The relationship between the psoas muscle mass index and postoperative complications in Crohn's Disease : A retrospective cohort study

The relationship between the psoas muscle mass index and postoperative complications in Crohn's Disease : A retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between the psoas muscle mass index and postoperative complications in Crohn's Disease : A retrospective cohort study Maho Sasaki, Tatsunari Fukuoka, Masatsune Shibutani, Hiroaki Kasashima, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4603078/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Sarcopenia is generally defined based on the age-related muscle mass and weakness. However, it has been reported that patients with Crohn’s disease, who develop severe inflammation of the gastrointestinal tract, are more likely to develop sarcopenia. We retrospectively investigated the effect of the iliopsoas muscle area, which is an indicator of sarcopenia, on postoperative complications in patients with Crohn's disease. Methods: We retrospectively analyzed 74 patients with Crohn's disease who underwent surgery in our department between January 2016 and November 2019. The psoas muscle index (PMI) was calculated as the average of the left and right iliopsoas muscles (L3, cm 2 ) / height 2 . The patients were divided into the low PMI (male <2.33 cm 2 /m 2 , female <1.85 cm 2 /m 2 ) and normal PMI groups. Preoperative and intraoperative factors and the postoperative outcomes were compared between the two groups. Results: The median age of the 74 patients was 37.6 (17-70) years. Complications were noted in 32 patients (43.2%), including 9 (12.2%) with anastomotic leakage. There were 21 (28.4%) patients with a low PMI. The incidence of all postoperative complications, complications, grade≥3 complications, and anastomotic leakage were significantly higher in the low-PMI group than in the normal-PMI group. According to a multivariate analysis, low PMI (p=0.04) was the only independent predictor of postoperative complications. Conclusion: A low PMI is associated with postoperative complications, especially anastomotic leakage, in patients with Crohn's disease. In the low-PMI group, the risk of anastomotic leakage was high, and the creation of a colostomy without anastomosis was considered as an option. Crohn's disease Postoperative complications PMI Figures Figure 1 Figure 2 Introduction Crohn's disease (CD) is an intractable inflammatory bowel disease that often develops in young individuals. Despite the advancements in medical therapy for Crohn's disease, the disease repeatedly relapses and goes into remission during the long course of the disease. Due to severe stenosis, fistula, or abscess during the course of the disease, intestinal resection is frequently indicated. The aim of surgical treatment is to improve these issues, in order to preserve the patient's quality of life. This includes an early restart of medical therapy to maintain disease control and an early return to society. Therefore, it is necessary to complete surgical treatment without postoperative complications in order to achieve the desired outcome [1, 2]. The preoperative nutritional status of patients with Crohn's disease is often poor. Additionally, intestinal anastomosis is associated with various postoperative complications, including anastomotic leakage. Recently, sarcopenia has been reported to be a prognostic factor for various diseases [3–5]; however there have been few reports on the association between sarcopenia and postoperative complications in patients with Crohn's disease [6–8]. We conducted this retrospective study to investigate the relationship between sarcopenia and postoperative complications in patients with CD. Materials and Methods Patients and specimens We retrospectively analyzed 74 patients with Crohn's disease who underwent surgery at our department between January 2016 and November 2019. In all cases, the left and right iliopsoas muscle areas at the L3 level were measured on preoperative CT scans, and the mean value was divided by the square of the height (m 2 ) to calculate the psoas muscle index (PMI). All clinicopathological data are shown in Table 1 . Postoperative complications were defined as those occurring within 30 days after surgery and were classified according to the Clavien-Dindo classification (CDC) system. Table 1. Clinicopathologic characteristics of 74 patients with Crohn's disease Clinicopathologic features n=74 Sex Male 62 (83.8%) Female 12 (16.2%) Age (years)* Mean (SD) 37.6 (12.1) BMI* Mean (SD) 20.6 (3.3) Biological products － 23 (31.1%) ＋ 51 (68.9%) Steroid medicines － 64 (86.5%) ＋ 10 (13.5%) Disease duration Mean (SD) 12.1 (9.3) Site of lesion Small intestine 54 (73.0%) Colon 11 (14.9%) Small intestine and colon 7 (9.5%) Rectum 1 (1.4%) Anus 1 (1.4%) Indications for surgery Stenosis 50 (67.6%) Abscess 8 (10.8%) Fistula 8 (10.8%) Perforation 6 (8.1%) Cancer 1 (1.4%) Severe ulcer 1 (1.4%) Number of anastomosis 0 5 1 59 2 9 3 1 Method of anastomosis Triangle 25 Kono-S 24 DST 6 FEEA 1 Operative time (min)* Mean (SD) 223 (62.3) Intraoperative bleeding (ml)* Mean (SD) 242.6 (288.5) Postoperative complications All 32 (43.2%) Surgical site infection 5 (6.8%) Anastomotic leakage 9 (12.2%) Remote infection 4 (5.4%) POI 7 (9.5%) CDC grade I 1 (1.4%) II 14 (18.9%) IIIa 10 (13.5%) IIIb 7 (9.5%) Continuous parameters are presented as the mean (SD)*, and categorical parameters are presented as n (%), CDC Clavien-Dindo classification, SD standard deviation Postoperative complications Table 1 shows the postoperative complications. These were defined as in-hospital morbidity or mortality occurring within 30 days of surgery and were classified according to the CDC system [9]. Surgical site infections (SSIs), anastomotic leakage, remote infection, and postoperative ileus (POI) were included as postoperative complications. Psoas muscle index (PMI) The preoperative PMA was measured in 2023, using CT/MRI images obtained within 30 days prior to the operation. The PMA was measured retrospectively in a transverse section at the L3 level by blinded researchers. The mean right and left PMA was used for the statistical analyses, and the psoas muscle index (PMI) was corrected for height (m 2 ). An ROC curve analysis was used to determine the cutoff values of the PMI. According to this analysis, the cutoff value for low-PMI was < 2.33 cm 2 /m 2 in males and < 1.85 cm 2 /m 2 in females (Figs. 1,2). The patients were classified into the low-PMI and normal-PMI groups according to these cutoff values. The preoperative, intraoperative, and postoperative conditions of the two groups were compared. Statistical analyses Continuous variables are described as median values (interquartile range [IQR]). Univariate analyses were performed using the chi-square test or Fisher’s exact test for categorical variables. To identify the predictors of POI, multivariate analyses, that included variables with p values of < 0.1 in the univariate analyses were performed using a logistic regression model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). More precisely, it is a modified version of the R commander designed to add statistical functions frequently used in biostatistics [10]. Results Patient characteristics A total of 74 (males, n = 62; females, n = 12) patients were included in this study. The median age was 37.6 years (17–70) (Table 1). Twenty-one patients were classified into the low-group and 53 patients were classified into the normal-PMI (Figs. 1, 2). The mean disease duration was 12.1 years (SD 9.3); 51 patients used biologics preoperatively and 10 used steroids. Correlation between the PMI and clinicopathological characteristic factors Regarding the preoperative factors, the low-PMI group showed a significant female (p = 0.03), low BMI (p = 0.0009), low albumin (p = 0.000005), and low PNI (p = 0.000003) (Table 2 ). Regarding the intraoperative factors, blood loss > 100 mL was significantly more frequent in the low-PMI group. Postoperative complications occurred in 32 of 74 patients (43.2%). Seventeen(23%) had grade > 3 complications, and 9 (12.2%) had anastomotic leakage. The incidence rates of all postoperative complications (p = 0.018), grade > 3 complications (p = 0.0004), and anastomotic leakage (p = 0.013) were significantly higher in the low-PMI group than in the normal-PMI group. Table 2 Clinicopathological background factors associated with a preoperative decrease in skeletal muscle mass Back ground Low PMI (n = 21) Normal PMI(n = 53) P-value Sex Female 7 (33.3%) 5 (9.4%) 0.03 Age (years)* mean (SD) 37.9 (9.5) 37.5 (13.1) 0.905 BMI 18.7 (2.2) 21.4 (3.3) 0.0009 PNI* mean (SD) 34.3 (9.7) 44.1 (6.2) 0.000003 Alb (g/dL)* mean (SD) 3.05 (0.62) 3.76 (0.52) 0.000005 Biological Products Positive 14 (66.7%) 37 (69.8%) 0.788 Steroid medicines Positive 3 (14.3%) 7 (13.2%) 1.0 Operative time (min) > 210 14 (66.7%) 28 (52.8%) 0.310 Bleeding (min) ≥ 101 16 (76.2%) 24 (45.3%) 0.021 CDC Grade ≥ 3 11 (52.4%) 6 (11.3%) 0.0004 All complications 14 (66.7%) 18 (34%) 0.018 SSI 1 (4.8%) 4 (7.5%) 1.0 Anastomotic leakage 6 (28.6%) 3 (5.7%) 0.013 Remote infection 2 (9.5%) 2 (3.8%) 0.318 POI 2 (9.5%) 5 (9.4%) 1.0 Continuous parameters are presented as the mean (SD)*, and categorical parameters are presented as n (%). SMI skeletal muscle index, BMI body mass index, PNI prognostic nutritional index, GPS Glasgow prognostic score, Alb albumin, Lung disease was defined as a condition with % vital capacity < 60% or a % force expiratory volume in 1.0 second < 50%, TNM tumor node metastasis, P peritoneal dissemination, H hepatic metastasis, CDC Clavien–Dindo classification, SSI surgical site infection, POI post operative ileus, P < 0.05. Univariate and multivariate analyses for postoperative complications Table 3 shows the results of a univariate analysis of postoperative complications. The univariate analysis showed that the operative time > 210 min (p = 0.024) and low-PMI (p = 0.013) were significantly associated with postoperative complications. In the multivariate analysis, a low-PMI (p = 0.021) was the only independent predictor of postoperative complications. Table 3 Clinicopathological characteristics associated with postoperative complications Univariate analysis Multivariate analysis Variable Hazard 95%CI P-value Hazard 95%CI P-value Sex Female 0.607 0.165–2.23 0.452 Age 1.02 0.979–1.06 0.377 BMI 1.02 0.884–1.17 0.806 PNI 0.985 0.933–1.04 0.584 Alb 0.607 0.283–1.31 0.202 Biologic agents Positive 0.457 0.168–1.24 0.125 0.485 0.163–1.44 0.180 Steroid medicines Positive 0.517 0.123–2.18 0.369 Operative time (min) > 210 3.09 1.16–8.25 0.024 2.67 0.94–7.57 0.055 Bleeding (ml) ≥ 101 1.83 0.718–4.68 0.205 PMI Low PMI 3.89 1.33–11.3 0.013 3.73 1.03–13.4 0.021 CI confidence interval, P < 0.05 Discussion The reoperation rates of reoperation for Crohn's disease have been reported to be 22–28% at 5 years, 30–40% at 10 years, and approximately 55% at 15 years [11, 12]. In other words, the likelihood that a patient will undergo surgery during the course of their treatment is very high. Patients with Crohn's disease are considered to be at an increased risk for diarrhea, abdominal pain, anorexia, and sarcopenia due to intestinal malabsorption, leakage from the intestinal tract, and increased energy requirements due to inflammation. In our study, many patients in the low-PMI group were emaciated and had a poor preoperative nutritional status. Among the postoperative complications, the incidence of anastomotic leakage has been reported to be 10% [13], and risk factors include the nutritional status, Crohn's disease status, drugs (e.g., steroids), and surgical history. In our study, anastomotic leakage was observed in 12.2% of patients. This rate was slightly higher comparison to previous reports. However, we believe that this is partly due to the inclusion of emergency and recurrent cases. In our study, the operative time and a low PMI were identified as risk factors for postoperative complications in a univariate analysis, while a low-PMI was the only independent predictor in a multivariate analysis. The relationship between operative time and complications is one of the most commonly discussed issues in gastrointestinal surgery [14–16]. In addition, although our study did not find significant differences, the ECCO-ESCP consensus on Crohn's disease surgery reported that anti-TNF agents increased the risk of postoperative sepsis, intra-abdominal abscess, anastomotic leakage, wound infection, and rehospitalization in patients with Crohn's disease. However, there has been much debate in the past, and at present no data are available to determine the safest preoperative discontinuation period for reducing the risk of postoperative complications in patients treated with anti-TNF agents [17]. In contrast, we found that the PMI, a measure of muscle mass, was associated with postoperative complications in patients with CD. Previous reports have shown that preoperative sarcopenia is associated with postoperative complications in many gastrointestinal cancer patients [18–20]. As the pathogenesis of Crohn's has been gradually elucidated in recent years, the relationship between Crohn's disease and inflammatory cytokines has become clear [21]. Pedersen et al. reported that inflammatory cytokines promote sarcopenia [22]. Patients with Crohn's disease whose condition has worsened to the point of requiring surgical treatment are likely to have elevated inflammatory cytokine levels and often have a compromised nutritional status. Accordingly, they may be more prone to sarcopenia, which may predispose them to postoperative complications. Since the PMI, the index used in this study, strongly correlates with skeletal muscle mass, which is useful in the diagnosis of sarcopenia [23], a low PMI was considered to be an independent risk factor for postoperative complications. Taken together, our findings suggest that the PMI was therefore associated with postoperative complications, especially with anastomotic leakage, in patients with CD. If the PMI predicts a high risk of suture failure, then the creation of a colostomy without anastomosis may be considered as an option. The prediction of postoperative complications also enables an early response. The PMI, which can be easily determined using preoperative abdominal CT, is considered to be useful for predicting postoperative complications in patients with Crohn's disease. The present study was associated with several limitations. First, this study was retrospective in nature and was conducted at a single institution with a relatively small sample size. Second, although we determined the cutoff values for the PMI based on the results of an ROC curve analysis, which is a standardized method for determining optimal cut off values should be established. Further prospective studies with larger numbers of patients are needed to validate the utility of the preoperative PMI for predicting postoperative complications. Conclusion A low preoperative PMI was identified to be an independent risk factor for postoperative complications in patients with Crohn's disease. Patients with Crohn's disease often have a poor preoperative nutritional status, and achieving an improvement in these conditions may be necessary in order to perform effective surgical treatment. Declarations Ethics approval and consent to participate The study was carried out with the approval of the ethics committee of our institution (Osaka Metropolitan University Graduate School of Medicine, reference number 3798) and with the informed consent of the participants. All research methods were carried out in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare no conflicts of interest in association with the present study. Funding This study has no funding sources. Author Contribution Maho Sasaki designed the study, performed the statistical analysis, and drafted the manuscript; Tatsunari Fukuoka designed the study, performed the statistical analysis and drafted the manuscript; Masatsune Shibutani collected the clinical data and critically revised the manuscript; Hiroaki Kasashima collected the clinical data and critically revised the manuscript; and Kiyoshi Maeda designed the study and critically reviewed the manuscript. All authors have read and approved the final manuscript. Acknowledgements None. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4603078","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":316385823,"identity":"84d274d4-b7d8-4f25-95ba-03a4c59b8f70","order_by":0,"name":"Maho Sasaki","email":"","orcid":"","institution":"Osaka Metropolitan University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Maho","middleName":"","lastName":"Sasaki","suffix":""},{"id":316385824,"identity":"e0d33439-b517-46f5-8e37-e4eebbb5e841","order_by":1,"name":"Tatsunari Fukuoka","email":"data:image/png;base64,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","orcid":"","institution":"Osaka Metropolitan University Graduate School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Tatsunari","middleName":"","lastName":"Fukuoka","suffix":""},{"id":316385825,"identity":"0d2460de-17c6-4f08-b7ac-7cd75aec2cf1","order_by":2,"name":"Masatsune Shibutani","email":"","orcid":"","institution":"Osaka Metropolitan University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Masatsune","middleName":"","lastName":"Shibutani","suffix":""},{"id":316385826,"identity":"16743f46-aa0c-4e39-9876-2dc20e38bc82","order_by":3,"name":"Hiroaki Kasashima","email":"","orcid":"","institution":"Osaka Metropolitan University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hiroaki","middleName":"","lastName":"Kasashima","suffix":""},{"id":316385827,"identity":"a31c0088-4ea1-4ca7-af91-9580b62d5789","order_by":4,"name":"Kiyoshi Maeda","email":"","orcid":"","institution":"Osaka Metropolitan University Graduate School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kiyoshi","middleName":"","lastName":"Maeda","suffix":""}],"badges":[],"createdAt":"2024-06-19 04:21:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4603078/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4603078/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60171277,"identity":"4761ea33-aa74-4f75-afe1-586ac085e60f","added_by":"auto","created_at":"2024-07-12 15:09:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":9178,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve for males\u003c/p\u003e\n\u003cp\u003eAccording to the ROC curve analysis, the cutoff value for predicting postoperative complications in males was 2.33.\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4603078/v1/f9e88b6ab2c48e898dee8b1a.png"},{"id":60171279,"identity":"afc552fb-ded1-4388-927b-1115b786c761","added_by":"auto","created_at":"2024-07-12 15:09:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":9054,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve for females\u003c/p\u003e\n\u003cp\u003eAccording to the ROC curve analysis, the cutoff value for predicting postoperative complications in females was 1.85.\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4603078/v1/cf5fa5d3eb3c4a963042c737.png"},{"id":64159758,"identity":"3dbe9d96-1aca-4aaf-8137-a9eac58f2583","added_by":"auto","created_at":"2024-09-09 07:02:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1391885,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4603078/v1/f32c1f6f-77cd-4884-851d-f588720d1a76.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between the psoas muscle mass index and postoperative complications in Crohn's Disease : A retrospective cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCrohn's disease (CD) is an intractable inflammatory bowel disease that often develops in young individuals. Despite the advancements in medical therapy for Crohn's disease, the disease repeatedly relapses and goes into remission during the long course of the disease. Due to severe stenosis, fistula, or abscess during the course of the disease, intestinal resection is frequently indicated. The aim of surgical treatment is to improve these issues, in order to preserve the patient's quality of life. This includes an early restart of medical therapy to maintain disease control and an early return to society. Therefore, it is necessary to complete surgical treatment without postoperative complications in order to achieve the desired outcome [1, 2]. The preoperative nutritional status of patients with Crohn's disease is often poor. Additionally, intestinal anastomosis is associated with various postoperative complications, including anastomotic leakage. Recently, sarcopenia has been reported to be a prognostic factor for various diseases [3\u0026ndash;5]; however there have been few reports on the association between sarcopenia and postoperative complications in patients with Crohn's disease [6\u0026ndash;8]. We conducted this retrospective study to investigate the relationship between sarcopenia and postoperative complications in patients with CD.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003ePatients and specimens\u003c/h2\u003e\n \u003cp\u003eWe retrospectively analyzed 74 patients with Crohn\u0026apos;s disease who underwent surgery at our department between January 2016 and November 2019. In all cases, the left and right iliopsoas muscle areas at the L3 level were measured on preoperative CT scans, and the mean value was divided by the square of the height (m\u003csup\u003e2\u003c/sup\u003e) to calculate the psoas muscle index (PMI). All clinicopathological data are shown in \u003cstrong\u003eTable\u0026nbsp;1\u003c/strong\u003e. Postoperative complications were defined as those occurring within 30 days after surgery and were classified according to the Clavien-Dindo classification (CDC) system.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Clinicopathologic characteristics of 74 patients with Crohn\u0026apos;s disease\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinicopathologic features\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en=74\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;62 (83.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e 12 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;37.6 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eBMI*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;20.6 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eBiological products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e－\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e23 (31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e＋\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e51 (68.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eSteroid\u0026nbsp;medicines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e－\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e64 (86.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e＋\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e10 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eDisease duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e12.1 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eSite of lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eSmall intestine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e54 (73.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eColon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e11 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eSmall intestine and colon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e7 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eRectum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eAnus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eIndications for surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eStenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e50 (67.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eAbscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e8 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eFistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e8 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003ePerforation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e6 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eSevere ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of anastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eMethod of anastomosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eTriangle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eKono-S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eDST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eFEEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eOperative time (min)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e223 (62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003eIntraoperative bleeding (ml)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e242.6 (288.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e32 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical site infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e5 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eAnastomotic leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e9 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eRemote infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e4 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003ePOI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e7 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eCDC grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e1 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e14 (18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eIIIa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e10 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.98233215547703%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.625441696113075%\" valign=\"top\"\u003e\n \u003cp\u003eIIIb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.3922261484099%\" valign=\"top\"\u003e\n \u003cp\u003e7 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eContinuous parameters are presented as the mean (SD)*, and categorical parameters are presented as n (%),\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eCDC\u0026nbsp;\u003c/em\u003eClavien-Dindo classification, \u003cem\u003eSD\u003c/em\u003e standard deviation\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003ePostoperative complications\u003c/h2\u003e\n \u003cp\u003eTable\u0026nbsp;1 shows the postoperative complications. These were defined as in-hospital morbidity or mortality occurring within 30 days of surgery and were classified according to the CDC system [9]. Surgical site infections (SSIs), anastomotic leakage, remote infection, and postoperative ileus (POI) were included as postoperative complications.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003ePsoas muscle index (PMI)\u003c/h2\u003e\n \u003cp\u003eThe preoperative PMA was measured in 2023, using CT/MRI images obtained within 30 days prior to the operation.\u003c/p\u003e\n \u003cp\u003eThe PMA was measured retrospectively in a transverse section at the L3 level by blinded researchers. The mean right and left PMA was used for the statistical analyses, and the psoas muscle index (PMI) was corrected for height (m\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e\n \u003cp\u003eAn ROC curve analysis was used to determine the cutoff values of the PMI. According to this analysis, the cutoff value for low-PMI was \u0026lt;\u0026thinsp;2.33 cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e in males and \u0026lt;\u0026thinsp;1.85 cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e in females (Figs. 1,2). The patients were classified into the low-PMI and normal-PMI groups according to these cutoff values. The preoperative, intraoperative, and postoperative conditions of the two groups were compared.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analyses\u003c/h2\u003e\n \u003cp\u003eContinuous variables are described as median values (interquartile range [IQR]). Univariate analyses were performed using the chi-square test or Fisher\u0026rsquo;s exact test for categorical variables. To identify the predictors of POI, multivariate analyses, that included variables with \u003cem\u003ep\u003c/em\u003e values of \u0026lt;\u0026thinsp;0.1 in the univariate analyses were performed using a logistic regression model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for R (The R Foundation for Statistical Computing, Vienna, Austria). More precisely, it is a modified version of the R commander designed to add statistical functions frequently used in biostatistics [10].\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003ePatient characteristics\u003c/h2\u003e\n\u003cp\u003eA total of 74 (males, n\u0026thinsp;=\u0026thinsp;62; females, n\u0026thinsp;=\u0026thinsp;12) patients were included in this study. The median age was 37.6 years (17\u0026ndash;70) (Table\u0026nbsp;1). Twenty-one patients were classified into the low-group and 53 patients were classified into the normal-PMI (Figs.\u0026nbsp;1, 2). The mean disease duration was 12.1 years (SD 9.3); 51 patients used biologics preoperatively and 10 used steroids.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eCorrelation between the PMI and clinicopathological characteristic factors\u003c/h2\u003e\n\u003cp\u003eRegarding the preoperative factors, the low-PMI group showed a significant female (p\u0026thinsp;=\u0026thinsp;0.03), low BMI (p\u0026thinsp;=\u0026thinsp;0.0009), low albumin (p\u0026thinsp;=\u0026thinsp;0.000005), and low PNI (p\u0026thinsp;=\u0026thinsp;0.000003) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Regarding the intraoperative factors, blood loss\u0026thinsp;\u0026gt;\u0026thinsp;100 mL was significantly more frequent in the low-PMI group. Postoperative complications occurred in 32 of 74 patients (43.2%). Seventeen(23%) had grade\u0026thinsp;\u0026gt;\u0026thinsp;3 complications, and 9 (12.2%) had anastomotic leakage. The incidence rates of all postoperative complications (p\u0026thinsp;=\u0026thinsp;0.018), grade\u0026thinsp;\u0026gt;\u0026thinsp;3 complications (p\u0026thinsp;=\u0026thinsp;0.0004), and anastomotic leakage (p\u0026thinsp;=\u0026thinsp;0.013) were significantly higher in the low-PMI group than in the normal-PMI group.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eClinicopathological background factors associated with a preoperative decrease in skeletal muscle mass\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBack ground\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLow PMI (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal PMI(n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e7 (33.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldSmallCaps\"\u003e0.03\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years)*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emean (SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37.9 (9.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.5 (13.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.905\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18.7 (2.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.4 (3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.0009\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePNI*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emean (SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.3 (9.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.1 (6.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAlb (g/dL)*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003emean (SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.05 (0.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.76 (0.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000005\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBiological Products\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (66.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37 (69.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.788\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSteroid medicines\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3 (14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (13.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOperative time (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;210\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (66.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (52.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.310\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBleeding (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e16 (76.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (45.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCDC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGrade\u0026thinsp;\u0026ge;\u0026thinsp;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11 (52.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (11.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.0004\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAll complications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (66.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (34%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSSI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1 (4.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (7.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnastomotic leakage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6 (28.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (5.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRemote infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2 (9.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.318\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePOI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2 (9.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eContinuous parameters are presented as the mean (SD)*, and categorical parameters are presented as n (%). \u003cem\u003eSMI\u003c/em\u003e skeletal muscle index, \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003ePNI\u003c/em\u003e prognostic nutritional index, \u003cem\u003eGPS\u003c/em\u003e Glasgow prognostic score, \u003cem\u003eAlb\u003c/em\u003e albumin, \u003cem\u003eLung disease\u003c/em\u003e was defined as a condition with % vital capacity\u0026thinsp;\u0026lt;\u0026thinsp;60% or a % force expiratory volume in 1.0 second\u0026thinsp;\u0026lt;\u0026thinsp;50%, \u003cem\u003eTNM\u003c/em\u003e tumor node metastasis, \u003cem\u003eP\u003c/em\u003e peritoneal dissemination, \u003cem\u003eH\u003c/em\u003e hepatic metastasis, \u003cem\u003eCDC\u003c/em\u003e Clavien\u0026ndash;Dindo classification, \u003cem\u003eSSI\u003c/em\u003e surgical site infection, \u003cem\u003ePOI\u003c/em\u003e post operative ileus, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eUnivariate and multivariate analyses for postoperative complications\u003c/h2\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results of a univariate analysis of postoperative complications. The univariate analysis showed that the operative time\u0026thinsp;\u0026gt;\u0026thinsp;210 min (p\u0026thinsp;=\u0026thinsp;0.024) and low-PMI (p\u0026thinsp;=\u0026thinsp;0.013) were significantly associated with postoperative complications. In the multivariate analysis, a low-PMI (p\u0026thinsp;=\u0026thinsp;0.021) was the only independent predictor of postoperative complications.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" style=\"width: 449px;\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eClinicopathological characteristics associated with postoperative complications\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003cth style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"height: 35px; width: 141.975px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eUnivariate analysis\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 35px; width: 141px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMultivariate analysis\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003eHazard\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003eHazard\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e0.607\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.165\u0026ndash;2.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e0.452\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e1.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.979\u0026ndash;1.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e0.377\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e1.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.884\u0026ndash;1.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e0.806\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003ePNI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e0.985\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.933\u0026ndash;1.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e0.584\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eAlb\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e0.607\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.283\u0026ndash;1.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e0.202\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eBiologic agents\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003ePositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e0.457\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.168\u0026ndash;1.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.125\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e0.485\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.163\u0026ndash;1.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\n\u003cp\u003e0.180\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eSteroid medicines\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003ePositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e0.517\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.123\u0026ndash;2.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e0.369\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eOperative time (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;210\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e3.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e1.16\u0026ndash;8.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e2.67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.94\u0026ndash;7.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\n\u003cp\u003e0.055\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eBleeding (ml)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e1.83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e0.718\u0026ndash;4.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e0.205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003ePMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px; width: 116px;\" align=\"left\"\u003e\n\u003cp\u003eLow PMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e3.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e1.33\u0026ndash;11.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40.9745px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 38px;\" align=\"left\"\u003e\n\u003cp\u003e3.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 63px;\" align=\"left\"\u003e\n\u003cp\u003e1.03\u0026ndash;13.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px; width: 40px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr style=\"height: 13px;\"\u003e\n\u003ctd style=\"height: 13px; width: 408.975px;\" colspan=\"7\"\u003e\u003cem\u003eCI\u003c/em\u003e confidence interval, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe reoperation rates of reoperation for Crohn's disease have been reported to be 22\u0026ndash;28% at 5 years, 30\u0026ndash;40% at 10 years, and approximately 55% at 15 years [11, 12]. In other words, the likelihood that a patient will undergo surgery during the course of their treatment is very high.\u003c/p\u003e \u003cp\u003ePatients with Crohn's disease are considered to be at an increased risk for diarrhea, abdominal pain, anorexia, and sarcopenia due to intestinal malabsorption, leakage from the intestinal tract, and increased energy requirements due to inflammation. In our study, many patients in the low-PMI group were emaciated and had a poor preoperative nutritional status.\u003c/p\u003e \u003cp\u003eAmong the postoperative complications, the incidence of anastomotic leakage has been reported to be 10% [13], and risk factors include the nutritional status, Crohn's disease status, drugs (e.g., steroids), and surgical history. In our study, anastomotic leakage was observed in 12.2% of patients. This rate was slightly higher comparison to previous reports. However, we believe that this is partly due to the inclusion of emergency and recurrent cases.\u003c/p\u003e \u003cp\u003eIn our study, the operative time and a low PMI were identified as risk factors for postoperative complications in a univariate analysis, while a low-PMI was the only independent predictor in a multivariate analysis. The relationship between operative time and complications is one of the most commonly discussed issues in gastrointestinal surgery [14\u0026ndash;16]. In addition, although our study did not find significant differences, the ECCO-ESCP consensus on Crohn's disease surgery reported that anti-TNF agents increased the risk of postoperative sepsis, intra-abdominal abscess, anastomotic leakage, wound infection, and rehospitalization in patients with Crohn's disease. However, there has been much debate in the past, and at present no data are available to determine the safest preoperative discontinuation period for reducing the risk of postoperative complications in patients treated with anti-TNF agents [17]. In contrast, we found that the PMI, a measure of muscle mass, was associated with postoperative complications in patients with CD. Previous reports have shown that preoperative sarcopenia is associated with postoperative complications in many gastrointestinal cancer patients [18\u0026ndash;20]. As the pathogenesis of Crohn's has been gradually elucidated in recent years, the relationship between Crohn's disease and inflammatory cytokines has become clear [21]. Pedersen et al. reported that inflammatory cytokines promote sarcopenia [22]. Patients with Crohn's disease whose condition has worsened to the point of requiring surgical treatment are likely to have elevated inflammatory cytokine levels and often have a compromised nutritional status. Accordingly, they may be more prone to sarcopenia, which may predispose them to postoperative complications. Since the PMI, the index used in this study, strongly correlates with skeletal muscle mass, which is useful in the diagnosis of sarcopenia [23], a low PMI was considered to be an independent risk factor for postoperative complications.\u003c/p\u003e \u003cp\u003eTaken together, our findings suggest that the PMI was therefore associated with postoperative complications, especially with anastomotic leakage, in patients with CD. If the PMI predicts a high risk of suture failure, then the creation of a colostomy without anastomosis may be considered as an option. The prediction of postoperative complications also enables an early response. The PMI, which can be easily determined using preoperative abdominal CT, is considered to be useful for predicting postoperative complications in patients with Crohn's disease.\u003c/p\u003e \u003cp\u003eThe present study was associated with several limitations. First, this study was retrospective in nature and was conducted at a single institution with a relatively small sample size. Second, although we determined the cutoff values for the PMI based on the results of an ROC curve analysis, which is a standardized method for determining optimal cut off values should be established. Further prospective studies with larger numbers of patients are needed to validate the utility of the preoperative PMI for predicting postoperative complications.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA low preoperative PMI was identified to be an independent risk factor for postoperative complications in patients with Crohn's disease. Patients with Crohn's disease often have a poor preoperative nutritional status, and achieving an improvement in these conditions may be necessary in order to perform effective surgical treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The study was carried out with the approval of the ethics committee of our institution (Osaka Metropolitan University Graduate School of Medicine, reference number 3798) and with the informed consent of the participants. All research methods were carried out in accordance with the relevant guidelines and regulations.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest in association with the present study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study has no funding sources.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMaho Sasaki designed the study, performed the statistical analysis, and drafted the manuscript; Tatsunari Fukuoka designed the study, performed the statistical analysis and drafted the manuscript; Masatsune Shibutani collected the clinical data and critically revised the manuscript; Hiroaki Kasashima collected the clinical data and critically revised the manuscript; and Kiyoshi Maeda designed the study and critically reviewed the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTillinger W, Mittermaier C, Lochs H, Moser G: \u003cstrong\u003eHealth-related quality of life in patients with Crohn's disease: influence of surgical operation--a prospective trial\u003c/strong\u003e. \u003cem\u003eDig Dis Sci \u003c/em\u003e1999, \u003cstrong\u003e44\u003c/strong\u003e(5):932-938.\u003c/li\u003e\n\u003cli\u003eNakase H, Uchino M, Shinzaki S, Matsuura M, Matsuoka K, Kobayashi T, Saruta M, Hirai F, Hata K, Hiraoka S\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eEvidence-based clinical practice guidelines for inflammatory bowel disease 2020\u003c/strong\u003e. \u003cem\u003eJ Gastroenterol \u003c/em\u003e2021, \u003cstrong\u003e56\u003c/strong\u003e(6):489-526.\u003c/li\u003e\n\u003cli\u003eKudou K, Saeki H, Nakashima Y, Edahiro K, Korehisa S, Taniguchi D, Tsutsumi R, Nishimura S, Nakaji Y, Akiyama S\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003ePrognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer\u003c/strong\u003e. \u003cem\u003eAnn Surg Oncol \u003c/em\u003e2017, \u003cstrong\u003e24\u003c/strong\u003e(7):1804-1810.\u003c/li\u003e\n\u003cli\u003eDeng CY, Lin YC, Wu JS, Cheung YC, Fan CW, Yeh KY, McMahon CJ: \u003cstrong\u003eProgressive Sarcopenia in Patients With Colorectal Cancer Predicts Survival\u003c/strong\u003e. \u003cem\u003eAJR Am J Roentgenol \u003c/em\u003e2018, \u003cstrong\u003e210\u003c/strong\u003e(3):526-532.\u003c/li\u003e\n\u003cli\u003eGruber ES, Jomrich G, Tamandl D, Gnant M, Schindl M, Sahora K: \u003cstrong\u003eSarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma\u003c/strong\u003e. \u003cem\u003ePLoS One \u003c/em\u003e2019, \u003cstrong\u003e14\u003c/strong\u003e(5):e0215915.\u003c/li\u003e\n\u003cli\u003eZhang C, Yu D, Hong L, Zhang T, Liu H, Fan R, Wang L, Zhong J, Wang Z: \u003cstrong\u003ePrevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn's Disease\u003c/strong\u003e. \u003cem\u003eGastroenterol Res Pract \u003c/em\u003e2021, \u003cstrong\u003e2021\u003c/strong\u003e:3267201.\u003c/li\u003e\n\u003cli\u003eZhang T, Cao L, Cao T, Yang J, Gong J, Zhu W, Li N, Li J: \u003cstrong\u003ePrevalence of Sarcopenia and Its Impact on Postoperative Outcome in Patients With Crohn's Disease Undergoing Bowel Resection\u003c/strong\u003e. \u003cem\u003eJPEN J Parenter Enteral Nutr \u003c/em\u003e2017, \u003cstrong\u003e41\u003c/strong\u003e(4):592-600.\u003c/li\u003e\n\u003cli\u003eZager Y, Khalilieh S, Ganaiem O, Gorgov E, Horesh N, Anteby R, Kopylov U, Jacoby H, Dreznik Y, Dori A\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eLow psoas muscle area is associated with postoperative complications in Crohn's disease\u003c/strong\u003e. \u003cem\u003eInt J Colorectal Dis \u003c/em\u003e2021, \u003cstrong\u003e36\u003c/strong\u003e(3):543-550.\u003c/li\u003e\n\u003cli\u003eDindo D, Demartines N, Clavien PA: \u003cstrong\u003eClassification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey\u003c/strong\u003e. \u003cem\u003eAnn Surg \u003c/em\u003e2004, \u003cstrong\u003e240\u003c/strong\u003e(2):205-213.\u003c/li\u003e\n\u003cli\u003eKanda Y: \u003cstrong\u003eInvestigation of the freely available easy-to-use software 'EZR' for medical statistics\u003c/strong\u003e. \u003cem\u003eBone Marrow Transplant \u003c/em\u003e2013, \u003cstrong\u003e48\u003c/strong\u003e(3):452-458.\u003c/li\u003e\n\u003cli\u003eTrnka YM, Glotzer DJ, Kasdon EJ, Goldman H, Steer ML, Goldman LD: \u003cstrong\u003eThe long-term outcome of restorative operation in Crohn's disease: influence of location, prognostic factors and surgical guidelines\u003c/strong\u003e. \u003cem\u003eAnn Surg \u003c/em\u003e1982, \u003cstrong\u003e196\u003c/strong\u003e(3):345-355.\u003c/li\u003e\n\u003cli\u003eOzuner G, Fazio VW, Lavery IC, Milsom JW, Strong SA: \u003cstrong\u003eReoperative rates for Crohn's disease following strictureplasty. 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\u003cem\u003eInt Immunol \u003c/em\u003e2023, \u003cstrong\u003e35\u003c/strong\u003e(2):79-94.\u003c/li\u003e\n\u003cli\u003ePedersen BK, Febbraio MA: \u003cstrong\u003eMuscle as an endocrine organ: focus on muscle-derived interleukin-6\u003c/strong\u003e. \u003cem\u003ePhysiol Rev \u003c/em\u003e2008, \u003cstrong\u003e88\u003c/strong\u003e(4):1379-1406.\u003c/li\u003e\n\u003cli\u003eHamaguchi Y, Kaido T, Okumura S, Kobayashi A, Hammad A, Tamai Y, Inagaki N, Uemoto S: \u003cstrong\u003eProposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults\u003c/strong\u003e. \u003cem\u003eNutrition \u003c/em\u003e2016, \u003cstrong\u003e32\u003c/strong\u003e(11-12):1200-1205.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Crohn's disease, Postoperative complications, PMI","lastPublishedDoi":"10.21203/rs.3.rs-4603078/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4603078/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Sarcopenia is generally defined based on the age-related muscle mass and weakness. However, it has been reported that patients with Crohn’s disease, who develop severe inflammation of the gastrointestinal tract, are more likely to develop sarcopenia. We retrospectively investigated the effect of the iliopsoas muscle area, which is an indicator of sarcopenia, on postoperative complications in patients with Crohn's disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe retrospectively analyzed 74 patients with Crohn's disease who underwent surgery in our department between January 2016 and November 2019. The psoas muscle index (PMI) was calculated as the average of the left and right iliopsoas muscles (L3, cm\u003csup\u003e2\u003c/sup\u003e) / height\u003csup\u003e2\u003c/sup\u003e. The patients were divided into the low PMI (male \u0026lt;2.33 cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e, female \u0026lt;1.85 cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e) and normal PMI groups. Preoperative and intraoperative factors and the postoperative outcomes were compared between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median age of the 74 patients was 37.6 (17-70) years. Complications were noted in 32 patients (43.2%), including 9 (12.2%) with anastomotic leakage. There were 21 (28.4%) patients with a low PMI. The incidence of all postoperative complications, complications, grade≥3 complications, and anastomotic leakage were significantly higher in the low-PMI group than in the normal-PMI group. According to a multivariate analysis, low PMI (p=0.04) was the only independent predictor of postoperative complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA low PMI is associated with postoperative complications, especially anastomotic leakage, in patients with Crohn's disease. In the low-PMI group, the risk of anastomotic leakage was high, and the creation of a colostomy without anastomosis was considered as an option.\u003c/p\u003e","manuscriptTitle":"The relationship between the psoas muscle mass index and postoperative complications in Crohn's Disease : A retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 15:09:39","doi":"10.21203/rs.3.rs-4603078/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b378ef1-5bf0-4c93-9da4-a93ac5e91286","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T06:54:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-12 15:09:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4603078","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4603078","identity":"rs-4603078","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}