P. S. Kirk1, J. F. Friedman1, D. C. Cron1, M. N. Terjimanian1, L. D. Canvasser1, A. M. Hammoud1, J. Claflin1, M. B. Alameddine1, E. D. Davis1, N. Werner1, S. C. Wang1, D. A. Campbell1, M. J. Englesbe1 1University Of Michigan Health System,Department Of Surgery,Ann Arbor, MI, USA
Introduction: It is well established that sarcopenic patients are at higher risk of postoperative complications and short-term healthcare utilization. Less well understood is how these patients fare over the long term after surviving the immediate postoperative period. We explored costs over the postoperative year among sarcopenic patients.
Methods: We identified 1,298 patients in the Michigan Surgical Quality Collaborative (MSQC) database who underwent inpatient elective surgery at the University of Michigan Health System from 2006 to 2011. Sarcopenia, defined by gender-stratified tertile of lean psoas area (LPA), was determined from preoperative CT scans using validated analytic morphomics. Data were analyzed to assess sarcopenia’s relationship to costs, readmissions, discharge location, surgical intensive care unit (SICU) admissions, hospital length of stay (LOS), and mortality. Multivariate models adjusted for patient demographics and surgical risk factors.
Results: Sarcopenia was independently associated with increased adjusted costs at 30, 90, 180, and 365 days (p=0.001, p<0.001, p=0.091, and p=0.021, respectively) (Fig. 1). The difference in adjusted postsurgical costs between sarcopenic and non-sarcopenic patients increased from $5,541 at 30 days to $9,938 at one year. Sarcopenic patients were more likely to be discharged somewhere other than home (OR=4.44, CI=2.30-8.59, p<0.001) and more likely to die in the postoperative year (OR=3.24, CI=1.72-6.11, p<0.001). Sarcopenia was not an independent predictor of increased readmission rates in the postsurgical year (p=0.69).
Conclusion: Sarcopenia is a robust predictor of healthcare utilization in the first year after surgery. These patients accumulate costs at a faster rate than their non-sarcopenic counterparts. It may be appropriate to allocate additional resources to sarcopenic patients in the perioperative setting to reduce the incidence of negative postoperative outcomes.
