The impact of sarcopenia on outcomes in patients with inflammatory bowel disease undergoing colorectal surgery

• Published in: ANZ journal of surgery Vol. 92; no. 3; pp. 397 - 402
• Main Authors: Trinder, Matthew W., Clifford, Matthew, Jones, Aimee Lee, Shepherd, Talia, Jacob, Abraham O.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.03.2022; Blackwell Publishing Ltd
• Subjects: Anastomotic leak; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Chronic Disease; Colitis, Ulcerative - surgery; Colorectal Surgery; Complications; Crohn Disease - complications; Crohn Disease - surgery; Crohn's disease; Female; Gastrointestinal system; Humans; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - surgery; Intestine; Male; Muscles; Nutrition; Parenteral nutrition; Patients; Population studies; Retrospective Studies; Sarcopenia; Sarcopenia - complications; Sarcopenia - epidemiology; Skeletal muscle; Surgery; Surgical anastomosis; Ulcerative colitis; Vertebrae; colorectal surgery; inflammatory bowel disease; sarcopenia
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.17439

Introduction Sarcopenia is an independent predictor of poor post‐operative outcomes following major surgery. Inflammatory bowel disease (IBD) consists of Crohn's disease (CD) and ulcerative colitis (UC), which are chronic inflammatory conditions involving the gastrointestinal system. Evidence demonstrates that up to 60% of patients with IBD have sarcopenia. Despite advances in medical management, more than 15% of patients with UC and 80% with CD eventually require surgical intervention. The primary aim of the study was to assess the impact of sarcopenia on post‐operative anastomotic leak rates. Methods A retrospective cohort study of patients at Royal Perth Hospital who underwent major abdominal surgery for management of IBD between January 2010 and December 2020 was performed. Sarcopenia was assessed according to the skeletal muscle index at the level of the third lumbar vertebrae using the cut off 52.4 and 38.5 cm2/m2 for men and women, respectively. Results A total of 147 patients were included. The prevalence of sarcopenia within the study population was 36.1%. Patients with sarcopenia were significantly taller (P = 0.025) and were more likely to be on pre‐operative steroid medications (P = 0.045). There was no difference in the remaining baseline characteristics between sarcopenic and non‐sarcopenic patients. Patients with sarcopenia were more likely to develop a post‐operative anastomotic leak (OR:11.303, 95% CI, 1.53–83.51, P = 0.017), grade IV complications (OR:6.79, 95%CI:1.1–43.6, P = 0.044) and require total parenteral nutrition (TPN) (OR:3.212, 95% CI:1.3–8.1, P = 0.013). Conclusions Sarcopenia significantly increases the risk of major post‐operative complications for patients with IBD undergoing colorectal surgery. A retrospective analysis of 147 patients with inflammatory bowel disease that underwent major abdominal surgery was performed. Patient CT scans were assessed for evidence of sarcopenia and outcomes were compared between sarcopenia and non‐sarcopenia patients. Sarcopenia patients were more likely to develop major post‐operative complications, anastomotic leak and require TPN.