The robotic arm working in the hospital. Credit: Queen Mary University London
Two major studies involving researchers at Queen Mary University of London have found that robotic-assisted hip and knee replacement does not reduce the overall early risk of repeat surgery compared with conventional surgery.
Published in The BMJ, the studies analysed more than one million joint replacements recorded in the National Joint Registry between 2018 and 2024. Together, they provide the largest real-world evaluation to date of whether the greater technical precision offered by robotic-assisted surgery translates into better outcomes for patients.
Researchers from Queen Mary, the University of Oxford and the University of Bristol found that, although robotic technology is designed to help surgeons position joint implants more accurately, this did not translate into a lower overall early risk of repeat surgery following either hip or knee replacement.
In robotic-assisted joint replacement, the surgeon remains in control of the operation, using computer and robotic technology to help plan and guide the placement of the implant.
The findings come as the NHS plans a major expansion of robotic surgery, aiming to increase the number of robotic-assisted procedures sevenfold by 2035. Robotic systems require substantial investment, costing around £1 million to introduce and adding approximately £1,000 to £2,500 to the cost of each procedure.
In the hip replacement study, researchers found no overall reduction in repeat surgery or mortality associated with robotic surgery. However, robotic hip replacement was associated with a lower risk of further surgery for problems related to implant positioning. This specific benefit did not translate into an overall reduction in the need for repeat surgery.
For knee replacement, researchers found no difference in the risk of repeat surgery between robotic-assisted and conventional procedures.
The studies examined early outcomes, and the researchers say longer-term follow-up will be needed to establish whether differences in implant survival emerge over time.
The team used a method known as target trial emulation to analyse large-scale real-world registry data. The statistical approach aims to make comparisons between groups more closely resemble those of a clinical trial by balancing patients according to known differences in their characteristics.
Dr Hasan Mohammad, Academic Clinical Lecturer in Trauma and Orthopaedics at Queen Mary University of London and lead author, said:
“This study, which uses novel methodology and represents the largest real-world analysis of its kind worldwide, provides important independent evidence for patients, surgeons and policymakers at a time when robotic hip and knee replacement surgery is being adopted rapidly.
“New technology should deliver meaningful benefit for patients and represent good value for a publicly funded health service.”
Researchers analysing data from more than 334 000 patients find that underweight patients face the highest risk of death
Photo by Piron Guillaume on Unsplash
Underweight patients are more likely to die after emergency general surgery than patients who are normal weight or overweight, and patients who are both frail and underweight face an even higher risk of death and other adverse clinical outcomes, according to new research findings. The study drew on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database, which covers more than 334 000 adults who had emergency general surgery between 2019 and 2024.
The research will be presented at the American College of Surgeons (ACS) Clinical Congress 2026 in Washington, Sept. 26-29, where thousands of surgeons will convene to advance surgical quality, patient safety, and access to care.
“Our study shows that patients who are both underweight and frail have the worst outcomes. We also saw that frailty reduces the positive impact of the obesity paradox – the finding that patients who are overweight, but not at the extremes of obesity, tend to have better outcomes. That protective effect is lost if a patient is frail,” said lead study author Ellen Cohn, MD, MPH, a third-year general surgery resident at the University of Chicago.
“What we take away from this study is that risk can be mitigated. We can make real-world changes to body mass index (BMI), and physical therapy can reduce frailty. What is unique about our study is that we were able to look at the impact of BMI and frailty together,” she said.
Using the ACS NSQIP database, researchers identified all adults, age 18 and older, in the U.S. who had emergency general surgery procedures between 2019 and 2024. ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals. More than 600 hospitals participate in the ACS NSQIP adult program, which began enrolling private sector hospitals beginning in 2004.
The ACS NSQIP data allowed researchers to evaluate the relationship between BMI and level of frailty on outcomes including death, hospital length of stay, and readmission rates 30 days after initial admission, as well as the interaction between BMI and frailty and their combined associated risk on these outcomes. Frailty was assessed on a scale with values from one to five, with one indicating patients who had one comorbidity such as diabetes or chronic obstructive pulmonary disease and five indicating patients who had five diseases and were severely frail.
Study Results
Among 334 278 patients included in the analysis, 37.6% were frail, more than one in three.
After adjusting for clinical factors, underweight patients had the highest risk of death, with 92% increased odds compared with normal-weight, non-frail patients. In contrast, obese patients had lower odds of death than normal-weight patients: 43% lower at a BMI of 30.0–34.9 and 27% lower at 35.0–39.9. At a BMI of 40 or higher, there was no significant difference.
Frailty alone was associated with 59% increased odds of death.
Compared to patients who were normal weight and not frail, those who were both underweight and frail had the worst outcomes across all measures: 9.8% mortality, 15.8% readmission rates, an average length of stay of 8.2 days, and an 88.5% discharge-to-home rate. For comparison, non-frail patients had a discharge to home rate of 96.9% and normal weight patients 90.3%.
Frailty reduced the protective effect of obesity on mortality. People who were both frail and obese faced 22% increased odds of death, whereas those who were obese but not frail remained 7% less likely to die after emergency general surgery.
“While the focus of our study was on underweight and frail patients, we were surprised to find that obese patients did better,” said study co-author Justin S. Hatchimonji, MD, assistant professor of surgery in the section of trauma and acute care surgery at the University of Chicago.
“I think recognizing the importance of not only underweight status, but also frailty, helps emergency general surgeons plan for postoperative outcomes and think about how to best manage these patients over the long term.”
Dr. Cohn said the findings can be used to improve postoperative outcomes regardless of frailty scores.
“Thinking about older patients, it’s important to focus on what we can affect: nutrition, making sure protein goals are met, bone health, and vitamins,” she said. “Keeping patients healthy that way can have a bigger impact on outcomes than the other comorbidities that make up the frailty score. We know that you can change underweight status and as a result get a better outcome.”
A limitation of the study is that a large database study cannot prove cause and effect, only an association.
A one-year follow-up analysis of a landmark clinical trial suggests that patients with severe strokes experienced better long-term outcomes after undergoing endovascular thrombectomy compared with medical management alone, according to findings published in JAMA.
The study evaluated ischemic stroke patients presenting with large-core infarcts, meaning a significant amount of brain tissue had suffered damage. These patients are historically considered less likely to benefit from mechanical clot removal because of the amount of brain damage that has already occurred by the time treatment begins, said Sameer A. Ansari, MD, PhD, professor and chief of Interventional Neuroradiology in the Department of Radiology, who was a co-author of the study.
While the original trial did not show meaningful benefit at 90 days, the newly reported one-year data show functional gains among patients who received thrombectomy. The results of the current study suggest longer-term follow-up was needed to fully understand the benefits of the procedure, Ansari said.
“At one year, it’s quite evident based on the statistical analysis that there’s significant benefit with thrombectomy,” said Ansari, also a professor in the Ken and Ruth Davee Department of Neurology and of Neurological Surgery.
In the study, investigators found that 23.6 percent of patients treated with endovascular thrombectomy achieved functional independence one year after their stroke, compared with 6.8 percent of patients who received medical management. Patients in the thrombectomy group were also significantly more likely to regain the ability to walk independently, with 35.4 percent achieving independent walking versus 18 percent in the medical-management group.
The multicentre trial enrolled patients at 47 US stroke centres who presented within 24 hours of symptom onset and had large strokes identified using noncontrast computed tomography (CT) imaging.
Patients who underwent thrombectomy also reported better quality of life one year after stroke, while one-year mortality rates were similar between the treatment groups.
The findings add to growing evidence from other large core interventional stroke trials that patients with extensive brain injury can still benefit from rapid thrombectomy to restore blood flow.
One possible explanation for the delayed benefit, Ansari said, is that recovery from severe stroke continues long after the standard 90-day assessment period used in most clinical trials.
“We know that people continue to improve after a stroke for the next one to two years,” Ansari said. “Three months has been an arbitrary standard used in prior stroke trials to assess benefit and functional outcomes after targeted interventions.”
Restoring blood flow may also support long-term neuroplasticity, the brain’s ability to reorganise and form new neural connections after injury, Ansari said. The study reported that patients who received thrombectomy continued to improve between 90 days and one year, while outcomes remained static or declined in the medical-management group.
While more research is needed to fully understand which large core stroke patients benefit most from thrombectomy, the results of the study may provide additional confidence that aggressive intervention can yield meaningful recovery for patients, even when improvement is not immediately apparent.
“What we’re seeing across multiple randomised controlled trials, endovascular thrombectomy remains a powerful intervention across a spectrum of stroke presentations,” Ansari said. “It gives clinicians more confidence to treat patients even with severe brain injury and to counsel their loved ones that the outcome benefit may require time to heal, hard work with physical therapy/rehabilitation, and family support.”
The study was supported by unrestricted grants from Medtronic, Cerenovus, Penumbra, Stryker and Genentech.
It also saves around 44 units of blood products for every 100 patients treated
Photo by Charliehelen Robinson on Pexels
Giving intravenous iron to patients with anaemia before heart surgery reduces the need for a red blood transfusion and results in an extra day at home in the first 90 days after surgery, finds a clinical trial published by The BMJ today.
Intravenous iron also saved approximately 44 units of blood products for every 100 patients treated.
A third of patients undergoing cardiac surgery are anaemic and 20-50% receive a blood transfusion after surgery, which is linked to increased risks of complications, longer hospital stays, and death after surgery.
Previous studies suggest that intravenous iron before surgery boosts haemoglobin levels (the protein in red blood cells that carries oxygen around the body) and may reduce the need for transfusion, but there is currently no evidence to show that this improves outcomes that matter to patients.
To address this gap, researchers enrolled 955 adults with anaemia (average age 66 years; 60% male) undergoing elective cardiac surgery across 33 hospitals in 10 countries between 15 July 2016 and 15 December 2023.
Patients with inherited blood disorders, those having kidney dialysis or who had intravenous iron given in the previous four weeks were excluded. Other factors such as age, sex, ethnicity, and pre-existing conditions were also taken into account.
Participants were randomly assigned to either intravenous iron or placebo 1-26 weeks before surgery and the number of days alive and at home up to 90 days after surgery was recorded. Other outcomes included red cell transfusion and postoperative complications.
Of 921 patients assessed, the average number of days alive and at home up to 90 days after surgery in patients assigned to intravenous iron was 81 and in patients receiving placebo was 80.
Red blood cell transfusions were given to 262 patients (61%) in the iron group and 302 patients (68%) in the placebo group during their hospital stay. There were no differences in major complications or length of hospital stay.
The researchers acknowledge several limitations. For example, they enrolled patients with anaemia but did not require confirmation of absolute iron deficiency and say a one day difference in a 90 day recovery period is in itself a very small treatment effect.
However, study strengths included a low drop-out rate and measurement of patient-centred outcomes such as quality of recovery, days at home, and quality of life. Findings were also consistent after further analyses, suggesting they are robust.
As such, they conclude: “This study shows that intravenous iron repletion in patients with anaemia before cardiac surgery increased preoperative haemoglobin concentration, reduced the need for red cell transfusion, and resulted in an extra day at home in the first 90 days after surgery.”
Intravenous iron also saved approximately 44 units of blood products for every 100 patients treated, they add.
UCT’s Professor Liesl Zühlke has won a global women in science award for her groundbreaking work in improving care for children with cardiovascular disease. (Photo: Supplied)
By Sue Segar for Spotlight
Long before she became a pioneering scientist, Professor Liesl Zühlke insisted on seeing her tonsils after they were removed when she was just five years old. Today, paediatric cardiology is close to her heart, and her research has helped answer critical questions in the entire pipeline of heart disease.
In the mid-2000s, while working as a trainee in paediatric cardiology at the Red Cross War Memorial Children’s Hospital, Liesl Zühlke helped treat a 12-year-old patient who had an unusual congenital heart condition.
“His heart was so weak that he was dying,” she says. “He was thin, short of breath and very tired. He’d had multiple admissions to hospital and numerous health folders, tied together with elastic. On the front of his folder, the letters DNR (meaning do not resuscitate) were written in black khoki-pen.”
Zühlke recalls requesting an ultrasound of the heart, among other tests that eventually led to a diagnosis of a coronary artery anomaly. “This is a structural heart defect, present at birth, where the major coronary artery supplying the heart itself has the wrong origin, resulting in oxygen-poor blood supplying the heart muscle, causing it to die,” she explains. (See this Cleveland Clinic page for more on the condition.)
Fortunately, the defect is treatable with cardiac surgery to move the coronary artery to the correct place. Within a year of having this operation, the boy’s heart function had returned to normal.
A journey to research
This encounter was something of a turning point in Zühlke’s life. Till then, she’d only done clinical work, but the case piqued her interest in this particular lesion.
This experience, she says, was a lesson in looking beyond the obvious, re-examining a patient with a fresh approach, and asking new questions. “By thinking differently, we changed the trajectory of his life and many others.”
Zühlke did a small study looking at 30 cases of this lesion, and found it was more common than thought. “Our work led us to being able to diagnose this condition much earlier, before heart damage could happen, and children with the lesion could get surgery earlier. It made me realise why research and evidence-based medicine are so important … if one wants to impact not just the patient in front of you but multiple patients.”
A lifetime steeped in medicine
Zühlke, who was born and raised in Athlone, Cape Town, was from childhood fascinated about the inner workings of the human body.
“My siblings remember me cutting up my dolls and doing transplants with pieces of chicken,” she recalls with amusement.
When she had her tonsils removed at a tender five years old, she insisted on seeing the fleshy lymph node masses.
“My grandmother worked as a domestic worker in a residence at the University of Cape Town (UCT) and told us stories about students and what was happening there. Apparently, from when I was three or four, I said I wanted to study medicine,” says Zühlke.
It thus came as no surprise that she ended up studying medicine and surgery at the UCT. In 2015, she completed her PhD on the outcomes of asymptomatic and symptomatic rheumatic heart disease, which was supervised by the late Professor of Cardiology Bongani Mayosi. She calls him her “academic father” and “the man who saw something in me that I didn’t”.
In 2019, Zühlke was the first woman in South Africa to be appointed as a full professor in paediatric cardiology.
“It was always going to be paediatrics,” she says, adding “there was always a kid on my hip during ward rounds. With children, it’s not about status but about caring, and meeting them at their level.”
Losing patients, Zühlke says, is part of any doctor’s experience, “but it’s terrible telling a mother their child hasn’t got a normal heart and that there’s a possibility of death. To do that with compassion … is what we’re put in this world for.”
She says while her work started with research into rheumatic heart disease, her focus later evolved. “I started looking more at the reasons why we have the outcomes we do; the overarching determinants of why people are diagnosed late, why they don’t have enough treatment, and enough surgery; and why they have poorer outcomes.”
Today, Zühlke is vice-president of the South African Medical Research Council, and at Red Cross she is director of the Children’s Heart Disease Research Unit and a paediatric cardiologist in the Division of Paediatric Cardiology.
What types of things go wrong in children’s hearts?
Heart disease in children refers to any problem with the structure or work of the heart, explains Zühlke. There are two main types: congenital heart disease which relates to structural problems with the heart that are present at birth; and acquired heart disease that develops later.
“The heart is complete between six and eight weeks in utero. With congenital heart disease, the structural abnormalities are there already,” she says.
“The heart can be viewed as a house with four rooms or chambers, with walls that separate them, and veins or arteries going in or out to allow blood to move from one chamber to the next, through four valves or doors. There can be problems with any of those, for example, a hole in the heart, which is one of the most common things we see. If there’s a hole in one of the walls separating these chambers, then oxygen-rich and oxygen-poor blood can mix, making the heart and lungs work harder,” Zühlke says.
She says that a much more serious problem is when, instead of being born with four parts of the heart, a child is born with three or there’s obstruction to blood flow to the body. “This critical cardiac lesion requires surgery to reorganise the circulation. No surgery almost certainly means death. The range of structural abnormalities ranges from mild to critical. Congenital heart disease is the most common birth defect, affecting one in 50 children,” Zühlke says.
Explaining rheumatic heart disease, she says: “This is acquired later in life, particularly in children between the ages of five and fifteen, as a consequence of an infection called Streptococcus pyogenes (Strep A) which causes a sore throat or a skin infection and sets off an abnormal immune response. The body attacks and damages the tissue in the heart, an acute illness follows called Rheumatic fever and the permanent heart valve damage which results is known as Rheumatic Heart Disease.”
Zühlke believes not enough studies have been done to prove categorically what the prevalence of heart disease is in children in South Africa. “It’s hard to do a true birth prevalence study. But we’ve done a lot of work (through extrapolating numbers from other studies) to fill in the data gap showing that the prevalence in South Africa is similar to other parts of the world.” She says congenital heart disease is within the top five killers of children and more common than any other birth defects combined.
Unclear causes
The causes of congenital heart disease could include genetic changes, like chromosomal disorders like Down syndrome; maternal health issues like diabetes, obesity or infections; or exposure to smoke, alcohol or restricted medications during pregnancy.
The causes of acquired heart disease are similarly varied, ranging from environmental causes to and infections. It can take many forms. Kawasaki disease is a childhood illness that causes inflammation in the walls of blood vessels, resulting in fever, rashes and swelling; cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. HIV-associated heart disease comes about because people living with HIV face a higher risk of developing cardiovascular disease.
The symptoms of heart disease, Zühlke says, include rapid breathing, an increased heart rate, and excessive sleepiness. Babies can be pale or blue around the fingers, toes or lips, and can tire when drinking or have problems gaining weight.
There are several possible diagnostics, but they are not always available in the public healthcare system. These include heart ultrasound, electrocardiograms, X-rays, and checking the amount of oxygen in the blood soon after birth, with a pulse oximetry test.
In addition, Zühlke says that some provinces such as the Northern Cape and Mpumalanga lack a paediatric cardiologist to make the diagnosis. “There are also issues with referrals to get diagnosed patients to centres for timeous attention. Sadly, people are dying without even knowing they had heart disease,” she says.
What we can do differently
Asked what could be done differently in the public sector to improve early diagnosis of heart issues, she says pulse oximetry screening is a simple, cost-effective, efficient test to rule out critical congenital heart disease. Zühlke says there are plans to incorporate it into the Road to Health Booklet used by health professionals and parents to monitor a child’s health and development.
“It wouldn’t be difficult to add pulse oximetry screening as a check before a baby is discharged from a hospital. It’s been well proven that it works. All that’s needed is a probe and somebody to do it; and it can tick a box on the child’s Road-to-Health chart.
“But that requires money because you need a particular newborn probe to do it … and people are busy in the clinics,” she says.
On rheumatic heart disease, Zühlke says it’s “unethical” that an entirely preventable disease is still such a problem in SA and Africa. “We need research, funding, and advocacy to change that, improving diagnosis, treatment and long-term care. Also, we need to make sure there’s a vaccine to treat strep A.”
First prize, she says, would be to enable immediate diagnosis of rheumatic fever. “Currently, there’s no one test to say a person has acute rheumatic fever.”
“Next, we need a different way of treating it (the current penicillin injection is extremely painful for children); and getting a vaccine in countries where it actually matters. In the meantime, the goal is to ensure people living with the disease get access to care.”
Zühlke says she’s following the work on a vaccine for rheumatic heart disease closely and is involved in a vaccine collaborative which is working to ensure that when the vaccine becomes available, it is accessible and affordable.
‘Some of them were my heart patients as children’
Meanwhile, her “varied, mad, interesting” life sees her overseeing numerous intra- and extramural research projects for the SAMRC and directing her childrens heart research unit at UCT. She still works in a multi-disciplinary clinic for women with cardio-vascular disease in Groote Schuur’s maternity centre which she loves.
“Some of them were my heart patients as children,” Zühlke says, adding that transitional care is a priority “because patients with congenital and rheumatic heart disease become adults, we need to ensure that they can get the best possible life-long care.”
Her big vision has always been “to integrate research into the clinical space, so that as you see patients, it goes into the research, and as you research, it goes back to the patient.” Zühlke adds: “Being part of the research landscape at the SAMRC is deeply gratifying. What I’d like to see, most importantly, is childhood onset heart disease recognised as an entity, part of policy … and in the national action plans.”
She is the 2026 laureate for Africa and the Arab States in the L’Oréal-UNESCO For Women in Science International Awards for her pioneering work in improving care for children with cardiovascular disease, particularly rheumatic heart disease. Given to the top five female scientists globally, the distinguished award recognised her for “combining cutting-edge science with social justice” and “turning the fight against childhood heart disease into a public policy priority”.
Zühlke is married to Alexander Zühlke, a plastic surgeon at Tygerberg Hospital in Cape Town, and together they have two children.
In a thoughtfully designed, adaptive clinical trial, University of Pittsburgh School of Medicine physician-scientists demonstrated that the United States could triple to quadruple the supply of platelets available to help save bleeding patients of all ages and extend the life-saving therapy into rural regions and community hospitals. Platelets are the component of blood that encourage clotting, plugging cuts and tears in blood vessels and stemming blood loss.
Of the 2.5 million room-temperature platelet units collected per year in the United States, roughly 10% to 20% are wasted due to the short shelf life, costing hospitals $300 million, according to recent research in the journal Hematology.
“Our findings could result in major international public health benefits,” said lead author Philip Spinella, professor of surgery and of critical care medicine in Pitt’s School of Medicine and codirector of Pitt’s Trauma and Transfusion Medicine Research Center. “This is incredibly transformative and will dramatically improve the availability of platelets while also reducing waste, allowing hospitals that aren’t in major cities to afford to keep this life-saving blood product on hand for bleeding patients.”
Currently, donated platelets are conventionally stored at room temperature with a five- to seven-day shelf life. Early studies conducted half a century ago in healthy volunteers led regulators to believe that refrigerating platelets to extend their shelf life made them less effective.
Recent preclinical studies indicated the opposite, though, so Spinella and colleagues designed CHIPS to safely test using refrigerated platelets stored for increasing amounts of time up to 21 days. The trial enrolled 1000 paediatric and adult patients undergoing cardiac surgery at 27 sites in the United States and Australia from December 2021 to March 2025.
The patients were randomised to receive either standard, room-temperature platelets stored for less than seven days or chilled platelets. At every 200 participants treated, independent data analysts looked at the results. If the chilled platelets were performing just as well as room temperature, they’d add up to another five days to the age of the chilled platelets used and enrol another 200 participants, up to a maximum of 21 days.
The research team discovered that platelets refrigerated for up to three weeks were just as effective at treating bleeding as room-temperature platelets stored for up to one week. Since it can take two days for blood banks to process donations, the finding holds the potential to extend the lifespan of platelets for use in controlling bleeding by almost four-fold.
“Rural and community hospitals, for the most part, simply cannot justify keeping room temperature platelets in stock – they don’t see enough severely bleeding patients, so the waste would far exceed the benefit, something our nation’s fragile blood supply chain cannot accommodate,” said coauthor Michael Boisen, cardiothoracic anaesthesiologist and medical director of the UPMC Patient Blood Management Program, who served as principal investigator for UPMC’s CHIPS trial site. “So, if we can safely extend the shelf life of platelets and reduce the waste, imagine how many more people we could help.”
More than 97% of platelets are donated through apheresis, where a donor’s blood runs from a tube in their arm to a machine that collects the platelets and returns the rest of the blood back to the donor–a time-consuming process. The age of platelet donors has steadily increased over the past decade and younger donors are not replacing the aging donor base fast enough to keep up with demand, according to data from Vitalant, which supplied the platelets for the study and is one of the nation’s largest nonprofit blood and biotherapies services providers.
“About 15% of hospitals can experience one or more delayed platelet transfusions within any given month due to supply shortages,” said Ralph Vassallo, Vitalant’s chief medical and scientific officer. “A 21-day shelf life for cold-stored platelets will reduce outdate rates and ensure platelets are available on hospital shelves when a surge in need occurs.”
In addition to the civilian applications, the findings could also benefit military personnel by making it more feasible to have platelets available in conflict areas, said Spinella, who is also associate medical director of Pitt’s Center for Military Medicine Research.
A unique facet of the trial is that it included children and babies from the start. Usually, clinical trials that aren’t specific to paediatric populations will exclude children.
“I believe it is unethical not to include children in a trial when there isn’t a rational biological reason to exclude them,” Spinella said. “Of the 1,000 participants in our trial, roughly a third were children—which makes sense because it is the very young who bleed the most from cardiac surgery and most frequently benefit from platelets. Our trial will hopefully motivate others to include children in their trials.”
Additional authors are listed in the JAMA article.
As cosmetic procedures surge worldwide and beauty content increasingly dominates social media platforms, a new study from the Hebrew University of Jerusalem, suggests that for some women, cosmetic treatments may begin to resemble compulsive or addiction-like behaviour. The study, led by Dr Vera Skvirsky alongside Dr Uri Lifshin, Dr Dvora Shmulewitz, and Prof Mario Mikulincer from the Department of Psychology at Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health (ICAMH), examined what the researchers describe as “addictive cosmetic procedures use,” or ACPU, among women.
Published in the Journal of Health Psychology, the study surveyed 1614 women between the ages of 25 and 71, making it one of the larger investigations to date into the psychological patterns associated with repeated cosmetic treatments. The findings point to a phenomenon that researchers say deserves greater attention from both clinicians and the public. Among women who had undergone cosmetic procedures, 20% met the threshold for moderate to severe risk of addictive cosmetic procedure use during their lifetime.
More than 15% reported symptoms that were active within the past year.
Across the full sample, nearly 9% of women showed moderate to severe signs of problematic cosmetic procedure use. The researchers adapted an assessment tool originally based on the Diagnostic and Statistical Manual of Mental Disorders criteria for substance-related disorders. Participants were asked questions typically associated with addiction, including whether they had unsuccessfully tried to stop undergoing cosmetic procedures, felt compelled to continue despite negative consequences, or experienced cravings related to treatments.
While previous research has linked cosmetic procedures to body image concerns and body dysmorphic disorder, this study goes further by examining whether repeated cosmetic treatments can, in some cases, resemble a behavioural addiction. Unlike earlier studies, which often focused on patients at cosmetic clinics, this research surveyed more than 1600 women from the general population and found that addiction-like patterns were most strongly associated with the combination of low body esteem and problematic social media use.
While cosmetic procedures are often associated with confidence and self-expression, the researchers found that repeated engagement may also intersect with vulnerabilities tied to body image and digital behaviour. Women with lower body esteem were significantly more likely to report addictive patterns of cosmetic procedure use, particularly when paired with high levels of problematic social media use. Participants who reported problematic or excessive social media behaviour were especially vulnerable if they also struggled with dissatisfaction about their appearance.
The researchers also observed smaller associations between addictive cosmetic procedure use and lower feminist attitudes, lower attachment security, and more negative attitudes toward aging, though those relationships were less consistent once multiple factors were analysed together.
The findings arrive amid a sharp global increase in cosmetic procedures. According to international estimates cited in the paper, cosmetic interventions worldwide rose by roughly 40% between 2019 and 2023.
The researchers stressed that the study does not argue cosmetic procedures are inherently harmful. Rather, they say the results suggest that in some cases, repeated engagement may take on characteristics similar to behavioral addictions already recognized in mental health research.
“Cosmetic procedures have become deeply normalised in many societies, and for many people they may be a positive experience,” said the researchers. “But our findings suggest that for a meaningful minority, the behaviour may begin to resemble other compulsive patterns we see in addiction research, especially when low body esteem and problematic social media use are involved.”
The researchers cautioned that the study was cross-sectional, meaning it cannot determine cause and effect. It remains unclear whether problematic social media use contributes to addictive cosmetic behaviour, whether cosmetic procedures themselves influence body image and online engagement, or whether other psychological factors drive both.
A Phase 2 feasibility study published today (30 July) in the prestigious Nature Communications Medicine journal has shown that early vitrectomy surgery treatment for acute endophthalmitis can be potentially more beneficial to patients’ vision compared with the current antibiotic-first approach.
This is a bacterial infection, affecting the fluid and tissue inside the eye. It is a rare condition (1 in 1000 to 2000 patients), but is a devastating complication from any form of eye surgery or eye injection, and can lead to sight loss and blindness. Treatment guidelines only exist for cataract treatment, and the conventional approach across ophthalmology has been to repeat intravitreal antibiotic injections during the early phase of the condition, then conduct a vitrectomy if this has not proved effective.
Thirty years ago, research indicated the potential benefits of immediate vitrectomy for patients developing endophthalmitis after cataract surgery, but this is seldom carried out. Since then, the development of small gauge (23-, 25 and 27-) pars plana vitrectomy (PPV), wide-angle viewing systems and the routine use of silicone oil have led to a significant evolution for the procedure. This 21-centre national UK study of 63 patients is the first randomised control trial to evaluate the potential benefits of carrying out the vitrectomy at an early stage, within 48-96 hours of diagnosis of endophthalmitis following any type of invasive eye procedures.
After six months, patients receiving this treatment had a median improvement of 40 letters (range 28-70 letters) compared with those having an initial regime of up to six months of antibiotics (median 13 letters increase in vision, range 0-66 letters). The median improvement for the new approach therefore shows over three times the median sight improvement of the conventional treatment.
Importantly, these improvements came earlier for patients too, bringing relief and recovery from what can be a painful condition as well as removing the psychological shadow of potential sight loss from them sooner. At the six-month cut-off period, this study shows these patients can potentially achieve greater improvements in acuity which, if this endures, further increases the social benefit.
Early vitrectomy also showed lower rates of non-serious adverse events (47% vs 68%) and retinal detachment.
The feasibility of the approach and its acceptability to patients and surgeons were validated by the study team. These promising results are based on a sample of 63 so have relatively low levels of statistical significance, but point to the merits of conducting a larger Phase 3 clinical trial.
Lead author Mahi Muqit, senior vitreoretinal consultant at Moorfields Eye Hospital and associate professor at the Institute of Ophthalmology at UCL, said:
“This important new study shows the potential short-term and long-term potential benefits to patients given an early vitrectomy if they contract endophthalmitis after their eye procedure. As using this intervention at diagnosis shows clear potential to improve clinical outcomes, we now intend to take this forward to a definitive Phase 3 randomised clinical trial that can definitively answer this question.”
Booking operating rooms with surgical precision starts with more accurate predictions of how surgeons spend their time
Photo by Piron Guillaume on Unsplash
Researchers at the University of Massachusetts Amherst have analysed nearly 86 500 surgeries at Baystate Medical Center to identify the top factors that influence inefficiencies in surgeon schedules. Having an efficiently organised surgical schedule has the potential to lower costs and reduce surgeon burnout, which would also improve patient outcomes.
As shortfalls in the availability of surgeons grow, the ability to meet surgical demands will only worsen, with implications for both healthcare delivery and costs.
This illustrates the timeline of two surgeries performed by the same surgeon. The blue area represents the duration of the actual surgery itself, while the white blocks represent pre- and post-surgery activity. Surgeon gap time is the time interval between two operations where the surgeon is not actively working.
“The most expensive part in this process of getting a surgery is the surgeon,” says Muge Capan, assistant professor in the Riccio College of Engineering at UMass Amherst and an author of the new paper published in the Journal of the American Medical Informatics Association. “Surgeons are highly skilled and they perform high-risk tasks. When we think about utilising a resource, we don’t want them to sit idle – but we also don’t want to overutilise them because these are not machines, these are people. Finding that right balance is a challenging problem.”
However, to efficiently schedule, hospitals need to predict how long a procedure will take. This includes the surgery itself as well as many other factors that surround an operation – has the surgeon recovered from their previous operation? Is the room clean? Is the proper equipment in place? “There is a lot of uncertainty there at the system level,” says Capan.
Currently, surgeries are scheduled in blocks, which is not compatible with the unpredictable nature of a hospital. “If you’re scheduling tennis lessons, it works because a tennis lesson is exactly one hour,” says Capan. “You block the court for one hour, you play, you leave, next group. But blocks don’t make sense for surgeries, because they’re so uncertain.” As a result, operating rooms (ORs) can sit empty since any block of time less than two-and-a-half hours is unusable for most surgeries.
In the pursuit of engineering a better schedule, Capan and her team collaborated with surgeons to predict their schedule by focusing on the person, not the operating room.
Surgeons are highly skilled and they perform high-risk tasks… we don’t want them to sit idle – but we also don’t want to overutilise them because these are not machines, these are people. Finding that right balance is a challenging problem.
Muge Capan, assistant professor in the Riccio College of Engineering at UMass Amherst
“There’s so much research on the operating room itself – what happens between the time a patient leaves the OR to the time the next patient enters the OR,” says Jonathan Akhagbosu, first author on the paper and UMass Amherst industrial engineering Ph.D. candidate. “But we wanted to look at it from a surgeon’s point of view: What happens between when a surgeon finishes one case and proceeds to the next case?”
The researchers named this time between operations “gap time.” In their study, they used machine learning to analyse three years of medical records from Baystate Medical Center in Springfield to determine the characteristics of a surgery that can predict these gaps in a surgeon’s schedule.
A selection of the top factors associated with larger gap times are: if the surgeon’s previous or following case is an emergency, the preceding surgery is related to the chest (thorax), the following procedure is on the heart, or the surgery is highly demanding.
Also, the last factor on the list – the assessment of how taxing an operation is on the surgeon – the researchers used mathematical models to create a new measurement called surgical case demand. Cases fall into one of three tiers. Type 1 consists of short, scheduled procedures of low-severity illness and elective surgeries, such as the removal of fatty lumps from the skin (lipoma excision) or simple dental rehabilitation. Type 2 events are more demanding, such as a mastectomy or knee replacement. And type 3 surgeries are the most onerous: the condition is more severe and they happen during off-hour times. Examples include emergency brain or abdominal operations and spine procedures.
It’s also worth noting that eye (ophthalmology) and orthopedic surgeries were associated with shorter gap times.
Capan envisions that predicting schedules can help recapture some of this lost time. “If there’s going be a gap, let’s figure out if that gap is long enough that I could squeeze in something else,” says Capan. “This is called ‘collectible time’ in the literature. Collectible time means it’s a useful gap. So what we learned about gap time could potentially help us understand collectible time.”
When 12-year-old Eugene underwent a highly specialised facial reanimation procedure earlier this year, the surgery represented something profoundly human, the possibility of smiling for the first time.
Born with Moebius syndrome, a rare neurological condition that affects facial movement and expression, Eugene had spent his life unable to smile, blink properly or express emotion through facial movement. And while his story is emotionally powerful, it also shines a light on a far broader healthcare reality, the growing importance of highly specialised reconstructive surgery in restoring not only appearance but movement, function, dignity and quality of life.
At Wits Donald Gordon Medical Centre (WDGMC), reconstructive microsurgery is helping redefine what is possible for patients facing some of the most complex medical challenges, from congenital conditions and cancer to severe trauma and tissue loss.
Often misunderstood as a field focused primarily on cosmetic procedures, reconstructive microsurgery sits at the intersection of surgical precision, innovation and long-term patient rehabilitation. These procedures frequently involve transplanting tissue, muscle and nerves from one part of the body to another and reconnecting blood vessels, often measuring less than two millimetres in diameter, under microscopic magnification.
Leading this work at WDGMC is Dr Dimitri Liakos, a plastic and reconstructive surgeon with fellowship training in reconstructive microsurgery and super microsurgery.
Dr Dimitri Liakos, a plastic and reconstructive surgeon with fellowship training in reconstructive microsurgery and super microsurgery.
“These procedures are not simply about appearance,” says Dr Liakos. “They are about restoring function, movement and ultimately helping patients regain parts of their lives that were lost or that they were born without.” In Eugene’s case, surgeons transferred functioning muscle together with its blood and nerve supply into the face, reconnecting these delicate structures under a microscope so movement could gradually return over time.
Eugene’s procedure was facilitated through the support of the Smile Foundation, which works to improve access to reconstructive surgery for children requiring specialised care.
“We are deeply grateful to Wits Donald Gordon Medical Centre and Dr Dimitri Liakos for their dedication in supporting Eugene on his journey,” says Tarri Parfitt, CEO of Smile Foundation. “It is truly remarkable to open a world-class facility to this family and provide care at the highest level of expertise. Facial reanimation surgery is profoundly life-changing. For Eugene, it represents the possibility of expression, connection and a future he may never have imagined before. For Smile, it was also an invaluable opportunity for other surgeons to learn from such a rare and complex case, turning one surgery into the potential to help many more children like Eugene. We highly value the opportunity to work alongside Wits Donald Gordon Medical Centre on cases such as this and look forward to helping many more children together.”
While these procedures are performed in highly specialised centres globally, access to this level of care remains limited in South Africa due to the advanced infrastructure, multidisciplinary expertise and years of specialised training required to perform them successfully.
For WDGMC, however, the ability to perform these surgeries forms part of a broader commitment to advancing highly specialised care within South Africa’s healthcare system while simultaneously strengthening academic medicine and specialist training.
As an academic hospital affiliated with the University of the Witwatersrand, WDGMC has become an important training environment for complex reconstructive microsurgery in South Africa. The hospital recently established the country’s first reconstructive microsurgery fellowship programme for qualified plastic surgeons, helping expand the number of specialists capable of performing these highly technical procedures.
“We have a responsibility not only to perform these surgeries, but to transfer the skill,” says Dr Liakos. “If we do not train future microsurgeons, access to this level of specialised care will remain limited.”
According to Dr Liakos, successful reconstructive microsurgery depends not only on surgical expertise but on building the right multidisciplinary environment around patients.
“To do these cases successfully, you need a dedicated team and an environment that functions seamlessly,” he explains. “Microsurgery is never a one-person effort. It is the nursing staff, anaesthetists, theatre teams and systems around you that make these outcomes possible.”
For surgeons working in the field, the impact of reconstructive microsurgery extends far beyond the operating theatre.
“These surgeries can take 10 or 12 hours. They are physically and emotionally demanding,” says Dr Liakos. “But when you step back and realise that what you are doing may change the course of a person’s life forever, it gives meaning to every moment spent in theatre.”
As WDGMC continues to build on its reconstructive microsurgery programme and the country’s first fellowship of its kind, the hospital is helping shape a future in which South African patients can access world-class reconstructive care close to home and in which the specialists capable of providing that care are trained locally.
