PREOPERATIVE HAND GRIP STRENGTH AS A PREDICTOR OF LENGTH OF STAY AFTER ESOPHAGECTOMY
Michael Watson1, Sally J. Trufan2, Nicole Gower1, Lauren A. Jeck1, Benjamin M. Motz1, Meredith Byrne3, Joshua S. Hill*1, Jonathan Salo1
1Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; 2Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; 3Clinical Nutrition, Carolinas Medical Center, Charlotte, NC
Objective: Nutritional deficits and sarcopenia in patients with esophageal cancer lead to postoperative complications and longer lengths of stay. Measuring hand grip strength (HGS), using a dynamometer, is a cost-effective way to estimate lean muscle mass prior to surgery. This measure can be used as a proxy for frailty. The aim of this study was to investigate the relationship between preoperative HGS and postoperative complications, length of stay, and discharge destination.
Methods: This retrospective study examined 90 patients with esophageal cancer undergoing esophagectomy between March 2015 and November 2018. HGS, measured in kilograms, was analyzed as a continuous variable and as a dichotomous variable above or below the median score. Length of stay (LOS), postoperative complications and discharge destination (Home or Other) were analyzed for associations with HGS. Covariates included race, smoking status, neoadjuvant chemoradiation, pathological staging, pathological node status and grade. Univariate and multivariate Fisher's Exact, Poisson and logistic regression methods were used as appropriate.
Results: There were 90 men in the sample with a mean age of 64.2 +/- 9.8. There were not enough women for adequate statistical analysis. The median HGS for patients was 30 kg (IQR=11). Higher HGS scores were significantly associated with shorter LOS in both univariate and multivariate Poisson regression for the continuous measure of HGS and as a dichotomous indicator above the median (p <.001). There was a significant association of HGS and discharge destination in the univariate analysis for both continuous (p=.003) and dichotomous (p =.007) measures. In the multivariate analysis, those who scored above the median HGS for the group were 7.7 times more likely to be discharged home compared to those who scored below the median (p=0.03, OR=7.7). In the univariate analysis, lower HGS scores were significantly associated with occurrence of pneumonia post-operatively (p=0.01, OR 1.2). Although not statistically significant, all cases of pneumonia occurred in patients who scored below the median.
Conclusion: Preoperative hand grip strength is associated with postoperative pneumonia, length of stay and discharge destination after esophagectomy in men with esophageal cancer.
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