Background Given that patients undergoing orthopaedic surgery frequently share risk factors that are associated with metabolic syndrome, the patients orthopaedic surgeons treat may be especially likely to have undiagnosed dysglycemia. Although its broader impact is documented in other specialties, its specific prevalence and association with postoperative outcomes after orthopaedic procedures remains incompletely defined. Quantifying this hidden burden is important to developing individual risk profiles, refining perioperative decision-making, and establishing targeted preoperative medical management strategies for patients considering orthopaedic surgery. Questions/purposes In a large-database study, we asked: (1) In adults who underwent orthopaedic surgery, what proportion of patients had previously undiagnosed dysglycemia? (2) Was undiagnosed dysglycemia associated with increased odds of 30-day readmission and reoperation compared with patients with normoglycemia? (3) What was the relationship between preoperative HbA1c levels and the 30-day risk of complications in patients who underwent orthopaedic surgery? Methods Among the 2,990,063 procedures recorded in the American College of Surgeons National Surgical Quality Improvement Program database (2021-2023), 25% (735,259 of 2,990,063) were orthopaedic. After excluding 75% (2,254,804 of 2,990,063) of nonorthopaedic procedures and 16% (493,272 of 2,990,063) of orthopaedic procedures without documented preoperative HbA1c, 8% (241,987 of 2,990,063) of all procedures were analyzed. Patients were assigned to one of eight glycemic groups (normoglycemic, undiagnosed prediabetes, undiagnosed diabetes, or diagnosed diabetes with near-normal, very good, good, poor, and very poor glycemic control) based on diabetes diagnosis and HbA1c level. The study cohort included patients undergoing a range of procedures, primarily consisting of total joint arthroplasty, fracture fixation, and spine surgery. The mean ± SD patient age was 66 ± 12 years and 56% [134,741 of 241,987] of patients were female. To address the first research question, the percentage of patients with previously undiagnosed dysglycemia in each cohort was measured, supplemented by a best-case sensitivity analysis to provide a conservative estimate for the entire surgical population. The second and third research questions investigated the association of undiagnosed dysglycemia on 30-day odds of readmission and reoperation and the relationship between preoperative HbA1c and 30-day odds of complications, using multivariable logistic regression adjusted for demographic, comorbidity, and procedural factors. To illustrate variation across operations, the 30-day complication rate of patients across HbA1c strata was evaluated for the 10 most frequent primary Current Procedural Terminology–coded procedures. Results We found that 22% (52,609 of 241,987) of patients with a recorded preoperative HbA1c had undiagnosed prediabetes and 4% (10,690 of 241,987) of patients met the criteria for undiagnosed diabetes. In a best-case sensitivity analysis in which we assumed that all patients without an HbA1c measurement did not have diabetes and had normoglycemia, the smallest percentage of patients with previously undiagnosed dysglycemia would have been 9% (63,299) across all 735,259 patients who underwent orthopaedic surgery. After adjusting for potentially confounding variables, neither prediabetes nor diabetes was independently associated with increased odds of 30-day readmission (adjusted OR 0.95 [95% CI 0.88 to 1.0]; p = 0.12 and adjusted OR 0.99 [95% CI 0.84 to 1.2]; p = 0.94) or reoperation (adjusted OR 0.94 [95% CI 0.85 to 1.0]; p = 0.25 and adjusted OR 0.99 [95% CI 0.84 to 1.2]; p = 0.94) compared with patients with normoglycemia. The adjusted ORs for any 30-day complication were higher in patients with undiagnosed diabetes (adjusted OR 1.1 [95% CI 1.0 to 1.2]; p = 0.03) and increased across HbA1c strata in those with diagnosed diabetes (adjusted OR 1.2, 1.1, 1.2, 1.4, and 2.0; all p ≤ 0.009) compared with patients with normoglycemia. Procedure-level analyses showed consistent patterns with variable magnitude: 30-day rates of any complication in THA rose from 5% (1425 of 27,812) to 17% (49 of 294) across HbA1c strata, whereas 30-day complication rates peaked at 30% (203 of 675) in hinged TKA and at 22% (11 of 49) in revision TKA. On the other hand, 30-day complication rates in shoulder procedures and knee arthroscopy remained uniformly low (< 6%) with minimal variation by HbA1c. Conclusion Unrecognized dysglycemia is common among patients undergoing orthopaedic surgery and is associated with postoperative morbidity. Selective preoperative HbA1c assessment and procedure-specific targets may improve perioperative risk stratification. Examining these effects in clinical studies with procedure-specific preoperative HbA1c screening to identify and appropriately treat patients at risk could help to further validate these findings. Level of Evidence Level III, therapeutic study.

BackgroundVascularized composite allotransplantation (VCA) enables functional and aesthetic restoration after devastating tissue loss. Yet, data-driven profiling of VCA recipients remains scarce. Identifying demographic and procedural patterns may improve transplant recipient selection, program planning, and perioperative care.MethodsVCA procedures in the Organ Procurement and Transplantation Network (OPTN, 1998–2023) were preprocessed, imputed, and clustered using weighted HDBSCAN. Resulting cluster patterns, temporal and geographic trends were analyzed. ARIMA models were applied to forecast patient demographics.ResultsAmong 107 recipients (mean age 37 ± 12 years; BMI 25 ± 5 kg/m²; 57% female), clustering analyses confirmed gender and VCA type as the primary differentiating dimensions, with face (19%) and upper-limb transplants (30%) predominantly performed in men and uterus transplants (31%) concentrated in United Network for Organ Sharing (UNOS) Regions 4 and 10. The facial VCA subgroup clustered regionally in Regions 1 and 9 (n = 13) and was characterized by comparatively high recipient age (42 ± 11 years) and long waiting times (246 ± 198 days). In the balanced clustering solution, 42% of recipients were classified as noise, highlighting substantial population heterogeneity. Temporal analyses showed declining activity in abdominal wall (11%) and upper-limb procedures, whereas ARIMA forecasts indicated stable age and BMI distributions through 2027.ConclusionsThis study provides the first machine-learning–based characterization of the national VCA recipient population using OPTN data. Rather than discovering entirely new recipient categories, the clustering framework successfully reproduced established population structures while identifying secondary regional and temporal patterns. Furthermore, density-based clustering highlighted substantial recipient heterogeneity through explicit outlier detection, thereby potentially providing a scalable framework for future registry-based analyses that incorporate immunological, outcome-related, and more granular clinical variables to enable earlier identification of atypical recipients and more targeted program planning.

BackgroundVascularized composite allotransplantation (VCA) has emerged as a reconstructive option for complex tissue defects, yet its oncologic long-term safety remains poorly characterized.AimsThis study aims to provide the most comprehensive overview of post-VCA malignancies to date.Methods and resultsA systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed/MEDLINE, EMBASE, and Web of Science for malignancies that emerged after VCA. Additionally, registry cases were identified through the Organ Procurement and Transplantation Network (OPTN). Risk of bias and methodological quality of included case reports were assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and Case Series. The review protocol is registered on PROSPERO (CRD420261350024). 13 articles met the inclusion criteria, comprising 13 patients with 18 malignancies, reflecting multiple malignancies in individual patients. A total of 15 patients with 22 malignancies, including two additional OPTN registry cases, were analyzed. The most frequently diagnosed malignancies included non-melanoma skin cancer (NMSC; 41%; n=9/22 malignancies) and lymphoproliferative disorders (36%; n=8/22 malignancies). One malignancy was a recurrence in a patient who was transplanted due to squamous cell carcinoma of the mouth. Median time to malignancy was 24 (interquartile range [IQR]: 12-72) months after transplantation, malignancy-associated mortality was 33% (n=5/15 patients) and mean survival time after VCA was 74 ± 58 months in these patients. Notably, no malignancy was identified at the graft site and 23% (n=5/22) of malignancies led to a modification of the immunosuppressive regimen. Two patients self-reported symptoms prior to their scheduled follow-up, including cutaneous morphologic changes and systemic symptoms (night sweats, dyspnea, swelling).ConclusionIn our cohort, post-VCA malignancies were associated with a malignancy-associated mortality of 33%, with NMSC (41%) and lymphoproliferative disorders (36%) predominating the spectrum. Notably, two patients self-reported symptoms prior to their scheduled follow-up, suggesting that structured patient education may be warranted. Given the elective nature of VCA, careful patient selection, structured dermatologic screening, and Epstein-Barr virus surveillance may be useful to enable early detection of post-VCA malignancies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261350024.

Epidemiological data show that while age-standardized mortality rates of oral squamous cell carcinoma (OSCC) have slightly declined, the absolute number of deaths continues to rise, with a concerning increase among younger patients and persistently high mortality in the elderly. The aim of this study was to assess the influence of age on oncological prognosis and to classify it within a multivariable model alongside established histopathological risk factors. In this retrospective single-center study, patients surgically treated for OSCC between 2012 and 2023 were included according to predefined eligibility criteria and stratified into three age groups (< 50, 50–69, ≥ 70 years). Primary endpoints were overall survival (OS) and disease-free survival (DFS). Prognostic factors were further evaluated with multivariable Cox regression models and competing-risk analyses, with age assessed both as a categorical and continuous variable using restricted cubic splines. In 525 included patients (mean age 63.5 years), age distribution was multimodal with three peaks in concordance with the predefined groups. Local recurrence, distant metastasis, and secondary cervical lymph node metastasis (CLNM) were weakly correlated overall, with a stronger association between CLNM and distant metastasis in younger patients. Age significantly predicted overall survival (HR per 10 years: 1.56, 95

Abstract Das obstruktive Schlafapnoe-Syndrom (OSAS) stellt die häufigste schlafbezogene Atmungsstörung dar und ist mit einer erheblichen kardiovaskulären, metabolischen und gesundheitsökonomischen Belastung assoziiert. Die wachsende Evidenz zu einer Vielzahl OSAS-assoziierter Komorbiditäten unterstreicht die zunehmende klinische Relevanz der Erkrankung. Eine frühzeitige Diagnostik und eine adäquate, individuell angepasste Therapie sind entscheidend, um das Risiko langfristiger Folgeerkrankungen zu reduzieren. Die chirurgische Therapie des maxillomandibulären Rotationsadvancement (MMA) stellt ein etabliertes Verfahren mit kurativer Intention dar. Durch die skelettale Vorverlagerung von Maxilla und Mandibula wird der posterior airway space erweitert und der Tonus der pharyngealen Muskulatur erhöht. Bereits mehrere multizentrische Studien des letzten Jahrzehnts zeigen eine signifikante Reduktion des Apnoe-Hypopnoe-Index (AHI) und eine mit der CPAP-Therapie vergleichbare Effektivität. Auswertungen an unserer Klinik zeigen, dass das MMA ebenfalls bei normognathen Patient*innen zu einem Behandlungserfolg führt. Digitale Planungsprozesse und patientenspezifische Implantate ermöglichen eine höhere chirurgische Präzision, verkürzte Operationszeiten und eine verbesserte Standardisierung der Operation. Daten aus der Berliner OSAS-MMA-Kohorte zeigen eine hohe Genauigkeit der skelettalen Verlagerung, sowie eine signifikante Verbesserung funktioneller und ästhetischer Ergebnisse. Bereits eine mittlere anteriore Verlagerung von etwa 8.63mm (SD±1.12mm) führt zu einer deutlichen AHI-Reduktion von im Mittel 71,2% des präoperativen Ausgangswerts. Moderne softwarebasierte Strömungsanalysen auf Basis von DVT-Datensätzen erlauben zusätzlich die Visualisierung statischer und dynamischer Atemwegsparameter. Indices wie der Pharyngeal Resistance Index (PRI) ermöglichen eine weitergehende funktionelle Einordnung der Obstruktion über klassische Schlaflaborparameter hinaus. Das maxillomandibuläre Advancement stellt auch bei normognathen Patient*innen mit obstruktiver Schlafapnoe eine hocheffektive therapeutische Option dar. Durch moderne virtuelle Operationsplanung und die Verwendung patientenspezifischer Implantate kann die Übertragungsgenauigkeit erhöht, die Operationsdauer reduziert und die intraoperative Sicherheit verbessert werden. Bei adäquat gewählter Verlagerungsstrecke lassen sich zudem eine stabile knöcherne Heilung sowie ästhetisch ansprechende Ergebnisse erzielen. Softwarebasierte Analysen unter Einbeziehung aktueller DVT-Bildgebung und strömungsdynamischer Parameter ermöglichen darüber hinaus eine präzisere Lokalisation und Quantifizierung der Atemwegsobstruktion und tragen so zu einem vertieften Verständnis der zugrunde liegenden Pathophysiologie bei.

Introduction Oral squamous cell carcinoma (OSCC) frequently requires extensive resections and microvascular free flap reconstruction, procedures associated with relevant perioperative blood loss. This study aimed to quantify transfusion rates in OSCC patients and identify procedure- and patient-specific predictors of transfusion to guide evidence-based patient blood management (PBM). Material and methods In this retrospective cohort study, 566 OSCC patients undergoing free flap reconstruction over five years were analyzed. Transfusion rates were determined, and predictors were assessed using univariate and multivariate logistic regression models. Results The overall transfusion rate was 59.7%. Fibula free flaps showed a high rate (82.7%), while radial forearm flaps required transfusion in 37.3% of patients. In reconstruction of mandible a transfusion rate of 83.7% was observed. Univariate analyses identified fibula (OR 4.95), anterolateral thigh (4.83), scapula (4.09), osseous free flaps (OR 4.34) and T4 tumor-stage (OR 6.45) as significant predictors. In multivariate analyses preoperative anemia (OR 3.98), antiplatelet therapy (OR 2.16), previous free flap surgery (OR 10.06), reconstruction of mandible (OR 6.27), floor of mouth (OR 4.02) and maxilla (OR 3.03) area, more than one reconstruction area (OR 5.20), N3 (OR 5.26) and T3 tumor-stage (OR 2.40) showed significant influence on transfusion. Mean perioperative requirements were 1.7 red blood cell (RBC) and 1.3 fresh frozen plasma (FFP) units. Conclusion Free flap surgery for OSCC is associated with substantial transfusion needs. Preoperative anemia emerged as the most relevant modifiable factor. Evidence-based correction of anemia and transfusion-oriented preoperative planning - including provision of at least two RBC - may enhance perioperative PBM.

Purpose: Facial expressions and aesthetics are vital for communication, self-expression, and social interaction. Therefore, this study aimed to evaluate the impact of localization and size of facial cutaneous squamous cell carcinoma (cSCC) on changes in perceived pre- and postoperative health-related quality of life (HR-QoL). Methods: This retrospective study included patients who had undergone surgery for facial cSCC. Size, localization and stage were assessed. Pre- and postoperative HR-QoL were evaluated using the Skindex-29. Statistical analyses, including descriptive statistics, the X2 Test, Wilcoxon Test, and repeated-measures ANOVA, were performed to analyze demographic data, tumor characteristics, and changes in HR-QoL. Results: Forty patients (mean age of 78.5 years) were included. Postoperatively, significant improvements were observed in the overall, emotional, and symptomatic HR-QoL. Tumor dimensions had an impact on presurgical emotional distress. For tumor sizes from 6 to 15 mm, significant release in symptom burden and improvement in general HR-QoL were observed. While women experienced notable improvement only in emotional distress, men also exhibited improvement in symptoms, and overall HR-QoL. All age groups showed improvements in emotional distress, symptoms and overall HR-QoL. No significant differences were found in terms of age or localization. Conclusions: This study suggests that sex, tumor localization, and tumor size may interact in influencing postoperative HR-QoL outcomes in patients with cSCC. While surgical treatment by experienced specialists was associated with an overall improvement in HR-QoL following successful tumor eradication, these findings should be interpreted with caution given the limited sample size. The results indicate that surgery remains an important first-line treatment option, particularly for medium-sized tumors. In this cohort, TNM classification was not associated with postoperative HR-QoL changes; however, interpretation is limited by the predominance of early-stage tumors. Further studies with larger patient populations are required to confirm these observations and to better elucidate the relationship between clinical staging and HR-QoL outcomes.

This study´s aim was to analyse clinical outcomes of microvascular reconstructions performed for malignancy-caused midface defects of varying sizes at our department. This retrospective study included 98 patients (38 women; 60 men; age range 16–94 years) who underwent microvascular reconstruction for a malignancy-related midface defect between April 2017 and August 2022. Bony (fibula, scapula) and soft tissue (radial forearm, anterolateral thigh) flap techniques were used depending on defect size. Most defects requiring coverage were classified as class II (n = 70, 71.4

Objective:. To characterize short-term functional trajectories and identify risk factors for loss and recovery of independence among older surgical patients at a national level. Background:. As the surgical population ages, frailty increasingly influences outcomes beyond mortality. Short-term postoperative functional independence is a key patient-centered outcome with long-term implications, yet national data across surgical specialties remain limited. Methods:. We conducted a retrospective cohort study using the 2022–2024 American College of Surgeons National Surgical Quality Improvement Program database, including all patients aged ≥75 years. Patients were categorized by functional trajectory from admission to 30 days postdischarge: maintenance of independence, loss of independence (LOI), maintenance of dependence, or gain of independence (GOI). Multivariable logistic regression identified independent factors associated with LOI among baseline-independent patients, and with GOI among baseline-dependent patients. Prespecified subgroup analyses assessed effect modification by dementia, age, frailty (mFI-5 score), surgical specialty, surgical approach, urgency, and setting. Results:. Among 436,471 patients, 28.2% of baseline-independent adults experienced LOI, while 5.6% of baseline-dependent patients experienced GOI. LOI rates increased stepwise with age and frailty and were strongly associated with frailty, recent falls, preoperative sepsis, higher American Society of Anesthesiologists class, urgent/emergent surgery, inpatient setting, and open surgical approaches. LOI was associated with markedly higher postoperative mortality, prolonged hospitalization, delirium, sepsis, ventilator dependence, and nonhome discharge. Dementia was independently associated with LOI risk and inversely with GOI risk across nearly all subgroups. Conclusions:. Short-term LOI is common among adults aged ≥75 years and represents a powerful marker of adverse postoperative complications. Dementia and perioperative acuity are dominant associated factors of short-term functional trajectory, while short-term recovery of independence is rare. Findings suggest that short-term functional outcomes should be incorporated into preoperative risk stratification, shared decision-making, and perioperative care pathways for older adults.

This study compared postoperative complication rates between bridging plate reconstruction with soft tissue free flaps and osseous free flaps for segmental mandibular defects. This retrospective study compared postoperative outcomes between both techniques in 335 reconstructions of segmental mandibular defects operated over 8 years. The N-1 χ2-test, Fisher’s exact test and Mann-Whitney-U test were used to test for statistical significance after mode and mean imputation were performed on independent variables with missing data. Patients who received bridging plate reconstructions were significantly older (74.4 ± 10.5 vs. 63.4 ± 10.6 years, p < 0.001) and had higher rates of hypertension (67.6

Background Magnesium-based implants are increasingly investigated as bioabsorbable materials for temporary osteosynthesis applications due to their favorable biocompatibility and bone-like elastic modulus. However, controlling the degradation rate remains a critical barrier to clinical translation, as rapid corrosion can compromise mechanical integrity and lead to adverse effects, such as gas formation. Methods PEO-modified WE43MEO (WE43-PEO) and non-modified WE43MEO screws and plates were implanted in the humerus and femur of Göttinger minipigs in a non-fracture model and assessed after 18 months. Explants were analyzed using micro-computed tomography and non-decalcified histology with histomorphometric quantification of residual implant structure and peri-implant bone response. Results No significant differences in cortical implant volume were observed. However, PEO modified implants were surrounded by significantly higher volumes of lamellar bone, suggesting reduced remodeling and improved bone integration. Non-modified WE43MEO implants underwent complete degradation, while PEO modified implants showed partial resorption with preserved structure, indicating effective degradation control. Both implant types remained integrated without long-term complications. Conclusion PEO surface modification of WE43 magnesium implants supports predictable, biocompatible long-term degradation and promotes favorable bone quality without late complications, underscoring the potential of surface-engineered magnesium fixation devices for load-bearing applications. The translational potential of this article PEO-modified WE43MEO osteosynthesis systems may offer clinically relevant, bioabsorbable fixation with controlled degradation and improved long-term bone integration, potentially reducing implant-related complications and the need for secondary removal procedures in orthopaedic and craniomaxillofacial surgery.

BACKGROUND:Microvascular free tissue transfer is a key technique in reconstructive surgery, enabling functional and aesthetic restoration of complex defects. While initial flap survival relies on the vascular pedicle, some flaps may become independent through a process known as autonomization, where new vascular connections form between the flap and recipient site. Understanding the timeline, mechanisms, and clinical relevance of this process is essential for safe surgical planning and postoperative interventions. METHODS:A narrative review was conducted to synthesize current literature on microvascular flap autonomization. Databases including PubMed and Google Scholar were searched up to June 2025, focusing on studies examining flap selection, neovascularization, perfusion monitoring, and predictors of flap vascular independence. Articles were screened based on relevance, methodological quality, and clinical applicability. RESULTS:Flap autonomization showed heterogeneous timelines in literature. Skin and muscle flaps generally tolerated earlier pedicle compromise than jejunal or osteocutaneous flaps, while tissue composition, vascular contact area, recipient bed quality, and comorbidities strongly influenced revascularization. Favorable conditions-such as thin fasciocutaneous or muscle flaps on well-perfused beds-were associated with earlier integration, whereas irradiated tissue and systemic vascular disease delayed independence. Monitoring tools (ICG angiography, laser Doppler, NIRS) aided perfusion assessment but could not confirm full autonomization. Complications were linked to delayed or incomplete neovascularization, particularly during secondary procedures. Adjunctive strategies, including ischemic conditioning and flap "training," showed potential to promote vascular remodeling, but clinical evidence remains limited. CONCLUSION:Flap autonomization is a critical but poorly understood process that varies by flap type and patient context. Despite early neovascular activity, the lack of reliable markers necessitates conservative postoperative protocols. Emerging technologies and bioengineered strategies hold promise but require further validation. Standardized criteria to assess vascular independence could significantly improve outcomes in microvascular reconstructive surgery.

Aim: Mandibular fractures are common and challenging to reduce accurately, particularly in multi-fragment or edentulous settings. Virtual fracture reduction (VFR) could standardize preoperative planning and provide millimetric targets for open reduction and internal fixation but remains limited by manual workflows and variable imaging quality. Methods: We developed a two-stage VFR algorithm using computed tomography (CT)-derived 3D models. Coarse alignment was achieved via a genetic optimization algorithm, followed by fine alignment with the Iterative Closest Point (ICP) algorithm. A weighted objective function optimized (i) condylar positioning, (ii) dental occlusion, and (iii) fracture gap minimization. We tuned weights over 14 experiments and optimized 6 pose parameters per segment with a Genetic Algorithm. Accuracy was evaluated on a synthetic fracture model and applied to three clinical cases. Outcomes included surface-distance maps, occlusal landmark deviation, interfragmentary gaps, and overlap volume and direct contact area. Results: On the synthetic model, maximum surface deviation was 1.58 mm, with fracture-surface errors predominantly < 1 mm. Occlusal reconstruction reproduced molar relationships within 0.07-0.15 mm of the pre-fracture model. In three clinical cases (simple and comminuted patterns), mean interfragmentary gaps were 0.22-0.70 mm, overlap volumes ranged from 28.54 to 119.26 mm3, and direct contact areas spanned 216.00-533.17 mm2, indicating minimal interpenetration and substantial bone-to-bone fit. The pipeline demonstrated stable convergence and reproducible alignment without intraoperative data. Conclusion: These preliminary technical findings support the proposed VFR algorithm as a practical proof-of-concept adjunct to trauma planning. Larger multicenter clinical validations with statistical analyses and functional endpoints are warranted to validate its clinical impact and scalability.

BACKGROUND:Solid organ transplantation (SOT) is the standard therapeutic approach to end-stage organ failure. Artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), has emerged as a promising tool for analyzing large, complex datasets, enabling both prediction of rejection risk and early detection of established graft injury. This systematic review synthesizes current evidence on AI-based approaches for predicting future rejection risk and detecting active rejection in human SOT, evaluates their performance, and identifies gaps for future research. METHODS:This review followed PRISMA 2020 guidelines. PubMed/MEDLINE, EMBASE, and Web of Science were searched up to April 30, 2025, using terms related to AI and graft rejection. Eligible studies included peer-reviewed original research using AI to predict, detect, or monitor rejection in humans. Three reviewers independently screened titles, abstracts, and full texts, resolving disagreements by consensus. Due to heterogeneity in methods and objectives, meta-analysis was not feasible. RESULTS:Of 195 studies identified, 62 met inclusion criteria. Most focused on kidney transplantation (n = 49, 79%), followed by heart (n = 6, 10%), liver (n = 4, 6%), lung (n = 1, 2%), and pancreas (n = 1, 2%). One study addressed multiple organs. Among diagnostic studies, AI, particularly ML and DL, demonstrated high diagnostic performance in non-kidney transplantation, often exceeding reported AUC of 0.90. In kidney transplantation, DL models, including convolutional neural networks and transformer-based architectures, reached accuracies up to 99.89% and AUCs up to 0.99. ML methods such as XGBoost, Bayesian classifiers, and logistic regression also performed well, with XGBoost achieving AUCs of 0.95-0.97, Bayesian classifiers reaching accuracies of 93.3% to 97%, and logistic regression models reporting AUC values up to 0.969. Among predictive studies, ML-based models similarly demonstrated strong discriminative performance. CONCLUSION:AI models using ML and DL may show strong potential, particularly in kidney transplantation, for non-invasive early detection of active graft rejection and prediction of future rejection risk, across diverse data types. The exceptionally high performance reported by some studies warrants careful interpretation. Challenges such as lack of standardization, limited validation, and interpretability must be addressed through well-designed multicentre studies to support clinical translation.

Plastic and reconstructive surgery (PRS) encompasses a wide range of procedures, and postoperative complications remain a persistent challenge. While preoperative laboratory values (PLVs) are routinely assessed, their predictive value for postoperative outcomes in PRS is unclear. This study evaluates the association between PLVs and postoperative morbidity to enhance risk stratification. The ACS-NSQIP database (2008–2022) was analyzed for PRS patients. PLVs included sodium, blood urea nitrogen, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white blood cell count, hematocrit, platelets, partial thromboplastin time, international normalized ratio, and prothrombin time (PT). Multivariate logistic regression identified independent predictors of complications, while decision tree analysis established risk thresholds, validated through cross-validation. A total of 200,015 patients with a mean age of 50.3±14.5 years and a mean BMI of 29.1±6.8 kg/m2 were included in this study. Albumin levels emerged as the strongest predictor for the occurrence of any complications. Patients with albumin ≤ 3.3 g/dL had a 36.5 www.springer.com/00266 .

Existing evidence on transfusion requirements in oral and maxillofacial surgery (OMFS) is limited to selected indications. This study aimed to provide an overview of transfusion rates across the full diagnostic spectrum and to identify factors influencing transfusion rates with relevance for patient blood management (PBM). All operated OMFS patients from a five-year period (n = 13,239) were retrospectively analyzed. Diagnosis-specific transfusion rates were determined, followed by a subgroup analysis of free flap surgeries. Logistic regressions identified factors influencing transfusion rates. ROC analysis in the free flap subgroup determined preoperative hemoglobin cut-off values for increased transfusion risk. Differences in treatment course associated with preoperative anemia were assessed. Overall transfusion rate was 5.1

Background: The Le Fort I osteotomy is a standard approach for treating the maxilla in orthognathic surgery. Achieving stable ossification, particularly in cases requiring significant movements, can be clinically challenging and may compromise the ossification process. Despite the clinical significance of this issue, there remains a lack of robust multicenter studies directly comparing outcomes of Le Fort I osteotomies performed with versus without bone grafting (BG). Methods: In this study, the authors accessed the ACS-NSQIP database from 2008 to 2023 to identify patients who underwent isolated surgical Le Fort I osteotomy with and without BG. Collected data included demographics, comorbidities, surgical characteristics, and 30-day postoperative outcomes. Results: Of 418 patients who underwent an isolated Le Fort I osteotomy, 95 patients (22.7%) underwent augmentation of the gap using BG, while 323 patients (77.3%) underwent surgery without BG. Overall, 13 (4.0%) non-BG and 7 (7.4%) BG patients experienced any complication ( P =0.88). In a multivariable analysis of all study cases, longer hospital stays ( P <0.01) were identified as an independent risk factor for the occurrence of any postoperative complications, whereas higher BMI ( P =0.02) and obesity ( P =0.04) were found to be independent risk factors for the occurrence of surgical complications. Conclusion: The Le Fort I osteotomy is an overall safe procedure. In this study, the use of BG did not appear to increase the risk of postoperative complications compared with procedures performed without BG. Identified risk factors for postoperative complications are prolonged hospital stays, higher BMI, and obesity.

Preservation rhinoplasty has transformed nasal surgery by prioritizing structural conservation while achieving aesthetic refinement and functional optimization. Unlike traditional rhinoplasty, which relies on extensive resection and reconstruction, preservation techniques aim to maintain key anatomical components, reducing complications and improving long-term stability. Recent advancements, including open dorsal preservation approaches and hybrid rhinoplasty techniques (bridging preservation and structural concepts), have expanded its indications, making it applicable to a broader range of nasal deformities and functional impairments. However, the efficacy, limitations, and functional outcomes of these techniques remain to be synthesized. A systematic review was conducted following PRISMA 2020 guidelines, searching PubMed/MEDLINE, EMBASE, and Web of Science databases up to March 1st, 2025. Studies evaluating surgical techniques, functional and aesthetic outcomes, complications, and patient satisfaction in preservation rhinoplasty were included. Given the heterogeneity of study designs and outcome measures, a narrative synthesis was performed. Thirteen studies comprising 855 patients were included, with publication years ranging from 2020 to 2024 and a mean Newcastle–Ottawa Scale score of 5.8 (SD 0.4), indicating moderate methodological quality. Dorsal preservation techniques—including push-down, let-down, and subdorsal strip methods—consistently yielded favorable results. Patient satisfaction was high, with Rhinoplasty Outcome Evaluation (ROE) scores exceeding 85 in up to 90.3 www.springer.com/00266 .