Skeletal Muscle Loss after HPB Surgery and its Relation with Objectively Measured Postoperative Physical Activity and Nutritional Intake

Abstract

Introduction: Although muscle loss is a well-known phenomenon in critical ill ICU-patients, little is known about muscle loss after major elective surgery and its association with in-hospital physical activity and nutritional intake. Methods: The MUSCLE POWER study is a prospective cohort study including patients undergoing major hepato-pancreato-biliary surgery. Postoperative muscle diameter was measured in six muscles (bilateral biceps, vastus intermedius, rectus femoris) by using ultrasound (Lumify, Philips) at baseline, three, seven and ten days after surgery. Physical activity and nutritional intake were objectively measured by Actigraph-device (wGT3X-BT) and a nutritional diary. Surgery-related muscle loss (SRML) was defined as >10% muscle loss in minimally one arm and one leg muscle. Results: Of the 111 included patients (67 (60%) men; mean age 66.11±11.65), 63 (57%) underwent pancreatic-, 43 (39%) liver- and 5 (4%) no-resection surgery. SRML after seven days was found in 41 (37%) patients. Patients with SRML had a higher median Comprehensive Complication Index (20.92 (8.66-27.61) versus 8.66 (0-25.86), p=0.029). Median activity in steps after four days was lower in patients with SRML (746 (358-1205) versus 1073 (519-2144) p=0.043). In pancreatic-surgery patients, significant lower protein intake per kilogram bodyweight was found in the SRML group at postoperative days two, three and five (p<0.05). In liver-surgery patients significant lower activity at postoperative days three and four was found (p<0.05) (Figure 1). Combination of lowest physical activity and lowest nutritional intake was highly related to SRML (p=0.004). Conclusion: Low postoperative physical activity and nutritional intake are associated with postoperative muscle loss.