BACKGROUND: While the role of chronic preoperative steroid use in orthopedic outcomes has been studied, particularly in hip, knee, and lumbar surgeries, its impact on total shoulder arthroplasty (TSA) outcomes is not well understood. This study aimed to evaluate the impact of chronic preoperative steroid use on early-onset postoperative infectious outcomes and readmission within 30 days following TSA compared to patients without chronic steroid use. METHODS: A retrospective analysis was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) spanning from 2010-2018. Clinical data including preoperative demographics, operative variables, and 30-day post-TSA outcomes were collected. Groups were balanced using propensity score matching based on gender, age, race, ethnicity, BMI, functional status, ASA, smoking status, alcohol use, year of operation, and comorbidities. A conditional logistic regression model was used to calculate odds ratios for each outcome measure. RESULTS: A total of 3,445 identified cases were included in this analysis after propensity score matching, with 1,157 exhibiting chronic steroid use. The steroid group demonstrated significantly greater rates of readmission (OR: 1.86; 95% CI: 1.22-2.81; P = 0.004). No significant differences were observed between groups in all other adverse outcomes, including reoperation, specific infectious outcomes, and combined infectious outcomes. CONCLUSIONS: Preoperative chronic steroid use is an independent predictor of readmission but not infection following TSA. While the surgeon should be aware of the increased risk of readmission associated with chronic steroid use, the role of steroid use as a risk factor for postoperative infections following TSA may be less pronounced, particularly compared to surgeries of other joints. Further investigation of infectious outcomes and readmissions with longer follow-up is needed to clarify the specific role of chronic preoperative steroid use in adverse outcomes following TSA.

Petersen's hernia is a well-recognized idiosyncratic complication of gastric bypass surgery for morbid obesity. Mesenteric vein thrombosis is a much rarer clinical entity and is generally associated with an underlying thrombophilia. We present a patient who developed a Petersen's space hernia with concomitant superior mesenteric vein thrombosis following a laparoscopic Roux-en-Y gastric bypass procedure. We discuss the pathophysiology of both conditions and a potential causal relationship.

BACKGROUND: Body mass index (BMI) is associated with the sites of intracerebral hemorrhage (ICH), which affect functional decline. However, the optimal BMI range for minimizing functional decline remains unclear. This study aimed to clarify the relationship between BMI and ICH-related functional decline. METHODS: ICH survivors registered in the Japanese Registry Of All Cardiac and Vascular Diseases Diagnosis Procedure Combination (JROAD-DPC) database from April 2016 to March 2020 were included. BMI was categorized according to the World Health Organization Asia-Pacific classification. The primary outcome was ICH-related functional decline, defined as an increase in the modified Rankin Scale (mRS) score at discharge compared to pre-stroke. RESULTS: This study included 155,211 patients with ICH, with a mean BMI of 22.3 kg/m2. Among these patients, 74.1% experienced ICH-related functional decline. The overweight group (23.0 < BMI ≤ 25.0 kg/m2) exhibited the lowest rate of functional decline (Odds ratio: 0.90, 95% CI: 0.85-0.94). The relationship between BMI and ICH-related functional decline followed a U-shaped curve, indicating that a BMI range of 22.2-30.4 kg/m2 was associated with reduced odds of functional decline. CONCLUSION: In patients with ICH, both extremely low and high BMIs were associated with a higher likelihood of functional decline post-ICH onset. Maintaining a BMI within the range of 22.2-30.4 kg/m2 may be beneficial for reducing the risk of functional decline.

OBJECTIVE: The aim of this study was to examine the impact of obesity on the diagnosis of periprosthetic joint infections (PJI) by assessing the levels and diagnostic efficacy of biomarkers. METHODS: A total of 254 patients were divided into obese group (n=59) and non-obese group (n=195) according to BMI. Each group was further divided into the PJI group and the AF group. Data on CRP, ESR, fibrinogen, D-dimer, CRP-albumin ratio (CAR), CRP-lymphocyte ratio (CLR), and CRP-monocyte ratio (CMR) were collected from all patients. ROC curve was performed to evaluate the diagnostic values of these biomarkers. RESULTS: The levels of biomarkers were significantly higher in PJI patients compared to the AF patients in both the obese and non-obese groups (P < 0.001), but the levels of biomarkers were similar between the obese and non-obese groups. In the obese group, CRP exhibited the highest diagnostic value (AUC=0.982). In the non-obese group, CAR demonstrated the highest diagnostic value (AUC =0.935). Subgroup analysis showed no significant differences in biomarker levels (P > 0.05). CONCLUSIONS: Obesity did not affect biomarker levels in patients with PJI. But for obese patients, the diagnostic thresholds for CRP and ESR are higher, and clinical diagnosis should be careful to avoid false positives. CRP and CAR were identified as the most effective biomarkers for diagnosing PJI in the obese and non-obese groups, respectively.

Background  There has been a surge in sudden and unexpected deaths, presenting a significant challenge for health policymakers and researchers. These individuals showed no signs of recent or past illnesses and died suddenly during routine activities like walking, standing, or working. Objective  This study focuses on exploring nontraumatic brain hemorrhage as a cause of death in autopsies of individuals without prior illnesses. The research aims to explore patterns, prevalence, and risk factors associated with nontraumatic brain hemorrhage, specifically obesity in sudden and unexpected deaths. Materials and Methods  This retrospective, observational study was conducted using autopsy cases with nontraumatic brain hemorrhage as the identified cause of sudden and unexpected deaths. Information on demographic details, medical history, and circumstances surrounding the deaths was collected. The cases were classified based on the body mass index according to the classification of the World Health Organization. Results  From April 2023 to January 2024, 10 cases of sudden and unexpected deaths due to nontraumatic brain hemorrhage were identified. Key findings included predominantly cases of obesity or overweight, deaths occurring predominantly between 8 p.m. and midnight, and all cases being males. Conclusion  The study sheds light on the surge in sudden deaths, specifically attributed to nontraumatic brain hemorrhage. The findings reveal a significant association between obesity and brain hemorrhage in sudden deaths, especially among males. The study's temporal analysis adds depth to understanding these patterns.

PURPOSE: To evaluate the relation between zona orbicularis (ZO) thickness on magnetic resonance imaging and distractibility of the hip in patients undergoing hip arthroscopy. METHODS: We conducted a retrospective review of primary hip arthroscopy patients treated for femoroacetabular impingement syndrome from December 2021 to September 2022. Prior to arthroscopy, hips were subjected to 100 lb of force (lbf) with fluoroscopic images taken to calculate joint space and overall distraction distance. The ZO was measured on coronal sequences of preoperative magnetic resonance imaging or magnetic resonance arthrography. Multivariable linear regression was performed and controlled for age, sex, body mass index, and lateral center-edge angle. RESULTS: Sixty-eight patients were included in the final analysis. The mean age was 34.5 ± 12.4 years. The mean joint space at 100-lbf axial traction was 11.0 ± 3.8 mm, and the mean distraction distance was 6.6 ± 3.7 mm. The mean ZO size was 3.2 ± 1.0 mm. Linear regression showed no relation between ZO size and joint space at 100 lbf (β = -0.109, R = 0.107, P = .842). The results of our linear regression analysis also showed no significant association between ZO size and overall distraction distance (β = -0.15, R = 0.108, P = .977). CONCLUSIONS: The results of this study show no significant association between ZO size and resistance to axial traction at the hip joint. CLINICAL RELEVANCE: Our results suggest that the resistance to axial traction on the hip from the ZO is conferred by its overall integrity and presence-and is not dependent on its size-and that, likely, deviations in other soft-tissue restraints contribute to the spectrum of hip stability experienced by patients.

BACKGROUND: Mental disorders are relatively common in individuals who undergo metabolic bariatric surgery (MBS). Prior research suggests that mental disorders may relate to increased healthcare use after MBS. We retrospectively explored the association between preoperative mental health disorders and healthcare use in the first postoperative year. METHODS: Patients who underwent primary MBS and had a structured preoperative psychological assessment report were included. Data on healthcare use was collected as the total number of non-routine healthcare appointments including inpatient, outpatient, and emergency department visits. Additionally, gastrointestinal (GI) healthcare use at the radiology, gastroenterology, and emergency departments was analyzed separately. RESULTS: Of the 944 included patients, 261 (28%) had a preoperatively diagnosed mental disorder. Most prevalent were depressive disorders, anxiety disorders, and eating disorders. Patients with a preoperative mental disorder had a 15% (adjusted, CI 1.04-1.27, p = 0.005) higher rate of total healthcare use compared to those without. Among patients who had any GI-related healthcare, those with a mental disorder had a 61% higher rate of GI-related healthcare use (CI 1.02-2.55, p = 0.041). Patients with a mental disorder tended to have 20% lower odds of having no GI-related healthcare appointments (unadjusted, not statistically significant, CI 0.37-1.74, p = 0.568). CONCLUSION: The presence of preoperative mental disorders was weakly related to higher total non-routine hospital healthcare use in the first year after MBS. Models explained only 5-13% of the variation in appointment frequency, meaning unmeasured and/or unknown factors play a role in healthcare use.

Obesity (BMI > 30 kg/m2) is rapidly increasing worldwide with 26% of the UK population being obese and 38% being overweight. Obesity is intimately related to several life-limiting conditions including colorectal cancer (CRC). Obese patients have a higher degree of perioperative systemic inflammatory response (SIR) and an increased risk of perioperative complications. The aim of this current study was to investigate whether robotic-assisted surgery mitigates the effects of obesity in left sided CRC resections on the SIR and clinical outcomes. All patients undergoing left-sided colorectal cancer resections from May 2021 to May 2023 were, prospectively, entered into a database with patient characteristics and perioperative short-term outcomes recorded. CRP was considered a surrogate for SIR. The relationship between obesity and complications were examined using Chi Square for linear association, Kruskal-Wallis for continuous data and multivariate binary logistic regression model. 221 patients who underwent RAS for left-sided CRC were analysed. Obesity was associated with more comorbidity (ASA, p < 0.01) and SSI (p < 0.05) but not with age, sex, procedure or pathology. POD3 CRP < 150 mg/l was also associated with obesity (p < 0.01). In turn, greater comorbidity was associated with age (p < 0.001), site of resection (p < 0.05), SSI (p < 0.05), postoperative blood transfusion (p < 0.01) and LOS (p < 0.001). On multivariate analysis, only greater ASA (p < 0.05) and surgical procedure (p < 0.01) were associated with the development of an SSI independently. Greater comorbidity but not obesity was independently associated with postoperative SIR and clinical outcomes in patients undergoing RAS. These results support the use of RAS for left sided CRC resections, particularly in the obese.

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