Tags

Type your tag names separated by a space and hit enter

Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy.
J Surg Res. 2021 01; 257:252-259.JS

Abstract

BACKGROUND

Emergency laparotomy (EL) is an increasingly common procedure in the elderly. Factors associated with mortality in the subpopulation of frail patients have not been thoroughly investigated. Sarcopenia has been investigated as a surrogate for frailty and poor prognosis. Our primary aim was to evaluate the association between easily measured sarcopenia parameters and 30-day postoperative mortality in elderly patients undergoing EL. Length of stay (LOS) and admission to an intensive care unit were secondary end points.

METHODS

We conducted a retrospective cohort study, over a 5-year period, of patients aged 65 y and older who underwent EL at a tertiary university hospital. Sarcopenia was evaluated on admission computed tomography scan by two methods, first by psoas muscle attenuation and second by the product of perpendicular cross-sectional diameters (PCSDs). The lowest quartile of PCSDs and attenuation were defined as sarcopenic and compared with the rest of the cohort. Attenuation was stratified for the use of contrast enhancement. Multivariant logistic regression was performed to determine independent risk factors.

RESULTS

During the study period, 403 patients, older than 65 y, underwent EL. Of these, 283 fit the inclusion criteria and 65 (23%) patients died within 30 d of surgery. On bivariate analysis, psoas muscle attenuation, but not PCSDs, was found to be associated with 30-day mortality (OR = 2.43, 95% CI = 1.34-4.38, P = 0.003) and longer LOS (35.7 d versus 22.2 d, Δd 13.5, 95% CI = 6.4-20.7, P < 0.001). In a multivariate analysis, psoas muscle attenuation, but not PCSDs, was an independent risk factor for 30-day postoperative mortality (OR = 2.35, 95% CI = 1.16-4.76, P = 0.017) and longer LOS (Δd = 14.4, 95% CI = 7.7-21.0, P < 0.001). Neither of the sarcopenia parameters was associated with increased admission to an intensive care unit.

DISCUSSION

Psoas muscle attenuation is an independent risk factor for 30-day postoperative mortality and LOS after EL in the elderly population. This measurement can inform clinicians about the operative risk and hospital resource utilization.

Authors+Show Affiliations

Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.Department of Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel. Electronic address: jyuval@gmail.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32862053

Citation

Salem, Samer Abu, et al. "Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy." The Journal of Surgical Research, vol. 257, 2021, pp. 252-259.
Salem SA, Almogy G, Lev-Cohain N, et al. Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy. J Surg Res. 2021;257:252-259.
Salem, S. A., Almogy, G., Lev-Cohain, N., Bala, M., Cohen, N., Issachar, O., Pikarsky, A. J., & Yuval, J. B. (2021). Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy. The Journal of Surgical Research, 257, 252-259. https://doi.org/10.1016/j.jss.2020.07.031
Salem SA, et al. Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy. J Surg Res. 2021;257:252-259. PubMed PMID: 32862053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy. AU - Salem,Samer Abu, AU - Almogy,Gidon, AU - Lev-Cohain,Naama, AU - Bala,Miklosh, AU - Cohen,Nir, AU - Issachar,Omer, AU - Pikarsky,Alon J, AU - Yuval,Jonathan B, Y1 - 2020/08/27/ PY - 2019/11/14/received PY - 2020/06/19/revised PY - 2020/07/08/accepted PY - 2020/8/31/pubmed PY - 2021/1/8/medline PY - 2020/8/31/entrez KW - Elderly patients KW - Emergency surgery KW - Frailty KW - Laparotomy KW - Postoperative mortality KW - Sarcopenia SP - 252 EP - 259 JF - The Journal of surgical research JO - J Surg Res VL - 257 N2 - BACKGROUND: Emergency laparotomy (EL) is an increasingly common procedure in the elderly. Factors associated with mortality in the subpopulation of frail patients have not been thoroughly investigated. Sarcopenia has been investigated as a surrogate for frailty and poor prognosis. Our primary aim was to evaluate the association between easily measured sarcopenia parameters and 30-day postoperative mortality in elderly patients undergoing EL. Length of stay (LOS) and admission to an intensive care unit were secondary end points. METHODS: We conducted a retrospective cohort study, over a 5-year period, of patients aged 65 y and older who underwent EL at a tertiary university hospital. Sarcopenia was evaluated on admission computed tomography scan by two methods, first by psoas muscle attenuation and second by the product of perpendicular cross-sectional diameters (PCSDs). The lowest quartile of PCSDs and attenuation were defined as sarcopenic and compared with the rest of the cohort. Attenuation was stratified for the use of contrast enhancement. Multivariant logistic regression was performed to determine independent risk factors. RESULTS: During the study period, 403 patients, older than 65 y, underwent EL. Of these, 283 fit the inclusion criteria and 65 (23%) patients died within 30 d of surgery. On bivariate analysis, psoas muscle attenuation, but not PCSDs, was found to be associated with 30-day mortality (OR = 2.43, 95% CI = 1.34-4.38, P = 0.003) and longer LOS (35.7 d versus 22.2 d, Δd 13.5, 95% CI = 6.4-20.7, P < 0.001). In a multivariate analysis, psoas muscle attenuation, but not PCSDs, was an independent risk factor for 30-day postoperative mortality (OR = 2.35, 95% CI = 1.16-4.76, P = 0.017) and longer LOS (Δd = 14.4, 95% CI = 7.7-21.0, P < 0.001). Neither of the sarcopenia parameters was associated with increased admission to an intensive care unit. DISCUSSION: Psoas muscle attenuation is an independent risk factor for 30-day postoperative mortality and LOS after EL in the elderly population. This measurement can inform clinicians about the operative risk and hospital resource utilization. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/32862053/Psoas_Attenuation_and_Mortality_of_Elderly_Patients_Undergoing_Nontraumatic_Emergency_Laparotomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(20)30488-1 DB - PRIME DP - Unbound Medicine ER -