Is sarcopenia a useful predictor of outcome in patients after emergency laparotomy? A study using the NELA database

Abstract

Introduction Studies have reported on the use of frailty as a prognostic indicator in patients undergoing elective surgery. Similar data do not exist for patients undergoing emergency surgery. The aim of this study was to evaluate the effect of preoperative sarcopenia measured by computed tomography (CT) on outcome following emergency laparotomy. Materials and methods Data from the National Emergency Laparotomy Audit database were retrieved for patients who had undergone an emergency laparotomy over 12 months at York NHS Foundation Trust. Sarcopenia was assessed by psoas density and area on preoperative CT. Mortality rates at 30 days and 1 year were recorded. Secondary outcomes included discharge rates to non-independent living. Results A total of 259 patients were included. Overall cohort 30-day and 1-year mortality was 13.9% (36/259) and 28.2% (73/259), respectively. Sarcopenia measured by psoas density was associated with increased mortality compared with patients who did not develop sarcopenia at 30 days (29.7%, 19/64, vs. 8.7%, 17/195; P < 0.001; odds ratio, OR, 4.42; 95% confidence interval, CI 2.13-9.26) and at 1 year (57.8%, 37/64, vs. 18.5%, (36/195; P < 0.001; OR 6.05; 95%CI 3.28-11.18). An increase in mortality was seen in patients with sarcopenia measured by psoas area at 30 days (21.3%, 13/61, vs. 9.1%, 17/187; OR 2.71; 95%CI 1.23-5.96, P = 0.013) and at 1 year (42.6%, 26/61, vs. 20.9%, 39/187; OR 2.82; 95% CI 1.52-5.23, P < 0.001). Conclusions Sarcopenia assessed by measurement of psoas density and area on CT is associated with increased mortality following emergency laparotomy. The use of sarcopenia as a predictive tool merits further attention and may be useful in patients undergoing emergency surgery.

Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy

“…12,15,16 The values of the lower quartile for psoas attenuation in this study were 26 and 35.5 for unenhanced scans and enhanced scans, respectively, which is consistent with previous reported values ranging from 26 to 34 HU. 12,15,16 Previous studies did not address the effect of contrast enhancement on the association between psoas attenuation and postoperative outcomes, despite reports of a 10 HU difference between enhanced and unenhanced scans. 32,33 We therefore stratified for the presence of contrast enhancement in this study.…”

“…We demonstrated that when stratified for contrast enhancement, psoas attenuation is an independent risk factor for both 30-day mortality and prolonged LOS, whereas the psoas PCSDs was not associated with either outcome. The greater importance of attenuation over the PCSDs has been reported in the emergency surgery setting 12 and in the elective surgery setting. 34 Our findings along with these studies suggest that muscle quality may be more important than muscle size.…”

“…9 Furthermore, the accuracy of most of these algorithms is reduced when applied to older patients. [10][11][12][13] Such inaccuracies could result from additional factors such as frailty, which is unaccounted for in most of these algorithms.…”

“…In previous studies, sarcopenia has been suggested as a surrogate for frailty and has been associated with poor outcomes both in elective and emergency surgeries. 12,[14][15][16][17] The incidence of sarcopenia increases with age, and the prevalence of sarcopenia is therefore increasing as the world's population is aging. 18,19 Sarcopenia is commonly assessed by the muscle cross-sectional area (CSA) at the L3 vertebra level.…”

Emergency Laparotomies: Causes, Pathophysiology, and Outcomes

“…Sarcopenic patients had increased 30-day (29.7% vs 8.7%; odds ratio 4.42; 95% CI 2.13–9.26; p < 0.001) and 1-year mortality (57.8% vs 18.5%; p < 0.001; odds ratio 6.05; 95% CI 3.28–11.18) when compared non-sarcopenic patients. 9 …”