Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia; Vascular Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia; Vascular Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
J Vasc Surg. 2018 Feb;67(2):460-467. doi: 10.1016/j.jvs.2017.06.085. Epub 2017 Aug 23.
Preoperative sarcopenia is an established risk factor for poor outcomes after surgery. Methods for assessing sarcopenia are either complex, time consuming, or poorly validated. We aimed to assess the interobserver reliability of scoring psoas area at the level of the L3 vertebra and to evaluate whether sarcopenia scored by this simple and rapid method correlated with other fitness scoring methods or impacted on mortality and duration of stay for patients undergoing endovascular aneurysm repair (EVAR).
We had access to 191 preoperative computed tomography scans of patients who underwent EVAR. For each scan the axial slice at the most caudal level of the L3 vertebra was extracted. Three observers independently calculated the combined cross-sectional area of the left and right psoas muscle at this level. Interobserver variability was calculated as per Band and Altman. Psoas area was normalized for patient height with sarcopenia defined as total psoas area of <500 mm/m. The effect of sarcopenia on patient survival was assessed using Cox proportional hazards models. Kaplan-Meier curves are also presented.
Interobserver reliability of scoring psoas area was acceptable (reproducibility coefficient as percent of mean for each observer pair: 7.92%, 7.95%, and 14.33%). Sarcopenic patients had poorer survival (hazard ratio, 2.37; P = .011) and an increased hospital duration of stay (4.0 days vs 3.0 days; P = .008) when compared with nonsarcopenic patients. Sarcopenic patients were more likely to self-report as unfit (12.4% vs 33.3%; P = .004). Sarcopenia did not correlate with an increased rate of postprocedure complications.
Psoas area scoring has good interobserver reliability. Preoperative sarcopenia as defined by psoas area was associated with poorer survival and of longer length of stay. As all patients being worked up for an endovascular aortic aneurysm repair will undergo a computed tomography scan, this method is a rapid and effective way to highlight patients in the clinic setting who have an increased risk of morbidity and mortality after EVAR.
术前肌少症是手术预后不良的既定危险因素。评估肌少症的方法要么复杂，要么耗时，要么验证效果不佳。我们旨在评估在 L3 椎骨水平评估腰大肌面积的评分的观察者间可靠性，并评估这种简单快速的方法是否与其他体能评分方法相关，或者是否影响接受血管内腹主动脉瘤修复 (EVAR) 的患者的死亡率和住院时间。
我们获得了 191 例行 EVAR 的患者术前 CT 扫描。对于每一次扫描，提取 L3 椎骨最尾端的轴向切片。三位观察者独立计算了这一水平处左右腰大肌的横截面积。观察者间的变异性按 Band 和 Altman 计算。用身高标准化腰大肌面积，将总腰大肌面积<500mm/m 定义为肌少症。用 Cox 比例风险模型评估肌少症对患者生存率的影响。还呈现了 Kaplan-Meier 曲线。
评分腰大肌面积的观察者间可靠性尚可（每个观察者对的平均可重复性系数：7.92%、7.95%和 14.33%）。与非肌少症患者相比，肌少症患者的生存率较差（风险比，2.37；P=0.011），住院时间延长（4.0 天比 3.0 天；P=0.008）。与非肌少症患者相比，肌少症患者更有可能自我报告为体能不佳（12.4%比 33.3%；P=0.004）。肌少症与术后并发症发生率增加无关。
腰大肌面积评分具有良好的观察者间可靠性。以腰大肌面积定义的术前肌少症与生存率下降和住院时间延长相关。由于所有接受血管内主动脉瘤修复治疗的患者都将进行 CT 扫描，因此这种方法是一种快速有效的方法，可以在诊所环境中突出显示 EVAR 后发病率和死亡率增加的患者。
