Abstract
Sarcopenia along with nutritional status are associated with postoperative pulmonary complications in various surgical fields. Recently, the creatinine/cystatin C ratio and CONtrolling NUTritional status score were introduced as biochemical indicators for sarcopenia and malnutrition, respectively. We aimed to investigate the associations among these indicators and postoperative pulmonary complications in elderly patients undergoing off-pump coronary artery bypass surgery. We reviewed the medical records of 605 elderly patients (aged ≥ 65 years) who underwent off-pump coronary artery bypass surgery from January 2010 to December 2019. Postoperative pulmonary complications (pneumonia, prolonged ventilation [> 24 h], and reintubation during post-surgical hospitalisation) occurred in 80 patients. A 10-unit increase of creatinine/cystatin C ratio was associated with a reduced risk of postoperative pulmonary complications (odds ratio: 0.80, 95% confidence interval: 0.69–0.92, P = 0.001); the optimal cut-off values for predicting postoperative pulmonary complications was 89.5. Multivariable logistic regression analysis revealed that age, congestive heart failure, and creatinine/cystatin C ratio < 89.5 (odds ratio 2.36, 95% confidence interval 1.28–4.37) were independently associated with the occurrence of postoperative pulmonary complications, whereas CONtrolling NUTritional status score was not. A low creatinine/cystatin C ratio was associated with an increased risk of developing postoperative pulmonary complications after off-pump coronary artery bypass surgery.
Highlights
Sarcopenia along with nutritional status are associated with postoperative pulmonary complications in various surgical fields
Among the complications related to sarcopenia, postoperative pulmonary complications (PPCs) are common after cardiac surgery; this complication is often associated with detrimental p rognosis[10,11]
Single-centre study, we investigated the associations between the creatinine/cystatin C (CysC) ratio and CONtrolling NUTritional status (CONUT) score and PPCs and other morbidities/mortality outcomes in older patients undergoing off-pump coronary artery bypass surgery (OPCAB)
Summary
Sarcopenia along with nutritional status are associated with postoperative pulmonary complications in various surgical fields. While computed tomography (CT) and magnetic resonance imaging (MRI) are the gold standard techniques for the measurement of muscle quantity[4], they may not be readily feasible for general use in terms of accessibility and socioeconomic efficiency[5] In this context, the creatinine/cystatin C (CysC) ratio, a recently introduced objective biochemical sarcopenia indicator[5], may be considered as a practical alternative. In addition to the nutritional status, CONUT score reflects the patient’s immunologic status[15], both of which could be closely interlinked with PPCs. Despite the interrelationship between sarcopenia, malnutrition, and PPCs, limited evidence is available on the relevance of the objective indices (creatinine/CysC ratio and CONUT score, respectively) and occurrence of PPCs in older patients undergoing OPCAB. Single-centre study, we investigated the associations between the creatinine/CysC ratio and CONUT score and PPCs (primary outcomes) and other morbidities/mortality outcomes (secondary outcomes) in older patients undergoing OPCAB
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