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Multifactorial patterns of low performance development in german elite athletes
(2025) Wiedenbrüg, Kati; Roffler, Andrea; Reichert, Lukas; Mutz, Michael; Zentgraf, Karen; Krüger, Karsten
Introduction: Low performance development (LPD) has been related to several training-related, biological or psychosocial factors. However, there is still hardly any comprehensive research on its multifactorial nature. Tis study explored whether factors previously associated with LPD manifest as cross-disciplinary pattern combinations across such athletes. Methods: Cluster analyses were computed based on performance-related (speed and strength of the lower body), biological (ratio TNFα:IL10; fT3, leptin, insulin) and psychosocial (perceived social support; mental well-being) data from 62 of 296 elite athletes whose performance development was below the samples’ average range. Group comparisons were calculated for demographic, anthropometric, nutritional and sleep-related variables, as well as for additional psychosocial (critical life events; perceived stress) and biological (single infammatory markers) variables. Results: Six patterns were identifed, which could be described via domain-specifc characteristics (lower body dynamics and social support), via an interdisciplinary combination of factors (social support, mental well-being and/or lower body dynamics) or by no characteristic pattern at group level. Conclusion: In general, this study extends research on LPD and illustrates the limited validity of generalisations while emphasising the additional value of individualisation for athletes who drop behind their peers. Moreover, the identifed Patterns point to the limitations of taking a cross-disciplinary approach at group level
Postoperative ileus after emergency surgery for acute bowel obstruction : a case-control study of predictors and impact on recovery
(2025) Amati, Anca-Laura; Kümmel, Niklas; Negruta, Nicoleta; Reichert, Martin; Schwandner, Thilo; Noll, Julia; Braun, Jaqueline; Grau, Veronika; Petzoldt, Sebastian; Hecker, Andreas
Purpose: Acute bowel obstruction (ABO) is a common indication for emergency abdominal surgery, often performed on a severely dilated intestine with compromised barrier function. The recovery of bowel motility in this acute setting differs from elective surgery and remains insufficiently investigated. Yet, its understanding is crucial for improving perioperative care in surgical emergencies. This study aimed to identify risk factors for postoperative ileus (POI) after emergency surgery for ABO and to explore its impact on postoperative outcomes. Methods: We retrospectively analyzed 466 patients who underwent emergency surgery for ABO between 2014 and 2020, of whom 156 developed POI. POI was defined as the absence of postoperative bowel movement requiring intravenous prokinetic therapy following an insufficient response to initial conservative measures, including oral laxatives. Perioperative predictors for POI were identified by univariate and multivariate logistic regression. The association between POI and adverse postoperative outcomes was examined using correlation analysis. Results: Multivariate analysis revealed male sex (p = 0.0009), chronic steroid therapy (p = 0.0064), high postoperative SOFA score (p = 0.0037), and elevated CRP levels on postoperative day two (p = 0.048) as independent predictors for POI. Patients with POI had significantly higher rates of postoperative respiratory (p < 0.0001) and surgical complications (p = 0.0014). Conclusion: Our findings suggest sex-dependent differences and an involvement of inflammatory processes in bowel function recovery following emergency surgery for ABO. POI in this setting is associated with increased risk of postoperative respiratory complications and surgical morbidity. These results highlight the need for targeted preventive strategies and form a solid foundation for future prospective studies aimed at optimizing perioperative care and reducing POI-related morbidity in surgical emergencies.
The underestimated burden of postoperative pulmonary complications in emergency laparotomy: a propensity score-matched analysis
(2025) Amati, Anca-Laura; Negruta, Nicoleta; Ebert, Romina; Kümmel, Niklas; Fritzenwanker, Moritz; Wolff, Matthias; Petzoldt, Sebastian; Reichert, Martin; Hecker, Andreas
Introduction: Emergency laparotomy (EL) remains one of the highest-risk procedures in general surgery, characterized by substantial postoperative morbidity and mortality. Despite major advances in perioperative medicine, current enhanced-recovery and infection-prevention protocols are largely derived from elective surgical cohorts and are seldom validated in emergency settings. This lack of EL-specific data represents a critical gap in establishing evidence-based perioperative guidelines for this uniquely vulnerable patient population. Among postoperative complications, pulmonary complications (PPCs) are the most frequent and consequential, affecting 20–40% of patients and significantly impairing recovery and survival. This study aimed to identify preoperative predictors of PPCs and their impact on postoperative mortality, highlighting potentially actionable targets within the constraints of emergency surgical care. Methods: A total of 928 EL patients were analyzed. To control for non-modifiable demographics and comorbidities, propensity score matching generated two cohorts of 328 patients each—those with and without PPCs. Univariate and multivariate logistic regression identified independent preoperative predictors of PPCs, and survival analyses assessed their association with postoperative mortality. Results: Mortality was significantly higher in patients with PPCs (42.1%) than in those without (11.9%). Independent preoperative predictors of PPCs included ASA score (p = 0.0004), hemoglobin level (p = 0.0340), C-reactive protein-to-albumin ratio (CAR) (p = 0.0001), and colonization with multidrug-resistant organisms (MDROs) on preoperative screening (p = 0.0420). Each of these factors also predicted reduced postoperative survival. Notably, 67.3% of MDROs were not covered by initial empiric antibiotic regimens, and 28.6% of Gram-negative MDROs detected preoperatively were later isolated from the airways of patients who developed PPCs. PPC patients colonized with MDROs had a 47% higher 90-day mortality risk compared with non-colonized counterparts (HR 1.46, 95% CI 0.99–2.15). Conclusion: PPCs are the most frequent and deadly complications following EL, and their occurrence substantially worsens survival. Among identified predictors, Gram-negative MDRO colonization represents the most clinically actionable target. Tailoring empiric antibiotic therapy for high-risk, colonized EL patients could represent a pivotal step toward evidence-based, condition-specific perioperative guidelines aimed at reducing pulmonary complication–related mortality.
Graft function and renal protection with peritransplant systemic dexmedetomidine in kidney and liver recipients: systematic review and meta-analysis of randomized controlled trials
(2025) Reichert, Martin; Willis, Franziska; Koch, Christian; Amati, Anca-Laura; Braun, Jacqueline; Weigand, Markus A.; Sander, Michael; Karakizlis, Hristos; Schneider, Martin; Hecker, Andreas
This systematic review analyzed ten randomized controlled trials to assess the effects of dexmedetomidine during kidney and liver transplants. The study found that dexmedetomidine may reduce delayed graft function in deceased donor kidney transplants and living donor liver transplants, and decrease posttransplant acute kidney injury. Improvements in early postoperative serum creatinine and allograft function were noted in living donor liver transplants, but not in deceased donor liver transplants. Despite these benefits, there was no evidence of improved long-term allograft survival. More extensive trials are needed to confirm these findings and evaluate long-term outcomes.
Sex-based differences in patients with locally advanced pharyngeal and laryngeal SCC treated with definitive or adjuvant radiotherapy
(2025) Agolli, Linda; Reinhard, Luise; Gawish, Ahmed; Langer, Christine; Arens, Christoph; Krombach, Gabriele A.; Harth, Sebastian; Wendrich, Leon; Exeli, Ann-Katrin; Gattenlöhner, Stefan; Adeberg, Sebastian; Habermehl, Daniel
Aim: To evaluate sex-based differences in survival outcomes, toxicity, and patterns of local recurrence in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) treated with definitive or adjuvant radiotherapy (RT). Methods: We conducted a retrospective review of 309 patients (246 males, 63 females) diagnosed with primary squamous cell carcinoma of the oropharynx, larynx, or hypopharynx treated with curative-intent RT at our institution between 2016 and 2023. Inclusion criteria comprised histologically confirmed SCC, stage T3/T4 and/or node-positive disease, and complete RT treatment with adequate follow-up. Survival endpoints—overall survival (OS), progressionfree survival (PFS), and metastasis-free survival (MFS)—were analyzed using the Kaplan-Meier method and log-rank tests. Patterns of local failure were classified using an established five-type system: A (central high-dose), B (peripheral high-dose), C (central intermediate- or low-dose), D (peripheral intermediate- or low-dose), and E (extraneous dose). Treatment-related toxicity was also compared between sexes. Results: No significant differences in OS, PFS, or MFS were found between male and female patients across all treatment subgroups. Log rank test did not identify any significant prognostic factor for survival and local recurrence. However, female patients experienced a higher rate of grade ≥ 3 dermatitis (12.7% vs. 5.3%, p = 0.037). Pattern A nodal failures (central high-dose volume) were significantly more common in females (64.3%) than in males (28.8%; p = 0.014), while other recurrence patterns showed no significant sex-based differences. Conclusion: Sex was not an independent predictor of survival in this cohort of locally advanced HNSCC patients. Nevertheless, the higher rate of severe skin toxicity and nodal failures in females highlights a potential need for sexadapted radiotherapy strategies and further prospective investigation.