Sarcopenia index based on serum creatinine and cystatin C predicts the risk of postoperative complications following hip fracture surgery in older adults

Xiaoyan Chen,Birong Dong,Yanjiao Shen,Qiukui Hao,Binyu Yang,Lisha Hou

doi:10.1186/s12877-021-02522-1

Xiaoyan Chen, Birong Dong + Show 4 more

Open Access

https://doi.org/10.1186/s12877-021-02522-1

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Abstract

ObjectiveTo assess the utility of the preoperative Sarcopenia index (SI) as a predictive marker of the risk of postoperative complications following hip fracture surgery in older adults.Study designThis observational study enrolled older adults with hip fracture who were hospitalized in the Department of Orthopedics of West China Hospital, Sichuan University, from December 7, 2010 - June 14, 2017, and who underwent hip fracture surgery.Primary outcome and measuresClinical data were collected from medical records and serum creatinine and cystatin C were measured before surgery. Outcomes included postoperative complications such as pneumonia, urinary tract infection, respiratory failure, heart failure, and non-grade A healing. Binary logistic regression analyses were used to analyze association between SI and postoperative complications.ResultsA total of 897 patients aged 60 years and over were enrolled in this study (age range: 60 – 100 years), of whom 306(34.1%)were male, and 591(65.9%)were female. Postoperative complications included pneumonia (12%), urinary tract infections (1.8%), respiratory failure (1.5%), heart failure (1.6%), and non-A- grade healing (3.6%). In the patient group that received joint replacements, the incidence of pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was independently associated with a lower risk of pneumonia after joint replacement surgery (OR:0.39, 95% CI:0.18-0.89, P<0.05). However, we did not find statistically significant association between SI and the risk of postoperative complications other than pneumonia among patients with two types of hip fracture surgery.ConclusionThe SI based on serum creatinine and cystatin C can predict pneumonia rather than other postoperative complications among older patients with hip fracture after joint replacement surgery.

Highlights

Hip fracture is common in older adults, and is usually treated via surgical approaches that promote fracture healing and shorten the course of the disease
After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher Sarcopenia index (SI) was independently associated with a lower risk of pneumonia after joint replacement surgery (OR:0.39, 95% confidence interval (CI):0.18-0.89, P
The SI based on serum creatinine and cystatin C can predict pneumonia rather than other postoperative complications among older patients with hip fracture after joint replacement surgery

Summary

Introduction

Hip fracture is common in older adults, and is usually treated via surgical approaches that promote fracture healing and shorten the course of the disease. Chen et al BMC Geriatr (2021) 21:541 lead to poor prognosis and even death after hip fracture surgery [4,5,6] indicating the importance of preoperative identification of sarcopenia. Sarcopenia is an age-related disorder that results in the loss of skeletal muscle mass and muscle strength, and/or reduced physical performance [7]. Low muscle mass can usually be quantified through imaging approaches such as dual-energy x-ray absorptiometry (DXA), bioelectrical impedance analyses (BIA), magnetic resonance imaging (MRI), or computed tomography (CT). These approaches, require specific instruments and are expensive, with MRI and CT scans necessitating the use of a special image-processing system to calculate muscle mass. Accessible, and cost-effective approaches are necessary to better characterize muscle mass loss

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