Annali Italiani Di Chirurgia[JOURNAL]
Sun
200 papers
Multidisciplinary Team-Based Perioperative Care in Patients Undergoing Oblique Lumbar Interbody Fusion: Assessing Safety and Surgical Stress in Lumbar Degeneration.
Liu S, Liu Y
Ann Ital Chir · 2026 Mar · PMID 41834541 · Publisher ↗
AIM: This study aims to explore the effectiveness of the multidisciplinary team (MDT)-based perioperative care model in the surgical safety and stress response of patients undergoing oblique lumbar interbody fusion (OLIF...
AIM: This study aims to explore the effectiveness of the multidisciplinary team (MDT)-based perioperative care model in the surgical safety and stress response of patients undergoing oblique lumbar interbody fusion (OLIF) for lumbar degeneration (LDD), to provide an evidence-based reference to optimizing the nursing strategy during minimally invasive spine surgery. METHODS: This retrospective cohort analysis included 100 LDD patients who received OLIF in Beijing Tongren Hospital, Capital Medical University between May 2023 and March 2025. Patients were divided into two groups based on the nursing model: an MDT group (n = 51) and a conventional group (n = 49). The MDT group received an integrated, MDT-based care provided by a team of experienced surgeons, anesthesiologists, rehabilitation experts, nutritionists, and psychologists. The conventional group received traditional single-discipline nursing care. The primary outcome measures included: length of hospital stay (cumulative time from admission to discharge); perioperative safety outcomes (operative time, intraoperative blood loss, and complication rates); physiological and psychological stress responses, including C-reactive protein (CRP), cortisol levels, visual analogy scale (VAS) pain scores, Generalized Anxiety Disorder-7 (GAD-7), and Pittsburgh Sleep Quality Index (PSQI) scores; nursing quality (patient compliance and satisfaction); and short-term imaging indicators such as the 3-month lumbar fusion rate, oswestry disability index (ODI) scores, and the incidence of adjacent segment disease (ASD). RESULTS: Compared with the conventional group, the MDT group had significantly shorter operation time and less intraoperative blood loss ( < 0.05). However, there was no difference in the length of postoperative hospital stays between the two groups ( > 0.05). The incidence of postoperative complications was significantly lower in the MDT group than in the conventional group (13.72% . 28.57%, = 0.036). At postoperative days 1, 3, and 7, the MDT group had substantially lower CRP and Cortisol (Cor) levels than the conventional group ( < 0.05). Furthermore, at postoperative days 1 and 3, the MDT care group showed lower VAS and GAD-7 scores ( < 0.05). The PSQI was also lower in the MDT group at postoperative days 3 and 7 ( < 0.05). In terms of nursing quality, the team nursing compliance (TNC) rate and Nurse-Patient Communication Efficacy (NPCE) were higher in the MDT group than the conventional group ( < 0.05), along with a lower non-compliance rate (11.76% . 30.61%, = 0.021). Finally, patients in the MDT group reported greater nursing satisfaction than the conventional group (88.24% . 71.43%, = 0.036). The follow-up results showed that there was no difference in ASD between the two groups ( > 0.05), but the lumbar fusion rate was higher and ODI was lower in the MDT group ( < 0.05). CONCLUSIONS: In patients with lumbar degenerative diseases undergoing OLIF surgery, perioperative management based on a MDT was associated with improved short-term perioperative outcomes, including reduced surgical stress indicators, decreased postoperative pain and anxiety levels, and lower complication rates. These findings suggested that MDT-based management may be a feasible perioperative management strategy for OLIF, but further prospective studies with longer follow-up were needed.
Safety and Efficacy of Day-Case Versus Inpatient Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Retrospective Cohort Study.
He Q, Kong M, Jiang L
Ann Ital Chir · 2026 Mar · PMID 41834540 · Publisher ↗
AIM: This study aimed to evaluate the safety, clinical efficacy, and economic benefits of day-case endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in a Chinese population, and to compare these indicators...
AIM: This study aimed to evaluate the safety, clinical efficacy, and economic benefits of day-case endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in a Chinese population, and to compare these indicators between the day-surgery and traditional inpatient models. METHODS: This retrospective cohort study enrolled 80 CRS patients who underwent ESS. Patients were divided into a day-case group (n = 36) and an inpatient group (n = 44). Furthermore, perioperative indicators, hospitalization costs, follow-up costs, subjective symptoms (visual analogue scale [VAS] scores), and objective endoscopic findings (Lund-Kennedy scores) were assessed between the two groups over four weeks post-discharge period. RESULTS: The day-surgery group demonstrated significantly shorter preoperative waiting times (2.97 ± 0.96 hours vs 18.03 ± 4.47 hours, < 0.001) and hospital stays (0.52 ± 0.18 days vs 3.64 ± 0.90 days, < 0.001) compared with the inpatient group. Similarly, hospitalization costs were also lower in the day-case group (11,861.56 ± 3024.71 Yuan vs 29,061.75 ± 4603.45 Yuan, < 0.001, 1 USD = 7.2 CNY). There were no significant differences in surgical duration, Wong-Baker Faces Pain Score, follow-up costs, or the rate of postoperative adverse events between the two groups. Both groups showed significant and comparable improvements in VAS and Lund-Kennedy scores from baseline through four weeks post-discharge. CONCLUSIONS: Day-case endoscopic sinus surgery is comparable to inpatient surgery in terms of short-term safety and clinical improvement, while significantly shortening hospital stay and reducing hospitalization costs. However, given that this study is a retrospective study and may have selection bias, the above results should still be interpreted with caution.
Therapeutic Efficacy of Anterior-Middle-Posterior Approach Strengthened With ERAS and Internet+ in Elderly Patients With Hip Fractures: A Clinical Analysis.
Zhou X, Li L, Xi M … +5 more , Zhang B, Yue C, Cao J, Li X, Jia Y
Ann Ital Chir · 2026 Mar · PMID 41834539 · Publisher ↗
AIM: This study aims to investigate the therapeutic efficacy of combined anterior-mid-posterior approaches integrated with Enhanced Recovery After Surgery (ERAS) and enhanced management through Internet+ in elderly patie...
AIM: This study aims to investigate the therapeutic efficacy of combined anterior-mid-posterior approaches integrated with Enhanced Recovery After Surgery (ERAS) and enhanced management through Internet+ in elderly patients with hip fractures through clinical analysis. METHODS: This study employed a prospective quasi-experimental design. The research protocol was developed in December 2024, and complete clinical data were collected from the time of patient admission. A total of 166 cases of elderly patients with hip fractures who received surgical treatment in Dongying People's Hospital were selected. Patients who underwent surgical treatment from January to February 2025 were assigned to the control group ( = 90), whereas those receiving surgical treatment from March to April 2025 were designated to the intervention group ( = 76). Conventional diagnosis and treatment approaches were applied to the control group, while the anterior-middle-posterior approach strengthened with ERAS and Internet+ was applied to the intervention group. Between-group comparative analyses were performed for preoperative waiting time, incidence of complications at 3 months after discharge, quality-of-life scores, functional recovery scores, satisfaction, and self-care ability at 1 and 3 months after discharge. RESULTS: There was a statistically significant difference in preoperative waiting time between the two groups ( < 0.001). At 3 months after discharge, the complication rate in the intervention group was significantly lower than that in the control group (13.16% [10/76] vs 31.11% [28/90]; χ = 13.284, < 0.05). At 1 month and 3 months post-discharge, the intervention group demonstrated significantly higher quality of life scores, functional recovery scores, and self-care abilities compared to the control group (all < 0.05). Additionally, the overall satisfaction of patients in the intervention group was significantly higher than that of the control group. CONCLUSIONS: Enhanced with the ERAS concept and Internet+, the anterior-middle-posterior approach shortens preoperative waiting time, reduces complication incidence, improves quality of life, accelerates recovery of hip joint function, and enhances satisfaction levels in elderly patients with hip fractures, showing the potential for clinical applications. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500095730).
Validation of a Risk Scoring System for Postoperative Pancreatic Fistula.
Kartal K, Balik A, Coker A … +9 more , Aydinli B, Karayalcin K, Kerem M, Kapan M, Abbasoglu O, Kilicturgay S, Unek T, Tekant Y, Erkan M
Ann Ital Chir · 2025 Aug · PMID 41681110 · Publisher ↗
AIM: The aim of this study is to analyze the effects of pancreatic texture and pancreatic duct diameter on postoperative pancreatic fistula (POPF) formation and to define a risk scoring system for identifying high-risk p...
AIM: The aim of this study is to analyze the effects of pancreatic texture and pancreatic duct diameter on postoperative pancreatic fistula (POPF) formation and to define a risk scoring system for identifying high-risk patients for pancreatic surgery. METHODS: The data of 100 consecutively operated patients who underwent pancreatic surgery between May 2017 and June 2018 from seven different centers were collected through a web-based data collection module that is accessible at the website of The Turkish Hepato Pancreatico Biliary Surgery Association and analyzed retrospectively. The patients' data were evaluated according to the International Study Group for Pancreatic Fistula (ISGPF) criteria. The risk scoring system is defined according to the texture of the pancreatic tissue and the diameter of the pancreatic duct. Risk coefficients were distributed as 3, 2, and 1 for soft, intermediate and firm pancreatic tissue, respectively. The risk coefficients for the pancreatic duct diameter were distributed as 3, 2, and 1 for the pancreatic duct diameter as smaller or equal to 3 mm, wider than 3 mm and smaller or equal to 5 mm, and wider than 5 mm, respectively. The total risk score was calculated by multiplying the distributed risk coefficients. RESULTS: Thirteen out of 100 patients were excluded from the study due to missing or incomplete data. 17 of 87 (19.5%) patients had POPF. Six of 17 patients (35%) were in concordance with ISGPF-Grade A. Nine of 17 (53%) patients were in concordance with ISGPF-Grade B, and 2 of 17 (12%) patients were in concordance with ISGPF-Grade C. 22 of 87 (25.4%) patients were in the low-risk group, 18 (20.6%) patients were in the intermediate-risk group and 47 (54%) patients were in the high-risk group. There were no clinically relevant POPF in the low-risk group, while one patient developed an ISGPF-Grade A fistula. Two of 18 patients in the intermediate-risk group had POPF and both were clinically relevant. Fourteen of 47 patients in the high-risk group had POPF and 5 of 14 patients were clinically non-relevant, while 9 of 14 patients had clinically relevant POPF. The sensitivity and the specificity of the scoring system were 82.35% and 52.86% ( = 0.012), respectively. The area under the curve was 0.666 (95% CI: 0.54-0.77). CONCLUSIONS: This study proposes and validates a simple intraoperative risk scoring system, based on pancreatic tissue and duct diameter, for predicting POPF. The scoring system demonstrated a high negative predictive value, allowing clinicians to identify patients less likely to develop POPF. This practical tool may assist in surgical decision-making and in tailoring postoperative management in pancreatic surgery.
Complications Caused by Apical Extrusion of Sodium Hypochlorite. A Case Report Study and Systematic Review.
Inchingolo AD, Inchingolo AM, Del Vecchio G … +6 more , de Ruvo E, Ferrante L, Di Lorenzo A, Palermo A, Inchingolo F, Dipalma G
Ann Ital Chir · 2025 Nov · PMID 41681109 · Publisher ↗
AIM: Sodium hypochlorite (NaOCl) is widely used as an irrigant during root canal treatments due to its potent antimicrobial properties. However, its inadvertent apical extrusion can lead to significant complications. Thi...
AIM: Sodium hypochlorite (NaOCl) is widely used as an irrigant during root canal treatments due to its potent antimicrobial properties. However, its inadvertent apical extrusion can lead to significant complications. This study aims to assess the safety and efficacy of NaOCl as an irrigant in endodontic procedures and analyze the risks associated with its apical extrusion. METHODS: A systematic review and case report study were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed in the Web of Science, Scopus, and PubMed databases, limited to articles published in English between 2004 and 2024. RESULTS: The initial search identified 724 articles, with 267 remaining after the removal of duplicates. Following the application of inclusion criteria, 9 studies were selected for final analysis. CONCLUSIONS: While NaOCl remains the gold standard for root canal irrigation, improper handling can result in severe complications, including chemical burns and tissue necrosis. The study highlights the importance of implementing safety measures such as accurate irrigation techniques, the use of rubber dams, and side-exit needles to minimize risks. Further research is necessary to refine irrigation protocols and enhance patient safety, emphasizing the need for collaboration among dental professionals for optimal treatment outcomes.
Insights Into Thoracic Surgery Training Program in Italy: A Nationwide Residents' Survey.
Mattioni G, Raveglia F, Onofri A … +11 more , Carleo G, Mongiello D, Sampietro D, Scala C, Paladini L, Cardillo G, Melfi F, Ibrahim M, Zirafa C, Orlandi R, Group OBOTSRCC
Ann Ital Chir · 2025 Dec · PMID 41681108 · Publisher ↗
AIM: To achieve continuous improvement of thoracic surgery residency program, it is of paramount importance to acknowledge and understand its features. Due to the lack of Italian evidence in literature, the residents' pe...
AIM: To achieve continuous improvement of thoracic surgery residency program, it is of paramount importance to acknowledge and understand its features. Due to the lack of Italian evidence in literature, the residents' perspective was investigated through a nation-wide survey, focusing on the surgical exposure within Italian residency programs. METHODS: An online anonymous and voluntary survey of 74 items was generated with SurveyMonkey and sent to all thoracic surgery residents in Italy, between the 2nd and the 5th year of residency, selectively investigating surgical exposure and its potential influencing factors. RESULTS: Among 193 Italian thoracic surgery residents, 103 (53.4%) completed the survey and were included in the analysis. The mean cumulative and monthly number of surgical procedures carried out as first operator were 32.5 ± 44.0 (median 20.0) and 1.97 ± 1.95 (median 1.0), respectively. Independent factors associated to surgical exposure at the multivariable analysis were the administrative workload relative ratio (RR) 0.89, ([95% CI 0.84-0.99], < 0.001), the perceived idea of free time RR 2.69 ([1.45-4.96], = 0.003), the year of residency RR 0.34 ([0.17-0.68], = 0.009), the gender RR 1.46 ([1.07-2.45], = 0.045), and the number of residents per department RR 0.43 ([0.22-0.85], = 0.043). CONCLUSIONS: According to the residents' perspective, Italian thoracic surgery residency program is a well-structured educational offer, where surgical exposure overlaps with that offered across Europe. Nonetheless, efforts should be done to address the main criticalities raised to continuously increase the quality of Italian residency programs, aiming at enhancing surgical exposure, as well as promoting fair education.
Management of Malignant Left-Side Colonic Obstruction Using Self-Expandable Metal Stents as a Bridge to Elective Surgery: A Case Report and Literature Review.
Andolfi E, Fusario D, Barni L … +4 more , Poto GE, Giulitti D, Spiezia S, Cavargini E
Ann Ital Chir · 2025 Dec · PMID 41681107 · Publisher ↗
AIM: Colonic obstruction is a life-threatening condition, requiring emergency surgery (ES) that usually implies laparotomy and stoma construction. Self-expandable metal stents (SEMS) can be used to overcome the occlusion...
AIM: Colonic obstruction is a life-threatening condition, requiring emergency surgery (ES) that usually implies laparotomy and stoma construction. Self-expandable metal stents (SEMS) can be used to overcome the occlusion, realizing the so-called "bridge to surgery (BTS)", allowing management of the patient in an elective setting. CASE PRESENTATION: We present a case of a 59-year-old man with left colonic obstruction related to stenosing colorectal cancer (CRC) successfully treated with SEMS placement and early laparoscopic definitive surgery. The patient had an excellent course with no stenting or surgery-related complications. Probably young age, no comorbidity and endoscopic expertise played a main role in this favourable outcome, at least in the short term. RESULTS: Our critical review of the literature published over a period spanning more than two decades, encompassing 41 studies, indicates that SEMS used as a BTS in patients with malignant colorectal obstruction is associated with improved short-term outcomes compared to ES. Specifically, SEMS placement has been shown to reduce postoperative morbidity, lower stoma formation rates, and facilitate preoperative optimization in selected patients. Nevertheless, concerns remain regarding potential adverse oncological outcomes, particularly in terms of local recurrence and disease-free survival. These concerns are compounded by the heterogeneity of available studies, which are predominantly retrospective and underpowered, and by the scarcity of large-scale randomized controlled trials (RCTs). Furthermore, the limited dissemination of technical expertise and institutional experience in SEMS placement continues to restrict its widespread implementation in clinical practice. CONCLUSIONS: The clinical success of SEMS placement as a BTS strategy is contingent upon rigorous patient selection, coordinated multidisciplinary team involvement, and the availability of experienced endoscopists and surgical teams. When these prerequisites are met, SEMS offers an effective means of converting an acute surgical emergency into an elective procedure, thereby mitigating perioperative risk and improving patient-centered outcomes. However, the lack of robust long-term oncological data and the limited penetration of stenting expertise across healthcare institutions remain major impediments to broader adoption. Continued efforts to generate high-quality evidence and promote structured training programs are essential to fully define the role of SEMS in the management of malignant bowel obstruction.
Advances in Minimally Invasive Approach for Impacted Mandibular Third Molar Extractions: From Incision Design to Dynamic Navigation.
Wu Y, Lu L, Zhai T … +4 more , Jiang M, Quan X, Jiang Q, Sun Z
Ann Ital Chir · 2026 Jan · PMID 41681106 · Publisher ↗
The application of the minimally invasive concept in the extraction of impacted mandibular third molars has significantly improved surgical outcomes and patient prognosis. This review systematically examines the up-to-da...
The application of the minimally invasive concept in the extraction of impacted mandibular third molars has significantly improved surgical outcomes and patient prognosis. This review systematically examines the up-to-date research advances in various methods used for the extraction of impacted mandibular third molars within the context of the minimally invasive concept. Modified incision and flap designs have effectively reduced tissue damage. Ultrasonic bone knife technology has proven to reduce intraoperative bleeding and the risk of thermal injury, and its combined use with a dental electric motor further enhances procedural precision and efficiency. Dynamic navigation technology holds significant potential in improving surgical accuracy, facilitating precise debridement and distraction techniques, and reducing the risk of nerve injury and postoperative complications. Future integration of dynamic navigation with preoperative artificial intelligence assessment will further advance the minimally invasive approach, making it more widespread and cost-effective. Minimally invasive techniques are not only the starting point but also the means to achieve functional objectives, propelling the development of minimally invasive alveolar surgery to new heights.
Melanoma of Unknown Primary Origin: A Case Report and Literature Review.
Matteucci M, D'Andrea V, Cirillo B … +7 more , Pesce A, Ranucci MC, Bruzzone P, Rizzuto A, Properzi L, Guarino S, Cirocchi R
Ann Ital Chir · 2026 Jan · PMID 41681105 · Publisher ↗
AIM: Melanoma of unknown primary origin (MUP) is a rare clinical entity, accounting for approximately 3-4% of all cases of melanoma. It is defined as histologically confirmed metastases of melanoma occurring in the absen...
AIM: Melanoma of unknown primary origin (MUP) is a rare clinical entity, accounting for approximately 3-4% of all cases of melanoma. It is defined as histologically confirmed metastases of melanoma occurring in the absence of any identifiable primary lesion. Due to its rarity, diagnostic and therapeutic guidelines remain poorly defined. The aim of this literature review of published case reports is to investigate the most commonly affected anatomical sites, the most frequent presenting symptoms, the diagnostic approaches, and the available therapeutic strategies. CASE PRESENTATION: 81-year-old woman was admitted with a right inguinal mass of unknown origin. Biopsy revealed metastatic melanoma involving the inguinal lymph nodes, with no clinically or radiologically detectable primary lesion. The patient underwent right inguinal-iliac-obturator lymphadenectomy. The postoperative course was uneventful, with no significant medical or surgical complications. Considering the patient's advanced age and overall condition, no adjuvant therapy was administered, and a strategy of active surveillance was adopted. At present, no evidence of disease recurrence has been observed. RESULTS: A total of 94 case reports were included in our review. MUP appears to be more frequent in males than in females. The axillary lymph nodes were the most commonly involved site, followed by the cervical and inguinal lymph nodes. Among extranodal sites, the gastrointestinal tract, particularly the stomach and small bowel, was most frequently affected. Patients with MUP should be managed similarly to those with melanoma of known primary origin (MKP), based on corresponding stage and anatomical involvement. CONCLUSIONS: MUP is an uncommon and challenging presentation of metastatic melanoma. Its pathogenesis remains unclear, although several theories, including immune-mediated regression of the primary lesion, have been proposed. MUP should be staged as stage IV disease and treated with the same systemic therapies used for stage IV MKP, including immune checkpoint inhibitors and targeted agents. Prompt recognition and standardized management are crucial to optimizing outcomes in this subset of patients.
The MARS2 Trial - Is Surgical Treatment of Pleural Mesothelioma a Relic of the Past?
Ou MT, Nguyen K, Velotta JB
Ann Ital Chir · 2026 Jan · PMID 41681104 · Publisher ↗
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Salvage Neck Dissection in Head and Neck Squamous Cell Carcinoma: Balancing Necessity and Quality of Life.
Maniaci A, Fakhry N, Ferini G … +4 more , Chiesa Estomba C, Lavalle S, Lechien JR, Lentini M
Ann Ital Chir · 2026 Feb · PMID 41681103 · Publisher ↗
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Research Progress on / Mutations in Sporadic Gastric Cancer: Risk Stratification, Surgical Prognosis, and Individualized Treatment.
Chen M, Dong Y, Wang R … +1 more , Cui H
Ann Ital Chir · 2026 Feb · PMID 41681102 · Publisher ↗
Gastric cancer is one of the most prevalent malignant tumors worldwide. Sporadic gastric cancer accounts for more than 80% of all gastric cancer cases, and its pronounced heterogeneity underlies the substantial variabili...
Gastric cancer is one of the most prevalent malignant tumors worldwide. Sporadic gastric cancer accounts for more than 80% of all gastric cancer cases, and its pronounced heterogeneity underlies the substantial variability in clinical outcomes and the complexity of treatment strategies. The breast cancer gene 1 () and breast cancer gene 2 () are core regulators of the DNA damage homologous recombination repair (HRR) pathway, and their pathogenic mutations are closely associated with hereditary breast and ovarian cancer syndrome. Recent evidence has shown that mutations also exist in some sporadic gastric cancer patients and may profoundly affect tumor biological behavior, clinical prognosis, and treatment response. This article systematically reviews the latest research progress on mutations in sporadic gastric cancer, focusing on their incidence and molecular characteristics, their impact on patients' postoperative prognosis, and their potential value as novel biomarkers for guiding individualized therapy, thereby providing a theoretical basis for clinical risk stratification and tailored treatment strategies.
Impact of Individualized Nursing on Postoperative Recovery Following Trabeculectomy in Primary Open-Angle Glaucoma: A Retrospective Cohort Study.
Hao J, Zhang S, Sun Y … +2 more , Sun X, Zhang L
Ann Ital Chir · 2026 Feb · PMID 41681101 · Publisher ↗
AIM: Primary open-angle glaucoma (POAG) is one of the leading contributors to irreversible blindness. This study evaluated the impact of individualized nursing interventions in patients with POAG undergoing trabeculectom...
AIM: Primary open-angle glaucoma (POAG) is one of the leading contributors to irreversible blindness. This study evaluated the impact of individualized nursing interventions in patients with POAG undergoing trabeculectomy. METHODS: This retrospective analysis included 94 cases of POAG (94 eyes) undergoing primary trabeculectomy at the Department of Ophthalmology in Binzhou Medical University Hospital between January 2021 and December 2021. Based on the type of postoperative nursing care received, patients were allocated to either an individualized nursing group (n = 54), which received individualized nursing care, or a control group (n = 40), which received standard care. Individualized care comprised preoperative psychological assessment, tailored education, visual function rehabilitation, structured complication monitoring, lifestyle counseling, and remote follow-up support. Assessments were conducted at 1 week and at 1, 6, 12, 24, and 36 months postoperatively. Key outcomes included intraocular pressure (IOP), use of antiglaucoma medication, length of hospital stay, postoperative complications, and cumulative surgical success. RESULTS: The individualized nursing group exhibited markedly shorter hospital stays ( = 0.007), lower IOP at 24 and 36 months (all < 0.05), and fewer antiglaucoma medications at early time points (1 week and 1 month; all < 0.05). Overall complications occurred less frequently in the individualized nursing group ( = 0.020). Kaplan-Meier analysis demonstrated a significantly higher cumulative surgical success rate in the individualized nursing group ( = 0.019). Multivariable Cox regression identified individualized nursing as an independent predictor of reduced surgical failure (hazard ratio (HR) = 0.519, = 0.023). CONCLUSIONS: Individualized nursing interventions significantly improve postoperative outcomes following trabeculectomy in POAG patients. Integrating individualized nursing care into routine clinical practice may enhance surgical success and reduce postoperative complications.
Application of a Multidisciplinary Collaboration Model-Supported Structured Home Care in Reducing Postoperative Complications in Children with Hypospadias.
He L, Zhong Q, Xiao L
Ann Ital Chir · 2026 Feb · PMID 41681100 · Publisher ↗
AIM: Hypospadias is a common congenital anomaly in males and often requires surgical intervention, usually with tubularized incised plate (TIP) urethroplasty. However, postoperative complications such as urethrocutaneous...
AIM: Hypospadias is a common congenital anomaly in males and often requires surgical intervention, usually with tubularized incised plate (TIP) urethroplasty. However, postoperative complications such as urethrocutaneous fistula, stenosis, and wound dehiscence remain persistent clinical challenges. Reducing these complications depends not only on surgical approach but also on optimized perioperative and postoperative care pathways, supported by high-quality nursing and timely identification of early warning signs. Therefore, this study aims to investigate the application of multidisciplinary team (MDT) care integrated with a structured home care model in paediatric hypospadias management. METHODS: This retrospective study compared postsurgical outcomes in children (aged 1-5 years) with distal hypospadias undergoing primary TIP urethroplasty at Ganzhou People's Hospital between June 2022 and August 2024. Study participants were divided into two groups based on care pathway: MDT combined with a structured home care (intervention group) and a conventional nursing care (control group). Key outcomes assessed were complication rates, urodynamic parameters, postoperative pain levels, caregiver anxiety, and cosmetic outcomes (Hypospadias Objective Scoring Evaluation [HOSE] scores). RESULTS: The intervention group showed significantly shorter surgery times, lower postoperative pain (Children's and Infants' Postoperative Pain Scale [CHIPPS]), reduced parental anxiety (Self-Rating Anxiety Scale [SAS]) (all < 0.001). Compared with the control group, the intervention group demonstrated significantly improved HOSE scores at 12 months postoperatively, indicating superior cosmetic outcomes ( < 0.001). At 12 months, the intervention group demonstrated comparatively lower complication rates (14.95% vs. 24.37%), though not statistically significant ( > 0.05). Urodynamic parameters, such as corrected maximum and average flow rates (maximum urinary flow rate corrected for voided volume[cQmax] and average urinary flow rate corrected for voided volume [cQave]), showed gradual recovery but remained lower than baseline ( < 0.05). Multivariate analysis further confirmed that parental anxiety is an independent predictor of postoperative complications ( < 0.001). Mediation analysis revealed that parental anxiety mediated the relationship between care pathway and complication risk ( < 0.001). CONCLUSIONS: The structured home-based nursing model supported by a MDT may be associated with a reduced risk of complications in children after hypospadias repair. This association might be related to improved postoperative pain control and enhanced mental health levels among parents. This model emphasizes collaborative perioperative care and structured support during the postoperative recovery phase. Given that the difference in complication rates has not reached statistical significance, the above results should still be interpreted with caution. Further multi-center studies with larger sample sizes and longer follow-up periods are needed to verify its clinical benefits and elucidate the underlying mechanisms.
Development and Validation of a Predictive Model for Poor Healing After Great Saphenous Vein Stripping in Patients With Varicose Ulcers: Focusing on Preoperative Iron Metabolism Markers.
Zhou Y, Zhan X, Qiao T
Ann Ital Chir · 2026 Feb · PMID 41681099 · Publisher ↗
AIM: To develop and validate a nomogram for predicting the risk of poor healing after great saphenous vein stripping in patients with venous varicose ulcers, based on preoperative iron metabolism markers and other clinic...
AIM: To develop and validate a nomogram for predicting the risk of poor healing after great saphenous vein stripping in patients with venous varicose ulcers, based on preoperative iron metabolism markers and other clinical indicators. METHODS: Clinical data from 278 patients with venous varicose ulcers who underwent great saphenous vein stripping at Wujin Hospital Affiliated with Jiangsu University between July 2022 and January 2025 were retrospectively analyzed. Patients were randomly divided to a training set (n = 166) and a validation set (n = 112) at a 6:4 ratio. Based on the ulcer healing status at 6 months postoperatively, patients were categorized into a poor healing group and a good healing group. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative poor healing, and a nomogram prediction model was developed based on these factors. Internal validation of model performance was conducted using the Bootstrap resampling method. Model discrimination, calibration, and clinical utility were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. RESULTS: The overall incidence of postoperative poor healing was 40.29% (112/278). Multivariate logistic regression analysis revealed that diabetes (odds ratio [OR] = 3.01, 95% confidence interval [CI]: 1.38-6.57), increased soluble transferrin receptor (sTfR) (OR = 1.78, 95% CI: 1.17-2.70), decreased albumin (OR = 0.92, 95% CI: 0.85-0.99), and elevated C-reactive protein (CRP) (OR = 1.05, 95% CI: 1.02-1.08) were independent risk factors for postoperative poor healing (all < 0.05). The nomogram model based on these factors yielded an area under the curve (AUC) of 0.75 (95% CI: 0.68-0.83) in the training set and 0.74 (95% CI: 0.64-0.83) in the validation set. Calibration curves demonstrated good agreement between predicted and observed probabilities. Decision curve analysis indicated a favorable clinical net benefit of the model. CONCLUSIONS: The prediction model developed in this study effectively assesses the risk of poor healing after great saphenous vein stripping in patients with venous varicose ulcers, facilitating early identification of high-risk patients and supporting targeted clinical interventions.
Effect of Comprehensive Nursing on Postoperative Complications and Recovery of Elderly Patients Undergoing Prone-Position Lumbar Spine Surgery.
Liu Y, Yang H
Ann Ital Chir · 2026 Feb · PMID 41681098 · Publisher ↗
AIM: This study aimed to retrospectively analyze the effects of comprehensive nursing care on postoperative complications and clinical outcomes in elderly patients undergoing prone lumbar spine surgery. METHODS: A retros...
AIM: This study aimed to retrospectively analyze the effects of comprehensive nursing care on postoperative complications and clinical outcomes in elderly patients undergoing prone lumbar spine surgery. METHODS: A retrospective study was conducted between July 2020 and July 2025, including 130 elderly patients undergoing prone lumbar spine surgery at Taihe County People's Hospital. Based on the nursing model, the patients included were classified into a control group (conventional care, = 71) and an observation group (comprehensive care, = 59). Evaluation criteria included preoperative anxiety and depression, clinical outcomes (time to first in-bed activity, time to first out-of-bed activity, and average length of hospital stay), perioperative hypothermia classification (mild/moderate/severe), incidence of perioperative shivering, postoperative infection rate, postoperative postural nerve damage, and incidence of pressure injuries 12 hours, 24 hours, and 48 hours after surgery. RESULTS: There were no statistically significant differences in the distribution of depression and anxiety scores and severity between the observation group and the control group before the intervention. After the intervention, the depression and anxiety levels in the observation group were significantly lower than those in the control group ( < 0.05), and the severity distribution was significantly better in the observation group than in the control group ( < 0.05). Time to first in-bed activity, time to first out-of-bed activity, and average length of hospital stay were significantly shorter in the observation group than in the control group ( < 0.001). The incidence rates of mild, moderate, and severe hypothermia were significantly lower in the observation group than in the control group (13.56%, 5.08%, and 1.69% vs 23.94%, 14.08%, and 11.27%, < 0.05). The incidence of perioperative shivering was significantly lower in the observation group than in the control group (15.25% vs 33.81%, < 0.05). There was no significant difference in the incidence of postoperative postural nerve damage between the two groups. The postoperative infection rate in the observation group was 5.08%, which was significantly lower than the 16.90% in the control group. Furthermore, the incidence rates of pressure injuries in the observation group 12 hours, 24 hours, and 48 hours after surgery were significantly lower than those in the control group (0%, 3.39%, and 10.17% vs 2.82%, 18.31%, and 29.58%, < 0.05). CONCLUSIONS: In this retrospective cohort, the implementation of comprehensive nursing significantly improved psychological status, reduced the incidence of perioperative hypothermia and other complications, and accelerated postoperative recovery in elderly patients undergoing prone lumbar spine surgery.
Analysis of Influencing Factors and Construction of Prediction Model for Delirium After Intraspinal Anesthesia in Elderly Patients Undergoing Femoral Neck Fracture Surgery.
Liu J, Liu X, Zhang C
Ann Ital Chir · 2026 Feb · PMID 41681097 · Publisher ↗
AIM: To analyze the influencing factors of postoperative delirium (POD) after intraspinal anesthesia in elderly patients undergoing femoral neck fracture (FNF) surgery and to construct a prediction model for early identi...
AIM: To analyze the influencing factors of postoperative delirium (POD) after intraspinal anesthesia in elderly patients undergoing femoral neck fracture (FNF) surgery and to construct a prediction model for early identification of high-risk patients. METHODS: This retrospective study included 407 elderly patients who underwent FNF surgery under spinal anesthesia from January 2020 to January 2024 as the modeling cohort; and another 82 patients who underwent similar surgery under spinal anesthesia between February 2024 and February 2025, according to the same inclusion and exclusion criteria, as an independent time-limited external validation cohort. Data were collected from the hospital's electronic medical records. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POD. A nomogram prediction model was constructed and validated internally and externally. RESULTS: The incidence of POD was 16.95% (69/407). Independent risk factors identified were age >80 years (odds ratio (OR) = 2.25, 95% CI: 1.25-4.05, = 0.007), diabetes (OR = 1.91, 95% CI: 1.03-3.56, = 0.041), preoperative hemoglobin <90 g/L (OR = 2.11, 95% CI: 1.14-3.90, = 0.017), preoperative albumin <30 g/L (OR = 3.76, 95% CI: 1.95-7.25, < 0.001), preoperative waiting time ≥3 days (OR = 2.62, 95% CI: 1.40-4.90, = 0.003), American Society of Anesthesiologists (ASA) grade ≥III (OR = 2.12, 95% CI: 1.08-4.17, = 0.029), postoperative hypoxemia (OR = 2.22, 95% CI: 1.22-4.05, = 0.009), and postoperative visual analog scale (VAS) score ≥4 (OR = 2.55, 95% CI: 1.39-4.68, = 0.002). The nomogram exhibited strong discriminative ability (area under the curve (AUC) = 0.79 for internal, 0.85 for external validation) and satisfactory calibration (Hosmer-Lemeshow > 0.05). CONCLUSIONS: This study identified independent risk factors for POD after intraspinal anesthesia in elderly FNF patients and established a nomogram with excellent predictive ability, offering a reliable tool for early detection of high-risk cases and facilitating implementation of targeted preventive measures.
Influence of Chronic Lymphocytic Thyroiditis and Mutation on Clinicopathological Features in Papillary Thyroid Carcinoma With Different Tumor Size.
Yang YX, Feng JW, Ye J … +2 more , Wu WX, Jiang Y
Ann Ital Chir · 2026 Feb · PMID 41681096 · Publisher ↗
AIM: Chronic lymphocytic thyroiditis (CLT) is recognized as the most prevalent inflammatory disorder of the thyroid, while the B-Raf proto-oncogene, serine/threonine kinase () mutation is the most frequently identified...
AIM: Chronic lymphocytic thyroiditis (CLT) is recognized as the most prevalent inflammatory disorder of the thyroid, while the B-Raf proto-oncogene, serine/threonine kinase () mutation is the most frequently identified genetic alteration in papillary thyroid carcinoma (PTC). This study aims to explore the relationship between CLT and mutation and to assess their combined impact on tumor behavior across different tumor sizes. METHODS: We conducted a retrospective analysis of clinical and pathological data from 1474 patients who underwent surgical treatment for PTC. Univariate and multivariate logistic regression analyses were applied to identify independent factors influencing tumor characteristics. RESULTS: CLT was detected in 27.5% (405/1474) of the PTC cases. Multivariate analysis revealed that CLT was significantly associated with female sex; simultaneously, CLT was significantly negatively associated with mutation, extrathyroidal extension (ETE), central lymph node metastasis (CLNM), and advanced disease stage (all < 0.05). The mutation was observed in 80.7% (1189/1474) of patients. Stratified analysis by tumor size showed that mutation independently predicted CLT and advanced tumor-node-metastasis (TNM) stage in papillary thyroid microcarcinoma (PTMC); CLT, ETE, and CLNM in tumors 1-2 cm; CLT, ETE, CLNM, and lateral lymph node metastasis (LLNM) in tumors 2-4 cm; and CLT, ETE, vascular invasion, CLNM, and LLNM in tumors >4 cm (all < 0.05). Notably, PTC patients without CLT but harboring mutation showed a combined association with advanced TNM stage and aggressive features. CONCLUSIONS: The presence of CLT appears to exert a protective effect in PTC. However, the prognostic significance of mutation varies with tumor size. While CLT-related inflammatory microenvironment may counteract tumor progression in small cancers, it seems insufficient to mitigate the aggressive behavior driven by mutation in larger tumors.
Comparison of Robotic-Assisted and Uniportal Video-Assisted Thoracoscopic Lobectomy for Early-Stage Non-Small Cell Lung Cancer: A Retrospective Cohort Study.
Ni Y, Zhang J
Ann Ital Chir · 2026 Feb · PMID 41681095 · Publisher ↗
AIM: This study aimed to compare perioperative outcomes, lymphadenectomy quality, postoperative recovery, pulmonary function, and short-term oncologic results between robotic-assisted thoracoscopic surgery (RATS) and uni...
AIM: This study aimed to compare perioperative outcomes, lymphadenectomy quality, postoperative recovery, pulmonary function, and short-term oncologic results between robotic-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) for early-stage non-small cell lung cancer (NSCLC). METHODS: This retrospective cohort study included 231 consecutive patients with stage I-IIA NSCLC who underwent curative-intent anatomic lobectomy at our institution between January and December 2023. Based on the surgical approach, patients were assigned to either the RATS group (n = 105) or the U-VATS group (n = 126). All procedures were performed by the same experienced surgical team using standardized perioperative protocols. Clinical characteristics, intraoperative and postoperative parameters, pulmonary function, and 12-month oncologic outcomes were collected for comparative evaluation. RESULTS: RATS resulted in shorter operative time, reduced blood loss, and increased lymph node and mediastinal station retrieval compared with U-VATS. Postoperative pain, drainage volume, length of hospital stay, and complication rates were comparable between groups. Patients undergoing RATS demonstrated significantly higher global health and functional scores, along with lower symptom scores, during the first 6 months after surgery ( < 0.05). Pulmonary function recovery, 1-year disease-free survival (DFS), and overall survival (OS) did not differ significantly between the two approaches. However, hospitalization costs were higher for the RATS group ( < 0.001). CONCLUSIONS: Both RATS and U-VATS are safe and effective minimally invasive approaches for anatomic lobectomy in early-stage NSCLC. RATS offers advantages in operative precision, lymph node dissection, and short-term quality of life without compromising safety or early oncologic outcomes, although it is associated with increased cost.
Predictive Value of Intraoperative Glucose Variability for Chronic Postsurgical Pain After Arthroscopic Rotator Cuff Repair: A Retrospective Cohort Study.
Zhou X, Xu L
Ann Ital Chir · 2026 Feb · PMID 41681094 · Publisher ↗
AIM: To investigate the predictive value of intraoperative glucose variability (GV) for chronic postsurgical pain (CPSP) in patients undergoing arthroscopic rotator cuff repair (ARCR). METHODS: A retrospective study was...
AIM: To investigate the predictive value of intraoperative glucose variability (GV) for chronic postsurgical pain (CPSP) in patients undergoing arthroscopic rotator cuff repair (ARCR). METHODS: A retrospective study was conducted on 211 ARCR patients admitted to Tongxiang First People's Hospital from January 2021 to December 2024. Patients were divided into CPSP group (n = 35) and non-CPSP group (n = 176). Influencing factors were analyzed with univariate and binary logistic regression. The predictive value of these factors for CPSP in ARCR patients was evaluated with receiver operating characteristic (ROC) curve analysis. Shoulder joint indicators of patients with different levels of intraoperative GV were compared before and after treatment. GV was expressed as the ratio of the standard deviation to the mean value of intraoperative blood glucose. RESULTS: There were no statistically significant differences ( > 0.05) in age, sex, body mass index (BMI), surgery time, intraoperative blood loss, length of hospital stay, tear location, tear area, glycated hemoglobin (HbA1c), fasting blood glucose and full-thickness tear between the groups. However, there were statistically significant differences ( < 0.05) in the number of torn tendons, shoulder acromioplasty, coefficient of variance (CV), largest amplitude of glycemic excursions (LAGE), and preoperative pain. Binary logistic regression analysis revealed that the number of torn tendons, LAGE, and CV were influencing factors for CPSP in ARCR patients ( < 0.05). The area under the ROC curve for CV was 0.864, standard error 0.027 (95% CI: 0.812-0.916, < 0.001), with a Youden index of 0.62, sensitivity of 91.43%, and specificity of 70.45%. Post-treatment Constant-Murley Score (CMS) and American Shoulder and Elbow Surgeons Score (ASES) scores were significantly better in patients with CV ≤0.18 compared to CV >0.18 ( < 0.001). CONCLUSIONS: Intraoperative GV has predictive value for CPSP in ARCR patients.
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