TY - JOUR
T1 - Sarcopenia and Myosteatosis Predict Adverse Outcomes After Emergency Laparotomy
T2 - A Multi-Centre Observational Cohort Study
AU - Body, Samantha
AU - Ligthart, Marjolein A P
AU - Rahman, Saqib
AU - Ward, James
AU - May-Miller, Peter
AU - Pucher, Philip H
AU - Curtis, Nathan J
AU - West, Malcolm A
AU - Airofarulla, Clizia
AU - Alder, Louise
AU - Baylem, Nicholas
AU - Berry, David
AU - Benjafield, Anastasia
AU - Bhuvanakrishna, Thakshyanee
AU - Bond, Amanda
AU - Booth, Richard
AU - Broadhurst, Jack
AU - Byrne, James P
AU - Carten, Rachel
AU - Chambler, Duncan
AU - Davis, Heather
AU - Edwards, Mark R
AU - Froggatt, Paul
AU - Francis, Nader
AU - Grocott, Michael P W
AU - Lee, Gui Han
AU - Levett, Denny Z H
AU - Hickish, Camilla
AU - Howse, Frances
AU - Kangesu, Prashan
AU - Khawaja, Zeeshan
AU - Lee, Jieyun
AU - Lee, Chui
AU - McLachlan, Jenny
AU - Mercer, Stuart
AU - Mirnezami, Alex H
AU - Moran, Brendan
AU - Jones, Victoria Morrison
AU - Nicholls, Kate
AU - Damink, Steven W M Olde
AU - Pearson, Katherine
AU - Primrose, John N
AU - Robinson, Paul
AU - Sorensen, Eva
AU - Stubbs, Benjamin M
AU - Suhail, Noori
AU - Toh, Simon
AU - Terry, Michael
AU - Tzivanakis, Alexios
AU - Underwood, Timothy J
AU - Wessex Research Collaborative
N1 - Funding Information:
The authors would like to thank the Wessex Clinical Research Network for supporting the study, and individual research nurses at each recruiting site. No commercial support was involved in the study. This work was undertaken whilst MAW, JNP, and MPWG were funded by the National Institute of Health Research and TJU was funded by Cancer Research UK and the Royal College of Surgeons, England. JNP and MPWG are NIHR Senior Investigators.
Funding Information:
Funding was provided by the UK National Institute for Health Research, Academic Clinical Lecturer (personal award MAW) CL-206-26-002.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/6
Y1 - 2022/6
N2 - Objective:To determine the relationship between BC, specifically low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) and outcomes in emergency laparotomy patients.Background:Emergency laparotomy has one of the highest morbidity and mortality rates of all surgical interventions. BC objectively identifies patients at risk of adverse outcomes in elective cancer cohorts, however, evidence is lacking in emergency surgery.Methods:An observational cohort study of patients undergoing emergency laparotomy at ten English hospitals was performed. BC analyses were performed at the third lumbar vertebrae level using preoperative computed tomography images to quantify skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SM-RA). Sex-specific SMI and SM-RA were determined, with the lower tertile splits defining sarcopenia (low SMI) and myosteatosis (low SM-RA). Accuracy of mortality risk prediction, incorporating SMI and SM-RA variables into risk models was assessed with regression modeling.Results:Six hundred ten patients were included. Sarcopenia and myosteatosis were both associated with increased risk of morbidity (52.1% vs 45.1%, P = 0.028; 57.5% vs 42.6%, P = 0.014), 30-day (9.5% vs 3.6%, P = 0.010; 14.9% vs 3.4%, P < 0.001), and 1-year mortality (27.4% vs 11.5%, P < 0.001; 29.7% vs 12.5%, P < 0.001). Risk-Adjusted 30-day mortality was significantly increased by sarcopenia [OR 2.56 (95% CI 1.12-5.84), P = 0.026] and myosteatosis [OR 4.26 (2.01-9.06), P < 0.001], similarly at 1-year [OR 2.66 (95% CI 1.57-4.52), P < 0.001; OR2.08 (95%CI 1.26-3.41), P = 0.004]. BC data increased discrimination of an existing mortality risk-prediction model (AUC 0.838, 95% CI 0.835-0.84).Conclusion:Sarcopenia and myosteatosis are associated with increased adverse outcomes in emergency laparotomy patients.
AB - Objective:To determine the relationship between BC, specifically low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) and outcomes in emergency laparotomy patients.Background:Emergency laparotomy has one of the highest morbidity and mortality rates of all surgical interventions. BC objectively identifies patients at risk of adverse outcomes in elective cancer cohorts, however, evidence is lacking in emergency surgery.Methods:An observational cohort study of patients undergoing emergency laparotomy at ten English hospitals was performed. BC analyses were performed at the third lumbar vertebrae level using preoperative computed tomography images to quantify skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SM-RA). Sex-specific SMI and SM-RA were determined, with the lower tertile splits defining sarcopenia (low SMI) and myosteatosis (low SM-RA). Accuracy of mortality risk prediction, incorporating SMI and SM-RA variables into risk models was assessed with regression modeling.Results:Six hundred ten patients were included. Sarcopenia and myosteatosis were both associated with increased risk of morbidity (52.1% vs 45.1%, P = 0.028; 57.5% vs 42.6%, P = 0.014), 30-day (9.5% vs 3.6%, P = 0.010; 14.9% vs 3.4%, P < 0.001), and 1-year mortality (27.4% vs 11.5%, P < 0.001; 29.7% vs 12.5%, P < 0.001). Risk-Adjusted 30-day mortality was significantly increased by sarcopenia [OR 2.56 (95% CI 1.12-5.84), P = 0.026] and myosteatosis [OR 4.26 (2.01-9.06), P < 0.001], similarly at 1-year [OR 2.66 (95% CI 1.57-4.52), P < 0.001; OR2.08 (95%CI 1.26-3.41), P = 0.004]. BC data increased discrimination of an existing mortality risk-prediction model (AUC 0.838, 95% CI 0.835-0.84).Conclusion:Sarcopenia and myosteatosis are associated with increased adverse outcomes in emergency laparotomy patients.
KW - ABDOMINAL-SURGERY
KW - COMPUTED-TOMOGRAPHY
KW - DEPLETION
KW - ELDERLY-PATIENTS
KW - FRAILTY
KW - MORBIDITY
KW - MORTALITY
KW - MUSCLE RADIATION ATTENUATION
KW - PREVALENCE
KW - SOLID TUMORS
KW - emergency
KW - laparotomy
KW - mortality
KW - myosteatosis
KW - sarcopenia
U2 - 10.1097/SLA.0000000000004781
DO - 10.1097/SLA.0000000000004781
M3 - Article
C2 - 33914486
SN - 0003-4932
VL - 275
SP - 1103
EP - 1111
JO - Annals of Surgery
JF - Annals of Surgery
IS - 6
ER -