General Surgery

Prehabilitation improves function and reduces severe complications after elective colorectal cancer surgery

This meta-analysis of 11 RCTs (976 patients) in elective colorectal cancer surgery found that prehabilitation improved postoperative 6-minute walk distance by about 33 meters. Prehabilitation significantly reduced severe postoperative complications (risk ratio 0.65; 95% CI, 0.46-0.93), without affecting overall complication rates or length of stay. Benefits were greatest with multimodal programs of at least 3 weeks, in younger patients, and when function was assessed beyond 4 weeks postoperatively. Findings support embedding structured prehabilitation into colorectal cancer pathways, with intensity tailored to patient fitness and program feasibility. 1

Network meta-analysis clarifies effective prophylactic antibiotic classes for colorectal surgery SSI prevention

This network meta-analysis of 105 RCTs (18,273 patients) compared 32 prophylactic antibiotic strategies for elective colorectal surgery. Compared with placebo or no antibiotic, broad-spectrum penicillins, third-generation cephalosporins, metronidazole plus second-generation cephalosporins, and tetracyclines all significantly reduced surgical site infection risk. Broad-spectrum penicillins and fluoroquinolone–penicillin combinations were associated with reduced 30-day mortality versus placebo. Across regimens, evidence supports using appropriately broad prophylaxis with anaerobic coverage, balanced against local resistance patterns and stewardship priorities. 2

Nonadherence to perioperative IDSA antibiotic metrics increases SSI risk in noncardiac surgery

This nationwide cross-sectional study analyzed 119,236 noncardiac surgical cases from 37 institutions against IDSA perioperative antibiotic metrics. Nonadherence to any IDSA metric occurred in 26.1% of cases, most often involving incorrect antibiotic choice and weight-adjusted dosing errors. Overall IDSA-nonadherent antibiotic administration was associated with higher surgical site infection risk (relative risk 1.34; 95% CI, 1.26-1.43). Incorrect antibiotic choice (relative risk 1.43; 95% CI, 1.33-1.53) and missed intraoperative redosing (relative risk 1.12; 95% CI, 1.02-1.24) were independently associated with increased infections. 3

Immediate endoscopic necrosectomy after drainage speeds resolution of necrotizing pancreatitis

The WONDER-01 randomized trial enrolled 70 patients with symptomatic necrotizing pancreatitis undergoing endoscopic ultrasound-guided transmural drainage. Immediate direct endoscopic necrosectomy reduced median time to clinical success to 29 days versus 44 days with a drainage-oriented step-up strategy (P = .009). Procedure-related adverse event rates were similar between immediate and step-up arms (24% vs 22%), and mortality did not differ significantly. All patients in the immediate arm underwent necrosectomy, versus less than half in the step-up arm, increasing procedure numbers but not harm. 4