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Loss of Muscle Mass: A Significant Predictor of Postoperative Complications in Patients with Acute Diverticulitis
S82
Scientific Forum Abstracts
RESULTS: Median age and BMI were 67 years and 26.1 kg/m2, respectively. The majority of patients (53.1%) were male. There were 72.5% of patients who had an American Society of Anesthesiologists score 3, and the median mFI was 0.09 (range 0e0.64). As the mFI increased from 0 (no frailty-associated variables) to 0.36 (4 of 11) or higher, the rate of overall morbidity increased from 32.5% to 54.2%. The proportion of Clavien class IV complications increased from 7.2% to 25.4% and the mortality rate increased from 1.5% to 11.0%. All results were significant at p<0.01. On multivariate analysis, mFI was an independent predictor of overall morbidity (adjusted odds ratio [AOR] 3.2, p<0.01), Clavien class IV complications (AOR 11.3, p<0.01), and mortality (AOR 18.7, p<0.01). CONCLUSIONS: Frailty, assessed by the mFI, is significantly associated with increased morbidity and mortality after pancreaticoduodenectomy for cancer. With an aging population, preoperative selection is important to minimize morbidity and mortality and improve risk stratification for an informed decision-making process. Frailty is a Predictor of Adverse Outcomes after Hepatic Resections for Hepatocellular Carcinoma Raghunandan Venkat, MD, MPH, Felipe B Maegawa, MD, FACS University of Arizona, Tucson, AZ INTRODUCTION: Frailty has emerged as an important predictor of operative risk among surgical patients. We sought to evaluate the effects of frailty on 30-day postoperative outcomes after hepatic resection for hepatocellular carcinoma (HCC). METHODS: The NSQIP participant use files were used to identify 2,097 patients who underwent hepatic resections for HCC between 2005 and 2012. A previously described and validated modified frailty index (mFI) was calculated on the basis of NSQIP variables. Our primary outcomes were overall morbidity, Clavien class IV (requiring critical care support), and Clavien class V (mortality) complications. RESULTS: Median age and BMI were 64 years and 26.5 kg/m2, respectively. The majority of patients (67.3%) were male. Seventy-eight percent of patients had an American Society of Anesthesiologists score 3 and the median mFI was 0.09 (range 0e0.45). There were 1,166 (55.6%) partial lobectomies, 242 (11.5%) trisegmentectomies, 427 right (20.4%), and 262 (12.5%) left hemi-hepatectomies. As the mFI increased from 0 (no frailty-associated variables) to 0.36 (4 of 11) or higher, the rate of overall morbidity increased from 21.3% to 47.2%. The proportion of Clavien class IV complications increased from 5.7% to 27.8%, and the mortality rate increased from 1.6% to 16.7%. All results were significant at p<0.01. On multivariate analysis, mFI was an independent predictor of overall morbidity (adjusted odds ratio [AOR] 10.7, p<0.01), Clavien class IV complications (AOR 30.8, p<0.01), and mortality (AOR 47.7, p<0.01). CONCLUSIONS: The mFI is significantly associated with increased morbidity and mortality in hepatic resection for HCC. Assessment of frailty may facilitate perioperative optimization, risk stratification, and counseling related to postoperative outcomes.
J Am Coll Surg
Loss of Muscle Mass: A Significant Predictor of Postoperative Complications in Patients with Acute Diverticulitis Kazuhide Matsushima, MD, Kenji Inaba, MD, FACS, Vidhi Jhaveri, Vincent Cheng, Aaron M Strumwasser, MD, Gregory A Magee, MD, Stefano Siboni, MD, Elizabeth R Benjamin, MD, PhD, FACS, Tristan Tham, MD, Demetrios Demetriades, MD, PhD, FACS University of Southern California, Los Angeles, CA INTRODUCTION: Severe muscle mass depletion, sarcopenia, has been associated with poor operative outcomes. However, its impact on emergency abdominal operations remains unclear. The purpose of this study was to examine the association of sarcopenia with outcomes after emergency operations for acute diverticulitis. METHODS: Patients 18 years old requiring an emergency operation for acute diverticulitis between January 2007 and September 2014 were included. On preoperative CT, the cross-sectional area (CSA) and transverse diameter (TVD) of bilateral psoas muscle were measured at the level of the L3 vertebral body. A sensitivity analysis was performed to determine the cut-off values for CSA and TVD to define sarcopenia. Clinical outcomes of patients with low muscle mass (sarcopenia group) were compared with those of the non-sarcopenia group. RESULTS: A total of 161 patients were identified and 89 (55%) had a preoperative CT. Median CSA and TVD were 794 mm2 and 24 mm, respectively. There was a strong correlation between the CSA and TVD (R2¼0.84) (Table). In univariate analysis, significantly higher rates of postoperative major complications (63% vs 37%, p¼0.027) and surgical site infection (SSI) (47% vs 19%, p¼0.008) were identified in the sarcopenia group. After adjusting for clinically important covariates (age, Charlson comorbidity index, colostomy, Hinchey score) in a logistic regression model, sarcopenia was significantly associated with higher odds of SSI and major complications. Measurement type (cut-off values) Outcomes
CSA (male: 750/ female: 550) Complications
Adjusted odds ratio 3.01 (95% CI) (1.18-7.68)
SSI
TVD (male: 23/ female: 18) Complications
3.16 3.09 (1.22-8.17) (1.22-7.84)
SSI 3.69 (1.42-9.60)
CONCLUSIONS: Sarcopenia was associated with worse outcomes after an emergency operation in patients with acute diverticulitis. Preoperative assessment of the psoas muscle CSA and TVD on CT can be a practical method for identifying patients at a risk of postoperative complications. Mild Traumatic Brain Injury in Elderly Patients: Is Routine ICU Admission Necessary? Amy Gore, MD, Christine Y Mau, MD, Charles J Prestigiacomo, MD, FACS, Ziad C Sifri, MD, FACS Rutgers New Jersey Medical School, Newark, NJ INTRODUCTION: Evidence-based guidelines for inpatient monitoring of elderly (age 65 y) patients suffering mild with
Scientific Forum Abstracts
RESULTS: Median age and BMI were 67 years and 26.1 kg/m2, respectively. The majority of patients (53.1%) were male. There were 72.5% of patients who had an American Society of Anesthesiologists score 3, and the median mFI was 0.09 (range 0e0.64). As the mFI increased from 0 (no frailty-associated variables) to 0.36 (4 of 11) or higher, the rate of overall morbidity increased from 32.5% to 54.2%. The proportion of Clavien class IV complications increased from 7.2% to 25.4% and the mortality rate increased from 1.5% to 11.0%. All results were significant at p<0.01. On multivariate analysis, mFI was an independent predictor of overall morbidity (adjusted odds ratio [AOR] 3.2, p<0.01), Clavien class IV complications (AOR 11.3, p<0.01), and mortality (AOR 18.7, p<0.01). CONCLUSIONS: Frailty, assessed by the mFI, is significantly associated with increased morbidity and mortality after pancreaticoduodenectomy for cancer. With an aging population, preoperative selection is important to minimize morbidity and mortality and improve risk stratification for an informed decision-making process. Frailty is a Predictor of Adverse Outcomes after Hepatic Resections for Hepatocellular Carcinoma Raghunandan Venkat, MD, MPH, Felipe B Maegawa, MD, FACS University of Arizona, Tucson, AZ INTRODUCTION: Frailty has emerged as an important predictor of operative risk among surgical patients. We sought to evaluate the effects of frailty on 30-day postoperative outcomes after hepatic resection for hepatocellular carcinoma (HCC). METHODS: The NSQIP participant use files were used to identify 2,097 patients who underwent hepatic resections for HCC between 2005 and 2012. A previously described and validated modified frailty index (mFI) was calculated on the basis of NSQIP variables. Our primary outcomes were overall morbidity, Clavien class IV (requiring critical care support), and Clavien class V (mortality) complications. RESULTS: Median age and BMI were 64 years and 26.5 kg/m2, respectively. The majority of patients (67.3%) were male. Seventy-eight percent of patients had an American Society of Anesthesiologists score 3 and the median mFI was 0.09 (range 0e0.45). There were 1,166 (55.6%) partial lobectomies, 242 (11.5%) trisegmentectomies, 427 right (20.4%), and 262 (12.5%) left hemi-hepatectomies. As the mFI increased from 0 (no frailty-associated variables) to 0.36 (4 of 11) or higher, the rate of overall morbidity increased from 21.3% to 47.2%. The proportion of Clavien class IV complications increased from 5.7% to 27.8%, and the mortality rate increased from 1.6% to 16.7%. All results were significant at p<0.01. On multivariate analysis, mFI was an independent predictor of overall morbidity (adjusted odds ratio [AOR] 10.7, p<0.01), Clavien class IV complications (AOR 30.8, p<0.01), and mortality (AOR 47.7, p<0.01). CONCLUSIONS: The mFI is significantly associated with increased morbidity and mortality in hepatic resection for HCC. Assessment of frailty may facilitate perioperative optimization, risk stratification, and counseling related to postoperative outcomes.
J Am Coll Surg
Loss of Muscle Mass: A Significant Predictor of Postoperative Complications in Patients with Acute Diverticulitis Kazuhide Matsushima, MD, Kenji Inaba, MD, FACS, Vidhi Jhaveri, Vincent Cheng, Aaron M Strumwasser, MD, Gregory A Magee, MD, Stefano Siboni, MD, Elizabeth R Benjamin, MD, PhD, FACS, Tristan Tham, MD, Demetrios Demetriades, MD, PhD, FACS University of Southern California, Los Angeles, CA INTRODUCTION: Severe muscle mass depletion, sarcopenia, has been associated with poor operative outcomes. However, its impact on emergency abdominal operations remains unclear. The purpose of this study was to examine the association of sarcopenia with outcomes after emergency operations for acute diverticulitis. METHODS: Patients 18 years old requiring an emergency operation for acute diverticulitis between January 2007 and September 2014 were included. On preoperative CT, the cross-sectional area (CSA) and transverse diameter (TVD) of bilateral psoas muscle were measured at the level of the L3 vertebral body. A sensitivity analysis was performed to determine the cut-off values for CSA and TVD to define sarcopenia. Clinical outcomes of patients with low muscle mass (sarcopenia group) were compared with those of the non-sarcopenia group. RESULTS: A total of 161 patients were identified and 89 (55%) had a preoperative CT. Median CSA and TVD were 794 mm2 and 24 mm, respectively. There was a strong correlation between the CSA and TVD (R2¼0.84) (Table). In univariate analysis, significantly higher rates of postoperative major complications (63% vs 37%, p¼0.027) and surgical site infection (SSI) (47% vs 19%, p¼0.008) were identified in the sarcopenia group. After adjusting for clinically important covariates (age, Charlson comorbidity index, colostomy, Hinchey score) in a logistic regression model, sarcopenia was significantly associated with higher odds of SSI and major complications. Measurement type (cut-off values) Outcomes
CSA (male: 750/ female: 550) Complications
Adjusted odds ratio 3.01 (95% CI) (1.18-7.68)
SSI
TVD (male: 23/ female: 18) Complications
3.16 3.09 (1.22-8.17) (1.22-7.84)
SSI 3.69 (1.42-9.60)
CONCLUSIONS: Sarcopenia was associated with worse outcomes after an emergency operation in patients with acute diverticulitis. Preoperative assessment of the psoas muscle CSA and TVD on CT can be a practical method for identifying patients at a risk of postoperative complications. Mild Traumatic Brain Injury in Elderly Patients: Is Routine ICU Admission Necessary? Amy Gore, MD, Christine Y Mau, MD, Charles J Prestigiacomo, MD, FACS, Ziad C Sifri, MD, FACS Rutgers New Jersey Medical School, Newark, NJ INTRODUCTION: Evidence-based guidelines for inpatient monitoring of elderly (age 65 y) patients suffering mild with