The Impact of Sarcopenia and Diabetes on Postoperative Complications in Abdominal Surgery Patients

Abstract

Sarcopenia and diabetes (DM) are independent predictors of poor postoperative outcomes. Limited data exists on the prevalence and impact of both conditions on perioperative outcomes in abdominal surgery patients. We performed a retrospective analysis of patients undergoing abdominal surgery who had abdominal CT imaging within 30 days prior to surgery. Measurements of psoas muscle surface area and attenuation values (in Hounsfield units) were recorded at the most anterior convex part of the lumbar spine corresponding to the level of the L3/L4 vertebrae. Sarcopenia was defined as the lowest sex-specific quartile of psoas muscle density. Composite of complications was determined using ICD-9 coding and included: acute MI, stroke, wound infection, pneumonia, UTI, bacteremia and respiratory failure. Among 343 patients, 85 (24%) met criteria for sarcopenia. Patients with sarcopenia were older, more likely to be Caucasian, had a longer length of hospital stay and had more postoperative complications. In fully adjusted analyses, patients with both DM and sarcopenia had four-fold higher rates of complications compared to those without DM or sarcopenia (Table). In summary, sarcopenia is associated with higher rates of complications in patients with and without DM; the combination of sarcopenia and DM confers an additional risk of perioperative complications in patients undergoing abdominal surgery. No Sarcopenia (n=258)Sarcopenia (n=85)P-valueAge, years56.7 ± 15.2763.5 ± 14.290.001BMI, kg/m227.3 ± 6.6827.2 ± 7.030.64Male gender, n (%)119 (46)39 (46)0.97Race, n (%) 0.005Caucasian154 (60)66 (78) African American82 (32)18 (21) Other20 (8)1 (1) Diabetes status, n (%) 0.06No diabetes202 (78)58 (68) Diabetes56 (22)27 (32)LOS, median, days (interquartile range)9 (6, 17)15 (10, 29)<0.01No diabetes, composite complications Odds ratio* (95% CI)1.0 (Ref)2.47 (1.31-4.66)Diabetes, composite complications Odds ratio* (95% CI)0.61 (0.3-1.25)3.68 (1.48-9.19)*Odds ratio of composite of complication adjusted for age, gender, BMI and race Disclosure G. Davis: None. M. Fayfman: None. A. Singer: None. M. Umpierrez: None. A. Kakarala: None. L. Peng: None. S. Nair: None. F.J. Pasquel: Consultant; Self; Merck Sharp & Dohme Corp., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..