Background: Adhesive small bowel obstruction (ASBO) is a common and challenging surgical condition. In the absence of peritonitis, bowel ischemia, or clear surgical indicators on CT imaging, the initial management is typically non-operative. While clinical and radiological factors influencing non-operative management (NOM) are well described, the role of age and chronic health conditions remains less well defined. The primary aim of this study was to evaluate the incidence of NOM failure in patients with various comorbidities. Methods: This study utilized data from the National Inpatient Sample to analyze cases of ASBO between 2016 and 2019. Collected data included demographics, diagnosis, presence of chronic health conditions (diabetes mellitus, congestive heart failure, chronic kidney disease, chronic pulmonary diseases, peripheral vascular disease), length of hospital stay, and mortality. Patients were divided into two groups: Group A (18–65 years) and Group B (>65 years). We compared demographics comorbidities, NOM failure rates, and mortality between the groups. Univariate analysis was performed to assess age and comorbidities and risk factors for NOM failure in each group, followed by multivariable analysis within each group. Results: A total of 1,611,099 admissions with ASBO were identified in the NIS database; 63.03% were females. The failure rate of NOM in patients without comorbidities was 21%, compared to 26.5% in patients with one or more comorbidities. In Group A, 20% of patients required surgery, compared to 26.2% of patients in Group B (p = 0.001). Conclusions: Being aged over 65 and the presence of chronic health disease, excluding diabetes mellitus, are independent predictors of NOM failure in patients with ASBO. The presence of multiple comorbidities further increases the risk of NOM failure.

Introduction: ERCP with temporary biliary stenting followed by elective cholecystectomy and postoperative ERCP is commonly used to treat choledocholithiasis. While early stent removal (within 3–6 months) is generally recommended, some studies suggest that longer dwell time may not increase morbidity. This study aims to evaluate outcomes associated with prolonged stent dwell time of more than six months. Methods: We conducted a retrospective study of all patients who underwent ERCP with plastic biliary stent insertion, followed by elective cholecystectomy and postoperative ERCP at a single tertiary center between 2018–2024. Patients were divided into early-ERCP (≤6 months) and late-ERCP (>6 months) groups. The primary outcome was the rate of recurrent biliary episodes. Secondary outcomes included urgent postoperative ERCP, stent reinsertion, and the need for additional ERCP’s. Results: A total of 203 patients were included (mean age 58.3 ± 19.8 years). Thirty-one patients (15%) had a stent dwell time of more than six months. Demographic and presenting characteristics were comparable between groups, except for acute cholecystitis, which was more frequent in the early-ERCP group (18% vs. 3.2%, p = 0.034). Recurrent biliary episodes were significantly more frequent in the late-ERCP group (19.4% vs. 5.8%, p = 0.021), as were urgent postoperative ERCP (16.1% vs. 5.2%, p = 0.044), stent reinsertion (35.5% vs. 14.5%, p = 0.008), and additional ERCPs (38.7% vs. 15.7%, p = 0.006). Conclusions: Prolonged biliary stent dwell time beyond six months is associated with significantly higher rates of recurrent biliary episodes, urgent postoperative ERCP, postoperative stent reinsertion, and additional ERCP’s.

Background: While the severity of acute appendicitis is routinely evaluated, the significance of its morphological characteristics remains underexplored. This study aimed to evaluate the clinical impacts of appendiceal dimensions. Methods: This retrospective study included patients who underwent appendectomy. Data on demographics, appendiceal morphology, time from admission to surgery, postoperative complications, and readmission rates were analyzed. Statistical tests, including correlation analysis and multivariate regression, were used. p-value ≤ 0.05 was considered statistically significant. Results: Appendix diameter demonstrated positive correlations with age, complicated appendicitis, and surgery duration. Multivariate analysis showed that appendix diameter was found to be a significant predictor of readmission rates, regardless of clinical factors, and has a significant positive association with age in both univariate/multivariate analyses. Conclusions: Our findings demonstrate the significance of appendicular morphology in the prediction of readmission rates and the importance of age-specific diagnostic thresholds. The observed age-related changes may warrant re-evaluation of recent diagnostic criteria.

Background: Shoulder arthroplasty is performed for various etiologies, including osteoarthritis, proximal humerus fractures (PHFs), and rotator cuff tears. While previous studies have focused on outcomes based on implant choice, less is known about the independent effects of surgery type, comorbidities, and fracture status on postoperative outcomes. This study evaluates their influence on length of stay (LOS), in-hospital mortality, and postoperative complications. Methods: A retrospective cohort analysis of 664,545 patients undergoing anatomic total shoulder arthroplasty (ATSA), reverse total shoulder arthroplasty (RTSA), or hemiarthroplasty (HA) was conducted. Multivariable Poisson and logistic regression models assessed predictors of LOS, mortality, and complications. Results: Among 132,909 patients, 63.3% underwent RTSA, 31.3% underwent ATSA, and 5.4% underwent HA. Mean hospitalization was longest for HA (2.56 days) and RTSA (1.82 days) compared to ATSA (1.39 days; p < 0.001). Poisson regression confirmed that RTSA increased LOS by 24.1% versus ATSA (IRR = 1.24, p < 0.001), while HA had the highest LOS (IRR = 1.58, p < 0.001). Postoperative complications were observed in 8.37% of ATSA, 13.81% of RTSA, and 17.81% of HA cases (overall ~12.3%). Compared with ATSA, RTSA increased the odds of complications (OR = 1.48, p < 0.001), while HA presented the greatest complication risk (OR = 1.51, p < 0.001). Among proximal humerus fracture (PHF) patients (9.9% of the cohort), 84.7% underwent RTSA. PHF independently increased LOS (IRR = 1.61, p < 0.001), mortality (OR = 1.62, p = 0.051), and complications (OR = 2.33, p < 0.001). Conclusions: RTSA is associated with longer hospitalization and higher complication rates, while PHF worsens LOS, mortality, and complication risk.

Background: Chronic corticosteroids are commonly prescribed for autoimmune and inflammatory disorders, yet their impact on perioperative outcomes following elective total hip arthroplasty (THA) remains incompletely defined. This study evaluated the association between chronic corticosteroid use and postoperative complications and hospital outcomes after elective primary THA. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2021). Adult patients undergoing elective primary THA were identified using ICD-10-PCS codes. Chronic corticosteroid use was defined by ICD-10-CM code Z79.52. The primary outcome was any postoperative complication, including venous thromboembolism (VTE), major bleeding, acute kidney injury, myocardial infarction, stroke, or sepsis. Secondary outcomes included prolonged length of stay, high hospital charges, discharge to rehabilitation, and in-hospital mortality. Multivariable weighted logistic regression and 1:1 propensity score matching (PSM) was applied. Results: The weighted cohort represented approximately 600,000 hospitalizations, of which 0.91% involved chronic steroid use. Steroid users had a higher burden of comorbidities. After adjustment, chronic corticosteroid use was independently associated with increased odds of any postoperative complication (OR 1.32), major bleeding (OR 1.46), prolonged hospitalization (OR 1.26), discharge to rehabilitation (OR 1.06), and in-hospital mortality (OR 2.53). In the matched cohort (1079 pairs), steroid use remained significantly associated with overall complications (OR 1.84) and acute kidney injury (OR 2.10). Conclusions: Although uncommon, chronic corticosteroid use is associated with a clinically meaningful increase in perioperative morbidity after elective THA. These findings highlight chronic corticosteroid use as a marker of increased perioperative risk that warrants greater clinical recognition, and they provide hypothesis-generating evidence to inform future studies of perioperative management in this population.