SARCOPENIA IS A PREDICTOR FOR 30-DAY MORTALITY AND MAYOR COMPLICATIONS IN COLORECTAL SURGERY PATIENTS
Paulina Moctezuma Velázquez*, Omar Vergara Fernández, Noel Salgado-Nesme, Carlos Moctezuma-Velazquez
colorectal surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Tlalpan, Mexico
Background: Sarcopenia is an important predictor for oncological and surgical outcomes. The aim of this retrospective work was to find the association between sarcopenia, 30-day mortality and mayor morbidity in colorectal surgery patients with primary anastomosis with benign and malignant diagnoses.
Methods: We performed a retrospective analysis of a cohort of patients submitted to colorectal surgery with primary anastomosis at a tertiary center in Mexico City during January 2007 to December 2018, 551 patients were included.
For each patient, demographic variables were collected, and their preoperative CT, was assessed with NIH ImageJ software to determine the skeletal muscle area (SMA) at the level of L3, this evaluation was made by two observers and the interrater reliability was assessed by the kappa coefficient. Sarcopenia was defined as SMA/height2<52.4 cm2/m2for men and <38.5 cm2/m2for women. Univariate analysis with logistic regression was used to determine the factors associated with 30-day mortality and mayor morbidity defined as Clavien-Dindo III and IV.Those variables with p<0.05 were included in a multivariate analysis.
Results: The overall sarcopenia prevalence was 61.95%. In overall ,minor and mayor morbidity the sarcopenia rate was 153(59.7%), 81(57.44%) and 72(62.60%) respectively.
A 4.5% overall incidence of 30-day mortality was registered, 80% of this patients were sarcopenic. On univariate and multivariate analysis sarcopenia was a predictive factor por 30-day mortality and mayor morbidity. Sarcopenia was not a predictive factor for readmission, minor morbidity defined as Clavien- Dindo I and II or 30-day hospital readmission.
A substantial interobserver agreement for sarcopenia determination was found with a 0.76 kappa coefficient; p<0.001.
Conclusions: Sarcopenia was found to be a predictive factor for 30-day mortality and mayor morbidity in colorectal surgical patients with primary anastomosis in a tertiary center in Mexico City with benign and malignant diagnosis. Prospective studies are needed to reaffirm this findings, future research should address different strategies to decrease or prevent sarcopenia so better postoperative outcomes can be achieved. Sarcopenia identification by computed tomography analysis is easily calculated with a substantial interobserver agreement.
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