Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Surg Res. 2019 Mar;235:141-147. doi: 10.1016/j.jss.2018.09.027. Epub 2018 Oct 26.
Sarcopenia (a decline of skeletal muscle mass) has been identified as a predictor of poor postoperative outcomes. The impact of sarcopenia in emergency general surgery (EGS) remains undetermined. The aim of this study was to evaluate the association between sarcopenia and outcomes after EGS.
A 3-y (2012-15) review of all EGS patients aged ≥45 y was presented to our institution. Patients who underwent computer tomography-abdomen were included. Sarcopenia was defined as the lowest sex-specific quartile of total psoas index (computer tomography-measured psoas area normalized for body surface area). Patients were divided into sarcopenic (SA) and nonsarcopenic. Primary outcome measures were in-hospital complications, hospital-length of stay [h-LOS], intensive care unit-length of stay, adverse discharge disposition, and in-hospital mortality. Our secondary outcome measures were 30-d complications, readmissions, and mortality.
Four hundred fifty-two patients undergoing EGS were included. Mean age was 58 ± 8.7 y, and 60% were males. Hundred thirteen patients were categorized as SA. Compared to nonsarcopenic, SA patients had higher rates of minor complications (28% versus 17%, P = 0.01), longer hospital-length of stay (7d versus 5d, P = 0.02), and were more likely to be discharged to skilled nursing facility/Rehab (35% versus 17%, P = 0.01). There was no difference between the two groups regarding major complications, intensive care unit-length of stay, mortality, and 30-d outcomes. On regression analysis, sarcopenia was an independent predictor of minor complications (OR 1.8 [1.6-3.7]) and discharge to rehab/SNIF (OR: 1.9 [1.5-3.2]). However, there was no association with major complications, mortality, 30-d complications, readmissions, and mortality.
Sarcopenia is an independent predictor of minor postoperative complications, prolonged hospital-length of stay, and an adverse discharge disposition in patients undergoing EGS. Identifying SA EGS patients will improve both resource allocation and discussion about the patient's prognosis between physicians, patients, and their families.
肌肉减少症（骨骼肌量减少）已被确定为术后不良结局的预测指标。在急诊普通外科（EGS）中，肌肉减少症的影响仍不确定。本研究旨在评估 EGS 后肌肉减少症与结局之间的关系。
对我院 2012 年至 2015 年所有年龄≥45 岁的 EGS 患者进行了 3 年回顾性研究。所有接受腹部计算机断层扫描的患者均被纳入研究。肌肉减少症定义为男性和女性中最低的特定四分位数的总腰大肌指数（计算机断层扫描测量的腰大肌面积与体表面积的比值）。患者分为肌肉减少组（SA）和非肌肉减少组。主要观察指标为住院并发症、住院时间[h-LOS]、重症监护病房时间、不良出院处置和住院死亡率。我们的次要观察指标是 30 天并发症、再入院和死亡率。
共纳入 452 例接受 EGS 的患者。平均年龄为 58±8.7 岁，60%为男性。113 例患者被归类为 SA。与非肌肉减少组相比，SA 患者的轻微并发症发生率更高（28%比 17%，P=0.01），住院时间更长（7 天比 5 天，P=0.02），更有可能被送往康复护理机构/康复医院（35%比 17%，P=0.01）。两组间主要并发症、重症监护病房时间、死亡率和 30 天结局无差异。回归分析显示，肌肉减少症是轻微并发症（OR 1.8[1.6-3.7]）和康复护理机构/康复医院出院（OR：1.9[1.5-3.2]）的独立预测因素。然而，与主要并发症、死亡率、30 天并发症、再入院和死亡率无关。
肌肉减少症是 EGS 患者术后轻微并发症、住院时间延长和不良出院处置的独立预测因素。识别 EGS 患者的肌肉减少症将改善资源分配，并加强医生、患者及其家属之间对患者预后的讨论。
