Sarcopenic obesity and post‐operative morbidity after pancreatic surgery: a cohort study

• Published in: ANZ journal of surgery Vol. 89; no. 12; pp. 1587 - 1592
• Main Authors: Ratnayake, Chathura B. B., Wells, Cameron, Olsson, Magda, Windsor, John A., Pandanaboyana, Sanjay
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-12-2019; Blackwell Publishing Ltd
• Subjects: Attenuation; Cohort analysis; Computed tomography; Health risk assessment; Kirurgi; Morbidity; Multivariate analysis; Muscles; Musculoskeletal system; Obesity; Pancreas; pancreatic resection; Pancreaticoduodenectomy; post-operative morbidity; Psoas muscle; Risk analysis; Risk factors; Sarcopenia; sarcopenic obesity; Skeletal muscle; Standardization; Surgery; post-operative morbidity; sarcopenic obesity; pancreas; pancreatic resection; sarcopenia
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.15431

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.
Significant variability exists in the sarcopenic indices. All three sarcopenic indices previously described failed to predict post‐operative morbidity. Sarcopenic obesity was the only predictor of post‐operative morbidity.