D Wagner1, K Marsoner2, A Tomberger2, J Haybaeck3, J Haas4, G Werkgartner2, H Cerwenka2, H Bacher2, H J Mischinger2, P Kornprat2. 1. Medical University of Graz, Department of Surgery, Division for General Surgery, Graz, Austria. Electronic address: doris.wagner@medunigraz.at. 2. Medical University of Graz, Department of Surgery, Division for General Surgery, Graz, Austria. 3. Medical University of Magdeburg, Department for Pathology, Germany. 4. Medical University of Graz, Department of Gynecology and Obstetrics, Austria.
Abstract
INTRODUCTION: Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. METHODS: As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having low skeletal muscle mass (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity. RESULTS: Median patient age was 63 years (19-87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI]>6, 63.2%), 30-day mortality was 5.8% (n = 25). Median HUAC was 19.78 HU (IQR: 15.94-23.54) with 145 patients (34.2%) having low skeletal muscle mass. Preoperative frailty defined by low skeletal muscle mass was associated with an increased risk for postoperative complications (OR 1.55, CI 95% 0.98-2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, CI 95% 1.57-16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (CI 95% 0.78-0.91, p = 0.0001). Patients with CCI ≥6 and low skeletal muscle mass defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, CI 95% 2.98-12.2, p = 0.0001). CONCLUSION: Low skeletal muscle mass predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients.
INTRODUCTION: Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. METHODS: As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having low skeletal muscle mass (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity. RESULTS: Median patient age was 63 years (19-87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI]>6, 63.2%), 30-day mortality was 5.8% (n = 25). Median HUAC was 19.78 HU (IQR: 15.94-23.54) with 145 patients (34.2%) having low skeletal muscle mass. Preoperative frailty defined by low skeletal muscle mass was associated with an increased risk for postoperative complications (OR 1.55, CI 95% 0.98-2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, CI 95% 1.57-16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (CI 95% 0.78-0.91, p = 0.0001). Patients with CCI ≥6 and low skeletal muscle mass defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, CI 95% 2.98-12.2, p = 0.0001). CONCLUSION: Low skeletal muscle mass predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients.
Authors: Nick Lasse Beetz; Dominik Geisel; Christoph Maier; Timo Alexander Auer; Seyd Shnayien; Thomas Malinka; Christopher Claudius Maximilian Neumann; Uwe Pelzer; Uli Fehrenbach Journal: J Clin Med Date: 2022-04-22 Impact factor: 4.964
Authors: Linda B M Weerink; Anouk van der Hoorn; Barbara L van Leeuwen; Geertruida H de Bock Journal: J Cachexia Sarcopenia Muscle Date: 2020-03-03 Impact factor: 12.910
Authors: Franziska Alexandra Meister; Georg Lurje; Suekran Verhoeven; Georg Wiltberger; Lara Heij; Wen-Jia Liu; Decan Jiang; Philipp Bruners; Sven Arke Lang; Tom Florian Ulmer; Ulf Peter Neumann; Jan Bednarsch; Zoltan Czigany Journal: Cancers (Basel) Date: 2022-01-30 Impact factor: 6.639
Authors: Jose Roberto Gutierrez-Camacho; Lorena Avila-Carrasco; Alberto Murillo-Ruíz-Esparza; Idalia Garza-Veloz; Roxana Araujo-Espino; Maria Calixta Martinez-Vazquez; Perla M Trejo-Ortiz; Iram Pablo Rodriguez-Sanchez; Iván Delgado-Enciso; Maria E Castañeda-López; Araceli Gamón-Madrid; Margarita L Martinez-Fierro Journal: Healthcare (Basel) Date: 2022-02-12