Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
J Cachexia Sarcopenia Muscle. 2023 Dec;14(6):2642-2652. doi: 10.1002/jcsm.13337. Epub 2023 Sep 19.
Sarcopenia and frailty are both age-related declines in functional reserve that are linked to adverse health outcomes. It is critical to know about the outcomes of a combination of these conditions. The study aimed to investigate the effects of sarcopenia and frailty on postoperative recovery in elderly patients and to explore risk factors.
This prospective cohort study was conducted among 608 patients aged ≥60 years, American Society of Anesthesiologists I-III, who were scheduled to undergo thoracic (non-cardiac) and abdominal surgery from 1 March 2022 to 31 October 2022 at the Affiliated Hospital of Xuzhou Medical University. Frailty was measured by the 28-item frailty index, and sarcopenia was assessed sarcopenia was assessed by skeletal muscle index in computed tomographic scan, handgrip strength and 6-m walk. Participants were classified as follows: Group A: both sarcopenia and frailty; Group B: sarcopenia only; Group C: frailty only; and Group D: neither frailty nor sarcopenia. The primary outcome was 90-day morbidity. Multivariable logistic regression model was used to estimate the association between sarcopenia, frailty and 90-day morbidity.
The median (interquartile range) age of participants was 68 (64-72) years, and 62.7% were men. The prevalence rates of sarcopenia and frailty were 32.8% and 47.6%, respectively. The 90-day morbidity in Group A was 58.5%, in Group B was 46.2%, in Group C was 42.0% and in Group D was 28.8%, and the difference was significant (P < 0.001). In the multivariable analysis, both sarcopenia and frailty [odds ratio (OR), 2.21; 95% confidence interval (CI), 1.26-3.89], sarcopenia only (OR, 1.84; 95% CI, 1.01-3.36), frailty only (OR, 1.77; 95% CI, 1.03-3.03), women (OR, 0.67; 95% CI, 0.45-0.99), body mass index (OR, 0.94; 95% CI, 0.88-0.99), pre-operative albumin (OR, 0.96; 95% CI, 0.91-1.00) and operative stress score (OSS) [OSS 3 (OR, 2.09; 95% CI, 1.21-3.67); OSS 4-5 (OR, 3.81; 95% CI, 2.31-6.42)] were independently associated with 90-day morbidity. In the multivariable analysis with inverse probability weighting adjusted cohort, sarcopenia and frailty were also significantly associated with 90-day morbidity.
Sarcopenia and frailty were associated with higher risks of postoperative 90-day morbidity in elderly patients alone and in combination. Sex, body mass index, pre-operative albumin and operative stress were also independent factors for postoperative morbidity within 90 days.
肌少症和衰弱都是与不良健康结局相关的与年龄相关的功能性储备下降。了解这些情况的综合结果至关重要。本研究旨在探讨肌少症和衰弱对老年患者术后恢复的影响，并探讨其危险因素。
这是一项前瞻性队列研究，纳入了 2022 年 3 月 1 日至 2022 年 10 月 31 日在徐州医科大学附属医院接受非心脏胸腹部手术的 608 名年龄≥60 岁、美国麻醉医师协会 I-III 级的患者。衰弱通过 28 项衰弱指数进行测量，肌少症通过计算机断层扫描的骨骼肌指数、握力和 6 米步行进行评估。参与者分为以下 4 组：A 组：肌少症和衰弱均有；B 组：仅有肌少症；C 组：仅有衰弱；D 组：既无衰弱也无肌少症。主要结局为 90 天发病率。多变量逻辑回归模型用于估计肌少症、衰弱与 90 天发病率之间的关系。
参与者的中位（四分位距）年龄为 68（64-72）岁，62.7%为男性。肌少症和衰弱的患病率分别为 32.8%和 47.6%。A 组 90 天发病率为 58.5%，B 组为 46.2%，C 组为 42.0%，D 组为 28.8%，差异有统计学意义（P<0.001）。多变量分析显示，肌少症和衰弱[比值比（OR），2.21；95%置信区间（CI），1.26-3.89]、仅有肌少症（OR，1.84；95%CI，1.01-3.36）、仅有衰弱（OR，1.77；95%CI，1.03-3.03）、女性（OR，0.67；95%CI，0.45-0.99）、体重指数（OR，0.94；95%CI，0.88-0.99）、术前白蛋白（OR，0.96；95%CI，0.91-1.00）和手术应激评分（OSS）[OSS 3（OR，2.09；95%CI，1.21-3.67）；OSS 4-5（OR，3.81；95%CI，2.31-6.42）]与 90 天发病率独立相关。在经过逆概率加权调整队列的多变量分析中，肌少症和衰弱也与 90 天术后发病率显著相关。
肌少症和衰弱与老年患者术后 90 天发病率的增加相关，无论单独存在还是合并存在。性别、体重指数、术前白蛋白和手术应激也是 90 天内术后发病率的独立因素。
