Skeletal Muscle Mass Index Predicts Postoperative Complications in Intestinal Surgery for Crohn's Disease

Abstract

Background: The aim of this study was to evaluate the role of the skeletal muscle mass index (SMI) for major postoperative morbidity in patients with Crohn's disease (CD) and intestinal surgery at a tertiary referral center. Methods: A retrospective analysis of the prospectively maintained database for surgical patients with CD at our institution was performed. The cases of all patients operated on between December 2009 and December 2017 with sectional imaging prior to surgery were eligible for this study. Results: A total of 230 patients were included. Major postoperative complications were observed in 32 patients (13.9%). Common intestinal procedures were ileocecal resections (51.7%), segmental small-bowel resections (10%), and colectomy or proctocolectomy (8.3%). In multivariable analysis, SMI (P = .002; odds ratio = 0.914) was the only independent risk factor for major postoperative complications. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies were suitable to determine SMI. The cutoff values for SMI were 31.8 cm 2 /m 2 for females and 41.5 cm 2 /m 2 for males. Conclusion: We present the largest published cohort investigating SMI with regard to major postoperative morbidity in surgery for CD. In multivariable analysis, SMI was the only significant risk factor for Clavien-Dindo complications grade ࣙIII. Lumbar SMI was reliably determined by CT and MRI alike. Because preoperative abdominal imaging with either modality is common for patients with CD, SMI could be a reliable and largely available tool to stratify the risk of postoperative complications.

Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview

“…It was found that IBD patients with sarcopenia had a higher probability of requiring surgery and significantly higher rates of major complications [ 9 ]. There are a number of studies that support these findings in terms of sarcopenia as a predictor of surgical intervention and reduced operation-free survival [ 20 , 24 , 128 , 129 ]. Indeed, there is an increase in post-surgical infections in those with sarcopenia, specifically surgical-site infections after restorative proctocolectomy for UC [ 130 ] and abscesses following intestinal surgery in CD [ 131 ].…”

Preoperative assessment of skeletal muscle mass during magnetic resonance enterography in patients with Crohn’s disease

“…Recent evidence suggests that psoas muscle cross sectional area is a practical surrogate measure of sarcopenia that can be readily and reliably measured by clinicians using standard image viewing software [ 21 ], as confirmed by our findings. A recent study [ 39 ], identified CT and MRI measurement of the skeletal mass as reliable assessments of sarcopenia in CD surgery in a cohort of 230 patients, however although all CD operations were included only major postoperative complications were reported, whilst our study reported on all postoperative outcomes in the specific group of patients with CD undergoing primary ileocaecal resection.…”

Handgrip Strength and Phase Angle Predict Outcome After Bariatric Surgery

“…The association between preoperative muscle mass and postoperative outcome has been investigated in several different studies. A low value for muscle mass derived from preoperative imaging, for instance, is related to a significantly higher rate of major postoperative complications in patients with Crohn's disease [11] and of overall complications after colon resection [12]. Previous research showed that the decrease in fat mass is accompanied by a reduction of LBM [13,14].…”