The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: a systematic review and meta-analysis

Abstract

BackgroundGastric cancer is a major health problem, and frailty and sarcopenia will affect the postoperative outcomes in older people. However, there is still no systematic review to determine the role of frailty and sarcopenia in predicting postoperative outcomes among older patients with gastric cancer who undergo gastrectomy surgery.MethodsWe searched Embase, Medline through the Ovid interface and PubMed websites to identify potential studies. All the search strategies were run on August 24, 2016. We searched the Google website for unpublished studies on June 1, 2017. The data related to the endpoints of gastrectomy surgery were extracted. Odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled to estimate the association between sarcopenia and adverse postoperative outcomes by using Stata version 11.0. PRISMA guidelines for systematic reviews were followed.ResultsAfter screening 500 records, we identified eight studies, including three prospective cohort studies and five retrospective cohort studies. Only one study described frailty, and the remaining seven studies described sarcopenia. Frailty was statistically significant for predicting hospital mortality (OR 3.96; 95% CI: 1.12–14.09, P = 0.03). Sarcopenia was also associated with postoperative outcomes (pooled OR 3.12; 95% CI: 2.23–4.37). No significant heterogeneity was observed across these pooled studies (Chi2 = 3.10, I2 = 0%, P = 0.685).ConclusionSarcopenia and frailty seem to have significant adverse impacts on the occurrence of postoperative outcomes. Well-designed prospective cohort studies focusing on frailty and quality of life with a sufficient sample are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0569-2) contains supplementary material, which is available to authorized users.

Clinical Impact of Sarcopenia on Gastric Cancer

“…The evaluation of sarcopenia and its impact on prognosis of cancer patients has been attracting attention in clinical oncology. As shown in recent reviews and meta-analyses, compelling evidence has shown that sarcopenia, irrespective of definition, is independently associated with poor prognosis (37,38,(68)(69)(70). Considering the increase of the aged population, the proportion of patients suffering from both sarcopenia and gastric cancer will increase.…”

Use of hand grip strength in nutrition risk screening of older patients admitted to general surgical wards

“…This further complicates the association between reduced HGS and malnutrition in an older population. Whether indicative of nutritional status or sarcopenia, low HGS has been shown to be a predictor of increased length of stay, postoperative complications and requirement for assistance at admission and at 6 months post‐discharge . It may therefore be useful in screening patients who would most benefit from multidisciplinary intervention and early discharge planning.…”

The health economics burden of sarcopenia: a systematic review

“…They were all responsible for editing and reviewing the manuscript, and all saw approved the final version. 4…”

“…Sarcopenia, defined as a loss of muscle mass and function, is increasingly considered to be a major public health problem in the older population and in a range of clinical settings [1,2]. Indeed, the health consequences of sarcopenia include death, falls, new or prolonged hospitalizations, fractures, loss of mobility and physical function, a reduced quality of life [3][4][5][6]. Interestingly, most of these outcomes have potential direct or indirect costs, both for the patient and the society.…”