BackgroundFunctional compromise in elderly patients is considered to be a significant contributing factor in increased postoperative morbidity and mortality. It is described as a state of reduced physiologic reserves including, e.g., sarcopenia, cachexia, malnutrition and frailty with increased susceptibility to adverse health outcomes. Aim of this study was to investigate the association of sarcopenia with mortality in ICU patients.MethodsA retrospective analysis of a total of 687 patients admitted to the ICU from January 2013 until December 2014 was performed. Indirect measurements of functional compromise in these patients were conducted. Sarcopenia was assessed using the L3 muscle index by using Osirix© on computed tomography scans. Groningen Frailty Indicator (GFI) and Short Nutritional Assessment Questionnaire (SNAQ) scores were extracted from the digital patient filing system and were used to assess frailty and nutritional status. These factors were analyzed using logistic regression analysis as predictor for in-hospital mortality and 6-month mortality, which was the primary endpoint along with other secondary outcome measures.ResultsAge was an independent predictor of in-hospital mortality, OR 1.043 (95% CI 1.030–1.057, p < 0.001). Analysis of sarcopenia showed OR 2.361 (95% CI 1.138–4.895, p = 0.021), for GFI OR 1.012 (95% CI 0.919–1.113, p = 0.811) and for SNAQ OR 1.262 (95% CI 1.091–1.460, p = 0.002).ConclusionThis study shows a promising role for the sarcopenia score as a predictor of mortality on the ICU, based upon CT imaging at L3 level and SNAQ score. Further research is necessary to test this in larger cohorts and to develop a possible instrument to predict mortality in the intensive care unit.
<b><i>Introduction:</i></b> Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. <b><i>Methods:</i></b> This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. <b><i>Results:</i></b> A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, <i>p</i> = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, <i>p</i> < 0.001), longer operating time (3.2 vs. 2.5 hours, <i>p</i> < 0.001), and more readmissions (10.9 vs. 8.5%, <i>p</i> < 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, <i>p</i> < 0.001), less morbidity (37.3 vs. 55.1%, <i>p</i> < 0.001), and less mortality (1.8 vs. 5.6%, <i>p</i> = 0.013) for laparoscopy. <b><i>Conclusion:</i></b> During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.
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