Joseph J López1, Jennifer N Cooper2, Brett Albert3, Brent Adler4, Denis King5, Peter C Minneci6. 1. Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research and the Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus Ohio. 2. Center for Surgical Outcomes Research and the Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus Ohio. 3. The Ohio State University, Columbus, Ohio. 4. Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio. 5. Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio. 6. Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research and the Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus Ohio. Electronic address: peter.minneci@nationwidechildrens.org.
Abstract
BACKGROUND: Decreased skeletal muscle mass, or sarcopenia, has been shown to be associated with worse postoperative recovery and a higher risk of complications in adult surgical patients. We hypothesized that pediatric patients with complicated appendicitis may experience sarcopenic changes over the course of their treatment. METHODS: The medical records and computed tomography scans of 36 pediatric complex appendicitis patients who had both preoperative and postoperative computerized tomography scans at our hospital were reviewed. Changes in psoas muscle area were examined using linear mixed models with random patient-level intercept and time effects. RESULTS: The median change in body mass index among all patients from admission to discharge was -0.8 kg/m2 (interquartile range: -1.3 to -0.2). The mean percentage change in psoas muscle area per day over the course of appendicitis-related treatment was -0.81% (95% confidence interval: -1.12 to -0.50) (P < 0.001). The relative decrease in psoas muscle area per day did not vary by initial body mass index, gender, or race (P > 0.10 for all interactions). CONCLUSIONS: Our data suggest that pediatric patients with complex appendicitis experience sarcopenic changes during their hospital admission. Given previous reports that sarcopenia is a significant predictor of worse surgical outcomes, more investigation is warranted to assess whether these changes are associated with postsurgical complications and to evaluate potential interventions that may prevent these changes.
BACKGROUND: Decreased skeletal muscle mass, or sarcopenia, has been shown to be associated with worse postoperative recovery and a higher risk of complications in adult surgical patients. We hypothesized that pediatric patients with complicated appendicitis may experience sarcopenic changes over the course of their treatment. METHODS: The medical records and computed tomography scans of 36 pediatric complex appendicitispatients who had both preoperative and postoperative computerized tomography scans at our hospital were reviewed. Changes in psoas muscle area were examined using linear mixed models with random patient-level intercept and time effects. RESULTS: The median change in body mass index among all patients from admission to discharge was -0.8 kg/m2 (interquartile range: -1.3 to -0.2). The mean percentage change in psoas muscle area per day over the course of appendicitis-related treatment was -0.81% (95% confidence interval: -1.12 to -0.50) (P < 0.001). The relative decrease in psoas muscle area per day did not vary by initial body mass index, gender, or race (P > 0.10 for all interactions). CONCLUSIONS: Our data suggest that pediatric patients with complex appendicitis experience sarcopenic changes during their hospital admission. Given previous reports that sarcopenia is a significant predictor of worse surgical outcomes, more investigation is warranted to assess whether these changes are associated with postsurgical complications and to evaluate potential interventions that may prevent these changes.
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