Reported incidences of postoperative diaphragmatic dysfunction vary widely, largely because diagnostic criteria differ and preoperative imaging is seldom available; whether anatomical elevation, contractile impairment, or their combination carries clinical consequence is undefined, and the reproducibility of any composite definition has not been established. We prospectively studied 169 adults undergoing cardiac surgery, pairing standardised pre- and postoperative chest radiography with quantitative diaphragmatic ultrasonography performed in every patient, to determine the incidence, reliability, predictors and clinical consequences of dysfunction defined as new anatomical elevation combined with contractile failure. Combined dysfunction occurred in 18.3
Constrictive pericarditis remains a significant cause of heart failure in Africa, predominantly due to tuberculosis; however, pericardiectomy outcomes across African settings have not been systematically synthesised. This review aimed to determine the pooled perioperative mortality following pericardiectomy for constrictive pericarditis in the African population and identify predictors of early death. We searched PubMed, Scopus, African Journals Online, Cochrane Library, and Web of Science from inception to May 2026, supplemented by Google Scholar and citation tracking. Two reviewers independently screened the records and extracted the data, with a third reviewer resolving any disagreements. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Perioperative mortality and aetiology were pooled using a random-effects model with Freeman-Tukey double arcsine transformation. The certainty of evidence was rated using GRADE. This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 statement. Of the 2148 records identified, 16 studies met the eligibility criteria and were included in the narrative synthesis, spanning South Africa, Côte d’Ivoire, Ethiopia, Ghana, Senegal, Gabon, and Nigeria. Eleven studies (604 patients) contributed to the pooled mortality analyses. The pooled perioperative mortality was 10.0
Excessive perioperative bleeding remains a major challenge in non-cardiac thoracic surgeries. Antifibrinolytic therapy can enhance hemostasis and reduce transfusion requirements, although its use carries a theoretical risk of postoperative thromboembolic complications that warrants evaluation alongside its hemostatic benefits. Methods: For this systematic review and meta-analysis, we searched multiple databases for studies that compared antifibrinolytic therapy with placebo or no intervention in adult patients undergoing non-cardiac thoracic surgery. Primary outcomes included intraoperative and early postoperative bleeding and blood transfusion requirements. Additionally, thromboembolic events, length of hospital and ICU stay, respiratory complications, and all-cause postoperative mortality were also analyzed. Standardized mean differences (SMDs), mean differences (MDs), or odds ratios (ORs) with 95
The origins of cardiovascular knowledge are deeply rooted in ancient Egyptian civilization, where the heart occupied an unparalleled position in medicine, theology, and cultural identity. Drawing primarily from the Ebers Papyrus (ca. 1550 BCE) and the Edwin Smith Papyrus (ca. 1600 BCE), this review examines how ancient Egyptian physicians developed remarkably sophisticated concepts of cardiovascular anatomy, pathology, and even rudimentary surgical intervention, a millennium before the Hippocratic tradition. The Ebers Papyrus contains what is plausibly the first treatise on cardiology in human history, describing the heart as the center of a distributive vascular system composed of 22 vessels (mtw), recognizing the relationship between the peripheral pulse and cardiac function, and cataloguing a range of cardiac pathologies including what may represent early descriptions of heart failure and angina. The Edwin Smith Papyrus, distinguished by its rational and empirical approach, provides the earliest known surgical case reports, including descriptions of thoracic injuries and their cardiovascular consequences. Notably, the Ebers Papyrus also documents what is among the oldest surviving descriptions of an arterial aneurysm and its surgical treatment by cautery. Furthermore, modern paleopathological investigations using computed tomography have revealed widespread atherosclerotic disease in Egyptian mummies, confirming that cardiovascular pathology is not exclusively a disease of modernity. Ancient Egypt represents an important cradle of circulation knowledge and a main intellectual birthplace of cardiovascular surgery.
Suboptimal ergonomic postures during surgical procedures increase the susceptibility to work-related musculoskeletal disorders. We objectively compared surgeons’ ergonomics and posture between robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) lobectomy, using the validated rapid upper limb assessment (RULA) score. A prospective observational study evaluated 59 lobectomies performed by seven surgeons. Surgeon’s joint angles were tracked during real-life procedures using two software applications (Kinovea-0.9.5 and APECS platform). Sagittal and dorsal videos were recorded during robot (n = 31) and multiportal thoracoscopic (n = 28) lobectomies. We calculated neck, shoulder, elbow, trunk, hip, knee, and specific tilt angles to estimate the RULA scores for ergonomic risk during dissection/division of vascular structures. Data were analysed using linear mixed-effects models to adjust for intra-surgeon clustering and anthropometrics. The RULA score was significantly lower in the RATS (4.7±0.5) compared to VATS-group (7.0±0.6) (p < 0.001), indicating a high ergonomic risk for surgeons in the VATS-group, versus a low-to-medium risk in the RATS-group. The mean joint angles of neck, trunk, neck-tilt and shoulder-tilt were significantly higher in VATS (p < 0.001), while the elbow angles were significantly greater in RATS (p < 0.001). There was no significant intergroup difference regarding shoulder angles (p = 0.21) or operative time (p = 0.53). A within-surgeon subgroup analysis confirmed these postural advantages are intrinsically driven by the robotic platform. Inter-software agreement between the tracking platforms was excellent (mean intraclass correlation coefficient = 0.94). RATS demonstrated superior ergonomics and posture compared to VATS, with lower associated risk of musculoskeletal disorders. Integrating ergonomic checklists into surgical training is essential to minimize occupational injury risks.
Nicotine dependence increases the risk of adverse outcomes after cardiac surgery, but there are no current established studies directly comparing different smoking cessation medications’ effect on postoperative outcomes. We studied the association of varenicline, nicotine replacement therapy (NRT) use and postoperative outcomes. We performed a retrospective cohort study using the TriNetX Research Network, including adults with documented nicotine dependence who underwent cardiac surgery between November 1, 2005, and November 1, 2025. We included two independent comparative studies which compared preoperative varenicline use vs. preoperative NRT use and preoperative varenicline use vs. active smokers who did not receive pharmacologic cessation therapy. Patients with concurrent preoperative use of both varenicline and NRT were excluded to avoid confounding. For each analysis, we used an independent 1:1 propensity score matching to create matched cohorts. Primary outcome was major adverse cardiovascular events. Secondary outcomes included all-cause mortality, ED visit, myocardial infarction (MI), arrhythmias, pneumonia, acute respiratory failure or ARDS, mechanical ventilation, postoperative infection, and antipsychotic use. All outcomes are measured at 3,6 and 12 months postoperatively. At 3, 6, and 12 months postoperatively, varenicline use was associated with a significantly lower risk of the primary outcome, MACE, when compared to both NRT (at 12 months: 19.9
Abstract Background Uniportal video-assisted thoracoscopic surgery (uniVATS) minimizes surgical trauma while maintaining efficacy. Although traditionally performed under intubated general anesthesia, non-intubated awake techniques may reduce airway complications and enhance recovery. This systematic review and meta-analysis compared perioperative outcomes between non-intubated awake and intubated anesthesia in adult uniVATS. Following PRISMA 2020, PubMed, Web of Science, Scopus, Ovid, and Cochrane Library were searched on 16 December 2025. Eligible studies compared non-intubated awake with intubated general anesthesia in uniVATS patients and reported perioperative or postoperative outcomes. Two reviewers independently screened studies, extracted data, and assessed quality using RoB 2 for randomized controlled trials and the Newcastle–Ottawa Scale for observational studies. Meta-analyses were conducted using RevMan 5.4 and R with random-effects and fixed-effects models. Heterogeneity was assessed by I². Effect estimates was expressed as risk ratio (RR) or mean difference (MD) with 95% confidence interval (95% CI). Results Fourteen studies (6 randomized controlled trials and 8 observational) including 2,054 patients were analyzed. Pooled analysis of 7 studies showed that non-intubated anesthesia significantly reduced total postoperative complications (RR = 0.47, 95% CI 0.32–0.69, P = 0.0001, I² = 0%), postoperative pulmonary complications (RR = 0.49, 95% CI 0.34–0.69, P < 0.0001, I² = 0%), and mortality (RR = 0.21, 95% CI 0.07–0.66, P = 0.007, I² = 0%). Secondary outcomes significantly favoring non-intubated anesthesia included shorter chest tube duration (MD = − 0.41 days, I² = 0%), reduced awakening time (MD = − 5.44 min, I² = 60%), and lower sore throat frequency (RR = 0.31, I² = 78%). Intraoperative hypoxemia had a borderline non-significant increase with non-intubated anesthesia (RR = 1.92, P = 0.05, I² = 19%). Non-significant outcomes comprised Operative and anesthetic durations, postoperative pain, hospital length of stay, procedure-related cost, patient satisfaction, and re-operation rates. showed extreme heterogeneity with inconsistent direction of effect. Sensitivity analyses confirmed robust findings for primary outcomes though mortality was influenced by a single study. Subgroup analyses by study design and procedure type consistently favored non-intubated anesthesia without significant heterogeneity. Conclusions Non-intubated uniVATS reduces postoperative morbidity; however, recovery benefits remain uncertain, supporting its use in appropriately selected patients.
Abstract Background Numerous surgical strategies currently exist for managing D-transposition of the great arteries (D-TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS). This study evaluates survival, freedom from reintervention, and procedural effectiveness over a 30-year institutional experience (1988–2018). A retrospective analysis was conducted on all 64 patients who underwent the Rastelli procedure at Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia. Freedom from reintervention and survival were assessed using Kaplan–Meier curves with numbers at risk reported at each landmark, and groups were compared with the log-rank test and Cox proportional-hazards models. Results A Blalock–Taussig shunt was placed in 52 patients (53.1% of all previous-procedure events), and balloon atrial septostomy was performed in 12 patients (18.8%). After the index Rastelli operation, 37 patients (57.8%) remained free from any reintervention; 21 (32.8%) underwent surgical right ventricle-pulmonary artery (RV-PA) conduit replacement or pulmonary valve replacement (PVR); 12 (18.8%) underwent any catheter-based right ventricular outflow tract/ pulmonary artery (RVOT/PA) intervention; and 6 patients (9.4%) had a catheter-based procedure as their only reintervention. Kaplan–Meier freedom from surgical reintervention was 100% at 1 year, 91.3% at 5 years, 77.4% at 10 years, 53.9% at 15 years, and 49.8% at 20 years (median 16 years). Overall survival was 98.4% at 1 year and 95.2% from year 5 onward (3 deaths total: 1 in-hospital, 2 late, all within 3.5 years of surgery; 95% CI 85.9–98.4%). No patient required reoperation for left ventricular outflow tract obstruction (LVOTO) over the entire follow-up period. Conclusions The Rastelli procedure for D-TGA, VSD, and PS offers excellent early, mid- and long-term survival. Reintervention is primarily driven by RV-PA conduit replacement. Aggressive resection of the conal septum, with or without formal VSD enlargement, appears to prevent late LVOTO.
Abstract Background Truncus arteriosus (TA) is a rare congenital heart defect requiring early surgical repair. Most patients require subsequent catheter-based or surgical reintervention during follow-up. This study aimed to describe short- to long-term outcomes following primary TA repair, characterize the burden of reintervention, and identify risk factors associated with surgical and catheter-based reintervention. A single-center retrospective review was conducted of all patients who underwent TA repair between 2010 and 2023. Kaplan–Meier analysis, Firth-penalized Cox regression, Fine–Gray competing risk analysis, and Andersen–Gill modeling for recurrent events were performed. Results Thirty-four patients were included (median age 4.0 weeks; median weight 3.0 kg). Type 1 TA was the most common subtype (73.5%). Thirty-day mortality was 11.8%, and overall mortality was 17.6%. Sixteen patients (47.1%) underwent surgical reintervention, predominantly right ventricle-pulmonary artery (RV-PA) conduit replacement (87.5%). Freedom from surgical reintervention was 50.4% at 5 years. Truncal valve stenosis (HR 4.91, p = 0.022), concomitant pulmonary artery plasty (HR 4.52, p = 0.005), and concomitant truncal valve replacement (HR 4.85, p = 0.024) were significantly associated with surgical reintervention. Seventeen patients (50.0%) required catheter-based reintervention, with 10 requiring repeated procedures (total: 33 procedures). Confluent hypoplastic Pulmonary Artery (PA) anatomy was associated with catheter-based reintervention (HR 3.61, p = 0.021). Competing risk analysis yielded slightly lower cumulative incidence estimates for reintervention when death was treated as a competing event. Conclusions TA repair is feasible with acceptable early mortality; however, reinterventions are frequent, principally related to RV-PA conduit dysfunction and branch pulmonary artery stenosis. Truncal valve stenosis and the need for concomitant procedures at index repair identify patients at higher risk for earlier surgical reintervention. Long-term surveillance and a low threshold for catheter-based intervention are essential in this population.
Abstract Background Video-assisted thoracic surgery (VATS) is traditionally performed under general anesthesia with endotracheal intubation and one-lung ventilation. Renewed interest in non-intubated VATS (NIVATS) has refocused attention on thoracic surgery performed under spontaneous ventilation with regional anesthesia and carefully titrated sedation. This review examines the evolution, rationale, current evidence, and practical limits of NIVATS in modern thoracic surgery. Main body We summarize the terminology and development of NIVATS and discuss its physiological basis, indications, contraindications, patient selection, regional anesthesia, cough-control strategies, oxygenation adjuncts, and conversion pathways. Recent randomized syntheses and propensity-matched meta-analyses suggest that, in carefully selected patients managed in experienced centers, NIVATS can reduce airway-related morbidity, postoperative nausea and vomiting, chest-tube duration, and length of stay, with signals toward fewer postoperative pulmonary complications and faster recovery. These potential advantages are counterbalanced by specific intraoperative challenges, including respiratory motion, cough, permissive hypercapnia, and the need for immediate conversion to intubated anesthesia in cases of hypoxemia, bleeding, or inadequate surgical conditions. Successful implementation therefore depends on strict patient selection, high-quality regional analgesia, close surgeon-anesthesiologist coordination, and a predefined conversion strategy. Conclusion NIVATS should not be viewed as a universal replacement for intubated anesthesia, but as a complementary, precision-based approach for selected thoracic procedures. In experienced centers, current evidence supports its feasibility, safety, and clinical value, while broader adoption will depend on standardization, training, and robust long-term outcome data.
Abstract Background Lung transplant is a life-saving therapy for end stage lung disease. However, the shortage of donor organs limits its availability. The safety of utilizing lungs from COVID-19-positive donors remains uncertain due to potential transmission risks and variable practice patterns. This study aimed to compare allografts from COVID-19-positive donors and COVID-19-negative donors during lung transplantation, with a focus on survival, length of hospital stay, dialysis, 30-day graft failure, 30-day mortality and postoperative ECMO support. Methods PubMed, Scopus, and Embase were assessed. Four studies including 5,921 patients were included. Overall survival was estimated by the Kaplan-Meier method and compared with Cox proportional hazards models. Random-effects models were applied for all pooled analyses. Results There was no difference in overall survival (HR 1.35; 95% CI 0.67–2.71; p = 0.40), and dialysis (RR = 1.38; 95% CI 0.52–3.64; p = 0.52) between groups. Recipients of allografts from COVID-19-positive donors had longer hospital stay (MD = 6.43 days; 95% CI 1.53–11.33; p = 0.01). There were no significant differences between groups for 30-day graft failure (RR = 1.08; 95% CI 0.83–1.39; p = 0.58), 30-day mortality (RR = 1.76; 95% CI 0.75–4.13; p = 0.19), or ECMO within 72 h (RR = 0.61; 95% CI 0.14–2.58; p = 0.50). Conclusions Although outcomes of transplantation were comparable, recipients of lungs from COVID-19-negative donors had shorter hospital stay. However, these results should be interpreted with caution due to the limited number of available comparative studies reflecting the current evidence base, and variations in methods of ascertaining COVID-19 positivity across studies.
Abstract Background Lung cancer surgery in low- and middle-income countries (LMICs) is frequently challenged by late-stage presentation, high comorbidity burden, and limited healthcare resources. Although video-assisted thoracoscopic surgery (VATS) is widely adopted in high-income settings, evidence regarding its feasibility, oncologic adequacy, and economic impact in resource-constrained environments remains limited. This study evaluated real-world perioperative and oncologic outcomes of VATS lobectomy in an LMIC setting. Methods This retrospective observational study included 400 consecutive adult patients undergoing anatomical lobectomy or bilobectomy for primary lung cancer at two tertiary thoracic surgery centers between 2019 and 2024. Preoperative evaluation included clinical assessment, pulmonary function testing, and cross-sectional imaging, with positron emission tomography used when available. Operative variables, postoperative complications (graded using the Clavien-Dindo system), length of hospital stay, and institutional procedural costs were recorded. Oncologic quality indicators included resection margin status, mediastinal lymph node dissection, nodal yield, and nodal upstaging rates. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan–Meier analysis. Results The cohort demonstrated a high prevalence of cardiopulmonary comorbidity and predominantly stage II–III disease. Conversion to thoracotomy occurred in 1.5% of cases. Complete (R0) resection was achieved in 98.5% of patients. Systematic mediastinal lymph node dissection yielded a mean of 12.4 nodes across a median of four stations. Nodal upstaging from clinically node-negative disease occurred in 11.5% of patients. Perioperative outcomes were favorable, with low intraoperative blood loss, short chest tube duration, and brief hospital stay. Postoperative complications occurred in 20% of patients with low early mortality. Estimated overall survival exceeded 90% at 24 months and remained above 80% at approximately 40 months. Conclusions In a real-world LMIC setting, VATS lobectomy is feasible, safe, oncologically adequate, and economically comparable to open surgery. These findings support the structured integration of minimally invasive thoracic surgery into lung cancer treatment pathways in resource-constrained healthcare systems.
Abstract Background Interventional management of chronic obstructive pulmonary disease of the emphysema phenotype, include uniportal, non-intubated, video-assisted thoracic surgery (UNI-VATS) lung volume reduction surgery (LVRS), which has shown to offer significant clinical benefit and minimized surgery- and anesthesia-related morbidity. Nevertheless, the insertion of the chest tube through the single surgical incision may constitute a trigger-point for wound-related complications. Herein we report on two patients with severe emphysema who developed wound infection and pleural-cutaneous fistula following UNI-VATS LVRS. Cases presentation : In both patients the chest tube had been placed through the single surgical incision and the post-operative course was complicated by prolonged air leaks requiring discharge with the tube connected to a Heimlich valve. Following eventual removal of the chest tube, both patients came back to the emergency department on post-operative day 23 and 26, respectively, due to signs of local infection and pain. In one instance a recurrent pneumothorax required surgical debridement and placement of a further chest tube whereas in the other, sole surgical debridement at the surgical site proved curative. In both instances chest computed tomography clearly documented the pleural-cutaneous fistula first, and full recovery with complete lung re-expansion and proper wound healing subsequently. Conclusions These cases, which had never been reported so far, highlight a potentially preventable complication of UNI-VATS LVRS and suggest that alternative drainage strategies should be considered in patients at high-risk of prolonged air leaks.
Abstract Background Uniportal thoracoscopic sleeve lobectomy is being increasingly performed as a less invasive option than equivalent procedures carried out through thoracotomy. The addition of non-intubated anesthesia with maintenance of spontaneous ventilation is reported as a further step ahead within advanced minimally invasive thoracic surgery options. Main text. In this editorial commentary, the recently published paper titled “Surgical technique and outcome analysis of nonintubated uniportal VATS sleeve lobectomy: A cohort study”, by Drs Qu and Jiang is discussed in detail. Conclusion We don’t know yet if excellent results do mean that it is worth doing non-intubated uniportal thoracoscopic sleeve resection. Rather, further investigation is warranted to confirm general applicability.
Abstract Background Major open thoracic surgery is associated with severe postoperative pain and substantial opioid requirements, contributing to pulmonary complications and delayed recovery. Thoracic epidural analgesia (TEA) remains the standard regional technique but is frequently contraindicated or associated with complications in high-risk cardiothoracic patients. Intraoperative intercostal nerve cryoablation (CRYO) has emerged as a potential opioid-sparing alternative; however, its effectiveness across diverse thoracic surgical indications remains uncertain. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Cochrane Library were searched from inception to January 5, 2026 for randomized and observational studies evaluating intraoperative CRYO in adult patients undergoing major open thoracic surgery. Comparators included standard multimodal analgesia and TEA. Random-effects models were applied, and certainty of evidence was assessed using GRADE. Results Eight studies comprising nine independent cohorts (n = 825) were included. CRYO significantly reduced cumulative inpatient opioid consumption compared with control strategies (SMD − 0.86; 95% CI − 1.57 to − 0.15) and improved early postoperative pain scores (MD − 0.74; 95% CI − 1.45 to − 0.03). Pulmonary function recovery was significantly enhanced (SMD 0.61; 95% CI 0.20 to 1.01), with consistent effects across surgical indications. Conclusions Intraoperative intercostal nerve cryoablation is associated with no significant increase in reported complications and is an effective opioid-sparing adjunct that improves early pain control and pulmonary recovery following major open thoracic surgery. Its clinical benefits are procedure-dependent, with greatest impact observed outside the lung transplantation population. CRYO represents a viable alternative to neuraxial analgesia, particularly in patients at elevated risk for epidural-related complications.
Abstract Background Spontaneous ventilation video-assisted thoracic surgery (SV-VATS) represents an additional step ahead within the evolution of minimally invasive thoracic surgery and has been shown to be associated with reduced morbidity and hospitalization times in selected cohorts. Nevertheless, the economic implications of this strategy are still under-investigated. Aim of this study was to perform a cost-minimization analysis in order to compare SV- versus mechanical ventilation (MV) VATS across different surgical scenarios. Costs computation included non-device-related costs and costs related to management of post-operative complications. Results We compared SV-VATS (group A) versus MV-VATS (group B) through a cost-minimization analysis. Costs included in the analysis were hourly operating room expenses, daily costs for hospitalization, and costs related to post-operative complications. Economic evaluation was made using Monte Carlo simulation modeling. Two different scenarios were investigated: lung volume reduction surgery for emphysema and wedge resection for lung metastasectomy. Input data about operative room time, hospital stay, and morbidity were retrieved from 2 of our previously published comparative studies. In the first scenario about lung volume reduction surgery, group A presented significantly lower estimated mean costs (€6238.9 ± 2430.9 versus €11,874.1 ± 3529.1 for group B, p < 0.001). The analysis of cost distribution revealed that group B was associated with a wider and higher range of costs, suggesting greater financial variability. Evaluation of cost differences distribution showed that group B was associated with higher costs in 90.8% of simulations, with an expected mean cost saving of €5635.2 ± 4309.5 per patient by adopting SV. In the second scenario about wedge resection, group A confirmed lower estimated mean costs (€3199.8 ± 1074.2 versus €4538.7 ± 2405.4 of group B, p < 0.001) and a narrower cost distribution, reflecting a more predictable economic profile. Distribution of cost difference indicated that patients in group B presented higher costs in 65.8% of simulations, with an expected mean cost saving of €1338.9 ± 2629.9 by choosing SV. Conclusions SV-VATS was associated with lower overall costs compared to MV-VATS in different clinical scenarios, suggesting a lower in-hospital financial burden. These findings support the role of this strategy not only as clinically advantageous, but also as a cost-minimizing strategy in healthcare resource management.
Abstract Background Rigorous statistical methods and transparent reporting are fundamental to the integrity and reproducibility of cardiothoracic surgical research. As study designs and analytical approaches grow more sophisticated, comprehensive statistical guidelines have become essential to ensure research quality and reliability. These guidelines serve as a comprehensive framework for authors submitting manuscripts to The Cardiothoracic Surgeon, providing detailed recommendations for statistical analysis, interpretation, and reporting across the full spectrum of study designs commonly encountered in cardiothoracic surgical research. Main text The importance of sound statistical practice cannot be overstated in an era where evidence-based medicine drives clinical decision-making and patient care protocols. Inadequate statistical methodology undermines the validity of individual studies and fuels the broader reproducibility crisis in the medical literature. These guidelines establish clear standards for statistical rigor across the research continuum—from study design and power calculations to data analysis and result interpretation. The guidelines encompass key areas, including descriptive statistics, inferential testing, regression analysis, survival analysis, propensity score methods, diagnostic accuracy studies, and specialized techniques such as repeated measures analysis and competing risk models. Each section provides detailed guidance on appropriate test selection, assumption verification, result interpretation, and reporting requirements. Special attention is given to common statistical pitfalls and misconceptions that frequently appear in surgical literature, offering practical solutions and alternative approaches. The intended audience includes cardiothoracic surgeons, clinical researchers, biostatisticians, and journal reviewers who seek to enhance the statistical quality of surgical research. Conclusions By following these guidelines, authors will be better equipped to conduct methodologically sound analyses, interpret results appropriately, and communicate findings clearly to the scientific community. Ultimately, these standards aim to elevate the quality of evidence in cardiothoracic surgery, supporting improved patient outcomes through more reliable and reproducible research.
