BMC Surgery最新文献

Objective: To identify independent risk factors for radial artery occlusion (RAO) after coronary angiography (CAG) and percutaneous coronary intervention (PCI), and to develop risk prediction models for CAG, PCI, and the overall population.

Methods: This retrospective study included 781 patients undergoing CAG or PCI. RAO occurrence was recorded. Baseline characteristics, intraoperative factors, and laboratory indicators were collected. Variables were screened using univariate logistic regression and LASSO regression. Independent risk factors were identified via multivariate logistic regression to develop nomogram prediction models. Model performance was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis.

Results: The overall RAO incidence was 8.32%, significantly higher in the CAG group than the PCI group (11.26% vs. 5.64%, P=0.007). Independent risk factors for RAO in the CAG group were female, elevated creatine kinase, multiple punctures, radial artery spasm, and puncture site pain, with BMI ≥25 kg/m² as a protective factor; in the PCI group, heart failure, multiple punctures, and puncture site pain, with elevated creatinine as a protective factor; in the overall population, smoking, heart failure, high CHA₂DS₂VASc score, multiple punctures, radial artery spasm, and puncture site pain, with BMI ≥25 kg/m² and elevated creatinine as protective factors. The prediction models demonstrated good discriminatory ability in each group (AUCs: 0.979, 0.921, and 0.951, respectively) and clinical utility.

Conclusion: Risk prediction models for RAO established in patients undergoing CAG, PCI, and the overall population can accurately identify high-risk patients, providing a reference for individualized clinical prevention and treatment. Multiple punctures, radial artery spasm, and puncture site pain are significant, modifiable risk factors.

Background: Aortoesophageal fistula (AEF) is a rare but invariably life-threatening conditio. The optimal treatment for AEF resulting from postoperative anastomotic leakage following esophageal cancer surgery remains a significant clinical challenge. Here, we report a detailed case of AEF caused by anastomotic leakage from a thoracic esophageal anastomosis after esophageal cancer resection, which was successfully managed with emergent thoracic endovascular aortic repair (TEVAR) for hemorrhage control, followed by elective surgical intervention comprising esophagogastric re-anastomosis and aortic fistula repair with a bovine pericardial patch. The patient achieved long-term survival.

Case presentation: A 68-year-old male underwent minimally invasive McKeown esophagectomy with intrathoracic esophagogastric anastomosis after neoadjuvant chemotherapy and immunotherapy for advanced esophageal squamous cell carcinoma (SCC). Postoperatively, the patient experienced fever followed by hematochezia and hematemesis. Emergency endoscopy was unsuccessful in controlling the active arterial bleeding at the inflamed anastomotic site. Enhanced CT angiography (CTA) did not reveal a definitive aortoesophageal fistula, and subsequent transarterial embolization of the right gastric artery (confirmed by procedural records) failed to control the condition. The patient developed hemorrhagic shock manifested by loss of consciousness and hypotension. A repeat enhanced CT scan revealed active contrast extravasation from the descending aorta into the gastric conduit. An emergency TEVAR was performed to stabilize the hemodynamics. On postoperative day 10, we performed surgical exploration, which confirmed resection of the esophagogastric anastomotic leak, direct repair of the aortic wall defect, and reconstruction via esophagogastric anastomosis with the remnant stomach. Intraoperatively, a stapler clip from previous endoscopic hemostasis was identified as the potential culprit for the fistula formation. Ten months after the onset of AEF, the patient continued chemotherapy and led a normal daily life.

Conclusion: This case underscores that TEVAR is an effective and life-saving hemostatic method for managing life-threatening hemorrhage from AEF. However, TEVAR alone cannot ensure long-term survival due to its inability to control the underlying infection and address the gastrointestinal defect. Long-term survival requires subsequent definitive surgical repair of both the esophageal and aortic components.

Objective: To compare the clinical outcomes of open reduction and internal fixation (ORIF) versus percutaneous multiple-trajectory screw fixation (PMSF) in the treatment of unstable pelvic fractures with severe polytrauma, and to provide a basis for optimizing surgical strategies.

Methods: A prospective study included 26 patients (January-July 2024) divided into ORIF (n = 15) and PMSF (n = 11) groups. ORIF used traditional open plating/screws, while PMSF employed fluoroscopy-guided minimally invasive screws.

Primary outcomes: operative time, blood loss, complications (infection, nerve injury), fracture reduction (Matta criteria), functional recovery (Majeed score).

Secondary outcomes: hospital stay, preoperative waiting time. Age, ISS, and Tile classification were controlled. SPSS 27.0 analyzed data (significance P < 0.05).

Results: The PMSF group demonstrated significantly shorter preoperative waiting times (124.09 ± 54.45 h vs. 260.67 ± 170.92 h, P = 0.018), less intraoperative blood loss (68.18 ± 49.96 mL vs. 510.00 ± 264.71 mL, P < 0.001), and shorter hospital stays (23.36 ± 8.64 days vs. 33.93 ± 12.54 days, P = 0.024) compared with the ORIF group. There were no significant differences in the rates of excellent/good fracture reduction (Matta criteria: PMSF 90.91% vs. ORIF 86.67%, P = 1.000) or 12-month Majeed scores (82.73 ± 7.89 vs. 75.40 ± 13.64, P = 0.125) between the two groups.

Conclusion: For patients with unstable pelvic fractures with severe polytrauma, PMSF offers a better minimally invasive treatment option over traditional ORIF in terms of reducing trauma and shortening rehabilitation periods, while achieving comparable fracture reduction quality and functional recovery. Therefore, PMSF can be considered a preferred choice for such cases.

Trial registration: This study was retrospectively registered. Chinese Clinical Trial Registry (ChiCTR2500110578; Registration date: 16/10/2025;PID:288327).

Background: Surgical resources are often shared across medical specialties, which can lead to conflicts over prioritisation during on-call hours. This study investigated factors contributing to inter-speciality conflict in the prioritisation of emergency surgical cases.

Methods: A survey on views of surgical urgency and prioritisation of 22 hypothetical cases was distributed to Swedish physicians involved in emergency surgery via posters in operating departments and administrative areas, and by email. The Kruskal-Wallis test and Dunn's post-hoc test were used to compare responses across specialties. Factors associated with daily conflicts were identified using logistic regression.

Results: Of 233 respondents, 201 (90%) reported sharing resources with other specialties. General surgeons (45%), orthopaedic surgeons (15%), and anaesthetists (15%) were the most represented. Over half reported insufficient resources for emergency surgery. Sixty-nine per cent perceived that other specialties over-prioritised their own patients. Thirty-nine respondents (17%) experienced daily conflicts over case prioritisation. Minor differences were observed in how respondents perceived their own prioritisation, that of other specialties, and the prioritisation of hypothetical cases. Daily conflicts were associated with concerns about compromised patient safety (odds ratio [OR] 8.05 and 95% confidence interval [CI] 1.6-63.5 for agreeing vs. strongly disagreeing/disagreeing), whereas greater perceived resource availability was associated with fewer conflicts (OR 0.68, 95% CI 0.48-0.96).

Conclusions: Perceived threats to patient safety and resource scarcity were associated with daily prioritisation conflicts. Although respondents frequently suspected over-prioritisation by other specialties, observed differences in prioritisation between the responsible specialty and others were small. Further research on shared prioritisation protocols and resource allocation, including international comparisons across health-care systems and cultures, is warranted.