Sriwijaya Journal of Surgery

Diagnostic Accuracy of Serum Bilirubin and Magnetic Resonance Cholangiopancreatography for Differentiating Benign from Malignant Extrahepatic Obstructive Jaundice: A Histopathology-Referenced Study

Muhammad Faisal — 2026-08-05

Background: Differentiating benign from malignant extrahepatic obstructive jaundice before surgery determines whether patients are triaged towards curative or palliative treatment.

Objective: To evaluate the diagnostic accuracy of serum bilirubin and magnetic resonance cholangiopancreatography (MRCP) against histopathology.

Methods: This STARD-compliant, single-centre retrospective diagnostic-accuracy study included 50 consecutive adults treated at Dr. Mohammad Hoesin Central General Hospital, Palembang between January 2024 and December 2025. Serum bilirubin and MRCP were assessed against surgical or biopsy histopathology. Receiver-operating-characteristic analysis and 2×2 tables with Wilson 95% confidence intervals were computed.

Results: Thirty-nine patients (78%) had benign and 11 (22%) malignant aetiology. Direct bilirubin (13.7 vs 8.7 mg/dL; p=0.003), total bilirubin (20.17 vs 13.02 mg/dL; p=0.007), and common bile duct dilation (26.0 vs 18.5 mm; p=0.018) were higher in malignancy. Direct bilirubin had an AUC of 0.797 at 9.65 mg/dL; total bilirubin had an AUC of 0.773 at 14.3 mg/dL. MRCP had 94.9% specificity, 63.6% sensitivity, and 88.0% accuracy.

Conclusion: Serum bilirubin is a sensitive early rule-out marker, whereas MRCP is a highly specific confirmatory tool; their sequential use may improve pre-operative triage.

Prehospital Determinants of Emergency Department Mortality in Adult Trauma at a South Sumatran Tertiary Referral Centre: A Cross-Sectional Study with Penalised-Likelihood Reanalysis

Indra Kurniawan — 2026-08-20

Background: The prehospital phase is considered a modifiable determinant of trauma survival, but evidence from Indonesian tertiary centres with under-developed emergency medical services is scarce.

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

Methods: This cross-sectional study included 34 consecutive adult trauma patients presenting to the Emergency Department of Dr. Mohammad Hoesin General Hospital, Palembang. Associations were assessed using Fisher exact tests, exact conditional odds ratios (OR), Newcombe risk differences, Firth penalised logistic regression and the originally specified multivariable model. Minimum detectable effects and post-hoc power were calculated.

Results: Mortality was 20.6% (7/34; 95% CI 10.3–36.8). Death occurred in 6/24 patients with scene time >60 minutes versus 1/10 with shorter scene time (OR 2.92, 95% CI 0.28–153.08; p = 0.644), in 1/2 transported by ambulance versus 6/32 otherwise (OR 4.09, 95% CI 0.05–352.85; p = 0.374), and in 1/2 attended by a medical first responder versus 6/32 attended by lay rescuers (p = 0.374). No exposure was independently associated with mortality. The smallest detectable OR was 12.57; realised power was 12.6–23.1%.

Conclusion: No prehospital factor was significantly associated with mortality, but the wide intervals remain compatible with clinically important effects. The findings are uninformative rather than negative and support a prospective, adequately powered, biomarker-augmented 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

Victor Mattathias Noli Tjakrapawira — 2026-08-26

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

Alif Alfiansyah — 2026-09-04

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

Samuel Bertua Halomoan Manurung — 2026-09-07

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.