OBJECTIVE: To examine the risk factors of surgical site infection (SSI), delayed wound healing, and death after orthopedic surgery in patients with rheumatoid arthritis (RA).
METHODS: We identified articles indexed in the Cochrane Library, PubMed, and Japan Centra Revuo Medicina Web published from 2013 to 2019 and other articles. Articles fulfilling the predefined inclusion criteria were reviewed systematically and their quality was appraised according to the Grading of Recommendations Assessment, Development, and Evaluation system with some modifications.
RESULTS: After inclusion and exclusion by full-text review, 29 articles were analyzed. Use of biological disease modifying antirheumatic drugs was a risk factor of SSI (risk ratio 1.66, 95% confidence interval 1.25-2.19), but not of delayed wound healing. RA itself was a risk factor of SSI, and oral glucocorticoid use was a risk factor of SSI in three of the four studies analyzed and of postoperative death. Age, male sex, comorbidities such as diabetes mellitus and chronic obstructive pulmonary disease, surgical factors such as foot/ankle and spine surgery and longer operative time were risk factors of those postoperative complications.
CONCLUSIONS: Patients with those factors should be dealt with appropriate cautions to strike a risk-benefit balance of orthopedic surgeries.

OBJECTIVE: To examine the risk factors of surgical site infection (SSI), delayed wound healing, and death after orthopedic surgery in patients with rheumatoid arthritis (RA).
METHODS: We identified articles indexed in the Cochrane Library, PubMed, and Japan Centra Revuo Medicina Web published from 2013 to 2019 and other articles. Articles fulfilling the predefined inclusion criteria were reviewed systematically and their quality was appraised according to the Grading of Recommendations Assessment, Development, and Evaluation system with some modifications.
RESULTS: After inclusion and exclusion by full-text review, 29 articles were analyzed. Use of biological disease modifying antirheumatic drugs was a risk factor of SSI (risk ratio 1.66, 95% confidence interval 1.25-2.19), but not of delayed wound healing. RA itself was a risk factor of SSI, and oral glucocorticoid use was a risk factor of SSI in three of the four studies analyzed and of postoperative death. Age, male sex, comorbidities such as diabetes mellitus and chronic obstructive pulmonary disease, surgical factors such as foot/ankle and spine surgery and longer operative time were risk factors of those postoperative complications.
CONCLUSIONS: Patients with those factors should be dealt with appropriate cautions to strike a risk-benefit balance of orthopedic surgeries.

We investigated whether measurement of muscle quantity/quality has additional predictive value for postoperative complications and long-term survival after gastrectomy for gastric cancer in patients with probable sarcopenia, as defined by the new European Working Group on Sarcopenia in Older People 2 consensus.
We conducted a prospective study of patients who underwent a radical gastrectomy for gastric cancer between August 2014 and June 2019. Muscle strength was measured using a handgrip dynamometer. Computed tomography images at the third lumbar vertebra level were used to assess muscle quantity and quality by the measuring cross-sectional muscle area and mean muscle attenuation, respectively. Probable sarcopenia was defined by low muscle strength. Sarcopenia was diagnosed by additional low muscle quantity or quality. Clinical outcomes were obtained by prospective data collection and follow up.
Probable sarcopenia was identified in 419 patients, including 285 patients with sarcopenia. Patients with sarcopenia had a higher incidence of postoperative complications, higher costs, longer length of postoperative hospital stay, and worse overall survival (OS) and disease-free survival (DFS) compared with patients with low muscle strength only. The multivariate logistic analysis showed that sarcopenia and hypoproteinemia were independent risk factors for postoperative complications in patients with probable sarcopenia. Moreover, multivariate Cox analyses showed that sarcopenia remained an independent risk factor for OS and DFS in patients with probable sarcopenia.
The measurement of muscle quantity/quality has additional predictive value for postoperative complications, OS, and DFS after gastrectomy for gastric cancer in patients with probable sarcopenia.

UNASSIGNED: Macroglossia is a rare life-threatening postoperative complication in patients undergoing neurosurgical operations in a sitting position. It is difficult to identify the cause of macroglossia, which can be considered multifactorial in most patients.
UNASSIGNED: We herein present a case of a 37-year-old female patient who was known to have a posterior occipital lesion (low-grade glioma with pilocytic features) and underwent occipital craniectomy followed by supratentorial approach for debulking of the tumor under general anesthesia in a sitting position. The patient developed upper airway edema along with extreme macroglossia immediately following extubation, with increasing difficulty in ventilation. Re-intubation was impossible, and urgent tracheostomy was performed. In the intensive care unit (ICU), the macroglossia worsened, and the patient developed sepsis with multi-organ failure and died 16 days postoperatively.
UNASSIGNED: Acute macroglossia can be a catastrophic postoperative complication, necessitating early identification and a systematic approach to this critical event, in addition to being fully prepared to deal with difficult airway should this complication occur.

Background: Nutritional risk and sarcopenia are both associated with increased postoperative morbidity and mortality following elective surgery. This study aimed to investigate whether sarcopenia has additional predictive value for postoperative complications and long-term survival besides nutritional screening tools. Methods: Clinical data of patients underwent radical gastrectomy for gastric cancer was prospectively collected. Sarcopenia was diagnosed by grip strength plus muscle quanlity/quality based on preoperative abdominal CT scans. Nutritional screening was performed using 4 common nutritional screening tools, including Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS)-2002, Malnutrition Screening Tool (MST), and Short Nutritional Assessment Questionnaire (SNAQ). Results: A total of 880 patients were analyzed, in which 167 (18.98%) were diagnosed with sarcopenia. The incidence of nutritional risk identified by the 4 tools were 44.66% (MUST ≥1), 35.23% (NRS-2002 ≥3), 29.89% (MST ≥2), and 20.34% (SNAQ ≥2). Multivariate analyses showed that nutritional risk identified by the 4 nutritional screening tools were not independently associated with postoperative complications, overall survival (OS) or disease-free survival (DFS), except for NRS-2002 ≥3 as an independent risk factor of OS. Sarcopenia was always an independent risk factor for postoperative complications, OS, and DFS after adjusting for nutritional risk and the other covariates in the multivariate analyses. Conclusions: MUST, NRS-2002, MST, and SNAQ had low predictive power for postoperative complications and long-term survival in patients underwent radical gastrectomy for gastric cancer. Sarcopenia had additional predictive value for postoperative complications and long-term survival besides these nutritional screening tools and should be implemented in the preoperative assessments.

BACKGROUND: Despite the emerging knowledge about colorectal anastomotic leakage (CAL) through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.
OBJECTIVE: To reach consensus on the definition of CAL using a modified Delphi method.
METHODS: The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.
RESULTS: Twenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items (80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16 (84%) agreed with our final recommendations for the definition of CAL.
CONCLUSIONS: A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.

BACKGROUND: Radical surgical treatment is the preferred action for patients with early-stage non-small cell lung cancer (NSCLC). Qualification for surgical treatment should consider a risk associated with the effect of comorbidities on the general condition of the patient. The aim of this article was an attempt to identify the risk factors for postoperative complications in patients treated for NSCLC, with a special focus on the coexisting diseases.
METHODS: A total of 400 patients with NSCLC were included in this retrospective study. The incidence of postoperative complications (including major complications according to the European Society of Thoracic Surgeons [ESTS]) was analyzed. Factors associated with high risk of postoperative complications were identified.
RESULTS: Postoperative complications occurred in 151 patients (39% operated patients), including severe complications according to ESTS in 75 patients (19%). From univariate analysis, risk factors for postoperative complications were arrhythmias, pneumonectomy, and open thoracotomy. According to ESTS, for major complications, the risk factors included age ≥65 years, the presence of comorbidities, hypertension, and arrhythmias. From multivariate analysis, the risk of complications was higher in patients undergoing pneumonectomy and with cardiac arrhythmias, whereas the risk of serious complications according to ESTS was found in people ≥65 years of age and suffering from comorbidities.
CONCLUSIONS: The risk of postoperative complications is affected by both surgical factors and the general health of the patient. Elderly patients with chronic disease history, hypertension, and arrhythmias have an increased risk of postoperative complications. Knowledge of these factors will identify a group of patients requiring internal consultation and optimization of preoperative treatment and postoperative follow-up.