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Acute muscle wasting after intra-abdominal surgery and its associated outcomes: A Systematic review and meta-analysis
Thera Gram Ottesen1, Andreas Werner Nærum1, Jannick Brander Hansen1
1Emergency Surgery Research Group (EMERGE) Copenhagen, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
Background:
Postoperative loss of muscle mass, quality, and function (muscle wasting) has gained attention with emerging evidence pointing to a high prevalence of muscle wasting and an associated increased risk of postoperative complications. We aimed to review existing literature on the prevalence and clinical associations of acute muscle wasting in adult patients following intra-abdominal surgery.
Methods:
A systematic review was conducted in accordance with PRISMA and GRADE guidelines. A literature search was performed in CENTRAL, MEDLINE, and Embase. Studies that assessed acute muscle wasting by serial measurements in the early postoperative period were included. A random-effects pooled proportion meta-analysis was performed on prevalence and additionally a random-effects meta-analysis to evaluate the association between muscle wasting and postoperative complications. Bias and certainty of evidence were evaluated with Robins-I version 2 and GRADE assessment.
Results:
Fifty-five studies with 7,196 patients were included. A cut-off for muscle wasting was found in 13 observational studies, with a pooled proportion prevalence of acute muscle wasting of 0.35 (95% confidence interval 0.30-0.41, I2=89.2%). The meta-analysis found muscle wasting to be associated with postoperative complications (Clavien Dindo ≥2), with an odds ratio of 2.35 (95% confidence interval 1.38-3.97, I2=57.32%). Studies included for meta-analysis of postoperative complications were all at serious or critical risk of bias, and the certainty of evidence was very low.
Conclusion:
This review points to a high prevalence of acute muscle wasting after intra-abdominal surgery and an association between postoperative complications and muscle wasting. These findings should be interpreted with caution due to a serious-to-critical degree of bias and very low certainty of the evidence. The direction of causality between muscle wasting and postoperative complications is still uncertain and future research is needed to identify clear cut-offs for muscle wasting and further establish the association between muscle wasting and postoperative complications in both elective and emergency surgical settings.