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Sarcopenic obesity and post-operative morbidity after pancreatic surgery: a cohort study
Chathura B B Ratnayake1,2, Cameron Wells1,2, Magda Olsson3
1Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Background:
Several indices of sarcopenia (SARC) exist in the literature, however, there is no consensus as to the best SARC index to predict post-operative morbidity following pancreatic surgery.
Methods:
A prospectively collected database was reviewed in a single institution including a total of 89 consecutive patients who had undergone pancreatic resection between 2015 and 2018.
Results:
A total of 89 patients comprised the cohort. Seventy-one percent (63/89) underwent pancreaticoduodenectomy. SARC was identified in 49 patients (55%) using psoas muscle index, 44 patients (49%) using the skeletal muscle index and 25 patients (28%) using the skeletal muscle attenuation. Post-operative morbidity did not differ between SARC and non-SARC (NSARC) patients using all three preoperative computed tomography measures (skeletal muscle index SARC 64%, 28/44, NSARC 64%, 29/45, P = 1.000; psoas muscle index SARC 63%, 31/49, NSARC 65%, 26/40, P = 0.810; skeletal muscle attenuation SARC 17/25, NSARC 40/64, P = 0.247). However, sarcopenic obesity was a significant independent risk factor for overall post-operative morbidity on multivariate analysis (odds ratio 1.241 (SE 0.608), P = 0.041) with the highest specificity (81%).
Conclusion:
Preoperative sarcopenic obesity can be an important independent predictor of post-operative morbidity following pancreatic resection. There remains a need for standardization of SARC indices.
