Medical University of Graz, Department of Surgery, Division for General Surgery, Graz, Austria.
Medical University of Graz, Department of Surgery, Division for General Surgery, Graz, Austria.
Eur J Surg Oncol. 2018 May;44(5):658-663. doi: 10.1016/j.ejso.2018.01.095. Epub 2018 Feb 7.
Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity.
As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having low skeletal muscle mass (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity.
Median patient age was 63 years (19-87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI]>6, 63.2%), 30-day mortality was 5.8% (n = 25). Median HUAC was 19.78 HU (IQR: 15.94-23.54) with 145 patients (34.2%) having low skeletal muscle mass. Preoperative frailty defined by low skeletal muscle mass was associated with an increased risk for postoperative complications (OR 1.55, CI 95% 0.98-2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, CI 95% 1.57-16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (CI 95% 0.78-0.91, p = 0.0001). Patients with CCI ≥6 and low skeletal muscle mass defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, CI 95% 2.98-12.2, p = 0.0001).
Low skeletal muscle mass predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients.
低骨骼肌量是预测接受重大胰腺手术患者发病率和死亡率的已知指标。我们试图将低骨骼肌量与既定的风险预测因素结合起来，以提高其对术后结果和发病率的预后能力。
ASA 分级和 Charlson 合并症指数（CCI）被用作预测术前死亡率的既定参数。在 424 名接受恶性胰腺切除术的患者中，使用 Hounsfield 单位平均计算（HUAC）来定义低骨骼肌量。患者的 HUAC 处于最低性别调整四分位区间被定义为低骨骼肌量（肌肉减少症）。多变量 Cox 回归分析用于确定与术后发病率相关的术前风险因素。
中位患者年龄为 63 岁（19-87 岁），47.9%的患者为男性，一半的患者有多种合并症（CCI>6，63.2%），30 天死亡率为 5.8%（n=25）。HUAC 的中位数为 19.78HU（IQR：15.94-23.54），145 名患者（34.2%）存在低骨骼肌量。由低骨骼肌量定义的术前虚弱与术后并发症的风险增加相关（OR 1.55，95%CI 0.98-2.45，p=0.014），且 30 天死亡率更高（HR 5.17，95%CI 0.57-47.19，p=0.004）。HUAC 的 AUC 为 0.85，显示对 30 天死亡率的预测能力最高（95%CI 0.78-0.91，p=0.0001）。CCI≥6 且 HUAC 定义的低骨骼肌量的患者在术后即刻阶段死亡的风险增加 9.78 倍（HR 9.78，95%CI 2.98-12.2，p=0.0001）。
低骨骼肌量可最好地预测术后死亡率和并发症，应将其纳入传统风险评分，以识别高危患者。
