CT-derived sarcopenia should not preclude surgical stabilization of traumatic rib fractures

Abstract

Background Rib fractures are associated with considerable morbidity and mortality. Surgical stabilization of rib fractures (SSRF) can be performed to mitigate complications. Sarcopenia is in general known to be associated with poor clinical outcomes. We investigated if sarcopenia impacted number of days of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay in patients who underwent SSRF. Methods A retrospective single institutional review was performed including patients who underwent SSRF (2009–2017). Skeletal muscle index (SMI) was semiautomatically calculated at the L3 spinal level on computed tomography (CT) images and normalized by patient height. Sarcopenia was defined as SMI < 55 cm2/m2 in males and < 39 cm2/m2 in females. Demographics, operative details, and postoperative outcomes were reviewed. Univariate and multivariate analyses were performed. Results Of 238 patients, 88 (36.9%) had sarcopenia. There was no significant difference in number of days of mechanical ventilation (2.8 ± 4.9 versus 3.1 ± 4.3, p = 0.304), ICU stay (5.9 ± 6.5 versus 4.9 ± 5.7 days, p = 0.146), or total hospital stay (13.3 ± 7.2 versus 12.9 ± 8.2 days, p = 0.183) between sarcopenic and nonsarcopenic patients. Sarcopenic patients demonstrated increased modified frailty index scores (1.5 ± 1.1 versus 0.9 ± 0.9, p < 0.001) compared to nonsarcopenic patients. Conclusions For patients who underwent SSRF for rib fractures, sarcopenia did not increase the number of days of mechanical ventilation, ICU stay, or total hospital stay. Sarcopenia should not preclude the utilization of SSRF in these patients.

Prevalence and prognostic value of preexisting sarcopenia in patients with mechanical ventilation: a systematic review and meta-analysis

“…Three additional studies were identified through manual reference review. Finally, we selected 17 studies [ 7 , 18 – 20 , 29 – 41 ] that met our criteria for inclusion in the present systematic review and meta-analysis. The study selection flowchart is shown in Fig.…”

“…The characteristics of the 17 included studies are summarized in Table 1 . Of these, 3 adopted a prospective cohort study [ 30 , 36 , 38 ], 13 were retrospective cohort study [ 7 , 19 , 20 , 29 , 31 – 35 , 37 , 39 – 41 ], and 1 was a cross-sectional study [ 18 ]. The sample sizes for the included studies ranged from 45 to 519, with 3582 total patients and an average age ranging from 41.4 to 79 years.…”

“…CT scans were utilized for muscle mass assessments. Twelve studies measured total skeletal muscle mass at the L1, L3, or L4 lumbar vertebrae [ 7 , 18 – 20 , 29 , 31 – 34 , 36 , 37 , 39 ]; two studies defined sarcopenia by measuring the thoracic paravertebral muscle (TPM) (T4 or T12) [ 35 , 41 ]; one study defined sarcopenia based upon measurements of total psoas muscle area (TPA) [ 40 ]; and two studies defined sarcopenia based upon LMM (assessed by BIA) plus LMS (assessed by HGD) [ 30 , 38 ]. A range of measurement approaches and cutoff thresholds were employed to detect the LMM and LMS and are presented in Additional file 1 : Table S5.…”

“…Some studies have found that such patients on MV with preexisting sarcopenia tend to have poor outcomes, including increased ICU mortality, prolonged duration of MV, ICU stay, and hospital stay [ 7 , 17 – 19 ]. Other studies have reported inconsistent outcomes and conclusions [ 20 , 21 ]. There have been systematic reviews [ 22 , 23 ] about sarcopenia and mortality in critically ill patients, but these studies focused on critically ill patients.…”