Tan Edmund Wooi Keat, Yeo Jia Yi, Lee Yao Zong, Lohan Rahul, Lim Woan Wui, Lee Daniel Jin Keat
Department of General Surgery, Khoo Teck Puat Hospital, Singapore.
Ann Acad Med Singap. 2022 Dec;51(12):766-773. doi: 10.47102/annals-acadmedsg.2022158.
Sarcopenia, defined as low skeletal muscle mass and poor muscle function, has been associated with worse postoperative recovery. This study aims to evaluate the significance of low muscle mass in the elderly who require emergency surgeries and the postoperative outcomes.
Data from the emergency laparotomy database were retrieved from Khoo Teck Puat Hospital, Singapore, between 2016 and 2019. A retrospective analysis was performed on patients aged 65 years and above. Data collected included skeletal muscle index (SMI) on computed tomography scan, length of stay, complications and mortality. Low muscle mass was determined based on 25th percentile values and correlation with previous population studies.
A total of 289 patients were included for analysis. Low muscle mass was defined as L3 SMI of <22.09cm2/m2 for females and <33.4cm2/m2 for males, respectively. Seventeen percent of our patients were considered to have significantly low muscle mass. In this group, the length of stay (20.8 versus 16.2 =0.041), rate of Clavien-Dindo IV complications (18.4% vs 7.5% =0.035) and 1-year mortality (28.6% vs 14.6%, =0.03) were higher. Further multivariate analysis showed that patients with low muscle mass had increased mortality within a year (odds ratio 2.16, 95% confidence interval 1.02-4.55, =0.04). Kaplan-Meier analysis also shows that the 1-year overall survival was significantly lower in patients with low muscle mass.
Patients with low muscle mass have significantly higher post-surgical complication rates and increased mortality.
肌肉减少症被定义为骨骼肌质量低和肌肉功能差，与术后恢复较差有关。本研究旨在评估肌肉质量低对需要急诊手术的老年人的意义以及术后结局。
从新加坡 Khoo Teck Puat 医院 2016 年至 2019 年的急诊剖腹手术数据库中检索数据。对 65 岁及以上的患者进行回顾性分析。收集的数据包括计算机断层扫描上的骨骼肌指数（SMI）、住院时间、并发症和死亡率。根据第 25 百分位数确定低肌肉质量，并与先前的人群研究进行相关性分析。
共纳入 289 例患者进行分析。低肌肉质量分别定义为女性 L3 SMI <22.09cm²/m²，男性 <33.4cm²/m²。我们的患者中有 17%被认为肌肉质量显著低。在这组患者中，住院时间（20.8 天对 16.2 天，P = 0.041）、Clavien-Dindo IV 级并发症发生率（18.4%对 7.5%，P = 0.035）和 1 年死亡率（28.6%对 14.6%，P = 0.03）更高。进一步的多变量分析表明，肌肉质量低的患者一年内死亡率增加（比值比 2.16，95%置信区间 1.02 - 4.55，P = 0.04）。Kaplan-Meier 分析还表明，肌肉质量低的患者 1 年总生存率显著较低。
肌肉质量低的患者术后并发症发生率显著更高，死亡率增加。
