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Sarcopenia in children with perforated appendicitis
Joseph J López1, Jennifer N Cooper2, Brett Albert3
1Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Center for Surgical Outcomes Research and the Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus Ohio.
Insights
Pediatric complex appendicitis patients experienced sarcopenia, a decrease in skeletal muscle mass, during their hospital stay. This muscle loss may impact surgical outcomes and warrants further investigation for potential interventions.
Area of Science:
- Pediatric surgery
- Skeletal muscle physiology
- Medical imaging analysis
Background:
- Sarcopenia, or decreased skeletal muscle mass, is linked to poor surgical recovery in adults.
- The impact of sarcopenia on pediatric surgical patients, particularly those with complicated appendicitis, is not well understood.
Purpose of the Study:
- To investigate whether pediatric patients with complicated appendicitis undergo sarcopenic changes during treatment.
- To quantify the rate of muscle mass change in these patients.
Main Methods:
- Retrospective review of 36 pediatric patients with complex appendicitis.
- Analysis of pre- and post-operative computed tomography (CT) scans to measure psoas muscle area.
- Utilized linear mixed models to assess changes in muscle area over time.
Main Results:
- Patients showed a median decrease in body mass index (BMI) from admission to discharge (-0.8 kg/m²).
- A significant daily decrease in psoas muscle area was observed (-0.81% per day, P < 0.001).
- Muscle mass decrease did not significantly vary by BMI, gender, or race.
Conclusions:
- Pediatric complex appendicitis patients experience sarcopenia during hospitalization.
- Further research is needed to determine if this sarcopenia correlates with postsurgical complications.
- Investigating interventions to prevent muscle loss in these patients is recommended.
Background:
Decreased skeletal muscle mass, or sarcopenia, has been shown to be associated with worse postoperative recovery and a higher risk of complications in adult surgical patients. We hypothesized that pediatric patients with complicated appendicitis may experience sarcopenic changes over the course of their treatment.
Methods:
The medical records and computed tomography scans of 36 pediatric complex appendicitis patients who had both preoperative and postoperative computerized tomography scans at our hospital were reviewed. Changes in psoas muscle area were examined using linear mixed models with random patient-level intercept and time effects.
Results:
The median change in body mass index among all patients from admission to discharge was -0.8 kg/m2 (interquartile range: -1.3 to -0.2). The mean percentage change in psoas muscle area per day over the course of appendicitis-related treatment was -0.81% (95% confidence interval: -1.12 to -0.50) (P < 0.001). The relative decrease in psoas muscle area per day did not vary by initial body mass index, gender, or race (P > 0.10 for all interactions).
Conclusions:
Our data suggest that pediatric patients with complex appendicitis experience sarcopenic changes during their hospital admission. Given previous reports that sarcopenia is a significant predictor of worse surgical outcomes, more investigation is warranted to assess whether these changes are associated with postsurgical complications and to evaluate potential interventions that may prevent these changes.
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