OBJECTIVES: Determining operative risk in patients undergoing aortic surgery is a difficult process, as multiple variables converge to affect overall mortality. Patient frailty is certainly a contributing factor, but is difficult to measure, with surgeons often relying on subjective or intuitive influences. We sought to use core muscle size as an objective measure of frailty, and determine its utility as a predictor of survival after abdominal aortic aneurysm (AAA) repair. METHODS: Four hundred seventy-nine patients underwent elective open AAA repair between 2000 and 2008. Two hundred sixty-two patients (54.7%) had preoperative computed tomography (CT) scans available for analysis. Cross-sectional areas of the psoas muscles at the level of the L4 vertebra were measured. The covariate-adjusted effect of psoas area on postoperative mortality was assessed using Cox regression. RESULTS: Of the 262 patients, there were 55 deaths and the mean length of follow-up was 2.3 years. Cox regression revealed a significant association between psoas area and postoperative mortality (P = .003). The effect of psoas area was found to decrease significantly as follow-up time increased (P = .008). Among all covariates included in the Cox models (including predictors of mortality such as American Society of Anesthesiologists [ASA] score), the psoas area was the most significant. CONCLUSION: Core muscle size, an objective measure of frailty, correlates strongly with mortality after elective AAA repair. A better understanding of the role of frailty and core muscle size may aid in risk stratification and impact timing of surgical repair, especially in more complex aortic operations.
OBJECTIVES: Determining operative risk in patients undergoing aortic surgery is a difficult process, as multiple variables converge to affect overall mortality. Patient frailty is certainly a contributing factor, but is difficult to measure, with surgeons often relying on subjective or intuitive influences. We sought to use core muscle size as an objective measure of frailty, and determine its utility as a predictor of survival after abdominal aortic aneurysm (AAA) repair. METHODS: Four hundred seventy-nine patients underwent elective open AAA repair between 2000 and 2008. Two hundred sixty-two patients (54.7%) had preoperative computed tomography (CT) scans available for analysis. Cross-sectional areas of the psoas muscles at the level of the L4 vertebra were measured. The covariate-adjusted effect of psoas area on postoperative mortality was assessed using Cox regression. RESULTS: Of the 262 patients, there were 55 deaths and the mean length of follow-up was 2.3 years. Cox regression revealed a significant association between psoas area and postoperative mortality (P = .003). The effect of psoas area was found to decrease significantly as follow-up time increased (P = .008). Among all covariates included in the Cox models (including predictors of mortality such as American Society of Anesthesiologists [ASA] score), the psoas area was the most significant. CONCLUSION: Core muscle size, an objective measure of frailty, correlates strongly with mortality after elective AAA repair. A better understanding of the role of frailty and core muscle size may aid in risk stratification and impact timing of surgical repair, especially in more complex aortic operations.
Authors: Barbra S Miller; Kathleen M Ignatoski; Stephanie Daignault; Ceit Lindland; Megan Doherty; Paul G Gauger; Gary D Hammer; Stewart C Wang; Gerard M Doherty Journal: World J Surg Date: 2012-07 Impact factor: 3.352
Authors: Jonathan P Singer; Joshua M Diamond; Cynthia J Gries; Jamiela McDonnough; Paul D Blanc; Rupal Shah; Monica Y Dean; Beverly Hersh; Paul J Wolters; Sofya Tokman; Selim M Arcasoy; Kristy Ramphal; John R Greenland; Nancy Smith; Pricilla Heffernan; Lori Shah; Pavan Shrestha; Jeffrey A Golden; Nancy P Blumenthal; Debbie Huang; Joshua Sonett; Steven Hays; Michelle Oyster; Patricia P Katz; Hilary Robbins; Melanie Brown; Lorriana E Leard; Jasleen Kukreja; Matthew Bacchetta; Errol Bush; Frank D'Ovidio; Melanie Rushefski; Kashif Raza; Jason D Christie; David J Lederer Journal: Am J Respir Crit Care Med Date: 2015-12-01 Impact factor: 21.405
Authors: Sean M Bagshaw; H Thomas Stelfox; Robert C McDermid; Darryl B Rolfson; Ross T Tsuyuki; Nadia Baig; Barbara Artiuch; Quazi Ibrahim; Daniel E Stollery; Ella Rokosh; Sumit R Majumdar Journal: CMAJ Date: 2013-11-25 Impact factor: 8.262
Authors: Ryan Howard; Yue S Yin; Lane McCandless; Stewart Wang; Michael Englesbe; David Machado-Aranda Journal: J Am Coll Surg Date: 2018-10-22 Impact factor: 6.113
Authors: Michael J Englesbe; Michael N Terjimanian; Jay S Lee; Kyle H Sheetz; Calista M Harbaugh; Adnan Hussain; Sven A Holcombe; June Sullivan; Darrell A Campbell; Stewart C Wang; Christopher J Sonnenday Journal: J Am Coll Surg Date: 2013-03-21 Impact factor: 6.113