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Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery.
Ann Surg. 2015 Feb; 261(2):345-52.AnnS

Abstract

OBJECTIVE

To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery.

BACKGROUND

Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery. Therefore, the predictive value of preoperative functional compromise assessment was investigated. Sarcopenia is a hallmark of functional compromise.

METHODS

A total of 310 consecutive patients who underwent oncologic colorectal surgery were included in a prospective digital database. Sarcopenia was assessed using the L3 muscle index utilizing Osirix on preoperative computed tomography. Groningen Frailty Indicator and Short Nutritional Assessment Questionnaire scores were used to assess frailty and nutritional compromise. Predictors for anastomotic leakage, sepsis, and mortality were analyzed by logistic regression analysis.

RESULTS

Age was an independent predictor of mortality [P = 0.04; odds ratio, 1.17; 95% confidence interval (CI), 1.01-1.37]. Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8% versus 0.7% in nonsarcopenic patients (P = 0.001; odds ratio, 15.5; 95% CI, 2.00-120). Sarcopenia was not predictive for anastomotic leakage or sepsis. Combination of high Short Nutritional Assessment Questionnaire score, high Groningen Frailty Indicator score, and sarcopenia strongly predicted sepsis (P = 0.001; odds ratio, 25.1; 95% CI, 5.11-123), sensitivity, 46%; specificity, 97%; positive likelihood ratio, 13 (95% CI, 4.4-38); negative likelihood ratio, 0.57 (95% CI, 0.33-0.97).

CONCLUSIONS

Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome. Assessment of functional compromise by means of a nutritional questionnaire (Short Nutritional Assessment Questionnaire), a frailty questionnaire (Groningen Frailty Indicator), and sarcopenia measurement (L3 muscle index) can accurately predict postoperative sepsis.

Authors+Show Affiliations

*Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands †NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands ‡Department of Surgery, Orbis Medical Center, Sittard, The Netherlands; and §GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.No affiliation info availableNo affiliation info availableNo 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)

Evaluation Study
Journal Article

Language

eng

PubMed ID

24651133

Citation

Reisinger, Kostan W., et al. "Functional Compromise Reflected By Sarcopenia, Frailty, and Nutritional Depletion Predicts Adverse Postoperative Outcome After Colorectal Cancer Surgery." Annals of Surgery, vol. 261, no. 2, 2015, pp. 345-52.
Reisinger KW, van Vugt JL, Tegels JJ, et al. Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg. 2015;261(2):345-52.
Reisinger, K. W., van Vugt, J. L., Tegels, J. J., Snijders, C., Hulsewé, K. W., Hoofwijk, A. G., Stoot, J. H., Von Meyenfeldt, M. F., Beets, G. L., Derikx, J. P., & Poeze, M. (2015). Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Annals of Surgery, 261(2), 345-52. https://doi.org/10.1097/SLA.0000000000000628
Reisinger KW, et al. Functional Compromise Reflected By Sarcopenia, Frailty, and Nutritional Depletion Predicts Adverse Postoperative Outcome After Colorectal Cancer Surgery. Ann Surg. 2015;261(2):345-52. PubMed PMID: 24651133.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. AU - Reisinger,Kostan W, AU - van Vugt,Jeroen L A, AU - Tegels,Juul J W, AU - Snijders,Claire, AU - Hulsewé,Karel W E, AU - Hoofwijk,Anton G M, AU - Stoot,Jan H, AU - Von Meyenfeldt,Maarten F, AU - Beets,Geerard L, AU - Derikx,Joep P M, AU - Poeze,Martijn, PY - 2014/3/22/entrez PY - 2014/3/22/pubmed PY - 2015/3/10/medline SP - 345 EP - 52 JF - Annals of surgery JO - Ann Surg VL - 261 IS - 2 N2 - OBJECTIVE: To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery. BACKGROUND: Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery. Therefore, the predictive value of preoperative functional compromise assessment was investigated. Sarcopenia is a hallmark of functional compromise. METHODS: A total of 310 consecutive patients who underwent oncologic colorectal surgery were included in a prospective digital database. Sarcopenia was assessed using the L3 muscle index utilizing Osirix on preoperative computed tomography. Groningen Frailty Indicator and Short Nutritional Assessment Questionnaire scores were used to assess frailty and nutritional compromise. Predictors for anastomotic leakage, sepsis, and mortality were analyzed by logistic regression analysis. RESULTS: Age was an independent predictor of mortality [P = 0.04; odds ratio, 1.17; 95% confidence interval (CI), 1.01-1.37]. Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8% versus 0.7% in nonsarcopenic patients (P = 0.001; odds ratio, 15.5; 95% CI, 2.00-120). Sarcopenia was not predictive for anastomotic leakage or sepsis. Combination of high Short Nutritional Assessment Questionnaire score, high Groningen Frailty Indicator score, and sarcopenia strongly predicted sepsis (P = 0.001; odds ratio, 25.1; 95% CI, 5.11-123), sensitivity, 46%; specificity, 97%; positive likelihood ratio, 13 (95% CI, 4.4-38); negative likelihood ratio, 0.57 (95% CI, 0.33-0.97). CONCLUSIONS: Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome. Assessment of functional compromise by means of a nutritional questionnaire (Short Nutritional Assessment Questionnaire), a frailty questionnaire (Groningen Frailty Indicator), and sarcopenia measurement (L3 muscle index) can accurately predict postoperative sepsis. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/24651133/Functional_compromise_reflected_by_sarcopenia_frailty_and_nutritional_depletion_predicts_adverse_postoperative_outcome_after_colorectal_cancer_surgery_ L2 - https://Insights.ovid.com/pubmed?pmid=24651133 DB - PRIME DP - Unbound Medicine ER -