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Sarcopenia in emergency abdominal surgery.
J Surg Res. 2017 01; 207:13-21.JS

Abstract

BACKGROUND

Sarcopenia, a loss of skeletal muscle mass associated with aging, is a practical measure of frailty and has been previously identified as a predictor of outcomes in surgical cohorts including cancer resection and elderly patients. We hypothesized that sarcopenia, as measured by preoperative computerized tomography (CT) scan, predicts mortality and morbidity in emergent laparotomy.

METHODS

Institutional American College of Surgeons National Surgical Quality Improvement Program data were queried for adult patients who underwent open emergency abdominal surgery between 2008 and 2013. Patients with abdominal CT scans within 30 d before surgery were included, and cross-sectional areas of the psoas muscles at vertebral level L4 were summed, normalized by patient height, and stratified by sex. The influence of this total psoas area (TPA) on postoperative morbidity and mortality was evaluated using univariate and multivariate analysis.

RESULTS

Of 781 surgeries, 593 (75.9%) had appropriate preoperative CT scans. Median patient age was 61 years old, median TPA was 1719 mm2, and median body mass index was 26.7. Univariate analysis demonstrated a significant association between TPA and total postoperative morbidity (P = 0.0133), increased length of stay (<0.0001), and 90-d mortality (P = 0.0008) but not 30-d mortality (P = 0.26). In multivariate analysis, TPA lost its significance compared to more influential predictors of mortality, including American Society of Anesthesiologists classification.

CONCLUSIONS

Sarcopenia, as measured by TPA, significantly predicted mortality in univariate analysis but lost significance in multivariate analysis when factors such as American Society of Anesthesiologists score were included. Because TPA is readily available at no additional risk or cost, it is a convenient additional tool for preoperative risk assessment and counseling.

Authors+Show Affiliations

Department of Surgery, University of Virginia, 3530 Hospital Dr, Charlottesville, Virginia.Department of Surgery, University of Virginia, 3530 Hospital Dr, Charlottesville, Virginia.Department of Surgery, University of Virginia, 3530 Hospital Dr, Charlottesville, Virginia.Department of Surgery, University of Virginia, 3530 Hospital Dr, Charlottesville, Virginia.Department of Surgery, University of Virginia, 3530 Hospital Dr, Charlottesville, Virginia.Department of Surgery, University of Virginia, 3530 Hospital Dr, Charlottesville, Virginia.Department of Surgery, University of Virginia, 3530 Hospital Dr, Charlottesville, Virginia. Electronic address: philipsmith@virginia.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27979468

Citation

Dirks, Rebecca C., et al. "Sarcopenia in Emergency Abdominal Surgery." The Journal of Surgical Research, vol. 207, 2017, pp. 13-21.
Dirks RC, Edwards BL, Tong E, et al. Sarcopenia in emergency abdominal surgery. J Surg Res. 2017;207:13-21.
Dirks, R. C., Edwards, B. L., Tong, E., Schaheen, B., Turrentine, F. E., Shada, A., & Smith, P. W. (2017). Sarcopenia in emergency abdominal surgery. The Journal of Surgical Research, 207, 13-21. https://doi.org/10.1016/j.jss.2016.08.015
Dirks RC, et al. Sarcopenia in Emergency Abdominal Surgery. J Surg Res. 2017;207:13-21. PubMed PMID: 27979468.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sarcopenia in emergency abdominal surgery. AU - Dirks,Rebecca C, AU - Edwards,Brandy L, AU - Tong,Elizabeth, AU - Schaheen,Basil, AU - Turrentine,Florence E, AU - Shada,Amber, AU - Smith,Philip W, Y1 - 2016/08/10/ PY - 2016/02/15/received PY - 2016/05/29/revised PY - 2016/08/03/accepted PY - 2016/12/17/entrez PY - 2016/12/17/pubmed PY - 2017/7/20/medline KW - Complications KW - Frailty KW - Morphometrics KW - Preoperative assessment KW - Sarcopenia SP - 13 EP - 21 JF - The Journal of surgical research JO - J Surg Res VL - 207 N2 - BACKGROUND: Sarcopenia, a loss of skeletal muscle mass associated with aging, is a practical measure of frailty and has been previously identified as a predictor of outcomes in surgical cohorts including cancer resection and elderly patients. We hypothesized that sarcopenia, as measured by preoperative computerized tomography (CT) scan, predicts mortality and morbidity in emergent laparotomy. METHODS: Institutional American College of Surgeons National Surgical Quality Improvement Program data were queried for adult patients who underwent open emergency abdominal surgery between 2008 and 2013. Patients with abdominal CT scans within 30 d before surgery were included, and cross-sectional areas of the psoas muscles at vertebral level L4 were summed, normalized by patient height, and stratified by sex. The influence of this total psoas area (TPA) on postoperative morbidity and mortality was evaluated using univariate and multivariate analysis. RESULTS: Of 781 surgeries, 593 (75.9%) had appropriate preoperative CT scans. Median patient age was 61 years old, median TPA was 1719 mm2, and median body mass index was 26.7. Univariate analysis demonstrated a significant association between TPA and total postoperative morbidity (P = 0.0133), increased length of stay (<0.0001), and 90-d mortality (P = 0.0008) but not 30-d mortality (P = 0.26). In multivariate analysis, TPA lost its significance compared to more influential predictors of mortality, including American Society of Anesthesiologists classification. CONCLUSIONS: Sarcopenia, as measured by TPA, significantly predicted mortality in univariate analysis but lost significance in multivariate analysis when factors such as American Society of Anesthesiologists score were included. Because TPA is readily available at no additional risk or cost, it is a convenient additional tool for preoperative risk assessment and counseling. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/27979468/Sarcopenia_in_emergency_abdominal_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(16)30275-X DB - PRIME DP - Unbound Medicine ER -