Department of Surgery, University of Auckland, Auckland, New Zealand.
General Surgery Department, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3869-3878. doi: 10.1007/s00068-021-01833-7. Epub 2022 Jan 9.
Emergency laparotomy (EL) carries a high risk of morbidity and mortality, that is greater among older patients. Sarcopenia refers to an age- or pathology-associated muscle loss and has been demonstrated to correlate with poorer outcomes in several surgical conditions. This study assessed the impact of sarcopenia on morbidity and mortality in elderly patients undergoing EL.
Patients aged ≥ 65 years-old undergoing EL between May 2012-June 2017 with a pre-operative abdominal computerised tomography (CT) scan at Middlemore Hospital (New Zealand) were included. Psoas and Skeletal Muscle Index (PMI and SMI) were calculated from abdominal CT measurements after standardisation based on height. Validated cut-offs for sarcopenia were used. Frailty was estimated using the 11-point modified frailty index (mFI). The primary outcome was 30-day, 1-year, and 4-year post-operative mortality. Secondary outcomes included correlations between mFI and sarcopenic measures, unplanned readmissions, and post-operative complications.
A total of 167 patients (84 sarcopenic; 83 non-sarcopenic) were included. Sarcopenic and non-sarcopenic patients had similar 30-day (14.2 vs. 12.0%; p = 0.84), 1-year (23.8 vs. 25.3%; p = 0.96), and 4-year (39.3 vs. 47.0%; p = 0.40) mortality rates following an EL. Survivors had a higher mean PMI at 1-year (p = 0.0078) and 4-year (p = 0.013) but not 30-day (p = 0.40) follow-up. Sarcopenia performed poorly in discriminating between 30-day (AUC 0.51) and 1-year (AUC 0.53) mortality. The mFI did not correlate with PMI (p = 0.85) nor SMI (p = 0.18). Rates of readmissions and post-operative complications did not differ between sarcopenic and non-sarcopenic cohorts.
Sarcopenia does not provide useful short-term prognostic information in elderly EL patients.
急诊剖腹手术（EL）的发病率和死亡率较高，老年患者的发病率和死亡率更高。肌肉减少症是指与年龄或疾病相关的肌肉损失，已被证明与几种手术情况的预后较差相关。本研究评估了肌肉减少症对接受 EL 的老年患者发病率和死亡率的影响。
纳入 2012 年 5 月至 2017 年 6 月期间在新西兰 Middlemore 医院接受 EL 治疗且术前有腹部计算机断层扫描（CT）检查的年龄≥65 岁的患者。从腹部 CT 测量值中计算出腰大肌和骨骼肌指数（PMI 和 SMI），并根据身高进行标准化。使用经过验证的肌肉减少症截断值。使用 11 分改良虚弱指数（mFI）来评估虚弱。主要结局为术后 30 天、1 年和 4 年的死亡率。次要结局包括 mFI 和肌肉减少症测量值、计划外再入院和术后并发症之间的相关性。
共纳入 167 名患者（84 名肌肉减少症患者；83 名非肌肉减少症患者）。肌肉减少症和非肌肉减少症患者的术后 30 天（14.2%比 12.0%；p=0.84）、1 年（23.8%比 25.3%；p=0.96）和 4 年（39.3%比 47.0%；p=0.40）死亡率相似。幸存者在 EL 后 1 年（p=0.0078）和 4 年（p=0.013）时的平均 PMI 更高，但在 30 天时没有（p=0.40）。肌肉减少症在区分 30 天（AUC 0.51）和 1 年（AUC 0.53）死亡率方面表现不佳。mFI 与 PMI 无相关性（p=0.85），与 SMI 也无相关性（p=0.18）。肌肉减少症和非肌肉减少症组的再入院率和术后并发症发生率没有差异。
肌肉减少症不能为老年 EL 患者提供有用的短期预后信息。
