Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY; Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland.
Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, KY.
Surgery. 2022 Jul;172(1):310-318. doi: 10.1016/j.surg.2022.01.021. Epub 2022 Mar 1.
Surgery for chronic pancreatitis is associated with major morbidity and mortality. The aim of this study is to examine the role of preoperative muscle volume and quality on postoperative outcomes in patients with chronic pancreatitis.
All patients who underwent abdominal surgery for chronic pancreatitis between 2011 and 2018 were identified from an institutional surgical database. Patient demographics, clinical indices, and perioperative computed tomography scans were collected. Myopenia and myosteatosis were measured at the L3 vertebral level. Regression analysis was used to identify risk factors for major complications (Clavien-Dindo ≥3a) and length of stay.
Seventy-five patients were identified. Toxic-metabolic or obstructive causes were the main underlying etiologies. Thirty patients were myopenic (40%), and 36 patients were myosteatotic (48%). Sixteen patients (21%) had a major complication. Median length of stay was 10 days. Both myopenia and myosteatosis were associated with major complications (hazard ratio = 7.85, 95% confidence interval: 1.91-32.29, P = .004 and hazard ratio = 4.351, 95% confidence interval: 1.22-15.52, P = .023). Myosteatosis was associated with increased length of stay (parameter estimate = 0.297, 95% confidence interval: 0.012-0.583, P = .041).
Myopenia and myosteatosis were common and significant risk factors for adverse postoperative events. Preoperative muscle assessment may help in the risk stratification of surgical patients and identify patients that require preoperative nutritional and physical optimization.
慢性胰腺炎的手术与较高的发病率和死亡率相关。本研究旨在探讨慢性胰腺炎患者术前肌肉量和质量对术后结局的影响。
从机构手术数据库中确定了 2011 年至 2018 年间接受腹部手术治疗慢性胰腺炎的所有患者。收集患者的人口统计学、临床指标和围手术期计算机断层扫描数据。在 L3 椎体水平测量肌减少症和肌脂肪变性。采用回归分析确定主要并发症（Clavien-Dindo ≥3a）和住院时间的危险因素。
共确定了 75 例患者。毒性代谢或阻塞性病因是主要的潜在病因。30 例患者存在肌减少症（40%），36 例患者存在肌脂肪变性（48%）。16 例患者（21%）发生了主要并发症。中位住院时间为 10 天。肌减少症和肌脂肪变性均与主要并发症相关（风险比=7.85，95%置信区间：1.91-32.29，P=0.004 和风险比=4.351，95%置信区间：1.22-15.52，P=0.023）。肌脂肪变性与住院时间延长相关（参数估计=0.297，95%置信区间：0.012-0.583，P=0.041）。
肌减少症和肌脂肪变性是术后不良事件的常见且重要的危险因素。术前肌肉评估可能有助于对手术患者进行风险分层，并识别需要术前营养和身体优化的患者。
