Sarcomania? The Inapplicability of Sarcopenia Measurement in Predicting Incisional Hernia Development

Rooijen, M. M. J. van; Kroese, Leonard F.; Vugt, Jeroen L.A. van; Lange, Johan F.

doi:10.1007/s00268-018-4837-x

Cited by 16 publications

(28 citation statements)

References 51 publications

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“…Van Rooijen and colleagues recently published their series describing the development of ventral hernia after incisional laparotomy for oncologic surgery and demonstrated no predictive value of sarcopenia while commenting on the inherent selection bias, which occurs when selecting patients for a clinical trial and that obviously frail and/or deconditioned patients were not offered surgery and/or elected not to participate. 30 Similar findings have been seen in the elective spine surgery literature. It should be noted that aside from the presence of rheumatologic disease and a slightly lower, yet physiologically normal BMI, there was no obvious phenotypic evidence of sarcopenia in the breast cancer patients included in this study.…”

Section: Discussionsupporting

confidence: 80%

“…Similar results have been seen in other published series where the presence of sarcopenia does not predict certain postoperative complications in elective surgery. Van Rooijen and colleagues recently published their series describing the development of ventral hernia after incisional laparotomy for oncologic surgery and demonstrated no predictive value of sarcopenia while commenting on the inherent selection bias, which occurs when selecting patients for a clinical trial and that obviously frail and/or deconditioned patients were not offered surgery and/or elected not to participate 30 . Similar findings have been seen in the elective spine surgery literature.…”

Section: Discussionmentioning

confidence: 73%

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The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

Broyles

Smith

Phillips

et al. 2020

Journal of Surgical Oncology

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Purpose: The identification of patient-specific risk factors, which predict morbidity following abdominally based microvascular breast reconstruction is difficult. Sarcopenia is a proxy for patient frailty and is an independent predictor of complications in a myriad of surgical disciplines. We predict that sarcopenic patients will be at higher risk for surgical complications following abdominally based microvascular breast reconstruction. Methods: A retrospective study of all patients who underwent delayed abdominally based autologous breast reconstruction following postmastectomy radiation therapy from 2007 to 2013 at a single institution was conducted. Univariate and multiple logistic regression models were used to assess the effect of sarcopenia on postoperative outcomes. Results: Two hundred and eight patients met the inclusion criteria, of which 30 met criteria for sarcopenia (14.1%). There were no significant differences in demographics between groups. There were no significant differences in minor (36.7% vs 44.4%; P = .43) or major (16.7% vs 25.3%; P = .36) complications between groups as well as hospital length of stay. Multivariable logistic regression demonstrated that a staged reconstruction with the use of a tissue expander was the only consistent variable, which predicted major complications (OR, 2.24; 95% CI, 1.18-4.64; P = .015). Conclusions: Sarcopenia does not predispose to minor or major surgical complications in patients who undergo abdominally based microsurgical breast reconstruction.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 73%

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

Broyles

Smith

Phillips

et al. 2020

Journal of Surgical Oncology

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“…Univariate analysis for an increased risk of SSO demonstrated a significant association with obesity, preoperative RT, hypertension, and bilateral component separation ( abdominis release and should be considered whenever possible. [27][28][29] Similar to Rooijen et al 30 our study demonstrated that obesity had a greater impact on hernia occurrence and SSOs than sarcopenia.…”

Section: Surgical Site Occurrencesupporting

confidence: 88%

The impact of sarcopenia on oncologic abdominal wall reconstruction

Bailey¹,

Schaverien

Garvey

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Sarcopenia is an objective measure of patient frailty and is a predictor of adverse surgical outcomes. We hypothesized that sarcopenia is associated with increased surgical site occurrence (SSO) and hernia occurrences in patients undergoing oncologic abdominal wall reconstruction. Methods: Consecutive patients who underwent abdominal wall reconstruction (AWR) for an abdominal wall ablative defect at a single center from 2005 to 2015 were evaluated. The total psoas index (TPI) was used to define sarcopenia. The primary endpoint of the study was hernia occurrence; (SSO) was a secondary outcome measure. Results: Eighty-six patients met the inclusion criteria. Multivariate analysis demonstrated that sarcopenia increased the risk of hernia more than threefold, trending toward significance (OR = 3.3; 95% CI: 0.69-15.4; P = .13). Multivariate logistic regression demonstrated that preoperative radiotherapy (OR = 4.8, 95% CI: 1.4-16; P = .01) and obesity (OR = 4.9, 95% CI: 1.5-16.3; P =.009) were independent predictors of developing an SSO. Conclusions: Sarcopenia, as defined by TPI, is correlated with hernia occurrence, but not SSO. These findings emphasize the importance of preoperative fitness and nutritional optimization and provide useful information for preoperative counseling and risk stratification.

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“…Sarcopenia is of increasing clinical interest in a number of complex surgical specialties, including surgical oncology, transplant surgery, trauma, emergency, and vascular surgery [1][2][3][4][5][6][7][8][9][10]. Sarcopenia is defined as a loss of skeletal muscle mass, with an associated reduction in muscle strength and functional capacity [11][12][13]. Recent studies have identified sarcopenia as an independent predictor of poor postoperative outcomes following major abdominal surgery, particularly in patients undergoing oncological resection.…”

Section: Introductionmentioning

confidence: 99%

The emerging role of sarcopenia as a prognostic indicator in patients undergoing abdominal wall hernia repairs: a systematic review of the literature

Clark

Malietzis

Grove

et al. 2020

Hernia

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Background There is strong evidence suggesting that excessive fat distribution, for example, in the bowel mesentery or a reduction in lean body mass (sarcopenia) can influence short-, mid-, and long-term outcomes from patients undergoing various types of surgery. Body composition (BC) analysis aims to measure and quantify this into a parameter that can be used to assess patients being treated for abdominal wall hernia (AWH). This study aims to review the evidence linking quantification of BC with short-and long-term abdominal wall hernia repair outcomes. Methods A systematic review was performed according to the PRISMA guidelines. The literature search was performed on all studies that included BC analysis in patients undergoing treatment for AWH using Medline, Google Scholar and Cochrane databases by two independent reviewers. Outcomes of interest included short-term recovery, recurrence outcomes, and long-term data. Results 201 studies were identified, of which 4 met the inclusion criteria. None of the studies were randomized controlled trials and all were cohort studies. There was considerable variability in the landmark axial levels and skeletal muscle(s) chosen for analysis, alongside the methods of measuring the cross-sectional area and the parameters used to define sarcopenia. Only two studies identified an increased risk of postoperative complications associated with the presence of sarcopenia. This included an increased risk of hernia recurrence, postoperative ileus and prolonged hospitalisation. Conclusion There is some evidence to suggest that BC techniques could be used to help predict surgical outcomes and allow early optimisation in AWH patients. However, the lack of consistency in chosen methodology, combined with the outdated definitions of sarcopenia, makes drawing any conclusions difficult. Whether body composition modification can be used to improve outcomes remains to be determined.

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Sarcomania? The Inapplicability of Sarcopenia Measurement in Predicting Incisional Hernia Development

Cited by 16 publications

References 51 publications

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

The impact of sarcopenia on oncologic abdominal wall reconstruction

The emerging role of sarcopenia as a prognostic indicator in patients undergoing abdominal wall hernia repairs: a systematic review of the literature

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