Introduction Studies have reported on the use of frailty as a prognostic indicator in patients undergoing elective surgery. Similar data do not exist for patients undergoing emergency surgery. The aim of this study was to evaluate the effect of preoperative sarcopenia measured by computed tomography (CT) on outcome following emergency laparotomy. Materials and methods Data from the National Emergency Laparotomy Audit database were retrieved for patients who had undergone an emergency laparotomy over 12 months at York NHS Foundation Trust. Sarcopenia was assessed by psoas density and area on preoperative CT. Mortality rates at 30 days and 1 year were recorded. Secondary outcomes included discharge rates to non-independent living. Results A total of 259 patients were included. Overall cohort 30-day and 1-year mortality was 13.9% (36/259) and 28.2% (73/259), respectively. Sarcopenia measured by psoas density was associated with increased mortality compared with patients who did not develop sarcopenia at 30 days (29.7%, 19/64, vs. 8.7%, 17/195; P < 0.001; odds ratio, OR, 4.42; 95% confidence interval, CI 2.13-9.26) and at 1 year (57.8%, 37/64, vs. 18.5%, (36/195; P < 0.001; OR 6.05; 95%CI 3.28-11.18). An increase in mortality was seen in patients with sarcopenia measured by psoas area at 30 days (21.3%, 13/61, vs. 9.1%, 17/187; OR 2.71; 95%CI 1.23-5.96, P = 0.013) and at 1 year (42.6%, 26/61, vs. 20.9%, 39/187; OR 2.82; 95% CI 1.52-5.23, P < 0.001). Conclusions Sarcopenia assessed by measurement of psoas density and area on CT is associated with increased mortality following emergency laparotomy. The use of sarcopenia as a predictive tool merits further attention and may be useful in patients undergoing emergency surgery.
Aims:To evaluate if frailty, as determined by measurements of sarcopenia, is associated with adverse outcomes following emergency laparotomy and relate this to outcome as assessed by more traditional pre-operative P-Possum scoring. Methods: Data from a continuous serious of patients undergoing emergency non-resuscitative laparotomy, entered in the National Emergency Laparotomy (NELA) Database, in a single institution between October 2014-2015 and who had undergone a pre-operative CT were recorded. The primary outcome was mortality, which was assessed at day 30 and 1 year. Sarcopenia was assessed by psoas density (PD) at the L3 level. To establish a cohort-specific cut off value for sarcopenia, the bottom quartile (Q1) of the cohort was considered sarcopenic. Pre-operative P-POSSUM scoring was established for all patients. Survival at 30 days and 1 year where compared between sarcopenic and non-sarcopenic patients and related to overall predicted P-POSSUM mortality in both groups.Results: A total of 87 consecutive patients undergoing emergency non-resuscitative laparotomy were identified. Sarcopenia was considered at or below a PD of 29.96 Hounsfield Units (HU). Overall cohort 30-day and 1 year mortality were respectively 19.5% (17/87) and 32% (28/87). Of the 22 patients considered sarcopenic, mortality at 30 days was 36.3% (8/22) vs. 13.8% (9/65) for the non-sarcopenic; p = 0.021, hazard ratio = 2.63. 1 year mortality was respectively 64% (14/22) vs. 21.5% (14/65); p < 0.001, Hazard ratio = 2.98. Employing P-POSSUM, predicted overall median (IQR) mortality for sarcopenic and non-sarcopenic patients was respectively 25.2 (8.3-54.2) % vs. 7.4 (2.9-18.7) %; p = 0.011. Conclusions: In patients undergoing emergency laparotomy, frailty as assessed by CT estimates of PD sarcopenia appears to be associated with appreciable 30 day and 1 year mortality. Frailty assessment by estimating PD on a pre-operative CT is quick, simple and readily available but not routinely included in traditional predictive scoring systems of mortality. These results support using the commonly undertaken pre-operative CT in patients undergoing emergency non-resuscitative laparotomy to assess frailty. 1-year mortality prediction in particular can help clinical decision-making and informed consent akin to P-possum Scoring.
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