Simple psoas cross‐sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications

TLDR

Radiologically measured muscle mass, especially via CT, is a surrogate for frailty and can predict postoperative complications, yet sarcopenia is difficult to assess bedside. The study aimed to determine whether sarcopenia predicts postoperative complications in patients undergoing elective colorectal resection. Cross‑sectional area of the psoas at L3 on preoperative CT, normalized for height, was used to estimate lean muscle mass, with morbidity graded by Clavien‑Dindo and analyses performed in SPSS. Sarcopenia was present in 15 % of patients and was associated with a 5.4‑fold higher risk of major complications (Grade ≥ 3), with no deaths and no impact on length of stay, ICU stay, or mobilization time.

Abstract

Radiologically assessed muscle mass has been suggested as a surrogate marker of functional status and frailty and may predict patients at risk of postoperative complications. We hypothesize that sarcopenia negatively impacts on postoperative recovery and is predictive of complications.One hundred patients undergoing elective resection for colorectal carcinoma were included in this study. Lean muscle mass was estimated by measuring the cross-sectional area of the psoas muscle at the level of the third lumbar vertebra identified on a preoperative CT scan, normalizing for patient height. Perioperative morbidity was scored according to the Clavien-Dindo classification. All statistical data analyses were carried out using the Statistical Package for the Social Sciences (SPSS) version 20.0.Fifteen per cent of patients were identified as sarcopenic. There were no deaths in the study group. Sarcopenia was associated with a significantly increased risk of developing major complications (Grade 3 or greater, OR = 5.41, 95% CI: 1.45-20.15, P = 0.01). Sarcopenia did not predict length of stay, critical care dependency or time to mobilization.Sarcopenia, as a marker of frailty, is an important risk factor in surgical patients but difficult to estimate using bedside testing. CT scans, performed for preoperative staging, provide an opportunity to quantify lean muscle mass without additional cost or exposure to radiation and eliminate the inconvenience of further investigations.