Background: Esophagectomy is associated with substantial postoperative morbidity, with infectious complications remaining a leading cause of mortality. Septic shock represents the most severe infectious complication; however, data on its perioperative predictors and long-term impact after esophagectomy are limited. Methods: We conducted a retrospective observational study including consecutive adult patients who underwent esophagectomy with curative intent for esophageal cancer between January 2015 and December 2024 at a tertiary referral center. Postoperative septic shock was defined according to Sepsis-3 criteria. Demographic, clinical, surgical, laboratory, and oncological variables were analyzed. Independent risk factors for septic shock were identified using multivariate logistic regression. Overall survival was assessed using Kaplan–Meier analysis. Results: Among 106 patients, 19 (17.9%) developed postoperative septic shock. These patients had a lower body mass index, reduced preoperative and postoperative albumin levels, and a higher incidence of advanced lymph node involvement. Septic shock was strongly associated with severe postoperative complications, including anastomotic leakage, hemorrhagic shock, acute respiratory distress syndrome, acute kidney failure, and increased rates of PICU readmission. In multivariate analysis, lower albumin levels at PICU admission (OR 0.54; 95% CI 0.29–0.99) and advanced nodal stage (OR 4.98; 95% CI 1.36–18.3) were independently associated with the development of septic shock. Patients who developed septic shock had significantly higher in-hospital mortality (31.6% vs. 1.1%, p < 0.001) and markedly reduced long-term survival, even among those discharged alive. Conclusions: Postoperative septic shock after esophagectomy is a devastating complication with a profound negative impact on both short- and long-term survival. Hypoalbuminemia and advanced lymph node involvement are independent predictors of septic shock. These findings support the integration of simple clinical and laboratory markers into personalized perioperative risk stratification models, enabling individualized management strategies to reduce severe postoperative complications.

Background/Objectives: Lidocaine has demonstrated immunomodulatory properties and promising antitumor effects in experimental models, but its impact on long-term outcomes following oncologic surgery remains unclear. This study aimed to compare the impact of intraoperative lidocaine versus remifentanil on long-term cancer outcomes after primary lung cancer surgery. Methods: This is a post hoc analysis of a randomized controlled trial (NCT03905837, EudraCT 2016-004271-52). From 154 patients who underwent elective lung resection via video-assisted thoracoscopic surgery (VATS) between January 2019 and June 2021 and were randomized to receive intraoperative lidocaine (intravenous or paravertebral) or remifentanil, we analyzed data from patients with confirmed primary lung cancer in the surgery specimen. Overall survival (OS) and disease-free survival (DFS) were assessed through May 2025. Survival outcomes were analyzed using Kaplan–Meier curves and log-rank tests. A multivariate Cox proportional hazards model was used to adjust for potential confounders. Results: Among the 97 patients with primary lung cancer finally included in the analysis, those in the lidocaine group exhibited improved OS compared with those who received intravenous remifentanil (log-rank p = 0.022). This association remained significant in the multivariate Cox regression analysis (HR 2.59, 95% CI 1.13–5.96, p = 0.025). No significant differences were observed in DFS overall (log-rank p = 0.283) or in DFS limited to recurrences of cancers present at the time of surgery, either the resected primary tumor or a prior malignancy (log-rank p = 0.080). Conclusions: In this post hoc analysis, lidocaine administration during oncologic lung resection was associated with improved OS in primary lung cancer patients. No differences in DFS were observed between groups; however, a non-significant trend toward improved DFS in lidocaine patients was noted when focusing on recurrences of cancers present at the time of surgery. Further investigation in larger prospective studies is warranted.

Background/Objectives: Unplanned readmission to the surgical intensive care unit (UR-SICU) is a serious adverse event linked to higher morbidity, prolonged stay, and increased mortality. Most evidence derives from mixed ICUs, limiting applicability to surgical cohorts. We aimed to identify risk factors for UR-SICU and assess their impact on outcomes. Methods: We performed a retrospective cohort study of adults admitted to a 20-bed SICU in a tertiary hospital between June 2021 and December 2022 after non-cardiac surgery (elective, urgent, trauma, or liver transplantation). Patients dying during the first SICU stay or transferred to another ICU were excluded. Demographics, comorbidities, severity scores, treatments, and complications were recorded. Logistic regression identified predictors. Kaplan–Meier curves analyzed survival. Results: Among 1361 patients, 82 (6.4%) required UR-SICU. Half were surgical (mainly hemorrhage and sepsis), while respiratory and infectious complications predominated among medical readmissions. Independent predictors for UR-SICU were age (OR 1.03/year; p = 0.002), active malignancy (OR 1.79; p = 0.012), and delirium during the first SICU stay (OR 1.86; p = 0.030). UR-SICU patients had longer hospital stays [46 vs. 13 days; p < 0.001] and higher hospital mortality (27.1% vs. 1.48%; OR 24.68; p < 0.001). Mortality remained higher at 6 months (33.3% vs. 7.1%) and 1 year (42.3% vs. 11.1%). Conclusions: UR-SICU occurred in 6.4% of patients and was independently associated with age, malignancy, and delirium. Readmission was strongly linked to prolonged hospitalization and increased short- and long-term mortality. Early recognition of high-risk patients and targeted, personalized preventive strategies may help reduce avoidable readmissions.

Background: Cerebral desaturation during one-lung ventilation (OLV) in thoracic surgery has been associated with postoperative cognitive dysfunction (POCD). While the adverse effects of low intraoperative regional cerebral oxygen saturation (rScO₂) are well documented, the potential clinical value of maintaining supranormal rScO₂ levels has not been thoroughly studied. Methods: We conducted a retrospective observational study based on a previously collected cohort from a tertiary university hospital. Adult patients undergoing elective thoracic surgery between January 2019 and December 2022 were included, provided they received lidocaine either intravenously or via a paravertebral block as part of a standardized anesthetic protocol. Patients were divided into the following two groups based on their mean INVOS values 30 min into OLV: those with rScO₂ ≥75% (H-INVOS group) and <75% (L-INVOS group). Intraoperative physiological variables, inflammatory biomarkers, cognitive function via the Mini-Mental State Examination, and postoperative outcomes were analyzed. Results: The H-INVOS group exhibited significantly higher preoperative lung function, higher PaO₂ and PaCO₂ values during OLV, and higher hemoglobin concentrations across all timepoints. They also demonstrated better preservation of cognitive function, lower IL-18 expression at 24 h postoperatively, and shorter hospital stays. There were no statistically significant differences in intraoperative hemodynamics or ventilatory mechanics.

Background: Esophagectomy is associated with substantial postoperative morbidity, with infectious complications remaining a leading cause of mortality. Septic shock represents the most severe infectious complication; however, data on its perioperative predictors and long-term impact after esophagectomy are limited. Methods: We conducted a retrospective observational study including consecutive adult patients who underwent esophagectomy with curative intent for esophageal cancer between January 2015 and December 2024 at a tertiary referral center. Postoperative septic shock was defined according to Sepsis-3 criteria. Demographic, clinical, surgical, laboratory, and oncological variables were analyzed. Independent risk factors for septic shock were identified using multivariate logistic regression. Overall survival was assessed using Kaplan–Meier analysis. Results: Among 106 patients, 19 (17.9%) developed postoperative septic shock. These patients had a lower body mass index, reduced preoperative and postoperative albumin levels, and a higher incidence of advanced lymph node involvement. Septic shock was strongly associated with severe postoperative complications, including anastomotic leakage, hemorrhagic shock, acute respiratory distress syndrome, acute kidney failure, and increased rates of PICU readmission. In multivariate analysis, lower albumin levels at PICU admission (OR 0.54; 95% CI 0.29–0.99) and advanced nodal stage (OR 4.98; 95% CI 1.36–18.3) were independently associated with the development of septic shock. Patients who developed septic shock had significantly higher in-hospital mortality (31.6% vs. 1.1%, p < 0.001) and markedly reduced long-term survival, even among those discharged alive. Conclusions: Postoperative septic shock after esophagectomy is a devastating complication with a profound negative impact on both short- and long-term survival. Hypoalbuminemia and advanced lymph node involvement are independent predictors of septic shock. These findings underscore the importance of multidisciplinary perioperative optimization strategies, including nutritional assessment and tailored surgical planning, to mitigate the incidence and consequences of this life-threatening complication.

Background: Liver transplantation (LT) is a critical intervention for patients with end-stage liver disease. Infections caused by multidrug-resistant bacteria (MDRB) significantly worsen post-transplant outcomes. The main objective of this study was to analyze perioperative risk factors associated with MDRB infections within six months following LT. Methods: A retrospective analysis was conducted on 133 medical records of patients who underwent liver transplantation between October 2018 and May 2022. Data collected included the presence of MDRB colonization and infection, as well as various perioperative variables. These were analyzed to identify potential risk factors for MDRB infection and colonization. Results: Univariate analysis identified several perioperative variables associated with MDRB infection within six months after LT. Multivariate logistic regression revealed that pre-transplant MDRB colonization (OR 5.72, 95% CI 1.7–18.7, p = 0.005) and the requirement for dialysis during postoperative ICU stay (OR 6.42, 95% CI 1.7–23.4, p = 0.009) were independent risk factors for developing MDRB infections. MDRB infection occurred in 9.4% of patients and was not significantly associated with increased mortality (p = 0.126). Conclusions: These findings contribute to a better understanding of the epidemiology and pathophysiology of MDRB infections in the postoperative period of liver transplantation. This knowledge is essential for developing effective prevention and treatment strategies that may improve outcomes in this patient population.