@article{KnoedlerSchliermannKnoedleretal., author = {Kn{\"o}dler, Samuel and Schliermann, Rainer and Kn{\"o}dler, Leonard and Wu, Mengfan and Hansen, Frederik J. and Matar, Dany Y. and Obed, Doha and Vervoort, Dominique and Haug, Valentin and Hundeshagen, Gabriel and Paik, Angie and Kauke-Navarro, Martin and Kneser, Ulrich and Pomahac, Bohdan and Orgill, Dennis P. and Panayi, Adriana C.}, title = {Impact of sarcopenia on outcomes in surgical patients: A systematic review and meta-analysis}, series = {International journal of surgery}, journal = {International journal of surgery}, edition = {accepted}, publisher = {Wolters Kluwer}, doi = {10.1097/JS9.0000000000000688}, pages = {71}, abstract = {BACKGROUND Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, we aimed to synthesize the available literature and investigate the impact of sarcopenia on peri- and postoperative outcomes across all surgical specialties. METHODS We systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Our primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at one, three, and five years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population, and on those of higher quality or prospective study design. RESULTS A total of 294 studies comprising 97,643 patients, of which 33,070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P<0.00001). A significantly lower survival rate in patients with sarcopenia was noted at one, three, and five years (all P<0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P<0.00001), cardiovascular (both P<0.00001), and emergency (P=0.03 and P=0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia (P<0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients (P=0.007). Sensitivity analysis based on higher-quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P<0.00001). CONCLUSION Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons to identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical sub-specialties.}, language = {en} } @article{KnoedlerBerkinMoogetal., author = {Kn{\"o}dler, Leonard and Berkin, {\"O}zdemir and Moog, Philipp and Prantl, Lukas and Broer, P. Niclas and Kn{\"o}dler, Christoph and Rieger, Ulrich M. and Perl, Markus and von Isenburg, Sarah and Gassner, Ulrich M. and Obed, Doha and Haug, Valentin and Panayi, Adriana C and Kn{\"o}dler, Samuel}, title = {Thinking like a Lawyer - Human Rights and Their Association with the Plastic Surgeon of Today}, series = {Aesthetic Plastic Surgery}, volume = {114}, journal = {Aesthetic Plastic Surgery}, publisher = {Springer-Verlag GmbH}, address = {Heidelberg}, doi = {10.1007/s00266-022-02990-9}, pages = {8}, abstract = {Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR).}, language = {en} }