Psoas Attenuation and Mortality of Elderly Patients Undergoing Nontraumatic Emergency Laparotomy
| Autor: | Miklosh Bala, Nir Cohen, Jonathan B. Yuval, Alon J. Pikarsky, Samer Abu Salem, Gidon Almogy, Omer Issachar, Naama Lev-Cohain |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Sarcopenia medicine.medical_treatment Logistic regression Risk Assessment law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications law Risk Factors Laparotomy Internal medicine medicine Humans Hospital Mortality Risk factor Emergency Treatment Aged Psoas Muscles Retrospective Studies Aged 80 and over Frailty business.industry Retrospective cohort study Length of Stay medicine.disease Intensive care unit Cross-Sectional Studies Quartile 030220 oncology & carcinogenesis Cohort Feasibility Studies 030211 gastroenterology & hepatology Surgery Female business Tomography X-Ray Computed |
| Zdroj: | The Journal of surgical research. 257 |
| ISSN: | 1095-8673 |
| Popis: | Emergency laparotomy (EL) is an increasingly common procedure in the elderly. Factors associated with mortality in the subpopulation of frail patients have not been thoroughly investigated. Sarcopenia has been investigated as a surrogate for frailty and poor prognosis. Our primary aim was to evaluate the association between easily measured sarcopenia parameters and 30-day postoperative mortality in elderly patients undergoing EL. Length of stay (LOS) and admission to an intensive care unit were secondary end points.We conducted a retrospective cohort study, over a 5-year period, of patients aged 65 y and older who underwent EL at a tertiary university hospital. Sarcopenia was evaluated on admission computed tomography scan by two methods, first by psoas muscle attenuation and second by the product of perpendicular cross-sectional diameters (PCSDs). The lowest quartile of PCSDs and attenuation were defined as sarcopenic and compared with the rest of the cohort. Attenuation was stratified for the use of contrast enhancement. Multivariant logistic regression was performed to determine independent risk factors.During the study period, 403 patients, older than 65 y, underwent EL. Of these, 283 fit the inclusion criteria and 65 (23%) patients died within 30 d of surgery. On bivariate analysis, psoas muscle attenuation, but not PCSDs, was found to be associated with 30-day mortality (OR = 2.43, 95% CI = 1.34-4.38, P = 0.003) and longer LOS (35.7 d versus 22.2 d, Δd 13.5, 95% CI = 6.4-20.7, P 0.001). In a multivariate analysis, psoas muscle attenuation, but not PCSDs, was an independent risk factor for 30-day postoperative mortality (OR = 2.35, 95% CI = 1.16-4.76, P = 0.017) and longer LOS (Δd = 14.4, 95% CI = 7.7-21.0, P 0.001). Neither of the sarcopenia parameters was associated with increased admission to an intensive care unit.Psoas muscle attenuation is an independent risk factor for 30-day postoperative mortality and LOS after EL in the elderly population. This measurement can inform clinicians about the operative risk and hospital resource utilization. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect