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Impact of sarcopenia on outcomes in surgical patients: A systematic review and meta-analysis

  • 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.

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Metadaten
Author:Samuel KnödlerORCiD, Rainer SchliermannORCiDGND, Leonard Knödler, Mengfan Wu, Frederik J. Hansen, Dany Y. Matar, Doha Obed, Dominique Vervoort, Valentin Haug, Gabriel Hundeshagen, Angie Paik, Martin Kauke-Navarro, Ulrich Kneser, Bohdan Pomahac, Dennis P. Orgill, Adriana C. Panayi
DOI:https://doi.org/10.1097/JS9.0000000000000688
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/37696253
Parent Title (English):International journal of surgery
Publisher:Wolters Kluwer
Document Type:Article
Language:English
Year of first Publication:2023
Release Date:2023/10/17
Tag:Aging; Muscle; Muscle Loss; Sarcopenia; Surgery; Surgical Outcomes
Edition:accepted
Pagenumber:71
Institutes:Fakultät Angewandte Sozial- und Gesundheitswissenschaften
Begutachtungsstatus:peer-reviewed
research focus:Lebenswissenschaften und Ethik
OpenAccess Publikationsweg:Hybrid Open Access - OA-Veröffentlichung in einer Subskriptionszeitschrift/-medium
Licence (German):Creative Commons - CC BY-ND - Namensnennung - Keine Bearbeitungen 4.0 International