Tags

Type your tag names separated by a space and hit enter

Pre-operative psoas major measurement compared to P-POSSUM as a prognostic indicator in over-80s undergoing emergency laparotomy.
Eur J Trauma Emerg Surg. 2020 Feb; 46(1):215-220.EJ

Abstract

INTRODUCTION

Emergency laparotomy in patients over the age of 80 is associated with high morbidity and mortality. Accurate risk prediction in this patient population is desirable. Sarcopenia has been shown to be associated with outcome in multiple clinical settings and the psoas major muscle as measured on computed tomography (CT) imaging has been demonstrated as a marker of sarcopenia. We aim to assess the use of psoas major measurement on pre-operative CT as a prognostic indicator in over-80s undergoing emergency laparotomy and compare this measurement to P-POSSUM.

METHODS

A retrospective interrogation of the prospectively collected National Emergency Laparotomy Database including all over-80s undergoing emergency laparotomy between January 2014 and September 2016 was conducted. Demographic, operative data and P-POSSUM data were collected and analysed. Computed tomography (CT) images were accessed and analysed, and cross-sectional areas of psoas major and the corresponding lumbar vertebral body at the level of the L3 inferior end plate were calculated. The ratio of psoas major-to-L3 cross-sectional area (PM:L3) was calculated for each patient. Mann-Whitney U test and receiver-operating characteristics (ROC) curves were used for statistical analysis.

RESULTS

One hundred and three over-80s underwent emergency laparotomy. Male:female ratio was 60:43. Median age was 84 years (range 80-98 years). 30-day mortality was 19.4%.90-day mortality was 25.2%. Median PM:L3 ratio in patients who died as an inpatient was 0.3 and PM:L3 ratio in patients who survived to discharge was 0.52 (p < 0.0001). Median PM:L3 ratio in patient who died within 30 days post-op was 0.28 and 0.48 in those patients who survived to 30 days (p < 0.0001). Median PM:L3 ratio in patient who died within 90 days post-op was 0.28 and 0.51 in those patients who survived to 90 days (p < 0.0001). ROC analysis gave an area under the curve (AUC) of 0.85 for in-patient mortality, 0.86 for 30-day mortality, and 0.88 for 90-day mortality. ROC analysis for P-POSSUM in this data set demonstrated an AUC of 0.51 for in-patient mortality and 0.75 for 30- and 90-day mortality.

CONCLUSION

CT imaging of the abdomen and pelvis is routinely used in over-80s prior to emergency laparotomy making PM:L3 calculation feasible for the majority of patients in this group. PM:L3 ratio is a useful prognostic indicator for prediction of mortality in patients over the age of 80. PM:L3 is superior to the P-POSSUM score in this series.

Authors+Show Affiliations

Wirral University Teaching Hospitals, Wirral, UK.Wirral University Teaching Hospitals, Wirral, UK.Wirral University Teaching Hospitals, Wirral, UK.Wirral University Teaching Hospitals, Wirral, UK.Wirral University Teaching Hospitals, Wirral, UK. conormagee@nhs.net.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30317377

Citation

Simpson, Gregory, et al. "Pre-operative Psoas Major Measurement Compared to P-POSSUM as a Prognostic Indicator in Over-80s Undergoing Emergency Laparotomy." European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society, vol. 46, no. 1, 2020, pp. 215-220.
Simpson G, Parker A, Hopley P, et al. Pre-operative psoas major measurement compared to P-POSSUM as a prognostic indicator in over-80s undergoing emergency laparotomy. Eur J Trauma Emerg Surg. 2020;46(1):215-220.
Simpson, G., Parker, A., Hopley, P., Wilson, J., & Magee, C. (2020). Pre-operative psoas major measurement compared to P-POSSUM as a prognostic indicator in over-80s undergoing emergency laparotomy. European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society, 46(1), 215-220. https://doi.org/10.1007/s00068-018-1025-5
Simpson G, et al. Pre-operative Psoas Major Measurement Compared to P-POSSUM as a Prognostic Indicator in Over-80s Undergoing Emergency Laparotomy. Eur J Trauma Emerg Surg. 2020;46(1):215-220. PubMed PMID: 30317377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pre-operative psoas major measurement compared to P-POSSUM as a prognostic indicator in over-80s undergoing emergency laparotomy. AU - Simpson,Gregory, AU - Parker,Alexander, AU - Hopley,Philip, AU - Wilson,Jeremy, AU - Magee,Conor, Y1 - 2018/10/13/ PY - 2018/06/03/received PY - 2018/10/06/accepted PY - 2018/10/15/pubmed PY - 2018/10/15/medline PY - 2018/10/15/entrez KW - Emergency laparotomy KW - Frailty KW - Psoas major dimensions KW - Sarcopenia SP - 215 EP - 220 JF - European journal of trauma and emergency surgery : official publication of the European Trauma Society JO - Eur J Trauma Emerg Surg VL - 46 IS - 1 N2 - INTRODUCTION: Emergency laparotomy in patients over the age of 80 is associated with high morbidity and mortality. Accurate risk prediction in this patient population is desirable. Sarcopenia has been shown to be associated with outcome in multiple clinical settings and the psoas major muscle as measured on computed tomography (CT) imaging has been demonstrated as a marker of sarcopenia. We aim to assess the use of psoas major measurement on pre-operative CT as a prognostic indicator in over-80s undergoing emergency laparotomy and compare this measurement to P-POSSUM. METHODS: A retrospective interrogation of the prospectively collected National Emergency Laparotomy Database including all over-80s undergoing emergency laparotomy between January 2014 and September 2016 was conducted. Demographic, operative data and P-POSSUM data were collected and analysed. Computed tomography (CT) images were accessed and analysed, and cross-sectional areas of psoas major and the corresponding lumbar vertebral body at the level of the L3 inferior end plate were calculated. The ratio of psoas major-to-L3 cross-sectional area (PM:L3) was calculated for each patient. Mann-Whitney U test and receiver-operating characteristics (ROC) curves were used for statistical analysis. RESULTS: One hundred and three over-80s underwent emergency laparotomy. Male:female ratio was 60:43. Median age was 84 years (range 80-98 years). 30-day mortality was 19.4%.90-day mortality was 25.2%. Median PM:L3 ratio in patients who died as an inpatient was 0.3 and PM:L3 ratio in patients who survived to discharge was 0.52 (p < 0.0001). Median PM:L3 ratio in patient who died within 30 days post-op was 0.28 and 0.48 in those patients who survived to 30 days (p < 0.0001). Median PM:L3 ratio in patient who died within 90 days post-op was 0.28 and 0.51 in those patients who survived to 90 days (p < 0.0001). ROC analysis gave an area under the curve (AUC) of 0.85 for in-patient mortality, 0.86 for 30-day mortality, and 0.88 for 90-day mortality. ROC analysis for P-POSSUM in this data set demonstrated an AUC of 0.51 for in-patient mortality and 0.75 for 30- and 90-day mortality. CONCLUSION: CT imaging of the abdomen and pelvis is routinely used in over-80s prior to emergency laparotomy making PM:L3 calculation feasible for the majority of patients in this group. PM:L3 ratio is a useful prognostic indicator for prediction of mortality in patients over the age of 80. PM:L3 is superior to the P-POSSUM score in this series. SN - 1863-9941 UR - https://www.unboundmedicine.com/medline/citation/30317377/Pre_operative_psoas_major_measurement_compared_to_P_POSSUM_as_a_prognostic_indicator_in_over_80s_undergoing_emergency_laparotomy_ L2 - https://dx.doi.org/10.1007/s00068-018-1025-5 DB - PRIME DP - Unbound Medicine ER -