Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan.
Department of Trauma and Emergency Surgery, Saiseikai Yokohama-Shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-Ku, Yokohama-Shi, Kanagawa, 230-0012, Japan.
BMC Surg. 2023 Jun 24;23(1):171. doi: 10.1186/s12893-023-02085-5.
Older individuals increasingly require emergency abdominal surgeries. They are susceptible to surgical stress and loss of independence in performing daily activities. We hypothesized that the psoas muscle volume would be significantly associated with postoperative functional decline (FD) in older patients undergoing emergency abdominal surgery and aimed to evaluate the use of the psoas muscle volume on computed tomography (CT) scans.
A retrospective, single-center study of patients aged ≥ 65 years who had undergone emergency abdominal surgery between January 2019 and June 2021 was performed. We assessed patients' activities of daily living using the Barthel Index. FD was defined as a ≥ 5-point decrease between preoperative and 28-day postoperative values. The psoas muscle volume was measured by CT, which was used for diagnosis, and normalized by height to calculate total psoas muscle index (TPI). We evaluated associations between FD and TPI using receiver operating characteristics (ROC) analysis and multiple logistic regression analysis.
Of 238 eligible patients, 71 (29.8%) had clinical postoperative FD. Compared to the non-FD group, the FD group was significantly older and had a higher proportion of females, higher Charlson Comorbidity Index, lower body mass index, higher American Society of Anesthesiology score, lower serum albumin level, and lower TPI. ROC analyses revealed that TPI had the highest area under the curve (0.802; 95% confidence interval [CI], 0.75-0.86). A multivariable logistic regression model revealed that low TPI was an independent predictor of postoperative FD (odds ratio, 0.14; 95% CI, 0.06-0.32).
TPI can predict postoperative FD due to emergency abdominal surgery. Identification of patients who are at high risk of FD before surgery may be useful for enhancing the regionalized system of care for emergency general surgery.
越来越多的老年人需要接受紧急腹部手术。他们容易受到手术应激和丧失日常活动能力的影响。我们假设，在接受紧急腹部手术的老年患者中，腰大肌体积与术后功能下降（FD）显著相关，并旨在评估 CT 扫描中腰大肌体积的应用。
对 2019 年 1 月至 2021 年 6 月期间接受紧急腹部手术的年龄≥65 岁的患者进行了一项回顾性、单中心研究。我们使用巴氏指数评估患者的日常生活活动能力。FD 定义为术前和 28 天术后值之间下降≥5 分。使用 CT 测量腰大肌体积，CT 用于诊断，并通过身高进行标准化以计算总腰大肌指数（TPI）。我们使用接受者操作特征（ROC）分析和多因素逻辑回归分析评估 FD 与 TPI 之间的关联。
在 238 名符合条件的患者中，71 名（29.8%）出现临床术后 FD。与非 FD 组相比，FD 组年龄较大，女性比例较高，Charlson 合并症指数较高，体重指数较低，美国麻醉师协会评分较高，血清白蛋白水平较低，TPI 较低。ROC 分析显示 TPI 的曲线下面积最高（0.802；95%置信区间 [CI]，0.75-0.86）。多变量逻辑回归模型显示，低 TPI 是术后 FD 的独立预测因子（比值比，0.14；95%CI，0.06-0.32）。
TPI 可预测紧急腹部手术后的 FD。在手术前识别出 FD 风险较高的患者，可能有助于加强对紧急普通外科的区域化护理系统。
