Interventions to prevent and treat sarcopenia in a surgical population: a systematic review and meta-analysis

Abstract

Background The aim of this systematic review was to summarize the results of trials evaluating interventions for the reduction of sarcopenia in patients undergoing surgery. Methods Searches were conducted using the Cochrane Central Register of Controlled Trials, MEDLINE and Embase. RCTs evaluating exercise, dietary or pharmacological interventions to address sarcopenia in the perioperative period were included. Treatment effect estimates were expressed as standardized mean differences (MDs) with confidence intervals, and heterogeneity was expressed as I2 values. Results Seventy trials including 3402 participants were selected for the data synthesis. Exercise interventions significantly increased muscle mass (MD 0.62, 95 per cent c.i. 0.34 to 0.90; P < 0.001), muscle strength (MD 0.55, 0.39 to 0.71; P < 0.001), measures of gait speed (MD 0.42, 0.05 to 0.79; P = 0.03), and reduced time for completion of set exercises (MD −0.76, −1.12 to −0.40; P < 0.001) compared with controls. Subgroup analysis showed that interventions in the early postoperative period were more likely to have a positive effect on muscle mass (MD 0.71, 0.35 to 1.07; P < 0.001) and timed tests (MD −0.70, −1.10 to −0.30; P = 0.005) than preoperative interventions. Treatment effects on muscle mass (MD 0.09, −0.31 to 0.49; P = 0.66) and strength (MD 0.46, −0.01 to 0.92; P = 0.05) were attenuated by the presence of cancer. Results of analyses restricted to nine trials at low risk of allocation concealment bias and fourteen trials at low risk of attrition bias were comparable to those of the primary analysis. Risk-of-bias assessment showed that most trials were at high risk of incomplete outcome and attrition bias, thus reducing the estimate of certainty of the evidence according to the GRADE assessment tool. Conclusion Exercise interventions appear beneficial in reducing the impact of sarcopenia. Because of the high risk of bias and low certainty of the current evidence, large RCTs using standardized measures of muscle mass should be undertaken.

Incidence and factors associated with postoperative delirium in patients undergoing transurethral resection of bladder tumor

“…Low body weight could reflect low skeletal muscle mass, also known as sarcopenia, which is a risk factor for POD [ 22 , 23 ]. However, preoperative exercise training significantly contributes to increasing muscle mass [ 24 ]; therefore, our results provide the hypothesis whether increasing muscle mass can reduce the incidence of POD will be one of the most important topics for future research.…”

Preoperative physical performance as predictor of postoperative outcomes in patients aged 65 and older scheduled for major abdominal cancer surgery: A systematic review

“…Another recent RCT showed that frail older patients with colorectal cancer who had received moderate intensity exercise prehabilitation but were afterwards unable to attain 400 m on the 6MWT suffered more postoperative complications, implying that 400 m could be set as the minimum threshold to indicate successful prehabilitation [50]. It may also be possible to mitigate low muscle mass and strength through exercise and nutritional interventions, although data on the effectiveness of interventions to combat sarcopenia in older patients undergoing cancer surgery are still scarce [51].…”

Low Preoperative Serum Creatinine is Common and Associated With Poor Outcomes After Nonemergent Inpatient Surgery

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