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Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair.
J Vasc Surg. 2011 Apr; 53(4):912-7.JV

Abstract

OBJECTIVES

Determining operative risk in patients undergoing aortic surgery is a difficult process, as multiple variables converge to affect overall mortality. Patient frailty is certainly a contributing factor, but is difficult to measure, with surgeons often relying on subjective or intuitive influences. We sought to use core muscle size as an objective measure of frailty, and determine its utility as a predictor of survival after abdominal aortic aneurysm (AAA) repair.

METHODS

Four hundred seventy-nine patients underwent elective open AAA repair between 2000 and 2008. Two hundred sixty-two patients (54.7%) had preoperative computed tomography (CT) scans available for analysis. Cross-sectional areas of the psoas muscles at the level of the L4 vertebra were measured. The covariate-adjusted effect of psoas area on postoperative mortality was assessed using Cox regression.

RESULTS

Of the 262 patients, there were 55 deaths and the mean length of follow-up was 2.3 years. Cox regression revealed a significant association between psoas area and postoperative mortality (P = .003). The effect of psoas area was found to decrease significantly as follow-up time increased (P = .008). Among all covariates included in the Cox models (including predictors of mortality such as American Society of Anesthesiologists [ASA] score), the psoas area was the most significant.

CONCLUSION

Core muscle size, an objective measure of frailty, correlates strongly with mortality after elective AAA repair. A better understanding of the role of frailty and core muscle size may aid in risk stratification and impact timing of surgical repair, especially in more complex aortic operations.

Authors+Show Affiliations

Division of Transplantation, Section of General Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Mich., USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21215580

Citation

Lee, Jay Soong-Jin, et al. "Frailty, Core Muscle Size, and Mortality in Patients Undergoing Open Abdominal Aortic Aneurysm Repair." Journal of Vascular Surgery, vol. 53, no. 4, 2011, pp. 912-7.
Lee JS, He K, Harbaugh CM, et al. Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair. J Vasc Surg. 2011;53(4):912-7.
Lee, J. S., He, K., Harbaugh, C. M., Schaubel, D. E., Sonnenday, C. J., Wang, S. C., Englesbe, M. J., & Eliason, J. L. (2011). Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair. Journal of Vascular Surgery, 53(4), 912-7. https://doi.org/10.1016/j.jvs.2010.10.111
Lee JS, et al. Frailty, Core Muscle Size, and Mortality in Patients Undergoing Open Abdominal Aortic Aneurysm Repair. J Vasc Surg. 2011;53(4):912-7. PubMed PMID: 21215580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair. AU - Lee,Jay Soong-Jin, AU - He,Kevin, AU - Harbaugh,Calista M, AU - Schaubel,Douglas E, AU - Sonnenday,Christopher J, AU - Wang,Stewart C, AU - Englesbe,Michael J, AU - Eliason,Jonathan L, AU - ,, Y1 - 2011/01/07/ PY - 2010/07/11/received PY - 2010/10/20/revised PY - 2010/10/20/accepted PY - 2011/1/11/entrez PY - 2011/1/11/pubmed PY - 2011/5/28/medline SP - 912 EP - 7 JF - Journal of vascular surgery JO - J Vasc Surg VL - 53 IS - 4 N2 - OBJECTIVES: Determining operative risk in patients undergoing aortic surgery is a difficult process, as multiple variables converge to affect overall mortality. Patient frailty is certainly a contributing factor, but is difficult to measure, with surgeons often relying on subjective or intuitive influences. We sought to use core muscle size as an objective measure of frailty, and determine its utility as a predictor of survival after abdominal aortic aneurysm (AAA) repair. METHODS: Four hundred seventy-nine patients underwent elective open AAA repair between 2000 and 2008. Two hundred sixty-two patients (54.7%) had preoperative computed tomography (CT) scans available for analysis. Cross-sectional areas of the psoas muscles at the level of the L4 vertebra were measured. The covariate-adjusted effect of psoas area on postoperative mortality was assessed using Cox regression. RESULTS: Of the 262 patients, there were 55 deaths and the mean length of follow-up was 2.3 years. Cox regression revealed a significant association between psoas area and postoperative mortality (P = .003). The effect of psoas area was found to decrease significantly as follow-up time increased (P = .008). Among all covariates included in the Cox models (including predictors of mortality such as American Society of Anesthesiologists [ASA] score), the psoas area was the most significant. CONCLUSION: Core muscle size, an objective measure of frailty, correlates strongly with mortality after elective AAA repair. A better understanding of the role of frailty and core muscle size may aid in risk stratification and impact timing of surgical repair, especially in more complex aortic operations. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/21215580/Frailty_core_muscle_size_and_mortality_in_patients_undergoing_open_abdominal_aortic_aneurysm_repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(10)02575-9 DB - PRIME DP - Unbound Medicine ER -