Predictive value of total psoas muscle index for postoperative physical functional decline in older patients undergoing emergency abdominal surgery

Yamaguchi, Keishi; Matsumoto, Shokei; Abe, Takeru; Nakajima, Kento; Senoo, Satomi; Shimizu, Masayuki; Takeuchi, Ichiro

doi:10.1186/s12893-023-02085-5

Cited by 3 publications

(3 citation statements)

References 42 publications

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“…Although this study found that chronological age is statistically associated with postoperative physical function decline, functional decline cannot be predicted using age alone [ 30 ]; frailty, defined as a decrease of physiological reserve, is a greater risk factor for functional decline than age [ 31 ]. Several tools exist to identify frailty in emergency cases, and in a simplified approach, previously, we revealed that low psoas muscle volume predicted early postoperative functional decline [ 32 ]. In addition, recent studies have shown that the use of laparoscopy in emergency abdominal surgery demonstrates a significant reduction in mortality in frail older patients [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study

Yamaguchi,

Abe,

Matsumoto

et al. 2024

BMC Geriatr

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Background An increasing number of older patients require emergency abdominal surgery for acute abdomen. They are susceptible to surgical stress and lose their independence in performing daily activities. Laparoscopic surgery is associated with faster recovery, less postoperative pain, and shorter hospital stay. However, few studies have examined the relationship between laparoscopic surgery and physical functional decline. Thus, we aimed to examine the relationship between changes in physical function and the surgical procedure. Methods In this was a single-center, retrospective cohort study, we enrolled patients who were aged ≥ 65 years and underwent emergency abdominal surgery for acute abdomen between January 1, 2019, and December 31, 2021. We assessed their activities of daily living using the Barthel Index. Functional decline was defined as a decrease of ≥ 20 points in Barthel Index at 28 days postoperatively, compared with the preoperative value. We evaluated an association between functional decline and surgical procedures among older patients, using multiple logistic regression analysis. Results During the study period, 852 patients underwent emergency abdominal surgery. Among these, 280 patients were eligible for the analysis. Among them, 94 underwent laparoscopic surgery, while 186 underwent open surgery. Patients who underwent laparoscopic surgery showed a less functional decline at 28 days postoperatively (6 vs. 49, p < 0.001). After adjustments for other covariates, laparoscopic surgery was an independent preventive factor for postoperative functional decline (OR, 0.22; 95% CI, 0.05–0.83; p < 0.05). Conclusions In emergency abdominal surgery, laparoscopic surgery reduces postoperative physical functional decline in older patients. Widespread use of laparoscopic surgery can potentially preserve patient quality of life and may be important for the better development of emergency abdominal surgery.

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Section: Discussionmentioning

confidence: 99%

Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study

Yamaguchi,

Abe,

Matsumoto

et al. 2024

BMC Geriatr

Self Cite

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“…A decrease in muscle volume can lead to limitations in ADL and a decline in quality of life [27,28]. Low muscle volume predicts poor clinical outcomes in various diseases [12][13][14]. One study reported an association between skeletal muscle mass and mortality of patients with critical illness [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…However, measurable parameters early in ICU admission have not been clearly validated to assess the risk of PICS. In various settings, skeletal muscle mass has been associated with various outcomes, including physical function [12][13][14]. One study revealed that the skeletal muscle mass of patients with critical illness is associated with mortality and ventilation-free days [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Association of Psoas Muscle Mass at Intensive Care Unit Admission With Physical Function and Post-discharge Destination in Survivors of Critical Illness

Kohei,

Takamura,

Nonaka

et al. 2024

Cureus

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Objective: Survivors of critical illness may have physical impairments, known as post-intensive care syndrome (PICS). Early screening for the risk of PICS is recommended to prevent PICS. Skeletal muscle mass is a clinically important indicator associated with various outcomes. This study aimed to examine the association of psoas muscle mass at intensive care unit (ICU) admission with the destination and physical function at hospital discharge. Methods: In this single-center retrospective cohort study, we reviewed the medical records of adult patients who had required emergency ICU admission and who had been intubated and mechanically ventilated. Psoas major muscle was measured as an indicator of skeletal muscle mass from abdominal computed tomography images at ICU admission. Physical function was assessed using the functional status score for the ICU and ICU mobility scale at hospital discharge. Multinomial logistic and multivariable linear regression were used to analyze the associations of the psoas muscle mass with the discharge destination and physical function at discharge. Results: We enrolled 124 patients (79 men and 45 women) with a median (interquartile range) age of 72.0 (62.0-80.0) years; 39 (31.5%) were discharged to home, 50 (40.3%) were transferred to rehabilitation wards, and 35 (28.2%) were transferred to long-term care settings. The psoas muscle area and volume were 16.9 (11.3-20.6) cm 2 and 228.3 (180.2-282.0) cm 3 in home discharge patients, 17.5 (11.5-21.5) cm 2 and 248.4 (162.0-311.4) cm 3 in rehabilitation ward patients, and 15.9 (10.3-19.5) cm 2 and 184.0 (137.0-251.1) cm 3 in long-term care patients. The areas and volumes of the psoas muscle were not significantly different in the three groups. Furthermore, psoas muscle mass was not significantly associated with the discharge destination and physical function. Conclusions: Discharge destination and physical function at hospital discharge were not significantly associated with psoas muscle mass at ICU admission.

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Sarcopenia Is a Risk Factor for Postoperative Complications Among Older Adults With Inflammatory Bowel Disease

Minawala,

Kim,

Delau

et al. 2024

Inflammatory Bowel Diseases

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Background Sarcopenia has been associated with adverse postoperative outcomes in older age cohorts, but has not been assessed in older adults with inflammatory bowel disease (IBD). Further, current assessments of sarcopenia among all aged individuals with IBD have used various measures of muscle mass as well as cutoffs to define its presence, leading to heterogeneous findings. Methods In this single-institution, multihospital retrospective study, we identified all patients aged 60 years and older with IBD who underwent disease-related intestinal resection between 2012 and 2022. Skeletal Muscle Index (SMI) and Total Psoas Index (TPI) were measured at the superior L3 endplate on preoperative computed tomography scans and compared through receiver operating characteristic curve. We then performed multivariable logistic regression to assess risk factors associated with an adverse 30-day postoperative outcome. Our primary outcome included a 30-day composite of postoperative mortality and complications, including infection, bleeding, cardiac event, cerebrovascular accident, acute kidney injury, venous thromboembolism, reoperation, all-cause rehospitalization, and need for intensive care unit-level care. Results A total of 120 individuals were included. Overall, 52% were female, 40% had ulcerative colitis, 60% had Crohn’s disease, and median age at time of surgery was 70 years (interquartile range: 65-75). Forty percent of older adults had an adverse 30-day postoperative outcome, including infection (23%), readmission (17%), acute kidney injury (13%), bleeding (13%), intensive care unit admission (10%), cardiac event (8%), venous thromboembolism (7%), reoperation (6%), mortality (5%), and cerebrovascular accident (2%). When evaluating the predictive performance of SMI vs TPI for an adverse 30-day postoperative event, SMI had a significantly higher area under the curve of 0.66 (95% CI, 0.56-0.76) as compared to 0.58 (95% CI, 0.48-0.69) for TPI (P = .02). On multivariable logistic regression, prior IBD-related surgery (adjusted odds ratio [adjOR] 6.46, 95% CI, 1.85-22.51) and preoperative sepsis (adjOR 5.74, 95% CI, 1.36-24.17) significantly increased the odds of adverse postoperative outcomes, whereas increasing SMI was associated with a decreased risk of an adverse postoperative outcome (adjOR 0.88, 95% CI, 0.82-0.94). Conclusions Sarcopenia, as measured by SMI, is associated with an increased risk of postoperative complications among older adults with IBD. Measurement of SMI from preoperative imaging can help risk stratify older adults with IBD undergoing intestinal resection.

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Predictive value of total psoas muscle index for postoperative physical functional decline in older patients undergoing emergency abdominal surgery

Cited by 3 publications

References 42 publications

Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study

Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study

Association of Psoas Muscle Mass at Intensive Care Unit Admission With Physical Function and Post-discharge Destination in Survivors of Critical Illness

Sarcopenia Is a Risk Factor for Postoperative Complications Among Older Adults With Inflammatory Bowel Disease

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