Trinder Matthew W, Clifford Matthew, Jones Aimee Lee, Shepherd Talia, Jacob Abraham O
Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2022 Mar;92(3):397-402. doi: 10.1111/ans.17439. Epub 2021 Dec 29.
Sarcopenia is an independent predictor of poor post-operative outcomes following major surgery. Inflammatory bowel disease (IBD) consists of Crohn's disease (CD) and ulcerative colitis (UC), which are chronic inflammatory conditions involving the gastrointestinal system. Evidence demonstrates that up to 60% of patients with IBD have sarcopenia. Despite advances in medical management, more than 15% of patients with UC and 80% with CD eventually require surgical intervention. The primary aim of the study was to assess the impact of sarcopenia on post-operative anastomotic leak rates.
A retrospective cohort study of patients at Royal Perth Hospital who underwent major abdominal surgery for management of IBD between January 2010 and December 2020 was performed. Sarcopenia was assessed according to the skeletal muscle index at the level of the third lumbar vertebrae using the cut off 52.4 and 38.5 cm /m for men and women, respectively.
A total of 147 patients were included. The prevalence of sarcopenia within the study population was 36.1%. Patients with sarcopenia were significantly taller (P = 0.025) and were more likely to be on pre-operative steroid medications (P = 0.045). There was no difference in the remaining baseline characteristics between sarcopenic and non-sarcopenic patients. Patients with sarcopenia were more likely to develop a post-operative anastomotic leak (OR:11.303, 95% CI, 1.53-83.51, P = 0.017), grade IV complications (OR:6.79, 95%CI:1.1-43.6, P = 0.044) and require total parenteral nutrition (TPN) (OR:3.212, 95% CI:1.3-8.1, P = 0.013).
Sarcopenia significantly increases the risk of major post-operative complications for patients with IBD undergoing colorectal surgery.
肌肉减少症是大型手术后不良术后结局的独立预测因素。炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC），是涉及胃肠道系统的慢性炎症性疾病。有证据表明，高达60%的IBD患者存在肌肉减少症。尽管在药物治疗方面取得了进展，但超过15%的UC患者和80%的CD患者最终仍需要手术干预。本研究的主要目的是评估肌肉减少症对术后吻合口漏发生率的影响。
对2010年1月至2020年12月期间在皇家珀斯医院因IBD接受大型腹部手术的患者进行了一项回顾性队列研究。根据第三腰椎水平的骨骼肌指数评估肌肉减少症，男性和女性的截断值分别为52.4和38.5 cm/m。
共纳入147例患者。研究人群中肌肉减少症的患病率为36.1%。肌肉减少症患者明显更高（P = 0.025），且更有可能术前使用类固醇药物（P = 0.045）。肌肉减少症患者和非肌肉减少症患者的其余基线特征无差异。肌肉减少症患者更有可能发生术后吻合口漏（OR：11.303，95% CI，1.53 - 83.51，P = 0.017）、IV级并发症（OR：6.79，95%CI：1.1 - 43.6，P = 0.044），并需要全胃肠外营养（TPN）（OR：3.212，95% CI：1.3 - 8.1，P = 0.013）。
肌肉减少症显著增加了IBD患者接受结直肠手术后发生主要术后并发症的风险。
