Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"When to refer for surgery in long bone metastases: A powered multivariate analysis of fracture risk and simple algorithm for referral for surgery (the metastatic fracture prediction met FRAP score).","authors":"Samantha Downie, Calum Sreenan, Alison Stillie, Matthew Moran, Pankaj Pankaj, Cathie Sudlow, Robert U Ashford, A Hamish Rw Simpson","doi":"10.1016/j.surge.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.001","url":null,"abstract":"<p><strong>Background: </strong>It is difficult to predict the risk of pathological fracture in patients with bone metastases. Popular scoring systems like Mirels' may overestimate need for surgery by 20%. The aim was to identify predictors of fracture at 6 months in patients with long bone metastases managed non-surgically.</p><p><strong>Patients and methods: </strong>This was an adequately powered retrospective analysis of individuals with a long bone metastasis. Patients were identified from radiology reports and excluded if they had prophylactic surgery or died within 3 months. A literature review and pilot study identified 13 variables of interest. Multivariate analysis was used to generate the metastatic fracture prediction (Met FRAP) score.</p><p><strong>Results: </strong>From 2009 to 2021 (13 years), 2142 patients with new long bone metastases were identified. 1577 were excluded, leaving a dataset of 565 lesions in 503 patients managed non-surgically. The cohort were 45% female with a mean age of 71 years. Median follow-up in living patients was 2 years (range 1-12 years). The metastatic fracture rate at 1 year was 26%. On multivariate analysis, independent predictors of metastatic fracture included cognitive impairment, metastatic load (p < 0.001 for both), primary cancer type (p < 0.01), radiotherapy, pain requiring opiates and radiographic appearance (p < 0.05 for all). These were used to generate the Met FRAP score. Met FRAP score predicted metastatic fracture at 6 months with 82% accuracy and was more sensitive and specific than Mirels score (61% accuracy, p < 0.001).</p><p><strong>Discussion: </strong>The Met FRAP score accurately predicts metastatic fracture at 6 months and appears to be more reliable than Mirels score.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Constructing surgical confidence through simulation: A qualitative exploration in orthopaedic training.","authors":"Tahir Khaleeq, Karam Ahmed, Umar Hanif","doi":"10.1016/j.surge.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.007","url":null,"abstract":"<p><strong>Background and purpose: </strong>Simulation-based training is widely used within surgical education. Although confidence is frequently evaluated as a post-training outcome, less attention has been given to how trainees experience confidence development in relation to preparedness for operative participation. This study explored how orthopaedic trainees develop confidence and perceived preparedness during simulation-based Dynamic Hip Screw (DHS) fixation training.</p><p><strong>Methods: </strong>A qualitative study was undertaken with ten Core Surgical Trainees (CT1-CT2) at a UK teaching hospital. Participants completed DHS fixation simulation using sawbone models and procedure-specific orthopaedic instrumentation, followed by a semi-structured focus group. Data were analysed using reflexive thematic analysis, with interpretation informed by Kolb's Experiential Learning Theory.</p><p><strong>Main findings: </strong>Four interconnected processes characterised confidence development: experiential learning through practice and decision-making, technical familiarity, collaborative learning, and authentic engagement. Participants described progressing from uncertainty towards greater procedural familiarity and perceived preparedness through repeated practice, feedback, reflection and social interaction. Confidence extended beyond technical performance to include procedural sequencing, decision-making, communication and anticipation of future operative participation. Simulation was regarded as preparation for, rather than a substitute for, supervised clinical experience.</p><p><strong>Conclusions: </strong>Procedure-specific simulation supported perceived preparedness for supervised operative participation through interacting technical, cognitive and collaborative learning processes. Its educational value may lie not simply in increasing confidence, but in supporting confidence grounded in procedural familiarity, feedback and authentic engagement.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic femoral fractures: Ten-year clinical experience using a fracture-specific fixation system: A retrospective study.","authors":"Alex Korosi, Kwame Buadooh, Omar El-Omar, Omar Ismail, Mohammad Tassadaq, Timothy Boddice, Aaron B Y Ng","doi":"10.1016/j.surge.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.003","url":null,"abstract":"<p><strong>Background: </strong>Incidence of periprosthetic femoral fractures (PFFs) is increasing with rising use of hip and knee arthroplasty in the elderly population. These injuries require complex management and are associated with high morbidity and mortality.</p><p><strong>Aim: </strong>To evaluate outcomes and complications of PFFs in 111 patients treated with Zimmer Biomet Non-Contact Bridging (NCB) plating over a 10-year period.</p><p><strong>Methods: </strong>Retrospective analysis of 111 patients treated with NCB plating from 2012 to 2022 at a single UK centre was conducted. Fractures were classified by the Unified Classification System (UCS). Data collection consisted of patient demographics, the type of fracture, and follow-up outcomes; primary outcomes were fracture union, implant failure, reoperation rates and mortality at 30 days and 1 year. Secondary outcomes included functional mobility and length of admission. Continuous and categorical variables were compared using Mann-Whitney U and Fisher's exact tests; predictors of non-union and mortality were examined using Firth's penalised logistic regression.</p><p><strong>Results: </strong>Median patient age was 81 years (age range was 43-100 years). Fractures involved 68 total hip replacements, 42 total knee replacements, 17 retained intramedullary nails, and one hip hemiarthroplasty. UCS types were A (n = 1), B1 (n = 49), B2 (n = 10), C (n = 34), and D (n = 14). Non-union occurred in 13% of assessable patients (n = 12) with seven patients requiring revision surgery. Mortality was 4.5% at 30 days and 14.4% at one year. At one year follow-up, 68% of patients had maintained or improved their mobility status compared to prior to their injury. Patient age, post operative weight bearing status, working length, ASA grade and UCS classification type bore no statistical significance when used as predictors for non-union, but cable use did.</p><p><strong>Conclusion: </strong>We continue to believe that the NCB plate remains an effective management strategy for PFFs and that some outcomes are more specifically related to the nature of the injury.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morbid obesity and lower limb arthroplasty - A national survey on consultant practice.","authors":"Conor J Kilkenny, Charles Timon, Kieran O'Sullivan, Conor Farrell, Niall P McGoldrick, May Cleary, John F Quinlan","doi":"10.1016/j.surge.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.surge.2026.09.002","url":null,"abstract":"<p><strong>Background: </strong>Rising obesity rates and increasing demand for total hip and knee arthroplasty (THA/TKA) pose growing challenges for orthopaedic services. Despite higher perioperative risk, there is no national guidance in Ireland on managing patients with morbid obesity (BMI >40) who require joint replacement. This study aimed to describe current practices in Ireland regarding the assessment of this patient group.</p><p><strong>Methods: </strong>A 17-question online survey was distributed to 60 consultant orthopaedic surgeons through the Irish Orthopaedic Training Association; 50 responded (83.3%).</p><p><strong>Results: </strong>The survey received 50 responses with experience ranges from 1 to 30 years (mean 12.9 years) at consultant level. While 66% of consultants would offer THA or TKA to patients with BMI >40, 34% would not. BMI cut-offs were frequently applied (70% for THA, 72% for TKA), most commonly at 40-45, whereas 28-30% reported no threshold. 26% sought a second opinion and 20% engaged in MDT discussion. Pre-operative optimisation was inconsistently available with 68% providing lifestyle advice themselves, none prescribed weight-loss medication, and 56% referred directly to bariatric services. Surgeons estimated a median deep infection risk of 5-6% for patients with BMI ≥40. Awareness of guidelines or local weight-management protocols was low (32% and 24% respectively).</p><p><strong>Conclusion: </strong>This national survey demonstrates substantial variation in how Irish orthopaedic consultants assess and optimise morbidly obese patients for hip and knee arthroplasty. Reliance on BMI cut-offs, inconsistent access to multidisciplinary input, and limited awareness of obesity-management guidelines contribute to fragmented care. A clearer national guidance policy and coordinated perioperative support may be beneficial to ensure equitable, evidence-based care for this high-risk population.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of frailty on 30-day outcomes for older emergency general surgery admissions in Irish hospitals - A multicentre snapshot prospective audit.","authors":"Megan Power Foley, Carolyn Cullinane, Mohamed Ismaiel, Michael Devine, Czara Kennedy, Áine O'Neill, Mohammed Al Azzawi, Éanna Ryan, Nicola Raftery, Conor Toale","doi":"10.1016/j.surge.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.surge.2026.08.006","url":null,"abstract":"<p><strong>Introduction: </strong>As the population ages, more older patients with complex comorbidities are presenting with acute surgical pathology. Frailty is strongly associated with higher complication rates, functional decline and healthcare costs. This prospective collaborative study assessed the impact of frailty on outcomes after emergency general surgery in patients aged ≥65 years to guide future service provision.</p><p><strong>Methods: </strong>Through the Irish Surgical Research Collaborative, approval was granted for prospective snapshot audit in eight Irish hospitals. For fourteen consecutive days, all emergency general surgery admissions ≥65 years were screened for frailty using the Clinical Frailty Score. Demographics, comorbidities and inpatient course at 30 days were compared between frail and non-frail patients using SPSS.</p><p><strong>Results: </strong>In 112 cal l sessions, 244 patients ≥65 years were admitted and 55.5% were frail (n = 134/241). Frail patients were significantly older (p < 0.001), with higher rates of multimorbidity (p < 0.001), polypharmacy (p < 0.001), and both physical (p < 0.001) and cognitive impairment (p < 0.001). Similar numbers of frail and non-frail patients underwent surgery under general anaesthesia, though proportionally more frail patients required ICU care post-op. Frailty was associated with significantly higher rates of all inpatient complications (p < 0.001), including nosocomial infection (p = 0.034), cardiac events (p = 0.026), delirium (p = 0.025) and death (p = 0.016). Frail patients required significantly more medical consults (p = 0.034), MDT input (p < 0.001) and increased home-care packages (p = 0.024). Frail patients had longer hospital stays (p = 0.033) and fewer discharges to home (p < 0.001).</p><p><strong>Conclusions: </strong>High levels of frailty and frailty-associated morbidity were noted amongst emergency surgical admissions. Collaborative pathways between surgeons and geriatricians may optimise outcomes in this high-risk cohort.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopy of femoroacetabular impingement and osteoarthritis: a systematic review.","authors":"Filippo Migliorini, Federico Cocconi, Tommaso Bardazzi, Julian Koettnitz, Gennaro Pipino, Nicola Maffulli","doi":"10.1016/j.surge.2026.07.004","DOIUrl":"https://doi.org/10.1016/j.surge.2026.07.004","url":null,"abstract":"<p><strong>Background and purpose: </strong>Although studies suggested an association between patient factors and various outcome measures in the surgical management of femoroacetabular impingement (FAI), there is a lack of consistent evidence of the influence of osteoarthritis (OA) in patients with FAI syndrome treated arthroscopically. This systematic review investigated the influence of OA on the outcome of arthroscopy for FAI.</p><p><strong>Methods: </strong>The present systematic review followed the PRISMA statement. Web of Science, PubMed, and Embase were accessed in June 2024. All the clinical investigations comparing the outcomes of arthroscopic FAI in patients with different OA stages according to the Tönnis classification were included.</p><p><strong>Main findings: </strong>Data from 1421 patients were retrieved, 52% of whom (552 of 1061) were women. The mean follow-up was 53.5 ± 34.5 months. The mean age was 37.5 ± 9.3 years, and the mean BMI was 25.7 ± 2.2 kg/m². No significant difference was evidenced in visual analogue scale (VAS), modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score - Activities of Daily Living (HOS-ADL), and modified Hip Outcome Score - Sport-Specific Subscale (HOS-SSS), rate of reoperation (P = 0.2), but a higher rate of progression to THA was evidenced in the groups with more advanced OA stages (P < 0.001).</p><p><strong>Conclusions: </strong>The clinical outcomes of patients who underwent arthroscopic surgery for FAI with Tönnis stages 0, I, or II were similar at approximately 54 months of follow-up. However, a higher rate of progression to THA was evidenced in the groups with more advanced OA.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of negative-pressure wound therapy with adjunctive silver nanoparticle spray in post-revascularization diabetic foot wounds: A randomized controlled trial.","authors":"Moustafa Mabrouk, Ahmed Fouda, Mohab Saeed, Reda Fawzy, Islam Atta","doi":"10.1016/j.surge.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.surge.2026.08.008","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot wounds persisting after successful revascularization are challenging to heal and prone to infection. Negative-pressure wound therapy (NPWT) facilitates granulation, while silver nanoparticles offer antimicrobial benefits; their combination may improve clinical outcomes.</p><p><strong>Objective: </strong>To compare the efficacy of NPWT with adjunctive silver nanoparticle spray versus standard NPWT alone in patients with post-revascularization diabetic foot wounds.</p><p><strong>Methods: </strong>This single-center, randomized, double-blinded controlled trial enrolled 115 patients with diabetic foot wounds following successful surgical or endovascular revascularization. Patients were randomized 1:1 to receive either NPWT with silver nanoparticle spray (Group A) or standard NPWT (Group B). Primary outcomes were the incidence and time to complete epithelialization over six months. Secondary outcomes included skin grafting, changes in wound dimensions, and infection rates.</p><p><strong>Results: </strong>A total of 100 patients (50 per group) completed the study. Complete closure was achieved in 74% of Group A versus 62% of Group B (p = 0.198). While the mean time to complete closure was similar between groups, the time to skin grafting was significantly shorter in the silver NPWT group (3.5 ± 0.3 vs. 4.1 ± 0.3 months; p = 0.001). Group A also showed significant reductions in wound area and depth at three and six months. Additionally, Group A had significantly lower systemic inflammatory markers (CRP and WBC) and a shorter mean hospital stay (5.6 ± 3.2 vs. 7.05 ± 4.0 days; p = 0.048).</p><p><strong>Conclusions: </strong>Adjunctive silver nanoparticle therapy with NPWT significantly reduced wound infection risk, accelerated wound reduction, and shortened the time to grafting and hospital stay, although it did not significantly alter ultimate closure rates. These findings support a selective, adjunctive role for silver nanoparticles in managing complex post-revascularization diabetic foot wounds.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Techniques of Laparoscopic Donor Nephrectomy in the United Kingdom: A narrative review.","authors":"Katie Nightingale, Josh Stephenson, Kamran Haq, Alistair Rogers, Rajesh Sivaprakasam, Kunal Bhanot, Frank J M F Dor, Hemant Sharma, Sanjay Mehra, Titus Augustine","doi":"10.1016/j.surge.2026.07.005","DOIUrl":"https://doi.org/10.1016/j.surge.2026.07.005","url":null,"abstract":"<p><p>Laparoscopic living donor nephrectomy, first carried out in 1995 by Lloyd Ratner, is now the established gold standard technique of donor nephrectomy globally and in the United Kingdom. Its minimally invasive nature with associated patient benefits, and concomitant excellent recipient outcomes underpin surgeon preference as the technique of choice in living kidney donation. There are 23 transplant centres in the United Kingdom currently offering laparoscopic donor nephrectomy. There are however variations in the laparoscopic approach amongst and within the different centres. These variations have evolved due to various centre-related factors, including local expertise, training, and the availability of specific instrumentation. This review discusses the five variations of laparoscopic donor nephrectomy currently offered in the United Kingdom. These techniques include: Totally laparoscopic donor nephrectomy (TLDN), hand-assisted laparoscopic donor nephrectomy (HALDN), Robotic-assisted donor nephrectomy (RADN), Hand assisted retroperitoneoscopic (HARP) donor nephrectomy and Laparoscopic retroperitoneal donor nephrectomy (RDN).</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metaplastic breast cancer: A single-centre retrospective experience.","authors":"Sadia Siddiky, Sarder Rizwan Nayeem, Neil R McLean, Magdi Youssef, Alex Humphreys","doi":"10.1016/j.surge.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.surge.2026.08.005","url":null,"abstract":"<p><strong>Background: </strong>Metaplastic Breast Cancer (MpBC) is a rare disease entity accounting for less than 1% of all breast cancers. There is limited data focusing on this aggressive disease. The aim of this study was to evaluate the incidence of MpBC at a UK centre and describe the demographic variables, clinical characteristics and treatment.</p><p><strong>Methods: </strong>Between 2017-2024, we have reviewed 23 patients diagnosed with histologically proven MpBC from the hospital cancer database.</p><p><strong>Results: </strong>A total of 2097 patients were diagnosed with breast cancer in our centre between 2017-2024, of which 23 patients were diagnosed with MpBC. The incidence was 1.1%. The median age at diagnosis was 71 years, the median tumour size at presentation was 5.2 cm and twenty (87%) patients had a Grade III tumour, while three (13%) patients were Grade II. Seventeen (74%) patients were triple negative. Histologically, the most common component of MpBC was purely squamous cell metaplasia found in eight patients. With regards to treatment, twenty-one patients had surgery whereas three patients received neoadjuvant chemotherapy. Eight patients had axillary lymph nodal involvement. Eight patients passed away due to various causes.</p><p><strong>Conclusion: </strong>Our incidence of MpBC is consistent with literature. MpBC is an infrequently encountered pathology where the current protocols are still under evaluation. Most patients have early disease progression and poor prognosis in comparison to other breast cancer subtypes. Further research and randomised control trials are needed to determine a gold standard treatment for this disease.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-Kidney-Metabolic (CKM) syndrome staging as a unified predictor of morbidity and mortality following pancreatic resection: A national cohort analysis.","authors":"Miri Elgabsi, Isis Abumouch, Veacheslav Zilbermints, Fadi Abu Baker, Rawi Hazzan, Ahmad Mahamid","doi":"10.1016/j.surge.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.surge.2026.08.007","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic resection is a profound physiologic stress test. Traditional risk assessment often focuses on procedure-specific technical failures, yet postoperative recovery depends heavily on a patient's systemic physiologic reserve. We evaluated the association between the American Heart Association's Cardiovascular-Kidney-Metabolic (CKM) syndrome framework and outcomes following pancreatic resection.</p><p><strong>Methods: </strong>This retrospective study utilized the National Inpatient Sample to identify patients undergoing pancreatectomy. Patients were stratified into three CKM stages (0/1, 2/3, and 4a/4b) using ICD-10-CM proxies. Primary outcomes included in-hospital mortality and major morbidity (Clavien-Dindo grade ≥ III); failure-to-rescue after systemic complications was evaluated as a secondary outcome.</p><p><strong>Results: </strong>Among 1162 patients, 22.9% were classified as CKM Stage 4a/4b. Systemic complications escalated significantly with advancing CKM stage, while the surgical/technical complication composite did not differ significantly across stages. CKM Stage 4a/4b was independently associated with major postoperative morbidity (aOR 2.63; 95% CI 1.71-4.05; P < .001) and prolonged length of stay (aOR 2.03; 95% CI 1.30-3.17; P = .002), but not in-hospital mortality (aOR 0.55; 95% CI 0.23-1.32; P = .182). Failure-to-rescue was not higher in CKM Stage 4a/4b after adjustment (aOR 0.47; 95% CI 0.20-1.08; P = .075).</p><p><strong>Conclusion: </strong>CKM staging identifies a clinically meaningful gradient of systemic vulnerability. Advanced CKM burden predicts major morbidity and high resource utilization, without an independent increase in in-hospital mortality or failure-to-rescue.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}