Functionele kwetsbaarheid, gedefinieerd als sarcopenie, frailty en ondervoeding, is een voorspeller voor een gecompliceerd postoperatief beloop na oncologische colorectale chirurgie
Reisinger, K.W., Vugt, J.L.A. van, Tegels, J.J.W., Snijders, C., Hulsewe, K.W.E., Hoofwijk, A.G.M., Stoot, J., Von Meyenfeldt, M.F., Beets, G.L., Derikx, J.P.M., Poeze, M.
Voorzitter(s): P. Hemmer, chirurg, Universitair Medisch Centrum Groningen, Groningen & J.M.T. Omloo, AIOS Heelkunde, Gelre Ziekenhuizen, Apeldoorn
Locatie(s): Brabantzaal
Categorie(ën):
Objective
To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery.
Summary background data
Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery. Therefore, the predictive value of pre-operative functional compromise assessment was investigated. Sarcopenia is a hallmark of functional compromise.
Methods
310 consecutive patients who underwent oncologic colorectal surgery were enrolled in a prospective digital database. Sarcopenia was assessed using the L3 muscle index using Osirix® on pre-operative computed tomography (CT). Groningen Frailty Indicator (GFI) and Short Nutritional Assessment Questionnaire (SNAQ) scores were used to assess frailty and nutritional compromise. Predictors for anastomotic leakage, sepsis and mortality were analyzed by logistic regression analysis.
Results
Age was an independent predictor of mortality (p=0.04; odds ratio (OR), 1.17; 95% confidence interval (CI), 1.01 - 1.37). 30-day/in-hospital mortality rate in sarcopenic patients was 8.8% versus 0.7% in non-sarcopenic patients (p=0.001; OR 15.5; 95% CI, 2.00 - 120). Sarcopenia was not predictive for anastomotic leakage or sepsis. Combination of high SNAQ score, high GFI score and sarcopenia strongly predicted sepsis (p=0.001; OR, 25.1; 95% CI, 5.11 - 123), sensitivity, 46%; specificity, 97%; positive likelihood ratio, 13 (95% CI, 4.4 - 38); negative likelihood ratio, 0.57 (95% CI, 0.33 - 0.97).
Conclusion
Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome. Assessment of functional compromise by means of a nutritional questionnaire (SNAQ), a frailty questionnaire (GFI), and sarcopenia measurement (L3 muscle index) can accurately predict postoperative sepsis.
- Over Reisinger, K.W.
- Over Vugt, J.L.A. van
- Over Tegels, J.J.W.
- Over Snijders, C.
- Over Hulsewe, K.W.E.
- Over Hoofwijk, A.G.M.
- Over Stoot, J.
- Over Von Meyenfeldt, M.F.
- Over Beets, G.L.
- Over Derikx, J.P.M.
- Over Poeze, M.