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DOI: 10.1055/s-0041-1726396
A Novel Technique for Radiographic Diagnosis of Sarcopenia that Accurately Predicts Postoperative Complications in Lower Extremity Free Flap Patients
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Abstract
Background Sarcopenia is linked to poor outcomes throughout the surgical literature and can be assessed on preoperative imaging to potentially aid in risk stratification. This study examined the effects of sarcopenia on surgical morbidity following lower extremity (LE) reconstruction, and also compared two methods of assessment, one of which is novel (“ellipse method”).
Methods A retrospective cohort study of 50 patients receiving free flap-based reconstruction of the LE was performed. Bilateral psoas density and area were quantified at L4 through tracing (“traditional method”) and encircling (“ellipse method”) to calculate Hounsfield unit average calculation (HUAC). Logistic regression and receiving operator curve analysis for the primary outcome of any postoperative complication was used to determine HUAC cutoffs (≤ 20.7 vs. ≤ 20.6) for sarcopenia. Risk of complications associated with sarcopenia was evaluated using Fisher's exact tests.
Results Twelve patients (24%) met criteria for sarcopenia via the traditional method and 16 (32%) via the ellipse method. By both methods, sarcopenic patients were older and more often female and diabetic. These patients also had higher American Society of Anesthesiologists scores and lower serum prealbumin levels. The ellipse method was found to be more accurate, sensitive, and specific than the traditional method in predicting postoperative morbidity (p = 0.009). Via the ellipse method, sarcopenic patients were at higher risk for any complication (p = 0.002) and were at a higher risk for a deep vein thrombus or pulmonary embolism via the traditional method (p = 0.047).
Conclusion Sarcopenia is associated with greater pre- and postoperative morbidity in LE reconstruction. The novel ellipse method is a simplified and accurate method of assessing sarcopenia that can be easily performed in the clinical setting.
* Co-first authors.
Publikationsverlauf
Eingereicht: 26. Oktober 2020
Angenommen: 27. Januar 2021
Artikel online veröffentlicht:
14. April 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Chen LK, Liu LK, Woo J. et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014; 15 (02) 95-101
- 2 Cruz-Jentoft AJ, Baeyens JP, Bauer JM. et al; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39 (04) 412-423
- 3 Cruz-Jentoft AJ, Bahat G, Bauer J. et al; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48 (01) 16-31
- 4 Santilli V, Bernetti A, Mangone M, Paoloni M. Clinical definition of sarcopenia. Clin Cases Miner Bone Metab 2014; 11 (03) 177-180
- 5 Dodds RM, Roberts HC, Cooper C, Sayer AA. The epidemiology of sarcopenia. J Clin Densitom 2015; 18 (04) 461-466
- 6 Han A, Bokshan SL, Marcaccio SE, DePasse JM, Daniels AH. Diagnostic criteria and clinical outcomes in sarcopenia research: a literature review. J Clin Med 2018; 7 (04) 70
- 7 Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet 2019; 393 (10191): 2636-2646
- 8 Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle 2016; 7 (05) 512-514
- 9 Woo J, Leung J, Sham A, Kwok T. Defining sarcopenia in terms of risk of physical limitations: a 5-year follow-up study of 3,153 Chinese men and women. J Am Geriatr Soc 2009; 57 (12) 2224-2231
- 10 Tanimoto Y, Watanabe M, Sun W. et al. Association between sarcopenia and higher-level functional capacity in daily living in community-dwelling elderly subjects in Japan. Arch Gerontol Geriatr 2012; 55 (02) e9-e13
- 11 Auyeung TW, Lee JS, Leung J, Kwok T, Woo J. The selection of a screening test for frailty identification in community-dwelling older adults. J Nutr Health Aging 2014; 18 (02) 199-203
- 12 Goodpaster BH, Park SW, Harris TB. et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2006; 61 (10) 1059-1064
- 13 Lim S, Kwon SY, Yoon JW. et al. Association between body composition and pulmonary function in elderly people: the Korean Longitudinal Study on Health and Aging. Obesity (Silver Spring) 2011; 19 (03) 631-638
- 14 Karakelides H, Nair KS. Sarcopenia of aging and its metabolic impact. Curr Top Dev Biol 2005; 68: 123-148
- 15 Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 2004; 52 (01) 80-85
- 16 Cesari M, Pahor M, Lauretani F. et al. Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2009; 64 (03) 377-384
- 17 Newman AB, Kupelian V, Visser M. et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 2006; 61 (01) 72-77
- 18 Friedman J, Lussiez A, Sullivan J, Wang S, Englesbe M. Implications of sarcopenia in major surgery. Nutr Clin Pract 2015; 30 (02) 175-179
- 19 Barnes LA, Li AY, Wan DC, Momeni A. Determining the impact of sarcopenia on postoperative complications after ventral hernia repair. J Plast Reconstr Aesthet Surg 2018; 71 (09) 1260-1268
- 20 Hajibandeh S, Hajibandeh S, Jarvis R, Bhogal T, Dalmia S. Meta-analysis of the effect of sarcopenia in predicting postoperative mortality in emergency and elective abdominal surgery. Surgeon 2019; 17 (06) 370-380
- 21 Matsubara Y, Matsumoto T, Aoyagi Y. et al. Sarcopenia is a prognostic factor for overall survival in patients with critical limb ischemia. J Vasc Surg 2015; 61 (04) 945-950
- 22 Cheng BT, Soult MC, Helenowski IB, Rodriguez HE, Eskandari MK, Hoel AW. Sarcopenia predicts mortality and adverse outcomes after endovascular aneurysm repair and can be used to risk stratify patients. J Vasc Surg 2019; 70 (05) 1576-1584
- 23 Taniguchi R, Deguchi J, Hashimoto T, Sato O. Sarcopenia as a possible negative predictor of limb salvage in patients with chronic limb-threatening ischemia. Ann Vasc Dis 2019; 12 (02) 194-199
- 24 Ardeljan AD, Polisetty TS, Palmer J, Vakharia RM, Roche MW. Comparative analysis on the effects of sarcopenia following primary total knee arthroplasty: a retrospective matched-control analysis. J Knee Surg 2020; DOI: 10.1055/s-0040-1713355.
- 25 DeAndrade J, Pedersen M, Garcia L, Nau P. Sarcopenia is a risk factor for complications and an independent predictor of hospital length of stay in trauma patients. J Surg Res 2018; 221: 161-166
- 26 Wahlen BM, Mekkodathil A, Al-Thani H, El-Menyar A. Impact of sarcopenia in trauma and surgical patient population: a literature review. Asian J Surg 2020; 43 (06) 647-653
- 27 Zhang S, Tan S, Jiang Y. et al. Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: a prospective cohort study. Clin Nutr 2019; 38 (06) 2881-2888
- 28 O'Brien S, Twomey M, Moloney F. et al. Sarcopenia and post-operative morbidity and mortality in patients with gastric cancer. J Gastric Cancer 2018; 18 (03) 242-252
- 29 Miller TJ, Sheckter CC, Barnes LA, Li AY, Momeni A. Sarcopenia is a risk factor for infection for patients undergoing abdominoperineal resection and flap-based reconstruction. Plast Reconstr Surg Glob Open 2019; 7 (07) e2343
- 30 Achim V, Bash J, Mowery A. et al. Prognostic indication of sarcopenia for wound complication after total laryngectomy. JAMA Otolaryngol Head Neck Surg 2017; 143 (12) 1159-1165
- 31 Alwani MM, Jones AJ, Novinger LJ. et al. Impact of sarcopenia on outcomes of autologous head and neck free tissue reconstruction. J Reconstr Microsurg 2020; 36 (05) 369-378
- 32 Makiguchi T, Yamaguchi T, Nakamura H. et al. Impact of skeletal muscle mass volume on surgical site infection in free flap reconstruction for oral cancer. Microsurgery 2019; 39 (07) 598-604
- 33 Makiguchi T, Yamaguchi T, Nakamura H. et al. Impact of skeletal muscle mass on postoperative delirium in patients undergoing free flap repair after oral cancer resection. J Plast Surg Hand Surg 2020; 54 (03) 161-166
- 34 Nakamura H, Makiguchi T, Yamaguchi T, Fujii T, Shirabe K, Yokoo S. Impact of skeletal muscle mass on complications following expander breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 73 (07) 1285-1291
- 35 Nakamura H, Makiguchi T, Yamaguchi T, Suzuki K, Yokoo S. Impact of sarcopenia on postoperative surgical site infections in patients undergoing flap reconstruction for oral cancer. Int J Oral Maxillofac Surg 2020; 49 (05) 576-581
- 36 Pittelkow EM, DeBrock WC, McLaughlin BE. et al. Preoperatively identified sarcopenia leads to increased postoperative complications, hospital and ICU length of stay in autologous microsurgical breast reconstruction. J Reconstr Microsurg 2020; 36 (01) 59-63
- 37 Joglekar S, Asghar A, Mott SL. et al. Sarcopenia is an independent predictor of complications following pancreatectomy for adenocarcinoma. J Surg Oncol 2015; 111 (06) 771-775
- 38 Youden WJ. Index for rating diagnostic tests. Cancer 1950; 3 (01) 32-35
- 39 Nagelkerke NJ. A note on a general definition of the coefficient of determination. Biometrika 1991; 78 (03) 691-692
- 40 Rosenberg IH. Summary comments. Am J Clin Nutr 1989; (05) 1231-1233
- 41 Cruz-Jentoft AJ, Landi F, Topinková E, Michel JP. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care 2010; 13 (01) 1-7
- 42 Frontera WR, Zayas AR, Rodriguez N. Aging of human muscle: understanding sarcopenia at the single muscle cell level. Phys Med Rehabil Clin N Am 2012; 23 (01) 201-207 , xiii
- 43 Ciciliot S, Rossi AC, Dyar KA, Blaauw B, Schiaffino S. Muscle type and fiber type specificity in muscle wasting. Int J Biochem Cell Biol 2013; 45 (10) 2191-2199
- 44 Correa-de-Araujo R, Harris-Love MO, Miljkovic I, Fragala MS, Anthony BW, Manini TM. The need for standardized assessment of muscle quality in skeletal muscle function deficit and other aging-related muscle dysfunctions: a symposium report. Front Physiol 2017; 8: 87
- 45 Arneson PC, Doles JD. Impaired muscle regeneration in cancer-associated cachexia. Trends Cancer 2019; 5 (10) 579-582
- 46 Zamboni M, Rubele S, Rossi AP. Sarcopenia and obesity. Curr Opin Clin Nutr Metab Care 2019; 22 (01) 13-19
- 47 Iannuzzi-Sucich M, Prestwood KM, Kenny AM. Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol A Biol Sci Med Sci 2002; 57 (12) M772-M777
- 48 Newman AB, Kupelian V, Visser M. et al; Health ABC Study Investigators. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 2003; 51 (11) 1602-1609
- 49 Lau EM, Lynn HS, Woo JW, Kwok TC, Melton III LJ. Prevalence of and risk factors for sarcopenia in elderly Chinese men and women. J Gerontol A Biol Sci Med Sci 2005; 60 (02) 213-216
- 50 Lee JS, Auyeung TW, Kwok T, Lau EM, Leung PC, Woo J. Associated factors and health impact of sarcopenia in older Chinese men and women: a cross-sectional study. Gerontology 2007; 53 (06) 404-410
- 51 Park SW, Goodpaster BH, Lee JS. et al; Health, Aging, and Body Composition Study. Excessive loss of skeletal muscle mass in older adults with type 2 diabetes. Diabetes Care 2009; 32 (11) 1993-1997
- 52 Maggio M, Lauretani F, Ceda GP. Sex hormones and sarcopenia in older persons. Curr Opin Clin Nutr Metab Care 2013; 16 (01) 3-13
- 53 Auyeung TW, Lee JS, Kwok T. et al. Testosterone but not estradiol level is positively related to muscle strength and physical performance independent of muscle mass: a cross-sectional study in 1489 older men. Eur J Endocrinol 2011; 164 (05) 811-817
- 54 Hogan KA, Cho DS, Arneson PC. et al. Tumor-derived cytokines impair myogenesis and alter the skeletal muscle immune microenvironment. Cytokine 2018; 107: 9-17
- 55 Engel H, Lin CH, Wei FC. Role of microsurgery in lower extremity reconstruction. Plast Reconstr Surg 2011; 127 (Suppl. 01) 228S-238S
- 56 Moreland JD, Richardson JA, Goldsmith CH, Clase CM. Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2004; 52 (07) 1121-1129
- 57 Yamada M, Nishiguchi S, Fukutani N. et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc 2013; 14 (12) 911-915
- 58 Ji HM, Han J, Jin DS, Suh H, Chung YS, Won YY. Sarcopenia and sarcopenic obesity in patients undergoing orthopedic surgery. Clin Orthop Surg 2016; 8 (02) 194-202
- 59 Gomez-Perez SL, Haus JM, Sheean P. et al. Measuring abdominal circumference and skeletal muscle from a single cross-sectional computed tomography image: a step-by-step guide for clinicians using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr 2016; 40 (03) 308-318
- 60 Price KL, Earthman CP. Update on body composition tools in clinical settings: computed tomography, ultrasound, and bioimpedance applications for assessment and monitoring. Eur J Clin Nutr 2019; 73 (02) 187-193
- 61 Paris M, Mourtzakis M. Assessment of skeletal muscle mass in critically ill patients: considerations for the utility of computed tomography imaging and ultrasonography. Curr Opin Clin Nutr Metab Care 2016; 19 (02) 125-130
- 62 Kim G, Kang SH, Kim MY, Baik SK. Prognostic value of sarcopenia in patients with liver cirrhosis: a systematic review and meta-analysis. PLoS One 2017; 12 (10) e0186990
- 63 Weimann A, Braga M, Harsanyi L. et al; DGEM (German Society for Nutritional Medicine), ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: surgery including organ transplantation. Clin Nutr 2006; 25 (02) 224-244
- 64 Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F. ESPEN. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr 2009; 28 (04) 378-386
- 65 Jie B, Jiang ZM, Nolan MT, Zhu SN, Yu K, Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition 2012; 28 (10) 1022-1027
- 66 Fukuda Y, Yamamoto K, Hirao M. et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 2015; 22 (Suppl. 03) S778-S785
- 67 Wischmeyer PE, Carli F, Evans DC. et al; Perioperative Quality Initiative (POQI) 2 Workgroup. American society for enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg 2018; 126 (06) 1883-1895
- 68 Steenhagen E. Preoperative nutritional optimization of esophageal cancer patients. J Thorac Dis 2019; 11 (Suppl. 05) S645-S653