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Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 2nd Edition
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Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 25 April 2025 | Viewed by 4244

Special Issue Editors

Dr. Dimitrios E. Magouliotis

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Guest Editor
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
Interests: cardio-thoracic surgery; surgical oncology; bariatric surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Dimitris Zacharoulis

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Guest Editor
Department of Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece
Interests: pancreatic surgery; liver surgery; bariatric surgery; surgical oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The art and science of clinical outcome analysis, quality improvement, perioperative management of surgical patients and patient safety continue to evolve at an increasingly rapid pace. In fact, over the years, novel concepts have arisen (risk stratification, shared decision making, interdisciplinary meetings, prehabilitation, etc.), new initiatives have taken shape (e.g., state/nation-wide or international clinical databases), and new technologies and methods have been adopted across all surgical specialties (e.g., minimally invasive or robotic approaches).

In order to care for our patients, raise the standards of healthcare services, and be successful in today’s and tomorrow’s rapidly changing healthcare environment, understanding and evolving these topics represents an essential duty of all surgeons, physicians and professionals related to surgical patients. In this context, we call all surgeons, physicians and professionals from all associated disciplines involved in the perioperative pathway of surgical patients (surgeons, anesthesiologists, radiologists, intensivists, cardiologists, oncologists, pulmonologists, nurses, physiotherapists, nutritionists, etc.) to contribute to this Special Issue. Following the big success of the first volume of the Special Issue, we decided to launch a second volume to discuss a greater number of relevant topics. Our vision remains to provide the best currently available evidence in this field, thus providing all the necessary information to clinicians on core concepts in the perioperative management of surgical patients.

Dr. Dimitrios E. Magouliotis
Prof. Dr. Dimitris Zacharoulis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • clinical outcomes
  • surgery
  • quality
  • quality of life
  • quality improvement
  • postoperative
  • morbidity
  • postoperative care

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Related Special Issue

Published Papers (4 papers)

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Research

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15 pages, 916 KiB  
Article
Aortic Stent Graft Treatment in a Medium-Size Aortic Center Performed by a Cardiac Surgeon Only—The 9 Years Experience in Poland
by Marian Burysz, Jakub Batko, Krzysztof Greberski, Artur Słomka and Radosław Litwinowicz
J. Clin. Med. 2024, 13(21), 6517; https://doi.org/10.3390/jcm13216517 - 30 Oct 2024
Viewed by 425
Abstract
Background: The incidence of thoracic aortic aneurysms is estimated at 3.0–8.3/100,000 persons per year. There is a lack of reports in the literature on the outcomes of small- and medium-sized thoracic endovascular aortic repairs. The aim of this study is to present [...] Read more.
Background: The incidence of thoracic aortic aneurysms is estimated at 3.0–8.3/100,000 persons per year. There is a lack of reports in the literature on the outcomes of small- and medium-sized thoracic endovascular aortic repairs. The aim of this study is to present the results of thoracic endovascular aortic repairs at a single medium-sized center performed exclusively by a cardiac surgeon. Methods: Ninety patients who had undergone aortic stent graft implantations for the treatment of thoracic aortic anomalies were comprehensively, retrospectively evaluated. The detailed preoperative, surgical, and postoperative parameters of the patients, including the survival rate up to five years, were recorded and further analyzed. Results: The patients’ Euroscores were four (2.1–9). The 30-day mortality rate was 8.9%, the 1-year mortality rate was 15.6%, and the 5-year mortality rate was 38.9% for all causes. Postoperative complications were observed in 10% of the patients. Statistically significant differences were observed between the urgency of surgery at 30 days and survival at one year, but not at five years. The most common complications were related to respiratory (4.4%), renal (3.3%), and neurological (3.3%) dysfunction. Conclusions: Thoracic endovascular aortic repair can be safely performed in small- and medium-sized centers with optimal long-term results. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 2nd Edition)
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13 pages, 1603 KiB  
Article
Transthoracic Cross Clamp versus Endoaortic Balloon Occlusion in Minimally Invasive Mitral Valve Surgery: A Pooled Study with Subgroup Analyses
by Dimitrios E. Magouliotis, Serge Sicouri, Massimo Baudo, Yoshiyuki Yamashita, Andrew Xanthopoulos, Arian Arjomandi Rad, Thanos Athanasiou and Basel Ramlawi
J. Clin. Med. 2024, 13(17), 4989; https://doi.org/10.3390/jcm13174989 - 23 Aug 2024
Viewed by 1497
Abstract
Objective: We assessed the available literature regarding patients undergoing minimally invasive mitral valve surgery (MIMVS) with either transthoracic clamping (TTC) or endoaortic balloon occlusion (EABO). Methods: Original research studies that evaluated the perioperative outcomes of TTC versus EABO group were identified [...] Read more.
Objective: We assessed the available literature regarding patients undergoing minimally invasive mitral valve surgery (MIMVS) with either transthoracic clamping (TTC) or endoaortic balloon occlusion (EABO). Methods: Original research studies that evaluated the perioperative outcomes of TTC versus EABO group were identified from 2000 to 2024. The incidence of all-cause mortality, cerebrovascular accidents (CVA), and aortic dissections were the primary endpoints. The cardiopulmonary bypass (CPB), cross-clamp, and ventilation time, along with the incidence of conversion to sternotomy, re-exploration, new-onset atrial fibrillation (AF), postoperative acute kidney injury (AKI), ICU stay, and LOS were the secondary endpoints. Subgroup analyses were performed regarding the EABO cannulation approach (femoral and aortic) and MIMVS approach (video-assisted and robotic-assisted). Sensitivity analyses were performed with the leave-one-out method and by including risk-adjusted populations. Results: Sixteen studies were included in both the qualitative and quantitative syntheses. After pooling data from 6335 patients, both groups demonstrated similar outcomes on all primary and secondary endpoints in the non-adjusted and adjusted total cohort analyses. These outcomes were further validated by the leave-one-out sensitivity analysis. In addition, the aortic cannulation EABO was associated with a lower cross-clamp time, followed by TTC and the femoral cannulation EABO approach. Furthermore, in the video-assisted subgroup analysis, the EABO approach was associated with a higher incidence of CVA, conversion to sternotomy, and longer ICU stay compared to the TTC group. Conclusions: The present meta-analysis indicates that both aortic occlusion techniques are safe and feasible in the context of MIMVS. A future well-designed randomized-control trial should further validate the current outcomes. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 2nd Edition)
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12 pages, 1202 KiB  
Article
Contemporary Use of Sodium Glucose Co-Transporter 2 Inhibitors in Hospitalized Heart Failure Patients: A “Real-World” Experience
by Andrew Xanthopoulos, Nikolaos Katsiadas, Grigorios Giamouzis, Kleoniki Vangelakou, Dimitris Balaskas, Michail Papamichalis, Angeliki Bourazana, Nikolaos Chrysakis, Sotirios Kiokas, Christos Kourek, Alexandros Briasoulis, Niki Skopeliti, Konstantinos P. Makaritsis, John Parissis, Ioannis Stefanidis, Dimitrios Magouliotis, Thanos Athanasiou, Filippos Triposkiadis and John Skoularigis
J. Clin. Med. 2024, 13(12), 3562; https://doi.org/10.3390/jcm13123562 - 18 Jun 2024
Viewed by 935
Abstract
Background/Objectives: The aim of this study was to examine the association between in-hospital initiation of sodium glucose co-transporter 2 inhibitors (SGLT2is) and outcomes in hospitalized heart failure (HHF) patients utilizing data from a Greek center. Methods: The present work was a [...] Read more.
Background/Objectives: The aim of this study was to examine the association between in-hospital initiation of sodium glucose co-transporter 2 inhibitors (SGLT2is) and outcomes in hospitalized heart failure (HHF) patients utilizing data from a Greek center. Methods: The present work was a single-center, retrospective, observational study of consecutive HF patients hospitalized in a tertiary center. The study endpoint was all-cause mortality or HF rehospitalization. Univariate and multivariate Cox proportional-hazard models were conducted to investigate the association between SGLT2i administration at discharge and the study endpoint. Results: Sample consisted of 171 patients, 55 of whom (32.2%) received SGLT2is at discharge. Overall, mean follow-up period was 6.1 months (SD = 4.8 months). Patients who received SGLT2is at discharge had a 43% lower probability of the study endpoint compared to those who did not receive SGLT2is at discharge (HR = 0.57; 95% CI: 0.36–0.91; p = 0.018). After adjusting for age, gender, smoking, hemoglobin (Hgb), use of SGLT2is at admission, use of Angiotensin-Converting Enzyme Inhibitors (ACEI-Is)/Angiotensin Receptor Blockers (ARBs) at discharge and Sacubitril/Valsartan at discharge, the aforementioned result remained significant (HR = 0.38; 95% CI: 0.19–0.73; p = 0.004). The 55 patients who received SGLT2is at discharge were propensity score matched with the 116 patients who did not receive SGLT2is at discharge. Receiving SGLT2is at discharge continued to be significantly associated with a lower probability of the study endpoint (HR= 0.43; 95% CI: 0.20–0.89; p = 0.024). Conclusions: Initiation of SGLT2is in HHF patients may be associated with better outcomes. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 2nd Edition)
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Review

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22 pages, 985 KiB  
Review
The Role of Anesthetic Management in Lung Cancer Recurrence and Metastasis: A Comprehensive Review
by Jaewon Huh and Wonjung Hwang
J. Clin. Med. 2024, 13(22), 6681; https://doi.org/10.3390/jcm13226681 - 7 Nov 2024
Viewed by 406
Abstract
Lung cancer remains a leading cause of cancer-related mortality worldwide. Although surgical treatment is a primary approach, residual cancer cells and surgery-induced pathophysiological changes may promote cancer recurrence and metastasis. Anesthetic agents and techniques have recently been shown to potentially impact these processes [...] Read more.
Lung cancer remains a leading cause of cancer-related mortality worldwide. Although surgical treatment is a primary approach, residual cancer cells and surgery-induced pathophysiological changes may promote cancer recurrence and metastasis. Anesthetic agents and techniques have recently been shown to potentially impact these processes by modulating surgical stress responses, immune function, inflammatory pathways, and the tumor microenvironment. Anesthetics can influence immune-modulating cytokines, induce pro-inflammatory factors such as HIF-1α, and alter natural-killer cell activity, affecting cancer cell survival and spread. Preclinical studies suggest volatile anesthetics may promote tumor progression by triggering pro-inflammatory signaling, while propofol shows potential antitumor properties through immune-preserving effects and reductions in IL-6 and other inflammatory markers. Additionally, opioids are known to suppress immune responses and stimulate pathways that may support cancer cell proliferation, whereas regional anesthesia may reduce these risks by decreasing the need for systemic opioids and volatile agents. Despite these findings, clinical data remain inconclusive, with studies showing mixed outcomes across patient populations. Current clinical trials, including comparisons of volatile agents with propofol-based total intravenous anesthesia, aim to provide clarity but highlight the need for further investigation. Large-scale, well-designed studies are essential to validate the true impact of anesthetic choice on cancer recurrence and to optimize perioperative strategies that support long-term oncologic outcomes for lung cancer patients. Full article
(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 2nd Edition)
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