Gao Danyang, Miao Huihui, Sheng Weixuan, Liu Lei, Wang Rengui, Shi Hanping, Li Tianzuo
From the Departments of Anesthesiology.
Science and Technology.
Anesth Analg. 2025 Aug 1;141(2):343-351. doi: 10.1213/ANE.0000000000007301. Epub 2024 Nov 6.
This study aimed to investigate the associations of 2 preoperative muscle-related parameters, the third lumbar vertebra skeletal muscle index (L3 SMI) for muscle mass and the Hounsfield unit average calculation (HUAC) for muscle density, with the occurrence of postoperative complications among patients undergoing colorectal tumor resection surgery under general anesthesia. We hypothesized that muscle-related parameters are associated with the occurrence of postoperative complications.
This was a single-center, retrospective observational study. Adult patients who underwent colorectal tumor resection surgery under general anesthesia between 2018.09.01 and 2021.09.01 were enrolled. The last abdominal computed tomography (CT) scan images obtained within 3 months before surgery were used to calculate the L3 SMI and HUAC. The primary outcome was defined as the occurrence of any postoperative complications corresponding to Clavien-Dindo classification before discharge. The secondary outcome was defined as the occurrence of any severe postoperative complications (Clavien-Dindo grade ≥3) before discharge. Multivariable logistic regression analyses were used to estimate the association between muscle-related parameters and incidence of postoperative complications. Patients' baseline demographics, past medical history and intraoperative parameters were adjusted in the multivariable logistic regression analysis.
A total of 317 patients with a median age of 66 (58-72) years were included. Sarcopenia (muscle mass reduction) patients in our cohort and myosteatosis (muscle density decline) were present in 254 (80.1 %) and 79 (24.9%) patients, respectively. A total of 135 patients (42.6 %) developed postoperative complications. According to the multivariable logistic regression, myosteatosis (odds ratio [OR], 1.8, 95% confidence interval [CI], 1.0-3.3, P = .039) was significantly associated with postoperative complications.
A significant association was observed between myosteatosis and postoperative complications (corresponding to Clavien-Dindo classification before discharge), especially severe postoperative complications (Clavien-Dindo grade ≥3) in patients undergoing colorectal tumor resection. Screening for myosteatosis with HUAC using the CT before surgery may help clinicians identify high-risk perioperative patients early.
本研究旨在探讨两个术前肌肉相关参数，即用于评估肌肉量的第三腰椎骨骼肌指数（L3 SMI）和用于评估肌肉密度的亨氏单位平均计算值（HUAC），与全身麻醉下接受结直肠肿瘤切除手术患者术后并发症发生情况之间的关联。我们假设肌肉相关参数与术后并发症的发生有关。
这是一项单中心回顾性观察研究。纳入2018年9月1日至2021年9月1日期间在全身麻醉下接受结直肠肿瘤切除手术的成年患者。使用术前3个月内获得的最后一次腹部计算机断层扫描（CT）图像来计算L3 SMI和HUAC。主要结局定义为出院前发生的任何符合Clavien-Dindo分类的术后并发症。次要结局定义为出院前发生的任何严重术后并发症（Clavien-Dindo分级≥3级）。采用多变量逻辑回归分析来评估肌肉相关参数与术后并发症发生率之间的关联。在多变量逻辑回归分析中对患者的基线人口统计学、既往病史和术中参数进行了调整。
共纳入317例患者，中位年龄为66（58 - 72）岁。我们队列中的肌肉减少症（肌肉量减少）患者和肌肉脂肪变性（肌肉密度下降）患者分别有254例（80.1%）和79例（24.9%）。共有135例患者（42.6%）发生了术后并发症。根据多变量逻辑回归分析，肌肉脂肪变性（优势比[OR]，1.8，95%置信区间[CI]，1.0 - 3.3，P = 0.039）与术后并发症显著相关。
在接受结直肠肿瘤切除的患者中，观察到肌肉脂肪变性与术后并发症（对应出院前的Clavien-Dindo分类）之间存在显著关联，尤其是严重术后并发症（Clavien-Dindo分级≥3级）。术前使用CT通过HUAC筛查肌肉脂肪变性可能有助于临床医生早期识别围手术期高危患者。
