Implications of Sarcopenia in Major Surgery

Friedman, Jeffrey F.; Lussiez, Alisha; Sullivan, J. A.; Wang, Stewart; Englesbe, Michael J.

doi:10.1177/0884533615569888

Cited by 128 publications

(108 citation statements)

References 20 publications

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“…Sarcopenia, or low muscle mass for height, is a catabolic state associated with an inflammatory condition (9). Futhermore, sarcopenia has been associated with increased morbidity and mortality risk following major surgical procedures (10). Inflammation has been implicated as a driving mechanism for the development of sarcopenia (11).…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Kays

Liang

Zimmers

et al. 2018

JCSM Clinical Reports

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Aims Repair of abdominal aortic aneurysms (AAA) decreases the incidence of rupture and death. In cancer patients, sarcopenia has been associated with increased surgical complications and mortality. The impact of sarcopenia on survival after AAA repair has yet to be described. Methods and ResultsPatient demographic, laboratory, body composition measurements and survival data were obtained from patients undergoing AAA repair at the Indiana University medical campus over a 5-year period. Univariate and multivariate analyses were performed to identify factors associated with overall survival. Overall, 58.2% presented with sarcopenia. Sarcopenic patients were older (71.88.3 versus 66.88.1 years; p<0.001), had lower body mass index (BMI) (26.35.2 versus 31.55.9 kg/m 2 ; p<0.001), higher rates of myosteatosis (84.4% versus 52.%; p<0.001), greater AAA diameter (60.614.0 versus 57.811.7 mm; p=0.016), higher Charlson Comorbidity Index (CCI) (32.3% versus 25.1% 6; p=0.034), and increased rates of rupture (8.2% versus 3.8%; p=0.047). Sarcopenic and nonsarcopenic patients had no difference in 30-day morbidity (8.5% versus 8.5%; p=0.991) or mortality (3.7% versus 0.9%; p=0.07). Univariate analysis demonstrated age, sarcopenia, myosteatosis, CCI, and BMI to be associated with long-term survival. There was no correlation between BMI and sarcopenia. Both sarcopenia and myosteatosis resulted in decreased one-, three-, and five-year survivals compared to their counterparts. On multivariate analysis sarcopenia is independently associated with survival, conferring a 1.6-fold increase in death (p=0.04). The combination of sarcopenia plus myosteatosis doubled the risk of death compared to sarcopenia alone.Conclusions This is the first study to demonstrate that over half of all patients undergoing AAA repair are sarcopenic, a condition associated with increased mortality. Sarcopenia with myosteatosis is associated with double the mortality of sarcopenia alone. CT scan, but not BMI, accurately identifies sarcopenia and myosteatosis. Defining the mechanisms through which sarcopenia contributes to late death after AAA repair is critical to developing novel interventions that may improve survival in this high risk population.

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Section: Introductionmentioning

confidence: 99%

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Kays

Liang

Zimmers

et al. 2018

JCSM Clinical Reports

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“…In critically ill patients, clinical measurement using handgrip strength or another validated instrument is difficult or near to impossible if the patient is either sedated or suffering from delirium. Low muscle mass is referred to as sarcopenia, which is prevalent in critically ill patients, potentially complicating their clinical course [21-23]. …”

Section: Discussionmentioning

confidence: 99%

“…Our results show a moderate correlation between TMA and LPA regardless of age group (below or above 65 years) or sex. Despite this moderate correlation, both measuring techniques were able to identify patients at risk for prolonged length of hospital stay, length of stay in intensive care, and functional outcome in several studies [21, 23-27]. The transmission from planimetric to diametric measurement of LPA has been described before with a high correlation [10].…”

Section: Discussionmentioning

confidence: 99%

Quantification of Adipose Tissue and Muscle Mass Based on Computed Tomography Scans: Comparison of Eight Planimetric and Diametric Techniques Including a Step-By-Step Guide

et al. 2018

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Background: Recent scientific work proved that knowledge about body composition beyond the body mass index is essential. Both adipose tissue and muscular status are determining risk factors of morbidity and mortality. Analysis of single cross-sectional computed tomography (CT) images, acquired during routine care only to prevent additional radiation exposure, provide a detailed insight into the body composition of chronically and critically ill patients. Methods: This retrospective study included 490 trauma patients of whom a whole-body multiple detector CT scan was acquired at admission. From a single cross-sectional CT, we compared eight diametric and planimetric techniques for the assessment of core muscle mass as well as visceral and subcutaneous adipose tissue. Furthermore, we derived formulas for converting the measurement results of various techniques into each other. Results: For intra- and interobserver reliability, we obtained intraclass correlation coefficients (ICCs) ranging from 0.947 to 0.997 (intraobserver reliability) and from 0.850 to 0.998 (interobserver reliability) for planimetric measurements. Diametric techniques conferred lower ICCs with 0.851–0.995 and 0.833–0.971, respectively. Overall, area-based measurements of abdominal adipose tissue yielded highly correlated results with diametric measures of obesity. For example, the Pearson correlation of visceral adipose tissue and sagittal abdominal diameter was 0.87 for male and 0.82 for female patients. Planimetric and diametric muscle measurements correlated best for lean psoas area and bilateral diametric measurement of the psoas with a Pearson correlation of 0.90 and 0.93 for male and female patients, respectively. Conclusion: Planimetric measurements should remain the gold standard to describe fat and muscle compartments. Diametric measurements could however serve as a surrogate if planimetric techniques are not readily available or feasible as for example in large registries.

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“…47,48 Frailty and its underlying sarcopenia have been shown to predict risk of death, disability, and other adverse outcomes, including muscle mass atrophy, metabolic deterioration, slowed wound or postsurgical healing, and delayed recovery from illness. 32,34,35 Frailty and the weakness that follows muscle loss lead to higher risk of falls, fractures, 30 physical disability, 29 need for institutional care, 29 reduced quality of life, 36 and heightened mortality. 29,33 Early identification of frailty risk provides the opportunity to provide interventions and avoid or delay disability as well as enhance recovery.…”

Section: Complications Associated With Loss Of Musclementioning

confidence: 99%

“…34,49,50 Results of a recent study showed that older adults (mean age=70 years) who were very frail spent (Euro) 1917 more on total health costs in an interval of 3 months than did those who were not frail. 51 In the United States, the direct cost of cachexia/sarcopenia to health care was reported to be 1.5% of annual total health care expenses.…”

Section: Complications Associated With Loss Of Musclementioning

confidence: 99%

Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease

Argilés

Campos

López-Pedrosa

et al. 2016

Journal of the American Medical Directors Association

328

238

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Skeletal muscle is recognized as vital to physical movement, posture, and breathing. In a less known but critically important role, muscle influences energy and protein metabolism throughout the body. Muscle is a primary site for glucose uptake and storage, and it is also a reservoir of amino acids stored as protein. Amino acids are released when supplies are needed elsewhere in the body. These conditions occur with acute and chronic diseases, which decrease dietary intake while increasing metabolic needs. Such metabolic shifts lead to the muscle loss associated with sarcopenia and cachexia, resulting in a variety of adverse health and economic consequences. With loss of skeletal muscle, protein and energy availability is lowered throughout the body. Muscle loss is associated with delayed recovery from illness, slowed wound healing, reduced resting metabolic rate, physical disability, poorer quality of life, and higher health care costs. These adverse effects can be combatted with exercise and nutrition. Studies suggest dietary protein and leucine or its metabolite β-hydroxy β-methylbutyrate (HMB) can improve muscle function, in turn improving functional performance. Considerable evidence shows that use of high-protein oral nutritional supplements (ONS) can help maintain and rebuild muscle mass and strength. We review muscle structure, function, and role in energy and protein balance. We discuss how disease- and age-related malnutrition hamper muscle accretion, ultimately causing whole-body deterioration. Finally, we describe how specialized nutrition and exercise can restore muscle mass, strength, and function, and ultimately reverse the negative health and economic outcomes associated with muscle loss.

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Implications of Sarcopenia in Major Surgery

Cited by 128 publications

References 20 publications

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Quantification of Adipose Tissue and Muscle Mass Based on Computed Tomography Scans: Comparison of Eight Planimetric and Diametric Techniques Including a Step-By-Step Guide

Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease

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