Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery

Journal of Trauma and Acute Care Surgery - Tập 83 Số 6 - Trang 1179-1186 - 2017
Erika L. Rangel1,2,3,4,5,6,7,8, Arturo J. Rios-Diaz1,2,3,4,5,6,7,8, Jennifer W. Uyeda1,2,3,4,5,6,7,8, Manuel Castillo‐Angeles1,2,3,4,5,6,7,8, Zara Cooper1,2,3,4,5,6,7,8, Olubode A. Olufajo1,2,3,4,5,6,7,8, Alí Salim1,2,3,4,5,6,7,8, Aaron D. Sodickson1,2,3,4,5,6,7,8
1Address for reprints: Erika L. Rangel, MD, MS, Department of Surgery, Brigham and Women’s Faulkner Hospital, 4th Floor, 1153, Centre St, Boston, MA 02130
2Division of Emergency Radiology, Department of Radiology (J.W.U., A.D.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.
3From the Division of Trauma, Burn and Surgical Critical Care, Department of Surgery (E.L.R., M.C-A., Z.C., O.A.O., A.S.), Center for Surgery and Public Health, Department of Surgery (A.J.R-D., M.C-A., Z.C., O.A.O., A.S.), Brigham and Women’s Hospital, Harvard Medical School
4Harvard T.H. Chan School of Public Health;
5Submitted: August 24, 2016, Revised: June 16, 2017, Accepted: June 25, 2017, Published online: August 3, 2017.
6Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).
7This study was presented at the 50th annual meeting of The American Association for the Surgery of Trauma, September 14 to 17, 2016, in Waikoloa, HI.
8*Email: [email protected]

Tóm tắt

BACKGROUND Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. METHODS Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. RESULTS Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p < 0.05). Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6–3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9–7.4), 90 days (HR, 3.3; 95% CI, 1.8–6.0), 180 days (HR, 2.5; 95% CI, 1.4–4.4), and 1 year (HR, 2.4; 95% CI, 1.4–3.9). CONCLUSION Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is a simple and objective measure of frailty that identifies vulnerable patients for improved preoperative counseling, setting realistic goals of care, and consideration of less invasive approaches. LEVEL OF EVIDENCE Prognostic study, level III.

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Journal of Trauma and Acute Care Surgery

Tập 83 Số 6

1179-1186

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