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Sarcopenia Is a Predictor of Surgical Complications in a Population Younger Than 40 Years Suffering From Inflammatory Bowel Disease
Mark Pederson, John Cromwell, James J. Mezhir, Peter Nau*
The University of Iowa Hospitals and Clinics, Iowa City, IA

Introduction
Sarcopenia, defined as a subclinical loss of skeletal muscle mass, is associated with increased risk of operative complications following major general and oncologic procedures and predicts worse cancer specific survival in the treatment of solid tumors. The impact of sarcopenia in patients with Inflammatory Bowel Disease (IBD) has not been evaluated. The objective of this study is to determine the impact of sarcopenia on operative outcomes in the surgical treatment of patients with IBD.
Methods
A retrospective review of ACS-NSQIP data of patients with IBD treated at a single center from 2009-2014 was completed. Records were abstracted for comorbidities and perioperative complications. The Hounsfield Unit Average Calculation (HUAC), a previously validated technique to measure muscle density and cross-sectional area, was utilized from preoperative CT scans. Criteria for sarcopenia was based on the lowest 25th percentile of muscle density measurements. Complications were graded using the Clavien-Dindo classification system. Univariate logistic regression was performed to assess correlation between sarcopenia and surgical outcomes. Multivariable logistic regression was performed to assess the impact of comorbid conditions and sarcopenia on surgical outcomes. A subgroup analysis was performed in patients less than 40 years of age.
Results
There were 178 patients with IBD included. Forty-four (24.7%) met the criteria for sarcopenia. The overall complication rate was 69.1%. Sarcopenic patients were much more likely to be older (P =0.001), have hypertension (O.R. = 2.23), be diabetic (5.27), and have a lower BMI (P<0.05). In multivariable analysis, sarcopenia was not an independent predictor of post-operative complications when considering the cohort as a whole. In those patients under the age of 40, sarcopenia was an independent predictor for venous thromboembolism (VTE), receiving blood transfusion, post-operative sepsis, and ICU admission. This subset was also significantly more likely to have either a normal or elevated BMI.
Discussion
In this population, the average age of sarcopenic patients is significantly increased from those who do not meet criteria. Among patients below the age of 40, sarcopenia has a profound impact on surgical outcomes. In that subset, sarcopenia is a significant predictor of several significant post-operative complications. Assessment of sarcopenia can be used to improve preoperative management and describe risks prior to surgery in patients with IBD.
Complications in IBD patients less than 40 years old who suffer from sarcopenia
ComplicationVariableOdds Ratio(95%CI)P-value
Required blood transfusionHUAC1.31(1.056-1.625)0.014
 Total psoas index3.2060.0136
ICU admissionHUAC1.32(1.053-1.656)0.016
 H/O VTE12.24((1.167-128.481)0.0367
Post-operative sepsisHUAC1.325(1.072-1.636)0.0091
 H/O VTE27.084(2.498-292.604)0.0067
Venous thrombosis requiring treatmentHUAC1.265(1.043-1.535)0.169


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