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Sriwijaya Journal of Surgery
Published by Universitas Sriwijaya
ISSN : -     EISSN : 27223558     DOI : https://doi.org/10.37275/sjs.v2i2
Core Subject : Health,
Medicine & Pharmacology
SRIWIJAYA JOURNAL OF SURGERY Sriwijaya Journal of Surgery (SJS) is a peer-reviewed journal published twice a year (June and December) by Department of Surgery, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia. SJS is intended to be the journal for publishing articles reporting the results of research on surgery. SJS invites manuscripts in the various topics include: General Surgery, Gastrointestinal Surgery, Neurosurgery, Orthopedics, Oncology Surgery, Thoracovascular Surgery, Reconstruction Surgery, Children Surgery, Urology, all aspect related surgery and medicine.
Arjuna Subject : Kedokteran - Pembedahan
Articles 132 Documents
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Digestive Surgery Patterns in Rural Indonesia: Insights from Lampung Province Satrio Sarwo Trengginas
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.123

Abstract

Introduction Digestive surgical conditions represent a significant portion of the global surgical burden, particularly impacting low- and middle-income countries (LMICs). However, epidemiological data detailing the specific patterns of digestive surgery in rural Indonesian healthcare settings remain scarce. Understanding these patterns is crucial for effective healthcare planning and resource allocation. Methods: A descriptive observational study was conducted retrospectively across three type D hospitals situated in Central and South Lampung, Indonesia. Data were collected from surgical records and patient registers spanning the period from January 2024 to February 2025. All patients undergoing digestive surgical procedures during this timeframe, for whom complete data were available, were included. Results: A total of 773 patients underwent digestive surgery during the study period. The patient cohort showed a male predominance (65.20%). The three most frequent surgical conditions encountered were hernia (n=274, 35.45%), hemorrhoids (n=148, 19.15%), and appendicitis (n=123, 15.91%). Inguinal hernia (82%) treated predominantly with herniorrhaphy (89%) was the leading hernia type, peaking in the 51–60 year age group. Internal hemorrhoids (86%), primarily grade III (45%), were most common, with a peak incidence in the 41–50 year age group. Acute appendicitis (92%) was more frequent in females (53.66%), with a mean age of approximately 27 years. Conclusion: Hernia, hemorrhoids, and appendicitis constitute the primary digestive surgical workload in the surveyed rural type D hospitals in Lampung province. These findings underscore the specific surgical needs within these limited-resource settings and highlight a critical need for comprehensive, nationwide studies encompassing diverse hospital types and including non-operative cases to inform Indonesian health policy.
Predicting Mortality in Gastric Perforation: A Comparative Analysis of Boey Score and Mannheim Peritonitis Index Accuracy in an Indonesian Tertiary Hospital Bobi Wijaya; Alsen Arlan; Theodorus
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.124

Abstract

Introduction: Peptic ulcer perforation (PUP), often leading to gastric perforation, represents a significant surgical emergency demanding rapid intervention. Effective risk stratification using prognostic scoring systems is crucial for optimizing patient management and improving outcomes. This study aimed to evaluate and compare the predictive performance of the Mannheim Peritonitis Index (MPI) and the Boey Score in estimating in-hospital mortality risk among patients presenting with gastric perforation at a tertiary hospital in Indonesia. Methods: A retrospective descriptive study employing an accuracy testing design was conducted. Data were collected from the medical records of 31 adult patients (≥18 years) who underwent exploratory laparotomy for non-traumatic gastric perforation at Dr. Mohammad Hoesin General Hospital Palembang, between January 2023 and December 2024. Patients with incomplete medical records were excluded. Boey Scores and MPI scores were calculated for each patient based on predefined criteria. The primary outcome measured was in-hospital mortality. Statistical analysis included descriptive statistics, calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Receiver Operating Characteristic (ROC)1 curve analysis to determine optimal cutoff values. Results: The median age was 62 years, with a male predominance (87.1%). Most patients presented late (>24 hours post-perforation, 90.3%) and had organ dysfunction (80.6%). Preoperative shock was present in 48.4%. The optimal cutoff for MPI predicting mortality was ≥22, yielding a sensitivity of 87.5% and specificity of 40.0%. The optimal Boey Score cutoff was ≥2, with a sensitivity of 75.0% and specificity of 53.3%. Comparing MPI (cutoff ≥22) against Boey Score (cutoff ≥2) as a reference, the MPI demonstrated an accuracy of 74.19%, sensitivity of 73.91%, specificity of 75.00%, PPV of 89.47%, and NPV of 50.00%. Conclusion: Both the Boey Score and MPI showed moderate predictive performance for in-hospital mortality in patients with gastric perforation in this cohort. MPI (cutoff ≥22) demonstrated higher sensitivity for identifying high-risk patients compared to the Boey Score (cutoff ≥2), although with lower specificity regarding mortality itself. MPI appears advantageous for identifying high-risk individuals, while the simpler Boey Score remains useful for rapid initial assessment.
Total Elbow Arthroplasty as a Viable Reconstruction Option for Proximal Ulna Giant Cell Tumor: Case Report Mujaddid Idulhaq; Muhammad Haris Wibowo
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.125

Abstract

Introduction: Giant cell tumor (GCT) of bone is a relatively common primary bone tumor, typically benign but known for local aggressiveness and potential for recurrence. It commonly affects the epiphyseal regions of long bones, particularly around the knee. Occurrence in the proximal ulna is rare, accounting for less than 1% of skeletal tumors, posing significant treatment challenges due to the complex elbow anatomy. Treatment aims for complete tumor removal, preservation of function, and prevention of recurrence, with options ranging from curettage to wide resection. Reconstruction after resection, especially involving the joint, is complex. Case presentation: We report the case of a 39-year-old female presenting with a painful swelling in her right elbow three months after a fall. Clinical examination revealed swelling, tenderness, and limited range of motion. Radiographs and MRI showed an expansile lytic lesion in the proximal ulna, suggestive of GCT. The patient underwent wide resection of the tumor followed by reconstruction using total elbow arthroplasty (TEA). Histopathology confirmed the diagnosis of GCT. Conclusion: At 8-month follow-up, the patient demonstrated excellent functional recovery with a range of motion from 0° extension to 150° flexion, a DASH score of 6.7, and an MSTS score of 26, with no signs of local recurrence. This case illustrates that wide resection combined with TEA is a viable and effective treatment strategy for GCT of the proximal ulna, offering good functional outcomes and local tumor control.
Impact of Prolonged Cardiopulmonary Bypass and Aortic Cross-Clamp Time on Postoperative Ventilator Dependency Following Mitral Valve Replacement Aswin Nugraha; Reizkhi Fitriyana; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.126

Abstract

Introduction: Mitral valve replacement (MVR) is a common procedure for severe mitral valve disease. Prolonged cardiopulmonary bypass (CPB) time and aortic cross-clamp (AOX) time during cardiac surgery are known to be associated with adverse postoperative outcomes, including prolonged mechanical ventilation. Understanding the predictive value of these intraoperative times specifically for ventilator dependency after MVR is crucial for risk stratification and patient management. This study aimed to determine the accuracy of CPB time and AOX time as predictors of postoperative ventilator duration in patients undergoing MVR at a tertiary referral hospital in Palembang, Indonesia. Methods: A retrospective cohort study was conducted using medical records of patients aged ≥ 18 years who underwent MVR between January 2022 and December 2024 at RSUP Dr. Mohammad Hoesin Palembang. Data from 79 patients meeting the inclusion criteria were analyzed. The primary independent variables were CPB time and AOX time (categorized using a 90-minute cut-off). The primary outcome was prolonged mechanical ventilation (defined as >24 hours). Secondary outcomes included ICU length of stay (>4 days) and in-hospital mortality. Statistical analysis involved Chi-square tests and multivariate logistic regression. Results: Prolonged CPB time (≥90 minutes) was observed in 62% of patients, and prolonged AOX time (≥90 minutes) in 45.6%. Both prolonged AOX time (OR 15.167, p=0.01) and prolonged CPB time (OR 8.88, p=0.01) were significantly associated with mechanical ventilation >24 hours. Multivariate analysis confirmed both AOX time (Adjusted OR 8.741, p=0.049) and CPB time (Adjusted OR 5.163, p=0.027) as independent predictors for prolonged ventilation. Significant associations were also found between prolonged AOX/CPB times and ICU stay >4 days (p=0.03 for both). No significant association was found between CPB/AOX times and in-hospital mortality (p=0.968 and p=0.206, respectively). Conclusion: Prolonged CPB time and AOX time are significant independent predictors of postoperative ventilator dependency exceeding 24 hours following MVR in this patient cohort. Minimizing these intraoperative durations may reduce the burden of prolonged mechanical ventilation.
Beyond Clinical Intuition: Quantitative Mortality Prediction in Blunt Thoracic Trauma using the Thoracic Trauma Severity Score (TTSS) Harief Seamaladi; Aswin Nugraha; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.127

Abstract

Introduction: Blunt thoracic trauma is a leading cause of significant morbidity and mortality, particularly in younger populations. Accurate and early prediction of mortality is crucial for guiding clinical management and resource allocation. This study aimed to move beyond subjective clinical assessment by evaluating the accuracy of the Thoracic Trauma Severity Score (TTSS) as an objective, quantitative tool for predicting in-hospital mortality in patients with blunt thoracic trauma in a specific regional trauma center. Methods: A retrospective cohort study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data from 38 patients admitted with blunt thoracic trauma between January 2023 and January 2025 were analyzed. The TTSS was calculated for each patient based on five parameters: age, number of rib fractures, presence of bilateral rib fractures, extent of pulmonary contusion (assessed by chest X-ray), and the PaO2​/FiO2​ ratio (from arterial blood gas analysis). The primary outcome was in-hospital mortality. Receiver Operating Characteristic (ROC) curve analysis was used to determine the predictive accuracy of the TTSS, including the Area Under the Curve (AUC), sensitivity, specificity, and optimal cut-off value. Bivariate analysis using the chi-square test was performed. Results: Of the 38 patients, 76.3% (n=29) were male. The mortality rate was 15.8% (n=6). The ROC curve analysis for TTSS in predicting mortality yielded an AUC of 0.727 (95% CI: 0.447–1.000; p = 0.082). At an optimal cut-off value of 10.5, the TTSS demonstrated a sensitivity of 66.6% and a specificity of 71.8% for mortality prediction. Patients with TTSS >7 had a significantly higher proportion of mortality (83% of deaths occurred in this group) compared to those with TTSS $\leq$7. Conclusion: The Thoracic Trauma Severity Score (TTSS) showed fair predictive accuracy for in-hospital mortality in patients with blunt thoracic trauma in this study setting. While demonstrating reasonable sensitivity at a cut-off of 10.5, its specificity was also moderate. The TTSS can serve as a useful quantitative adjunct to clinical judgment, aiding in the early identification of patients at higher risk, though its limitations, particularly the modest specificity and non-significant p-value for AUC in this cohort, warrant cautious interpretation and highlight the need for further validation in larger, multicenter studies.
Perioperative Profile of Stand-Alone Cages in Anterior Cervical Discectomy and Fusion for Degenerative Cervical Stenosis: Reduced Bleeding and Hospital Stay Compared to Cage-Plate Constructs Handi Suntama Effendy; Rendra Leonas; Debby Handayati Harahap
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.128

Abstract

Introduction: Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment for degenerative cervical stenosis. Stand-alone cages (SAC) and cage-plate constructs (CPA) are frequently used, with comparable reported fusion rates. This study aimed to compare the perioperative profiles, specifically intraoperative bleeding and length of hospital stay, alongside fusion rates, between ACDF-SAC and ACDF-CPA for single-level degenerative subaxial cervical stenosis in an Indonesian population. Methods: A retrospective cohort study was conducted using medical records from February to March 2025, including patients who underwent single-level ACDF-SAC or ACDF-CPA for degenerative subaxial cervical stenosis between June 2022 and June 2024 at Dr. Mohammad Hoesin General Hospital, Palembang. Twenty-one patients (10 ACDF-SAC, 11 ACDF-CPA) were included. Data on demographics, operative level, intraoperative bleeding, length of hospital stay, and 6-month fusion rates were analyzed. Results: No significant differences were observed in age (p=0.056), gender (p=0.635), or BMI (p=0.708) between groups. The ACDF-CPA group had significantly more procedures at the C5-6 level (p=0.010). Intraoperative bleeding was significantly lower in the ACDF-SAC group (86.90 ± 30.00 cc) compared to ACDF-CPA (183.27 ± 58.74 cc; p=0.000). Length of hospital stay was shorter for ACDF-SAC (4.70 ± 1.49 days) versus ACDF-CPA (6.27 ± 1.19 days; p=0.015). Fusion rates were 100% for ACDF-SAC and 90.9% for ACDF-CPA (RR=2.000; 95% CI 1.290–3.100; p=1.000), a non-statistically significant difference. The single non-fusion occurred at C3-4 in the ACDF-CPA group. Conclusion: In patients undergoing single-level ACDF for degenerative subaxial cervical stenosis, the use of stand-alone cages was associated with significantly less intraoperative bleeding and shorter hospital stays compared to cage-plate constructs, without compromising 6-month fusion rates. These findings suggest potential perioperative advantages for the ACDF-SAC technique.
Unveiling the Concordance: Pirani Score and Key Radiological Angles (TCA AP, Talo-1st Metatarsal) in Monitoring Ponseti-Treated Congenital Talipes Equinovarus Muhammad Randi Akbar; Mochamad Ridho Nur Hidayah; Debby Handayati Harahap
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.129

Abstract

Introduction: Congenital talipes equinovarus (CTEV) is a significant pediatric foot deformity. The Ponseti method, assessed clinically by the Pirani score, is the standard treatment. However, the precise relationship between this clinical score and objective radiological measurements, particularly key angles like the talocalcaneal anteroposterior (TCA AP) and talo-first metatarsal (Talo-1st MT) angles, requires ongoing detailed investigation to optimize treatment monitoring. This study aimed to meticulously evaluate the correlation between Pirani scores and these specific radiological parameters in CTEV patients undergoing Ponseti management at a tertiary care center in Palembang, Indonesia. Methods: A descriptive case series was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, involving 29 infants with idiopathic CTEV. Clinical assessments using the Pirani score and radiological evaluations measuring TCA AP, Talo-1st MT, lateral talocalcaneal (TCA lateral), and lateral tibiocalcaneal (TiCA lateral) angles were performed before initiating and after completing the Ponseti casting phase. Spearman’s rank correlation coefficient was utilized to analyze the relationship between Pirani scores and these radiological angles. Results: Significant improvements were observed in both Pirani scores (mean pre-treatment 4.36 ± 1.41 to post-treatment 0.20 ± 0.29; p < 0.001) and radiological parameters following Ponseti treatment. Pre-correction, Pirani scores showed very strong positive correlations with TCA AP (r = 0.892, p < 0.001), Talo-1st MT (r = 0.939, p < 0.001), and TCA lateral (r = 0.880, p < 0.001). Post-correction, moderate significant positive correlations persisted for TCA AP (r = 0.404, p = 0.045) and Talo-1st MT (r = 0.404, p = 0.045) with Pirani scores. The TiCA lateral angle showed weaker and less consistent correlations. Conclusion: Key radiological parameters, specifically the TCA AP and Talo-1st MT angles, demonstrate a significant correlation with the Pirani score both before and after Ponseti correction in CTEV patients. These findings underscore the synergistic value of integrating these specific radiological assessments with clinical Pirani scoring for comprehensive monitoring of deformity correction during Ponseti treatment.
High Improved Glasgow Prognostic Score (iGPS) Predicts Increased Postoperative Mortality in Stage I-III Colorectal Cancer: A Kaplan-Meier Survival Analysis Gerry Armando; Efman Manawan; Theodorus
Sriwijaya Journal of Surgery Vol. 8 No. 1 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i1.130

Abstract

Introduction: Colorectal cancer (CRC) represents a formidable cause of cancer-related mortality globally. Accurate prognostication that extends beyond conventional TNM staging is imperative for optimizing patient management. The Improved Glasgow Prognostic Score (iGPS), an inflammation-based biomarker derived from C-reactive protein (CRP) and albumin, has demonstrated considerable promise; however, its clinical utility has not been extensively validated in Southeast Asian populations. This study was therefore designed to investigate the association between preoperative iGPS and postoperative mortality among patients with non-metastatic CRC in an Indonesian tertiary care center. Methods: This study employed an ambispective cohort design, enrolling 33 patients with stage I-III CRC who underwent surgical resection at Dr. Mohammad Hoesin Hospital, Palembang. Preoperative serum CRP and albumin concentrations were utilized to calculate each patient's iGPS, which was then stratified into three risk categories: score 0 (low), 1 (medium), or 2 (high). The primary endpoint was all-cause postoperative mortality. The prognostic significance of iGPS in relation to survival was evaluated using the Kaplan-Meier method and log-rank test. Results: The patient cohort was predominantly composed of individuals aged ≥40 years (90.9%), with a median age of 59. Stage 3B was the most frequently observed pathological stage (39.4%). The overall mortality rate during the observational period was 57.6%. A robust association was identified between iGPS and survival outcomes. The survival probability for patients with iGPS 0 was 100%. Conversely, survival was substantially diminished in patients with iGPS 1 (33.3%) and iGPS 2 (42.1%). Kaplan-Meier analysis revealed a statistically significant divergence in survival distributions (p < 0.05), with higher iGPS scores correlating with markedly inferior survival. Conclusion: The preoperative iGPS is a potent and significant predictor of postoperative mortality in this Indonesian cohort of patients with non-metastatic CRC. Its utility as an accessible, cost-effective, and objective instrument for risk stratification is substantial. The integration of iGPS into routine clinical practice could enhance prognostic accuracy and aid in therapeutic decision-making.
Establishing an APACHE II Cut-off Score for Predicting Mortality in Post-Thoracotomy Patients: A Single-Center Cohort Analysis Awan Rochaniawan; Ahmat Umar; Erial Bahar
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.131

Abstract

Introduction: Thoracotomy represents a significant physiological challenge with considerable mortality risk. Early, objective risk stratification in the General Intensive Care Unit (GICU) is essential for guiding clinical management. This study sought to evaluate the utility of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score as a prognostic tool in a heterogeneous post-thoracotomy population at a tertiary referral center in Southeast Asia. Methods: A retrospective cohort study was conducted on 33 consecutive patients admitted to the GICU following thoracotomy between January and December 2024. The APACHE II score was calculated using the most deranged physiological values within the first 24 hours of admission. The primary outcome was in-hospital mortality. Statistical analyses included non-parametric tests for group comparisons, Spearman's rank correlation, and Receiver Operating Characteristic (ROC) curve analysis. A novel aspect of this study was the post-hoc stratification of the cohort by the primary surgical indication (malignancy versus non-malignancy) to explore sources of prognostic variability. Results: The overall mortality rate was 27.3% (9 of 33 patients). Non-survivors had a significantly higher median APACHE II score than survivors (23 vs. 8; p < 0.001). A strong, positive correlation was observed between the APACHE II score and mortality (Spearman's ρ = 0.706; p < 0.001). ROC analysis demonstrated excellent discriminatory performance for the overall cohort, with an Area Under the Curve (AUC) of 0.956 (95% CI: 0.891–1.000). A score of ≥12.5 was identified as the optimal cut-off, yielding a sensitivity of 88.9% and specificity of 87.5%. Analysis of the APACHE II components revealed that mortality was primarily driven by derangements in neurological (GCS), renal (Creatinine), and acid-base (pH) parameters. Conclusion: In this preliminary, single-center analysis, the initial 24-hour APACHE II score demonstrated potential as a powerful prognostic marker for in-hospital mortality following thoracotomy. A candidate cut-off score of ≥12.5 successfully identified a high-risk subgroup. However, given the study's significant limitations, including a small and heterogeneous sample, these findings should be interpreted as hypothesis-generating. They underscore the need for larger, prospective studies to validate this cut-off and to develop more refined prognostic models for specific subgroups of post-thoracotomy patients.
Integrating the Colon Leakage Score (CLS) and Serum Albumin to Predict Anastomotic Leakage in Colorectal Cancer Surgery: A Diagnostic Accuracy Study in an Indonesian Cohort Muhammad Rizqi Firyal; Muhammad Hafidh Komar; Theodorus
Sriwijaya Journal of Surgery Vol. 8 No. 2 (2025): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v8i2.132

Abstract

Introduction: Anastomotic leakage (AL) is a devastating complication in colorectal surgery, associated with high rates of morbidity and mortality. Accurate preoperative risk stratification is essential for guiding clinical decision-making. This study aimed to evaluate the diagnostic accuracy of a synergistic model combining the clinical Colon Leakage Score (CLS) with the biochemical marker of preoperative serum albumin for predicting AL in an Indonesian patient cohort. Methods: A retrospective diagnostic accuracy study was conducted at a single tertiary care center. The study included 60 patients who underwent resection and primary anastomosis for colorectal cancer between January 2022 and June 2024. Patients who received a diverting stoma were excluded. A "high-risk" status was defined by a composite criterion: a CLS > 11 and a preoperative serum albumin level < 3.5 g/dL. The primary outcome was clinically significant AL. Following the identification of inconsistencies in the initial analysis, a complete data re-analysis was performed. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and overall accuracy, with 95% confidence intervals (CI), were calculated. Results: The incidence of AL was 21.7% (13/60 patients). A striking 71.7% of the cohort presented with preoperative hypoalbuminemia. The analysis revealed that the combined model demonstrated poor sensitivity of 46.2% (95% CI: 19.2% - 74.9%) but excellent specificity of 97.9% (95% CI: 88.7% - 99.9%). The model yielded a high PPV of 85.7% (95% CI: 42.1% - 99.6%) and a robust NPV of 86.8% (95% CI: 75.0% - 94.6%). The overall accuracy was 86.7%. Conclusion: The combined CLS-albumin model functions as a highly specific "rule-in" test, not a general screening tool. While it fails to identify more than half of the patients who will leak, a positive result correctly identifies a small subset of patients at extremely high risk for anastomotic leakage. The findings also highlight a profound baseline burden of malnutrition in this population, which warrants further investigation and clinical attention.

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