Al-Sarireh Ahmad, Al-Sarireh Hashim, Ambler Olivia, Hajibandeh Shahin, Hajibandeh Shahab
University of Cambridge, Cambridge, UK.
University of Leeds, Leeds, UK.
Updates Surg. 2025 Apr;77(2):591-603. doi: 10.1007/s13304-025-02105-4. Epub 2025 Jan 16.
The aim of this study was to investigate the relationship between sarcopenia and American Society of Anesthesiologists (ASA) status in predicting post-operative mortality after emergency laparotomy. A PRISMA-compliant systematic review and meta-analysis (using random effects modelling) was performed searching for studies reporting 30-day mortality risk in patients with sarcopenia undergoing emergency laparotomy. The ASA status of sarcopenic and non-sarcopenic patients was determined, and the effect of difference in ASA status on 30-day mortality in sarcopenic and non-sarcopenic patients was determined via a meta-regression model. The risk of bias and certainty was assessed using the QUIPS tool and the GRADE system, respectively. Seven studies comprising 2663 patients were included. Thirty-day mortality risk was 22.9% (95% CI 11.6-40.0%) in sarcopenic patients and 6.2% (95% CI 2.9-13.0%) in non-sarcopenic patients; the risk was significantly higher in sarcopenic patients (OR: 4.452, p = 0.016). In sarcopenic patients, ASA status IV-V increased the risk of mortality (Coefficient: 0.07612, p < 0.0001), while ASA status I-II (Coefficient: - 0.09039, p < 0.0001) or ASA status III (Coefficient: 0.01300, p = 0.344) did not. In non-sarcopenic patients, ASA status III (Coefficient: 0.06830, p < 0.0001) and ASA status IV-V (Coefficient: 0.17809, p < 0.0001) increased the risk of mortality, while ASA status I-II (Coefficient: - 0.05841, p < 0.0001) did not. The GRADE certainty was moderate. Sarcopenia and ASA status are two independent predictors of mortality after emergency laparotomy with no significant collinearity. Sarcopenia and ASA status synergistically increase the risk of mortality after emergency laparotomy. ASA status IV and ASA status III are critical thresholds for increased risk of mortality in sarcopenic and non-sarcopenic patients, respectively.
本研究旨在探讨肌少症与美国麻醉医师协会（ASA）分级在预测急诊剖腹术后死亡率方面的关系。我们进行了一项符合PRISMA标准的系统评价和荟萃分析（采用随机效应模型），以查找报告肌少症患者急诊剖腹术后30天死亡风险的研究。确定了肌少症患者和非肌少症患者的ASA分级，并通过荟萃回归模型确定了ASA分级差异对肌少症患者和非肌少症患者30天死亡率的影响。分别使用QUIPS工具和GRADE系统评估偏倚风险和确定性。纳入了7项研究，共2663例患者。肌少症患者的30天死亡风险为22.9%（95%CI 11.6 - 40.0%），非肌少症患者为6.2%（95%CI 2.9 - 13.0%）；肌少症患者的风险显著更高（OR：4.452，p = 0.016）。在肌少症患者中，ASA分级IV - V增加了死亡风险（系数：0.07612，p < 0.0001），而ASA分级I - II（系数： - 0.09039，p < 0.0001）或ASA分级III（系数：0.01300，p = 0.344）则没有。在非肌少症患者中，ASA分级III（系数：0.06830，p < 0.0001）和ASA分级IV - V（系数：0.17809，p < 0.0001）增加了死亡风险，而ASA分级I - II（系数： - 0.05841，p < 0.0001）则没有。GRADE确定性为中等。肌少症和ASA分级是急诊剖腹术后死亡率的两个独立预测因素，且无显著共线性。肌少症和ASA分级协同增加急诊剖腹术后的死亡风险。ASA分级IV和ASA分级III分别是肌少症患者和非肌少症患者死亡风险增加的关键阈值。
