Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair

Lee, Jay Soong Jin; He, Kevin; Harbaugh, Calista M.; Schaubel, Douglas E.; Sonnenday, Christopher J.; Wang, Stewart C.; Englesbe, Michael J.; Eliason, Jonathan L.

doi:10.1016/j.jvs.2010.10.111

Cited by 231 publications

(199 citation statements)

References 19 publications

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“…There is a growing body of literature on the negative effect of sarcopenia on surgical outcomes and mortality. Both Lee et al and Drudi et al demonstrated increased risk of mortality after AAA repair with decreasing total psoas muscle (25,26). However, both studies defined sarcopenia based on the lowest tertile within the study group, making their definition susceptible to selection bias.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Kays

Liang

Zimmers

et al. 2018

JCSM Clinical Reports

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Aims Repair of abdominal aortic aneurysms (AAA) decreases the incidence of rupture and death. In cancer patients, sarcopenia has been associated with increased surgical complications and mortality. The impact of sarcopenia on survival after AAA repair has yet to be described. Methods and ResultsPatient demographic, laboratory, body composition measurements and survival data were obtained from patients undergoing AAA repair at the Indiana University medical campus over a 5-year period. Univariate and multivariate analyses were performed to identify factors associated with overall survival. Overall, 58.2% presented with sarcopenia. Sarcopenic patients were older (71.88.3 versus 66.88.1 years; p<0.001), had lower body mass index (BMI) (26.35.2 versus 31.55.9 kg/m 2 ; p<0.001), higher rates of myosteatosis (84.4% versus 52.%; p<0.001), greater AAA diameter (60.614.0 versus 57.811.7 mm; p=0.016), higher Charlson Comorbidity Index (CCI) (32.3% versus 25.1% 6; p=0.034), and increased rates of rupture (8.2% versus 3.8%; p=0.047). Sarcopenic and nonsarcopenic patients had no difference in 30-day morbidity (8.5% versus 8.5%; p=0.991) or mortality (3.7% versus 0.9%; p=0.07). Univariate analysis demonstrated age, sarcopenia, myosteatosis, CCI, and BMI to be associated with long-term survival. There was no correlation between BMI and sarcopenia. Both sarcopenia and myosteatosis resulted in decreased one-, three-, and five-year survivals compared to their counterparts. On multivariate analysis sarcopenia is independently associated with survival, conferring a 1.6-fold increase in death (p=0.04). The combination of sarcopenia plus myosteatosis doubled the risk of death compared to sarcopenia alone.Conclusions This is the first study to demonstrate that over half of all patients undergoing AAA repair are sarcopenic, a condition associated with increased mortality. Sarcopenia with myosteatosis is associated with double the mortality of sarcopenia alone. CT scan, but not BMI, accurately identifies sarcopenia and myosteatosis. Defining the mechanisms through which sarcopenia contributes to late death after AAA repair is critical to developing novel interventions that may improve survival in this high risk population.

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Section: Discussionmentioning

confidence: 99%

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Kays

Liang

Zimmers

et al. 2018

JCSM Clinical Reports

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“…This is in agreement with the work of authors in other surgical disciplines. 3,7,12,13,17,18,22,24 The association with preoperative psoas size and postoperative morbidity is especially apparent in male patients. It is important to note that our morphometric analysis was not predictive or statistically significant in female patients.…”

Section: Discussionmentioning

confidence: 99%

“…Morphometric analysis has proven utility in predicting postoperative morbidity and mortality following major general, vascular, and transplant surgery. 2,4,6,7,12,13,17,18,22,24,31 This study evaluates whether morphometrics can be used as a reliable predictor of perioperative morbidity in patients undergoing lumbar spine surgery.…”

mentioning

confidence: 99%

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Zakaria¹,

Schultz

Mossa-Basha

et al. 2015

FOC

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OBJECT Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery. METHODS The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit. RESULTS The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04–2.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17–5.01, p = 0.016) for having a postoperative complication. The paraspinal muscle groups did not provide any significant data for postoperative morbidity, even after multivariate analysis. CONCLUSIONS The morphometric measurement of psoas muscle size may be a sensitive predictive tool compared with other risk factors for perioperative morbidity in male patients undergoing lumbar surgery.

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“…It leads to nosocomial infections [3], postoperative complications [4][5][6][7], increased length of hospital stay [7,8], and decreased survival in nonmalignant as well as malignant populations [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

et al. 2014

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Background Skeletal muscle loss is associated with physical disability, nosocomial infections, postoperative complications, and decreased survival. Preventing the loss of skeletal muscle mass after gastrectomy may lead to improved outcomes. The aims of this study were to assess changes in skeletal muscle mass after total gastrectomy (TG) and to clarify the clinical factors affecting significant loss of skeletal muscle after TG. Patients and methods One hundred and two patients undergoing TG for primary gastric cancer underwent abdominal computed tomography before and 1 year after TG to precisely quantify postoperative changes in skeletal muscle and adipose tissue. Univariate and multivariate logistic regression analyses identified clinical factors contributing to significant loss of skeletal muscle after TG.Results At 1 year after TG, the mass of both skeletal muscle and adipose tissue was reduced by 6.20 ± 6.80 and 65.8 ± 36.1 % of the preoperative values, respectively, and 26 patients (25.5 %) showed a significant loss of skeletal muscle of more than 10 %. Adjuvant chemotherapy with S-1 for C6 months (hazard ratio 26.61, 95 % confidence interval, 3.487-203.1) was identified as the single independent risk factor for a significant loss of skeletal muscle. Conclusions Skeletal muscle loss was exacerbated by extended adjuvant chemotherapy after TG. Further research should identify appropriate nutritional interventions for maintaining skeletal muscle mass and leading to improved outcomes.

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Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair

Cited by 231 publications

References 19 publications

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Skeletal muscle loss after total gastrectomy, exacerbated by adjuvant chemotherapy

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