118 Sarcopenia is Associated with Worse Postoperative Outcomes in Burn Patients

Abstract

Loss of lean muscle mass has been associated with worse outcomes in cancer patients. Although there have been studies that have examined outcomes related to metabolic derangements in burn patients, the prevalence of sarcopenia and sarcopenic obesity and their effects on operative outcomes of burned patients have yet to be described. Skeletal muscle mass index was measured for patients with ≥20% surface area burn admitted to the ICU with computed tomography scan performed between January 2007 and January 2017. Skeletal muscle area was measured at the L3 level and calculated the skeletal muscle mass index (cm2/m2). Sarcopenia was defined as two standard deviations below the index level defined in healthy adults. Statistical analysis evaluating demographics, co-morbidities and outcomes in relation to sarcopenia was performed. Nineteen patients were included in the study with a mean age of 43.2 (21–67) and 68.4% were male. The mean % burn surface area was 43.9% (20–77.5). Mean number of burn operations per patient was 8.6 (1–27). 47.4% of skin grafts healed after the first attempt and overall healing was 73.7%. Mean length of stay (LOS) was 99.4 days (median 91, 16–257). Mean BMI was 29.3 (21.2–41.8). The prevalence of sarcopenia was 68.4%; 69.2% of males and 66.7% of females. Sarcopenia was associated with overall postoperative complications (p=0.007) and superficial wound infections (p=0.012) and pneumonia (p=0.013). There were 6 (31.5%) patients categorized as having sarcopenic obesity. These patients were more likely to use or have used alcohol (p=0.004, 0.009) and had increased number of overall and burn-specific operations (p=0.006 and 0.011, respectively). They were more likely to have PE (p=0.028). Sarcopenia was not significantly associated with gender, race, co-morbidities, LOS, readmissions or mortality. Our findings suggest that decreased lean muscle mass at time of burn injury is associated with worse postoperative outcomes, especially if the patient is both sarcopenic and obese. Interestingly, co-morbidities and age were not associated with sarcopenia. In these patients, nutritional support was maintained throughout hospitalization. However, it may require interventions targeting muscle strengthening, even during these lengthy hospitalizations to help improve operative outcomes in severely burned patients. This study accomplishes two goals: it highlights the significance of close monitoring of nutritional status on eventual outcomes in Burn Patients. Also, we are describing another method of investigating metabolic studies, not previously applied to Burn Patients, that will allow centers to better care for their patients.