One-year postoperative resource utilization in sarcopenic patients

Kirk, Peter S.; Friedman, Jeffrey F.; Cron, David C.; Terjimanian, Michael N.; Wang, Stewart C.; Campbell, Darrell A.; Englesbe, Michael J.; Werner, N.

doi:10.1016/j.jss.2015.04.074

Cited by 32 publications

(24 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further, sarcopenia has been shown to influence drug pharmacokinetics (28) and can lead to increased drug toxicities (29). Finally, sarcopenic patients have been found to accrue increased costs in the first 6 months after a surgical procedure (30). However, little work has been done to date in clarifying the impact of sarcopenia in an older adult trauma population.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography abbreviated assessment of sarcopenia following trauma

Leeper

Lin

Hoffman

et al. 2016

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

Background Older adult trauma patients are at increased risk of poor outcome, both immediately after injury and beyond hospital discharge. Identifying patients early in the hospital stay who are at increased risk of death after discharge can be challenging. Methods Retrospective analysis was performed using our trauma registry linked with the social security death index from 2010–2014. Age was categorized by 18–64 and ≥65 years. We calculated mortality rates by age category then selected elderly patients with mechanism of injury being a fall for further analysis. CT Abbreviated Assessment of Sarcopenia for Trauma (CAAST) was obtained by measuring psoas muscle cross-sectional area adjusted for height and weight. Kaplan-Meier survival analysis was performed and proportional hazards regression modeling was utilized to determine independent risk factors for in-hospital and out-of-hospital mortality. Results 23,622 patients were analyzed (age 18–64: 16,748 and age≥65: 6,874). In-hospital mortality was 1.96% for age 18–64 and 7.19% for age ≥65 (p<0.001); post-discharge 6-month mortality was 1.1% for age 18–64 and 12.86% for age ≥65 (p<0.001). Predictors of in-hospital and post-discharge mortality for age 18–64 and in-hospital mortality for age≥65 group included injury characteristics such as ISS, admission vitals and head injury. Predictors of post-discharge mortality for age ≥65 included skilled nursing prior to admission, disposition, and mechanism of injury being a fall. In total, 57.5% (n=256) of older patients who sustained a fall met criteria for sarcopenia. Sarcopenia was the strongest predictor of out-of-hospital mortality in this cohort with hazard ratio 4.77 (95% CI 2.71–8.40; p<0.001) Conclusion Out of hospital does not assure out of danger for the elderly. Sarcopenia is a strong predictor of 6-month post-discharge mortality for older adults. The CAAST measurement is an efficient and inexpensive measure that can allow clinicians to target older trauma patients at risk of poor outcome for early intervention and/or palliative care services.

show abstract

Section: Discussionmentioning

confidence: 99%

Computed tomography abbreviated assessment of sarcopenia following trauma

Leeper

Lin

Hoffman

et al. 2016

Journal of Trauma and Acute Care Surgery

View full text Add to dashboard Cite

show abstract

“…(4) Emerging data suggest that frailty and sarcopenia affect survival after LT independent of recipient and donor factors. Using analytic morphomics, we and others have shown that body composition, especially the dorsal muscle group (DMG) area (psoas and paraspinal muscles), predicts postoperative complications (5)(6)(7) and survival after LT independent of MELD score. (6,(8)(9)(10)(11)(12) Analytic morphomics is a novel approach that uses high throughput semiautomated image-processing techniques to assess body composition, such as body dimensions, visceral fat (VF), and muscle mass, and to link it to clinical outcomes.…”

mentioning

confidence: 99%

Bone mineral density predicts posttransplant survival among hepatocellular carcinoma liver transplant recipients

Sharma

Parikh

Yu³

et al. 2016

Liver Transpl

Self Cite

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is a common indication for liver transplantation (LT). Recent data suggest that body composition features strongly affect post-LT mortality. We examined the impact of body composition on post-LT mortality in patients with HCC. Methods: Data on adult LT recipients who received MELD exception for HCC between 2/29/02-12/31/13 and had CT scan anytime 6 months prior to LT were reviewed (N=118). All available CT scan DICOM (Digital Imaging and Communications in Medicine) files were analyzed using a semiautomated high throughput methodology with algorithms programmed in MATLAB®. Analytic morphomics measurements including dorsal muscle group (DMG) area, visceral and subcutaneous fat and bone mineral density (BMD) were taken at the bottom of the 11th thoracic vertebral level. Results: Thirty-two patients (28%) died during the median follow up of 4.4 years. Number of HCC lesions (HR=2.72; P<0.001), BMD (HR=0.90/HU; P=0.03), pre-LT loco-regional therapy (HR=0.34; P<0.001) and donor age (HR=1.05; P<0.001) were the independent predictors of post-LT mortality. DMG area did not affect post-LT survival. Conclusion: In addition to number of HCC lesions and pre-LT loco-regional therapy, low BMD, a surrogate for bone loss rather than DMG area, was independently associated with post-LT mortality in HCC patients. Bone loss may be an early marker of deconditioning that precedes sarcopenia and may affect transplant outcomes.

show abstract

“…After the process of selection based on abstract and title and after on the full-text article review ( Fig. 1), we finally included 14 studies assessing the difference in health care costs between individuals with or without sarcopenia [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Sixteen studies were rejected because of duplicate (n = 2) [11,20], wrong outcomes (n = 13) [24][25][26][27][28][29][30][31][32][33][34][35][36] or wrong exposure factor (n = 1) [38].…”

Section: Literature Searchmentioning

confidence: 99%

“…A complete presentation of the characteristics and design of the 14 included studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23] is accessible in Table 3. All studies, specifically regarding their analysis of sarcopenia-related costs, followed a cross-sectional design and was comprised of 50 to 1593 participants.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…The way to diagnose sarcopenia was indeed very heterogeneous, the diagnostic thresholds being also arbitrarily placed for the majority of the included studies. For instance, 11 studies out of 14 [11][12][13][14][15][16][17][18]20,22,23] applied diagnostic thresholds according to the results intrinsic to their own study and population (i.e., lowest tertile or quartile) and not based on data validated and recognized in the scientific literature, as used by the three other studies [10,19,21]. However, when applicable, the cut-offs used to measure muscle strength and physical performance were all based on more robust scientific evidence.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

The health economics burden of sarcopenia: a systematic review

et al. 2019

View full text Add to dashboard Cite

Despite of better knowledge about sarcopenia, an optimal understanding of its consequences from a public health perspective remains a challenge. Specifically, the economic burden of the illness is unclear. As a support for the public health policy makers and other health actors, our objective was to perform a systematic review of the literature comparing healthcare costs between sarcopenic and non-sarcopenic patients (under the registration number CRD42018099291). A search for relevant articles was conducted on the Medline and Scopus databases. Rigorous eligibility criteria were established (e.g., subjects with sarcopenia, both men and women, mean age of the sarcopenic population) and applied by two investigators to identify suitable studies. The first screening phase, performed by 2 independent reviewers, covered 455 references. Fourteen relevant studies were included in the final analysis. Overall, we noted an important heterogeneity between studies in the way of assessing sarcopenia (i.e. operational definitions, tools and cut-offs used). There were also large variations between studies in their cost analysis settings (i.e., discrepancies in time horizon, types and sources of economic data). Most of the studies focused on hospitalization costs following surgery for a specific disease such as cancer. Finally, 11 out of the 14 studies reported higher healthcare costs for sarcopenic patients. However, most of the included studies have important methodological bias (e.g. potential confusion factors rarely taken into account), and low to moderate quality scores. More standardized research, taking into account all the limitations of the published studies, should be conducted to assess the true impact of sarcopenia on healthcare consumption.

show abstract

One-year postoperative resource utilization in sarcopenic patients

Cited by 32 publications

References 33 publications

Computed tomography abbreviated assessment of sarcopenia following trauma

Computed tomography abbreviated assessment of sarcopenia following trauma

Bone mineral density predicts posttransplant survival among hepatocellular carcinoma liver transplant recipients

The health economics burden of sarcopenia: a systematic review

Contact Info

Product

Resources

About