Gabriele Ricci (Rome / IT), Marco Bellucci (Rome / IT), Stefano Manfroni (Rome / IT), Noemi di Fuccia (Rome / IT), Chiara Scorziello (Rome / IT), Ennio Adami (Rome / IT), Pierluigi Marini (Rome / IT)
Introduction
Sarcopenia is characterized by decreased skeletal muscle mass and strength/function. Recent studies suggest sarcopenia predicts worse outcomes in elective operations. The purpose of this study is to assess whether CT-derived muscle mass and visceral fat mass are associated with in-hospital complications in acute care surgical patients.
Methods
This is a retrospective study of acute care surgery patients admitted to our institution between January 2019 and January 2023. Trauma patients were excluded from the study. Patients in whom bowel resection with small bowel anastomosis was performed were extracted. Morphometric data were collected manually from pre-operative axial CT images at L3 level, using Software ImageJ (NHI). Skeletal muscle index [L3-SMI], visceral adipose tissue index [L3-VATI] and subcutaneous adipose tissue index [L3-SATI] were calculated. Multivariable logistic and linear regression analyses were performed to assess associations between body composition parameters and outcomes.
Results
A total of 128 patients, 68 females and 60 males, were included for analysis. The median age was 73 ±13,7 years. Sarcopenia was seen in 29 patients (22,6%). No significant differences were seen between sarcopenic and non sarcopenic group in age, ASA score, co-morbidities, oncological diseases, types of surgery and types of anastomosis. Sarcopenia was not independently associated with anastomotic leak (odds ratio [OR] 0,95, 95% confidence interval [CI] 0,74-1,12) but was independently associated with complications (OR 0,57, 95% CI 0,35-0,94), LOS (OR 0,31, 95% CI 0,2-0,54) and mortality (OR 1,12, 95%CI 0,80-1,62). Interestingly L3-VATI but not L3-SATI was independently associated with morbidity (OR 0,73, 95%CI 0,57-1,19) and anastomotic leak (OR 0,60, 95%CI 0,40-0,81).
Conclusions
In urgent laparotomies, sarcopenia was associated with higher morbidity and mortality. The body composition appears to be a good predictor of the clinical outcome.
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