, and both rates were notably lower than those in laparotomy.</p><p><strong>Conclusion: </strong>Although this study was retrospective, single-center, and with small number of octogenarians, the incidence of postoperative complications after pancreatectomy might not be higher in octogenarians than in non-octogenarians, and it could be reduced with MIPS.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"432"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' experiences of thirst in the perioperative period: a phenomonological study.","authors":"Hatice Özsoy, Gönül Kara Söylemez","doi":"10.1186/s12893-025-03174-3","DOIUrl":"10.1186/s12893-025-03174-3","url":null,"abstract":"<p><strong>Background: </strong>Thirst is a common symptom among surgical patients and an important symptom affecting patient comfort. Thirst in the perioperative period is often described by patients as a more uncomfortable experience than pain or hunger. This study was conducted to determine the thirst experiences of surgical patients in the perioperative period.</p><p><strong>Methods: </strong>In this study, the phenomenological design within the qualitative research model was used. The study was conducted in the general surgery clinic of a university hospital between January 01, 2025 and April 01, 2025. The sample of the study consisted of 13 patients who underwent surgical intervention and the participants were selected by purposive sampling method. The research data were collected using the Patient Introduction Form, Data Collection Form for the Surgical Period and Semi-structured Interview Form. Qualitative data were analyzed using Colaizzi's seven-step method.</p><p><strong>Results: </strong>As a result of the study, five main themes and a total of 12 sub-themes were identified: \"thirst feeling\", \"thirst effect\", \"reaction to thirst\", \"thirst period\" and \"severity of thirst\". In the individual interviews with the patients, it was found that the patients generally expressed that they physically experienced dry mouth, lips, palate and throat, and emotionally they felt stress, anxiety and restlessness.</p><p><strong>Conclusions: </strong>Thirst in the perioperative period caused patients to experience not only physiologic but also emotional discomfort and negatively affected their overall experience of the surgical process. Accordingly, it is recommended that healthcare professionals adopt an approach that is sensitive to both physiological symptoms and emotional needs.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"441"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a nomogram for predicting high-risk pathology in clinical stage lA left upper lobe lung adenocarcinoma.","authors":"Defeng Luo, Kunsong Su, Yu Han, Qiduo Yu, Hongxiang Feng, Chaoyang Liang, Weijie Zhu","doi":"10.1186/s12893-025-03149-4","DOIUrl":"10.1186/s12893-025-03149-4","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative identification of high-risk pathological features in early-stage lung adenocarcinoma is critical for guiding surgical decisions and improving patient outcomes. This study aimed to develop and validate a nomogram to predict high-risk pathology in clinical stage IA lung adenocarcinoma located in the left upper lobe (LUL), an anatomical site with distinct surgical implications.</p><p><strong>Methods: </strong>We retrospectively reviewed 545 patients with clinical stage IA LUL adenocarcinoma who underwent surgery between January 2018 and May 2022. The cohort was randomly divided into training (80%) and validation (20%) sets. Independent predictors were identified via multivariate logistic regression and further validated using LASSO regression. A nomogram was constructed and evaluated using ROC curves, calibration plots, decision curve analysis (DCA), and bootstrap resampling.</p><p><strong>Results: </strong>High-risk pathology, defined by the presence of solid/micropapillary predominant patterns, complex glandular architecture, STAS, or LVI, was observed in 19.1% of patients. Four independent preoperative predictors were identified: elevated CEA levels, larger CT-measured tumor size, invasive histology on frozen section, and higher mean CT value. The nomogram demonstrated excellent discriminative ability, with AUCs of 0.837 in the training set and 0.865 in the validation set. Internal validation by bootstrap resampling confirmed model stability.</p><p><strong>Conclusion: </strong>The proposed nomogram integrates routinely available clinical, radiologic, and intraoperative variables to enable individualized preoperative risk assessment for high-risk pathology in stage IA LUL adenocarcinoma. This tool may assist surgeons in tailoring surgical approaches and identifying patients who may benefit from more extensive resection or adjuvant therapy. Prospective external validation is required to confirm generalizability.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"437"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and feasibility of the bowel-first versus conventional approach in intra-abdominal penetrating Crohn's disease: a propensity score-matched study.","authors":"Weilin Qi, Wei Liu, Xiaolong Ge, Wei Zhou","doi":"10.1186/s12893-025-03190-3","DOIUrl":"10.1186/s12893-025-03190-3","url":null,"abstract":"","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"445"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment tool for surgical hand washing skills: a scale development study.","authors":"Kübra Şengör, Hatice Merve Alptekin, Öykü Kara, Rabia Görücü, Tuluha Ayoğlu, Nuray Akyüz","doi":"10.1186/s12893-025-03192-1","DOIUrl":"10.1186/s12893-025-03192-1","url":null,"abstract":"<p><strong>Purpose: </strong>Valid and reliable assessment tools are essential for evaluating surgical hand washing skills, which play a crucial role in preventing surgical site infections. This study aimed to develop and validate an objective assessment tool for evaluating surgical hand washing competency among nursing students.</p><p><strong>Design: </strong>Methodological validation study.</p><p><strong>Methods: </strong>This study was conducted between November and December 2023 at Istanbul University-Cerrahpaşa with 105 second-year nursing students enrolled in surgical nursing courses. Data were collected using a 13-item Assessment Tool for Surgical Hand Washing Skills (ATSHWS) and demographic questionnaire. Content validity was established through expert review, and reliability was assessed through inter-observer agreement and test-retest analysis.</p><p><strong>Findings: </strong>Content validity was excellent (CVI: 0.976). Inter-observer reliability demonstrated strong agreement (ICC: 0.951, p<0.001), and test-retest reliability confirmed temporal stability.</p><p><strong>Conclusions: </strong>The ATSHWS provides a valid and reliable method for objectively evaluating surgical hand washing skills among nursing students and may be useful for educational assessment and quality improvement initiatives.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"443"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the efficacy of drug-coated balloons in the treatment of venous stenosis in hemodialysis access.","authors":"Jian Huang, Dayong Zhou, Xiao Wang, Yuqi Zeng, Guijun Huo","doi":"10.1186/s12893-025-03182-3","DOIUrl":"10.1186/s12893-025-03182-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficacy of drug-coated balloon (DCB) and conventional balloon (CB) in the treatment of venous stenosis in hemodialysis access.</p><p><strong>Method: </strong>The clinical data of 403 hemodialysis patients with arteriovenous fistula stenosis who were admitted to our hospital from November 1, 2020 to January 1, 2024 were retrospectively analyzed and divided into DCB group (n = 163) and CB group (n = 240). The Kaplan-Meier curve was used to evaluate the target lesion primary patency (TLPP) of the two groups. The primary endpoint was the primary patency rate of target lesions 12 months after surgery, and the secondary endpoints were the primary patency rates of target lesions 6 months, 18 months, and 24 months. Cox proportional hazard models were applied to explore the association between DCB and the risk of hemodialysis access dysfunction.</p><p><strong>Results: </strong>The primary patency rate of target lesions in DCB group was higher at 6 months, 12 months, 18 months and 24 months, and the difference was statistically significant at 6 months (85.0% VS 69.3%, P = 0.0109) and 12 months (64.6% VS 38.0%, 0.0300).There was no significant difference at 18 months (36.9% VS 14.9%, P = 0.1475) and 24 months (23.1% VS 7.5%, P = 0.5091). The median survival time of DCB group was 449 days, and that of CB group was 270 days. The patency time of DCB group was significantly higher than that of CB group (P < 0.0001). After full covariate adjustment, the analysis revealed that patients in DCB group (HR: 0.34, 95% CI: 0.16, 0.70) had a significantly lower risk of hemodialysis access dysfunction compared to those in CB group.</p><p><strong>Conclusion: </strong>The results show that compared with CB, DCB can obviously improve the primary patency rate of target lesions with vascular access stenosis in hemodialysis and reduce the re-intervention of target lesions, which is an effective and safe treatment for hemodialysis patients.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"436"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic nutritional index (PNI) for predicting perioperative complications after tuberculous constrictive pericarditis surgery: a single-center retrospective study.","authors":"Qiuyi Cai, Jing Guo, Zhengkai Zhao, Lijuan Zhang, Shuangshuang Yan, Li Zhang, Shuzhen Wang, Qiuyu Xiao, Jin Gao, Feng Xiong","doi":"10.1186/s12893-025-03170-7","DOIUrl":"10.1186/s12893-025-03170-7","url":null,"abstract":"<p><strong>Background: </strong>Perioperative complications following pericardiectomy in patients with constrictive pericarditis can significantly affect cardiac function recovery and postoperative outcomes. The prognostic nutritional index (PNI), a well-established nutritional marker, has been shown to predict outcomes in various diseases. However, its role as a predictive factor in patients with tuberculous constrictive pericarditis undergoing pericardiectomy remains unclear. This study aimed to evaluate the association between preoperative PNI and adverse perioperative outcomes in this patient population.</p><p><strong>Methods: </strong>This retrospective cohort study included 158 patients with tuberculous constrictive pericarditis who underwent pericardiectomy between January 2016 and June 2024. Preoperative PNI was calculated using the formula: (10 × serum albumin [g/dL]) + (0.005 × total lymphocyte count [cells/mm³]). The optimal PNI cutoff value was determined via ROC curve analysis, and patients were categorized into two groups: PNI ≥ 36.11 and PNI < 36.11. Univariate and multivariate logistic regression analyses were performed to assess the association between PNI and adverse perioperative outcomes.</p><p><strong>Results: </strong>Of the 158 patients, 67.7% had a PNI < 36.11. Significant differences were observed between the two groups in hemoglobin levels, platelet count, C-reactive protein, indirect bilirubin, lactate dehydrogenase, cholinesterase, B-type natriuretic peptide (BNP), D-dimer, positive ventricular septal bounce sign, pericardial calcification, pericardial effusion, and pleural effusion. Patients with PNI < 36.11 experienced longer total and postoperative hospital stays. The incidence of adverse perioperative events was 76.6% (82/107) in the PNI < 36.11 group. Both univariate logistic regression (OR = 4.324, 95% CI: 2.12-8.816) and multivariate logistic regression (OR = 3.586, 95% CI: 1.523-8.444) confirmed that lower PNI was significantly associated with increased adverse perioperative outcomes.</p><p><strong>Conclusion: </strong>A lower preoperative PNI is strongly associated with a higher incidence of adverse perioperative outcomes in patients undergoing pericardiectomy for tuberculous constrictive pericarditis. As a reliable indicator of preoperative nutritional status, PNI can serve as an independent risk factor and a modifiable clinical parameter to reduce adverse outcomes.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"446"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of refractory ischemic-side aneurysms in chronic internal carotid artery occlusion: insights from cases unfit for endovascular treatment.","authors":"Xiangping Zhong, Zhongying Ran, Weidong Xia, Meng Zhang, Maohua Ding, Lijin He, Xiaoguang Tong","doi":"10.1186/s12893-025-03155-6","DOIUrl":"10.1186/s12893-025-03155-6","url":null,"abstract":"<p><strong>Background: </strong>Managing ipsilateral intracranial aneurysms (IAs) in chronic internal carotid artery occlusion (ICAO) is surgically challenging, particularly when endovascular treatment is not viable. This study delineates patient characteristics, individualized microsurgical strategies, and outcomes.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients with chronic ICAO and ipsilateral IAs treated between 2015 and 2023. Based on surgical stroke risk, patients were stratified into low- and high-risk groups and received individualized treatments, including aneurysm clipping, external carotid artery-radial artery-middle cerebral artery (ECA-RA-MCA) or superficial temporal artery-middle cerebral artery (STA-MCA) bypass, or combined procedures. Outcomes were assessed via angiography and the modified Rankin Scale (mRS).</p><p><strong>Results: </strong>The cohort included 14 patients (mean age 50.56 ± 15.69 years) with 17 aneurysms. Symptoms included subarachnoid hemorrhage (SAH, n = 5) and cerebral ischemia (n = 5), among others (n = 4). ICAO was right-sided (n = 6), left-sided (n = 7), bilateral (n = 1); atherosclerosis was the main cause (n = 11). Most aneurysms were saccular (n = 12) and irregular (n = 4) morphologies (mean diameter 5.38 ± 2.75 mm), located within the ipsilateral circle of Willis. Cerebrovascular abnormalities such as stenosis, agenesis, and tortuosity were frequently observed. Atherosclerosis was the predominant etiology (n = 11). Circle of Willis compensation patterns were type I (n = 3), II (n = 5), III (n = 4), and IV (n = 2). Collateral flow grades were: grade 4 (n = 2), grade 3 (n = 4), grade 2 (n = 5), and grade 1 (n = 3). In the low-risk group (n = 10), 7 received STA-MCA bypass with clipping, 2 had bypass alone, and 1 underwent clipping only. In the high-risk group (n = 4), 3 underwent ECA-RA-MCA bypass with clipping, and 1 had bypass alone. One patient succumbed to death within 30 days postoperatively, one developed focal cerebral edema accompanied by ptosis, and one Manifested ipsilateral thalamic infarction. The 30-day stroke incidence was 7.14%, with an overall complication rate of 21.42%, CT-P/MR-P imaging demonstrates a perfusion improvement rate of 57.14%. Over a mean follow-up of 41.46 ± 26.82 months, bypass patency remained 100% (n = 10), ipsilateral stroke recurrence was 7.14%, and mRS scores improved. Clipped aneurysms (n = 11, 64.70%) resolved on imaging; untreated ones (n = 4, 23.52%) remained stable.</p><p><strong>Conclusions: </strong>In cases of chronic ICAO concomitant with ipsilateral IAs, a stratified approach based on surgical stroke risk factors, coupled with tailored bypass procedures and aneurysm clipping, represents a safe and effective strategy with promising clinical applicability for complex cases unfit for endovascular intervention.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"422"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecting pancreaticobiliary maljunction in pediatric congenital choledochal malformation patients using machine learning methods.","authors":"Yifeng Shao, Chengyang Jiang, Runmin Zhang, Kunpeng Yang, Chuanyu Yang, Chengji Dong, Yang Hong, Long Li, Mei Diao","doi":"10.1186/s12893-025-03154-7","DOIUrl":"10.1186/s12893-025-03154-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The presence of pancreaticobiliary maljunction (PBM) in pediatric patients with congenital choledochal malformation significantly impacts clinical management and surgical decision-making. Current preoperative evaluation of PBM coexistence remains challenging in children, while intraoperative cholangiography does not consistently provide diagnostic-quality imaging. This study aims to develop machine learning-based algorithm models for detecting pancreaticobiliary maljunction (PBM) in children with congenital choledochal malformation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective study utilizing data from patients with congenital choledochal malformation treated at our center between January 2019 and January 2024. Demographic characteristics, clinical features, and preoperative laboratory parameters were processed through rigorous data curation and feature engineering pipelines. Cases were allocated via random sampling into training (80%) and hold-out test (20%) cohorts, maintaining strict separation between training and test cohorts. Seven machine learning algorithms - Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF), eXtreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), Light Gradient Boosting Machine (LightGBM), and K-Nearest Neighbors (KNN) - were implemented with five-fold cross-validation. An ensemble voting classifier was specifically constructed using these models. Model performance was quantified through comprehensive metrics including area under the ROC curve (AUC), sensitivity, specificity, positive/negative predictive values, accuracy, precision, recall, and F1-score. This study employed the nonparametric bootstrap method to estimate the confidence interval for the area under the receiver operating characteristic curve (AUC). SHapley Additive exPlanations (SHAP) was employed for model interpretability, with feature importance rankings determined by absolute SHAP value magnitudes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In a cohort of 803 pediatric patients with congenital choledochal malformation, 628 (78.2%) demonstrated concurrent pancreaticobiliary maljunction. We developed a detection model incorporating 43 clinical features, with Random Forest showing optimal performance. An ensemble voting classifier integrating seven machine learning algorithms achieved enhanced discriminative performance (AUC: 0.87 (0.81, 0.92); Recall: 0.91 (0.85, 0.95); F1-score: 0.91 (0.87, 0.94)). Key features contributing to PBM detection included: laboratory markers and clinical parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;By integrating preoperative clinical symptoms and laboratory parameters, machine learning algorithms demonstrated significant detection capability in identifying PBM among pediatric congenital choledochal malformation patients, with the RF model achieving superior performance metrics among all base models. The developed ensemble voting classifier provides valu","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"424"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroidectomy for hyperthyroidism before the euthyroid state: is it safe?","authors":"Muhammer Ergenç, Sena Altunsu, Fatma Nazlı Zorlu, Ahmet Akmercan, M Ümit Uğurlu","doi":"10.1186/s12893-025-03195-y","DOIUrl":"10.1186/s12893-025-03195-y","url":null,"abstract":"<p><strong>Background: </strong>Guidelines generally recommend achieving a biochemically euthyroid state before thyroidectomy in patients with an indication for surgery to reduce the risk of thyroid storm. However, in real-world settings, this may not always be feasible. This study aimed to compare perioperative outcomes between biochemically controlled (normal fT3 and fT4) and uncontrolled (elevated fT3 and/or fT4) hyperthyroid patients undergoing thyroidectomy.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent thyroidectomy for hyperthyroidism at our institution between September 2020 and 2024. The demographic, perioperative, and postoperative data were collected. Patients with preoperative fT3 and/or fT4 levels above the institutional reference range were classified as uncontrolled, whereas those with both fT3 and fT4 levels within the reference range were considered controlled. The outcomes were compared between the controlled and uncontrolled groups.</p><p><strong>Results: </strong>A total of 110 patients were included: 92 (83.6%) in the controlled group and 18 (16.4%) in the uncontrolled group. Patients in the uncontrolled group were significantly younger (median age 33.5 vs. 49 years, p = 0.015). Graves' disease was more prevalent among uncontrolled patients (83.3% vs. 45.7%, p = 0.013). The use of Lugol's iodine (27.8% vs. 1.1%, p < 0.001) and steroids (38.9% vs. 6.5%, p < 0.001) was significantly higher in the uncontrolled group than in the control group. Operative times and complication rates-including transient/permanent hypocalcemia, recurrent laryngeal nerve palsy, and neck hematoma-did not significantly differ between the groups.</p><p><strong>Conclusions: </strong>Despite the presence of biochemical hyperthyroidism, no thyroid storm occurred in our cohort, and complication rates were comparable between groups. These findings suggest that thyroidectomy may be performed in selected patients without full biochemical control, particularly in urgent situations or in high-volume centers with experienced surgical teams. However, biochemical euthyroidism remains the standard of care, and our results should be interpreted cautiously given the small sample size and single-center setting.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"440"},"PeriodicalIF":1.8,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}