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Is sarcopenia a useful predictor of outcome in patients after emergency laparotomy? A study using the NELA database.
Ann R Coll Surg Engl. 2018 May; 100(5):377-381.AR

Abstract

Introduction Studies have reported on the use of frailty as a prognostic indicator in patients undergoing elective surgery. Similar data do not exist for patients undergoing emergency surgery. The aim of this study was to evaluate the effect of preoperative sarcopenia measured by computed tomography (CT) on outcome following emergency laparotomy. Materials and methods Data from the National Emergency Laparotomy Audit database were retrieved for patients who had undergone an emergency laparotomy over 12 months at York NHS Foundation Trust. Sarcopenia was assessed by psoas density and area on preoperative CT. Mortality rates at 30 days and 1 year were recorded. Secondary outcomes included discharge rates to non-independent living. Results A total of 259 patients were included. Overall cohort 30-day and 1-year mortality was 13.9% (36/259) and 28.2% (73/259), respectively. Sarcopenia measured by psoas density was associated with increased mortality compared with patients who did not develop sarcopenia at 30 days (29.7%, 19/64, vs. 8.7%, 17/195; P < 0.001; odds ratio, OR, 4.42; 95% confidence interval, CI 2.13-9.26) and at 1 year (57.8%, 37/64, vs. 18.5%, (36/195; P < 0.001; OR 6.05; 95%CI 3.28-11.18). An increase in mortality was seen in patients with sarcopenia measured by psoas area at 30 days (21.3%, 13/61, vs. 9.1%, 17/187; OR 2.71; 95%CI 1.23-5.96, P = 0.013) and at 1 year (42.6%, 26/61, vs. 20.9%, 39/187; OR 2.82; 95% CI 1.52-5.23, P < 0.001). Conclusions Sarcopenia assessed by measurement of psoas density and area on CT is associated with increased mortality following emergency laparotomy. The use of sarcopenia as a predictive tool merits further attention and may be useful in patients undergoing emergency surgery.

Authors+Show Affiliations

Combined Gastroenterology Research Unit, Scarborough General Hospital , Scarborough , UK.Combined Gastroenterology Research Unit, Scarborough General Hospital , Scarborough , UK.Combined Gastroenterology Research Unit, Scarborough General Hospital , Scarborough , UK.Combined Gastroenterology Research Unit, Scarborough General Hospital , Scarborough , UK.Combined Gastroenterology Research Unit, Scarborough General Hospital , Scarborough , UK.Combined Gastroenterology Research Unit, Scarborough General Hospital , Scarborough , UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29484927

Citation

Trotter, John, et al. "Is Sarcopenia a Useful Predictor of Outcome in Patients After Emergency Laparotomy? a Study Using the NELA Database." Annals of the Royal College of Surgeons of England, vol. 100, no. 5, 2018, pp. 377-381.
Trotter J, Johnston J, Ng A, et al. Is sarcopenia a useful predictor of outcome in patients after emergency laparotomy? A study using the NELA database. Ann R Coll Surg Engl. 2018;100(5):377-381.
Trotter, J., Johnston, J., Ng, A., Gatt, M., MacFie, J., & McNaught, C. (2018). Is sarcopenia a useful predictor of outcome in patients after emergency laparotomy? A study using the NELA database. Annals of the Royal College of Surgeons of England, 100(5), 377-381. https://doi.org/10.1308/rcsann.2017.0230
Trotter J, et al. Is Sarcopenia a Useful Predictor of Outcome in Patients After Emergency Laparotomy? a Study Using the NELA Database. Ann R Coll Surg Engl. 2018;100(5):377-381. PubMed PMID: 29484927.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is sarcopenia a useful predictor of outcome in patients after emergency laparotomy? A study using the NELA database. AU - Trotter,John, AU - Johnston,Judith, AU - Ng,Alvin, AU - Gatt,Marcel, AU - MacFie,John, AU - McNaught,Clare, Y1 - 2018/02/27/ PY - 2018/2/28/pubmed PY - 2018/5/10/medline PY - 2018/2/28/entrez KW - Emergency KW - Frail elderly KW - Laparotomy KW - Sarcopenia SP - 377 EP - 381 JF - Annals of the Royal College of Surgeons of England JO - Ann R Coll Surg Engl VL - 100 IS - 5 N2 - Introduction Studies have reported on the use of frailty as a prognostic indicator in patients undergoing elective surgery. Similar data do not exist for patients undergoing emergency surgery. The aim of this study was to evaluate the effect of preoperative sarcopenia measured by computed tomography (CT) on outcome following emergency laparotomy. Materials and methods Data from the National Emergency Laparotomy Audit database were retrieved for patients who had undergone an emergency laparotomy over 12 months at York NHS Foundation Trust. Sarcopenia was assessed by psoas density and area on preoperative CT. Mortality rates at 30 days and 1 year were recorded. Secondary outcomes included discharge rates to non-independent living. Results A total of 259 patients were included. Overall cohort 30-day and 1-year mortality was 13.9% (36/259) and 28.2% (73/259), respectively. Sarcopenia measured by psoas density was associated with increased mortality compared with patients who did not develop sarcopenia at 30 days (29.7%, 19/64, vs. 8.7%, 17/195; P < 0.001; odds ratio, OR, 4.42; 95% confidence interval, CI 2.13-9.26) and at 1 year (57.8%, 37/64, vs. 18.5%, (36/195; P < 0.001; OR 6.05; 95%CI 3.28-11.18). An increase in mortality was seen in patients with sarcopenia measured by psoas area at 30 days (21.3%, 13/61, vs. 9.1%, 17/187; OR 2.71; 95%CI 1.23-5.96, P = 0.013) and at 1 year (42.6%, 26/61, vs. 20.9%, 39/187; OR 2.82; 95% CI 1.52-5.23, P < 0.001). Conclusions Sarcopenia assessed by measurement of psoas density and area on CT is associated with increased mortality following emergency laparotomy. The use of sarcopenia as a predictive tool merits further attention and may be useful in patients undergoing emergency surgery. SN - 1478-7083 UR - https://www.unboundmedicine.com/medline/citation/29484927/Is_sarcopenia_a_useful_predictor_of_outcome_in_patients_after_emergency_laparotomy_A_study_using_the_NELA_database_ L2 - https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2017.0230?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -