Low skeletal muscle mass outperforms the Charlson Comorbidity Index in risk prediction in patients undergoing pancreatic resections

Wagner, Doris; Marsoner, Katharina; Tomberger, A.; Haybaeck, Johannes; Haas, Josef; Werkgartner, Georg; Cerwenka, Herwig; Bacher, H.; Mischinger, Hans‐Jörg; Kornprat, Peter

doi:10.1016/j.ejso.2018.01.095

Cited by 30 publications

(19 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to these studies, CT-assessed sarcopenia indexes could be classified into 2 groups -SMI and PMI. While both SMI and PMI presented only the muscle quantity [19][20], MA, IMAC, HUAC, and LPMA were related to muscle quality [13,14,27,35].…”

Section: Discussionmentioning

confidence: 92%

“…Both HUAC [35] and LPMA [14] reveal both the muscle mass and the CT value of the bilateral psoas muscles, although the formulae for calculating these indexes vary. In previous studies [60,61], sarcopenia was mainly defined by the skeletal muscle mass, and it was considered that muscle strength and physical performance were directly related to the muscle mass.…”

Section: Discussionmentioning

confidence: 99%

“…Fifteen studies [11,13,[20][21][22][23] [32], and 1 in China [26]. Among the included studies, 13 studies were directed at liver [11,13,[19][20][21][22][23][24][25][26][27][28][29] malignancy, 2 bile duct [30,31], 6 pancreas [12,14,[32][33][34][35], 2 periampullary [36,37], 4 periampullary and pancreas [38][39][40][41], and 1 hepatopancreatobiliary [42]. The sample size ranged from 67 to 763.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All of the image analysis was based on CT, and the third lumbar vertebra was the most commonly used level. SMI/ TAMA was the most commonly used index, and it was used in 16 studies [11, 13, 19, 21, 23-28, 32, 34, 36-39], with SBI in 2 studies [40,42], PMI/TPA in 7 studies [12,20,22,[29][30][31]33], MA/RA in 5 studies [13,24,37,38,41], IMAC in 4 studies [20,27,31,33], HUAC in 1 study [35], LPMA in 1 study [14], and TPV in 1 study [12] ( Table 3).…”

Section: Definition Of Sarcopeniamentioning

confidence: 99%

“…HUAC, TPV, and LPMA Due to the scarcity of original studies reporting the HUAC [35], TPV [12], and LPMA [14] indexes, the data were not pooled. In the 3 included studies, both lower HUAC (HR 1.55, 95% CI 0.98-2.45, p = 0.014) and TPV (OR 1.69, 95% CI 1.16-2.46, p = 0.006) were both associated with an increased risk of major postoperative complications.…”

Section: Intramuscular Adipose Tissue Contentmentioning

confidence: 99%

See 4 more Smart Citations

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

View full text Add to dashboard Cite

Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Definition Of Sarcopeniamentioning

confidence: 99%

Section: Intramuscular Adipose Tissue Contentmentioning

confidence: 99%

See 3 more Smart Citations

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

View full text Add to dashboard Cite

show abstract

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Weerink

Hoorn

Leeuwen

et al. 2020

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

Background Sarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta‐analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery. Methods PubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta‐analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien‐Dindo grade ≥3, including 30‐day mortality. Heterogeneity was evaluated with I2 testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date. Results A total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta‐analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30‐day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (ORpooled: 1.44, 95% CI: 1.24–16.8, P<0.001, I2=55%) and 30‐day mortality (ORpooled: 2.15, 95% CI: 1.46–3.17, P<0.001, I2=14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (ORpooled: 2.06, 95% CI: 1.37–3.09, ORpooled: 1.32, 95% CI: 1.14–1.53, respectively) and 30‐day mortality [ORpooled: 6.17 (95% CI: 2.71–14.08, ORpooled: 1.80 (95% CI: 1.24–2.62), respectively]. The effect was independent of tumour location and publication date. Conclusions The presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30‐day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.

show abstract

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

Broyles

Smith

Phillips

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

Purpose: The identification of patient-specific risk factors, which predict morbidity following abdominally based microvascular breast reconstruction is difficult. Sarcopenia is a proxy for patient frailty and is an independent predictor of complications in a myriad of surgical disciplines. We predict that sarcopenic patients will be at higher risk for surgical complications following abdominally based microvascular breast reconstruction. Methods: A retrospective study of all patients who underwent delayed abdominally based autologous breast reconstruction following postmastectomy radiation therapy from 2007 to 2013 at a single institution was conducted. Univariate and multiple logistic regression models were used to assess the effect of sarcopenia on postoperative outcomes. Results: Two hundred and eight patients met the inclusion criteria, of which 30 met criteria for sarcopenia (14.1%). There were no significant differences in demographics between groups. There were no significant differences in minor (36.7% vs 44.4%; P = .43) or major (16.7% vs 25.3%; P = .36) complications between groups as well as hospital length of stay. Multivariable logistic regression demonstrated that a staged reconstruction with the use of a tissue expander was the only consistent variable, which predicted major complications (OR, 2.24; 95% CI, 1.18-4.64; P = .015). Conclusions: Sarcopenia does not predispose to minor or major surgical complications in patients who undergo abdominally based microsurgical breast reconstruction.

show abstract

Low skeletal muscle mass outperforms the Charlson Comorbidity Index in risk prediction in patients undergoing pancreatic resections

Cited by 30 publications

References 35 publications

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

Contact Info

Product

Resources

About