Department of Radiology, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
Department of Radiology X, Rigshospitalet, Blegdamsvej 9, 2200, Copenhagen C, Denmark.
Abdom Radiol (NY). 2019 Mar;44(3):1155-1160. doi: 10.1007/s00261-018-1870-z.
Image-based measurement of sarcopenia is an established predictor of a decreased outcome for a large variety of surgical procedures. Sarcopenia in elderly patients undergoing emergency abdominal surgery has not been well studied. This study aims to investigate the association between the total psoas area (TPA) and postoperative mortality after 90 days in a group of elderly emergency laparotomy patients.
We retrospectively reviewed the emergency CT-scans of 150 elderly patients from a consecutive cohort undergoing emergency abdominal surgery at our surgical center. TPA was measured manually at the level of L3 and indexed to patient height. Sarcopenia was defined as having a TPA index below the first quartile for gender in the cohort. Other collected variables were age, vital status/date of death, ASA-score, surgical procedure, and WHO performance score.
Overall 90-day mortality was 42.7%. Sarcopenic patients had a higher 90-day mortality (60.5%) than non-sarcopenic patients (36.6%), corresponding to an odds ratio of 2.66 (95% confidence interval 1.2-5.7, p = 0.01). Sarcopenic patients had an increased mortality compared with non-sarcopenic patients (p = 0.0009, Log-rank test), with a clear separation of the two groups within 30 days postoperatively. In a multivariate logistic regression model, with age, ASA-score, and WHO performance score as covariates, sarcopenia was independently associated with 90-day mortality.
Manual measurement of TPA on an abdominal CT-scan is a relevant risk factor for postoperative mortality in elderly patients undergoing high-risk emergency abdominal surgery. Incorporation of sarcopenia in postoperative risk-prediction models in emergency abdominal surgery should be considered.
基于图像的肌肉减少症测量是多种手术结果降低的既定预测指标。在接受紧急腹部手术的老年患者中，肌肉减少症尚未得到很好的研究。本研究旨在调查一组老年急诊剖腹手术患者的总腰大肌面积（TPA）与术后 90 天死亡率之间的关系。
我们回顾性分析了我院外科中心连续队列中 150 名接受紧急腹部手术的老年患者的急诊 CT 扫描。在 L3 水平手动测量 TPA，并将其与患者身高进行指数化。根据队列中性别将 TPA 指数低于第一四分位数的患者定义为肌肉减少症。其他收集的变量包括年龄、生命状态/死亡日期、ASA 评分、手术程序和世卫组织表现评分。
总体 90 天死亡率为 42.7%。肌肉减少症患者的 90 天死亡率（60.5%）高于非肌肉减少症患者（36.6%），相应的优势比为 2.66（95%置信区间为 1.2-5.7，p = 0.01）。与非肌肉减少症患者相比，肌肉减少症患者的死亡率更高（p = 0.0009，对数秩检验），两组在术后 30 天内明显分开。在多变量逻辑回归模型中，以年龄、ASA 评分和世卫组织表现评分为协变量，肌肉减少症与 90 天死亡率独立相关。
腹部 CT 扫描上 TPA 的手动测量是接受高危紧急腹部手术的老年患者术后死亡率的一个相关危险因素。在紧急腹部手术的术后风险预测模型中应考虑纳入肌肉减少症。
