The effect of sarcopenic obesity and muscle quality on complications after DIEP-flap breast reconstruction

Sadok, Nadia; Hartmans, M.E.; Bock, Geertruida H. de; Klaase, Joost M.; Werker, Paul M. N.; Viddeleer, Alain R.; Jansen, Liesbeth

doi:10.1016/j.heliyon.2022.e09381

Cited by 3 publications

(3 citation statements)

References 38 publications

(56 reference statements)

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“…Sarcopenic obesity (SO) is a new type of obesity and a high-risk geriatric syndrome in elderly individuals. SO is characterized by the conjunction of insufficient muscle mass and function and excessive fat mass and is associated with many adverse health consequences, such as frailty, falls, disability, increased incidence rate and mortality, and the development of post-operative Clavien-Dindo grade ≥ II complications in women undergoing DIEP-flap breast reconstruction ( 51 , 52 ). Thus, the diagnostic criteria of SO in the indigenous plateau population are worthy of further research.…”

Section: Discussionmentioning

confidence: 99%

Normative reference data for body composition in healthy indigenous populations on the Qinghai-Tibet Plateau

Li²,

Huang³

et al. 2022

Front. Public Health

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Body composition represents an important aspect of physical fitness and has received increasing attention in recent years. The present study was designed and conducted to provide reference values for age-, sex-, and altitude-specific body composition for healthy indigenous Tibetan adults living on the Qinghai-Tibet Plateau, which has not yet been studied. A cross-sectional survey was conducted among 2,356 healthy Tibetan adults (1,433 females and 923 males) living on the Qinghai-Tibet Plateau for generations. The body composition of the participants was measured by bioelectrical impedance analysis (BIA). The measurements included weight, basal metabolic rate (BMR), fat-free mass (FFM), skeletal muscle mass (SMM), protein mass (PM), bone mass (BM), fat mass (FM), percentage of body fat (PBF), subcutaneous fat mass (SFM), visceral fat mass (VFM), total body water (TBW), intracellular water (ICW), and extracellular water (ECW). Overall, males had greater FFM, SMM, PM, BM, and water mass, whereas females were high in fat mass. Participants from plains generally had higher body composition values, and PM, BM, FM and body water values decreased with increasing altitude, with the lowest values found in >4,000 m Shigatse. FFM, SMM, PM, and BM tended to decrease with increasing age, whereas fat mass and ECW tended to increase with increasing age. This study provides the first normative reference data of body composition for healthy indigenous individuals on the Qinghai-Tibet Plateau. These datasets are important for future research related to body composition. A considerable decrease in body composition values in > 4,000 m-altitude areas suggested that body composition cutoff values should be established by altitude. Age-, sex-, and altitude-specific alterations in body composition values also inform the prevention and amendment of abnormal body composition changes and resultant health complications.

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Section: Discussionmentioning

confidence: 99%

Normative reference data for body composition in healthy indigenous populations on the Qinghai-Tibet Plateau

Li²,

Huang³

et al. 2022

Front. Public Health

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“…23 On the other hand, Broyles et al, Yoshino et al, and Sadok et al found that sarcopenia was not a strong predictor of complications and that BMI outperformed sarcopenia. [24][25][26] These three studies that found negative results in sarcopenia also suffered from smaller sample sizes than used in our study. Furthermore, each of these studies evaluated specific subsets of patients, not the overall breast reconstruction population.…”

Section: Discussionmentioning

confidence: 76%

“… 23 On the other hand, Broyles et al, Yoshino et al, and Sadok et al found that sarcopenia was not a strong predictor of complications and that BMI outperformed sarcopenia. 24 – 26 …”

Section: Discussionmentioning

confidence: 99%

Sarcopenia Best Predicts Complications in Free Flap Breast Reconstruction

Jain

Bingham

Luvisa

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Breast reconstruction remains a major component of the plastic surgeon’s repertoire, especially free-flap breast reconstruction (FFBR), though this is a high-risk surgery in which patient selection is paramount. Preoperative predictors of complication remain mixed in their utility. We sought to determine whether the sarcopenia score, a validated measure of physiologic health, outperforms the body mass index (BMI) and modified frailty index (mFI) in terms of predicting outcomes. Methods: All patients with at least 6-months follow-up and imaging of the abdomen who underwent FFBR from 2013 to 2022 were included in this study. Appropriate preoperative and postoperative data were included, and sarcopenia scores were extracted from imaging. Complications were defined as any unexpected outcome that required a return to the operating room or readmission. Statistical analysis and regression were performed. Results: In total, 299 patients were included. Patients were split into groups, based on sarcopenia scores. Patients with lower sarcopenia had significantly more complications than those with higher scores. BMI and mFI both did not correlate with complication rates. Sarcopenia was the only independent predictor of complication severity when other factors were controlled for in a multivariate regression model. Conclusions: Sarcopenia correlates with the presence of severe complications in patients who undergo FFBR in a stronger fashion to BMI and the mFI. Thus, sarcopenia should be considered in the preoperative evaluation in patients undergoing FFBR.

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Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis

Knoedler,

Schliermann,

Knoedler

et al. 2023

International Journal of Surgery

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Background: Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, we aimed to synthesize the available literature and investigate the impact of sarcopenia on peri- and postoperative outcomes across all surgical specialties. Methods: We systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Our primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at one, three, and five years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population, and on those of higher quality or prospective study design. Results: A total of 294 studies comprising 97,643 patients, of which 33,070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P<0.00001). A significantly lower survival rate in patients with sarcopenia was noted at one, three, and five years (all P<0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P<0.00001), cardiovascular (both P<0.00001), and emergency (P=0.03 and P=0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia (P<0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients (P=0.007). Sensitivity analysis based on higher-quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P<0.00001). Conclusion: Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons to identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical sub-specialties.

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The effect of sarcopenic obesity and muscle quality on complications after DIEP-flap breast reconstruction

Cited by 3 publications

References 38 publications

Normative reference data for body composition in healthy indigenous populations on the Qinghai-Tibet Plateau

Normative reference data for body composition in healthy indigenous populations on the Qinghai-Tibet Plateau

Sarcopenia Best Predicts Complications in Free Flap Breast Reconstruction

Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis

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