Sriwijaya Journal of Surgery

Admission Serum Bilirubin Fractions and Magnetic Resonance Cholangiopancreatography for Differentiating Choledocholithiasis from Pancreatobiliary Malignancy in Extrahepatic Obstructive Jaundice: A Retrospective Diagnostic Accuracy Study

2026-10-20T15:12:41+00:00

Background: Distinguishing benign from malignant extrahepatic obstructive jaundice before surgery determines whether patients proceed to stone clearance or to oncological staging and resection.

Objective: To evaluate the diagnostic accuracy of admission serum bilirubin fractions and preoperative magnetic resonance cholangiopancreatography (MRCP) for differentiating choledocholithiasis from pancreatobiliary malignancy.

Methods: This single-center retrospective study, reported according to STARD 2015, included 50 consecutive patients (71 screened) treated at Dr. Mohammad Hoesin Central General Hospital, Palembang, Indonesia, in 2024–2025. Admission bilirubin fractions and 1.5-T MRCP were compared with operative or biopsy histopathology using receiver operating characteristic analysis, Wilson 95% confidence intervals (CIs), likelihood ratios, and exploratory Firth logistic regression.

Results: Histopathology showed choledocholithiasis in 39 patients (78.0%) and pancreatobiliary carcinoma in 11 (22.0%). Direct bilirubin (median 13.7 vs 8.7 mg/dL; p = 0.003), total bilirubin (20.17 ± 6.78 vs 13.02 ± 7.64 mg/dL; p = 0.007), and common bile duct diameter (26.00 ± 8.60 vs 18.49 ± 9.06 mm; p = 0.018) were greater in malignancy. Direct bilirubin ≥9.65 mg/dL (AUC 0.797) and total bilirubin ≥14.3 mg/dL (AUC 0.773) each had a sensitivity of 90.9% (95% CI 62.3–98.4%), with specificities of 56.4% and 61.5% and negative predictive values of 95.7% and 96.0%. For MRCP, sensitivity was 63.6% and specificity 94.9%; accuracy reached 88.0%, LR+ was 12.4, and the adjusted odds ratio was 21.65 (95% CI 3.12–150.24).

Conclusion: Admission bilirubin flagged most cancers but also many stone patients, whereas MRCP rarely mislabeled stones but missed some tumors. A sequential pathway using both needs external validation.

Prehospital Determinants of Emergency Department Mortality in Adult Trauma at a South Sumatran Tertiary Referral Center: A Retrospective Cross-Sectional Study

2026-10-20T15:12:56+00:00

Background: Prehospital care is a modifiable determinant of trauma survival, but evidence from Indonesian referral centers without integrated emergency medical services is scarce.

Objective: To examine whether first-responder type, prehospital time, and transport mode were associated with emergency department mortality in adult trauma.

Methods: This retrospective cross-sectional study (STROBE) analyzed 34 consecutive adult trauma patients at the Emergency Department of Dr. Mohammad Hoesin General Hospital, Palembang. Associations were assessed with Fisher exact tests, exact conditional and Haldane–Anscombe odds ratios (OR), Newcombe risk differences, univariable Firth penalized logistic regression, and a multivariable model. Power, minimum detectable ORs, and reverse fragility indices were calculated.

Results: Mortality was 20.6% (7/34; 95% CI: 10.3–36.8%). Lay rescuers attended 94.1% (32/34) of patients, 94.1% (32/34) arrived by non-ambulance transport, and 70.6% (24/34) had prehospital times >60 minutes (mean 116.47 ± 55.10 minutes). Death occurred in 6/24 (25.0%) patients with prehospital time >60 minutes versus 1/10 (10.0%) with ≤60 minutes (exact conditional OR 2.92, 95% CI: 0.28–153.08; Firth OR 2.23, 95% CI: 0.38–23.63; Fisher p = 0.644), and in 1/2 (50.0%) versus 6/32 (18.8%) for both ambulance transport and medical responder (exact conditional OR 4.09, 95% CI: 0.05–352.85; Firth OR 4.08, 95% CI: 0.29–57.01; p = 0.374). No exposure was associated with mortality in multivariable analysis (p = 0.492; minimum detectable OR 12.57–69.82; power 12.6–23.1%).

Conclusion: No prehospital factor was significantly associated with mortality, but wide intervals and low power make these findings uninformative rather than negative; they support lay-responder training and a prospective regional trauma registry.

Peripheral Blood Inflammatory Ratios and Prostate Volume in Benign Prostatic Hyperplasia: An Equivalence-Tested Cross-Sectional Study at a Tertiary Indonesian Referral Centre

2026-10-20T22:45:21+00:00

Background: Chronic inflammation contributes to benign prostatic hyperplasia (BPH), and complete blood count-derived ratios have been proposed as inexpensive surrogates of prostatic inflammatory burden.

Objective: To determine whether neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and lymphocyte-to-platelet ratio (LPR) are associated with ultrasonographically measured prostate volume in Indonesian men with BPH.

Methods: This cross-sectional study included 45 consecutive men with BPH at Dr. Mohammad Hoesin General Hospital, Palembang (March–June 2026). Spearman correlation and Mann–Whitney tests were complemented by pre-specified equivalence tests, Bayes factors, minimum-detectable-effect analysis and sensitivity analyses.

Results: Mean age was 70.31 ± 7.98 years and mean prostate volume was 58.14 ± 29.49 mL. NLR was elevated in 77.8% and MLR in 53.3%. Correlations with prostate volume were ρ = 0.055, 0.056 and 0.027 for NLR, MLR and LPR, respectively, each explaining <0.32% of variance. Equivalence held to |ρ| < 0.30 for NLR and LPR and to |ρ| < 0.35 for all three markers; Bayes factors favoured the null 5.0–5.2:1. Prostate volume did not differ across NLR or MLR categories.

Conclusion: Systemic inflammation was prevalent yet quantitatively unrelated to prostate volume. Blood-count ratios should not be used to estimate gland size or select an operative approach.

Thoracoscore Risk Bands Substantially Underpredict In-Hospital Mortality After Thoracic Surgery: An External Validation Study in a Tertiary Referral Cohort

2026-10-20T22:45:58+00:00

Background: Thoracoscore is widely used to estimate preoperative mortality after general thoracic surgery, but its performance in Southeast Asian referral practice is uncertain.

Objective: To evaluate the discrimination and calibration of the Thoracoscore risk-band table used routinely at an Indonesian tertiary centre.

Methods: This retrospective cohort included 106 consecutive adults who underwent thoracic surgery at Dr Mohammad Hoesin General Hospital, Palembang, from January to December 2025. Seven of nine Thoracoscore domains were retrievable; therefore, the published points-to-risk band table, rather than the original logistic equation, was validated. Discrimination was assessed by permutation testing, calibration by observed-to-expected (O:E) ratios and within-band tests, and independent predictors by Firth-penalised logistic regression.

Result: In-hospital mortality was 26.4% (28/106; 95% CI 19.0–35.5). Discrimination was absent (AUC 0.572, 95% CI 0.457–0.687; permutation p = 0.249). Calibration failed in every risk band: 28 deaths occurred compared with 2.88 expected (O:E 9.71, 95% CI 6.45–14.03), with a minimum O:E of 4.89 under the most favourable assignment of the two unrecorded domains. Malignancy was the only independent predictor (adjusted OR 4.12, 95% CI 1.51–13.10), but it did not remain significant after multiplicity adjustment (BH p = 0.061).

Conclusion: The published Thoracoscore risk-band probabilities should not be used for individual consent at this centre. Recalibration reduces calibration error, but discrimination remains inadequate for reliable individual prediction.

Only the Boey Score Discriminates In-Hospital Mortality After Gastric Perforation: A STARD-Compliant Comparison with the Jabalpur Score

2026-10-20T22:46:09+00:00

Background: Gastric perforation remains a highly lethal surgical emergency, and competing preoperative mortality scores have not been compared directly in an Indonesian cohort.

Objective: To compare the discrimination, calibration, and clinical utility of the Boey and Jabalpur scores for in-hospital mortality after emergency surgery for gastric perforation.

Methods: This retrospective diagnostic-accuracy study, reported according to STARD 2015, included 55 consecutive adults who underwent emergency laparotomy for non-traumatic gastric perforation at a tertiary referral centre between January 2023 and September 2025. Both scores were evaluated against in-hospital death. Analyses included areas under the receiver operating characteristic curve, operating characteristics, calibration, and decision-curve analysis; quantities not identifiable from the aggregate source output were bounded rather than estimated.

Result: Twenty-nine patients (52.7%) died in hospital. The Boey score discriminated mortality (AUC 0.747, 95% CI 0.630–0.863), whereas the Jabalpur score did not (AUC 0.623, 95% CI 0.470–0.777; p = 0.118; power 34.1%). The AUC difference was 0.123, but its variance was not identifiable. At the optimal cut-offs, Boey ≥2 yielded 58.6% sensitivity and 73.1% specificity, while Jabalpur ≥10 yielded 69.0% sensitivity and 61.5% specificity. The published Boey risk table underpredicted mortality (observed-to-expected ratio 1.70), and decision-curve benefit was limited.

Conclusion: Only the Boey score separated survivors from decedents in this cohort. Formal superiority over the Jabalpur score remains unresolved, and the published Boey risk estimates require local recalibration before individual clinical use.