Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy

Salem, Samer Abu; Almogy, Gidon; Lev‐Cohain, Naama; Bala, Miklosh; Issachar, Omer; Pikarsky, Alon J.; Yuval, Jonathan B.

doi:10.1016/j.jss.2020.07.031

Cited by 12 publications

(25 citation statements)

References 37 publications

(44 reference statements)

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“…Table 2 summarizes the characteristics of the 11 articles that met the inclusion criteria. The total sample size ranged from 80 to 967, all of which were retrospective studies [ 5 , 17 , 18 , 32 – 39 ]. Of the studies, 10 of them examined muscle mass at the level of the L3 vertebral body on CT scans to diagnose sarcopenia [ 5 , 17 , 32 – 37 , 39 ] and only one assessed the muscle mass at the level of the L4 vertebral body on CT scans [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

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Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

Luo

Deng

et al. 2022

World J Emerg Surg

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Background While emergency laparotomy has been associated with high rates of postoperative mortality and adverse events, preoperative systematic evaluation of patients may improve perioperative outcomes. However, due to the critical condition of the patient and the limited operation time, it is challenging to conduct a comprehensive evaluation. In recent years, sarcopenia is considered a health problem associated with an increased incidence of poor prognosis. This study aimed to investigate the effect of sarcopenia on 30-day mortality and postoperative adverse events in patients undergoing emergency laparotomy. Methods We systematically searched databases including PubMed, Embase, and Cochrane for all studies comparing emergency laparotomy in patients with and without sarcopenia up to March 1, 2022. The primary outcome was of 30-day postoperative mortality. Secondary outcomes were the length of hospital stay, the incidence of adverse events, number of postoperative intensive care unit (ICU) admissions, and ICU length of stay. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Result A total of 11 eligible studies were included in this study. The results showed that patients with sarcopenia had a higher risk of death 30 days after surgery (OR = 2.42, 95% CI = 1.93–3.05, P < 0.00001). More patients were admitted to ICU after surgery (OR = 1.58, 95% CI = 1.11–2.25, P = 0.01). Both the ICU length of stay (MD = 0.55, 95% CI = 0.05–1.06, P = 0.03) and hospital length of stay (MD = 2.33, 95% CI = 1.33–3.32, P < 0.00001) were longer in the sarcopenia group. The incidence of postoperative complications was also significantly higher in patients with sarcopenia (OR = 1.78, 95% CI = 1.41–2.26, P < 0.00001). Conclusion In emergency laparotomy, sarcopenia was associated with increased 30-day postoperative mortality. Both the lengths of stay in the ICU and the total length of hospital stay were significantly higher than those in non-sarcopenic patients. Therefore, we concluded that sarcopenia can be used as a tool to identify preoperative high-risk patients, which can be considered to develop new postoperative risk prediction models. Registration number Registered on Prospero with the registration number of CRD42022300132.

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Section: Resultsmentioning

confidence: 99%

“…Nine articles with a total of 3626 patients reported 30-day mortality following emergency laparotomy [ 5 , 17 , 32 – 34 , 36 – 39 ]. Compared with non-sarcopenic patients, sarcopenic patients had a higher risk of death 30 days after surgery (Fig.…”

Section: Resultsmentioning

confidence: 99%

Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

Luo

Deng

et al. 2022

World J Emerg Surg

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“…In our study, due to the calculation requirements of PML3, we referred to the inferior end-plate level of the L3 vertebra selected by Simpson et al [ 12 , 13 , 17 ]. There were also other studies that chose the L3 level that makes the two transverse processes of the third lumbar vertebra visible[ 16 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Tzeng et al, PMD can be used as an independent risk factor for the postoperative hospital stay in patients undergoing transcatheter aortic valve implantation [ 35 ]. In the study of Salem et al, PMD can also be used as an independent risk factor for emergency laparotomy [ 16 ]. The population difference might be one of the reasons to explain this.…”

Section: Discussionmentioning

confidence: 99%

“…Lu et al defined total psoas gauge (TPG) in the prognosis study of gastric cancer, proved it was an independent risk factor in the prediction model of postoperative complications [ 19 ]. In addition, studies showed that psoas muscle density (PMD) was associated with the prognosis of emergency laparotomy [ 2 , 16 ]. No studies have compared the predictive capability of all these psoas major muscle calculations on prognosis yet.…”

Section: Introductionmentioning

confidence: 99%

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CT psoas calculations on the prognosis prediction of emergency laparotomy: a single-center, retrospective cohort study in eastern Asian population

Shen

Danzeng

et al. 2022

World J Emerg Surg

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Background Emergency laparotomy (EL) has a high mortality rate. Clinically, frail patients have a poor tolerance for EL. In recent years, sarcopenia has been used as an important indicator of frailty and has received much attention. There have been five different calculation methods of psoas for computed tomography (CT) to measure sarcopenia, but lack of assessment of these calculation methods in Eastern Asian EL patients. Methods We conducted a 2-year retrospective cohort study of patients over 18 years of age who underwent EL in our institution. Five CT measurement values (PMI: psoas muscle index, PML3: psoas muscle to L3 vertebral body ratio, PMD: psoas muscle density, TPG: total psoas gauge, PBSA: psoas muscle to body face area ratio) were calculated to define sarcopenia. Patients with sarcopenia defined by the sex-specific lowest quartile of each measurement were compared with the rest of the cohort. The primary outcome was "ideal outcome", defined as: (1) No postoperative complications of Clavien-Dindo Grade ≥ 4; (2) No mortality within 30 days; (3) When discharged, no need for fluid resuscitation and assisted ventilation, semi-liquid diet tolerated, and able to mobilize independently. The second outcome was mortality at 30-days. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were used. Results Two hundred and twenty-eight patients underwent EL met the inclusion criteria, 192 (84.2%) patients had an ideal outcome after surgery; 32 (14%) patients died within 30 days. Multivariate analysis showed that, except PMD, each calculation method of psoas was independently related to clinical outcome (ideal outcome: PML3, P < 0.001; PMI, P = 0.001; PMD, P = 0.157; TPG, P = 0.006; PBSA, P < 0.001; mortality at 30-days: PML3, P < 0.001; PMI, P = 0.002; PMD, P = 0.088; TPG, P = 0.002; PBSA, P = 0.001). In ROC analysis, the prediction model containing PML3 had the largest area under the curve (AUC) value (AUC value = 0.922 and 0.920, respectively). Conclusion The sarcopenia determined by CT psoas measurements is significantly related to the clinical outcome of EL. The calculation of CT psoas measurement is suitable for application in outcome prediction of EL. In the future, it is necessary to develop a scoring tool that includes sarcopenia to evaluate the risk of EL better.

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Short and long-term impact of sarcopenia on outcomes from emergency laparotomy

Barazanchi

Bhat

Wells

et al. 2022

Eur J Trauma Emerg Surg

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Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy

Cited by 12 publications

References 37 publications

Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis

CT psoas calculations on the prognosis prediction of emergency laparotomy: a single-center, retrospective cohort study in eastern Asian population

Short and long-term impact of sarcopenia on outcomes from emergency laparotomy

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