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Background Cochlear implants (CIs) have made it possible to significantly improve hearing in people with profound hearing loss. Although, cochlear implants are considered a safe procedure, this minimally invasive surgery has an overall complication rate of 12.5%. With Gusher (cerebrospinal fluid outflow) considered a common intraoperative complication of cochlear implants. Methods In this retrospective study, clinical files of patients with severe to profound sensorineural hearing loss who had undergone cochlear implantation were retrospectively reviewed. We calculated the incidence and risk factors of gusher and management options used . Statistical analysis included non-parametric tests and multivariate ordinal logistic regression to explore predictors of CSF leak intensity. Results 1050 patients with profound hearing loss who underwent CI, 21 of whom had an intraoperative cerebrospinal fluid (CSF) leak, i.e. 2%, with a mean age of 3.5 years, and a sex ratio of 0.62, i.e. 62% female and 38% male. 43% of patients with gusher had structural abnormalities on their CT scan. Dilatation of the vestibule and vestibular aqueduct, as well as Mondini dysplasia, were the most common anomalies in Gusher patients. Younger implantation age was the only factor associated with higher CSF leak intensity in univariate analysis, but no independent predictors were identified in multivariate analysis. Conclusions Advancements in surgical techniques, radiological assessments, and technological innovation have significantly reduced cochlear implant–related complications, leading to a decreased risk of cerebrospinal fluid leakage incidents.

Background Assessment of surgical complications is an important part of quality control on departments of otorhinolaryngology and head and neck surgery. Nevertheless, standardized assessment of surgical complications with easy-to-use instruments is not yet clinical routine. Methods Data from all 1,465 otorhinolaryngology and head and neck surgeries (male 60.3%; median age: 52 years) performed in 2020 at a department of otorhinolaryngology of a tertiary university hospital were analyzed. The postoperative complications were graded with the Clavien–Dindo classification (CDC). Results The most frequent types of surgery were: diagnostic endoscopy (19.4%), ear surgery (14.8%) and oral/pharyngeal surgery (12.1%). Two-hundred seven patients (14.1%) had CDC complications, mostly CDC grade II (6.9%) and CDC grade III (5.1%). Due to multivariate analysis, smoking was an important predictor of postoperative CDC complication (Odds ratio [OR] = 1.526; confidence interval [CI] = 1.037 to 2.244). The risk of re-admission was higher for patients with postoperative complications (OR = 2.859; CI = 2.119 to 3.8591). Compared to a diagnostic endoscopy, the incidence of postoperative complications was highest for esophageal surgery (highest risk: OR = 23.580; CI = 7.619 to 72.978), thyroid surgery (second highest risk: OR = 21.060; CI = 4.838 to 91.665), and salivary gland surgery (OR = 15.330; CI = 5.215 to 45.070). Conclusions The CDC grading is a useful tool for grading all kind of otorhinolaryngology and head and neck surgery complications. CDC is well suited for comparing different types of otorhinolaryngology and head and neck surgeries with each other and also patients of different hospitals.

Objective To systematically evaluate the performance and applicability of risk prediction models for complications after flap repair and to provide guidance for building and refining models. Methods PubMed, Embase, Web of Science, the Cochrane Library, CNKI, SinoMed, VIP and Wanfang were searched for studies on risk prediction models for flap complications. The search period is from inception to December 28, 2024. The PROBAST tool was used to evaluate the quality of the prediction model research, and Stata 18 software was employed to meta-analyze the predictors of the models. Results A total of 16 studies were included, 28 risk prediction models were constructed, and the area under the receiver operating characteristic curve (AUC) ranged from 0.655 to 0.964, with 16 prediction models performing well (AUC > 0.7). Eleven articles underwent model calibration, 16 were validated internally, and 3 were validated externally. The results of the PROBAST review revealed that all 16 studies were at high risk of bias. The incidence rate of flap complications was 14.8% (95% CI, 10.7 − 19.0%). Body mass index (BMI), smoking history, long flap reconstruction time, diabetes mellitus, hypertension, and postoperative infection were independent risk factors for complications after flap repair ( P  < 0.05). Conclusion The risk prediction model for complications after flap repair has certain predictive value, but the overall risk of bias is high, and there is a lack of external validation; thus, it needs to be further enhanced and optimized to increase its prediction accuracy and clinical practicability.

Tracheocutaneous fistula (TCF) is a common complication following tracheostomy tube removal. Although persistent TCF is not life-threatening, it profoundly compromises the quality of life for patients, leading to functional, aesthetic and psychosocial challenges. Numerous surgical techniques for the closure of TCFs have been documented in the literature, however, these methods are often associated with varying degrees of postoperative complications and suboptimal success rates. To address these limitations and enhance the efficacy of the TCF repair, we developed an innovative approach utilizing the double-layer hinged skin flap, aiming to minimize complications and optimize closure success rates. This retrospective study, conducted between 2019 and 2024, included 18 patients who underwent surgical closure of TCFs using the proposed technique. The surgical technique involves the creation of non-overlapping double-layer hinged skin flaps around the TCF, which are then meticulously positioned to achieve complete closure of the tracheostomy site. All cases achieved successful closure of the TCFs with outstanding cosmetic outcomes. The procedure is both safe and straightforward, offering a feasible and advantageous novel approach for managing TCFs in clinical practice.

Objective The objective of this study was to identify the perioperative risk factors associated with postoperative pulmonary complications (PPCs) following emergency surgery for Acute Type A Aortic Dissection (ATAAD) and to evaluate the impact of these complications on short- and long-term patient outcomes. Methods A retrospective observational analysis was conducted on 750 adult patients who underwent emergency surgery for ATAAD between January 2017 and December 2019. Results The overall in-hospital mortality was 5.7%. Among 750 patients, 91 patients(12.1%) developed PPCs. Multivariable logistic regression analysis indicated that smoking(OR = 2.212, 95%CI: 1.361–3.595, P  = 0.001), previous cardiac surgery(OR = 2.818, 95%CI: 1.259–6.310, P  = 0.012), CPB time(OR = 1.003, 95%CI: 1.000–1.006, P  = 0.047), and red blood cell transfusion(OR = 1.091, 95%CI: 1.059–1.124, P  < 0.001) were associated with an increased risk of developing PPCs. Patients who developed PPCs had a higher 30-day mortality rate ( P  < 0.001), longer lengths of stay in the ICU and hospital( P  < 0.001), increased healthcare costs( P  < 0.001), and lower long-term survival rates( P  = 0.005). Conclusion The incidence of PPCs is high in patients undergoing cardiac surgery for aortic dissection, adversely affecting their prognosis. This study identified four key risk factors associated with the development of PPCs.

Purposes Postoperative infections are the common cause of morbidity and mortality in colorectal surgery. Calprotectin, an S100 protein, may be a potential marker. The aim was to define the postoperative course (PC) of calprotectin in serum (CIS), compared to white blood cell (WBC), C-reactive protein (CRP), lactate and procalcitonin (PCT). Methods This prospective, single-center study measured all biomarkers preoperatively, on the first, third and fifth postoperative days (POD). The endpoint was the PC of CIS compared to the WBC, CRP, PCT, and lactate. CIS between benign and malignant disease and between patients with and without complications was compared. Also a correlation was carried out. Results 56 patients (14 rectum, 42 colon) were included. The postoperative CIS increased to preoperative values ( p  < 0.05). The preoperative CIS in malignant disease was higher ( p  < 0.05). CIS on the first and fifth POD was higher in the group with complications ( p  < 0.05). CIS and CRP, WBC and CRP on the third POD ( p  < 0.05) correlate in complications . Conclusion We present the normal course of CIS and its potential function as a marker for systemic inflammation. We showed that postoperative CIS were significantly higher in complications. Although our study has several limitations, - namely a small sample size and heterogeneous surgical procedures -, serum calprotectin may be an interesting biomarker for future larger studies, particularly due to its increased specificity for intestinal inflammation. Trial registration This study is prospectively registered in DRKS-ID (Deutsches Register Klinischer Studien, German WHO Register): DRKS00027142, data of registration 29.11.2021. This is a WHO-recognized primary registry that meets the requirements of the International Committee of Medical Journal Editors (ICMJE). We registered this study in the DKG (Deutsche Krebsgesellschaft) Sudybox ST-D512, data of registration 11.03.2022.

Objective To retrospectively analyze the repair of seven cases of complicated pharyngocutaneous fistula (PCF) to provide a reference for the treatment of complicated PCF. Methods We retrospectively analyzed the clinical data of seven patients with complicated PCF from February 2017 to December 2021, including six males and one female, with a history of neck radiotherapy in two cases. The range of PCF mucosal defects was 1.0 cm × 2.0–5.0 cm × 7.0 cm. A pedicled flap or free flap was chosen for repair depending on the site and size of the defect. A total of eight flaps were used to repair complicated PCF defects. Results One of the seven patients healed after conservative treatment. Among the five patients who underwent pedicled flap repair, three had first-intention healing, one had second-intention healing, and one had tumor recurrence with unhealed PCF. Free flap repair was performed in one case, which had first-intention healing. Conclusion Early, prompt, and appropriate treatment can prevent a PCF from progressing to complicated PCF. The repair of the complicated PCF needs to be individualized according to the patient’s local defect and the surgeon’s clinical experience.

Perioperative hypothermia is a frequent clinical complication resulting from the cold environment of the operating room and prolonged skin exposure, leading to adverse outcomes and increased healthcare burdens. To address this issue, this narrative review discusses in detail the currently common warming strategies for perioperative hypothermia .Forced air warming (FAW) systems are widely recognized as the most effective intervention for maintaining core body temperature. Additionally, alternative technologies, such as circulating-water mattresses, carbon-fiber resistive heating systems, self-regulated heated air garments, self-heating blankets, and chemical heat packs, offer diverse advantages and disadvantages. Passive warming methods, including thermal reflective blankets and cotton blankets, provide a cost-effective solution, albeit with reduced efficacy compared to active warming measures. Recent advancements have focused on improving both active and passive warming approaches to balance effectiveness and cost-efficiency. While FAW remains the gold standard, other systems offer specific benefits, such as improved portability and reduced costs, making them suitable for use in diverse clinical scenarios. Effective perioperative temperature management reduces hypothermia-related complications, decreases healthcare expenditures, and provides substantial social and organizational benefits. Thus, selecting the most appropriate warming intervention in clinical practice requires a tailored approach, considering both patient-specific needs and resource availability.

Background Surgical site infection (SSI) is a common complication following open appendectomy, particularly in low and middle income countries. Intraoperative wound irrigation with antibiotic solutions has been used as a preventive strategy, though its efficacy remains debated. Objective To evaluate the effectiveness of intraoperative wound irrigation using a combination of ceftriaxone and metronidazole in reducing SSIs after open appendectomy, compared to normal saline irrigation. Methods A double-blind randomized controlled trial was conducted between July 2023 and December 2024 at Abu Ghraib General Hospital. A total of 410 patients aged 15–50 years with acute appendicitis undergoing open appendectomy were randomized into two groups. The experimental group received layer by layer irrigation with ceftriaxone and metronidazole, while the control group received saline irrigation. Postoperative follow-up was conducted on days 10, 15, and 30 to assess the incidence of SSIs using CDC criteria. Results There was no statistically significant difference in SSI rates between the experimental and control groups (4.1% vs. 6.6%; p  = 0.278). Among patients with perforated appendices, SSI rates remained statistically insignificant between the two groups. Preoperative CRP and WBC levels were significantly higher in patients who developed SSIs ( p  < 0.0001). No significant difference was observed in hospital stay duration between the groups. Conclusion Intraoperative wound irrigation with ceftriaxone and metronidazole did not significantly reduce SSI incidence compared to saline irrigation in open appendectomy. Routine use of antibiotic irrigation may not be justified. Trial registration : The study was retrospectively registered with the International Standard Randomised Controlled Trial Number (ISRCTN) registry under the registration number ISRCTN19878512 on 19 May 2025.

Background Lung cancer is the world’s deadliest cancer, and surgery offers cure for over 75% of patients. However, postoperative delirium (POD) impairs recovery, accelerates cognitive decline, and increases mortality. Despite evidence that multicomponent prevention can avert 30–40% of POD, its incidence and predictors in lung cancer surgery remain under-studied. Methods We conducted a retrospective cohort study of adults (≥ 18 years) undergoing elective lung cancer surgery resection from 2010 to 2019 using the U.S. National Inpatient Sample. Emergency admissions, rib fractures, and preexisting delirium or dementia were excluded. POD was identified by ICD-9/10 codes. We extracted demographics, comorbidities, perioperative complications, length of stay, and costs. Wilcoxon rank-sum and χ² tests compared groups, and univariable and multivariable logistic regression—with stepwise selection and Bonferroni correction—identified independent POD predictors. Analyses were performed in R, with P  < 0.05. Results Among 30,813 resections, 1,499 patients (4.86%) developed POD. Age ≥ 71 years (OR 2.10; 95% CI 1.75–2.51) and 61–70 years (OR 1.59; 1.35–1.88), female sex (OR 1.12; 1.01–1.24), teaching-hospital status (OR 1.38; 1.21–1.57), and more extensive resections (lobectomy OR 1.43; 1.28–1.60; pneumonectomy OR 2.58; 2.06–3.23) increased POD risk, whereas urban hospitals were protective (OR 0.71; 0.55–0.91). Preoperative neurological disorders (OR 5.62; 5.02–6.29), psychoses (OR 1.62; 1.35–1.95), fluid–electrolyte disorders (OR 1.27; 1.14–1.42), and hypertension (OR 1.21; 1.08–1.36) were independent predictors. Postoperative arrhythmia, deep-vein thrombosis, stroke, shock, urinary infection, and hypoxemia further elevated risk; chronic pulmonary disease and respiratory failure were protective. Conclusions POD complicates nearly 5% of lung cancer resections. Key demographic, clinical, and institutional factors identify high-risk patients who may benefit from targeted, multicomponent prevention strategies in thoracic surgery.