Dr Nia Humphry, School of Medicine, Cardiff University, United Kingdom,
J Frailty Aging. 2023;12(4):305-310. doi: 10.14283/jfa.2023.30.
Emergency laparotomy procedures have high rates of postoperative mortality and morbidity in older patient. Sarcopenia is associated with poor postoperative outcomes in elective surgeries and there is growing evidence for its use as a risk predictor in the emergency setting. The study aimed to evaluate the effect of sarcopenia on postoperative mortality and morbidity following emergency laparotomy. Five electronic databases were systematically searched (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science) from conception until the 14th February 2022. All prospective cohort studies were included. Risk of bias was assessed with the Newcastle-Ottawa score. Pooled meta-analyses were estimated using the Mantel-Haenszel and inverse-generic variance method for mortality and morbidity outcomes. Eleven retrospective cohort studies were included, of which ten were included in the meta-analysis comprising of 3492 patients (1027 sarcopenic, 2465 non-sarcopenic). The study level incidence of sarcopenia ranged from 24.6 to 50.3% with a median rate of 25.1%. Sarcopenia was associated with increased 30-day mortality (OR 2.36, 95% CI, 1.66, 3.37, I2 = 43%), 90-day mortality (OR 2.51, 95% CI, 1.79, 3.52, I2 = 0%), and length of hospital stay (in days) (MD 1.18, 95% CI, 0.42, 1.94, I2 = 0%, P=0.002), but not incidence of postoperative major complications (OR 1.49, 95% CI, 0.86, 2.56, I2 = 70%, P = 0.15). Sarcopenia predicts poor outcomes following emergency laparotomy. We suggest assessment of sarcopenia should be incorporated into acute surgical assessment to identify high risk patients and inform clinical decision-making prior to an emergency laparotomy.
老年患者行急诊剖腹手术后的死亡率和发病率较高。在择期手术中，肌肉减少症与术后不良结局相关，并且越来越多的证据表明其可作为急诊情况下的风险预测指标。本研究旨在评估肌肉减少症对急诊剖腹手术后死亡率和发病率的影响。从构思到 2022 年 2 月 14 日，系统地在五个电子数据库（MEDLINE、EMBASE、CINAHL、Cochrane 中央对照试验注册库和 Web of Science）中进行了搜索。所有前瞻性队列研究均被纳入。使用纽卡斯尔-渥太华量表评估偏倚风险。使用 Mantel-Haenszel 和逆通用方差法对死亡率和发病率结果进行汇总荟萃分析。纳入了 11 项回顾性队列研究，其中 10 项研究纳入了包含 3492 例患者的荟萃分析（1027 例肌肉减少症患者，2465 例非肌肉减少症患者）。研究水平的肌肉减少症发生率范围为 24.6%至 50.3%，中位数为 25.1%。肌肉减少症与 30 天死亡率（OR 2.36，95%CI，1.66，3.37，I2 = 43%）、90 天死亡率（OR 2.51，95%CI，1.79，3.52，I2 = 0%）和住院时间（天）（MD 1.18，95%CI，0.42，1.94，I2 = 0%，P=0.002）的增加相关，但与术后主要并发症发生率（OR 1.49，95%CI，0.86，2.56，I2 = 70%，P = 0.15）无关。肌肉减少症预测急诊剖腹手术后的不良结局。我们建议在急性外科评估中纳入肌肉减少症评估，以识别高危患者，并在急诊剖腹手术前为临床决策提供信息。
