Incidence and associated morbidity of sarcopenia in non-malignant small and large bowel anastomosis: propensity score-matched analysis

• Published in: International journal of colorectal disease Vol. 38; no. 1; p. 159
• Main Authors: Traeger, Luke, Bedrikovetski, Sergei, Nguyen, Thuy-My, Moore, James W., Sammour, Tarik
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 02.06.2023
• Subjects: Aged; Anastomosis, Surgical - adverse effects; Cross-Sectional Studies; Gastroenterology; Hepatology; Humans; Incidence; Internal Medicine; Medicine; Medicine & Public Health; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctology; Propensity Score; Retrospective Studies; Risk Factors; Sarcopenia - complications; Sarcopenia - diagnostic imaging; Sarcopenia - epidemiology; Surgery; Sarcopenia; Colorectal; Non-malignant; Surgery
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-023-04441-6

Purpose Sarcopenia is a prognostic factor for poor outcomes in colorectal cancer, but data are scarce in colorectal surgery for benign conditions where patients could benefit from a deferral of surgery to enter a prehabilitation programme. We assessed the incidence of sarcopenia and complications in patients with benign colorectal disease. Methods Patients who underwent elective non-malignant colorectal surgery during 2018–2022 were retrospectively identified. The cross-sectional psoas area was calculated using computed tomography (CT) imaging mid-3 rd lumbar vertebrae. Sarcopenia was determined using gender-specific cut-offs. The primary outcome was complications measured by the comprehensive complication index (CCI). Results Of 188 patients identified, 39 (20.7%) were sarcopenic. Patients diagnosed with sarcopenia were older (63 vs. 58 years, p  = 0.047) and had a reduced BMI (24.7 vs. 27.38 kg/m 2 , p  = 0.001). Sarcopenic patients had more complications (82.1 vs. 64.4%, p  = 0.036), and CCI was statistically but not clinically higher (20.9 vs. 20.9, p  = 0.047). On univariate linear regression analysis, age ≥ 65 years old, ASA grade ≥ 3, active smokers, sarcopenia, and preoperative anaemia were predictive of CCI. Propensity score-matched analysis was performed, matching 78 cases to remove selection bias, which demonstrated sarcopenia had no impact on postoperative complications. On multivariate analysis, age ( p  = 0.022), smoking ( p  = 0.005), and preoperative anaemia ( p  = 0.008) remained predictive of CCI. Conclusion Sarcopenia is prevalent in one-fifth of patients undergoing benign colorectal surgery. Taking advantage of the longer preoperative waiting periods, sarcopenia could be explored as a target for prehabilitation programmes to improve outcomes.