Introduction Hospitalization is associated with acute changes in sarcopenia status in older people, but the influencing factors are not fully understood. Pre-admission care dependency level as a risk factor has not yet been investigated. Objective Evaluate if pre-admission care dependency level is an independent predictor of sarcopenia changes following hospitalization. Setting and subjects Data came from the Sarcopenia 9+ EAMA Project, a European prospective multi-centre study. For this study, 227 hospitalised older people were included from four different hospitals in Belgium, Spain and Poland, between 18 February 2019 and 5 September 2020. Methods Sarcopenia status at admission and discharge were calculated using a combined score (desirability value) based on muscle mass (calf circumference), strength (grip) and function (walking speed). Ratio of admission to discharge status was the outcome (desirability ratio; 1.00 meaning no difference). Predictor variable was the pre-admission care dependency level, classified into three groups: independent older people living at home, dependent older people living at home and older people living in a care home. Linear regression models were applied, considering potential confounders. Results Mean desirability ratio for dependent older people living at home (‘middle dependent group’) was lower (0.89) compared to independent older people (0.98; regression coefficient −0.09 [95% CI −0.16, −0.02]) and care home patients (1.05; −0.16 [95% CI −0.01, −0.31]). Adjusting for potential confounders or using another statistical approach did not affect the main results. Conclusion Dependent older people living at home were at higher risk of deterioration in sarcopenia status following hospitalization. In-depth studies investigating causes and potential interventions of these findings are needed.
Background and Objectives The optimal treatment sequence in stage IV rectal cancer (RC) with synchronous liver metastases (SLM) remains undefined. Here, we compared outcomes between patients treated with the bowel‐first approach (BFA) or the liver‐first approach (LFA). Methods Consecutive patients diagnosed with stage IV RC with SLM and who underwent complete resection were included. Both groups were matched using propensity scores. Differences in postoperative outcome, local control, and long‐term survival were studied. In addition, a decision analysis (DA) model was built using TreeAge Pro to define the approach that results in the highest treatment completion rate. Results During a 12‐year period, 52 patients were identified, 21 and 31 of whom underwent the BFA and the LFA, respectively. Twenty‐eight patients were matched; patients treated with the BFA experienced a longer median OS (50.0 vs 33.0 months; P = .40) and higher 5‐year OS (42.9% vs 28.6%). The DA defined the BFA to be superior when the failure threshold (ie, no R0 resection, treatment discontinuation regardless of cause) for colectomy is less than 28.6%. Conclusions In stage IV rectal cancer with SLM, either the BFA or the LFA result in similar long‐term outcomes. Treatment should be tailored according to clinicopathological variables.
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