C. Cadiz1, E. H. Wood1, M. Shah1, J. M. Eberhardt1, T. L. Saclarides1, D. Hayden1 1Loyola University Medical Center,Surgery,Maywood, ILLINOIS, USA
Introduction:
Sarcopenia has been associated with poor postoperative outcomes in cancer patients, and only recently has this been explored in patients with inflammatory bowel disease. We aim to describe the influence of sarcopenia on perioperative and postoperative outcomes after colectomy for patients with ulcerative colitis.
Methods:
Skeletal muscle mass index was measured on perioperative CT scans (within 1 month of surgery) of patients undergoing colectomy for ulcerative colitis at a single tertiary care center, 2007-2015. Using Mimics® software (Belgium), skeletal muscle area including the paraspinal, psoas and rectus muscles, was measured three times at the L3 level and the mean along with the patient’s height was then used to calculate the lumbar skeletal muscle mass index (cm2/m2). Sarcopenia was defined as 2 standard deviations below the index cutoff established in adult obese cancer patients: 38.5 in females, 52.4 in males (Lieffers 2012, Prado 2008).
Results:
36 UC patients had any type of colectomy with a CT scan performed within 1 month pre- or postoperatively. Mean age was 49.2 (17-84); 77.8% were male. Mean BMI was 26.8 (16.3-46.2). Overall prevalence of sarcopenia was 61.1%; 37.5% of females were sarcopenic at the time of surgery and 67.9% of males. Gender, race and surprisingly age were not associated with sarcopenia. Operative time was significantly associated with sarcopenia as was BMI. ICU admission trended toward significance (p=0.061). Overall postoperative complications were not associated with sarcopenia but UTIs were much more frequent (p=0.009). Readmissions, unexpected return to the operating room and mortalities were not associated with sarcopenia.
Conclusion:
Sarcopenia is extremely prevalent in patients with ulcerative colitis who require colectomy. Operative time, ICU admission and UTIs tend to be more longer and more frequent. Since the majority of patient did not undergo emergency colectomy, there may be time to optimize these patients with “pre-habilitation” if surgery is being considered in the near future.