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Sarcopenia Is a Risk Factor for Infection for Patients Undergoing Abdominoperineal Resection and Flap-based
Travis J Miller1, Clifford C Sheckter1, Leandra A Barnes1
1Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, Calif.
Abstract:
Abdominoperineal resection (APR) carries a high risk of morbidity. Preoperative risk assessment can help with patient counseling, minimize adverse outcomes, and guide surgeons in their choice of reconstruction. This study examined the impact of sarcopenia (low lean muscle mass) on postoperative complications after APR.
Methods:
One hundred seventy-eight patients who underwent APR between May 2000 and July 2017 were retrospectively analyzed. Sarcopenia was identified on preoperative computed tomography scans using the Hounsfield Unit Average Calculation. Two cohorts were compared (group 1: primary perineal closure; group 2: flap-based perineal reconstruction). Multivariable analysis evaluated predictors of complications.
Results:
Sarcopenia was an independent risk factor for postoperative surgical site infection in patients undergoing APR (odds ratio [OR] = 2.9, P = 0.04). The risk for sarcopenic patients who underwent flap-based perineal reconstruction was even higher (OR = 8.9, P < 0.01). Male sex was also found to be a risk factor for infection (OR = 3.5, P < 0.01). Perineal flap-based reconstruction was a risk factor for delayed wound healing (OR = 3.2, P < 0.01).
Conclusions:
Sarcopenia was an independent risk factor for infection in patients undergoing APR. This risk was even greater in patients undergoing flap-based perineal reconstruction. Sarcopenia can be identified on preoperative imaging and inform surgeons on risk stratification and surgical plan.
Insights
Sarcopenia, or low muscle mass, increases surgical site infection risk after abdominoperineal resection (APR). This risk is significantly higher with flap-based reconstruction in sarcopenic patients undergoing APR.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Patient Risk Stratification
Background:
- Abdominoperineal resection (APR) is associated with substantial morbidity.
- Preoperative risk assessment is crucial for patient counseling and optimizing surgical outcomes.
- Sarcopenia, characterized by low lean muscle mass, is an emerging factor in surgical outcomes.
Purpose of the Study:
- To investigate the impact of sarcopenia on postoperative complications following APR.
- To identify predictors of complications in patients undergoing APR.
Main Methods:
- Retrospective analysis of 178 patients who underwent APR between May 2000 and July 2017.
- Sarcopenia identification using preoperative CT scan Hounsfield Unit Average Calculation.
- Comparison of primary perineal closure versus flap-based perineal reconstruction cohorts; multivariable analysis of complication predictors.
Main Results:
- Sarcopenia independently predicted higher risk of surgical site infection (OR=2.9, P=0.04) after APR.
- Sarcopenic patients undergoing flap-based reconstruction had a substantially elevated infection risk (OR=8.9, P<0.01).
- Male sex (OR=3.5, P<0.01) and flap-based reconstruction (OR=3.2, P<0.01) were also risk factors for infection and delayed healing, respectively.
Conclusions:
- Sarcopenia is an independent risk factor for surgical site infection post-APR.
- The risk of infection is amplified in sarcopenic patients receiving flap-based perineal reconstruction.
- Preoperative identification of sarcopenia can enhance risk stratification and surgical planning for APR.
