Ito Eisaku, Ohki Takao, Nakagawa Hikaru, Toya Naoki
Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Tokyo, Japan.
Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, 3-19-18, Nishi-shimbashi, Minato-city, Tokyo, 105-8471, Japan.
Surg Today. 2022 Nov;52(11):1591-1598. doi: 10.1007/s00595-022-02506-7. Epub 2022 May 5.
Oral frailty is characterized by a decrease in the oral and swallowing function and is a risk factor for pneumonia. In the current study, we analyzed the association between the masseter muscle thickness (MMT) and postoperative pneumonia and mortality after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm.
Overall, 247 patients were retrospectively evaluated. The primary end point was postoperative pneumonia. The MMT was measured as the maximum thickness of the masseter muscle 2 cm caudal to the zygomatic arch using computed tomography images obtained within 3 months before EVAR. Pneumonia was defined as the presence of progressive infiltrates, consolidation, or cavitation on imaging and a fever or leukocytosis.
Twenty (8.1%) cases of postoperative pneumonia occurred within 1 year after EVAR. We found that patients with a low MMT (≤ 30th percentile: males, 10.4 mm; females: 8.8 mm) had a significantly higher risk of developing postoperative pneumonia within 1 year after elective EVAR than those with a high value. A comparison of the utility of the MMT and psoas muscle index (PMI) for predicting the 1-, 3-, and 5-year all-cause mortality revealed that the MMT had superior predictive performance.
The MMT before elective EVAR predicted postoperative pneumonia and life expectancy, and its predictive performance was superior to that of the PMI.
口腔功能衰退的特征是口腔及吞咽功能下降，是肺炎的一个风险因素。在本研究中，我们分析了咬肌厚度（MMT）与腹主动脉瘤腔内修复术（EVAR）后术后肺炎及死亡率之间的关联。
总共对247例患者进行了回顾性评估。主要终点是术后肺炎。使用在EVAR前3个月内获得的计算机断层扫描图像，将MMT测量为颧弓尾侧2 cm处咬肌的最大厚度。肺炎定义为影像学上出现进行性渗出、实变或空洞，以及发热或白细胞增多。
20例（8.1%）术后肺炎发生在EVAR后1年内。我们发现，MMT较低（≤第30百分位数：男性为10.4 mm；女性为8.8 mm）的患者在择期EVAR后1年内发生术后肺炎的风险显著高于MMT较高的患者。对MMT和腰大肌指数（PMI）预测1年、3年和5年全因死亡率的效用进行比较，结果显示MMT具有更好的预测性能。
择期EVAR前的MMT可预测术后肺炎和预期寿命，其预测性能优于PMI。
