30-Second Takeaway
- Clinically relevant celiac axis stenosis roughly doubles major complications after pancreatoduodenectomy or total pancreatectomy.
- ERAT for appendicitis is effective but carries ~16% long‑term recurrence, with identifiable 1‑year high‑risk features.
- In acute brain injury, higher dynamic driving pressure independently tracks with higher ICU and long‑term mortality.
- Spontaneous breathing trial mode or duration does not predict extubation failure in neurocritical patients; cough strength does.
- Sex and timing disparities around ECMO/ECPR and myocarditis biopsy may materially influence outcomes and equity.
Week ending January 17, 2026
Risk, perfusion, and support decisions across HPB, neurocritical, and acute cardiac care
Clinically relevant celiac axis stenosis doubles major morbidity after PD/TP
Among 1,698 pancreatoduodenectomy or total pancreatectomy patients, celiac axis stenosis (CAS) was present in 16%, with 6.5% having grade B/C (>50%). Grade B/C CAS independently increased severe complications (OR 2.20), bile leak (OR 2.67), liver perfusion failure (OR 2.60), and gastric ischemia (OR 11.29). Atherosclerotic CAS had higher bile leak rates than median arcuate ligament–related CAS, suggesting etiology matters for risk and management. Centers using standardized CAS protocols detected and treated stenosis more often, implying structured preoperative CT review is actionable. Clinicians should actively look for and document CAS severity and etiology preoperatively and consider targeted revascularization in high‑grade cases.
ERAT achieves high initial success but 1‑year appendicitis recurrence remains notable
In 435 acute appendicitis patients treated with ERAT, technical success was universal and clinical success reached 92.4%. Over a median 37‑month follow‑up, recurrence was 16.1%, with most recurrences occurring in the first year after ERAT. Higher 1‑year recurrence risk correlated with age >60, recurrent appendicitis history, Alvarado score >6, fecalith, operator inexperience, and prolonged procedures. Appendix lumen distortion and stent placement were also linked to increased recurrence, and a multivariable nomogram was developed from these eight factors. Surgeons using ERAT should counsel about early recurrence risk and consider interval surgery in patients flagged high‑risk by the model.
Higher dynamic driving pressure increases mortality in ventilated acute brain injury patients
In 1,555 mechanically ventilated acute brain injury patients, higher time‑varying dynamic driving pressure (ΔPdyn) was associated with higher ICU mortality. Each daily 1 cmH₂O increase in ΔPdyn carried an ICU mortality hazard ratio of 1.057, with a 99.9% posterior probability of harm. The association held across acute brain injury subtypes and was similar for static driving pressure, indicating a general mechanical ventilation risk signal. Harm from higher ΔPdyn was greatest in patients with severe neurologic injury (GCS ≤8) and severe hypoxemia (PaO₂/FiO₂ ≤100). These data support monitoring and minimizing driving pressure when setting tidal volume, PEEP, and peak pressures in neurotrauma co-managed by surgeons.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.