The Impact of Low Muscle Mass in Patients Undergoing Emergency Surgery for Colonic Perforation – A Single-center Experience

Imamura, Hajime; Haraguchi, Masashi; Minami, Shigeki; Isagawa, Yuriko; Morita, M; Hirabaru, Masataka; Kawahara, Daisuke; Tokai, Hirotaka; Noda, Kazumasa; Inoue, Keiji; Eguchi, Susumu

doi:10.21873/invivo.11505

Cited by 6 publications

(6 citation statements)

References 22 publications

(26 reference statements)

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“…Sarcopenia has been recognized as one of the key elements of frailty and is associated with poorer surgical outcomes. Pre‐operative sarcopenia as measured with CT data has been consistently demonstrated to be associated with higher post‐operative mortality after EL, 1–20 and further verified in systematic reviews and meta‐analyses 21–24 . One of the reported ways to quantify sarcopenia is via analysis of CT scans to measure the ratio of the cross‐sectional area of psoas muscle to the area of the L3 vertebral body.…”

Section: Introductionmentioning

confidence: 91%

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Ming

Howley

Holmes

et al. 2023

ANZ Journal of Surgery

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Background Risk assessment for emergency laparotomy (EL) is important for guiding decision‐making and anticipating the level of perioperative care in acute clinical settings. While established tools such as the American College of Surgeons National Surgical Quality Improvement Program calculator (ACS‐NSQIP), the National Emergency Laparotomy Audit Risk Prediction Calculator (NELA) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity calculation (P‐POSSUM) are accurate predictors for mortality, there has been increasing recognition of the benefits from including measurements for frailty in a simple and quantifiable manner. Psoas muscle to 3rd lumbar vertebra area ratio (PM:L3) measured on CT scans was proven to have a significant inverse association with 30‐, 90‐ and 365‐day mortality in EL patients. Methods A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016–2017, and had contemporaneous abdomino‐pelvic CT scans. Radiological sarcopenia was measured as PM:L3 ratios. ASC‐NSQIP, NELA and P‐POSSUM were retrospectively calculated. Univariate and multivariate logistic regression modelling was used to assess these ratios and scores, as well as American Society of Anaesthesiologists (ASA) classification separated into ASA I‐III and IV/V (simplified ASA), as potential predictors of 30‐, 90‐ and 365‐day mortality. Results PM:L3, simplified ASA, ACS‐NSQIP, NELA and P‐POSSUM were each statistically significant predictors of 30‐day, 90‐day and 365‐day mortality (P < 0.001). Logistic regression models of 30‐, 90‐ and 365‐day mortality combining PM:L3 (P = 0.001) and simplified ASA (P < 0.001) exhibited AUCs of 0.838 (0.780, 0.896), 0.805 (0.751, 0.860) and 0.775 (0.729, 0.822), respectively, which were comparable to that of ACS‐NSQIP and NELA. Conclusion Combining the semi‐physiological parameter ASA classification with PM:L3 provides a quick and simple alternative to the more complex established risk assessment scores and is superior to PM:L3 alone.

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Section: Introductionmentioning

confidence: 91%

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Ming

Howley

Holmes

et al. 2023

ANZ Journal of Surgery

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“…Four studies were excluded because the abstract was only available and the full study was not retrievable in any database. Then, following a review of the full papers of the remaining hits, six were rejected for the following reasons: did not measure stoma incidence or complications with stomas [18], the study only looked at inguinal hernias [19], sarcopenia was not directly measured [20], surgery was only for colonic perforation [21], not all patients undergoing surgery received a stoma [4], and did not explore the complications of stomas [22] (see Table 1). Thus nine studies were finally included [23][24][25][26][27][28][29][30][31] and form the basis of this review.…”

Section: Overview Of All Included Studiesmentioning

confidence: 99%

A systematic review of the association between parastomal hernia and sarcopenia

Schutte

Patton

Moore

et al. 2023

Int J Colorectal Dis

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Background Sarcopenia is a multifactorial loss of muscle mass that can complicate surgical outcomes and increase morbidity and mortality. Parastomal hernias can occur after any surgery requiring stoma formation and is an area of concern as a complication as it can require a second surgery or emergency surgical intervention. Aim To assess the impact of sarcopenia on parastomal hernia formation in the postoperative period. Method A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in June 2022. Data were extracted, and a narrative synthesis was undertaken. The Crowe Critical Appraisal Tool (CCAT) assessed the quality of the included studies. The systematic review included original research studies, prospective and retrospective designs, and human studies written in English. Reviews, conference papers, opinion papers, and those including participants < 18 years old were excluded. No restrictions on the date of publication and study setting were applied. Results Nine studies met the inclusion criteria, and these were conducted between 2016 and 2021; 56% (n = 5) used a retrospective study design. The mean sample size was 242.5 participants (SD = ±358.6). No consistent or standardized way of defining sarcopenia or measuring muscle mass was seen between the studies reviewed. However, 45% (n = 4) of the studies reported a significant relationship between sarcopenia and wound healing complications, including an increased incidence of parastomal and incisional hernias. The average CCAT score was 27.56 (SD = ±4.39). Conclusion There is no definitive relationship between sarcopenia and hernia development; however, four studies found a significant relationship between sarcopenia and hernia formation. It must also be considered that different disease processes can cause sarcopenia either through the disease process itself, or the treatment and management. More research and consistent measurements are needed before comparable and consistent outcomes can be compiled.

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“…Salem et al 12 Simpson et al 13 Simpson et al 11 Brandt et al 14 Imamura et al 10 Francomacaro et al 15 Trotter et al 16 Five of seven studies showed association between low muscle mass and increased mortality rates after emergency laparotomy surgery and the average 30-day mortality rate in the low muscle mass group as defined by low TPA was 26.6% (SD = 25.9) compared with 13.3% (SD = 15.8) in the control high TPA groups. Brandt et al 14 also showed a clear separation in mortality on day 30 after emergency laparotomy surgery between the investigated low and high muscle mass groups.…”

Section: Authorsmentioning

confidence: 99%

Markers of sarcopenia increase 30-day mortality following emergency laparotomy: A systematic review

Brzeszczyński

Brzeszczyńska

2022

Scand J Surg

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Background and objective: Decreased skeletal muscle mass and quality are one of the several markers used for sarcopenia diagnosis and are generally associated with increased rates of post-operative infections, poorer recovery and increased mortality. The aim of this review was to evaluate methods applied to detect markers of sarcopenia and the associated outcomes for patients undergoing emergency laparotomy. Methods: This review was conducted with reference to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. MEDLINE, Embase and Google Scholar databases were searched. Studies detecting patients with sarcopenia or skeletal muscle decline markers and the associated outcomes after emergency laparotomy surgery were considered. The Newcastle–Ottawa Scale was used to evaluate publication quality. Results: Out of 103 studies, which were screened, 19 full-text records were reviewed and 7 studies were ultimately analyzed. The study cohort sizes ranged from n = 46 to n = 967. The age range was 36–95 years. There were 1107 females (53%) and 973 males (47%) across all 7 studies. All studies measured psoas muscle mass and three studies assessed psoas muscle quality using computerized tomography (CT) imaging. No study assessed muscle strength or function, while five studies showed an association between low muscle mass and increased mortality rates after emergency laparotomy. Among the three studies, which assessed muscle quality, two of three studies showed poorer 30-day survival rates. Conclusions: The existing literature is limited, however it indicates that low psoas muscle mass and quality markers are associated with increased 30-day mortality rates after emergency laparotomy. Therefore, muscle markers can be used as a new feasible tool to identify most at risk patients requiring further interventions.

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The Impact of Low Muscle Mass in Patients Undergoing Emergency Surgery for Colonic Perforation – A Single-center Experience

Cited by 6 publications

References 22 publications

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

A systematic review of the association between parastomal hernia and sarcopenia

Markers of sarcopenia increase 30-day mortality following emergency laparotomy: A systematic review

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