S. J. O’Brien1,2, O. J. O’Connor3, E. J. Andrews2 1University Of Louisville,Surgery,Louisville, KY, USA 2University College Cork,Surgery,Cork, CORK, Ireland 3University College Cork,Radiology,Cork, CORK, Ireland
Introduction:
Sarcopenia has been defined by the European working group on Sarcopenia in Older People (EWGSOP) as a low muscle mass and either decreased muscle strength or low physical performance. Skeletal muscle index is use to measure muscle mass. Recent studies have demonstrated the association that sarcopenia has with adverse post-operative outcomes in patients with cancer. Few studies have examined the role of sarcopenia or myosteatosis, fatty infiltration of the muscle, in the setting of non-oncological surgery. The aim of this study was to assess the prognostic significance of sarcopenia and myosteatosis in patients with inflammatory bowel disease undergoing surgical resection with respect to post-operative complications.
Methods:
A retrospective analysis of a prospectively maintained surgical database was examined. All patients who underwent an elective or emergent colonic resection for IBD between 2011 and 2016 were included. Patient demographics, clinical indices and peri operative CT scans were collected. Skeletal muscle index was calculated by measuring the total muscle area (cm2),at the level of the L3 vertebra, and normalising to the patients height squared (m2?) using the Osirix image analysis software (Figure 1). Myosteatosis is calculated by measuring the average Hounsfield unit at the same vertebral level. Regression analysis was used to identify predictors of outcomes.
Results:
39%(30/77) of patients were sarcopenic. Both sarcopenic and non- sarcopenic groups were equally matched with the exception of weight and BMI (p=0.014 and 0.009). There was a significant difference in hospital readmission between sarcopenic and non-sarcopenic patients and between myosteatotic and non-myosteatotic patients (p=0.03 and p=0.018). On univariate analysis, sarcopenia and myosteatosis were risk factors for hospital readmission (OR= 4.778, 95CI: 1.121-20.361 p=0.034 and OR= 6.24 95CI: 1.224-31.811, p=0.028). There was no difference in the incidence of major complications, anastomotic leaks and length of stay between the study groups.
Conclusion:
Sarcopaenia and myosteatosis were associated with hospital readmission in this study. As the cut-off values for a low skeletal muscle index are calculated from a cohort of oncology patients, this may accout for the lack of difference in the incidence of major complications, anastomotic leaks and length of stay. Further research is required to elucidate the role of myopenia and myosteatosis in patients undergoing surgery for non-malignant disease.
