Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures

Deren, Matthew E.; Babu, Jacob; Cohen, Eric; Machan, Jason T.; Born, Christopher T.; Hayda, Roman A.

doi:10.2106/jbjs.16.00734

Cited by 74 publications

(61 citation statements)

References 32 publications

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“…However, our results differed in the positive relationship between sarcopenia and 1‐year mortality. Our results are consistent with numerous previous publications demonstrating an association with mortality following major surgery for carcinoma, solid organ transplant, and orthopedic trauma 8,10 . These results support the concept that patients presenting with sarcopenia, whether due to disease burden or frailty, have decreased physiologic reserves and are predisposed to postsurgical complication and mortality.…”

Section: Discussionsupporting

confidence: 92%

“…Research assessing the prognostic value of malnutrition and sarcopenia in patients undergoing orthopedic surgery, as well as clinical interventions to mitigate this risk is largely limited to elderly patients with hip fractures 4,5 . Retrospective studies have demonstrated an association between sarcopenia and increased risk of complications and mortality following emergency abdominal surgery, trauma, carcinoma resection, solid organ transplant, elective aortic aneurysm repair, hip fractures, and acetabular fracture in elderly patients 6‐19 . We sought to study the prognostic impact of skeletal muscle mass, for example, sarcopenia, as well as patient‐, tumor‐, and treatment‐related factors on postoperative outcomes following excision and limb reconstruction for sarcoma of the extremities.…”

Section: Introductionmentioning

confidence: 99%

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Sarcopenia is associated with increased mortality but not complications following resection and reconstruction of sarcoma of the extremities

Hendrickson

Mayo

Shamrock

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Evidence regarding the impact of sarcopenia on operative outcomes in patients with sarcoma is lacking. We evaluated the relationship between sarcopenia and postoperative complications or mortality among patients undergoing tumor excision and reconstruction.Methods: We retrospectively reviewed 145 patients treated with tumor excision and limb reconstruction for sarcoma of the extremities. Sarcopenia was defined as psoas index (PI) < 5.45 cm 2 /m 2 for men and <3.85 cm 2 /m 2 for women from preoperative axial CT. Regression analyses were used to assess the association between postoperative complications or mortality with PI, age, gender, race, body mass index, tumor histology, grade, depth, location, size, and neoadjuvant/adjuvant therapy.Results: There were 101 soft tissue tumors and 44 primary bone tumors. Sarcopenia was present in 38 patients (26%). Sarcopenic patients were older (median age: 72 vs 59 years, P = .0010) and had larger tumors (86.5%, >5 cm vs 77.7%, P = .023).Seventy-three patients experienced complications (51%) and 18 patients died within 1 year. Sarcopenia and metastatic disease were associated with increased 12-month mortality (hazard ratio [HR] = 6.68, P < .001; HR: 8.51, P < .001, respectively) but not complications (HR 1.45, P = .155, odds ratio, 1.32, P = .426, respectively).Conclusions: Sarcopenia and metastatic disease were independently associated with postoperative mortality but no complications following surgery.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Sarcopenia is associated with increased mortality but not complications following resection and reconstruction of sarcoma of the extremities

Hendrickson

Mayo

Shamrock

et al. 2020

Journal of Surgical Oncology

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“…By contrast, an extrinsically defined sarcopenia threshold faces scrutiny as to the similarity between the study population and the populations for which those thresholds have been established. Both Deren et al 25 and Kaplan et al 18 used sarcopenia cut-off values from a 2008 study by Prado et al , which examined sarcopenic obesity in patients with solid tumors of the respiratory and gastrointestinal tract 8 26 27…”

Section: Discussionmentioning

confidence: 99%

Radiographic assessment of sarcopenia in the trauma setting: a systematic review

Zumsteg

Chu

Midwinter

2020

Trauma Surg Acute Care Open

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BackgroundCompared with similarly injured patients of a younger age, elderly patients have worse outcomes from acute injury. One factor adversely affecting outcomes is sarcopenia, which has been assessed in healthy elderly populations through established clinical and radiological criteria. However, in the acute care setting, no such criteria have been established. Sarcopenia has been opportunistically assessed via radiographic means but there is as of yet no gold standard. The purpose of this review is to summarize the radiological methods used to diagnose sarcopenia in the acute care setting, and suggest ways in which these methods may lead to a consensus definition of sarcopenia and its relationship to patient outcomes.MethodsA systematic survey of medical databases was conducted, with 902 unique publications identified. After screening and application of inclusion and exclusion criteria, data regarding study population, outcome, imaging modality, and criteria for assessment of sarcopenia were extracted from 20 studies. Quality was assessed with the Newcastle-Ottawa Scale.ResultsCT was the imaging modality for 18 of the studies, with total psoas muscle cross-sectional area at the level of L3 and L4 being the dominant method for assessing sarcopenia. Adjustment for body morphology most commonly used patient height or L4 vertebral body area. The majority of articles found radiographically assessed sarcopenia to be significantly correlated to outcomes such as mortality, length of hospital stay, morbidity, and in-hospital complicationsConclusionsEstablishing a consistent definition would strengthen its applicability and generalizability to admission and discharge planning.Level of evidenceSystematic review, level III.

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“…7 In noncancer patients, CT-measured sarcopenia was associated with increased mortality in patients with chronic liver disease, chronic renal disease, pneumonia, and sepsis as well as in intensive care unit (ICU), trauma, vascular surgery, general surgery, orthopaedic surgery, and transplant patients. [44][45][46][47][48][49][50][51][52][53][54][55][56] In a cohort of 450 trauma patients age ! 65 years admitted to the ICU, CT-measured sarcopenia was associated with 1-year mortality.…”

Section: Consequences Of Sarcopeniamentioning

confidence: 99%

Sarcopenia: Beyond Muscle Atrophy and into the New Frontiers of Opportunistic Imaging, Precision Medicine, and Machine Learning

Lenchik

Boutin

2018

Semin Musculoskelet Radiol

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As populations continue to age worldwide, the impact of sarcopenia on public health will continue to grow. The clinically relevant and increasingly common diagnosis of sarcopenia is at the confluence of three tectonic shifts in medicine: opportunistic imaging, precision medicine, and machine learning. This review focuses on the state-of-the-art imaging of sarcopenia and provides context for such imaging by discussing the epidemiology, pathophysiology, consequences, and future directions in the field of sarcopenia.

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Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 74 publications

References 32 publications

Sarcopenia is associated with increased mortality but not complications following resection and reconstruction of sarcoma of the extremities

Sarcopenia is associated with increased mortality but not complications following resection and reconstruction of sarcoma of the extremities

Radiographic assessment of sarcopenia in the trauma setting: a systematic review

Sarcopenia: Beyond Muscle Atrophy and into the New Frontiers of Opportunistic Imaging, Precision Medicine, and Machine Learning

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