Abstract
Sarcopenia is known as one of the poor prognostic factors after surgery. There are some papers about the relationship between survival after endovascular aneurysm repair (EVAR) and preoperative sarcopenia. On the other hand, there are few reports about the relationship between nutritional status and the prognosis of surgery. Therefore, we investigated the effects of sarcopenia and nutritional status after EVAR. Between June 2007 and December 2013, EVAR was performed for 407 patients in our hospital. Of these, patients who underwent re-treatment during follow-up were excluded, and 324 patients were examined. We examined the relationship between comorbidities, sarcopenia, nutritional status, and long-term prognosis. Psoas muscle area at L4 level was used as an indicator of sarcopenia, and the cutoff value was calculated from this result and set to 16 cm2. Geriatric Nutritional Risk Index was used as an indicator of malnutrition, with a cutoff value of 98 from the original paper. There were 274 (85%) men in the study. Mean age was 78.1 ± 6.3 years; 166 (51.2%) had psoas area <16 cm2, and 145 (44.8%) had Geriatric Nutritional Risk Index <98. The median follow-up period was 56.7 months; 58 (18%) died during follow-up, and 2 (0.6%) died within 30 days after surgery. Five-year survival rate after surgery was 83%. Examining the factors involved in survival, significant differences were shown in sarcopenia (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.20-3.43; P = .009), malnutrition (HR, 2.28; 95% CI, 1.35-3.84; P = .002), and history of malignant tumors (HR, 1.76; 95% CI, 0.96-3.26; P = .04). Multivariate analysis of these factors indicates that sarcopenia (HR, 1.79; 95% CI, 1.02-3.14; P = .042) and malnutrition (HR, 1.78; 95% CI, 1.02-3.11; P = .043) were independent prognostic factors. Patients were divided into three groups based on the number of these two risk factors (zero, one, and two), and the survival rates were compared. Five-year survival rates were 90%, 84%, and 67%, respectively (P < .001, zero vs two; P = .007, one vs two). Sarcopenia and malnutrition were associated with midterm to long-term mortality after EVAR. In particular, patients with both indicators had poor prognosis.TablePredictors of overall survivalVariableUnivariateMultivariateHR95% CIP valueHR95% CIP valueCancer1.751.03-3.03.041.550.88-2.73.134Sarcopenia2.031.20-3.43.0091.781.00-3.14.049Malnutrition2.281.35-3.84.0021.841.05-3.24.034 Open table in a new tab
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