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Low Muscle Mass as a Prognostic Factor for Early Postoperative Outcomes in Pediatric Patients Undergoing the Fontan

Jimi Oh1, Won-Jung Shin2, DaUn Jeong1

  • 1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.

Journal of Clinical Medicine
|August 22, 2019
PubMed

Insights

Low muscle mass in pediatric cardiac patients undergoing the Fontan operation is linked to worse early outcomes. Higher skeletal muscle index predicts fewer complications and shorter hospital stays.

Area of Science:

  • Pediatric Cardiology
  • Cardiothoracic Surgery
  • Clinical Nutrition

Background:

  • The impact of low muscle mass on early postoperative outcomes in pediatric cardiac surgery patients, particularly those undergoing the Fontan operation, is not well understood.
  • Skeletal muscle mass is a crucial indicator of overall health and can influence surgical outcomes.

Purpose of the Study:

  • To investigate the association between preoperative low muscle mass and early postoperative outcomes in pediatric patients who underwent the Fontan operation.
  • To determine if low muscle mass is a predictor of complications, prolonged intensive care unit (ICU) stays, and extended hospitalizations.

Main Methods:

  • Retrospective review of 74 pediatric patients (<18 years) who underwent the Fontan operation.
  • Measurement of erector spinae and pectoralis muscle cross-sectional areas via preoperative chest CT, normalized to body surface area to calculate the total skeletal muscle index (TSMI).
  • Definition of low muscle mass as a TSMI below the median of the second quintile; analysis of postoperative outcomes including major complications, ICU duration, and hospital stay.

Main Results:

  • Patients with low muscle mass had a significantly higher incidence of major postoperative complications (48% vs. 14%, P = 0.003).
  • Higher TSMI was associated with a reduced likelihood of prolonged ICU stay (>5 days) (OR 0.86) and hospital stay (>14 days) (OR 0.92).
  • Increased TSMI correlated with a lower incidence of major postoperative complications (OR 0.90).

Conclusions:

  • Preoperative low muscle mass is associated with adverse early postoperative outcomes in pediatric patients undergoing the Fontan operation.
  • Assessing skeletal muscle mass preoperatively may help identify patients at higher risk for complications and prolonged recovery.
  • Optimizing muscle mass prior to surgery could potentially improve outcomes for these vulnerable patients.

Keywords:
childcongenitalfontan procedureheart defectspostoperative complicationssarcopenia

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