PREOPERATIVE SARCOPENIA IS A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AND PROLONGED STAY IN CROHN’S DISEASE PATIENTS UNDERGOING INTESTINAL RESECTION.
Ahmed Ouni*, Fares Ayoub, Chelsea Jacobs, Francesca M. Gesiotto, Anne Lopez, Joseph Grajo, Amir Y. Kamel, Naueen A. Chaudhry, Sanda Tan, Thomas Read, Ellen M. Zimmermann
Internal Medicine, University of Florida, Gainesville, FL
Background
Loss of muscle mass, or sarcopenia, is prevalent in patients with Crohn’s disease (CD) requiring surgery. The impact of sarcopenia on surgical outcomes in CD is not known. We investigated the association between sarcopenia, intraoperative, and postoperative outcomes.
Methods
We conducted a single-center retrospective study of 110 CD patients who underwent intestinal resection between March 2007 and March 2017 at a tertiary medical center. Using preoperative cross-sectional imaging, we measured psoas muscle area (PMA; cm2) at the third lumbar vertebra (L3). PMA was defined as the combination of the left psoas muscle area and the right psoas muscle area. After measuring PMA (cm2) at the third lumbar vertebra (L3), we adjusted for differences in muscle mass by height and calculated the PMI (cm2/m2). Sarcopenia was defined as a PMI less than the 25th percentile of the study population stratified by gender. We conducted univariate and multivariate analyses to identify the association between sarcopenia, intraoperative, and 30-day postoperative outcomes.
Results
Overall, 110 patients were included for analysis. Mean age was 41 (range 18-72) years and 64 (58.2%) were females. Intra-observer coefficient of variation was 0.994 (95% CI: 0.991-0.996). The average PMI was 5.4 cm2/m2 (SD ± 1.6) for the sarcopenic group compared to 9.6 cm2/m2 (SD ± 3) in the non-sarcopenic group (p < .001). Twenty-eight patients (25.4%) were found to be sarcopenic. No significant difference was observed between sarcopenic patients and non-sarcopenic patients in the rates of colonic resection (57% vs 55%, p=0.84), small bowel resection (14% vs 22%, p=0.38) or combined colonic and small bowel resection (25% vs. 19.5%, p=0.54). We found no statistically significant difference in intraoperative outcomes between the two groups. Sarcopenic patients had a longer length of stay compared to non-sarcopenic patients (10.8 days vs. 6.2 days; p <0.001). Patients with sarcopenia were more likely to experience infectious complications (29% vs 9%, p=0.008), skin and soft tissue infections (21% vs 4%, p=0.008), and line infections (11% vs 0%, p=0.015). No difference was found for non-infectious complications between the two groups (18% vs 20%, p=0.847). On univariate analysis, a history of smoking and sarcopenia were associated with postoperative infectious complications. On multivariate analysis, sarcopenia continued to be strongly associated with postoperative infectious complications (odds ratio [OR]: 4.61, 95%; confidence interval [CI]: 1.39-15.28)
Conclusion
In CD patients undergoing intestinal resection, radiographic sarcopenia was found to be associated with prolonged postoperative length of stay and significantly higher odds of developing infectious complications within the first 30 days postoperatively.
Psoas muscle measurements
Primary outcomes analysis
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