H. K. Weiss1, M. Errea2, B. W. Stocker1, N. Weingarten1, K. E. Engelhardt3, B. Cook2, J. A. Posluszny2 1Feinberg School Of Medicine – Northwestern University,Chicago, IL, USA 2Northwestern University,Department Of Surgery,Chicago, IL, USA 3The Medical University of South Carolina,Department Of Surgery,Charleston, SC, USA
Introduction: The diagnoses of sarcopenia and frailty are often intertwined—both identify less healthy patients with higher complication rates and worse outcomes. However, sarcopenia is a function of muscle density alone, while frailty measurements take into account a multidimensional understanding of frailty, including patient comorbidities, emotional health, nutrition, cognitive and physical function. We hypothesize that sarcopenia and frailty measure different forms of disability. The objective of our study is determine the concordance of sarcopenia and frailty in geriatric trauma and emergency general surgery (TEGS) patients.
Methods: We reviewed our QI database of geriatric (≥65 year old) TEGS patients. As part of this project, all geriatrics patients are screened for frailty using the validated TEGS frailty screening tool. Patients in whom a CT of the abdomen and pelvis was obtained were identified and total psoas index (TPI) (area of right and left psoas muscle at L3/2) was calculated, with lower TPIs signifying sarcopenia. Patients were then compared for frailty and sarcopenia.
Results: 117 geriatric TEGS patients were screened for frailty. Of all patients, 78 (67%) had a CT of the abdomen and pelvis. Of these 78 patients, 22 (28%) were frail. Mean TPI for all patients was 2.34±0.77. Mean TPI for non-frail patients was 2.34±0.81 and was 2.33±0.65 for frail patients (p=0.97). Since 28% of our patients were frail, we then compared patients with the 28% (n=23) lowest TPI for frailty. Only five (23%) of these patients were frail (p=0.59). Using the lowest quintile of TPI (15 patients) to define sarcopenia, as is done in other studies, only 3 (20%) of these sarcopenic patients were frail (p=0.53).
Conclusion: Although both sarcopenia and frailty identify patients at higher risk for complications and worse surgical outcomes, sarcopenia does not specifically reflect frailty. As such, frailty and sarcopenia are not concordant measures of illness. Further study will help elucidate the true relationship between frailty and sarcopenia and the clinical implications of sarcopenia for geriatric TEGS patients.