Matsushima Kazuhide, Inaba Kenji, Jhaveri Vidhi, Cheng Vincent, Herr Keith, Siboni Stefano, Strumwasser Aaron, Demetriades Demetrios
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
J Surg Res. 2017 May 1;211:39-44. doi: 10.1016/j.jss.2016.12.002. Epub 2016 Dec 9.
Severe muscle mass depletion, sarcopenia, has been shown to be associated with poor operative outcomes. However, its impact on emergency abdominal operations remains unclear. The purpose of this study was to examine the association between low muscle mass (LMM) and outcomes after emergency operations for acute diverticulitis.
Patients ≥18 y requiring an emergency operation for acute diverticulitis between January 2007 and September 2014 were included. On preoperative computed tomography, the cross-sectional area (CSA) and transverse diameter (TVD) of the right and left psoas muscle were measured at the level of the third lumbar vertebral body. Sensitivity analysis was performed to determine appropriate CSA and TVD cutoff values defining low skeletal muscle mass. Clinical outcomes of patients with low muscle mass (LMM group) were compared with the non-LMM group.
A total of 89 patients met our inclusion criteria. Median CSA and TVD were 794 mm and 24 mm, respectively. There was a strong correlation between the CSA and TVD (R = 0.84). In univariable analysis, significantly higher rates of postoperative major complications (63% versus 37%, P = 0.027) and surgical site infection (47% versus 19%, P = 0.008) were identified in the LMM group. After adjusting for clinically important covariates in a logistic regression model, patients with LMM were significantly associated with higher odds of major complications and surgical site infection.
Preoperative assessment of the psoas muscle CSA and TVD on computed tomography can be a practical method for identifying patients at risk for postoperative complications.
严重的肌肉量减少，即肌肉减少症，已被证明与手术效果不佳有关。然而，其对急诊腹部手术的影响仍不明确。本研究的目的是探讨低肌肉量（LMM）与急性憩室炎急诊手术后结局之间的关联。
纳入2007年1月至2014年9月期间因急性憩室炎需要进行急诊手术的18岁及以上患者。在术前计算机断层扫描中，于第三腰椎椎体水平测量左右腰大肌的横截面积（CSA）和横径（TVD）。进行敏感性分析以确定定义低骨骼肌量的合适CSA和TVD临界值。将低肌肉量患者（LMM组）的临床结局与非LMM组进行比较。
共有89例患者符合我们的纳入标准。CSA和TVD的中位数分别为794mm和24mm。CSA和TVD之间存在强相关性（R = 0.84）。在单变量分析中，LMM组术后主要并发症（63%对37%，P = 0.027）和手术部位感染（47%对19%，P = 0.008）的发生率显著更高。在逻辑回归模型中对临床重要协变量进行调整后，LMM患者与主要并发症和手术部位感染的较高几率显著相关。
术前在计算机断层扫描上评估腰大肌的CSA和TVD可以是识别术后并发症风险患者的一种实用方法。
