Abstract
The impact of low muscle mass on pediatric cardiac patients remains unclear. We investigated the impact of low muscle mass on early postoperative outcomes in patients undergoing the Fontan operation. The electronic medical records of 74 patients (aged <18 years) who underwent the Fontan operation were retrospectively reviewed. The cross-sectional areas of the erector spinae and pectoralis muscles were measured using preoperative chest computed tomography (CT), normalized to the body surface area, and combined to obtain the total skeletal muscle index (TSMI). Low muscle mass was defined as a TSMI value lower than the median TSMI for the second quintile. The incidence of major postoperative complications was higher in patients with low muscle mass than in those with high muscle mass (48% (15/31) versus 14% (6/43); P = 0.003). Multivariable analyses revealed that a higher TSMI was associated with a lower likelihood of an increased duration of intensive care unit (>5 days) and hospital stay (>14 days) (odds ratio (OR) 0.86; 95% confidence interval (CI) 0.77–0.96; P = 0.006 and OR 0.92; 95% CI 0.85–0.99; P = 0.035 per 1 cm2/m2 increase in TSMI) and incidence of major postoperative complications (OR 0.90; 95% CI 0.82–0.99; P = 0.039 per 1 cm2/m2 increase in TSMI). Preoperative low muscle mass was associated with poor early postoperative outcomes in pediatric patients undergoing the Fontan operation.
Highlights
Owing to advancements in surgical techniques, interventional procedures, and perioperative management, the survival of pediatric patients with functional single ventricle physiology has dramatically improved through the use of a series of staged palliative procedures, which are initiated during the neonatal period
The multivariable linear regression model, after adjusting for age, sex, weight, premature birth, and cardiopulmonary bypass (CPB) duration revealed that the total skeletal muscle index (TSMI) was independently associated with an increased duration of intensive care unit (ICU) and hospital stay (odds ratio (OR) 0.86; 95% confidence interval (CI) 0.77–0.96; P = 0.006 and OR, 0.92; 95% CI, 0.85–0.99; P = 0.035, per 1 cm2/m2 increase in TSMI) and incidence of major postoperative complications
This study demonstrated that preoperative low muscle mass as defined by TSMI was associated with an increased duration of ICU and hospital stay and incidence of major postoperative complications in pediatric patients undergoing the Fontan operation
Summary
Owing to advancements in surgical techniques, interventional procedures, and perioperative management, the survival of pediatric patients with functional single ventricle physiology has dramatically improved through the use of a series of staged palliative procedures, which are initiated during the neonatal period. This improved survival has led to an increased number of patients undergoing the Fontan operation [1]. Malnutrition and sarcopenia are associated with worse outcomes in pediatric patients with severe chronic illness [3] These data suggest that low muscle mass can be associated with postoperative complications and mortality in pediatric patients who undergo the Fontan operation. If low muscle mass considerably affects the postoperative outcomes in pediatric patients undergoing the Fontan operation, it could potentially serve as a prognostic factor to complement Choussat’s “Ten Commandments”, which are used to identify a potential Fontan candidate [4]
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