Review for 10.1186/s12876-025-03648-x (2025)

Title: Preoperative Optimization Strategy Management Model Applied in Gallbladder Surgery
Version: 5 Date: 01 Jan 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: Preoperative Optimization Strategy Management Model Applied in Gallbladder Surgery
I have reviewed your manuscript, supplementary data, and responses to previous reviews. Your
work addresses an important issue in optimizing hospital resource utilization and improving
surgical outcomes for gallbladder surgery patients through a preoperative optimization strategy
management model. This study offers significant insights, but there are areas for further
refinement and clarification to strengthen the findings and enhance the manuscript’s impact.
The inclusion and comparison of patients undergoing pre-hospitalization with those admitted
through regular procedures is a compelling feature. The results, as detailed in the tables, reveal
significant differences in outcomes. For instance, Table 1 shows a statistically significant
reduction in length of stay and costs for pre-hospitalization patients compared to general
hospitalization. Binary logistic regression analysis (Table 2) effectively highlights factors
influencing these outcomes, controlling for confounding variables such as age and underlying
conditions. Further subgroup analyses, such as those in Tables 3 to 7, provide a nuanced
understanding of the benefits across different demographic groups.
Your responses to previous reviewer comments reflect careful consideration and demonstrate
a genuine effort to address methodological and presentation concerns. Notably, the revision
of the methodology section to enhance clarity and conciseness is commendable. The addition
of regression analyses strengthens the study by addressing potential biases arising from
confounding factors.
However, the unequal distribution of participants between groups remains a significant
limitation. While you acknowledge this and provide justification, future studies should aim for
better balance, potentially through propensity score matching or alternative methods. Thus, it is
essential to state it clearly as a recommendation for future studies. Additionally, the absence of
detailed surgical outcomes, such as rates of complications (e.g., bleeding or bile duct injuries),
limits the assessment of pre-admission management's impact on surgical safety. It is essential
to broaden your discussion and methodology highlighting the importance of these clarifications
for future studies to adopt your method. Citing : 1- doi.org/10.1186/s12893-023-02301-2
2-  doi: 10.1186/s13017-021-00369-w.
In terms of presentation, certain sections, particularly the results, could be streamlined for
better readability. While the statistical analyses are comprehensive, some findings could be
summarized more effectively to maintain reader engagement without compromising depth.
Additionally, the abstract, while concise after revision, still lacks sufficient emphasis on the
study's broader implications.
The study’s limitations, as discussed, are relevant but should include a more detailed exploration
of socioeconomic factors and other potential confounders.
Overall, your manuscript presents valuable data and insights into optimizing hospital
management for gallbladder surgery.  Future studies should aim to expand the patient population,
include long-term outcomes, and explore the feasibility of applying this model to other surgical
procedures and healthcare systems.
Warm regards,